paywalled: Coffee and tea consumption and the risk of ovarian cancer: a prospective cohort study and updated meta-analysis

Blogger's Note/Opinion: as per abstract, to date and studies over decades, have not found a link between coffee/tea/ovarian cancer risk - so, the question is this: how many more studies will it take to finally put this issue to rest? Unless there are novel (new) findings then we need to move forward.

Coffee and tea consumption and the risk of ovarian cancer: a prospective cohort study and updated meta-analysis

Abstract

Background: In 2007 the World Cancer Research Fund Report concluded that there was limited and inconsistent evidence for an effect of coffee and tea consumption on the risk of epithelial ovarian cancer (EOC). 

Objective: In the European Prospective Investigation into Cancer and Nutrition (EPIC), we aimed to investigate whether coffee intakes, tea intakes, or both are associated with the risk of EOC. 

Design: All women participating in the EPIC (n = 330,849) were included in this study. Data on coffee and tea consumption were collected through validated food-frequency questionnaires at baseline. HRs and 95% CIs were estimated by using Cox proportional hazards models. Furthermore, we performed an updated meta-analysis of all previous prospective studies until April 2011 by comparing the highest and lowest coffee- and tea-consumption categories as well as by using dose-response random-effects meta-regression analyses. 

Results: During a median follow-up of 11.7 y, 1244 women developed EOC. No association was observed between the risk of EOC and coffee consumption [HR: 1.05 (95% CI: 0.75, 1.46) for the top quintile compared with no intake] or tea consumption [HR: 1.07 (95% CI: 0.78, 1.45) for the top quintile compared with no intake]. This lack of association between coffee and tea intake and EOC risk was confirmed by the results of our meta-analysis. 

Conclusion: Epidemiologic studies do not provide sufficient evidence to support an association between coffee and tea consumption and risk of ovarian cancer.

paywalled: Systematic review of progesterone use by midlife and menopausal women

Systematic review of progesterone use by midlife and menopausal women: Publication year: 2012

Source: Maturitas

 Progesterone treatment for menopausal symptoms is still controversial. Progesterone levels fall during menopause transition, therefore some menopausal women may benefit from progesterone therapy. A systematic review was conducted of studies published from 2001 reporting on progesterone use to treat symptoms associated with menopause or postmenopausal women. Fourteen data bases were searched using the search terms progesterone, menopause, aged, female and human; exclusions were breast cancer, animal and contraception. Thirteen studies were selected for inclusion (11 clinical trials, 1 cohort study and 1 qualitative study), evaluating progesterone effects on menopausal symptoms, bone, sleep, skin, cognition, plasma lipids and plaque progression. Most studies were of low methodological quality (GRADE low or very low). Progesterone improved vasomotor symptoms and sleep quality, with minimal risk. Large studies designed to identify confounders, such as hormone levels, menopausal status and metabolism are required to understand the place of progesterone in clinical practice.

Seth's Blog: Don't expect applause

Don't expect applause:

Accept applause, sure, please do.

But when you expect applause, when you do your work in order (and because of) applause, you have sold yourself short. That's because your work is depending on something out of your control. You have given away part of your art. If your work is filled with the hope and longing for applause, it's no longer your work--the dependence on approval has corrupted it, turned it into a process where you are striving for ever more approval.

Who decides if your work is good? When you are at your best, you do. If the work doesn't deliver on its purpose, if the pot you made leaks or the hammer you forged breaks, then you should learn to make a better one. But we don't blame the nail for breaking the hammer or the water for leaking from the pot. They are part of the system, just as the market embracing your product is part of marketing.

"Here, here it is, it's finished."

If it's finished, the applause, the thanks, the gratitude are something else. Something extra and not part of what you created. To play a beautiful song for two people or a thousand is the same song, and the amount of thanks you receive isn't part of that song.

medical news: Study confirms overuse of blood transfusions during surgery

Study confirms overuse of blood transfusions during surgery


"Citing the lack of clear guidelines for ordering blood transfusions during surgery, Johns Hopkins researchers say a new study confirms there is still wide variation in the use of transfusions and frequent use of transfused blood in patients who don't need it.
The resulting overuse of blood is problematic, the researchers say, because blood is a scarce and expensive resource and because recent studies have shown that surgical patients do no better, and may do worse, if given transfusions prematurely or unnecessarily. "Transfusion is not as safe as people think," says Steven M. Frank, M.D., leader of the study described in the journal Anesthesiology.....

Correspondence: Bevacizumab in Neoadjuvant Treatment for Breast Cancer — NEJM

Blogger's Note:  correspondence/author's reply/references; while this is specific to Avastin/breast cancer,  future trial protocols may take note

Bevacizumab in Neoadjuvant Treatment for Breast Cancer — NEJM

PLoS ONE: Effect of Angiogenesis Inhibitor (Avastin) Bevacizumab on Survival in Patients with Cancer: A Meta-Analysis of the Published Literature

 Blogger's Note: indicates which cancer patients did/did not show PFS/OS; limited to combo therapies (lack of monotherapy trials); read limitations to the analysis (eg. individual patient data/meta-analysis...); notes serious side effects

PLoS ONE: Effect of Angiogenesis Inhibitor Bevacizumab on Survival in Patients with Cancer: A Meta-Analysis of the Published Literature

paywalled: Role of HE4, CA72.4, and CA125 in monitoring ovarian cancer.

Role of HE4, CA72.4, and CA125 in monitoring ovarian cancer.

