National Guideline Clearinghouse | Epithelial ovarian, fallopian tube, and primary peritoneal cancer - Alberta, Canada

Blogger's Note: note the differences in early stage recommendations per cell type

National Guideline Clearinghouse | Epithelial ovarian, fallopian tube, and primary peritoneal cancer.

Guideline Title

Epithelial ovarian, fallopian tube, and primary peritoneal cancer.

Bibliographic Source(s)

 

Alberta Provincial Gynecologic Oncology Tumour Team. Epithelial ovarian, fallopian tube, and primary peritoneal cancer. Edmonton (Alberta): Alberta Health Services, Cancer Care; 2010 Jul. 19 p. (Clinical practice guideline; no. GYNE-005).  [104 references]

Guideline Status

This is the current release of the guideline.

- Scope Methodology Recommendations Evidence Supporting the Recommendations Benefits/Harms of Implementing the Guideline Recommendations

- Qualifying Statements Implementation of the Guideline Institute of Medicine (IOM) National Healthcare Quality Report Categories Identifying Information and Availability Disclaimer

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Scope

Disease/Condition(s)

• Epithelial ovarian cancer
• Fallopian tube cancer
• Primary peritoneal cancer

Guideline Category

Evaluation Management Treatment

Clinical Specialty

Obstetrics and Gynecology Oncology Radiation Oncology Surgery

Intended Users

Physician Assistants Physicians

 

Guideline Objective(s)

To outline management decisions for women with epithelial ovarian, fallopian tube, or primary peritoneal cancer



Key Points

1. Completely staged, early epithelial ovarian, fallopian tube, and primary peritoneal cancers are highly curable. As such, patients should be referred to a gynecologic oncologist for adequate staging, including sampling of para-aortic and pelvic lymph nodes, infracolic omentectomy, possible appendectomy and biopsy of suspicious peritoneal lesions, in addition to a thorough inspection and palpation of all peritoneal surfaces, and peritoneal washings.
2. Advanced epithelial ovarian, fallopian tube, and primary peritoneal cancers are best treated with optimal debulking surgery in conjunction with adjuvant therapy. As such, patients should be referred to a gynecologic oncologist  

National Guideline Clearinghouse | Palliative radiotherapy.

Blogger's Note: the document reveals only one indication for ovarian cancer and it has been categorized under urogenital bleeding

National Guideline Clearinghouse | Palliative radiotherapy.

Guideline Objective(s)

To provide recommended palliative radiotherapy strategies for adult patients with advanced cancer

Scope  

Disease/Condition(s)

Advanced cancer with:

• Brain metastases
• Malignant epidural spinal cord compression
• Malignant superior vena cava obstruction
• Bone metastases
• Upper aero-digestive tract obstruction, compression, or invasion
• Malignancy-associated urogenital or gastrointestinal bleeding, or hemoptysis

Guideline Category

Management Treatment

Clinical Specialty

Gastroenterology Neurological Surgery Obstetrics and Gynecology Oncology Pulmonary Medicine Radiation Oncology Urology

Bleeding
Recommendations for Urogenital Bleeding

1. External beam radiotherapy has been shown to control hematuria in up to 60 percent of patients with advanced bladder cancer; and control rates of 80 percent at six weeks have recently been reported in patients with advanced prostate cancer. In patients with a life expectancy less than six months, external beam radiotherapy treatment with 8 Gy/1 fraction could be considered. Otherwise, a short course multi-fraction schedule could be considered.
2. In patients with vaginal bleeding who are unsuitable for radical treatment, radiotherapy is effective in resolving bleeding secondary to endometrial or cervical cancer. There is insufficient evidence to recommend an ideal dose and fractionation schedule. Radiotherapy may also be used to control bleeding and palliate pain and mass effect in advanced ovarian cancer.  

paywalled: Clinical implications of pleural effusions in ovarian cancer - Porcel - Respirology - Wiley Online Library

 Blogger's Note: note the use of neoadjuvant therapy in this particular subset of ovarian cancer patients

Clinical implications of pleural effusions in ovarian cancer - Porcel - Respirology

