Personalized Medicine - Vol. 9
The parts of a Cochrane systematic review and the information they contain - learning to navigate a review
Saturday, May 05, 2012
paywalled: Psychological Distress of the Bereaved Seeking Medical Counseling at a Cancer Center
Blogger's Note/Opinion: the abstract is one of a few which is written in plain english and with an empathetic 'tone' both of which set it apart from many psycho-oncology papers
Psychological Distress of the Bereaved Seeking Medical Counseling at a Cancer Center
Abstract
Objective The death of
a loved one is one of the most stressful events in life and is related
to the physical and psychological wellbeing
of the bereaved. Some bereaved individuals seek
medical counseling to alleviate their distress. However, no studies have
focused
on the bereaved who have lost a loved one to
cancer and have asked for medical help at a cancer center as a result.
The aim
of this study was to investigate the distress of
the bereaved who sought consultation, as basic information for
considering
support.
Methods We conducted a
survey of people consulting outpatient services for bereaved families
between April 2007 and September 2009.
Data were obtained from medical records at
initial consultation and qualitatively analyzed by content analysis
using all statements
related to their distress.
Results Their
statements were classified into 11 categories, which were further
classified into six themes. The main categories of
bereavement-related distress were as follows:
(i) regret; (ii) anger; (iii) memories; (iv) loneliness; (v) anxiety;
and (vi)
hopelessness. ‘Regret’ was frequently recognized
in their distress and it includes some points related to the cancer
trajectory.
Conclusions
Psychological distresses of the bereaved who have lost a loved one and
have asked for medical counseling are revealed. Their
distresses are strongly related to the cancer
trajectory of a family member. Some of these distresses are related to
medical
misunderstanding about the course of cancer.
These findings might provide basic information for considering their
appropriate
treatment.
video: doctor who restricted his wife's appointment to one problem only - video
Blogger's Note/Opinion: while this media report is from Canada (Manitoba) this is not a country-specific issue, it is, however, not patient-centered nor patient-friendly care, watch media for upcoming 'apologies'
Canada News Videos
'Assembly line medicine' (video)
- Thu, 3 May, 2012 - CBC.ca 2:01 | 63,732 viewsMedical experts weigh in on a Manitoba man's complaint against a doctor who restricted his wife's appointment to one problem only.
paywalled: US firm corners exclusive license for RAD51C cancer gene : The Lancet Oncology (breast/ovarian mutation)
US firm corners exclusive license for RAD51C cancer gene : The Lancet Oncology
US firm corners exclusive license for RAD51C cancer gene
"Already facing a legal challenge to its BRCA1 and BRCA2 patents,
Myriad Genetics (Salt Lake City, UT, USA) has secured an exclusive
licence for another breast and ovarian cancer-associated gene, RAD51C ,
under agreement with the German Consortium for Hereditary Breast and
Ovarian Cancers, which will share exclusivity in Germany. RAD51C will be used to test patients' hereditary breast and ovarian cancer risks.
“I think it is unfortunate for both the clinical and research communities”, Jim Evans (University"
Editorial: Serrated Polyposis: The Last (or Only the Latest - Frontier of Familial Polyposis (Lynch Syndrome/familial/pre-malignant adenomas)
Wiki: Sessile serrated adenoma
In gastroenterology, a sessile serrated adenoma (abbreviated SSA), also known as sessile serrated polyp (abbreviated SSP), is a premalignant flat (or sessile) lesions of the colon, predominantly seen in the cecum and ascending colon.
Editorial: Serrated Polyposis: The Last (or Only the Latest|[quest]|) Frontier of Familial Polyposis|[quest]| : The American Journal of Gastroenterology
The American Journal of Gastroenterology 107, 779-781 (May 2012) | doi:10.1038/ajg.2012.62
Editorial: Serrated Polyposis: The Last (or Only the Latest?) Frontier of Familial Polyposis?
, and
Abstract
Serrated polyps are thought to be precursors of ~15%
of colorectal cancers and clinical criteria for a serrated polyposis
(SP) syndrome have been proposed. In this issue of American Journal of
Gastroenterology, Win et al. report that family members of individuals
who meet the clinical criteria for SP are at increased risk for
colorectal and possibly pancreatic cancer. The important data presented
by Win et al. strongly support the concept that familial SP exists and
help define the patterns of risk in this syndrome. The paper also
illustrates the difficulties of trying to define a genetic syndrome on
the basis of largely retrospective clinical data and highlights the
importance of efforts to define the genetic basis of familial SP and to
study these families in a systematic, prospective manner.
paywalled: Dosage Effect of BRCA1 and BRCA 2 Mutated Allelic Transcript (French Canadian)
Dosage Effect of BRCA1/2-Mutated Allelic Transcript:
We hypothesized that the transcriptome of primary cultures of morphologically normal ovarian surface epithelial cells could be altered by the presence of a heterozygous BRCA1 or BRCA2 mutation.
We aimed to discover early events associated with ovarian carcinogenesis, which could represent putative targets for preventive strategies of this silent killer tumor. We identified the first molecular signature associated with French Canadian BRCA1 or BRCA2 founder mutations in morphologically normal ovarian epithelial cells. We discovered that wild-type and mutated BRCA2 allelic transcripts were expressed not only in morphologically normal but also in tumor cells from BRCA2-8765delAG carriers. Further analysis of morphologically normal ovarian and tumor cells from BRCA1-4446C>T carriers lead to the same observation.
