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Tuesday, December 09, 2014

Longwoods eLetter December 9, 2014 | If We Had a Magic Wand



Sundry interesting articles:

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Quote

"I apologize because I didn't look hard enough, until now. I didn't look far enough. I didn't review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis." Dr. Sanjay Gupta Why I changed my mind on weed

Essays

If We Had a Magic Wand by Hugh MacLeod and Leslee Thompson
The second essay in the Ghost of Healthcare Hope series

Off the Cuff

"If the public had more information on the way doctors are compensated, they might have a more balanced perspective in terms of giving their views to the government during negotiations," says Tom Closson, former president of the Ontario Hospital Association. ...almost all suppliers of plasma products in the UK "have a track record of avoidable quality problems, in many cases resulting in deaths or serious chronic illness such as HIV." Read the essay Tories unlikely to stop Bill prohibiting paid plasma, but why are they even trying? by Rick Janson
While the public, some lawyers and even some politicians, especially in Quebec, are actively involved in the conversation about dying, what are oncologists, primary care and palliative care physicians and other allied health workers – the professionals who are most acutely involved with end-of-life care – doing to mobilize public and private conversations with their patients about PAD and euthanasia? 

...our research suggests that tens of thousands of incidents are slipping under the radar because those who witness poor care and try to report it are being told, in one particular case, to "mind their own business".

Part of the commitment to protect patients and the public should include the identification of risk, as well as the encouragement to voice concerns about the safety and relevance of our practices, policies and procedures in the workplace.

REGISTRATION OPEN: Ways & Means: Health Links – February 11, 2015: Ministries report. Patients reflect. Providers enlighten. Experts analyse. An interactive conference to define the opportunities and consider the possibilities to better care.

The Complete Library Online: Access to 50 issues of HealthcarePapers for the price of a one year subscription
Read the latest IHSPR Innovator newsletter

Last Week in Healthcare History
December 1, 1988: First World AIDS Day.
December 2, 1893: Royal Victoria Hospital officially opened by Governor General, Lord Aberdeen.
December 5, 1700: Montreal struck by influenza epidemic.


Longwoods' Events

      
Breakfast with the Chiefs – January 22, 2015
Dr. Jack Kitts, Dr. Barry McLellan, Dr. Kevin Smith and Leslee Thompson
Can innovation (1) improve care for patients (2) strengthen the healthcare system and (3) save money?
Register Now
Sponsored by Cerner Canada; PwC; Orion Health; National Research Corporation, HIROC, Canadian Foundation for Healthcare Improvement, and Rotman School of Management
REGISTER NOW – February 11, 2015. Ways & Means: Health Links – Ministries report. Patients reflect. Providers enlighten. Experts analyse. An interactive conference to define the opportunities and consider the possibilities to better care.

Join our Chairs:
Dr. Danielle Martin, Vice President, Medical Affairs and Health System Solutions, Women's College Hospital and
Dr. Sacha Bhatia, Director of the Institute for Health System Solutions and Virtual Care (WIHV) at Women's College Hospital.
More Information here.

Would you like to sign up your institution to become a Public Institution HealthcareBoard member and have unlimited number of your staff and board members attend a season of Breakfast with the Chiefs and receive discounts to HealthcareRounds? Contact Matthew Hart - mhart@longwoods.com

Our Editors Recommend

Healthcare Quarterly
Turning the Social Determinants of Health to Our Advantage: Policy Fundamentals for a Better Approach to Children's Health

HealthcarePapers
A Framework for Community-Oriented Primary Healthcare

Healthcare Policy
The Untold Story: Examining Ontario's Community Health Centres' Initiatives to Address Upstream Determinants of Health

Nursing Leadership
An Interview with Dr. Judith Shamian

World Health and Population
Health-seeking Behavior in Urban Delhi: An Exploratory Study

News

  • Advisory Panel on Healthcare Innovation holds National Health Consultation in Ottawa
  • Significant increase in concussions among Ontario children and youth: York U study
  • Obesity may shorten life expectancy up to 8 years
  • Nurses call for action to address violence against women
  • IRCM researchers identify a protein that controls the "guardian of the genome" - A study sheds new light on a well-known mechanism required for the immune response
  • Fitness Apps Don't Guarantee Weight-loss
  • Over 230,000 Ontario adults seriously considered suicide in 2013, CAMH survey shows
  • Canadian Cancer Society overwhelmed by support for GivingTuesday campaign
  • Canada Funds 11 New Global Health Innovations in La Francophonie Member States
  • Huge growth in Canadian doctors use of information technology, National Physician Survey reveals
  • Humber River Hospital Chief of Surgery wins Prestigious Award for Mentorship from the Royal College of Physicians and Surgeons of Canada
  • Canada Needs Federal Leadership to Accelerate Health Innovation and Improve System Performance
  • Keeping up with the pathogens: Dr. Kamran Khan launches company to track diseases
  • Doctors upset with changes proposed under Bill 20
  • Philips introduces MRI solution to enhance patient comfort and manage throughput
  • More Health News
  • More World Health News

