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Tuesday, April 24, 2012

Recombinant Measles Virus Vaccine Therapy and Oncolytic Virus Therapy in Treating Patients With Progressive, Recurrent, or Refractory Ovarian Epithelial Cancer or Primary Peritoneal Cancer - Full Text View - ClinicalTrials.gov



Recombinant Measles Virus Vaccine Therapy and Oncolytic Virus Therapy in Treating Patients With Progressive, Recurrent, or Refractory Ovarian Epithelial Cancer or Primary Peritoneal Cancer - Full Text View - ClinicalTrials.gov

This study is currently recruiting participants.
Verified April 2012 by Mayo Clinic

First Received on December 6, 2006.   Last Updated on April 20, 2012   History of Changes

Carboplatin/Taxol/Ridaforolimus in Endometrial, Ovarian and Solids - Full Text View - ClinicalTrials.gov



Carboplatin/Taxol/Ridaforolimus in Endometrial, Ovarian and Solids - Full Text View - ClinicalTrials.gov

This study is currently recruiting participants.
Verified April 2012 by H. Lee Moffitt Cancer Center and Research Institute

First Received on December 1, 2010.   Last Updated on April 20, 2012   History of Changes

UK: A Survivorship Care Plan for Gynaecological Cancer Patients - Full Text View - ClinicalTrials.gov



A Survivorship Care Plan for Gynaecological Cancer Patients - Full Text View - ClinicalTrials.gov

A Survivorship Care Plan for Gynaecological Cancer Patients
This study is currently recruiting participants.
Verified April 2012 by Royal Marsden NHS Foundation Trust

First Received on April 20, 2012.

Adenocarcinoma of the Gastroesophageal Junction
Cervical Cancer
Endometrial Cancer
Esophageal Cancer
Fallopian Tube Cancer
Gastric Cancer
Ovarian Cancer
Sarcoma
Vaginal Cancer
Vulvar Cancer

Canadian provinces need to adopt a patient charter of rights



Blogger's Note/Opinion: the actual paper published in the CMAJ is not an open access publication which defies logic given the subject matter- see below for CMAJ and following is the 'public' press release; as mentioned, but focused on institutional control, the other issue is the matter of who/what/control is included in a patient charter (see prior CMAJ publications on this issue); note also that 'professional Patient Navigators' in hospitals play in role, however, this is not an independent process/role; the role of an ombudsun has been a matter of great discussion over decades

                     ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

A patient charter of rights: how to avoid a toothless tiger and achieve system improvement
April 23, 2012
A patient charter of rights: how to avoid a toothless tiger and achieve system improvement Many countries have adopted patient charters of rights, but to be meaningful, such charters must include an economical, accessible and independent  complaints process. According to Flood and May, an ombudsman or commissioner can help reduce litigation and formal disciplinary proceedings against health care professionals.  Full article

This item requires a subscription to Canadian Medical Association Journal.
Full Text (PDF) Analysis
  • Colleen M. Flood and
  • Kathryn May
A patient charter of rights: how to avoid a toothless tiger and achieve system improvement CMAJ cmaj.111050; published ahead of print April 23, 2012

                         ~~~~~~~~~~~~~~~~~~~~~~~~ 

Canadian provinces need to adopt a patient charter of rights

Public release date: 23-Apr-2012
[ Print | E-mail | Share Share ] [ Close Window ]

Contact: Kim Barnhardt
kim.barnhardt@cmaj.ca
613-520-7116 x2224
Canadian Medical Association Journal

Canadian provinces need to adopt a patient charter of rights

Canadian provinces should adopt a patient charter of rights with independent enforcement as part of the move to patient-centred care, argues an analysis article in CMAJ (Canadian Medical Association Journal).

A properly designed patient charter of rights (standards set by whom?) can help patients resolve concerns and complaints easily and cost-effectively, through an independent ombudsman or commissioner. An effective patient charter contains clearly articulated patient rights — many of which are already provided in law but scattered in different places — such as patients' rights to access their health records, to privacy and to informed consent.
Many countries such as New Zealand, Norway, Finland, England, Israel have patient charters. Quebec is the only jurisdiction in Canada with a charter. Alberta has recently enacted one, but it lacks the critical feature of independent enforcement.

Health professionals may have concerns that patient charters will increase lawsuits or disciplinary actions, but evidence shows that "patient charters with dedicated complaints processes enable matters to be resolved at an early stage by informal means, averting the need for litigation or formal disciplinary proceedings," write Colleen Flood and Kathryn May, Faculty of Law, University of Toronto. In New Zealand, for example, formal disciplinary actions against providers have plummeted because a patient commissioner mediates patient complaints.

