Monday, November 11, 2013
Attachment Theory and Spirituality: Two Threads Converging in Palliative Care?
Aopen access
Introduction
The goal of palliative care is to improve the quality of life of terminally ill patients by preventing or relieving them from suffering. Relieving suffering does not only mean to insulate patients from physical pain. There are many more aspects which contribute to the patient’s wellbeing such as social, psychological, and spiritual support [1]. This is why palliative medicine has to take a multidisciplinary approach to patient care. In the present paper, two important concepts come into focus, both founding a multivariate understanding of the patient’s needs and challenges in the palliative situation: attachment theory and the concept of spirituality. Attachment Theory is a concept that is concerned with human relationship behavior in situations of loss, separation, or helplessness and can help to understand the patient’s behavior, needs, and challenges [2, 3]. The patient’s spirituality in health care and research is addressed by the field of Spiritual care. spiritual care is an interdisciplinary and cross-cultural discipline [4] in health care that scientifically addresses the spiritual and religious needs of patients and has become a part of medical care and education. Both concepts have been treated by palliative research in diverse the and multiform ways, as we will propound in the overview of research literature in the following section. But no effort has been made to integrate them into one theoretical framework in reference to the palliative context. The aim of this paper is to discuss the relevance of both concepts to palliative care, in order to develop a theoretical foundation for both aspects of the palliative situation.....
Research results in big savings for cancer treatment (neurotoxicity/oxaliplatin/magnesium/calcium)
healthnews
"....An intervention to counter the neurotoxic
effects of a chemotherapy treatment for cancer has been withdrawn after
research showed it was ineffective.
This resulted in big savings in the cost of the intervention
and in treatment time by nurses, at Auckland City Hospital’s medical
oncology service, one of the largest cancer treatment centres in
Australasia. Medical oncologist and doctoral student clinician Catherine Han carried out the research at the University of Auckland and Auckland City Hospital, as part of her work investigating the origins of neurotoxicity from oxaliplatin chemotherapy treatment. Her research is funded for three years by a Health Research Council Clinical Research Training fellowship for $250,000 awarded in 2012.
Research into the effectiveness of the calcium and magnesium infusions given to cancer patients to counter the neurotoxic effects of chemotherapy treatment with oxaliplatin showed it was not working.
“Catherine’s research showed clearly that the magnesium and calcium infusion does not work, and has led to a change in clinical practice in our cancer treatment centre at Auckland Hospital,” says her research supervisor, Associate Professor Mark McKeage who is a clinical pharmacologist and cancer specialist, and a co-director of the University-based Auckland Cancer Society Research Centre....
Olaparib Enters Phase III Clinical Testing
Olaparib
"After halting development of its PARP inhibitor olaparib nearly 2 years ago, AstraZeneca is reviving the drug and launching two phase III trials based on a retrospective analysis of phase II data that showed a marked effect in ovarian cancer patients with a BRCA mutation."
Sunday, November 10, 2013
Compartment syndrome after gynecologic operations: evidence from case reports and reviews
abstract
"Compartment syndrome (CS) of the lower leg is a rare
but severe complication of operations in the lithotomy (LT) position
after urologic, gynecologic and general surgery. A delay in diagnosis
and treatment can lead to loss of function and even life-threatening
complications. The pathophysiology is still not fully understood but it
is believed that ischemia as a result of increased compartment pressure
and decreased perfusion pressure may lead to CS. The type of leg support
and intraoperative hypotension have been discussed as risk factors but
evidence is mainly based on case reports and expert opinion. Studies
suggest that time spent in the LT position and the addition of head-down
tilt are associated with CS. As these positions are routinely applied
during various gynecologic procedures, forensically CS has to be
considered as a specific complication of gynecologic surgery in the LT
position. Despite the low incidence there is a need for prospective
studies and guidelines for its prevention.
Sixteen
case reports describing 19 cases of CS following gynecologic surgery in
lithotomy position were found during a literature search. This review is
based on 14 of these case reports (17 cases), which describe a
postoperative compartment syndrome in a previously healthy leg. We
summarize the reported cases and literature on CS after gynecologic
procedures in order to increase awareness among medical staff and to
give careful recommendations regarding perioperative management based on
available information."
Anatomy and Physiology: The 5 Unsung Heroes of the Abdominal Cavity
Anatomy and Physiology (excellent graphics)
1. Gallbladder: The Bile Keeper
2. Renal Pyramids: Cleansing Masters
3. Pancreas: Digestion Wunderkind
4. Adrenal Glands: Endocrine Celebrity
5. Cecum: Miss Congeniality (of the Abdomen)
Religiosity and Spirituality and the Intake of Fruit, Vegetable, and Fat: A Systematic Review
open access
Conclusion
Overall, the denominational studies showed that religious denomination is significantly related to fruit, vegetable, and fat intake. Specifically, the Adventists consumed more fruit and vegetable and less fat than non-Adventists. However, the relationship between the degree of R/S and dietary intake is mixed. The results of this review suggest that future research on R/S and diet may help explain the possible mechanism between religion and health. Methodology more sophisticated than observational studies is required. Longitudinal study methodologies (while still often observational) may enhance our understanding of underlying mechanisms. As religion is important for many people and affects their diet, improved methodological quality of R/S and diet research will surely shed more light on this area.
(video) BBC - Future - Health - A doctor's touch
The most important innovation in medicine to come in the next 10 years: the power of the human hand.
Saturday, November 09, 2013
Dartmouth researcher finds novel genetic patterns that make us rethink biology and individuality
Health News
Hanover, NH—Professor of Genetics Scott Williams, PhD, of the Institute for Quantitative Biomedical Sciences (iQBS) at Dartmouth's Geisel School of Medicine, has made two novel discoveries: first, a person can have several DNA mutations in parts of their body, with their original DNA in the rest—resulting in several different genotypes in one individual—and second, some of the same genetic mutations occur in unrelated people.....
(open access):
Click here to see the full paper at PLOS Genetics
Cancer-related neuropathic pain in out-patient oncology clinics: a European survey
open access
Background
Although pain is frequently experienced by patients with cancer, it remains under-treated.
The primary aim of this study was to estimate the prevalence of cancer-related neuropathic
pain (CRNP) in patients with chronic pain who attended an outpatient clinic for standard
care in Europe (irrespective of the reason or stage of the cancer). The secondary
aims of this study were to characterise pain and cancer in patients with CRNP (including
treatment) and to evaluate the usefulness of the painDETECT (PD-Q) screening tool
to help physicians identify a potential neuropathic component of cancer-related pain.
Methods
An observational, non-interventional, cross-sectional, multi-centre study of adult
patients with cancer using patient and physician case report forms (CRFs). Patients
with CRNP were identified by physicians' clinical assessments after examining the
completed PD-Q.