Conferences

December 10, 2014: Toronto, ON. IHSPR Policy Round
January 20, 2015: Webinar. Managing Multimorbidities
January 28, 2015: Webinar. Analyzing Data Over Time for Quality Improvement
February 5, 2015: Toronto, ON. Perspectives in Competency Assessment
February 11, 2015: Toronto, ON. Ways and Means: Health Links
February 23-28, 2015: Toronto, ON. Advanced Health Leadership Program at Rotman School of Management
February 25-26, 2015: Vancouver, BC. National Canadian Forensic Nursing Conference
March 9-11, 2015: Toronto, ON. The Baycrest Rotman Research Institute Conference – 25 Years of Brain and Aging
April 19-21, 2015: Richmond Hill, ON. 2015 HPCO Annual Conference - Call for abstracts deadline, November 17, 2014
May 19-22, 2015: Toronto, ON. Dorothy Wylie Health Leaders Institute
May 26-27, 2015: Ottawa, ON and Online. The Canadian Patient Safety Officer Course
May 26-27, 2015: Dartmouth, NS. The Atlantic Learning Exchange 2015
May 29-30, 2015: Toronto, ON. Global Telehealth 2015. Call for Papers deadline: December 15, 2014.
June 15-16, 2015: Charlottetown, PE. National Health Leadership Conference

More | Add your conference

Transitions

  • Michelle Floh to Entrepreneur in Residence, Alberta Innovates, Edmonton, AB
  • Cecily Wallace to Sr. Communications Advisor, Shared Services Canada, Ottawa, ON
  • Dr. Bert Lauwers to President and CEO, Ross Memorial Hospital, Lindsay, ON
  • Abdo Shabah to Vice President, Medical Affairs, Airmedic, Brossard, QC
  • Gary Kirk to Medical Officer of Health, Windsor-Essex County Health Unit, Windsor, ON
  • Helen Angus to Deputy Minister of Citizenship, Immigration and International Trade, Government of Ontario, Toronto, ON
  • Mary Jo Haddad to Board of Directors, Toronto-Dominion Bank, Toronto, ON
More | Send us your transitions.

Featured Careers

  • Vice President, Integrated Health Services - Regina Qu'Appelle Health Region, Regina, SK
  • President & CEO - Markham Stouffville Hospital, Markham, ON
  • Primary Care Nurse Practitioner - Algoma Nurse Practitioner-Led Clinic, Sault Ste. Marie, ON
  • Chief Executive Officer - Safehaven, Toronto, ON
  • Chief Administrative Officer - The Institute for Quality Management in Healthcare, Toronto, ON
  • Director, Nursing Practice & Education - St. Michael's Hospital, Toronto, ON
  • And, a number of Nurse positions in Alberta, Manitoba, British Columbia and Ontario
  • Plus many more Executive, Management and Nurse positions here
Follow us on Twitter and be notified of new jobs as soon as they are posted
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Saturday, November 29, 2014

Genetic features of Lynch syndrome in the Israeli population



abstract

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Inherited predisposition to breast cancer among African American women



abstract
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Estrogen Biosynthesis and Action in Ovarian Cancer | Experimental Endocrinology



open access

 The review explains the role of estrogen in ovarian cancer and it gives an overview on ovarian cancer subtypes. Furthermore, enzymes active to synthesize and metabolize estrogens as well as estrogen signaling pathways are described. Strategies to target these pathways are discussed.
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Potential Application of Curcumin and Its Analogues in the Treatment Strategy of Patients with Primary Epithelial Ovarian Cancer



Free Full-Text 


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Training randomized trial recruiters to facilitate recruitment and informed consent by exploring patients' treatment preferences



 Full text 

........Several previous studies have tended to assume that patients’ treatment preferences are simple and static entities that can be easily defined and measured [4,10]. However, there is also a small body of research that shows that preferences are complex, multifaceted, and changeable entities that can be based on incomplete or inaccurate information [11-16]. .....
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Friday, November 28, 2014

Up-to-dateness of reviews is often neglected in overviews: a systematic review



open access

 1. Introduction

What is new?

Key findings

•
The mean publication lag per review was more than 5 years.
•
Only one in four overviews considered up-to-dateness.
•
No overview systematically investigated whether an update was necessary.

What this adds to what was known?

•
This is the first systematic analysis of up-to-dateness in overviews.
•
We developed recommendations to produce up-to-date overviews.

What is the implication and what should change now?

•
Authors should analyze whether the underlying evidence of systematic reviews (SRs) is still up-to-date when conducting overviews.
•
Authors should search for primary studies not included in SRs, if needed
Keeping current with the scientific literature is a very challenging task for researchers but even more so for health professionals as the amount of published literature in medical science is rapidly rising. Eleven systematic reviews (SRs) and 75 trials need to be read every day to keep up-to-date, when just considering the publications listed in MEDLINE [1].
This huge amount of literature has led reviewers to perform evidence syntheses on reviews instead of primary studies that are often called overviews (of reviews), review of reviews, and umbrella reviews [2]........
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New concepts of biomarkers and clinical outcomes for therapeutic cancer vaccines in clinical trials, Immunotherapy



abstract

 Aim: This study aimed to derive meaningful parameters for immune monitoring during cancer vaccine development by analysis of the literature.  
Methods: This retrospective study was based on analysis of clinical trials registered at ClinicalTrials.gov and published data available on PubMed.  
Results: The most common sample evaluated in immune monitoring was peripheral blood. All trials employed ELISA for detecting a humoral immune response; however, cellular immune assays were not used across trials. Most cellular immune assays failed to correlate with clinical outcome, although results of other methods did. Conclusion: Standardization of the cellular immune assays across trials is important for predicting the effects of therapeutic cancer vaccines when considering the reliability and characteristics of the methods. Currently, assays mostly target detection of T-cell function, such as proliferation and cytokine release; however, T-cell phenotype analysis in peripheral blood and/or tumor sites may also be considered in the future.
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Wednesday, November 26, 2014