An independent health ombudsman can help spur overall improvement in the system by issuing recommendations or reports on system problems. Overseas experience suggests that despite having no formal powers to implement change such recommendations can nonetheless be a powerful force for change.

"A patient charter of rights should achieve greater clarity and awareness of the nature and extent of patients' rights; if well-designed, it should also help drive improvements in the quality and timeliness of care, improve the overall accountability of members of the health care system and reduce costly litigation," the authors conclude. "However, experience shows that it is easy for a patient charter to be a toothless tiger — that is, a mechanism to merely talk about improving the patient experience and reforming the health care system."

U of Michigan: Outpatient surgery patients also at risk for dangerous blood clots | University of Michigan Health System



 
Outpatient surgery patients also at risk for dangerous blood clots | University of Michigan Health System

"...With the information, the researchers created and validated a risk-stratification tool that can be used to predict a patient’s risk for VTE. The tool identified a 20-fold variation in VTE risk from 0.04 percent to 1.12 percent among the outpatient surgery population.
“These data are in stark contrast to provider and patient expectations that outpatient surgery is a low-risk event,” Pannucci says. “It also underscores the importance of evaluating a patient’s individual risk factors as opposed to procedure-type alone.”.....

open access: Viewpoint: Quality standards and samples in genetic testing - Journal of Clinical Pathology



Blogger's Note: includes reference to BRCA/

Quality standards and samples in genetic testing -- Ravine and Suthers 65 (5): 389 -- Journal of Clinical Pathology

Conclusion

The goal of a clinician is to provide the patient with an accurate diagnosis, prognosis and therapeutic options, including in relation to diseases for which genetic tests are available. Similarly, the goal of a medical laboratory is to provide the right result for the right patient in a timely fashion every time. Alexander Pope wrote in An Essay on Criticism that ‘To err is human…’. Three hundred years later, his message is still potent. All arenas of human endeavour are at risk of human error, and the emerging discipline of genetic testing is not immune. Errors will occur here, as they do in other areas of laboratory testing, and medicine in general. It is of little comfort that sample errors, such as WBIT, are likely to be more common than reports of adverse incidents. 

Like the proverbial elephant in the room, we know the errors are present but we hesitate to talk about them. The issue must be addressed, however, because errors in genetic testing have the potential to prompt clinical decisions with a high risk of attendant harm. They may also direct important life choices for those being tested, with ramifications that may influence human health and welfare at all developmental stages. Some errors will invariably lead to outcomes over which the person being tested will have no control, such as wrongful conviction in a court of law. Errors in genetic testing may also waste the increasingly scarce health dollars, and place individual healthcare practitioners at professional, legal and financial risk. It is now time for the profession to consider the full range of errors that are possible along the genetic test processing chain from patient to result, and devise appropriate risk minimisation strategies. Until such data are available, individual healthcare practitioners involved in genetic testing should consider the associated possible risks to patient health and welfare, and look beyond the baseline standard of testing a single sample.

open access: JCO - OCEANS: A Randomized, Double-Blind, Placebo-Controlled Phase III Trial of Chemotherapy With or Without Bevacizumab in Patients With Platinum-Sensitive Recurrent Epithelial Ovarian, Primary Peritoneal, or Fallopian Tube Cancer





OCEANS: A Randomized, Double-Blind, Placebo-Controlled Phase III Trial of Chemotherapy With or Without Bevacizumab in Patients With Platinum-Sensitive Recurrent Epithelial Ovarian, Primary Peritoneal, or Fallopian Tube Cancer

  • Submitted January 26, 2012; accepted
    February 17, 2012; published online
    ahead of print at www.jco.org on April
    23, 2012.
  • Supported by Genentech.
  • Presented in part at the 47th Annual
    Meeting of the American Society of
    Clinical Oncology, June 3-7, 2011,
    Chicago, IL.
Table 1. Baseline Patient Demographics and Disease Characteristics: 
(see actual table for further details; see other tables for adverse/safety event comparisons; )


Histology subtype #'s

Serous 202
Mucinous 1
Endometrioid 16
Transitional cell 2
Clear cell 6
Mixed 5
Other 10



 The limitations of OCEANS include a lack of quality-of-life data
and specimen collection for biomarker analysis. The strengths of
OCEANS, however, lie in the robustness of the primary end point,
with strict adherence to RECIST-defined progression and its supportive
IRC analysis, and to the schedule of assessments. The median
increase of 4 months in PFS is well above the frequency of radiologic
reassessments (9 weeks).24,25 TheOCEANS data demonstrate that GC
plus BV followed by BV until progression provides benefit over GC
alone in ROC. OCEANS, GOG 218, and ICON7 represent three
positive phase III trials of BVadded to chemotherapy in the treatment
of ovarian cancer.