Keywords:

• malignant pleural effusion;
• ovarian cancer;
• thoracoscopy;
• pleurodesis

ABSTRACT

The pleural cavity constitutes the most frequent extra-abdominal metastatic site in ovarian carcinoma (OC). In patients with OC and pleural effusions, a positive fluid cytology is required for a stage IV diagnosis. Unfortunately, about 30% of malignant pleural effusions exhibit false negative cytological pleural fluid results. In those circumstances, exploratory video-assisted thoracoscopic surgery (VATS) serves as a diagnostic, staging and even therapeutic modality. Maximal (no visible disease) or, at least, optimal (no residual implant greater than 1 cm) cytoreduction should be the primary surgical goal in stage IV OC patients. This is due to residual tumor after cytoreductive surgery being one of the most important factors impacting on survival. Although malignant pleural effusions do not preclude abdominal surgical debulking, excision of gross pleural nodules may be necessary to achieve optimal cytoreduction. VATS quantifies pleural tumor burden and allows for intrathoracic cytoreduction or, if the latter is not feasible, ensures that abdominal surgery is not unnecessarily performed on women in whom gross tumor would still remain in the pleural space afterwards. Taxane-platinum neoadjuvant chemotherapy should be offered to this group. Patients with tumor extension into the pleural space have a median overall survival of 2 years.

Insight: Training immune system to fight cancer comes of age | Reuters

 Blogger's Note: not specific to ovarian cancer

Insight: Training immune system to fight cancer comes of age | Reuters


".....While extending life is the gold standard, most cancer drug trials have been deemed successful if tumors shrink or if a treatment can demonstrate a delay in tumor growth or in worsening of the disease, known as progression-free survival (PFS).
But Provenge and Yervoy have extended survival without necessarily impacting PFS or tumor shrinkage in many cases.
"Overall survival is the accurate indicator. Tumors may look bigger because they are filled with immune cells, so they appear worse," said Wolchok. "We've proposed a new set of response criteria to try to incorporate some of this biology.".......

PLoS ONE: Empty Reviews: A Description and Consideration of Cochrane Systematic Reviews with No Included Studies - your opinions?

Blogger's Note/Opinion: gyn cancers - this topic of discussion should be of interest: Cochrane total gyn cancers reviews = #85; empty reviews = #7; because Cochrane synthesizes and analyses systematic reviews,  often the results are inadequate (for patients/providers) in that studies included are: poor quality; lacking in data or are not randomized clinical trials; we often see this as 'further research is required'; many 'argue' that the value of systematic reviews in gyn cancers are dated (as discussed in this article) but part of this issue is the nature of, in particular, ovarian cancer research itself; the other 'issue' for this blogger is the number of systematic reviews which  continually review reviews; (re: reviews that include Cochrane systematic reviews); there needs to be a streamlining of systematic reviews (randomized clinical trial reviews) nominating or permitting one entity/conglomerate - eg. the philosophy of meaningful use, however, therein lies system wide issues within cancer; observational studies are often not included in the reviews and Cochrane is attempting to address this issue within the parameters of the purpose and philosophy of Cochrane itself, still for quality evidence Cochrane remains the leader; note also that Cochrane has always been one of, if not the leader, in including patients/consumers - your thoughts?

PLoS ONE: Empty Reviews: A Description and Consideration of Cochrane Systematic Reviews with No Included Studies

Introduction  

The Cochrane Library is the largest and perhaps best recognized global collection of health care evidence, currently hosting more than 4,500 systematic reviews in its Cochrane Database of Systematic Reviews (CDSR). However, it has been reported that clinicians find Cochrane reviews of limited relevance to practice decisions. For example, one study found that while Cochrane reviews are highly regarded for their quality, they are used less than other sources for clinical decision-making because of their emphasis on methodology and rigor rather than on clinical relevance [1].