InVitae Poster Expands Data on Hereditary Cancer Panel Testing - BRCA1/2 / Lynch Syndrome



GenomeWeb

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Recalls, Market Withdrawals, & Safety Alerts > Natura Pet Recalls



 Natura Pet Recalls 5 Lots of Dry Cat and Dry Ferret Food due to Vitamin Insufficiency
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Prognostic Significance of Sugarbaker's Peritoneal Cancer Index for the operability of ovarian carcinoma



abstract


INTRODUCTION:

This study aimed to investigate Sugarbaker's peritoneal cancer index (PCI) as a prognostic indicator for the resectability of ovarian carcinoma (OC), as depicted in the study using the completeness of cytoreduction score (CCS).Currently, the intraoperative assessment of operability in OC surgery is primarily a subjective measurement that is dependent on the surgeon.

METHODS:

The retrospective data from 98 patients with OC International Federation of Gynecology and Obstetrics (FIGO) III to IV who had received surgery between January 2010 and December 2011 were analyzed. The PCI and the CCS were determined retrospectively using surgical reports, histological findings, and intraoperative photographic documentation. Receiver operating characteristic curves and ordinal regression were applied to evaluate the predictability of CCS using the PCI.

RESULTS:

Of 98 patients, 80 (81.6%) were staged FIGO III and 18 (18.4%) FIGO IV. A statistically significant correlation was demonstrated between the PCI and CCS (P < 0.01).......

CONCLUSIONS:

The PCI more precisely defined the heterogeneous group of patients with OC FIGO III. The PCI provided objectivity and reproducibility, and it seems to be a possible prognostic indicator for OC resectability.
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worth reading: Looking For Light in a Dark Room - note references to YAC/clinical trials/Canada....



 Cancer Knowledge Network

 .....The AIDS movement, which changed the fates of thousands of dying people was not built from positive thinking.  Change happened because people were angry. Access to drugs came about because people stood up and said “this is not acceptable”. It is not acceptable that those of us with advanced disease cannot access the drugs we need because of bureaucracy and the screwed up drug trial system. It is not acceptable that many provinces do not cover drugs like oral chemo.  It is not acceptable that as an act to save our lives some of us have to go out of country to access up and coming drug trials.  It is not acceptable that we are dying.  Empowerment and positive thinking is important but so is addressing the dark side of cancer.  Young adult organizations need to decide whether or not they will take a stand with those of us who are dying and living chronically.  They need to explore how they can contribute to the empowerment of those of us who cannot get past our cancer experience. They need to help end isolation and take affirmative action towards change.
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Genetics of Skin Cancer (references to BRCA (BAP1) and BRCA2



National Cancer Institute


BRCA-Associated Protein 1 (BAP1) BRCA-associated protein 1 (BAP1) has recently emerged as a gene implicated both in sporadic and hereditary melanomas......

BRCA2
The Breast Cancer Linkage Consortium found that mutations in BRCA2 were associated with a relative risk of melanoma of 2.58 (95% CI, 1.3–5.2).[155] A second study reported a similar increase in risk, although the result fell short of statistical significance.[156] In contrast, another large cohort study of BRCA2 mutation carriers in the Netherlands showed a decreased risk of melanoma; however, the expected incidence of melanoma was rare in this population, and this result reflects a difference of only two melanoma cases.[157] Ashkenazi Jewish melanoma patients have not been shown to have an increased prevalence of the three founder mutations in BRCA1 and BRCA2 that are commonly found in this population.[158] Overall, the evidence for increased risk of melanoma in the BRCA2 population is inconsistent at this time.
(Refer to the BRCA1 and BRCA2 section in the PDQ summary on Genetics of Breast and Ovarian Cancer for more information.)


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Google and Women's Health-Related Issues: What Does the Search Engine Data Reveal?



abstract

pdf  (requires registration - free - to view full text)

OBJECTIVES:

Identifying the gaps in public knowledge of women's health related issues has always been difficult. With the increasing number of Internet users in the United States, we sought to use the Internet as a tool to help us identify such gaps and to estimate women's most prevalent health concerns by examining commonly searched health-related keywords in Google search engine.

METHODS:

We collected a large pool of possible search keywords from two independent practicing obstetrician/gynecologists and classified them into five main categories (obstetrics, gynecology, infertility, urogynecology/menopause and oncology), and measured the monthly average search volume within the United States for each keyword with all its possible combinations using Google AdWords tool.

RESULTS:

We found that pregnancy related keywords were less frequently searched in general compared to other categories with an average of 145,400 hits per month for the top twenty keywords. Among the most common pregnancy-related keywords was "pregnancy and sex' while pregnancy-related diseases were uncommonly searched. HPV alone was searched 305,400 times per month. Of the cancers affecting women, breast cancer was the most commonly searched with an average of 247,190 times per month, followed by cervical cancer then ovarian cancer.