No, Virginia, cancer care in Europe doesn't suck, contrary to what a recent paper implies : Respectful Insolence



No, Virginia, cancer care in Europe doesn't suck, contrary to what a recent paper implies : Respectful Insolence

Monday, April 23, 2012

Toronto Local Health Integrated Network (LHIN): Meeting with Patients: Their experiences and perspectives



Blogger's Note: patients views and opinions, not specific to any one particular disease but patients opinions and views of their healthcare system/s

                                         ~~~~~~~~~~~~~~
 Erella: 

"Just because I'm getting used to the symptoms doesn't mean things are okay."

Patient Destiny prepared this report summarizing
the findings of the December 7th ‘Meeting with
Patients’ in collaboration with the Toronto Central
LHIN. In January, Patient Destiny sent an initial report
to meeting participants which provided a complete
account of their comments and input. (newsletter - 6 patients views/opinions)

TCLHIN-PDR-ENG-web.pdf (application/pdf Object)

                  ~~~~~~~~~~~~~~~~~~~~

Ontario Health Promotion (backgrounder) Meeting with Patients: Their Experiences and Perspectives Report

Sent on Behalf of Camille Orridge, CEO, Toronto Central LHIN
Dear colleagues
There is growing understanding that involving patients, clients and caregivers as partners in their health care results in better health outcomes and a system that better serves us all.
We also know that there is often a divide between how health care is delivered and what patients and their families say they want.
Patient Destiny and the Toronto Central LHIN co-hosted a day with patients and caregivers who receive services in the Toronto Central LHIN on December 7, 2011.   The session brought together a cross-section of patients and caregivers to discuss their experiences, perspectives and ideas for improvement and change.
Participants talked about their fears, frustrations, gratitude and hopes.  Most of all, they offered inspiration and concrete ideas that will help us achieve a better health care experience for all.
This report Meeting with Patients: their experiences and perspectives  will help to inform health system planning in the Toronto Central LHIN, including the Toronto Central LHIN's 2012-14 Strategic Plan and health quality and equity initiatives.
We encourage you to incorporate the report into planning within your own sectors and organizations.  This report is relevant to all members of the health care system from administrators to health professionals to policy makers.  Please distribute it widely.
I would like to thank all of the individuals who participated in the Meeting with Patients and contributed to this report.  We would also like to recognize Patient Destiny for their vision and commitment to strengthening the patient's voice in health care.
Sincerely,
Camille Orridge
CEO, Toronto Central LHIN

abstract: Relationship among glycolytic phenotype, grade, and histological subtype in ovarian carcinoma - F-18 FDG PET/CT imaging



Relationship among glycolytic phenotype, grade, and histological subtype in ovarian carcinoma.

Abstract

PURPOSE:

Knowing the glycolytic phenotype of cancers is important for the appropriate use of F-18 FDG PET/CT imaging. This study was performed to determine the influence of tumor grade and histology on the glycolytic phenotype of epithelial ovarian cancer patients.

MATERIALS AND METHODS:

Only histopathologically confirmed epithelial ovarian cancer patients, with no other concurrent malignancies, who had F-18 FDG PET/CT either before or at least 3 months after any therapeutic intervention and had confirmed measurable disease of >1 cm were included. The F-18 FDG PET/CT uptake was determined as maximum standard uptake value (SUVmax) at the pathologically confirmed site of disease or in the most active lesion. SUVmax was correlated to tumor grade and histology.

RESULTS:

Of 171 ovarian cancer patients, 42 referred for F-18 FDG PET/CT scans between January 2003 and December 2010 were eligible for inclusion. Histologic diagnosis most frequently revealed the serous subtype (n = 32) and grade III (n = 28) epithelial ovarian cancer. Overall, ovarian carcinomas exhibited a strong glycolytic phenotype (average SUVmax, 7.6 g/mL). The SUVmax averaged 7.76 g/mL, 6.76 g/mL, and 7.95 g/mL for Grade I, II, and III, respectively. There was no statistically significant correlation between tumor SUVmax and the histologic tumor grade (P = 0.74). No statistically significant differences were found between the tumor SUVmax of serous and endometrioid subtypes (P = 0.53). For other histology subtypes, no statistic evaluation was possible due to the low number of cases.