Abstract

The aim of this study was to investigate the role of biomarkers CA125, HE4, and CA72.4 at diagnosis and throughout the follow-up in patients with epithelial ovarian cancer (EOC). Thirty-nine patients with EOC were deemed eligible, and 20 were followed up. CA125, HE4, and CA72.4 serum levels were determined for all patients at initial diagnosis of EOC. Among these patients, the number of cases with an elevated level of each individual marker was CA125 77 %, HE4 85 %, and CA72.4 72 %. A statistically significant difference was observed between the level of HE4 when compared to CA72.4 (p < 0.02). In the follow-up phase, we observed tumor marker levels fluctuating according to response to chemotherapy. When combining two out of the three biomarkers together, we observed increased values of CA125 and CA72.4 in 55 % of the patients, increased values of CA125 and HE4 in 65 % of the patients, and finally increased HE4 and CA72.4 in 75 % of the patients. A statistically significant difference was observed when combining HE4 and CA72.4, but not CA125 and CA 72.4 (p < 0.002). In conclusion, our study demonstrates that the association of three biomarkers CA125, HE4, and CA72.4 provides a valuable contribution in the follow-up of EOC patients.

open access: Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

Obstetrics and Gynecology International
Volume 2012 (2012), Article ID 953937, 11 pages
doi:10.1155/2012/953937 Review Article Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

• Abstract
• Introduction
• Methods and Materials
• Results and Discussion
• Options for Fertility Preservation
• Additional Considerations
• Pregnancy after Cancer

Conclusions 

Given the relatively high incidence of cancer in reproductive age women and improvements in 5-year survival, an increasing number of women are presenting for discussion of fertility preservation and pregnancy after cancer treatment. The ASCO published recommendations in 2006 on fertility preservation in cancer patients. These guidelines state that oncologists should address the possibility of infertility with cancer patients and be prepared to discuss possible fertility preservation options or refer the patient to a reproductive specialist. Part of the difficulty in counseling patients regarding the risk of infertility and/or subsequent pregnancy complications is that the risks are dependent on several factors. These risks include the dose and duration of treatment, other risk factors for infertility, the age of the patient, and the patient’s baseline ovarian reserve at the time of initiation of treatment.

paywalled: Predisposition gene identification in common cancers by exome sequencing: insights from familial breast cancer.

Predisposition gene identification in common cancers by exome sequencing: insights from familial breast cancer.

Breast Cancer Res Treat. 2012 Apr 18;

Abstract
The genetic component of breast cancer predisposition remains largely unexplained. Candidate gene case-control resequencing has identified predisposition genes characterised by rare, protein truncating mutations that confer moderate risks of disease. In theory, exome sequencing should yield additional genes of this class. Here, we explore the feasibility and design considerations of this approach. We performed exome sequencing in 50 individuals with familial breast cancer, applying frequency and protein function filters to identify variants most likely to be pathogenic. We identified 867,378 variants that passed the call quality filters of which 1,296 variants passed the frequency and protein truncation filters. The median number of validated, rare, protein truncating variants was 10 in individuals with, and without, mutations in known genes. The functional candidacy of mutated genes was similar in both groups. Without prior knowledge, the known genes would not have been recognisable as breast cancer predisposition genes. Everyone carries multiple rare mutations that are plausibly related to disease. Exome sequencing in common conditions will therefore require intelligent sample and variant prioritisation strategies in large case-control studies to deliver robust genetic evidence of disease association.

blogger: Hospitals, Practice Administrators and Clinicians: You Gotta Learn to Love Patient Ratings – Health Affairs Blog

Hospitals, Practice Administrators and Clinicians: You Gotta Learn to Love Patient Ratings – Health Affairs Blog

paywalled: Breast-feeding and risk of epithelial ovarian cancer (clear cell/endometrioid)

Breast-feeding and risk of epithelial ovarian cancer

 Abstract

PURPOSE:

Evidence suggests that breast-feeding may decrease the risk of epithelial ovarian cancer but it is not clear whether there is a relationship with duration of breast-feeding, patterns of breast-feeding, or particular histological subtypes of ovarian cancer. We sought to investigate these issues in detail.

METHODS:

Data from participants in a population-based study of ovarian cancer in western Washington State, USA (2002-2007) who had had at least one birth (881 cases and 1,345 controls) were used to assess relations between patterns of breast-feeding and ovarian cancer. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS:

Women who ever breast-fed had a 22 % reduction in risk of ovarian cancer compared with those who never breast-fed (OR = 0.78, 95% CI 0.64-0.96) and risk reduction appeared greater with longer durations of feeding per child breast-fed (OR = 0.56, 95% CI 0.32-0.98 for 18 months average duration breast-feeding versus none). Introduction of supplementary feeds did not substantially alter these effects. The overall risk reduction appeared greatest for the endometrioid and clear cell subtypes (OR per month of average breast-feeding per child breast-fed = 0.944, 95% CI 0.903-0.987).

CONCLUSIONS:

Among women who have had the opportunity to breast-feed, ever breast-feeding and increasing durations of episodes of breast-feeding for each breast-fed child are associated with a decrease in the risk of ovarian cancer independent of numbers of births, which may be strongest for the endometrioid subtype.

paywalled: Journal of Cancer Education: Knowledge of Reproductive System Cancers, Their Treatments and Side Effects (Canada)

Knowledge of Reproductive System Cancers, Their Treatments and Side Effects

 Abstract 

We explored, via an online questionnaire, knowledge of breast and reproductive system cancers in patients and non-patients who access the internet for information on these diseases. We compared that knowledge to the attention the diseases have received in medical research and on the Internet. Data were collected from 690 respondents (37 % male, 63 % female) about their knowledge of prevalence, lethality, treatments and side effects of testicular, prostate, breast, uterine, cervical and ovarian cancers. Most males, but only half of the female participants, were patients themselves. Although participants showed better knowledge of cancers specific to their own sex, both sexes felt familiar with breast cancer and less aware of other cancers. Women were as aware as men of side effects of treatments for male reproductive cancers. Sex differences in awareness appear to reflect different attitudes towards illness, bias toward females as caregivers, and the disproportionate media attention given to breast cancer.

open access: Cell–cell and cell–matrix dynamics in intraperitoneal cancer metastasis (ovarian/GI tract cancers)

Cell–cell and cell–matrix dynamics in intraperitonealcancer metastasis

 Abstract/pdf full text:

IntroductionIntraperitoneal dissemination is the primary metastatic route
of ovarian cancers. It is also a common progression for
gastrointestinal malignancies including colorectal, gastric,
and pancreatic cancers.....
                              ~~~~~~~~~~~~~~~~~