CONCLUSION:

The commonly searched keywords are often issues that are not discussed in our daily practice as well as in public health messages. The search volume is relatively related to disease prevalence with the exception of ovarian cancer which could signify a public fear.
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Amgen Ends Gastric Cancer Drug Studies on Safety Review - Amgen/Trebananib/ovarian



Analyst Blog

....We note that Amgen stumbled with its oncology pipeline earlier this month as well when its experimental ovarian cancer treatment, trebananib, failed to meet the secondary endpoint of overall survival in a late-stage study. Although trebananib had achieved the primary endpoint of the study, overall survival is an important criterion for gaining FDA approval. Moreover, the rate of discontinuation due to adverse events was much higher in the trebananib arm compared to the control arm (20% versus 7%).....
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Tuesday, November 25, 2014

On vitamin D, the so-called experts have it wrong, U.K. researcher says (re: the Lancet)



media

.....However, The Lancet, the world’s best-known medical journal, recently suggested in an editorial that most of the benefits of vitamin D advanced by scientific studies are a “myth.” It says people tend to have low vitamin D when they are ill because they do not go outdoors very much.
Most of The Lancet’s trials have used low doses of vitamin D
This was also the view presented in papers published in The Lancet by two teams, Philippe Autier of the International Prevention Research Institute, Lyon, and Mark Bolland of the Department of Medicine, University of Auckland.
They argue that clinical trials of vitamin D have failed to show any clear benefit. However, most of the trials have used low doses of the vitamin. Professor Michael Holick, pioneer of vitamin D research at Boston University, says 4,000 units per day is required to give an optimum level of the vitamin in the blood, enough to prevent disease. A number of clinical trials relied on by The Lancet editorial and its authors used a daily dose of just 400 units.....
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Blurring of boundaries in the doctor–patient relationship : The Lancet Oncology



 Note: too bad open access is not available on this one

extract only

Blurring of boundaries in the doctor—patient relationship


Oncology is a specialty that can be enormously rewarding but is fraught with many challenges. Young oncologists have to master dealing with anxious patients who are facing a life-threatening disease; conveying the true prognosis; discussing the complexity of modern treatments; and explaining the unavailability of some drugs, the side-effects of treatment, and likely therapeutic aims. Evidence-based courses have been shown to help oncologists to communicate all these issues in a clear, honest, an ...
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Prognostic role and predictors of complete pathologic response to neoadjuvant chemotherapy in primary unresectable ovarian cancer



abstract

 Objective
The objective of the study was to analyze in a large series of unresectable advanced ovarian cancer (AOC) patients the prognostic role of pathological response to neoadjuvant chemotherapy (NACT).....
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Outcomes from ultrasound follow-up of small complex adnexal masses in women over 50



abstract

Objective

The discovery of a complex adnexal mass in an older woman often raises concern for cancer. We evaluate outcomes for a large population-based cohort of women older than age 50 years with a small complex adnexal mass reported on ultrasound, without elevated CA125 or other evidence of malignancy, including time to detection of malignancy and stage at diagnosis for those initially observed...........
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Comparison of clinical features between suspected familial colorectal cancer type X and Lynch syndrome in Japanese patients (extracolonic cancers)



abstract

 Conclusion A significant difference in extracolonic Lynch syndrome-associated cancer was evident between suspected familial colorectal cancer type X and Lynch syndrome.
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(Lynch Syndrome patients) Clinical and prognostic factors for renal parenchymal, pelvis, and ureter cancers in SEER registries: Collaborative stage data collection system, version 2 - Altekruse - 2014 - Cancer - Wiley Online Library



 Note: not specific to genetics (eg. Lynch Syndrome)

SEER registries: Collaborative stage data collection system, version 2 (open access)

Renal pelvis and ureter

Kidney and renal pelvis cancers often are combined for the purposes of cancer surveillance, with ureter cancer presented separately. Renal pelvis and ureter cancers share CSv2 SSFs, however, and are grouped in the AJCC stage coding schema; cancers of the renal parenchyma have a different set of SSFs.[3] Findings for both renal pelvis and ureter cancers are presented in this report.
The SSFs for these cancer sites are World Health Organization or International Society of Urological Pathology (WHO/ISUP) grade[31] (SSF1) and depth of renal parenchymal invasion (SSF2).[32] Both SSFs for these sites affect prognosis. SSF1 for renal pelvis and ureter is the WHO/ISUP grade, a 2-grade system (low and high grade). This grading system was proposed by ISUP in 1998 and adopted by WHO in 2004 to better classify the tumor grade for urothelial carcinomas of the renal pelvis, ureter, bladder, and urethra.[33, 34] The strengths of the WHO/ISUP grade's clear-cut criteria and the elimination of subjective and arbitrary interpretation have greatly improved the ambiguous language that marked the 1973 WHO system.[35] SSF2, depth of renal parenchymal invasion, records the depth of tumor invasion into the renal parenchyma in millimeters as documented in the pathology report.

 With respect to renal pelvis and ureter cancer, a high WHO/ISUP grade (SSF1) is independently associated with worse outcomes in surgical cases.[42] WHO/ISUP grade was known for 85% of cases with resection. SSF2 (depth of renal parenchymal invasion as a marker of recurrence) also has been validated[43]; however, most values for this variable were unknown. Additional SSFs for renal pelvis and ureter cancer might be considered based on prognostic value. Promising markers for these understudied cancers include tumor architecture,[44, 45] multifocality,[46] and the presence of concomitant carcinoma in situ.[47] In some studies,[48] tumor location (ie, ureter, renal pelvis, or both) has also been suggested to have prognostic value.

#ovariancancers
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A quantitative proteomics-based signature of platinum sensitivity in ovarian cancer cell lines



abstract
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Editorial: Screening for Vitamin D Deficiency: Is the Goal Disease Prevention or Full Nutrient Repletion?