It is not Cochrane's policy to provide guidelines for practice or policy decisions [2]. Instead, it sees itself as the provider of best quality evidence and specifically states that guidelines go “beyond a systematic review and require additional information and informed judgments that are typically the domain of clinical practice guideline developers.”
Systematic reviews that find no studies eligible for inclusion, commonly known as “empty reviews,” may be especially problematic for clinicians and other decision-makers. Little is known about the incidence, prevalence or variation in reporting of such reviews [3]. The little that has been written about them suggests that the reporting of implications for practice may sustain a risk for bias. With no studies meeting criteria for inclusion, these empty reviews may appear to: (1) offer no conclusions, (2) offer conclusions based on referenced excluded studies, (3) offer conclusions based on other evidence, or (4) offer conclusions not based on evidence. Thus, empty reviews may contribute to what appears to be generalized disappointment with The CDSR among some clinicians and policymakers [1], [4]........

Conclusions

The stated purpose of Cochrane reviews is to help healthcare providers, consumers, researchers, and policy makers “make well-informed decisions about health care… by providing a reliable synthesis of the available evidence on a given topic… considering all the evidence on the effect of an intervention” [2]......

www.ccocr.org - Guest Speakers - 6th Canadian Conference on Ovarian Cancer Research (patients/ advocates need not apply)

Blogger's Note: unlike the annual SGO programme ovarian cancer patient advocates need not apply (not welcome); survivor's course available for a fee

www.ccocr.org - Guest Speakers

Epigenetic modification and cancer: mark or stamp? (BRCA/fallopian tube....)

Epigenetic modification and cancer: mark or stamp?

Abstract

Hypotheses are built upon data, but data require hypotheses before they can be understood. The development of the ‘two-hit’ hypothesis of carcinogenesis was a key event in cancer genetics because it provided a testable model of how tumours develop. In this commentary on ‘Promoter hypermethylation patterns in Fallopian tube epithelium of BRCA1 and BRCA2 germline mutation carriers’ by Bijron et al. published in the February 2012 issue of Endocrine-Related Cancer, the need for new grammar and some new hypotheses in epigenetics is discussed. Meanwhile, data suggesting an important role of epigenetic modification in the cause, progression and treatment of cancer continues to accumulate............

Introduction

In hereditary tumours, the first hit occurs in the germ line, whereas in non-hereditary tumours, the first hit occurs in the cell from which the tumour arises. The second hits are always somatic, and can inactivate the second allele in various different ways. The development of the ‘two-hit’ hypothesis of carcinogenesis was a key event in cancer genetics because it provided a testable model of how tumours develop (Knudson 1971, 1978). Although there have been extensions and revisions to the basic model (Tomlinson et al. 2001), the essential elements of the basic hypothesis remain intact, 40 years on. In the original ‘test case’ of RB-1 mutations in retinoblastoma, these events were physical alterations in the structure of the chromosome or gene (Cavenee et al. 1983), and the perception was such that physical changes put a ‘stamp’ on the tumour that could be detected by examination of genomic DNA.............

continue to read full paper

paywalled: Sleep disturbance, cytokines, and fatigue in women with ovarian cancer.

Sleep disturbance, cytokines, and fatigue in women with ovarian cancer.

Abstract

Pro-inflammatory cytokines, such as interleukin-6 (IL-6), have been implicated in the underlying processes contributing to sleep regulation and fatigue. Despite evidence for sleep difficulties, fatigue, and elevations in IL-6 among women with ovarian cancer, the association between these symptoms and IL-6 has not been investigated. To address this knowledge gap, we examined relationships between sleep disturbance, fatigue, and plasma IL-6 in 136 women with ovarian cancer prior to surgery. These relationships were also examined in 63 of these women who were disease-free and not receiving chemotherapy 1 year post-diagnosis. At both time-points, higher levels of IL-6 were significantly associated with sleep disturbances (p<0.05), controlling for potentially confounding biological and psychosocial covariates. Higher IL-6 was significantly associated with fatigue prior to surgery (p<0.05); however, when sleep disturbance was included in the model, the relationship was no longer significant. IL-6 was not significantly associated with fatigue at 1 year. Changes in sleep over time were significantly associated with percent change in IL-6 from pre-surgery to 1 year, adjusting for covariates (p<0.05). These findings support a direct association of IL-6 with sleep disturbances in this population, whereas the relationship between IL-6 and fatigue prior to surgery may be mediated by poor sleep. As this study is the first to examine cytokine contributions to sleep and fatigue in ovarian cancer, further research is warranted to clarify the role of biological correlates of sleep and fatigue in this population.