The peritoneal metastatic route of cancer dissemination
is shared by cancers of the ovary and gastrointestinal
tract. Once initiated, peritoneal metastasis typically proceeds
rapidly in a feed-forward manner. Several factors
contribute to this efficient progression. In peritoneal metastasis,
cancer cells exfoliate into the peritoneal fluid and
spread locally, transported by peritoneal fluid. Inflammatory
cytokines released by tumor and immune cells compromise
the protective, anti-adhesive mesothelial cell layer that lines
the peritoneal cavity, exposing the underlying extracellular
matrix to which cancer cells readily attach. The peritoneum
is further rendered receptive to metastatic implantation and
growth by myofibroblastic cell behaviors also stimulated by
inflammatory cytokines. Individual cancer cells suspended
in peritoneal fluid can aggregate to form multicellular spheroids.

paywalled: Emergency department visits for symptoms experienced by oncology patients: a systematic review

Emergency department visits for symptoms... [Support Care Cancer. 2012] - PubMed - NCBI

CONCLUSIONS:

Individuals with cancer present to emergency departments with a myriad of symptoms. Over half of emergency department visits resulted in hospital admissions. Few symptoms were defined adequately to compare data across studies, thereby revealing an important gap in cancer symptom reporting.

paywalled: Cancer Risks for Relatives of Patients With Serrated Polyposis : The American Journal of Gastroenterology + link to Johns Hopkins (further explanation/genetics)

Access : Cancer Risks for Relatives of Patients With Serrated Polyposis : The American Journal of Gastroenterology

CONCLUSIONS:

Our finding that relatives of serrated polyposis patients are at significantly increased risk of colorectal and pancreatic cancer adds to the accumulating evidence that serrated polyposis has an inherited component.

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

 Johns Hopkins Colon Cancer Center:

What Is Hyperplastic Polyposis?

---

Individuals are diagnosed with hyperplastic polyposis when they have multiple hyperplastic polyps, usually greater than 20 polyps.  The number of polyps ranges anywhere from 6 to greater than 100, though most individuals with hyperplastic polyposis have between 40 and 100 polyps.  A diagnosis of Hyperplastic polyposis may also made in individuals who present with fewer than 20 hyperplastic polyps, but whose polyps are larger, often greater than 2 centimeters.  Individuals may also be diagnosed with multiple serrated adenomas or a mix of both serrated adenomas and hyperplastic polyps.  Hyperplastic polyposis is usually diagnosed in individuals in their 40’s to 60’s, though it has been reported in individuals as young as 11 years old.  Individuals with hyperplastic polyposis are at an increased risk for developing colorectal cancer, so routine screening is extremely important.  Although the genetic basis for FAP, HNPCC, Peutz-Jeghers, MYH-Associated Polyposis, and juvenile polyposis has been identified, hyperplastic polyposis has not yet been explained. Hyperplastic polyposis is suspected to have a familial basis and reports have shown that is inheritable in 5% of cases, though the exact mechanism of inheritance has not been identified.   

Supplements and cancer prevention: A cautionary tale - Journal of National Cancer Institute - press release

Supplements and cancer prevention: A cautionary tale

Public release date: 25-Apr-2012
Journal of the National Cancer Institute

Supplements and cancer prevention: A cautionary tale

Government regulators and the scientific community should work to ensure that they give clear guidance to the public about dietary supplements and cancer risk, according to a commentary published April 25 in the Journal of the National Cancer Institute.

Evidence from animal, in vitro and observational studies has suggested that taking dietary supplements may lower cancer risk. However, the small number of randomized controlled studies, the gold standard in evidence-based medicine, has not confirmed this—and some studies have actually shown that supplements may increase cancer risk. Still, the supplement industry is booming, with estimated annual sales at $30 billion in the U.S.

To examine the potential role of dietary supplements and cancer risk, Maria Elena Martinez, Ph.D., of the University of California San Diego Moores Cancer Center and colleagues, looked at observational studies of several supplements, including anti-oxidants, folic acid, vitamin D, and calcium. Several observational studies found that diets high in fruits and vegetables were associated with lower risk of certain cancers, including respiratory and gastrointestinal. Specifically, with respect to anti-oxidant supplements, the authors found that: "The importance of oxidative stress for carcinogenesis does not establish that the administration of supplemental antioxidants will protect against the carcinogenesis that oxidative stress may induce." Furthermore, they write, "Supplementation by exogenous antioxidants may well be a two-edged sword; these compounds could, in vivo, serve as pro-oxidants or interfere with any of a number of protective processes such as apoptosis induction." Indeed, several antioxidant trials the researchers examined reported increased cancer risks with supplementation. They looked at trials with supplements using folic acid, vitamin D and calcium, among other compounds.

The researchers caution against taking dietary supplements for cancer prevention, adding that many expert committees and organizations have concluded that nutritional supplements have little or no benefit in cancer prevention. They say that more randomized control trials—spanning many years instead of just a few—are needed to verify the effect of nutritional supplementation in cancer risk. 

Meanwhile, people continue to take supplements, spurred by manufacturers' suggestions that supplements are healthy at best and harmless at worst. Furthermore, believers in supplements assume that they are well regulated, the authors write. "These beliefs underscore the need for efforts by scientists and government officials to encourage the public to make prudent decisions based on sound evidence with respect to use of dietary supplements for cancer prevention."

Add-on bevacizumab slows progression of recurrent ovarian cancer - - ModernMedicine

Add-on bevacizumab slows progression of recurrent ovarian cancer - - ModernMedicine


(from Reuters) "....Dr. Aghajanian and colleagues note that overall survival data from the trial are not yet available; information on clinicaltrials.gov indicates a predicted study completion date of October 2013.
For now, say the researchers, "The data from OCEANS demonstrate that the addition of BV (bevacizumab) to GC (gemcitabine and carboplatin) can improve outcomes, and ongoing studies will assess whether this ability to add benefit is universal to other platinum-based combinations."
OCEANS is supported by Genentech, which markets bevacizumab as Avastin.