Results
A total of 951 patients visiting outpatient clinics across Europe were enrolled in
this study between August 2010 and July 2011. Of these, 310 patients (32.60%; 95%
confidence interval 29.62, 35.58) were identified as having CRNP. Twenty-nine of 39
(74.4%) physicians who completed the CRF relating to the PD-Q considered it a useful
tool to help detect CRNP in daily practice and 28 of 39 (71.8%) indicated that they
would use this tool in the future for most or some of their patients. Data from physicians
before and after review of the completed PD-Qs showed a shift in clinical opinion
(either to positive CRNP diagnosis [yes] or negative CRNP diagnosis [no]) in respect
of 142 patients; about half of which (74) were categorised with an initial diagnosis
of unknown. Opinions also shifted from a no to a yes diagnosis in 10 patients and
from a yes to a no diagnosis in 51 patients.
Conclusions
Approximately one-third of adults with cancer experiencing chronic pain attending
outpatient clinics as part of routine care were considered to have CRNP in the opinion
of the physicians after considering scores on the PD-Q. While physicians did not consider
the PD-Q to be a useful tool for all patients, shifts in diagnosis before and after
the use of this tool indicate that it may help physicians identify CRNP, especially
where there is initial uncertainty.
close
Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making
abstract
Objectives
To systematically
review patient-reported barriers and facilitators to shared decision
making (SDM) and develop a taxonomy of patient-reported barriers.
Methods
Systematic
review and thematic synthesis. Study findings/results for each included
paper were extracted verbatim and entered into qualitative software for
inductive analysis.
Results
Electronic
and follow-up searches yielded 2956 unique references; 289 full-text
articles were retrieved, of which 45 articles from 44 unique studies met
inclusion criteria. Key descriptive themes were grouped under two broad
analytical themes: how the healthcare system is organized (4
descriptive themes) and what happens during the decision-making
interaction (4 descriptive themes, 10 sub-themes). Predominant emergent
themes related to patients’ knowledge and the power imbalance in the
doctor-patient relationship. Patients need knowledge and power to
participate in SDM–knowledge alone is insufficient and power is more
difficult to attain.
Conclusions
Many
barriers are potentially modifiable, and can be addressed by
attitudinal changes at the levels of patient, clinician/healthcare team,
and the organization. The results support the view that many patients
currently can’t participate in SDM, rather than they won’t participate
because they do not want to.
Practice implications
Future
implementation efforts should address patient-reported factors together
with known clinician-reported barriers and the wider organizational
context.
How can we explain physician accuracy in assessing patient distress? A multilevel analysis in patients with advanced cancer
abstract
Objective
To examine the
determinants of the accuracy with which physicians assess metastatic
cancer patient distress, also referred to as their empathic accuracy
(EA). Hypothesized determinants were physician empathic attitude,
self-efficacy in empathic skills, physician-perceived rapport with the
patient, patient distress and patient expressive suppression.
Methods
Twenty-eight
physicians assessed their patients’ distress level on the distress
thermometer, while patients (N = 201) independently rated their distress
level on the same tool. EA was the difference between both scores in
absolute value. Hypothesized determinants were assessed using
self-reported questionnaires. Multilevel analyses were carried out.
Results
Little
of the variance in EA was explained by physician variables. EA was
higher with higher levels of patient distress. Physician-perceived
quality of rapport was positively associated with EA. However, for
highly distressed patients, good rapport was associated with lower EA.
Patient expressive suppression was also related to lower EA.
Conclusion
This
study adds to the understanding of EA in oncological settings,
particularly in challenging the common assumption that EA depends
largely on physician characteristics or that better rapport would always
favor higher EA.
Practice implications
Physicians
should ask patients for feedback regarding their emotions. In parallel,
patients should be prompted to express their concerns.
‘What they’re not telling you’: A new scale to measure grandparents’ information needs when their grandchild has cancer
abstract
Conclusions
Grandparents of
children with cancer desire more information for their own reassurance,
to reduce their reliance on ‘second-hand’ information from their
grandchild's parents and to improve the support they provide their
families. Grandparents strongly endorse the development of
grandparent-targeted educational resources.
Gender-specific quality of life after cancer in young adulthood: a comparison with the general population
young adulthood
Conclusions
Results clearly
indicate that young adult cancer patients have a reduced quality of life
in comparison with the general population even long after the treatment
of their disease is complete. Women had a lower quality of life than
men. Age-specific interventions should be offered that lead to
improvements in quality of life for this age group. And future studies
should clarify what factors lead to women’s quality of life being worse
than men’s.
Venous Thromboembolism Risk in Patients With Cancer Receiving Chemotherapy: A Real-World Analysis
abstract
Types
of tumor associated with the highest VTE risk are hematologic
cancers,followed by lung,pancreatic,stomach,ovarian,uterine,bladder,and
brain
tumors.
Implications for Practice:
This large observational study of unselected patients receiving cancer
chemotherapy demonstrates considerably greater rates of venous
thromboembolism (VTE) than commonly reported in patients accrued to clinical trials.The risk of VTE appears to increase progressively over the year following initiation of treatment. Cancer patients
developing VTE also experience a greater risk of major bleeding and greater health care costs than patients without VTE.
Patients considered at high risk for VTE should be considered for
thromboprophylaxis after assessing the balance of potential benefits and harms.
Progesterone receptor PROGINS and +331G/A polymorphisms confer susceptibility to ovarian cancer: a meta-analysis based on 17 studies
abstract
Progesterone
and its receptor, progesterone receptor (PGR), have been widely studied
for their roles in the onset and development of ovarian cancer.
Although numerous epidemiological studies have focused on the
association of PGR PROGINS and +331G/A polymorphisms with ovarian cancer
susceptibility, presently, available results remain controversial, in
part due to low sample sizes. Thus, a meta-analysis is required to
evaluate this association. A literature search of PubMed, Embase, Web of
Science, CNKI, and CBM databases was performed to retrieve eligible
studies published before August 15, 2013. Summary odds ratios (ORs) with
95 % confidence intervals (CIs) were used to evaluate the strength of
this association. All analyses were done using STATA 12.0 software
(Stata Corp., College Station, TX, USA). Seventeen case-control studies
with a total of 6,365 cases and 9,998 controls were identified. While no
statistically significant association between the PROGINS allele and
ovarian cancer risk was found in an overall analysis, a stratified
analysis revealed that for Caucasians, never-oral contraceptive (OC)
users, and serous tumor patients, there were statistically significant
ORs for ovarian cancer risk associated with the mutated PROGINS allele.
No significant association, however, between the +331G/A polymorphism
and ovarian cancer susceptibility was observed in the overall analyses
and subgroup analyses based on ethnicity and histological type. This
meta-analysis provides evidence that the PROGINS allele occurs more
frequently in ovarian cancer patients and especially in non-OC users and
serous cancer patients, indicating that PROGINS may be a risk modifier.