Our data support the idea that one single hit in BRCA1 or BRCA2 is sufficient to alter the transcriptome of phenotypically normal ovarian epithelial cells. The highest level of BRCA2-mutated allele transcript expression was measured in cells originating from the most aggressive ovarian tumor. The penetrance of the mutation and the aggressiveness of the related tumor could depend on a dosage effect of the mutated allele transcript.
paywalled: Prophylactic oophorectomy rates in relation to a guideline update on referral to genetic counseling
Prophylactic oophorectomy rates in relation to a guideline update on referral to genetic counseling: Publication year: 2012
Source: Gynecologic Oncology
Objective We sought to determine whether prophylactic oophorectomy rates changed after the introduction of a 2007 health plan clinical guideline recommending systematic referral to a genetic counselor for women with a personal or family history suggestive of an inherited susceptibility to breast/ovarian cancer.
Methods We conducted a retrospective cohort study of female members of Group Health, an integrated delivery system in Washington State. Subjects were women aged ≥35years during 2004–2009 who reported a personal or family history consistent with an inherited susceptibility to breast/ovarian cancer. Personal and family history information was collected on a questionnaire completed when the women had a mammogram. We ascertained oophorectomies from automated claims data and determined whether surgeries were prophylactic by medical chart review.....
Results Prophylactic oophorectomy rates were relatively unchanged after compared to before the guideline change, 1.0 versus 0.8/1,000 person-years, (IRR=1.2; 95% CI: 0.7-2.0), whereas bilateral oophorectomy rates for other indications decreased. Genetic counseling receipt rates doubled after the guideline change (95% CI: 1.7-2.4) from 5.1 to 10.2/1,000 person-years. During the study, bilateral oophorectomy rates were appreciably greater in women who saw a genetic counselor compared to those who did not regardless of whether they received genetic testing as part of their counseling.
Conclusion A doubling in genetic counseling receipt rates lends support to the idea that the guideline issuance contributed to sustained rates of prophylactic oophorectomies in more recent years.
Randomized Phase II Trial of Carboplatin and Paclitaxel with or without Lonafarnib in First-Line Treatment of Epithelial Ovarian Cancer Stage IIB-IV
Randomized Phase II Trial of Carboplatin and Paclitaxel with or without Lonafarnib in First-Line Treatment of Epithelial Ovarian Cancer Stage IIB-IV: Publication year: 2012
Source: Gynecologic Oncology
Objectives This study evaluates whether a molecular targeted therapy with the farnesyl transferase inhibitor lonafarnib added to standard chemotherapy in first-line treatment of advanced ovarian cancer (OC) could improve progression-free (PFS) and overall survival (OS).
Patients and Methods We performed a prospective randomized phase II study to compare standard therapy carboplatin (C; AUC 5) and paclitaxel (T; 175mg/m2) in primary advanced OC with or without lonafarnib (L). Lonafarnib was given in a dose of 100mg orally twice a day during chemotherapy and was increased afterwards to 200mg up to six months as a maintenance therapy.
Results 105 patients were recruited( 53 patients were randomised to receive LTC, 52 to TC). Hematologic toxicity was similar in both arms. Grade 3 and 4 non-hematological toxicity, occurred significantly more often with LTC (23% versus 4%, p=0.005) and was associated with a higher dropout rate. PFS and OS were not significantly different among both arms. The LTC arm showed inferiority in the stratum with residual tumor of more than 1cm:.....
Conclusion The addition of lonafarnib did not improve PFS or OS. Patients with a residual tumor of more than 1cm had significantly shorter PFS and OS. Incorporation of lonafarnib into future studies for primary therapy of OC is not recommended.
paywalled: Gynecologic Oncology - Green Tea for Ovarian Cancer Prevention and Treatment: A Systematic Review of the in Vitro, in Vivo and Epidemiological Studies
ScienceDirect.com - Gynecologic Oncology - Green Tea for Ovarian Cancer Prevention and Treatment: A Systematic Review of the in Vitro, in Vivo and Epidemiological Studies
Abstract
Objective
This
systematic review was conducted to examine the effects of green tea or
green tea components on the prevention and progression of epithelial
ovarian cancer.
Methods
Using Medline, EMBASE and SciVerse (last researched: July 2011), we retrieved 22 articles including 5 epidemiological studies.
Results
In
epithelial ovarian cancer cell lines, green tea and green tea
components have been shown to down regulate the expression of proteins
involved in inflammation, cell signalization, cell motility and
angiogenesis. Green tea and green tea components would induce apoptosis
and could potentiate the effects of cisplatin, a chemotherapeutic agent.
In human observational studies, significant associations between green
tea intake and both decreased ovarian cancer occurrence and better
prognosis were reported.
Conclusions
Available
literature suggests potential molecular targets for green tea in
ovarian cancer treatment and also provides data supporting the clinical
evaluation of the role of green tea or green tea components in ovarian
cancer prevention and treatment.
Highlights
►
Green tea decreases ovarian cancer-associated protein expression in
cell lines.