CONCLUSIONS:

The glycolytic phenotype in epithelial ovarian cancer, expressed as SUVmax, is strong. However, tumor FDG uptake is unrelated to tumor grade and histologic subtype implying that F-18 FDG PET/CT cannot be used to predict tumor aggressiveness or histology.

Fortitude: true stories of true grit - Malinda Teel - Google Books



Fortitude: true stories of true grit - Malinda Teel - Google Books

This powerful, inspirational book launched the publisher's "Virtue Victorious" series "FORTITUDE" stories feature ordinary people who have triumphed over extraordinary obstacles. Topics include wilderness and wartime survival, tough athletic challenges, domestic violence and grave illness. Two-hour Christian TV special was devoted to stories of editor and four other contributors. "Booklist" termed this book "compelling" and recommended it to libraries across the U.S. and Canada.

Fortitude:

true stories of true grit
Front Cover

Malinda P. TEEL Obituary: View Malinda TEEL's Obituary by The Atlanta Journal-Constitution



Malinda P. TEEL Obituary: View Malinda TEEL's Obituary by The Atlanta Journal-Constitution


TEEL, Malinda P. MALINDA P. TEEL October 23, 1942 – April 16, 2012

Malinda P. Teel died on April 16, in the Grant Park home she helped renovate and where she lived for 34 years, following a proactive 7-year fight against ovarian cancer. She was a graduate of UGA's School of Social Work and Thiel College and retired from her third career as a therapist and social worker in 2010. Previously, she had been a skilled writer and editor and for several years ran a small moving company in New York City known as Huckleberry Truck. She was the editor of a collection of true stories, Fortitude, published in 2000. An enthusiastic Francophile, she pursued study of the French language throughout her life, including a year at the Sorbonne in Paris. Other interests included vegetable gardening and all aspects of food-cooking, nutrition, restaurants, etc. After being diagnosed with ovarian cancer, Malinda was active as an advocate in the ovarian cancer community, and in 2010 was recognized by the Georgia Ovarian Cancer Alliance for her support of its mission. Malinda was born in Charlottesville, Virginia, and is survived by her dear husband, Thomas F. McGowan, beloved son, Samuel F. McGowan and his fiancé Jordan Dieck and her brothers Martin, Steve and Parker Teel and their families. Everyone loved Malinda. She blessed us all with her amazing fortitude, her joy for life and her optimism for the future. A celebration of her life will be held at a later time. In lieu of flowers, please make donations to the Ovarian Cancer Institute at Georgia Tech, http://ovariancancerinstitute.org/contributions.html. Goolsby Mortuary (404)588-0128.


abstract: Comparability and Biosimilarity






Conclusion: Given the knowledge gap under which biosimilars are developed, data to establish biosimilarity should go beyond a simple comparability exercise.


Read More: http://informahealthcare.com/doi/abs/10.1185/03007995.2012.686902

abstract: End-of-life preferences in advanced cancer patients willing to discuss issues surrounding their terminal condition



End-of-life preferences in advanced cancer patients willing to discuss issues surrounding their terminal condition


Abstract: 

The aim of the present study is to describe end-of-life preferences of advanced cancer patients willing to talk about death issues. Eighty-eight advanced cancer patients were interviewed through End of Life Preferences Interview (ELPI), a 23-item interview covering a wide range of end-of-life care issues.

Sunday, April 22, 2012

For whom the bell tolls at Prima Biomed - CVac ovarian cancer vaccine



For whom the bell tolls at Prima Biomed

"Prima is developing a treatment for ovarian cancer and, at 22¢, its market capitalisation is $256 million. This is hefty for a company that is not forecast to make a profit for at least another four years (if it ever does)."

"The clinical results Prima Biomed has come up with so far do not seem to support its share price rise from 2¢ or so in early 2009, to peak at 39¢ this time last year. The full results of its preliminary (phase two) are due out in the next few months, but what we know so far is that the data from 21 patients ''has not demonstrated statistically significant results'', in the words of a report by Nomura Equity Research."

DNA donor rights affirmed : Nature News & Comment



DNA donor rights affirmed : Nature News & Comment

"It is a familiar scenario in genetic research: a subject's DNA is collected for one study, deposited in a database or biobank and then analysed by other researchers for separate studies. But what happens when a later study stumbles on something that could be of significance for the donor....."

"..... But, increasingly, geneticists are embracing the idea that research participants have a right to know of any unwelcome surprises in their genome...."