No significant association between the +331G/A polymorphism and ovarian
cancer was found, even in stratified analyses by ethnicity and
histological type. More detailed and well-designed studies are still
needed to confirm the role of the PROGINS allele in ovarian cancer
development.
A study of ovarian cancer biomarker amplification using ultrasound for early stage detection
open access
Highlights
- •
- We amplify ovarian cancer biomarkers by using ultrasound for early stage detection.
- •
- Ultrasound at 1 MHz, 0.3 W cm−2 and 50% duty cycle is applied on ovarian cancer cells (SKOV3).
- •
- After 5 min sonication, the CA125 and CA19-9 levels are increased by 2.02 and 4.21-fold respectively.
Monoclonal antibody-based immunotherapy of ovarian cancer: targeting ovarian cancer cells with the B7-H3-specific mAb 376.96
abstract
Highlights
- •
- The mAb 376.96 defined B7-H3 epitope is expressed by chemosensitive and chemoresistant ovarian cancer cells, as well as patient tumors
- •
- mAb 376.96 enhanced the cytotoxicity of Sunitinib in vitro
- •
- Further studies are warranted examining B7-H3 as a potential target of mAb-based immunotherapy in ovarian cancer
Cleveland Clinic - Quantitative Health Sciences - Risk Calculators
Risk Calculators
This information is provided by Cleveland Clinic as a convenience service only to physicians and is not intended to replace the physicians' medical advice. Please remember that this information, in the absence of a visit with a physician's patient, must always be considered as an educational service only and are not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure or recommendations for a given patient. CCF makes no representation or warranty concerning the accuracy or reliability of this information and does not warrant the results of using this tool. In no event shall CCF be liable for any damages, direct, indirect, consequential or otherwise, relating to the use of this information or this tool.
Topics:
Acute Coronary Syndrome
Benign Prostatic Hyperplasia:
Bladder Cancer
Brain Cancer
Breast Cancer
Colorectal Cancer
Complex Colorectal Surgery
Suspected Coronary Artery Disease
Cardiac Surgery
Type 2 Diabetes
Gastric Cancer
Suspected Kidney Cancer
Chronic Kidney Disease
Oral Cancer
Ovarian Cancer
Pancreatic Cancer
Penile Cancer
First Pregnancy
Prostate Cancer
Sarcoma
Thyroid Cancer
Total Joint Replacement
Friday, November 08, 2013
Prevalence and characteristics of moderate to severe fatigue
abstract
BACKGROUND
The
effective management of fatigue in patients with cancer requires a
clear delineation of what constitutes nontrivial fatigue. The authors
defined numeric cutpoints for fatigue severity based on functional
interference and described the prevalence and characteristics of fatigue
in patients with cancer and survivors.
METHODS
In
a multicenter study, outpatients with breast, prostate, colorectal, or
lung cancer rated their fatigue severity and symptom interference with
functioning on the M. D. Anderson Symptom Inventory numeric scale of 0
to 10. Ratings of symptom interference guided the selection of numeric
rating cutpoints between mild, moderate, and severe fatigue levels.
Regression analysis identified significant factors related to reporting
moderate/severe fatigue.
RESULTS
The
statistically optimal cutpoints were ≥ 4 for moderate fatigue and ≥ 7
for severe fatigue. Moderate/severe fatigue was reported by 983 of 2177
patients (45%) undergoing active treatment and was more likely to occur
in patients receiving treatment with strong opioids (odds ratio [OR],
3.00), those with a poor Eastern Cooperative Oncology Group performance
status (OR, 2.00), those who had > 5% weight loss within 6 months
(OR, 1.60), those who were receiving > 10 medications (OR, 1.58),
those with lung cancer (OR, 1.55), and those with a history of
depression (OR, 1.42). Among survivors (patients with complete remission
or no evidence of disease, and not currently receiving cancer
treatment), 29% of patients (150 of 515 patients) had moderate/severe
fatigue that was associated with poor performance status (OR, 3.48) and a
history of depression (OR, 2.21).
CONCLUSIONS
The current study statistically defined fatigue severity categories related to significantly increased symptom interference. The high prevalence of moderate/severe fatigue in both actively treated patients with cancer and survivors warrants the promoting of the routine assessment and management of patient-reported fatigue.A Patient with Recurrent Ovarian Clear Cell Adenocarcinoma and Chronic Kidney Disease Exhibited Complete Response to Paclitaxel plus Carboplatin (Japan)
abstract
A
41-year-old woman receiving hemodialysis 3 times a week for chronic
kidney disease caused by interstitial nephritis was referred to our
hospital because of a pelvic mass and subsequently underwent primary
surgery . The patient was diagnosed with FIGO stage Ic(b)clear cell
adenocarcinoma. She did not receive postoperative chemotherapy. However,
9 months after surgery, ascites and a pelvic mass developed, on the
basis of which recurrence was confirmed. She received combination
chemotherapy with paclitaxel plus carboplatin(TC). Paclitaxel was
administered at 175mg/m2, and the carboplatin dosage was calculated by
the Calvert formula. The glomerular filtration rate was considered to be
0, and the target area under the plasma concentration versus time curve
was 5. Hemodialysis was performed 24 hours after the infusion of
carboplatin. After 6 courses of combination chemotherapy, complete
response was confirmed by computed tomography. The patient developed
grade 3 neutropenia, grade 1 sensory neuropathy , and grade 2 alopecia,
but the other adverse events were mild. In conclusion, TC combination
chemotherapy was well tolerated and generated a good response in a
patient with recurrent ovarian clear cell adenocarcinoma who was
receiving hemodialysis for chronic kidney disease.
Preventing Ovarian Cancer through Genetic Testing: a Population-Based Study
abstract
"Genetic testing for BRCA1 and BRCA2 gene mutations, in conjunction with preventive oophorectomy for mutation carriers, may be used to prevent a proportion of invasive ovarian cancers (‘personalized medicine’). We evaluated the potential utility of this approach at a population level by reviewing the pedigree information and genetic test results from 1,342 ovarian cancer patients in Ontario. Of the 1,342 patients tested, 176 patients had a BRCA1 or BRCA2 mutation; of these, 48 women would have qualified for testing prior to the development of cancer based on the eligibility criteria in place for the province of Ontario. In summary, 48 of 1,342 unselected cases of ovarian cancer (3.6 %) might have been prevented if genetic testing criteria were universally applied to all women in Ontario at risk for ovarian cancer."
Thursday, November 07, 2013
Small fallopian tube carcinoma with extensive upper abdominal dissemination: a case report (Portugal)
a case report - open access
Introduction
Fallopian tube carcinoma is a rare gyncological malignancy with low accuracy detection
preoperatively. The symptoms are unspecific and imaging can be misleading. Since it
was first described in 1847, there have been only a little over 2000 case reports.