Patient-Centered Outcomes Research Institute Amends Draft Research Agenda in Response to Public Comment -- WASHINGTON, April 25, 2012 /PRNewswire-USNewswire/ --

Patient-Centered Outcomes Research Institute Amends Draft Research Agenda in Response to Public Comment -- WASHINGTON, April 25, 2012 /PRNewswire-USNewswire/ --

".....After discussion, the Board voted to make important changes to the Research Agenda. These include clarification of PCORI's focus on patient engagement and transparency; on patients with multiple chronic conditions; on patients with rare diseases; on improving health care systems, including care coordination, access to care, and the role of practice settings and allied health professionals; and on the importance of health literacy.
"The comments we received did not identify major gaps in the National Priorities, and there were no suggestions for additional priorities," said PCORI Executive Director Joe Selby, M.D., MPH. "This indicates that our priorities effectively capture the broad areas where more research is needed. Once the revised National Priorities and Research Agenda are approved, we will issue PCORI's first primary research funding announcements, which will emphasize the inclusion of patients and caregivers at all stages of the research."
PCORI reiterated its commitment to being a learning organization that will continually work with patients and stakeholders to revise its priorities and agenda as needed to address patients' evolving needs....."

open access: What Is the Heart of Health Care? Advocating for and Defining the Clinical Relationship in Patient-Centered Care | Journal of Participatory Medicine

What Is the Heart of Health Care? Advocating for and Defining the Clinical Relationship in Patient-Centered Care | Journal of Participatory Medicine

open access: Oxaliplatin-related thrombocytopenia

Oxaliplatin-related thrombocytopenia

Abstract/Full Text:

Oxaliplatin is a third generation platinum compound that inhibits DNA synthesis, mainly through intrastrandal cross-links in DNA. Most of the experience with the clinical use of this drug is derived from colorectal cancer but it is also used in other tumor types such as ovary, breast, liver and non-Hodgkin's lymphoma. Thrombocytopenia is a frequent toxicity seen during oxaliplatin treatment, occurring at any grade in up to 70 % of patients and leading to delays or even discontinuation of the chemotherapy. Although myelossupression is recognized as the main cause of oxaliplatin-related thrombocytopenia, new mechanisms for this side-effect have emerged, including splenic sequestration of platelets related to oxaliplatin-induced liver damage and immune thrombocytopenia. These new pathophysiology pathways have different clinical presentations and evolution and may need specific therapeutic maneuvers. This article attempts to review this topic and provides useful clinical information for the management of oxaliplatin-related thrombocytopenia. 

conclusions

Oxaliplatin-related thrombocytopenia can prevent the administration of the optimal dose and schedule of this important chemotherapy agent and limit its benefits in the adjuvant or metastatic setting. Mild to moderate bone marrow suppression is the main cause of thrombocytopenia during and after treatment with oxaliplatin. In this setting, patients present thrombocytopenia concomitant to anemia and neutropenia usually 1–2 weeks after treatment. Therapeutic approaches will include dose delays or reduction and consideration of platelet-stimulating agents. However, novel mechanisms of oxaliplatin-related thrombocytopenia should promptly be recognized by physicians and include an immune-dependent mechanism, as well as portal hypertension related to sinusoidal injury yielding splenic sequestration of platelets.

OIIT usually presents a sudden and isolated drop in platelet counts minutes to hours after oxaliplatin administration, leading to acute hemorrhagic events. Female patients with advanced CRC and prior oxaliplatin exposure are more likely to develop this consequence. Prompt immunological testing documenting oxaliplatin-mediated platelet destruction leads to definitive diagnosis. Platelets counts will improve after discontinuation of treatment and transfusions may be necessary during the acute phase. Other measures such as corticoid or immunoglobulin administration are controversial and patients with documented OIIT should not be rechallenged with oxaliplatin.

Hepatic sinusoidal injury is a well-known complication of oxaliplatin treatment and can lead to portal hypertension and hypersplenism. Thrombocytopenia in this setting demonstrates a different natural history, with moderate but prolonged reductions in platelet counts. Splenomegaly and other complications of portal hypertension are recognized in these patients. Platelet recovery is slow and usually takes 2–3 years to be complete after treatment discontinuation. When a fast platelet recovery is wanted, splenic embolization might be considered as a therapeutic measure.

An improvement in the recognition of these mechanisms of oxaliplatin-related thrombocytopenia will permit a better documentation of them and help to understand possible risk factors associated with this complication in different settings. This information may help the development of new preventive and therapeutic approaches and allow for a more rational management of cancer patients treated with oxaliplatin that present thrombocytopenia.

paywalled: Japanese Journal of Clinical Oncology- LAPTM4B Polymorphisms is Associated with Ovarian Cancer Susceptibility and Its Prognosis

LAPTM4B Polymorphisms is Associated with Ovarian Cancer Susceptibility and Its Prognosis:

Objective
Lysosome-associated protein transmembrane 4 beta (LAPTM4B) is an important novel gene associated with the proliferation and differentiation of cells. Recent studies have shown that it was overexpressed in many cancer tissues. This study investigated the association between different LAPTM4B polymorphisms and the susceptibility and prognosis of ovarian cancer.

Methods
A case–control study was performed in 282 patients with ovarian cancer and 365 control subjects. Genomic DNA was extracted from peripheral blood lymphocytes in all participants. LAPTM4B genotypes were determined using polymerase chain reaction.

Results
There was a significantly higher LAPTM4B*2 allele frequency in ovarian cancer cases than controls (P < 0.05). Using the LAPTM4B*1/1 genotype as the reference, we found that the LAPTM4B*1/2 and LAPTM4B*2/2 genotypes were positively associated with ovarian cancer.

Current Drug Shortages: Paclitaxel Injection (updated)

Current Drug Shortages: Paclitaxel Injection (updated):

APP is currently back-ordered on 100 mg/16.7 mL vial (NDC 63323-0763-16) and 300 mg/50 mL vial (NDC 63323-0763-50). 30 mg/5 mL vial (NDC 63323-0763-05) is currently available.