► Green tea-fed mice develop smaller, less vascularized ovarian cancer xenografts.
► Green tea intake could decrease ovarian cancer occurrence and recurrence in women.
► Green tea-fed mice develop smaller, less vascularized ovarian cancer xenografts.
► Green tea intake could decrease ovarian cancer occurrence and recurrence in women.
EphA2 Gene Targeting Using Neutral Liposomal Small Interfering RNA Delivery - Full Text View - ClinicalTrials.gov Phase 1 solid tumors
EphA2 Gene Targeting Using Neutral Liposomal Small Interfering RNA Delivery - Full Text View - ClinicalTrials.gov
| Official Title: | EphA2 Gene Targeting Using Neutral Liposomal Small Interfering RNA Delivery (IND# 72924): A Phase I Clinical Trial |
This study is not yet open for participant recruitment.
Verified May 2012 by M.D. Anderson Cancer Center
First Received on May 2, 2012.
No Changes Posted
| Sponsor: | M.D. Anderson Cancer Center |
|---|---|
| Collaborator: | Ovarian Cancer Research Fund |
| Information provided by (Responsible Party): | M.D. Anderson Cancer Center ( M.D. Anderson Cancer Center ) |
| ClinicalTrials.gov Identifier: | NCT01591356 |
Purpose
The
goal of this clinical research study is to learn about the safety of
siRNA-EphA2-DOPC when given to patients with advanced, recurrent cancer. Researchers also want to learn the highest tolerable dose of this drug that can be given.
siRNA-EphA2-DOPC is designed to shut down the activity of a gene that causes tumor growth.
Structural and Functional Imaging and Cognitive Functions in Ovarian Cancer - Full Text View - ClinicalTrials.gov (clinical trials)
Structural and Functional Imaging and Cognitive Functions in Ovarian Cancer - Full Text View - ClinicalTrials.gov
This study is currently recruiting participants.
Verified May 2012 by Memorial Sloan-Kettering Cancer Center
First Received on April 30, 2012.
Last Updated on May 2, 2012
History of Changes
| Sponsor: | Memorial Sloan-Kettering Cancer Center |
|---|---|
| Collaborator: | Weill Medical College of Cornell University |
| Information provided by (Responsible Party): | Memorial Sloan-Kettering Cancer Center ( Memorial Sloan-Kettering Cancer Center ) |
| ClinicalTrials.gov Identifier: | NCT01591772 |
Purpose
The
purpose of this study is to learn about possible changes in brain
anatomy and function, and in thinking abilities, such as memory skills,
in patients with ovarian cancer who receive treatment with chemotherapy. Cancer
patients treated with chemotherapy may experience changes in thinking
abilities, and these may interfere with quality of life. Most of the
research to date has involved patients with breast cancer, and there are no studies in women with ovarian cancer looking at at treatment-related changes in brain anatomy and function.
Friday, May 04, 2012
In silico analysis and immunohistochemical characterization of NaPi2b protein expression in ovarian carcinoma with monoclonal antibody Mx35.
In silico analysis and immunohistochemical characterization of NaPi2b protein expression in ovarian carcinoma with monoclonal antibody Mx35.
Abstract
INTRODUCTION: Ovarian adenocarcinoma is frequently detected at the late stage, when therapy efficacy is limited and death occurs in up to 50% of the cases. A potential novel treatment for this disease is a monoclonal antibody that recognizes phosphate transporter sodium-dependent phosphate transporter protein 2b (NaPi2b).
MATERIALS AND METHODS: To better understand the expression of this protein in different histologic types of ovarian carcinomas, we immunostained 50 tumor samples with anti-NaPi2b monoclonal antibody MX35 and, in parallel, we assessed the expression of the gene encoding NaPi2b (SCL34A2) by in silico analysis of microarray data.
RESULTS: Both approaches detected higher expression of NaPi2b (SCL34A2) in ovarian carcinoma than in normal tissue. Moreover, a comprehensive analysis indicates that SCL34A2 is the only gene of the several phosphate transporters genes whose expression differentiates normal from carcinoma samples, suggesting it might exert a major role in ovarian carcinomas. Immunohistochemical and mRNA expression data have also shown that 2 histologic subtypes of ovarian carcinoma express particularly high levels of NaPi2b: serous and clear cell adenocarcinomas. Serous adenocarcinomas are the most frequent, contrasting with clear cell carcinomas, rare, and with worse prognosis.
CONCLUSION: This identification of subgroups of patients expressing NaPi2b may be important in selecting cohorts who most likely should be included in future clinical trials, as a recently generated humanized version of MX35 has been developed.