Case presentation
This case report describes a 66-year-old Caucasian woman who presented with progressive
diffuse abdominal pain, without other symptoms. After abdominopelvic magnetic resonance
imaging, she was sent to the Portuguese Oncology Institute of Oporto with the suspicion
of peritoneal carcinomatosis of unknown primary tumor. Due to a pelvic palpable mass
(calcified giant uterine fibroid) she was directed to the Gynecology team. Surgery
was performed and a large mass in her upper abdomen was identified. The extemporary
examination revealed a high-grade adenocarcinoma. During surgery a small change of
color and consistency of her left fallopian tube was noted and unilateral adnexectomy
was performed. After pathologic and immunohistochemistry tests, the diagnosis of fallopian
tube carcinoma with peritoneal dissemination was made.
Conclusions
This case is very unique in the way that a small primary fallopian tube carcinoma
was able to disseminate to the upper abdominal quadrant with little pelvic dissemination.
The symptoms and imaging were unspecific. Although a rare occurrence, we should not
forget fallopian tube carcinoma in the differential diagnosis of peritoneal carcinomatosis,
even in the absence of Latzke's triad (symptoms).
Epidermal Growth Factor Receptor (EGFR), HER2 and Insulin Growth Factor Receptor-1 (IGFR-1) Status in Ovarian Adult Granulosa Cell Tumours
abstract
Aims
Adult
granulosa cell tumours (AGCTs) are uncommon ovarian sex cord-stromal
tumours which recur following surgical removal in up to 50% of patients.
Treatment options for recurrent and advanced stage AGCTs are limited
with poor response to chemotherapy and radiotherapy. We aimed to assess
the Epidermal Growth Factor Receptor (EGFR) (HER1), HER2 and Insulin
Growth Factor Receptor-1 (IGFR-1) status in AGCTs with a view to
investigating whether these receptors might be potential therapeutic
targets in these neoplasms.
Methods And Results
Immunohistochemical
staining for EGFR, HER2 and IGFR-1 was undertaken in 31 AGCTs. Tumour
DNA was also analysed for mutations in the tyrosine kinase domain of EGFR
(exons 18-21) by Cobas mutation RT-PCR. 23/31 (74%) AGCTs showed some
degree of EGFR expression, generally with cytoplasmic or mixed
membranous and cytoplasmic staining of variable intensity. 11/27 (41%)
cases exhibited strong membranous and cytoplasmic expression of IGFR-1.
HER2 expression was not seen. No mutations were found in exons 18-21 of
the EGFR gene in hotspots of therapeutic relevance.
Conclusions
This
study raises the possibility that anti-EGFR and/or anti-IGFR-1
therapies may be potential agents in ovarian AGCTs and this requires
further study. Lack of known mutations within the tyrosine kinase domain
of EGFR suggests that EGFR-related tyrosine kinase inhibitors may not
be useful therapeutically.
How well is our health system working? · Canada
NHS England » NHS England launches major exercise to shape the future of specialised services
NHS England-future of specialised services
The scoping event will be held in London on 9 December. Anybody who is interested in being involved in the debate about the future of specialised services and wishes to apply for a place should email dorothy.chen@shca.info.
Canadian Doctors for Medicare: Fraser Institute report on wait times flawed
Canadian Doctors for Medicare E-News November 2013
CDM: Fraser Institute report on wait times flawed
Dr. Ryan Meili questions the usefulness of the Fraser Institute’s latest report on wait times in the National Post.
The Fraser Institute’s annual wait times report is based on a survey,
not objective data, and it looks only at specialists providing elective
surgeries, ignoring Canada’s good record with acute and emergency
surgeries. Respondents are therefore self-selected, and responses are
solicited with the incentive of winning an iPad.
CDM knows that this isn’t a credible way to gather data on wait times. We can be doing better on wait times, but we should be looking at the evidence, not surveys of a self-selected group, to tell us how we’re doing.
National Post
But some question the Fraser Institute report and the conclusions of its authors.
“It is the same old sky-is-falling report,” said Dr. Ryan Meili, a family physician in Saskatoon who is vice-chairman of Canadian Doctors For Medicare.
“Wait times don’t get shorter when you introduced more delivery of care outside of the public system, they get longer. You don’t just draw patients away from the public system, you also draw away providers,” he said.
Dr. Michael Rachlis, a health policy analyst associated with the Canadian Health Coalition, a pro-universal-healthcare organization, said the co-payment plans from abroad “which allow some people to jump the queue” is not the answer to Canada’s wait times.
“We do tend to wait too long but it has nothing to do with us having a public system. It has a lot to do with how we organize services,” Dr. Rachlis said. “We can eliminate virtually every wait time by better management.”
The institute’s (Fraser) questionnaire was sent to practitioners between the beginning of January and the end of April. The response rate to the surveys was 21%.
CDM knows that this isn’t a credible way to gather data on wait times. We can be doing better on wait times, but we should be looking at the evidence, not surveys of a self-selected group, to tell us how we’re doing.
National Post
But some question the Fraser Institute report and the conclusions of its authors.
“It is the same old sky-is-falling report,” said Dr. Ryan Meili, a family physician in Saskatoon who is vice-chairman of Canadian Doctors For Medicare.
“Wait times don’t get shorter when you introduced more delivery of care outside of the public system, they get longer. You don’t just draw patients away from the public system, you also draw away providers,” he said.
Dr. Michael Rachlis, a health policy analyst associated with the Canadian Health Coalition, a pro-universal-healthcare organization, said the co-payment plans from abroad “which allow some people to jump the queue” is not the answer to Canada’s wait times.
“We do tend to wait too long but it has nothing to do with us having a public system. It has a lot to do with how we organize services,” Dr. Rachlis said. “We can eliminate virtually every wait time by better management.”
The institute’s (Fraser) questionnaire was sent to practitioners between the beginning of January and the end of April. The response rate to the surveys was 21%.
Characteristics, treatment and prognostic factors of patients with gynaecological malignancies treated in a palliative care unit at a university hospital
abstract
Background: Limited clinical data have been published on patients suffering from advanced gynaecological malignancies treated in palliative care units, and little is known about prognostic factors.
Methods: In a retrospective study, the data of 225 patients with breast, ovarian and cervical cancer treated in the palliative care unit of a university hospital between 1998 and 2009 were assembled. Clinical aspects and baseline symptoms, laboratory parameters, the clinical course, and outcome were evaluated.
Results: 225 patients (497 cases; cancer diagnoses: breast 79%, ovarian 13%, and cervix 8%) were included in the analysis. The main symptoms were weakness/fatigue (71%), pain (65%), anorexia/nausea (62%), and dyspnea (46%). Pain control was achieved in 85% of all cases, satisfying control of other symptoms in 80%.