The Healthcare Blog: Will Regina Holliday Become Health Care’s Rosa Parks?

Blogger's Note:  the outcome/s of these issues/activities will have international implications with a direct/indirect application to the 99%/1% movements in the recent past
                                   ~~~~~~~~~~~~~~~~~~

Will Regina Holliday Become Health Care’s Rosa Parks?:

By Michael L. Millenson

The protest organized by Regina Holliday over a patient’s right to access their medical information is not quite the same magnitude as agitating for integration in 1950s-era Alabama. Yet there are intriguing similarities between the crusade Rosa Parks launched then and what Holliday is attempting today. Both involve a refusal to accept second-class status and a resolve to push back against entrenched institutions.
Parks’ story is well known. Her refusal to surrender her seat to a white male passenger on a Montgomery city bus in December, 1955, prompted her arrest and a sustained bus boycott by outraged black residents. That boycott’s success propelled a young Martin Luther King, Jr. to the forefront of the fight against segregation. Parks eventually came to be known as the “mother of the modern day civil rights movement.”
Holliday’s protest is seeking media attention – as this is written, it had not taken place – by targeting the American Hospital Association’s annual meeting at a Washington hotel. The rights issue involves how quickly patients are able to see their own electronic medical information after leaving the hospital. The AHA, representing an industry that grew up as “the physician’s workshop,” wants a 30-day grace period to give doctors more time to prepare and review material. Holliday demands immediate access.
What makes this a fight about freedom, and not just fodder for the Federal Register, is its profound potential to affect how each of us takes responsibility for our own health and health care in the digital information age. What is most likely to capture the general public’s interest, however, is the way that general principle finds emotional resonance in Holliday’s personal story.
A widow with two young children, Holliday recalls on her blog how her husband, Fred, died “painfully [from cancer] after suffering for weeks.” She blames inadequate pain management and uncoordinated care due to a chaotic medical record. When they sought access to his electronic medical record, the hospital responded by saying “we must wait 21 days and pay 73 cents per page to see the story of his care. Then they told us we could go home to die.”
Just as Rosa Parks was not a random bus passenger – she and her husband, Raymond, were active members of the NAACP – Holliday is not a random patient protester. An artist, she responded to Fred’s death by becoming a “patients right arts advocate,” producing paintings with titles like “73 Cents,” and “Hubris Hospital” and “Give Us Our Damned Data.”
Also like Parks, Holliday is part of a larger community that shares a similar outrage over being relegated to the back seat, even if in the doctor- and hospital-dominated world of health care, the “back of the bus” is symbolic rather than literal. Her protest drew expressions of support from the National Partnership for Women & Families, the Center for Democracy and Technology and others. But the key to whether this protest is a turning point may lie in a phrase used in a letter supporting immediate access from the Society for Participatory Medicine, to which Holliday belongs. (Disclosure: I’m a Society board member and a friend of Holliday’s, but did not draft the comments.)

The Society wrote: “The overarching principle with respect to patient access to electronic health record data…should be: ‘Nothing about me, without me.’”

That phrase comes from a health care conference held in Salzburg, Austria in the late 1990s. It echoes the slogan, “Nothing about us without us” popularized by disability activists in South Africa and then adopted by activists in this country. It is a powerful statement about equality, engagement and control of one’s own destiny even when those who do not want to share control do so with the best of intentions, whether seeking to help the disabled or trying to implement electronic medical records in hospitals.

The problem, as The Silent World of Doctor and Patient defined it so insightfully more than a quarter-century ago, is that many providers genuinely believe it is their duty to act as “rational agents” on the patient’s behalf without asking the patient’s opinion. In contrast, “nothing about me without me” is the patient’s demand for freedom and, yes, the responsibility that comes with it.