Editorial open access
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Screening for Vitamin D Deficiency: A Systematic Review for the U.S. Preventive Services Task ForceScreening for Vitamin D Deficiency | Annals of Internal Medicine



open access


Background: Vitamin D deficiency has been associated with adverse health outcomes.
Purpose: To systematically review benefits and harms of vitamin D screening in asymptomatic adults.
Data Sources: Ovid MEDLINE (through the third week of August 2014), Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews.
Study Selection: Randomized trials of screening for and treatment of vitamin D deficiency and case–control studies nested within the Women's Health Initiative.
Conclusion: Treatment of vitamin D deficiency in asymptomatic persons might reduce mortality risk in institutionalized elderly persons and risk for falls but not fractures.
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Monday, November 24, 2014

Genetic Testing Fact Sheet - National Cancer Institute



NCI

 3. What genetic tests are available for cancer risk?

More than 50 hereditary cancer syndromes have been described. The majority of these are caused by highly penetrant mutations that are inherited in a dominant fashion. The list below includes some of the more common inherited cancer syndromes for which genetic testing is available, the gene(s) that are mutated in each syndrome, and the cancer types most often associated with these syndromes.

Hereditary breast cancer and ovarian cancer syndrome
  • Genes: BRCA1, BRCA2
  • Related cancer types: Female breast, ovarian, and other cancers, including prostate, pancreatic, and male breast cancer
Li-Fraumeni syndrome
  • Gene: TP53
  • Related cancer types: Breast cancer, soft tissue sarcoma, osteosarcoma (bone cancer), leukemia, brain tumors, adrenocortical carcinoma (cancer of the adrenal glands), and other cancers
Cowden syndrome (PTEN hamartoma tumor syndrome)
  • Gene: PTEN
  • Related cancer types: Breast, thyroid, endometrial (uterine lining), and other cancers
Lynch syndrome (hereditary nonpolyposis colorectal cancer)
  • Genes: MSH2, MLH1, MSH6, PMS2, EPCAM
  • Related cancer types: Colorectal, endometrial, ovarian, renal pelvis, pancreatic, small intestine, liver and biliary tract, stomach, brain, and breast cancers
Familial adenomatous polyposis
  • Gene: APC
  • Related cancer types: Colorectal cancer, multiple non-malignant colon polyps, and both non-cancerous (benign) and cancerous tumors in the small intestine, brain, stomach, bone, skin, and other tissues
Retinoblastoma
  • Gene: RB1
  • Related cancer types: Eye cancer (cancer of the retina), pinealoma (cancer of the pineal gland), osteosarcoma, melanoma, and soft tissue sarcoma
Multiple endocrine neoplasia type 1 (Wermer syndrome)
  • Gene: MEN1
  • Related cancer types: Pancreatic endocrine tumors and (usually benign) parathyroid and pituitary gland tumors
Multiple endocrine neoplasia type 2
  • Gene: RET
  • Related cancer types: Medullary thyroid cancer and pheochromocytoma (benign adrenal gland tumor)
Von Hippel-Lindau syndrome
  • Gene: VHL
  • Related cancer types: Kidney cancer and multiple noncancerous tumors, including pheochromocytoma
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HealthNewsReview.org - Independent Expert Reviews of News Stories



Independent Expert Reviews of News Stories

OUR CRITERIA FOR WHAT USERS NEED IN STORIES

On treatments, tests, products, procedures
Visit each link to hear from patients and doctors about why these matter, and to see Thumbs up and Down story examples.


  • What’s the total cost?
  • How often do benefits occur?
  • How often do harms occur?
  • How strong is the evidence?
  • Is this condition exaggerated?
  • Are there alternative options?
  • Is this really a new approach?
  • Is it available to me?
  • Who’s promoting this?
  • Do they have a conflict of interest?
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11 country survey: International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient-Centered Care



The Commonwealth Fund

About the Study

The 2014 Commonwealth Fund International Health Policy Survey of Older Adults was conducted by phone from March through May 2014. More than 15,000 people age 65 or older took part in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States......
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Nurturing Empathy: An Oncologist Looks at Medicine and Himself



The Oncologist (pdf)

Empathy in medicine matters. I should know—I have been
a practicing oncologist for 35 years—but it was only when, in
a matter of seconds, I went from doctor to patient that I
grasped its true significance.......
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Friday, November 21, 2014

Recent progress in the treatment and prevention of cancer-related lymphedema - Shaitelman - 2014 - CA: A Cancer Journal for Clinicians - Wiley Online Library



open access


Lymphedema Beyond Patients With Breast Cancer

Patients with other solid tumors requiring treatment that adversely affects lymphatic function are also at significant risk of developing lymphedema. Unfortunately, relatively few studies have investigated lymphedema in these patient populations. For example, a recent systematic review identified only 47 studies that assessed non-breast cancer-related lymphedema, and most of those studies were retrospective.[50] The following subsections provide an overview of the current body of published literature regarding the incidence of lymphedema as a result of the treatment of nonbreast malignancies......