"The need to establish policies for the return of results has grown with the proliferation of whole-genome sequencing, says James Evans, editor-in-chief of Genetics in Medicine, which is publishing an entire issue on the return of results in genetic research, along with the consensus statement."

2012 Implementation of Tumor Based Screening for Lynch Syndrome in an integrated delivery system - slideset




Implementation of Tumor Based Screening for Lynch Syndrome in an integrated delivery system

abstract: Postmenopausal hormone therapy is associated with a reduced risk of colorectal cancer lacking CDKN1A expression




 http://cancerres.aacrjournals.org/content/early/2012/04/17/0008-5472.CAN-11-2619.abstract
  
Abstract
Experimental studies have shown that estrogen- or progesterone-activated signaling leads to growth inhibition effects on colon cancer cells through the upregulation of several cell cycle regulators. However, epidemiologic studies evaluating hormone therapy (HT) use and colorectal cancer risk by the status of cell cycle regulators are lacking. In this study, we used data from the prospective Nurses' Health Study to evaluate whether the association between HT use and colorectal cancer risk differs by the molecular pathological status of microsatellite instability (MSI) and expression of cell cycle-related tumor biomarkers, including CDKN1A (p21, CIP1), CDKN1B (p27, KIP1), and TP53 (p53) by immunohistochemistry. Duplication Cox regression analysis was used to determine an association between HT use, cancer risk, and specific tumor biomarkers in 581 incident colon and rectal cancer cases that occurred during 26 years of follow-up among 105520 postmenopausal women. We found a difference between HT use and colorectal cancer risk according to CDKN1A expression (p-value for heterogeneity=0.01). Current HT use was associated with a reduced risk for CDKN1A-nonexpressed (multivariate relative risk (RR)=0.61, 95% confidence interval (CI), 0.46-0.82), but not for CDKN1A-expressed (RR=1.32, 95% CI, 0.76-2.31) tumors. The lower risk for CDKN1A-nonexpressed, but not for CDKN1A-expressed cancers was also present among current users of estrogen-alone therapy. We found no significant difference in the relations between HT use and cancer risk according to MSI, CDKN1B, or TP53 status. Together, our molecular epidemiology findings suggest a preventive effect of HT against colorectal carcinogenesis which depends, in part, on loss of cyclin-dependent kinase inhibitor CDKN1A.

2010-2011-Annual Report English: Canadian Partnership Against Cancer



http://www.partnershipagainstcancer.ca/wp-content/uploads/2010-2011-Annual-Report-English.pdf
 
  • (pages 55+)  STATEMENT OF FINANCIAL POSITION As at March 31, 2011 (with comparative figures)
(search) "ovarian":
  • In collaboration with the Terry Fox Research Institute, the
    following progress occurred in other areas: Pilot projects in translational research related to ovarian and prostate cancer were funded.
  • Anticipatory Science: Part 1 of an ovarian cancer screening summary, which will be updated with mortality statistics in 2011/12
  • Surgery: Electronic synoptic reporting (summary/general overview) for cancer surgery was successfully implemented in selected centres in Nova Scotia, Quebec, Ontario, Manitoba and Alberta for surgery for four disease sites: breast, colorectal, ovarian and head/neck.
  • Electronic synoptic reporting for cancer surgery was
    successfully implemented in selected centres in Nova Scotia, Quebec, Ontario, Manitoba and Alberta for surgery for four disease sites: breast, colorectal, ovarian and head/neck.
  • The first of five ICBP modules produced robust and comparable analyses of cancer survival among all ICBP partners. Survival rates for four cancers — lung, breast, colorectal and ovarian — were analyzed and presented as a scientific paper in The Lancet in December 2010

abstract: Curr Oncol. 2012 Apr;19(2):70-7. Accelerating knowledge to action: the pan-Canadian cancer control strategy (including blogger's note)



Blogger's Note/Opinion: this is the medline abstract secondary to the recent posting via Oncology Reports; some points to consider: details of the history past need clarification so as not to presume certain statements; in fact a further ~$250 million was funded by the Canadian government at the 5 year renewal date; note also that the Canadian Partnership Against Cancer existed previously (name change), albeit without the current wider structure

                   ~~~~~~~~~~~~~~~~~~~~~~~~~

Accelerating knowledge to action: the pan-Canadia... [Curr Oncol. 2012] - PubMed - NCBI
 

Abstract

"In 2006, the federal government committed funding of $250 million over 5 years for the Canadian Partnership Against Cancer Corporation to begin implementation of the Canadian Strategy for Cancer Control (cscc)...."