That demand is not unprecedented. I’ve written how new moms were given strict baby feeding schedules by pediatricians until Dr. Benjamin Spock declared that mothers deciding when to feed their babies was “was used by the entire human race until the turn of the century.” How the first American Medical Association code of ethics required patients to obey their doctors, and how it required repeated lawsuits by patients before doctors had to tell patients in clear language the risks as well as benefits of a procedure. And how the AHA, facing the threat of legislation, adopted a Patient Bill of Rights that included such privileges as being told the names of all the doctors treating you.

What distinguishes Holliday’s effort is the power of information access in the digital age. “Give us our damned data” means possessing the raw clinical material that lets us partner with our own doctors or choose other clinicians who better meet our needs. We can go “off the grid,” perhaps “crowdsourcing” questions to others, or we can apply that digitized information to treatment recommendations and outcome prediction algorithms based on the same evidence our doctor uses.

Demanding access to our digitized information immediately, rather than when it is convenient for the doctor and hospital to give it to us, is a stark declaration that it is our health and our lives that are immediately at stake: “Nothing about me without me” from our first cry for food on the day we are born and then every day after.

This dispute may soon be forgotten as a kerfuffle over criteria for “Stage 2 meaningful use” subsidies from the Department of Health and Human Services. But if it can ignite an understanding about what takes for us to be true equals in health and health care decisions, it could be the start of a mass movement that would make Rosa Parks proud.

Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age.

Survey: doctoral thesis - Personal Health Record System Survey (international survey/anonymous)

Blogger's Note: although many patients/consumers may agree/disagree with the use of the term 'chronic' as it applies to cancer, it is one way to voice your opinions should you choose to do so
                           ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Survey

PERSONAL HEALTH RECORD SYSTEM SURVEY

The following pages contain an anonymous questionnaire, which we invite you to complete.

This questionnaire was developed as part of a doctoral thesis at HEC Montréal on the following topic: "The role of personal health records in the improvement of healthcare services for individuals with chronic diseases".

Not only will your participation be greatly appreciated, but it may also be beneficial for improving healthcare services for individuals with chronic diseases.

Please answer the questions included in this questionnaire without hesitation, because generally, your first impressions best reflect your true opinions. There is no time limit for completing the questionnaire, although we have estimated that it should take about 30 to 45 minutes.

The information gathered is anonymous and shall remain strictly confidential. It will be used only to advance knowledge and for the dissemination of the overall results at academic or professional forums and thought publications. The information collected for this research project can be utilized in further studies about personal health records and chronic care.

You are completely free to refuse to participate in this project and you may decide to stop answering the questions at any time. If you do not want to answer to a particular question, simply stop answering this questionnaire, which will put an end to your participation to this study. Completing this questionnaire will be considered as your consent to participate in our research project.

If you have any questions about this research, please contact the senior researcher, Dr. Chekli, at the telephone number or email address indicated below.

The research ethics committee of HEC Montréal has determined that the collection of data linked to the present study meets the ethics standards for research involving human subjects. If you have any questions related to ethics, please contact the committee secretary at 1-514-340-7182 or at cer@hec.ca

Thank you very much for your participation.


Mohamed Chekli, MD, MSc eng.
Ph. D. Candidate - Administration
HEC Montréal
1-514-739-2502
mohamed.chekli@hec.ca

Albert Lejeune, PhD
Titular Professor
Université du Québec à Montréal
1-514-987-3000 (#4844)
lejeune.albert@uqam.ca

Francois Bellavance, PhD
Titular Professor
HEC Montréal
1-514-340-6485
francois.bellavance@hec.ca

U.S. Hospital Association (AHA) Fights Digital Data Access for Patients | Center for Democracy & Technology

Hospital Association Fights Digital Data Access for Patients | Center for Democracy & Technology

Forbes: (U.S.) Hospital Association "Declares War" on Patient Empowerment

 Blogger's Note: click on the pdf link for letter from AHA (as below):

"A firestorm has been triggered by the American Hospital Association’s (AHA) 68 page letter (PDF) commenting on the Stage 2 Meaningful Use proposed requirements."
 "Our members are particularly concerned with the proposed objective to provide patients with the ability to view, download and transmit large volumes of protected health information via the Internet (a “patient portal”). The AHA believes that this objective is not feasible as proposed, raises significant security issues, and goes well beyond current technical capacity. We also believe that CMS should not include this objective because the Office of Civil Rights, and not CMS, regulates how health care providers and other covered entities fulfill their obligations under the Health Insurance Portability and Accountability Act (HIPAA), including the obligation to give patients access to their health records. Please see our detailed comments for more
recommendations on changes to specific objectives and measures."