 One recent systematic review highlighted several areas in the delivery and cost of lymphedema treatment that might benefit from changes in health policy. Stout et al[239] identified 8 articles about health care delivery models and 6 articles about economic and cost analyses. They found that although evidence-based care for the diagnosis and treatment of lymphedema is limited, much of the burden to facilitate diagnosis and referral for effective care is placed on the patient. The authors also found that, compared with patients who do not have lymphedema, patients with lymphedema have significantly higher hospitalization rates, higher rates of medical services use, lower QOL, and significantly higher indirect costs. However, the study had a low level of evidence and yielded only speculative findings.
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Circulating tumor cells and circulating tumor DNA for precision medicine: dream or reality?



open access

 Abstract

 Next-generation sequencing studies have provided further evidence to support the notion that cancer is a disease characterized by Darwinian evolution. Today, we often fail to capture this evolution and treatment decisions, even in the metastatic setting, are often based on analysis of primary tumor diagnosed years ago. Currently, this is considered a major reason for treatment failures in cancer care. Recent technological advances in the detection and characterization of circulating tumor cells and circulating tumor DNA might address this and allow for treatment tailoring based on real-time monitoring of tumor evolution. In this review, we summarize the most important recent findings in the field, focusing on challenges and opportunities in moving these tools forward in clinical practice......
  1. Ann Oncol (2014) 25 (12): 2304-2313. doi: 10.1093/annonc/mdu480 First published online: October 21, 2014
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Prioritizing targets for precision cancer medicine



open access (technical)

 Abstract
The implementation of cancer genomic testing into the clinical setting has brought major opportunities. However, as our understanding of cancer initiation, maintenance and progression improves through detailed cancer genomic studies, the challenges associated with driver identification and target classification in the clinical setting become clearer. Here, we review recent insights into cancer genomic testing in the clinical setting, and suggest a target classification approach that considers the levels of evidence supporting the prioritization of tumour drivers for therapeutic targeting in light of complex cancer clonal and sub-clonal structures and clinical successes and failures in the field. We argue that such classification approaches, together with transparent reporting of both positive and negative clinical data and continued research to identify the sub-clonal dynamics of driver events during the disease course, will facilitate inter-trial comparisons, optimize patient informed consent and provide a critically balanced evaluation of genomic testing in clinical practice....... 

This Article

  1. Ann Oncol (2014) 25 (12): 2295-2303. doi: 10.1093/annonc/mdu478 First published online: October 24, 2014
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In year two, MD Anderson Moon Shots Program begins to spin off innovation | MD Anderson Cancer Center



media

Personalized surgery
A new protocol for determining which ovarian cancer patients should proceed to surgery upfront and which need presurgical chemotherapy has radically increased the rate of complete surgical removal of tumors, an accomplishment that improves patient survival.

Under the MD Anderson algorithm developed by the moon shot, a patient receives a less-invasive laparoscopic evaluation, during which two surgeons independently rank the cancer’s spread to other organs. The resulting score guides the treatment decision.

Previously, virtually all new patients had surgery to explore the extent of disease and to remove as much of it as possible. Worldwide, this practice results in 20 to 30 percent of these patients achieving “complete gross resection.” In the first 155 cases in which the algorithm was followed, complete resection was achieved 89 percent of the time......
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MD Anderson’s David M. Gershenson, MD, Receives IGCS’s Award for Excellence in Gynecologic Oncology



David M. Gershenson

Houston, Texas -- For his myriad clinical, organizational and scientific accomplishments in the field of gynecologic oncology and the health and well-being of women, David M. Gershenson, M.D. has been recognized with the International Gynecology Cancer Society’s (IGCS) Award of Excellence.......
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Thursday, November 20, 2014

Dietary acrylamide and cancer risk: An updated meta-analysis



abstract

The debate on the potential carcinogenic effect of dietary acrylamide is open. In consideration of the recent findings from large prospective investigations, we conducted an updated meta-analysis on acrylamide intake and the risk of cancer at several sites.

Up to July 2014, we identified 32 publications. We performed meta-analyses to calculate the summary relative risk (RR) of each cancer site for the highest vs. lowest level of intake and for an increment of 10 µg/day of dietary acrylamide, through fixed-effects or random-effects models, depending on the heterogeneity test. Fourteen cancer sites could be examined. No meaningful associations were found for most cancers considered.

The summary RRs for high vs. low acrylamide intake were 0.87 for oral and pharyngeal, 1.14 for esophageal, 1.03 for stomach, 0.94 for colorectal, 0.93 for pancreatic, 1.10 for laryngeal, 0.88 for lung, 0.96 for breast, 1.06 for endometrial, 1.12 for ovarian, 1.00 for prostate, 0.93 for bladder, and 1.13 for lymphoid malignancies. The RR was of borderline significance only for kidney cancer (RR=1.20; 95% confidence interval, CI, 1.00-1.45).

All the corresponding continuous estimates ranged between 0.95 and 1.03, and none of them was significant. Among never-smokers, borderline associations with dietary acrylamide emerged for endometrial (RR=1.23; 95% CI, 1.00-1.51) and ovarian (RR=1.39; 95% CI, 0.97-2.00) cancers. This systematic review and meta-analysis of epidemiological studies indicates that dietary acrylamide is not related to the risk of most common cancers. A modest association for kidney cancer, and for endometrial and ovarian cancers in never smokers only, cannot be excluded.
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FIGO: Staging Classification for Cancer of the Ovary, Fallopian Tube, and Peritoneum: Estimation of Survival in Patients With Node-Positive Epithelial Ovarian Cancer



abstract

OBJECTIVE:

The objective of this study was to determine the survival of patients with node-positive epithelial ovarian cancer according to the 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system.