"Evaluation findings support the conclusions that Canada has made progress in achieving immediate outcomes (achievable in <5 years) associated with advancing its cancer control goals and that there is evidence that, with sustained effort, those goals will translate into a long-term (>25 years) impact on cancer."

"With the ongoing funding commitment to support coordinated action within a federated environment of health care delivery, there is opportunity to reduce the impact that cancer may have in the long term in Canada...."

Saturday, April 21, 2012

Dying mom makes breast cancer video, begs the FDA to have a heart - She The People - The Washington Post (writer/ovarian cancer survivor: Donna Trussell)



Dying mom makes breast cancer video, begs the FDA to have a heart - She The People - The Washington Post

Phytoestrogens (soy) for menopausal symptoms: A review.



Wiki:  Isoflavones


Wiki:  Phytoestrogens
  .....(food sources) "According to a study by Canadian researchers about the content of nine common phytoestrogens in a Western diet, foods with the highest relative phytoestrogen content were nuts and oilseeds, followed by soy products, cereals and breads, legumes, meat products, and other processed foods that may contain soy, vegetables, fruits, alcoholic, and nonalcoholic beverages. Flax seed and other oilseeds contained the highest total phytoestrogen content, followed by soybeans and tofu.[21] The highest concentrations of isoflavones are found in soybeans and soybean products followed by legumes, whereas lignans are the primary source of phytoestrogens found in nuts and oilseeds (e.g. flax) and also found in cereals, legumes, fruits and vegetables....."
                        ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Phytoestrogens for menopausal symptoms: A review

Maturitas. 2012 Apr 17;

Abstract

OBJECTIVE:
To review the evidence that isoflavones are effective treatments for menopausal symptoms and to present the safety data.

METHODS:
The databases Scopus, ScienceDirect and Primo Central Index were searched and preference was given to systematic reviews and meta-analyses.

RESULTS: 
The available evidence suggests that isoflavones do not relieve menopausal vasomotor symptoms any better than placebo. Long-term safety studies suggest that women who consume a diet high in isoflavones may have a lower risk of endometrial and ovarian cancer.

CONCLUSIONS: Isoflavones cannot be recommended for the relief of hot flushes.

abstract: Effects on the immune system and toxicity of carboplatin/paclitaxel combination chemotherapy in patients with stage III-IV ovarian and non small cell lung cancer and its role in survival and toxicity.



 
Effects on the immune system and toxicity of carboplatin/paclitaxel combination chemotherapy in patients with stage III-IV ovarian and non small cell lung cancer and its role in survival and toxicity.


Abstract
 
Purpose:
To examine the impact of paclitaxel and carboplatin combination chemotherapy on the parameters of the immune system in patients with non small cell lung cancer (NSCLC) and with ovarian cancer before, during and after chemotherapy, and the effect of this combination on the overall patient survival.

Methods:
24 patients with NSCLC and 20 with ovarian cancer (all in stage IIIb-IV) treated with 6 courses of paclitaxel and carboplatin combination chemotherapy were separated into two groups according to their survival group A: long survival (> 12 months for NSCLC; > 30 months for ovarian cancer) group B: short survival (<12 months for NSCLC; <30 months for ovarian cancer).

At the same time we studied some immunological parameters (CD3, CD4, CD8, CD56, CD34, IL-3, IFN-γ) in relation with the induced toxicity during chemotherapy. The results were analysed using the ANOVA method.

Results: 
We observed a statistically significant difference of CD4 and CD4/CD8 after chemotherapy between groups A and B (p<0.001 and p< 0.006 respectively), implying that the further increase of T-helper cells after chemotherapy had a positive impact on survival. In addition, statistically interesting was the difference in values of IFN-γ between patients of groups A and B before and after chemotherapy (p< 0.039 and p< 0.027, respectively). Patients with high IL-3 had little chance of toxicity.

Conclusion:
Our findings support that with carboplatin/ paclitaxel combination chemotherapy, important parameters of the immune system (IFN-γ, CD4, CD4/CD8) can be used as prognostic factors for survival, while others (IL-3) as indicators of toxicity.



abstract: Hormone Therapy and Different Ovarian Cancers: A National Cohort Study (postmenopausal women/does not include reference to clear cell ovarian)



 Blogger's Note: the abstract makes no reference to clear cell ovarian, given the number of women followed this omission (in the abstract) is curious


Hormone Therapy and Different Ovarian Cancers: A National Cohort Study

Abstract

Postmenopausal hormone therapy use increases the risk of ovarian cancer. In the present study, the authors examined the risks of different histologic types of ovarian cancer associated with hormone therapy

Using Danish national registers, the authors identified 909,946 women who were followed from 1995–2005. The women were 50–79 years of age and had no prior hormone-sensitive cancers or bilateral oophorectomy. 