Thursday, May 03, 2012
England: The Cancer Drugs Fund: Guidance to support operation of the Cancer Drugs Fund in 2012-13 : Department of Health - Publications
Blogger's Note: this is primarily an administrative document, patient/consumer searches for specific drugs are not part of this guidance report
The Cancer Drugs Fund: Guidance to support operation of the Cancer Drugs Fund in 2012-13 : Department of Health - Publications
-
Document type:Guidance
-
Author:Department of Health
-
Published date:23 April 2012
-
Primary audience:Health and social care professionals
-
Publication format:A4: electronic format only
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Gateway reference:17340
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Pages:14
-
Supersedes/replaces:
-
Copyright holder:Crown
Vitamin D testing – Authors' reply : The Lancet
Patient empowerment—who empowers whom? : The Lancet
Patient empowerment—who empowers whom? : The Lancet
Cochrane: YourHealthNet - navigating effective treatments with systematic reviews
YourHealthNet - navigating effective treatments with systematic reviews
Cochrane systematic reviews
Cochrane systematic reviews are the major output of the international organisation The Cochrane Collaboration, and over 4,000 Cochrane reviews are available online on The Cochrane Library. Because Cochrane review authors carry out their research with scientific rigour and follow detailed guidelines Cochrane reviews are considered a high quality source of research evidence.
| David Tovey from The Cochrane Collaboration talks about systematic reviews.
» Read a transcript or
|
Explore the parts of a Cochrane systematic review
Systematic reviews are a complex mix of process and product - they report on the process review authors undertook, and the conclusions authors came to about what they found. All Cochrane systematic reviews follow the same format and methods; they have the same content in the same sections. This ensures their transparency and rigour.....
Healthnewsreview: The limitations of – and explosion in the number of – observational studies
The limitations of – and explosion in the number of – observational studies:
In the Wall Street Journal, Gautam Naik has a thoughtful piece, “Analytical Trend Troubles Scientists,” hitting on the limitations of – and the explosion in the number of – observational studies. Excerpts:
“While the gold standard of medical research is the randomly controlled experimental study, scientists have recently rushed to pursue observational studies, which are much easier, cheaper and quicker to do. Costs for a typical controlled trial can stretch high into the millions; observational studies can be performed for tens of thousands of dollars.The article addresses the “hot area of medical research” – the search for biomarkers.
In an observational study there is no human intervention. Researchers simply observe what is happening during the course of events, or they analyze previously gathered data and draw conclusions. In an experimental study, such as a drug trial, investigators prompt some sort of change—by giving a drug to half the participants, say—and then make inferences.
But observational studies, researchers say, are especially prone to methodological and statistical biases that can render the results unreliable. Their findings are much less replicable than those drawn from controlled research. Worse, few of the flawed findings are spotted—or corrected—in the published literature.
“You can troll the data, slicing and dicing it any way you want,” says S. Stanley Young of the U.S. National Institute of Statistical Sciences. Consequently, “a great deal of irresponsible reporting of results is going on.”
Despite such concerns among researchers, observational studies have never been more popular.
Nearly 80,000 observational studies were published in the period 1990-2000 across all scientific fields, according to an analysis performed for The Wall Street Journal by Thomson Reuters. In the following period, 2001-2011, the number of studies more than tripled to 263,557, based on a search of Thomson Reuters Web of Science, an index of 11,600 peer-reviewed journals world-wide. The analysis likely doesn’t capture every observational study in the literature, but it does indicate a pattern of growth over time.
A vast array of claims made in medicine, public health and nutrition are based on observational studies, as are those about the environment, climate change and psychology.”
“The presence or absence of the biomarkers in a patient’s blood, some theorized, could indicate a higher or lower risk for heart disease—the biggest killer in the Western world.But the story also appropriately points out the contribution obervational studies have made:
Yet these biomarkers “are either completely worthless or there are only very small effects” in predicting heart disease, says John Ioannidis of Stanford University, who extensively analyzed two decades’ worth of biomarker research and published his findings in Circulation Research journal in March. Many of the studies, he found, were undermined by statistical biases, and many of the biomarkers showed very little predictive ability of heart disease.
His conclusion is widely upheld by other scientists: Just because two events are statistically associated in a study, it doesn’t mean that one necessarily sets off the other. What is merely suggestive can be mistaken as causal.
That partly explains why observational studies in general can be replicated only 20% of the time, versus 80% for large, well-designed randomly controlled trials, says Dr. Ioannidis. Dr. Young, meanwhile, pegs the replication rate for observational data at an even lower 5% to 10%.
Whatever the figure, it suggests that a lot more of these studies are getting published. Those papers can often trigger pointless follow-on research and affect real-world practices.”
“Observational studies do have many valuable uses. They can offer early clues about what might be triggering a disease or health outcome. For example, it was data from observational trials that flagged the increased risk of heart attacks posed by the arthritis drug Vioxx. And it was observational data that helped researchers establish the link between smoking and lung cancer.”I have written many times about the weakness of news stories that fail to point out the limitations of observational studies and – more specifically – stories that use causal language to describe the findings from observational studies that can “only” point to statistical associations.
News consumers and health care consumers need to better understand the limitations of all studies – including randomized clinical trials.
paywalled: Risk of Colonic Neoplasia After Proctectomy for Rectal Cancer in Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome)
abstract
Abstract
Objective: To define the neoplastic risk in the remaining
colon after proctectomy for rectal cancer in patients with hereditary
nonpolyposis colorectal cancer (HNPCC). (Lynch Syndrome)
Conclusions: Surgeons and patients need to be aware of substantial risk for metachronous neoplasia after proctectomy. Selection of operation should be individualized, but total proctocolectomy and ileoanal pouch should be strongly considered. If patients undergo proctectomy alone, close surveillance is mandatory.