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


Hospital Association "Declares War" on Patient Empowerment:

A firestorm has been triggered by the American Hospital Association’s (AHA) 68 page letter (PDF) commenting on the Stage 2 Meaningful Use proposed requirements. The reaction has been swift from various individuals and organizations focused on patient rights and empowerment.

Consumer Rights and Patient Empowerment Organizations also weighed in.

• The Center for Democracy & Technology picked apart the legal “hail mary” that the AHA was using in their response. See Hospital Association Fights Digital Data Access for Patients for more.
• The Society for Participatory Medicine stated the following. “Patient engagement is the cornerstone of a successful, cost effective, and high-quality health care system,” said Daniel Z. Sands, MD, the Society’s president and a practicing internist. “Those goals cannot be achieved unless we give patients access to their own health information and encourage them to use it.”

paywalled: Ovarian Low-Grade Serous Carcinoma: A Comprehensive Update

Ovarian Low-Grade Serous Carcinoma: A Comprehe... [Gynecol Oncol. 2012] - PubMed - NCBI

Ovarian Low-Grade Serous Carcinoma: A Comprehensive Update

 Abstract

Ovarian low-grade serous ovarian carcinoma (OvLGSCa) comprises a minority within the heterogeneous group of ovarian carcinomas. Despite biological differences with their high-grade serous counterparts, current treatment guidelines do not distinguish between these two entities. OvLGSCas are characterized by an indolent clinical course. They usually develop from serous tumors of low malignant potential, although they can also arise de novo. When compared with patients with ovarian high grade serous carcinoma (OvHGSCa) patients with OvLGSCa are younger and have better survival outcomes. Current clinical and treatment data available for OvLGSCa come from retrospective studies, suggesting that optimal cytoreductive surgery remains the cornerstone in treatment, whereas chemotherapy has a limited role. Molecular studies have revealed the preponderance of the RAS/RAF/MAPK signalling pathway in the pathogenesis of OvLGSCa, thereby representing an attractive therapeutic target for patients affected by this disease. Improved clinical trial designs and international collaboration are required to optimally address the unmet medical treatment needs of patients affected by this disease.

open access: Reproductive Technologies and the Risk of Birth Defects — NEJM

Blogger's Note: this is not cancer-specific/related but may be of interest to young cancer survivors

Reproductive Technologies and the Risk of Birth Defects — NEJM

(sundry items) Personalized Medicine - Vol. 9 Special Issue - Focus on Genomics (personalized medicine/genome/clinical/pathology....)