Hormone therapy prescription data were obtained from the National Register of Medicinal Product Statistics. The National Cancer and Pathology Register provided data on ovarian cancers, including information about tumor histology......... In an average of 8.0 years of follow up, 2,681 cases of epithelial ovarian cancer were detected. 

Compared with never users, women taking unopposed oral estrogen therapy had increased risks of both serous tumors and endometrioid tumors but decreased risk of mucinous tumors. Similar increased risks of serous and endometrioid tumors were found with estrogen/progestin therapy, whereas no association was found with mucinous tumors. 

Consistent with results from recent cohort studies, the authors found that ovarian cancer risk varied according to tumor histology. The types of ovarian tumors should be given attention in future studies.

abstract: Unusual DNA mismatch repair-deficient tumors in Lynch syndrome: a report of new cases and review of the literature.



Unusual DNA mismatch repair-deficient tumors in Lynch syndrome: a report of new cases and review of the literature.

Hum Pathol. 2012 Apr 17;


Abstract

Immunohistochemical detection of DNA mismatch repair proteins and polymerase chain reaction detection of microsatellite instability have enhanced the recognition of mismatch repair-deficient neoplasms in patients with Lynch syndrome and, consequently, led to the identification of tumors that have not been included in the currently known Lynch syndrome tumor spectrum.

Here, we report 4 such unusual tumors. Three of the 4, a peritoneal mesothelioma, a pancreatic acinar cell carcinoma, and a pancreatic well-differentiated neuroendocrine tumor, represented tumor types that, to the best of our knowledge, have not been previously reported in Lynch syndrome. The fourth tumor was an adrenocortical carcinoma, which has rarely been reported previously in Lynch syndrome. Three of our 4 patients carried a pathogenic germ-line mutation in a mismatch repair gene. The unusual tumor in each of the 3 patients showed loss of the mismatch repair protein corresponding to the mutation. The fourth patient did not have mutation information but had a history of colonic and endometrial carcinomas; both lacked MSH2 and MSH6 proteins. Interestingly, none of the 4 unusual tumors revealed microsatellite instability on polymerase chain reaction testing, whereas an appendiceal carcinoma from 1 of the study patients who was tested simultaneously did. The recognition of such tumors expands the repertoire of usable test samples for the workup of high-risk families.

As yet, however, there are no data to support the inclusion of these tumors into general screening guidelines for detecting Lynch syndrome, nor are there data to warrant surveillance for these tumors in patients with Lynch syndrome.

Reuters News: Should more patients continue aspirin therapy before surgery? - - ModernMedicine



Should more patients continue aspirin therapy before surgery? - - ModernMedicine

Friday, April 20, 2012

Improving cancer control in Canada through knowledge translation: from in-the-field projects to policy initiatives in a new standing section in Current Oncology



Improving cancer control in Canada through knowledge translation: from in-the-field projects to policy initiatives in a new standing section in Current Oncology

abstract: High scores on the Edmonton Symptom Assessment Scale identify patients with self-defined high symptom burden.



High scores on the Edmonton Symptom Assessment Scale identify patients with self-defined high symptom burden.

Abstract:

The terms symptom burden and symptom distress are frequently seen in palliative care literature yet are used in multiple ways ranging from addition of symptom scores to more in-depth assessments of interference in function. Patient input to date has had little role in these varied definitions yet previous reviews have suggested the importance of such input. This mixed qualitative and quantitative prospective study was conducted to seek patient input into the definition of 'symptom burden' and to correlate burden self-ranked scores with symptom scores on the Edmonton Symptom Assessment Scale (ESAS).

Results suggest that patients with advanced disease followed by palliative care providers are a group with a high level of self-defined burden. Further, any patient rating one or more symptoms on the ESAS ≥7 is at high risk of self-defined burden and likely to be experiencing significant impact on physical, emotional and social functioning. Further work should look at which aspects of symptom management best promote a lessening of perceived burden.


Medscape: Colonoscopy No Help in Finding Melena Source - in Gastroenterology, General Gastroenterology



 Wiki: Melena

Medical News: Colonoscopy No Help in Finding Melena Source - in Gastroenterology, General Gastroenterology

"Colonoscopy had a lower-than-expected yield when used after a negative upper endoscopy in stable patients with melena, researchers found.
The procedure diagnosed a suspected source of the bleeding in just 4.8% of patients with melena in a retrospective case-control study by Jason P. Etzel, MD, of Oregon Health and Science University, Portland, and colleagues......