Wednesday, November 06, 2013
Is CA72-4 a Useful Biomarker in Differential Diagnosis between Ovarian Endometrioma and Epithelial Ovarian Cancer?
open access
Abstract
Background. Surgical excision of ovarian endometriomas in patients desiring pregnancy has recently been criticized because of the risk of damage to healthy ovarian tissue and consequent reduction of ovarian reserve. A correct diagnosis in cases not scheduled for surgery is therefore mandatory in order to avoid unexpected ovarian cancer misdiagnosis. Endometriosis is often associated with high levels of CA125. This marker is therefore not useful for discriminating ovarian endometrioma from ovarian malignancy. The aim of this study was to establish if the serum marker CA72-4 could be helpful in the differential diagnosis between ovarian endometriosis and epithelial ovarian cancer.
Methods. Serums CA125 and CA72-4 were measured in 72 patients with ovarian endometriomas and 55 patients with ovarian cancer.
Results. High CA125 concentrations were observed in patients with ovarian endometriosis and in those with ovarian cancer. A marked difference in CA72-4 values was observed between women with ovarian cancer (71.0%) and patients with endometriosis (13.8%) ( ).
Conclusions. This study suggests that CA72-4 determination can be useful to confirm the benign nature of ovarian endometriomas in women with high CA125 levels.
1. Introduction
Endometriosis is a common chronic disease, affecting 5–10% of women in reproductive age [1]. The disease is characterized by the presence and growth of endometrial tissue outside the uterine cavity, often associated with infertility and pelvic pain and that tends to recur [2–5]. Endometriosis can be diagnosed by clinical and ultrasound examinations (US), but the most accurate procedure to confirm the diagnosis is laparoscopy that allows visualization of lesions and histological confirmation [6].
Endometriosis is a benign disease but it shares several characteristics with invasive cancer. Cancer antigen 125 (CA125) is a tumor marker used for the differential diagnosis in a postmenopausal woman with an adnexal mass [7]. However, in premenopausal age, CA125 is characterized by a low diagnostic specificity, as abnormally high concentrations can be found in malignancies of different origin including nonovarian gynecological cancer [8], in women with nongynecological diseases such as tuberculosis and liver cirrhosis, and also in pelvic inflammatory disease, uterine fibroids, or physiological conditions such as pregnancy or different phases of the menstrual cycle [9, 10]. In patients with endometriosis, CA125 levels can be high. In fact, CA125 is the most extensively investigated and used peripheral biomarker for monitoring the disease [11]. Thus, CA125 has a limited role in the differential diagnosis between endometriosis and ovarian cancer due to the lack of specificity [12].....
Cancer Drug Trial Put on Partial Hold After Death (Curis - CUDC-427)
CUDC-427 Phase 1 Trial Placed on Partial Clinical Hold by FDA
"The current open-label, single-agent, dose escalation Phase 1 study of CUDC-427 was initiated in the third quarter of 2013 in patients with advanced and refractory solid tumors or lymphomas."
Bevacizumab-induced transient sixth nerve palsy in ovarian cancer: A case report
abstract
"We report a case of transient sixth nerve palsy after systemic administration of bevacizumab. Two days after systemic administration of bevacizumab in conjunction with gemcitabine and carboplatin in a 67-year-old woman with recurrent primary ovarian cancer, the patient developed sixth nerve palsy. After bevacizumab was stopped, the complete left sixth nerve palsy resolved spontaneously over the course of 3 months. This is the first reported case of bevacizumab-induced cranial sixth nerve palsy in the treatment of gynecologic malignancy."
Prevalence of Occult Gynecologic Malignancy at the Time of Risk Reducing and Non Prophylactic Surgery in Patients with Lynch Syndrome
abstract
Highlights
- •
- Surgeons should consider the possibility of malignancy in patients with Lynch syndrome who are undergoing risk-reducing surgery.
- •
- Surgeons should consider pre-operative testing and sending operative specimens for frozen pathology to determine the need for staging.
Objective:
The primary aim of this study was to determine the prevalence of occult
gynecologic malignancy at the time of risk reducing surgery in patients
with Lynch Syndrome. A secondary aim was to determine the prevalence of
occult gynecologic malignancy at the time of surgery for
non-prophylactic indications in patients with Lynch Syndrome.
Methods:
A retrospective review of an Inherited Colorectal Cancer Registry found
76 patients with Lynch syndrome (defined by a germline mutation in a
DNA mismatch repair gene) or hereditary nonpolyposis colorectal cancer
(HNPCC) (defined by Amsterdam criteria) who had undergone hysterectomy
and/or salpingo-oophorectomy for a prophylactic or non-prophylactic
indication. Indications for surgery and the prevalence of cancer at the
time of each operation were reviewed.
Results: 24 of
76 patients underwent prophylactic hysterectomy and/or bilateral
salpingo-oophorectomy for Lynch syndrome or HNPCC. In 9 of these
patients, a benign indication for surgery was also noted. 4 of 24
patients (17%, 95% CI = 5-38%) were noted to have cancer on final
pathology. 20 of 76 patients (26%) undergoing operative management for
any indication were noted to have occult malignancy on final pathology.
Conclusions:
Patients should be counseled about the risks of finding gynecologic
cancer at the time of prophylactic or non-prophylactic surgery for Lynch
syndrome and HNPCC, and the potential need for additional surgery.
Prognostic value of baseline survival determined for 11 types of cancer
science news
Nov. 6, 2013 — Results of an EORTC study published in Cancer point out the prognostic value of baseline recorded health-related quality of life for survival for eleven types of cancer: brain, breast, colorectal, esophageal, head and neck, lung, melanoma, ovarian, pancreatic, prostate, and testicular cancer. For each cancer site, at least one health-related quality of life parameter provided additional prognostic information over and above the clinical and sociodemographic variables.....
"nausea and vomiting for ovarian cancer"
abstract
A global analysis of multitrial data investigating quality of life and symptoms as prognostic factors for survival in different tumor sites
BACKGROUND
The
objective of this study was to examine the prognostic value of baseline
health-related quality of life (HRQOL) for survival with regard to
different cancer sites using 1 standardized and validated patient
self-assessment tool.
METHODS
In
total, 11 different cancer sites pooled from 30 European Organization
for Research and Treatment of Cancer (EORTC) randomized controlled
trials were selected for this study. For each cancer site, univariate
and multivariate Cox proportional hazards modeling was used to assess
the prognostic value (P < .05) of 15 HRQOL parameters using
the EORTC Core Quality of Life Questionnaire (QLQ-C30). Models were
adjusted for age, sex, and World Health Organization performance status
and were stratified by distant metastasis.
RESULTS
In
total, 7417 patients completed the EORTC QLQ-C30 before randomization.