Personalized Medicine - Vol. 9

Special Focus Issue: Genomic pathology - Foreword  Genomic pathology: a disruptive innovation Jeffrey E Saffitz Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 237-239. Citation | Full Text | PDF (575 KB) | PDF Plus (577 KB)  | Reprints & Permissions Editorial  Pathologists and the third wave of medical genomics Mark S Boguski Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 241-242. Citation | Full Text | PDF (501 KB) | PDF Plus (502 KB)  | Reprints & Permissions Commentary  Between hype and hope: whole-genome sequencing in clinical medicine Iris Schrijver , Stephen J Galli Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 243-246. Citation | Full Text | PDF (956 KB) | PDF Plus (957 KB)  | Reprints & Permissions  Deriving clinical action from whole-genome analysis Dennis P Wall , Peter J Tonellato Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 247-252. Citation | Full Text | PDF (1606 KB) | PDF Plus (1623 KB)  | Reprints & Permissions News & Views  Interview: An evolving career in personalized medicine: an interview with Dr Paul Billings Paul Billings Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 253-257. Summary | Full Text | PDF (554 KB) | PDF Plus (555 KB)  | Reprints & Permissions  Interview: A perspective on personalized medicine: Dr David Korn David Korn Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 259-263. Summary | Full Text | PDF (593 KB) | PDF Plus (594 KB)  | Reprints & Permissions Review  The business value and cost–effectiveness of genomic medicine James M Crawford , Mara G Aspinall Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 265-286. Summary | Full Text | PDF (738 KB) | PDF Plus (738 KB)  | Reprints & Permissions TRIG on TRACK: educating pathology residents in genomic medicine Richard L Haspel , James B Atkinson , Frederic G Barr , Karen L Kaul , Debra GB Leonard , Julianne O’Daniel , Henry M Rinder , Joan Scott , Mark E Sobel , VO Speights Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 287-293. Summary | Full Text | PDF (483 KB) | PDF Plus (484 KB)  | Reprints & Permissions Modernizing US regulatory and reimbursement policy to support continued innovation in genomic pathology Sheila D Walcoff , John D Pfeifer Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 295-308. Summary | Full Text | PDF (669 KB) | PDF Plus (672 KB)  | Reprints & Permissions General content - Editorial  Mapping genes for oligodendroglioma Chetan Bettegowda , Nicholas Papadopoulos , Nishant Agrawal Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 311-313. Citation | Full Text | PDF (975 KB) | PDF Plus (987 KB)  | Reprints & Permissions  Direct-to-consumer genetic testing: regulating offer or use? Emmanuelle Rial-Sebbag , Pascal Borry Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 315-317. Citation | Full Text | PDF (597 KB) | PDF Plus (602 KB)  | Reprints & Permissions  Will gene–environment interactions explain differential antidepressant response? Robert Keers Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 319-322. Citation | Full Text | PDF (448 KB) | PDF Plus (459 KB)  | Reprints & Permissions News & Views  News & Views in ... Personalized Medicine Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 323-325. Citation | Full Text | PDF (841 KB) | PDF Plus (842 KB)  | Reprints & Permissions  Latest News & Updates from the Personalized Medicine Coalition: Letter from Washington Edward Abrahams Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 327-328. Citation | Full Text | PDF (429 KB) | PDF Plus (429 KB)  | Reprints & Permissions  Research Highlights Yun Wu , Wenrui Duan , Gregory A Otterson , L James Lee , S Patrick Nana-Sinkam Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 329-332. Citation | Full Text | PDF (523 KB) | PDF Plus (524 KB)  | Reprints & Permissions Company Profile: Multiple Myeloma Research Foundation Kathy Giusti Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 333-336. Summary | Full Text | PDF (415 KB) | PDF Plus (416 KB)  | Reprints & Permissions  Institutional Profile: Center for Connected Health Stephen O Agboola , Joseph C Kvedar Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 337-340. Summary | Full Text | PDF (450 KB) | PDF Plus (451 KB)  | Reprints & Permissions Research Article Association between endothelin type A receptor haplotypes and mortality in coronary heart disease Katrina L Ellis , Anna P Pilbrow , Howard C Potter , Chris M Frampton , Rob N Doughty , Gillian A Whalley , Chris J Ellis , Barry R Palmer , Lorraine Skelton , Tim G Yandle , Richard W Troughton , A Mark Richards , Vicky A Cameron Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 341-349. Summary | Full Text | PDF (799 KB) | PDF Plus (821 KB)  | Reprints & Permissions Acknowledgements  Acknowledgements Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 351-351. Citation | Full Text | PDF (118 KB) | PDF Plus (119 KB)  | Reprints & Permissions Corrigendum  Corrigendum Personalized Medicine, May 2012, Vol. 9, No. 3, Pages 354-354. Citation | Full Text | PDF (285 KB) | PDF Plus (285 KB)  | Reprints & Permissions

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)

1. Thu, 3 May, 2012 - CBC.ca 2:01 | 63,732 views

   Medical 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

Bryant Furlow

 

"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?

Stephen J Lanspa, Dennis J Ahnen and Henry T Lynch

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.

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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.

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.