Current Drug Shortages: Ondansetron Injection 2 mg/mL (updated)

Current Drug Shortages: Ondansetron Injection 2 mg/mL (updated):

APP has Ondansetron 2 mg/mL 2 mL vials on back order with an estimated release date of early May 2012. Check wholesalers for inventory. The 40 mg, 20mL vials are on back-order until late May.

paywalled: Jpn. J. Clin. Oncol. (2012) - Oncology Information on the Internet

Oncology Information on the Internet

Abstract:

Owing to new developments in Internet technologies, the amount of available oncology information is growing. Both patients and caregivers are increasingly using the Internet to obtain medical information. However, while it is easy to provide information, ensuring its quality is always a concern. Thus, many instruments for evaluating the quality of health information have been created, each with its own advantages and disadvantages. The increasing importance of online search engines such as Google warrants the examination of the correlation between their rankings and medical quality. The Internet also mediates the exchange of information from one individual to another. Mailing lists of advocate groups and social networking sites help spread information to patients and caregivers. While text messages are still the main medium of communication, audio and video messages are also increasing rapidly, accelerating the communication on the Internet. Future health information developments on the Internet include merging patients' personal information on the Internet with their traditional health records and facilitating the interaction among patients, caregivers and health-care providers. Through these developments, the Internet is expected to strengthen the mutually beneficial relationships among all stakeholders in the field of medicine.

paywalled: Clinical development of new formulations of cytotoxics in so... : Current Opinion in Oncology

Clinical development of new formulations of cytotoxics in so... : Current Opinion in Oncology

Current Opinion in Oncology:

May 2012 - Volume 24 - Issue 3 - p 325–331

doi: 10.1097/CCO.0b013e328351fb29

INNOVATIVE EARLY CLINICAL TRIALS METHODOLOGY AND NEW THERAPEUTICS IN CANCER: Edited by Ahmad Awada

Clinical development of new formulations of cytotoxics in solid tumors

Abstract

Purpose of review: 

To discuss the clinical development of new formulations of old cytotoxic agents and highlight the value of adopting this strategy.

Recent findings: 

Several drugs are currently in clinical development with high potential in improving clinical outcomes compared with their older counterparts. We emphasize on the results of four of these agents, each belonging to a known group of cytotoxics namely amrubicin, EndoTAG-1, pralatrexate and NKTR-102. Each has shown promising results that have the potential in addressing some limitations that have been observed with the ‘earlier generation’ agents.

Summary:  

Improvement in drug development strategies and the appreciation of the mechanisms of action and resistance of the cytotoxic agents currently available in the clinic open the door for developing agents that have the potential of improving clinical outcomes with better safety profiles. It is important to adopt innovative clinical trials designs integrating molecular markers in early clinical development in order to identify the subgroups of patients who would derive the maximal benefit of these novel agents.

paywalled: Targeting the DNA damage response in oncology: past, presen... : Current Opinion in Oncology

Targeting the DNA damage response in oncology: past, presen... : Current Opinion in Oncology

Current Opinion in Oncology:

May 2012 - Volume 24 - Issue 3 - p 316–324

doi: 10.1097/CCO.0b013e32835280c6

INNOVATIVE EARLY CLINICAL TRIALS METHODOLOGY AND NEW THERAPEUTICS IN CANCER: Edited by Ahmad Awada

Targeting the DNA damage response in oncology: past, present and future perspectives

Abstract

Purpose of review: 

The success of poly(ADP-ribose) polymerase inhibition in BRCA1 or BRCA2 deficient tumors as an anticancer strategy provided proof-of-concept for a synthetic lethality approach in oncology. There is therefore now active interest in expanding this approach to include other agents targeting the DNA damage response (DDR). We review lessons learnt from the development of inhibitors against DNA damage response mechanisms and envision the future of DNA repair inhibition in oncology.

paywalled: Vascular disrupting agents: a delicate balance between efficacy and side (safety) effects

Vascular disrupting agents: a delicate balance between effi... : Current Opinion in Oncology

Current Opinion in Oncology:

May 2012 - Volume 24 - Issue 3 - p 305–315

doi: 10.1097/CCO.0b013e32835249de

INNOVATIVE EARLY CLINICAL TRIALS METHODOLOGY AND NEW THERAPEUTICS IN CANCER: Edited by Ahmad Awada

Abstract

Purpose of review: 

Targeting the tumor vasculature is an attractive approach for cancer therapy. Vascular disrupting agents (VDAs) are compounds that directly target tumor blood vessels and create central tumor necrosis. The current review aims to summarize the clinical development (i.e. safety and efficacy) of this class of compounds.

Recent findings: 

VDAs have demonstrated signs of clinical activity in different tumor types [e.g. anaplastic thyroid carcinoma (ATC), nonsmall cell lung carcinoma (NSCLC), ovarian cancer, sarcoma]. However, the lack of predictive biomarkers to identify patients with a high probability of response to VDAs, places this class of compounds at a high risk of failure. This has recently been exemplified by several negative phase II/III trials in NSCLC, ATC, and castration-refractory metastatic prostate cancer.

Summary: 

VDAs represent a unique class of anticancer compounds. Their clinical development is hampered by cardiovascular, neurological toxicities as single agent and by hematological toxicity in combination with chemotherapy. Molecular predictors of their efficacy are crucial for further development. As single agent, only few objective responses have been observed in a variety of solid tumors. However, VDAs have failed to demonstrate a survival advantage in several phase II/III trials especially in combination with chemotherapy.

7 steps to managing angry (hostile) patients - Staff members are central to this proven technique - ModernMedicine

7 steps to managing angry patients - Staff members are central to this proven technique - ModernMedicine

paywalled: ncreased risk of neoplasm in appendicitis treated w... [Am Surg. 2012] - PubMed - NCBI

Increased risk of neoplasm in appendicitis treated w... [Am Surg. 2012] - PubMed - NCBI

Am Surg. 2012 Mar;78(3):339-43.