In brain cancer, cognitive functioning was predictive for survival; in
breast cancer, physical functioning, emotional functioning, global
health status, and nausea and vomiting were predictive for survival; in
colorectal cancer, physical functioning, nausea and vomiting, pain, and
appetite loss were predictive for survival; in esophageal cancer,
physical functioning and social functioning were predictive for
survival; in head and neck cancer, emotional functioning, nausea and
vomiting, and dyspnea were predictive for survival; in lung cancer,
physical functioning and pain were predictive for survival; in melanoma,
physical functioning was predictive for survival; in ovarian cancer,
nausea and vomiting were predictive for survival; in pancreatic cancer,
global health status was predictive for survival; in prostate cancer,
role functioning and appetite loss were predictive for survival; and, in
testis cancer, role functioning was predictive for survival.
CONCLUSIONS
The current results demonstrated that, for each cancer site, at least 1 HRQOL domain provided prognostic information that was additive over and above clinical and sociodemographic variables.eNews: Live at the AICR Annual Research Conference (AICR)
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This article appears in the November 7, 2013 issue of AICR's eNews.
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Editorial: A structured approach to uncommon cancers: what should a clinician do?
Abstract
In this issue of Annals of Oncology, Pecuchet et al. [1]
have produced an elegant, original paper describing an innovative
approach to the management of metastatic collecting duct
carcinoma, using bevacizumab, gemcitabine and a
platinum complex. They have shown surprising anticancer activity, which
appears
to have been sustained. They have addressed the
usual concerns about case selection bias, positive response bias and
pathology
review of an uncommon tumor, and thus, this
regimen certainly will bear confirmatory testing in other structured
trials, especially
as this triplet really does seem to give a
different result from the more conventional gemcitabine–cisplatin
combination or
the established MVAC regimen (notwithstanding
the absence of level 1 data at this time).
The editorial review of this manuscript
raised an important generic question, viz. what should a clinician do
when approaching
a patient with a truly uncommon or rare tumor?
Using a cut-off figure of 15 new cases/100 000 of population per year as
a
definition for ‘rare cancers’, Greenlee et al. [2]
have suggested that these tumors cumulatively account for around 25% of
incident cases in the United States. This figure
seems inflated to me, because of their cut-off
value, especially as I do not view testicular cancer as a rare tumor
(yet it
has an incidence of 6.8/100 000 males per year).
Nonetheless, Greenlee et al. make an important point—rare tumors
cumulatively
do constitute a significant proportion of the
total cancers presenting, yet we have remarkably little information
available
to guide management, when compared with the
common tumors that arise in breast, lung, prostate, colon, pancreas and
bladder.
A similar situation appears to apply to oncology
practice in Europe, in a report using a cut-off of less than six new
cases/100
000 of population per year, with the
accompanying suggestion …...
Genome-wide association study of subtype-specific epithelial ovarian cancer risk alleles using pooled DNA
abstract
Epithelial
ovarian cancer (EOC) is a heterogeneous cancer with both genetic and
environmental risk factors. Variants influencing the risk of developing
the less-common EOC subtypes have not been fully investigated. We
performed a genome-wide association study (GWAS) of EOC according to
subtype by pooling genomic DNA from 545 cases and 398 controls of
European descent, and testing for allelic associations. We evaluated for
replication 188 variants from the GWAS [56 variants for mucinous, 55
for endometrioid and clear cell, 53 for low-malignant potential (LMP)
serous, and 24 for invasive serous EOC], selected using pre-defined
criteria.
Genotypes from 13,188 cases and 23,164 controls of European descent were used to perform unconditional logistic regression under the log-additive genetic model; odds ratios (OR) and 95 % confidence intervals are reported. Nine variants tagging six loci were associated with subtype-specific EOC risk at P < 0.05, and had an OR that agreed in direction of effect with the GWAS results. Several of these variants are in or near genes with a biological rationale for conferring EOC risk, including ZFP36L1 and RAD51B for mucinous EOC (rs17106154, OR = 1.17, P = 0.029, n = 1,483 cases), GRB10 for endometrioid and clear cell EOC (rs2190503, P = 0.014, n = 2,903 cases), and C22orf26/BPIL2 for LMP serous EOC (rs9609538, OR = 0.86, P = 0.0043, n = 892 cases). In analyses that included the 75 GWAS samples, the association between rs9609538 (OR = 0.84, P = 0.0007) and LMP serous EOC risk remained statistically significant at P < 0.0012 adjusted for multiple testing. Replication in additional samples will be important to verify these results for the less-common EOC subtypes.
Genotypes from 13,188 cases and 23,164 controls of European descent were used to perform unconditional logistic regression under the log-additive genetic model; odds ratios (OR) and 95 % confidence intervals are reported. Nine variants tagging six loci were associated with subtype-specific EOC risk at P < 0.05, and had an OR that agreed in direction of effect with the GWAS results. Several of these variants are in or near genes with a biological rationale for conferring EOC risk, including ZFP36L1 and RAD51B for mucinous EOC (rs17106154, OR = 1.17, P = 0.029, n = 1,483 cases), GRB10 for endometrioid and clear cell EOC (rs2190503, P = 0.014, n = 2,903 cases), and C22orf26/BPIL2 for LMP serous EOC (rs9609538, OR = 0.86, P = 0.0043, n = 892 cases). In analyses that included the 75 GWAS samples, the association between rs9609538 (OR = 0.84, P = 0.0007) and LMP serous EOC risk remained statistically significant at P < 0.0012 adjusted for multiple testing. Replication in additional samples will be important to verify these results for the less-common EOC subtypes.
Platinum versus platinum-combination chemotherapy in platinum-sensitive recurrent ovarian cancer: a meta-analysis using individual patient data
abstract
BACKGROUND:
The majority of women with ovarian cancer develop recurrent disease. For patients with a platinum-free interval of >6 months, platinum-based chemotherapy is a treatment of choice. The benefit of platinum-based combination chemotherapy in randomized trials varies, and a meta-analysis was carried out to gain more secure information on the size of the benefit of this treatment.MATERIALS AND METHODS:
We initiated a systematic review and meta-analysis following a pre-specified protocol to determine whether combination chemotherapy is superior to single-agent platinum chemotherapy in women with relapsed platinum-sensitive ovarian cancer.RESULTS:
A total of five potentially eligible randomized trials were identified that had used combination-platinum chemotherapy versus single-agent platinum chemotherapy in women with relapsed platinum-sensitive ovarian cancer. For one trial (190 patients), adequate contact with the investigators could not be established. Therefore, four trials that randomly assigned 1300 patients were included, with a median follow-up of 36.1 months. Overall survival (OS) analyses were based on 865 deaths and demonstrated evidence for the benefit of combination-platinum chemotherapy (HR = 0.80; 95% CI, 0.64-1.00; P = 0.05). Progression-free survival (PFS) analyses were based on 1167 events and demonstrated strong evidence for the benefit of combination-platinum chemotherapy (HR = 0.68; 95% CI, 0.57-0.81; P < 0.001). There was no evidence of a difference in the relative effect of combination-platinum chemotherapy on either OS or PFS in patient subgroups defined by previous paclitaxel (Taxol) treatment (OS, P = 0.49; PFS, P = 0.66), duration of treatment-free interval (OS, P = 0.86; PFS, P = 0.48) or the number of previous lines of chemotherapy (OS, P = 0.21; PFS, P = 0.27).CONCLUSIONS:
In this individual patient data (IPD) meta-analysis, we have demonstrated that combination-platinum chemotherapy improves OS and PFS across all subgroups. This provides the strongest evidence to date of the benefit of combination-platinum over single-agent platinum.Single-Port Laparoscopic Extraperitoneal Para-aortic Lymphadenectomy
abstract
Objective: The aim of this study was to evaluate the
feasibility and the safety of single-port extraperitoneal laparoscopic
para-aortic lymphadenectomy for patients with gynecologic cancer.