Conclusions: Surgeons and patients need to be aware of substantial risk for metachronous neoplasia after proctectomy. Selection of operation should be individualized, but total proctocolectomy and ileoanal pouch should be strongly considered. If patients undergo proctectomy alone, close surveillance is mandatory.
Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality - The Commonwealth Fund
Blogger's Note: some interesting comparisons on a variety of comparables including in-hospital 30 day mortality rates, breast/cervical/colorectal cancer survival rates, diagnostic imaging; comparisons of countries:
Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality - The Commonwealth Fund
Overview
This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States......paywalled: Evaluation of Society of Gynecologic Oncologists (SGO) Ovarian Cancer Quality Surgical Measures
Evaluation of Society of Gynecologic Oncologists (SGO) Ovarian Cancer Quality Surgical Measures: Publication year: 2012
Source: Gynecologic Oncology
Objectives
The Society of Gynecologic Oncologists has developed two measures to assess & improve the surgical care of patients with ovarian cancer (1) description of residual disease following cytoreduction and (2) adequacy of surgical staging. Our aim was to establish baseline surgeon compliance with these two measures.
Methods
A retrospective review of patients with ovarian, fallopian tube or peritoneal cancer undergoing surgery between 7/1/2006 and 7/1/2011 for the purposes of staging and/or cytoreduction was performed at the University of Washington and Geisinger Medical Center. Operative and pathology reports were reviewed to obtain information pertaining to stage, histology, residual disease after surgery and the extent of surgical staging.
Results
537 cases were identified; 91% with ovarian cancer. 61% of patients had at least stage IIIC disease; 15% had recurrent disease and 16% had neoadjuvant therapy. For patients with stage I-IIIB disease, 74% had full surgical staging, 10% did not have full surgical staging but documented the reason for this in the operative report; 15% did not have full surgical staging, no reason was noted. 25% of all operative reports lacked documentation of residual disease with 40% documenting no gross residual disease, 18% with residual disease<1cm and 18% had suboptimal debulking with>1cm disease remaining. There was a statistically significant increase in appropriate documentation of amount of residual disease over time (p<0.001).
Conclusions
Our study sets benchmarks for evaluation of documentation in gynecologic oncology centers. Improved documentation and staging will allow for equivalent standards of care across institutions.
Wednesday, May 02, 2012
paywalled Primary fallopian tube carcinoma risk in users of postmenopausal hormone therapy in Finland
Primary fallopian tube carcinoma risk in users of postmenopausal hormone therapy in Finland: Publication year: 2012
Source:Gynecologic Oncology
Objective Primary fallopian tube carcinoma (PFTC) is a rare malignancy and only sparse data exist on its possible association with postmenopausal hormone therapy (HT). We therefore studied this association in a nationwide cohort of Finnish HT users.
Conclusions The long-term, sequential use of EPT associates with an increased risk for PFTC. In absolute terms, 4 additional cases of PFTC would be detected in 10-year follow-up of 10,000 women who have used EPT for at least 5 years
Family history: Still relevant in the genomics era - Cleveland Clinic
Family history: Still relevant in the genomics era
Key points
- The family history is an underused tool for predicting the risk of disease and for personalizing preventive care.
- Barriers to the appropriate collection and use of the family history include concerns over the reliability of patient reporting, a lack of time and reimbursement, and provider knowledge gaps.
- Use of family history to inform genetic testing for hereditary cancer syndromes has been shown to improve outcomes and may reduce overall health care costs.
- Future solutions need to focus on creating time-effective ways to collect and analyze the family history, and on developing innovative methods of educating medical providers at all levels of training as to how to apply the family history in clinical practice.
Study Downplays Risk of CT Scans - MedicineNet
Blogger's Note: cancer patients know this; the concern is 'excess' or unnecessary scans (as indicated in the article)
Study Downplays Risk of CT Scans - MedicineNet
"More often than not, patients should be getting that CT scan because the risk of the underlying cause is higher than from radiation."
"...The findings were similar -- with deaths ranging from 2 percent to 33 percent -- in the more than 15,000 who got abdominal CTs. The researchers think 23 people in the entire group would have gotten cancer due to radiation exposure."
""In the patients getting 15 or more scans, all of them had pretty significant disease, where their expected mortality was likely to occur much sooner than the chances of the radiation-induced cancer taking effect," Zondervan said. In other words: Those who were the sickest, requiring the most CT scans, would probably die before any cancer caused by the CT radiation could start hurting them."
Tuesday, May 01, 2012
Medscape Oncologist Compensation Report: 2012 Results - U.S.
Blogger's Note: not broken down specifically to the sub-specializtion of gyn/oncology, patients/public perceptions of physician's compensation/expenses, income demographics, time spent with patients, physician hours of work, satisfaction with profession.....
Medscape Oncologist Compensation Report: 2012 Results
Medscape: Many Clinical Trials Unable to Supply High-Quality Evidence
Many Clinical Trials Unable to Supply High-Quality Evidence
"Given the deficit in evidence to support key decisions in clinical practice guidelines…as well as concerns about insufficient numbers of volunteers for trials…the desire to provide high-quality evidence for medical decisions must include consideration of a comprehensive redesign of the clinical trial enterprise," they continue. Currently, less than 15% of major guideline recommendations are evidence-based, they write........