Increased risk of neoplasm in appendicitis treated with interval appendectomy: single-institution experience and literature

Abstract

Appendicitis is a common diagnosis encountered by the acute care surgeon. Management of complicated appendicitis is controversial and often involves initial nonoperative therapy with interval appendectomy. This study reviews single-institutional experience with management of complicated appendicitis with interval appendectomy and addresses an unusually high occurrence of incidental appendiceal malignancies observed with a review of relevant literature. A retrospective review of all diagnoses of appendicitis was performed over 5 years at a tertiary care center. Patient demographics, time to surgery, operative technique, pathologic diagnosis, and clinical outcomes were examined. Three hundred fifteen patients were diagnosed with acute appendicitis. Of these, 24 (7.6%) were deemed complicated and did not undergo immediate appendectomy, and 18 ultimately underwent appendectomy at our institution and were included in analysis. There were no statistical demographic or symptomatic differences between the immediate and interval appendectomy patients. Ninety-nine per cent of the immediate appendectomy patients were treated laparoscopically; 78 per cent of the interval group underwent attempted laparoscopic treatment with 56 per cent completed without conversion to open (P < 0.01). Neoplasms were discovered in 1 per cent of the acute appendectomy group and 28 per cent of the interval appendectomy group (P < 0.0001). Two of the three neoplasms in the acute group were carcinoid, whereas three of the five neoplasms in the interval group were adenocarcinoma. Surgeons should consider appendiceal or colonic neoplasms in cases of complicated appendicitis when nonoperative management is considered. This is most important in patients older than 40 years, in those who forego interval appendectomy, or in those who could be lost to follow-up.

2012 ASCO Annual Meeting | Abstracts to be released online May 16th

2012 ASCO Annual Meeting | Abstracts

 May 16 at 6:00 PM (EDT) Abstracts released on ASCO.org*

paywalled: Breast cancer metastasising to the pelvis and abdomen: what the gynaecologist needs to know - 2012 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library

Breast cancer metastasising to the pelvis and abdomen: what the gynaecologist needs to know - Moore - 2012 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library

A small proportion of breast cancers metastasize within the peritoneal cavity. With increasing breast cancer incidence rates, gynaecologists and oncologists will encounter such women more frequently. Most women with intraperitoneal breast cancer are premenopausal. Although data are limited and are likely to be subject to selection bias, the median survival of women undergoing resection appears superior to those not undergoing surgery. Furthermore, survival is broadly similar to that for women undergoing advanced ovarian cancer surgery, particularly when tumour debulking is optimal. Obtaining data via randomised trials is unlikely to be feasible and therefore we recommend prospective data collection via the establishment of an international intraperitoneal breast cancer patient registry. For individual women where survival is anticipated to be more than a few months, we suggest considering referral to a gynaecological oncology team for discussion of surgical options.

future postings - term 'subscription required' replaced by 'paywalled'

Blogger's Note: wording/term change - 'paywalled' (new) = subscription required ($$$) (old), plain english - blog postings of the future which indicate the term 'paywalled' means that access to the article requires a paid subscription

abstract: Topoisomerase 1 Inhibitors and Cancer Therapy

 Blogger's Note: to view full paper, subscription ($$$) required

Topoisomerase 1 Inhibitors and Cancer Therapy

 Abstract: "Topoisomerase 1 inhibitors cure human cancer xenografts in animal models, more so than most other chemotherapy agents. However, their activity in patients with cancer is modest. Ongoing research is studying the optimal analogues that could reproduce animal data in the cancer population. This article analyzes the clinical research with topoisomerase 1 inhibitors in ovarian cancer."

Harvard Libraries join the fight for open access - science blog

Harvard Libraries join the fight for open access

financial: Amgen - Media - Press Release (Product Sales Performance eg. Neupogen/Etanercept/Darbepoetin/Aranesp/Epogen...)

Amgen - Media - Press Release

Product Sales Performance
 

XGEVA^® (denosumab) sales were $153 million in the first quarter of 2012, an increase of 14 percent over the fourth quarter of 2011, reflecting increased segment share as well as overall segment growth.

Prolia^® (denosumab) sales were $88 million in the first quarter of 2012, an increase of 9 percent over the fourth quarter of 2011, reflecting continued global growth.

Combined Neulasta^® (pegfilgrastim) and NEUPOGEN^® (Filgrastim) sales increased 9 percent to $1,344 million in the first quarter of 2012 versus $1,232 million in the first quarter of 2011. Combined U.S. Neulasta and NEUPOGEN sales increased 13 percent to $1,053 million in the first quarter of 2012 versus $930 million in the first quarter of 2011, driven primarily by an increase in the average net sales price and, to a lesser extent, an increase in Neulasta unit demand. Combined Neulasta and NEUPOGEN international sales decreased 4 percent to $291 million in the first quarter of 2012 versus $302 million in the first quarter of 2011, due primarily to a decrease in the average net sales price. A mid single-digit percentage point increase in Neulasta unit demand was offset by a decline in NEUPOGEN units due primarily to biosimilar competition.

Enbrel^® (etanercept) sales increased 7 percent to $938 million in the first quarter of 2012 versus $875 million in the first quarter 2011, driven primarily by an increase in the average net sales price. ENBREL remains the segment share leader in both the rheumatology and dermatology segments.

Aranesp^® (darbepoetin alfa) sales decreased 11 percent to $518 million in the first quarter of 2012 versus $580 million in the first quarter of 2011. U.S. Aranesp sales decreased 19 percent to $202 million in the first quarter of 2012 versus $250 million in the first quarter of 2011, due primarily to a decline in unit demand, offset partially by a mid single-digit percentage point increase in the average net sales price. The unit decline reflects segment contraction resulting from changes to the product label and reimbursement environment that occurred during 2011. International Aranesp sales decreased 4 percent to $316 million in the first quarter of 2012 versus $330 million in the first quarter of 2011, due primarily to a decrease in the average net sales price.

EPOGEN^® (epoetin alfa) sales decreased 17 percent to $446 million in the first quarter of 2012 versus $535 million in the first quarter of 2011, reflecting the impact of changes to the label and reimbursement. The decline was comprised of an approximately 30 percent decrease in unit demand driven by a reduction in dose utilization, offset partially by reductions in customer discounts as part of new provider contracts that became effective Jan. 1, 2012.