Methods: From July 2012 to January 2013, a total of 7
patients with gynecologic cancer underwent a laparoscopic pelvic and
para-aortic lymphadenectomy with a single-port device. An
extraperitoneal approach was performed for para-aortic lymphadenectomy
using only one 2.5-cm incision on the left side. In 6 patients,
additionally, hysterectomy and pelvic lymphadenectomy with conventional
laparoscopy were performed to complete the treatment.
Results: Aortic dissection was complete in all cases
without complications. The median age of the patients was 63 years
(range, 48–78 years), and the median patient body mass index was 31 kg/m2 (range, 19–38 kg/m2).
The median number of para-aortic nodes was 17 (range, 10–25); the
median operative time was 204 minutes (range, 120–300 minutes). The
median hospital stay was 4 days (range, 3–6 days). No patient
encountered postoperative complications.
Conclusions: This study demonstrates the feasibility of single-port laparoscopic (youtube) extraperitoneal para-aortic lymphadenectomy.
Incidence and Predictors of Venous Thromboembolism After Debulking Surgery for Epithelial Ovarian Cancer
abstract
Objective: The aim of this study was to determine the
incidence and the risk factors of venous thromboembolism (VTE) within 30
days after primary surgery for epithelial ovarian cancer (EOC).
Methods: In a historical cohort study, we estimated
the postoperative 30-day cumulative incidence of VTE among consecutive
Mayo Clinic patients undergoing primary cytoreduction for EOC between
January 2, 2003, and December 29, 2008. We tested perioperative patient
characteristics and process-of-care variables (defined by the National
Surgical Quality Improvement Program, >130 variables) as potential
predictors of postoperative VTE using the Cox proportional hazards
modeling.
Results: Among 569 cases of primary EOC cytoreduction
and/or staging and no recent VTE, 35 developed symptomatic VTE within 30
days after surgery (cumulative incidence = 6.5%; 95% confidence
interval, 4.4%–8.6%). Within the cohort, 95 (16.7%) received graduated
compression stockings (GCSs), 367 (64.5%) had sequential compression
devices + GCSs, and 69 (12.1%) had sequential compression devices + GCSs
+ postoperative heparin, with VTE rates of 1.1%, 7.4%, and 5.8%,
respectively (P = 0.07, χ2 test). The remaining 38
(6.7%) received various other chemical and mechanical prophylaxis
regimens. In the multivariate analysis, current or past tobacco smoking,
longer hospital stay, and a remote history of VTE significantly
increased the risk for postoperative VTE.
Conclusions: Venous thromboembolism is a substantial
postoperative complication among women with EOC, and the high cumulative
rate of VTE within 30 days after primary surgery suggests that a more
aggressive strategy is needed for VTE prevention. In addition, because
longer hospital stay is independently associated with a higher risk for
VTE, methods to decrease length of stay and minimize factors that
contribute to prolonged hospitalization are warranted.
A Phase 2 Study of Oxaliplatin Combined With Continuous Infusion Topotecan for Patients With Previously Treated Ovarian Cancer
Abstract
Background: Phase 2 trials suggest that prolonged
intravenous (IV) infusion of the topoisomerase 1 inhibitor topotecan may
be less toxic than when given by standard IV bolus 5-day
administration. Oxaliplatin exhibits efficacy in platinum-pretreated
disease and shows preclinical synergy with topoisomerase 1 inhibitors.
We sought to determine the efficacy and safety of oxaliplatin plus
infusion topotecan in recurrent platinum-pretreated ovarian cancer.
Methods: Patients with recurrent epithelial ovarian,
fallopian tube, or primary peritoneal cancers previously treated with 1
to 2 prior regimens including platinum and taxane received oxaliplatin
(85 mg/m2 day 1 and day 15) and topotecan (0.4 mg/m2
per day) by continuous IV infusion over 14 days every 4 weeks. The
primary objective of the trial was to estimate the objective response
rate in platinum-resistant disease (stratum 1) and in platinum-sensitive
disease (stratum 2). Toxicities were assessed in all patients.
Results: Thirty-eight patients received 144 cycles of
therapy (median, 4; range, 1–6). The most common grade 3 and grade 4
toxicities included thrombocytopenia (grade 3, 37%; and grade 4, 19%),
neutropenia (grade 3, 37%; grade 4, 11%), and anemia (grade 3, 15%).
Response occurred in 4 of 19 patients in stratum I (21%; 95% confidence
intervals, 6%–46%) and 9 of 19 patients in stratum 2 (47%; 95% CI,
24%–71%). Three in each stratum had lengthy complete responses.
Conclusions: Biweekly oxaliplatin plus a 14-day
continuous IV infusion of topotecan, given monthly, is an active regimen
in platinum-pretreated ovarian cancer and merits additional evaluation.
Clinical Outcome of Isolated Serous Tubal Intraepithelial Carcinomas (STIC)
abstract
Objective: Risk-reducing salpingo-oophorectomy (RRSO) is recommended for women with BRCA
mutation due to increased risk of pelvic serous carcinoma. Serous tubal
intraepithelial carcinoma (STIC) is a pathologic finding of unknown
clinical significance. This study evaluates the clinical outcome of
patients with isolated STIC.
Materials/Methods: We retrospectively reviewed the medical records of consecutive patients with a germline BRCA1/2
mutation or a high-risk personal or family history of ovarian cancer
who underwent RRSO between January 2006 and June 2011. All patients had
peritoneal washings collected. All surgical specimens were assessed
using the sectioning and extensively examining the fimbria protocol,
with immunohistochemistry when indicated. p53 signature lesions and
secretory cell outgrowths were excluded.
Results: Of 593 patients who underwent RRSO, isolated STIC was diagnosed in 12 patients (2%). Five patients (42%) were BRCA1 positive, 5 patients (42%) were BRCA2
positive, and 2 patients (17%) had high-risk family history.