Women, Minorities More Likely to Leave Surgery Career Path
Women, Minorities More Likely to Leave Surgery Career Path
May 1, 2012 — Women and minority trainees in general surgery are more likely to fall short of board certification than their peers, according to a study published yesterday in the May issue of the Journal of the American College of Surgeons (JACS).......
paywalled: Epigenetic Resensitization to Platinum in Ovarian Cancer (low-dose decitabine/carboplatin)
Epigenetic Resensitization to Platinum in Ovarian Cancer
"Together, the results of this study suggest that low-dose decitabine altered DNA methylation of genes and cancer pathways, restoring sensitivity to carboplatin in patients with heavily pretreated ovarian cancer and resulting in a high RR and prolonged PFS."
Abstract
Preclinical studies have shown that hypomethylating agents reverse platinum resistance in ovarian cancer. In this phase II clinical trial, based upon the results of our phase I dose defining study, we tested the clinical and biologic activity of low-dose decitabine administered before carboplatin in platinum-resistant ovarian cancer patients. Among 17 patients with heavily pretreated and platinum-resistant ovarian cancer, the regimen induced a 35% objective response rate
paywalled: Requirements to Assess Feasibility of Phase 0 Trials during Major Abdominal Surgery: Variability of PARP Activity
Requirements to Assess Feasibility of Phase 0 Trials during Major Abdominal Surgery: Variability of PARP Activity
Abstract
Purpose: The aim of this
study was to evaluate the feasibility of phase 0 trials in the setting
of a routine surgical procedure. Logistic
considerations, tissue sampling and tissue
handling, and variability of a biomarker during surgery, in here PARP,
were evaluated.
Experimental Design:
Patients with highly suspicious or proven diagnosis of advanced ovarian
cancer, planned for debulking surgery were asked
to allow sequential tumor biopsies during surgery.
Biopsies were frozen immediately and PARP activity was measured
subsequently.
Conclusions: Conducting phase 0 trials during surgery seems to be feasible in terms of logistic considerations. In preparation of a phase 0 trial during surgery, a feasibility study like this should be conducted to rule out major interactions of the surgical intervention with respect to the targeted biomarker.
Conclusions: Conducting phase 0 trials during surgery seems to be feasible in terms of logistic considerations. In preparation of a phase 0 trial during surgery, a feasibility study like this should be conducted to rule out major interactions of the surgical intervention with respect to the targeted biomarker.
A Comprehensive Analysis of Human Gene Expression Profiles Identifies Stromal Immunoglobulin κ C as a Compatible Prognostic Marker in Human Solid Tumors
A Comprehensive Analysis of Human Gene Expression Profiles Identifies Stromal Immunoglobulin κ C as a Compatible Prognostic Marker in Human Solid Tumors
"No association was observed in ovarian cancer."
phase 1 - A Open-Label, Multiple Ascending Dose Study of DS-3078a, an Oral TORC1/2 Kinase Inhibitor, in Subjects With Advanced Solid Tumors or Lymphomas - Full Text View - ClinicalTrials.gov
A Open-Label, Multiple Ascending Dose Study of DS-3078a, an Oral TORC1/2 Kinase Inhibitor, in Subjects With Advanced Solid Tumors or Lymphomas - Full Text View - ClinicalTrials.gov
This study is currently recruiting participants.
Verified April 2012 by Daiichi Sankyo Inc.
First Received on April 26, 2012.
Last Updated on April 27, 2012
History of Changes
paywalled: Evaluation of prevalent and incident ovarian cancer co-morbidity : British Journal of Cancer
Access : Evaluation of prevalent and incident ovarian cancer co-morbidity : British Journal of Cancer
British Journal of Cancer , (1 May 2012) | doi:10.1038/bjc.2012.164
Evaluation of prevalent and incident ovarian cancer co-morbidity
Abstract
Background:
The
peak in incidence of ovarian cancer occurs around 65 years and
concurrent increasing risk by age for a number of diseases strongly
influence treatment and prognosis. The aim was to explore prevalence and
incidence of co-morbidity in ovarian cancer patients compared with the
general population.
Methods:
The study population was patients with ovarian cancer in Sweden 1993–2006 (n=11 139) and five controls per case (n=55 687).
Co-morbidity from 1987 to 2006 was obtained from the Swedish Patient
Register. Prevalent data were analysed with logistic regression and
incident data with Cox proportional hazards models.
Results:
Women
developing ovarian cancer did not have higher overall morbidity than
other women earlier than 3 months preceding cancer diagnosis. However,
at time of diagnosis 11 of 13 prevalent diagnosis groups were more
common among ovarian cancer patients compared with controls. The
incidence of many common diagnoses was increased several years following
the ovarian cancer and the most common diagnoses during the follow-up
period were thromboembolism, haematologic and gastrointestinal
complications.
Conclusion:
Women
developing ovarian cancer do not have higher overall morbidity the
years preceding cancer diagnosis. The incidence of many common diagnoses
was increased several years following the ovarian cancer. It is crucial
to consider time between co-morbidity and cancer diagnosis to
understand and interpret associations.
Next-generation 'epigenetic' cancer pill shown to be safe in phase I trial (CHR-3996)
Next-generation 'epigenetic' cancer pill shown to be safe in phase I trial
" CHR-3996 was tested in 39 patients with a range of advanced cancers."