Medscape: (Avastin) Bevacizumab: First-Line Therapy in Ovarian Cancer?: Evidence for First-Line Therapy Dr's Markman, Burger, Swenterton



Bevacizumab: First-Line Therapy in Ovarian Cancer?: Evidence for First-Line Therapy

Editor’s Note:
 
Two phase 3 trials published in the New England Journal of Medicine on December 29, 2011, found bevacizumab to be active as first-line therapy in advanced ovarian cancer. Although both trials showed an increase in progression-free survival [PFS], not enough time has elapsed to determine whether the drug extends overall survival. Furthermore, it is unclear whether bevacizumab in ovarian cancer is best used as first-line or second-line therapy. Recently, Drs. Robert Burger and Kenneth Swenerton participated in a Medscape virtual debate via email to address this question: "Should bevacizumab be used as first-line therapy in patients with advanced ovarian cancer?" Dr. Maurie Markman served as moderator. What follows is their conversation......

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abstract: Preoperative PET/CT in early-stage breast cancer (including ovarian cancer primary/metastases)



Preoperative PET/CT in early-stage breast cancer

Abstract

Background: The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer. 

Patients and methods: A total of 103 consecutive patients with newly diagnosed operable breast cancer with tumors ≥2 cm were independently examined preoperatively with conventional assessment (mammography, breast/axillary ultrasound, chest X-ray and blood samples) and PET/CT with no prior knowledge of the other. 

Results: PET/CT identified a primary tumor in all but three patients (97%). PET/CT solely detected distant metastases (ovary, bones and lung) in 6 patients and new primary cancers (ovary, lung) in another two patients, as well as 12 cases of extra-axillary lymph node involvement. In 15 patients (15%), extra-axillary malignancy was detected by PET/CT only, leading to an upgrade of initial staging in 14% (14/103) and ultimately a modification of planned treatment in 8% (8/103) of patients. 

Conclusions: PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases and other occult primary cancers. Preoperative 18F-fluorodeoxyglucose–PET/CT has a substantial impact on initial staging and on clinical management in patients with early-stage breast cancer with tumors ≥2 cm.

Aspirin and cancer risk: a quantitative review to 2011



Aspirin and cancer risk: a quantitative review to 2011:

Background:
Aspirin has been associated to a reduced risk of colorectal and possibly of a few other common cancers.

Methods:
To provide an up-to-date quantification of this association, we conducted a meta-analysis of all observational studies on aspirin and 12 selected cancer sites published up to September 2011.

Results:
Regular aspirin is associated with a statistically significant reduced risk of colorectal cancer and of other digestive tract cancers, for squamous cell esophageal cancer, for esophageal and gastric cardia adenocarcinoma,, for gastric cancer), with somewhat stronger reductions in risk in case–control than in cohort studies. Modest inverse associations were also observed for breast and prostate cancer, while lung cancer was significantly reduced in case–control studiesbut not in cohort ones. No meaningful overall associations were observed for cancers of the pancreas, endometrium, ovary, bladder, and kidney.

Conclusions:
Observational studies indicate a beneficial role of aspirin on colorectal and other digestive tract cancers; modest risk reductions were also observed for breast and prostate cancer. Results are, however, heterogeneous across studies and dose–risk and duration–risk relationships are still unclear.

2011 Dec open access: Nuclear Medicine and Radiation Therapy - 18FDG-PET/CT Definition of Clinical Target Volume for Robotic Stereotactic Body Radiosurgery Treatment of Metastatic Gynecologic Malignancies




Blogger's Note: investigative research; study of 27 gyn patients of whom 15 were ovarian cancer patients

18FDG-PET/CT Definition of Clinical Target Volume for Robotic Stereotactic Body Radiosurgery Treatment of Metastatic Gynecologic Malignancies

 "As stereotactic body radiosurgery for abdominopelvic sites
of metastatic gynecologic cancers becomes more mainstream,
accumulated 18F-FDG PET and CT data will better guide treating
physician target contouring. Future research directions by our group
will study better radiosurgical target delineation, as modified by the
extent of respiratory motion, by four-dimensional (4D)-CT scanners
or by single 18F-FDG PET-magnetic resonance imaging (PET/MRI)
scanners."

23andMe Founder Discusses Genetics and Healthcare | News | The Harvard Crimson



23andMe Founder Discusses Genetics and Healthcare | News | The Harvard Crimson