MATERIALS AND METHODS:

We performed a retrospective chart review. Data from all consecutive patients with node-positive epithelial ovarian cancer (stages IIIC and IV) who underwent cytoreductive surgery at the Mayo Clinic from 1996 to 2000 were reassessed to evaluate the prognostic significance of the new FIGO stages.......

CONCLUSIONS:

The current 2014 FIGO staging system for ovarian cancer successfully correlates survival, anatomical location of peritoneal metastases, and extra-abdominal lymph node metastases.
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testosterone in women - Google Scholar



search results since 2013
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(Lynch Syndrome patients) Editorial: ‘Discontent is the first necessity of progress’ (upper tract urothelial carcinoma)



BMJ Editorial

This study from Kaag et al. [1] investigates predictors of renal functional decline after radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC). They evaluate early (2 months) and late (6 months) predictors of renal functional decline, finding that on a multivariable model only age at surgery and preoperative renal function were independently associated with early postoperative function. This is an intuitive finding whereby we expect older patients and those with lower renal function to have a more dramatic decrease in renal function after RNU......


References
1 Kaag M, Trost L, Thompson RH et al. Pre-operative predictors of renal function decline following radical nephroureterectomy for upper tract urothelial carcinoma. BJU Int 2014; 114: 674–9
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FDA Puts Partial Hold on CytRx Cancer Drug Trials (Aldoxorubicin)



media

 By Reuters Staff
November 19, 2014

(Reuters) - CytRx Corp said the U.S. Food and Drug Administration placed a hold on enrolling new patients in clinical trials of its experimental cancer drug after a patient died, sending the company's shares down 11% in premarket trading.
The patient received the drug, aldoxorubicin, under the company's expanded access program that makes promising drugs and devices available to patients with serious diseases who do not qualify for the trials.
Patients already enrolled in the trials, currently in mid stage, will continue receiving the treatment, CytRx said.
The company said it would change its inclusion and exclusion criteria for new patients and add additional patient screening assessment, at the request of the FDA.
Aldoxorubicin is an improved version of the chemotherapy agent, doxorubicin, and it does not cause the side effects associated with doxorubicin such as heart muscle damage at higher doses and gastrointestinal disorders.
This means aldoxorubicin can be administered in higher doses than doxorubicin.
Aldoxorubicin is being tested for treating soft tissue sarcoma, small cell lung cancer, pancreatic cancer and a type of brain tumor.
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The prevalence and outcomes of frailty in older cancer patients: a systematic review



 Note: only 1 study included ovarian cancer patients (2007) with no outcomes reported:

(reference: Wedding [38] 2007 Germany 180 Outpatient Haematological, gastrointestinal,
lung, breast,ovary, other)

open access (download pdf)


 To our knowledge, this is the first review of the prevalence and outcomes of frailty in
older cancer patients. Three recent reviews [42–44] have investigated the use of
geriatric assessment in older cancer patients, mainly focusing on diagnostic accuracy, but none have investigated the identification of frailty to predict outcomes.


Conclusion

More than half of older cancer patients have pre-frailty or frailty and these patients are at increased risk of chemotherapy intolerance, postoperative complications and mortality. The findings of this review support routine assessment of frailty in older cancer patients to guide treatment decisions, and the development of multidisciplinary geriatric oncology services. 
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A new approach to integrate toxicity grade and repeated treatment cycles in the analysis and reporting of phase I dose-finding trials



Abstract

 More than 50% of phase I adverse drug reactions occur after the first cycle of treatment and moderate toxicities are an important source of information to investigate increasing probability of toxicity over time. Appropriate statistical modelling can be used to evaluate per cycle probability of moderate or severe toxicity, and cumulative probability of severe toxicity. Three situations were identified: Constant probability of toxicity over time and numerous repeated cycles provide a major gain in the precision of the estimate of the risk of toxicity at the RPD2. Increased risk of toxicity with time and numerous repeated cycles support reassessment of the RP2D that would be safe over the treatment period.

Background Safety assessment beyond the dose-limiting toxicity evaluation period provides relevant information to define the recommended phase II dose (RP2D) of a new treatment. We retrospectively analyzed three phase I trials to illustrate two indicators: per cycle probability of graded toxicity and cumulative probability of severe toxicity over the treatment period.
Patients and methods Data were collected from two continual reassessment method (CRM) trials (T1: aviscumine in solid tumors with short time on treatment; T2: erlotinib+radiotherapy in brainstem gliomas with longer time on treatment) and one 3+3 design (T3: liposomal doxorubicin+cyclophosphamide combination in ovarian carcinoma). The probability of severe and moderate or severe toxicity per cycle was estimated at each dose level
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Wednesday, November 19, 2014

Body fatness at adolescence, adult attained height and the development of tumours among persons with Lynch syndrome