BMJ » Blog Archive » Chris Williams: When will we learn HOW to deliver healthcare?
BMJ » Blog Archive » Chris Williams: When will we learn HOW to deliver healthcare?
Chris Williams is a medical student at the University of Liverpool, currently intercalating at the Liverpool School of Tropical Medicine for an MSc in Humanitarian studies.
paywalled: Conveying empathy to hospice family caregivers: Team responses to caregiver empathic communication
Conveying empathy to hospice family caregivers: Team responses to caregiver empathic communication: Publication year: 2012
Source: Patient Education and Counseling
Objective The goal of this study was to explore empathic communication opportunities presented by family caregivers and responses from interdisciplinary hospice team members.
Methods Empathic opportunities and hospice team responses were analyzed from bi-weekly web-based videoconferences between family caregivers and hospice teams. The authors coded the data using the Empathic Communication Coding System (ECCS) and identified themes within and among the coded data.
Results Data analysis identified 270 empathic opportunity-team response sequences. Caregivers expressed statements of emotion and decline most frequently. Two-thirds of the hospice team responses were implicit acknowledgments of caregiver statements and only one-third of the team responses were explicit recognitions of caregiver empathic opportunities.
Conclusion Although hospice team members frequently express emotional concerns with family caregivers during one-on-one visits, there is a need for more empathic communication during team meetings that involve caregivers.
Practice implications Hospice clinicians should devote more time to discussing emotional issues with patients and their families to enhance patient-centered hospice care. Further consideration should be given to training clinicians to empathize with patients and family caregivers.
press release: New surgical technique for removing inoperable tumors of the abdomen
New surgical technique for removing inoperable tumors of the abdomen
New surgical technique for removing inoperable tumors of the abdomen
Abdominal tumors involving both roots of the celiac and superior mesenteric artery (SMA) are deemed unresectable by conventional surgical methods, as removal would cause necrosis of the organs that are supplied by those blood vessels.A case report published in the journal American Journal of Transplantation presents a novel surgical technique that enables surgeons to remove tumors that are unresectable by the usual surgical techniques.
Diamond Pet Foods Expands Voluntary Recall to Include Diamond Puppy Formula due to Possible Salmonella Contamination
Diamond Pet Foods Expands Voluntary Recall to Include Diamond Puppy Formula due to Possible Salmonella Contamination:
Diamond Pet Foods is expanding a voluntary recall to include Diamond Puppy Formula dry dog food. The company took this precautionary measure because sampling revealed Salmonella in the product.
Ovarian Cancer National Alliance Submits Comments to Government Regarding Ovarian Cancer Screening
Ovarian Cancer National Alliance Submits Comments to Government Regarding Ovarian Cancer Screening:
The Ovarian Cancer National Alliance submitted the following comments in response to the United States Preventive Service Task Force request for comments on draft recommendations for ovarian cancer screening.
Comments to USPSTF re:
Draft Reaffirmation Recommendation Statement
Screening for Ovarian Cancer: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement
As a patient advocacy organization dedicated to promoting the interests of women with ovarian cancer, the Ovarian Cancer National Alliance is pleased to provide comments on the Draft Screening Statement for Ovarian Cancer.
The United States Preventive Services Task Force is to be commended for reviewing the recent scientific publications regarding ovarian cancer screening. As the Task Force correctly noted, the latest studies confirm that the current blood and imaging tests are not useful for population based screening.
However, the Recommendation Statement does not specify that these tools are valid as part of the diagnostic protocol for women suspected of having ovarian cancer, due in large part to the presence of symptoms.
Further, the Task Force did not appear to use the results of studies that indicate more favorable results of using the CA-125 in tailored ways. For example, a study presented at the 2010 American Society of Clinical Oncology Annual Meeting had more than 3,000 post-menopausal women stratified into high, medium and low risk categories based on an algorithm. The women, based on risk, then had different follow up procedures. The practice followed in this study had a low false-positive rate.
While we are by no means arguing that the CA-125 and/or transvaginal ultrasound be recommended as appropriate screening tools, we urge the Task Force to consider all available information when making its recommendations.
We also request that the recommendation include language regarding the symptoms of ovarian cancer (bloating, difficulty eating/feeling full quickly, urinary frequency or urgency, abdominal pain). We encourage the Task Force to also note that if women have symptoms of the disease these screening recommendations do not apply. We suggest: These recommendations apply only to asymptomatic women at average risk (or instead of “at average risk”, “without any hereditary or family history that would put them at an elevated risk”.)
We thank the Committee for noting that this recommendation does not apply to high risk women, including those with a known genetic mutation that puts them at an increased risk of developing ovarian cancer.
About Ovarian Cancer
According to the American Cancer Society, approximately 21,000 American women are diagnosed with ovarian cancer each year, and approximately 15,000 women die from the disease annually. Ovarian cancer is the deadliest gynecologic cancer and the fifth leading cause of cancer death among women in America. Currently, more than half of the women diagnosed with ovarian cancer die within five years.