On a sequential basis, EPOGEN sales decreased 8 percent, comprised of an approximately 20 percent decrease in unit demand driven by the timing of end-user purchases at the end of 2011 and a reduction in dose utilization. These decreases were offset partially by reductions in customer discounts as part of new provider contracts.
Sales of our other, growth-phase products increased 22 percent to $399 million in the first quarter 2012 versus $327 million in the first quarter of 2011. Sales of Sensipar^®/Mimpara^® (cinacalcet) increased 17 percent to $219 million in the first quarter of 2012 versus $187 million in the first quarter of 2011. Sales of Vectibix^® (panitumumab) increased 20 percent to $90 million in the first quarter of 2012 versus $75 million in the first quarter of 2011. Sales of Nplate^® (romiplostim) increased 38 percent to $90 million in the first quarter of 2012 versus $65 million in the first quarter of 2011. These increases were driven primarily by global unit growth.

Campaigners call for Scottish Government to act over needless ovarian cancer deaths - The Daily Record

Campaigners call for Scottish Government to act over needless ovarian cancer deaths - The Daily Record

"New research shows woeful symptom awareness among women in Scotland with only one per cent of those surveyed being very confident of noticing a symptom. Across the UK the figure was just three per cent.
And, of the GPs surveyed in Scotland, 86 per cent agreed that updates to Scottish clinical guidelines would support them to diagnose ovarian cancer more effectively.
Now campaigners have called on the Scottish Government top spearhead a national campaign to increase symptom awareness.
In April 2011, the National Institute for Health and Clinical Excellence (NICE) published the first official guidance to GPs in England and Wales about the symptoms, diagnosis and early treatments for ovarian cancer.
The Target Ovarian Cancer Pathfinder Study 2012 found 68 per cent of a UK-wide representative sample of 402 GPs was aware of the NICE guidance.
However, GPs in Scotland will have to wait until later this year for updated guidance from the Scottish Intercollegiate Guidelines Network......"

Target Ovarian Cancer can be found online at www.targetovariancancer.org.uk

Oncologists in Top 10 of High-Earning Specialties

 Blogger's Note: response rate was low which may scew results (averages); ASCO report 2008: nearly 10,500 oncologists in the U.S. (as at 2005)

                           ~~~~~~~~~~~~~~~~~
Oncologists in Top 10 of High-Earning Specialties

".... With an average annual compensation of $295,000, oncologists were number 7 of 25 medical specialties surveyed."

"The report compiles the results from an online survey of 24,216 American physicians conducted in February 2012. Oncologists made up 2% of all respondents (n = 433)."

"These responses were recorded in February 2012, before the American Society of Clinical Oncology (ASCO) issued its recommendation on 5 cancer practices that must stop, which include cutting down on expensive imagining tests in cancer patients. It will be interesting to look at the responses to this question next year to see if the ASCO recommendation has had any effect on oncologists' attitudes about testing."

Journal of Ovarian Research: Thailandepsins are new small molecule class I HDAC inhibitors with potentcytotoxic activity in ovarian cancer cells: a preclinical study of epigenetic ovarian cancer therapy

Thailandepsins are new small molecule class I HDAC inhibitors with potentcytotoxic activity in ovarian cancer cells: a preclinical study of epigenetic ovarian cancer therapy

 Abstract
Background
New treatment strategies are emerging to target DNA damage response pathways in ovarian cancer. Our group has previously shown that the class I biased HDAC inhibitor romidepsin (FK228) induces DNA damage response and has potent cytotoxic effects in ovarian cancer cells. Here, we investigated newly discovered HDAC inhibitors, thailandepsin A (TDP-A) and thailandepsin B (TDP-B), to determine the effects on cell viability, apoptosis and DNA damage response in ovarian cancer cells......

Fallopian Tube Removal as a Method of Ovarian Cancer Prevention: A Descriptive Study - Full Text View - ClinicalTrials.gov

Fallopian Tube Removal as a Method of Ovarian Cancer Prevention: A Descriptive Study - Full Text View - ClinicalTrials.gov

This study is currently recruiting participants.

Verified February 2012 by University of Washington

First Received on February 28, 2012.   Last Updated on March 2, 2012   History of Changes

Official Title: Patients Salpingectomy as a Method of Ovarian Cancer Prevention: A Descriptive Study 

Sponsor:	University of Washington
Information provided by (Responsible Party):	Elizabeth Swisher, University of Washington
ClinicalTrials.gov Identifier:	NCT01544049

  Purpose

The purpose of this study is to better understand why women choose to have their fallopian tubes removed as a method for ovarian cancer prevention. This will be done through a paper questionnaire and phone interviews. The investigators hope to gain information that will allow us to better counsel women about ovarian cancer prevention.

Utah: Surgical Trial Comparing LIGASURE Assisted Recto-Sigmoid Resection and Omentectomy Compared to Stand - Full Text View - ClinicalTrials.gov

Surgical Trial Comparing LIGASURE Assisted Recto-Sigmoid Resection and Omentectomy Compared to Stand - Full Text View - ClinicalTrials.gov

 Purpose

The objective of this prospective randomized surgical trial is to evaluate whether the use of the LIGASURE surgical device during omentectomy and/or recto-sigmoid resection for women with ovarian cancer will reduce the surgical time compared to standard surgical resection using clamps and surgical ligatures.

phase 2/UK: The Activity of TroVax® Versus Placebo in Relapsed Asymptomatic Ovarian Cancer - Full Text View - ClinicalTrials.gov

The Activity of TroVax® Versus Placebo in Relapsed Asymptomatic Ovarian Cancer - Full Text View - ClinicalTrials.gov

The Activity of TroVax® Versus Placebo in Relapsed Asymptomatic Ovarian Cancer (TRIOC)

This study is not yet open for participant recruitment.