Preoperatively, all patients with STIC had normal CA-125 levels and/or
pelvic imaging results. Seven patients underwent hysterectomy and
omentectomy, 6 patients (46%) had pelvic node dissections, and 5
patients (39%) had para-aortic node dissections. With the exception of
positive peritoneal washings in 1 patient, no invasive or metastatic
disease was identified. No patient received adjuvant chemotherapy. At
median follow-up of 28 months (range, 16–44 months), no recurrences have
been identified.
Conclusions: Among the cases of isolated STIC after
RRSO reported in the literature, the yield of surgical staging is low,
and short-term clinical outcomes are favorable. Peritoneal washings are
the most common site of disease spread. Individualized management is
warranted until additional data become available.
The Inverse Relationship between 25-Hydroxyvitamin D and Cancer Survival: Discussion of Causation
Free Full-Text
"The best information that we have on disease severity is stage at the time of diagnosis. Most studies included in this review have taken disease severity into account in the analyses, e.g., using stage or other known prognostic factors (Table 1). Generally, these adjustments have had little effect on the relationship between 25-OHD level and cancer survival."
(ovarian cancer) reference:
Schwartz, G.G.; Skinner, H.G. Prospective studies of total and ionized serum calcium in relation to incident and fatal ovarian cancer. Gyn. Oncol. 2013, 129, 169–172.
Saturday, January 19, 2013 (prior blog posting)
Prospective Studies of Total and Ionized Serum Calcium in Relation to Incident and Fatal Ovarian Cancer.
Source
Departments of Cancer Biology, Urology, and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: gschwart@wakehealth.edu.Abstract
OBJECTIVE:
Biological markers that could aid in the detection of ovarian cancer are urgently needed. Many ovarian cancers express parathyroid hormone-related protein, which acts to raise calcium levels in serum. Thus, we hypothesized that high serum calcium levels might predict ovarian cancer.METHODS:
We examined associations between total and ionized serum calcium and ovarian cancer mortality in the Third National Health and Nutrition Survey (NHANES III) using Cox proportional hazard models. We then examined associations of serum calcium with incident ovarian cancer in a second prospective cohort, the NHANES Epidemiological Follow-up Study (NHEFS).RESULTS:
There were eleven deaths from ovarian cancer over 95,556 person-years of follow-up in NHANES III. After multivariable adjustment, the risk for fatal ovarian cancer was 52% higher for each 0.1mmol/L increase in total serum calcium (RH=1.52, 95% CI 1.06 - 2.19) and 144% higher for each 0.1mmol/L increase in ionized serum calcium (RH=2.44, 95% CI=1.45 - 4.09). Associations persisted after adjusting for nulliparity and the use of oral contraceptives. Eight incident ovarian cancers occurred over 31,089 person-years of follow-up in the NHEFS. After adjusting for covariates, there was a 63% higher risk for ovarian cancer with each 0.1mmol/L increase in total serum calcium (95% CI 1.14 - 2.34). Similar results were observed for albumin-adjusted serum calcium.CONCLUSIONS:
Higher serum calcium may be a biomarker of ovarian cancer. This is the first report of prospective positive associations between indices of calcium in serum and ovarian cancer. Our findings require confirmation in other cohorts.Tuesday, November 05, 2013
Traumatization and chronic pain: a further model of interaction
open access
Up to 80% of patients with severe posttraumatic stress disorder are suffering from “unexplained” chronic pain. Theories about the links between traumatization and chronic pain have become the subject of increased interest over the last several years. We will give a short summary about the existing interaction models that emphasize particularly psychological and behavioral aspects of this interaction. After a synopsis of the most important psychoneurobiological mechanisms of pain in the context of traumatization, we introduce the hypermnesia–hyperarousal model, which focuses on two psychoneurobiological aspects of the physiology of learning. This hypothesis provides an answer to the hitherto open question about the origin of pain persistence and pain sensitization following a traumatic event and also provides a straightforward explanatory model for educational purposes.
Keywords: posttraumatic stress disorder, chronic pain, hypermnesia, hypersensitivity, traumatization
"...We consider that the psychotherapeutically desirable step of reframing is strongly supported by our model: for patients, it is therapeutically very meaningful to conceive trauma-associated sequelae as a “normal” reaction to an extremely “abnormal” event....
Metabolic complications with the use of mTOR inhibitors for cancer therapy
abstract
Interpretation
The risk of all grade
and grade 3–4, hyperglycemia, hypercholesterolemia, and
hypertriglyceridemia, are increase in patients treated with mTOR
inhibitors compared with control.
A phase I study of the combination of ro4929097 and cediranib in patients with advanced solid tumours (PJC-004/NCI 8503)
open access
Background:
The Notch signalling
pathway has been implicated in tumour initiation, progression,
angiogenesis and development of resistance to vascular endothelial
growth factor (VEGF) targeting, providing a rationale for the
combination of RO4929097, a γ-secretase inhibitor, and cediranib, a VEGF receptor tyrosine kinase inhibitor.
(U.S.) ACR Appropriateness Criteria Staging and Follow-up of Ovarian Cancer
Abstract
Purchase this article for 30.00 USD
Imaging
is used to detect and characterize adnexal masses and to stage ovarian
cancer both before and after initial treatment, although the role for
imaging in screening for ovarian cancer has not been established. CT and
MRI have been used to determine the resectability of tumors, the
candidacy of patients for effective cytoreductive surgery, the need for
postoperative chemotherapy if debulking is suboptimal, and the need for
referral to a gynecologic oncologist. Radiographic studies such as
contrast enema and urography have been replaced by CT and other
cross-sectional imaging for staging ovarian cancer. Contrast-enhanced CT
is the procedure of choice for preoperative staging of ovarian cancer.
MRI without and with contrast may be useful after equivocal CT, but is
usually not the best initial procedure for ovarian cancer staging.
Fluorine-18-2-fluoro-2-deoxy-D-glucose–PET/CT may not be needed
preoperatively, but its use is appropriate for detecting and defining
post-treatment recurrence. Ultrasound is useful for evaluating adnexal
disease, but has limited utility for staging ovarian cancer.
The
ACR Appropriateness Criteria are evidence-based guidelines for specific
clinical conditions that are reviewed every 2 years by a
multidisciplinary expert panel. The guideline development and review
include an extensive analysis of current medical literature from
peer-reviewed journals and the application of a well-established
consensus methodology (modified Delphi) to rate the appropriateness of
imaging and treatment procedures by the panel. In those instances where
evidence is lacking or not definitive, expert opinion may be used to
recommend imaging or treatment.
Figures and tables from this article: (requires paid subscription)
Figures and tables from this article: (requires paid subscription)
- Variant 1. Pretreatment staging of ovarian cancer. (See narrative for comments regarding CA-125.)
- Rating scale: 1, 2, 3 = usually not appropriate; 4, 5, 6 = may be appropriate; 7, 8, 9 = usually appropriate.
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