About the Ovarian Cancer National Alliance
The Ovarian Cancer National Alliance is a survivor-led national umbrella organization with state and local groups representing grassroots activists, women’s health advocates and health care professionals. The Ovarian Cancer National Alliance submits this testimony as a patient advocacy group dedicated to promoting the interests of women with ovarian cancer.
NIH grants $10.5 Million for Genome Explorations -The Burrill Report
NIH grants $10.5 Million for Genome Explorations -The Burrill Report:
The National Human Genome Research Institute, part of the National Institutes of Health, is awarding $10.5 million in ten grants to help researchers identify millions of genomic elements that play a role in determining what genes are expressed and at what levels in different cells. The multi-year grants are part of the Encyclopedia of DNA Elements project, or ENCODE, set up to provide scientists with a comprehensive catalog of functional genomic elements. The project's goal is to help explain the role that the genome plays in health and disease.
paywalled: Mucin 16 (cancer antigen 125) expression in human tissues and cell lines and correlation with clinical outcome in adenocarcinomas of the pancreas, esophagus, stomach, and colon
Mucin 16 (cancer antigen 125) expression in human... [Hum Pathol. 2012] - PubMed - NCBI
Hum Pathol. 2012 Apr 26
Mucin 16 (cancer antigen 125) expression in human tissues and cell lines and correlation with clinical outcome in adenocarcinomas of the pancreas, esophagus, stomach, and colon
Abstract
Mucin 16 (cancer antigen 125) is a cell surface glycoprotein that plays a role in promoting cancer cell growth in ovarian cancer. The aims of this study were to examine mucin 16 expression in a large number of digestive tract adenocarcinomas and precursors and to determine whether mucin 16 up-regulation is correlated with patient outcome.Tissue microarrays were constructed using surgical resection tissues and included pancreatic (115 normal, 29 precursors, 200 pancreatic ductal adenocarcinomas), esophageal (86 normal, 104 precursors, 95 esophageal adenocarcinomas, 35 lymph node metastases), gastric (211 normal, 8 precursors, 119 gastric adenocarcinomas, 62 lymph node metastases), and colorectal (34 normal, 17 precursors, 39 colorectal adenocarcinomas) tissues. Mucin 16 was detected in 81.5%, 69.9%, 41.2%, and 64.1% of the pancreatic ductal adenocarcinomas, esophageal adenocarcinomas, gastric adenocarcinomas, and colorectal adenocarcinomas, respectively. Mucin 16 was seen in a subset of the precursors. On multivariate analysis, moderate/diffuse mucin 16 in pancreatic ductal adenocarcinomas was strongly associated with poor survival (P < .001), independent of other prognosis predictors. A similar trend was observed for esophageal adenocarcinomas (P = .160) and gastric adenocarcinomas (P = .080). Focal mucin 16 in colorectal adenocarcinomas was significantly correlated (P = .044) with a better patient outcome, when compared with mucin 16-negative cases. Using Western blot analysis, we found mucin 16 expression in 3 of 6 pancreatic ductal adenocarcinoma and 1 of 2 esophageal adenocarcinoma cell lines.
We conclude that most of the digestive tract adenocarcinomas and a
subset of their precursors express mucin 16. Mucin 16 expression is an
independent predictor of poor outcome in pancreatic ductal
adenocarcinomas and potentially in esophageal adenocarcinomas and
gastric adenocarcinomas. We propose that mucin 16 may function as a
prognostic marker and therapeutic target in the future.
paywalled: Prevalence of mismatch repair-deficient crypt foci in Lynch syndrome: a pathological study : The Lancet Oncology
Prevalence of mismatch repair-deficient crypt foci in Lynch syndrome: a pathological study : The Lancet Oncology
Methods
"Resections done for small and large bowel cancer between January, 2002, and January, 2011, were retrieved. We systematically analysed non-tumorous mucosa from carriers of a Lynch syndrome mutation (set 1: ten patients) and control patients without Lynch syndrome (set 1: nine patients) for MMR protein expression (MLH1, MSH2, and EPCAM) with immunohistochemistry.....
May 1st (open access) Commentary including link to original paper: Lynch syndrome: new tales from the crypt : The Lancet Oncology
Blogger's Note: commentary focus is primarily on colorectal cancer:
Lynch syndrome: new tales from the crypt : The Lancet Oncology
"...Unfortunately, these lesions are too small and subtle to be relied upon clinically to suggest a diagnosis of Lynch syndrome. Importantly, the investigators acknowledge that, although they noted these lesions occurred frequently, most patients with Lynch syndrome will develop zero to two cancers, and typically only a few adenomatous polyps, through their lifetimes.5 Small bowel cancers occur in no more than 1—4% of patients with Lynch syndrome,6 yet that organ has one MMR-deficient crypt per 2 cm2 of mucosa. Obviously, most of these lesions do not develop into cancer. So, what happens to them?....."
"...The missing link in this work is the contrast between the large number of MMR-deficient crypts and the relatively small number of clinically relevant neoplasms in this disease. That said, this work is highly novel, underscores the differences between Lynch syndrome and sporadic colorectal cancers, and raises a fresh group of important questions to be addressed."
Original paper - link/reference:
. Prevalence of mismatch repair-deficient crypt foci in Lynch syndrome: a pathological study. Lancet Oncol 201210.1016/S1470-2045(12)70109-2. published online May 1.
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