Verified March 2012 by University College, London

First Received on March 14, 2012.   Last Updated on March 27, 2012   History of Changes

Sponsor:	University College, London
Collaborators:	Oxford BioMedica Cancer Research UK
Information provided by (Responsible Party):	University College, London
ClinicalTrials.gov Identifier:	NCT01556841

  Purpose

The purpose of this trial is to assess the effectiveness of TroVax® compared to placebo in extending the time to progression in patients with asymptomatic relapsed platinum resistant ovarian, fallopian tube or primary peritoneal cancer.The trial will also look at overall survival times and quality of life.

Phase Ib Trial of Folate Binding Protein Vaccine in Ovarian Cancer - Full Text View - ClinicalTrials.gov

Phase Ib Trial of Folate Binding Protein Vaccine in Ovarian Cancer - Full Text View - ClinicalTrials.gov

Phase Ib Trial of Folate Binding Protein Vaccine in Ovarian Cancer

This study is currently recruiting participants.

Verified April 2012 by San Antonio Military Medical Center

First Received on April 16, 2012.   Last Updated on April 17, 2012   History of Changes

Sponsor:	COL George Peoples, MD, FACS
Information provided by (Responsible Party):	COL George Peoples, MD, FACS, San Antonio Military Medical Center
ClinicalTrials.gov Identifier:	NCT01580696

  Purpose

Folate binding protein (FBP) is highly over-expressed in breast, ovarian and endometrial cancers and is the source of immunogenic peptides (E39) that can stimulate cytotoxic T lymphocytes (CTL) to recognize and destroy FBP-expressing cancer cells in the laboratory. The purpose of this study is to test whether a peptide-based vaccine consisting of the E39 peptide mixed with the FDA-approved immunoadjuvant granulocyte macrophage colony-stimulating factor (GM-CSF) is safe and effective at inducing an in vivo peptide-specific immune response. Furthermore, the investigators intend to determine the best dose of the vaccine to utilize to produce this immunity most efficiently. The investigators will determine whether immunity to FBP will prevent clinical recurrence. Additionally, the investigators will compare these results with results from a trial utilizing the E75 peptide (from the HER2/neu protein) in ovarian and endometrial cancer patients in preparation for studying a combination vaccine.

phase 2: Vargatef (Nintedanib) in Addition to First Line Chemotherapy With Interval Debulking Surgery in Patients With Ovarian Cancer - Full Text View - ClinicalTrials.gov - France) (treatment/placebo/note: Avastin...)

Vargatef in Addition to First Line Chemotherapy With Interval Debulking Surgery in Patients With Ovarian Cancer - Full Text View - ClinicalTrials.gov

This study is not yet open for participant recruitment.

Verified April 2012 by ARCAGY/ GINECO GROUP

First Received on April 19, 2012.   Last Updated on April 23, 2012   History of Changes

Sponsor:	ARCAGY/ GINECO GROUP
Information provided by (Responsible Party):	ARCAGY/ GINECO GROUP
ClinicalTrials.gov Identifier:	NCT01583322

  Purpose

Patients with extensive and bulky disease are often those whose initial surgery is delayed after 3 or 4 cycles of neo-adjuvant chemotherapy.

In that case, there is, indeed, some concern to administer bevacizumab during the chemotherapy surrounding the interval debulking surgery due to the long half life (14- 21 days) of this monoclonal antibody and the interference of anti angiogenic agents with wound healing.

Vargatef® (Nintedanib) might offer a better alternative to bevacizumab in the neo-adjuvant setting. Vargatef® (Nintedanib) has a much shorter half-life of 7 to 19 hours. Preliminary experience in cancer did not show a trend for increased incidence of fistula or bowel perforation. For more details please refer to the investigator drug brochure for Vargatef® (Nintedanib).

This trial will compare progression-free survival and surgical complications of 188 patients with FIGO stage IIIC/IV treated in first line with either neo-adjuvant chemotherapy (carboplatin & paclitaxel) and interval debulking surgery or the same treatment + Vargatef® (Nintedanib).

Current Drug Shortages: Paclitaxel Injection (updated)

Current Drug Shortages: Paclitaxel Injection (updated):

Teva has all presentations available with ample inventory.

PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer.

PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer.

PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer.

Abstract

OBJECTIVE: This study was undertaken to evaluate the clinical contribution of positron emission tomography using (18)F-fluorodeoxyglucose and integrated computer tomography (FDG-PET/CT) guided intensity-modulated radiotherapy (IMRT) for treatment of recurrent ovarian cancer.

MATERIALS AND METHODS: Fifty-eight patients with recurrent ovarian cancer from 2003 to 2008 were retrospectively studied. In these patients, 28 received PET/CT guided IMRT (PET/CT-IMRT group), and 30 received CT guided IMRT (CT-IMRT group). Treatment plans, tumor response, toxicities and survival were evaluated.

RESULTS: Changes in GTV delineation were found in 10 (35.7%) patients based on PET-CT information compared with CT data, due to the incorporation of additional lymph node metastases and extension of the metastasis tumor. PET/CT guided IMRT improved tumor response compared to CT-IMRT group (CR: 64.3% vs. 46.7%, P=0.021; PR: 25.0% vs. 13.3%, P=0.036). The 3-year overall survival was significantly higher in the PET-CT/IMRT group than control (34.1% vs. 13.2%, P=0.014).

CONCLUSIONS: PET/CT guided IMRT in recurrent ovarian cancer patients improved the delineation of GTV and reduce the likelihood of geographic misses and therefore improve the clinical outcome.

Women of Teal: ASCO 2012 (HAWMC 23 My choice)

ASCO 2012 (HAWMC 23 My choice): Health Activist Choice Day 2! Write about whatever you like.

(Women of Teal) I am one happy cancer research advocate. I learned last week that I will be receiving a scholarship from the Conquer Cancer Foundation to attend this year's ASCO (American Society of Clinical Oncologists ) Annual meeting in Chicago. Their goal is to improve cancer care and prevention. The Annual Meeting is the largest conference on....

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

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
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 ] [ 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

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

Ontario Health Promotion E-Bulletin, 20 April 2012 - OHPE Bulletin 750, Volume 2012, No. 750

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

Malinda Teel