World Cancer Research Fund

Plain language abstract

Background
Persons with Lynch Syndrome (LS) have an inherited mutation in certain genes, which results in a substantial increased lifetime risk of cancer. They are mainly at risk of cancer of the large bowel or of the uterus, but also of a range of other cancers, such as cancer of the ovaries, stomach, small bowel, pancreas, urinary tract, brain and possibly breast. Many of these types of cancer have convincingly been associated with greater body fatness and probably/convincingly with height in the general population. The influence of these factors on cancer risk may already start during childhood and adolescence. Linear growth and accumulation of both lean and fat tissue during that critical period, represented by height and body mass index (BMI) at age 18-20 years, has never been investigated in relation to overall cancer risk among persons with LS.
Aims and Objectives
We propose to study BMI at age 18-20 years and height in relation to risk of overall, large bowel and uterus cancer among persons with LS. In addition, we will evaluate these relationships within specific subgroups, such as in men and women separately.
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(Lynch Syndrome) High prevalence of MMR deficiency in prostate cancers



abstract

The question of whether prostate cancer is part of the Lynch syndrome spectrum of tumors is unresolved. We investigated the mismatch repair (MMR) status and pathologic features of prostate cancers diagnosed in MMR gene mutation carriers. Prostate cancers (mean age at diagnosis = 62 ± SD = 8 years) from 32 MMR mutation carriers (23 MSH2, 5 MLH1 and 4 MSH6) enrolled in the Australasian, Mayo Clinic and Ontario sites of the Colon Cancer Family Registry were examined for clinico-pathologic features and MMR-deficiency (immunohistochemical loss of MMR protein expression and high levels of microsatellite instability; MSI-H).

Tumor MMR-deficiency was observed for 22 cases [69 %; 95 % confidence interval (CI) 50-83 %], with the highest prevalence of MMR-deficiency in tumors from MSH2 mutation carriers (19/23, 83 %) compared with MLH1 and MSH6 carriers combined (3/9, 33 %; p = 0.01). MMR-deficient tumors had increased levels of tumor infiltrating lymphocytes compared with tumors without MMR-deficiency (p = 0.04). Under the assumption that tumour MMR-deficiency occurred only because the cancer was caused by the germline mutation, mutation carriers are at 3.2-fold (95 % CI 2.0-6.3) increased risk of prostate cancer, and when assessed by gene, the relative risk was greatest for MSH2 carriers (5.8, 95 % CI 2.6-20.9). Prostate cancer was the first or only diagnosed tumor in 37 % of carriers. MMR gene mutation carriers have at least a twofold or greater increased risk of developing MMR-deficient prostate cancer where the risk is highest for MSH2 mutation carriers. MMR IHC screening of prostate cancers will aid in identifying MMR gene mutation carriers
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Google notes the growing impact of older articles



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The lung-restricted marker napsin a is highly expressed in clear cell carcinomas of the ovary



abstract

 From PhenoPath Laboratories, PLLC, Seattle, WA, and CellNetix Pathology and Laboratories, Seattle, WA. cisacson@cellnetix.com.

OBJECTIVES:

We recently observed expression of the "lung" marker napsin A in ovarian clear cell carcinomas and therefore sought to determine the extent of napsin A expression in a subset of ovarian neoplasms.

METHODS:

We identified an archival series of ovarian clear cell carcinomas (n = 36), serous borderline tumors (n = 21), high-grade serous carcinomas (n = 37), and endometrioid adenocarcinomas (n = 29). Using standard immunohistochemical techniques on whole sections of formalin-fixed, paraffin-embedded specimens, we employed a panel of antibodies: napsin A (IP64), estrogen receptor (SP1), WT-1 (6F-H2), PAX-8 (BC12), and TTF-1 (SPT24).

RESULTS:

Thirty-six of 36 clear cell carcinomas showed napsin A expression, typically in a uniform pattern. None of the serous borderline tumors or high-grade serous carcinomas manifested napsin A expression. Napsin A was expressed in three (10%) of 29 endometrioid adenocarcinomas, generally in a focal pattern.

CONCLUSIONS:

Our study showed that napsin A is an extremely sensitive (100%) marker of ovarian clear cell carcinomas and exhibits very high specificity (100%) in distinguishing clear cell carcinomas from high-grade serous carcinomas and serous borderline tumors and 90% specificity in discriminating clear cell carcinomas from endometrioid carcinomas.
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Cancer antigen 125 after delivery in women with a normal pregnancy



abstract


OBJECTIVE:

To establish reference intervals for cancer antigen 125 (CA-125) in women with expected normal pregnancy, delivery, and early postpartum period.

DESIGN:

Prospective observational study.

POPULATION:

Eight hundred and one women with expected normal pregnancies were investigated. Of these, 640 delivered vaginally, 82 by emergency cesarean section, and 79 by elective cesarean section; 720 women had uncomplicated pregnancies.

METHODS:

Samples were collected at gestational weeks 13-20, 21-28, 29-34, 35-42, during labor, and on first and second day postpartum. Reference intervals were calculated for each gestational period as recommended by the International Federation of Clinical Chemistry and Laboratory Medicine.

MAIN OUTCOME MEASURES:

Concentration of serum CA-125 during the gestational period and around delivery.

RESULTS:

CA-125 was fairly stable below 35 U/mL during pregnancy but increased markedly during vaginal delivery, to a minor degree during emergency cesarean section, and only slightly during elective cesarean section. In the early postpartum period, CA-125 decreased with an apparent half-life of 24 h.

CONCLUSIONS:

The CA-125 cut-off value (<35 U/mL) used for non-pregnant women can be used for women during pregnancy after gestational week 13 as a supplement to ultrasound evaluation of ovarian cysts. The wide range of CA-125 concentration during normal pregnancies makes it unlikely that small fluctuations in CA-125 can be clinically useful for identifying other conditions. Measuring CA-125 around the time of delivery is not recommended. Gestational age-specific reference intervals during normal pregnancy are not needed.
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Relevance and efficacy of breast cancer screening in BRCA1/2 60 years+



abstract

Annual MRI and mammography is recommended for BRCA1/2 mutation carriers to reduce breast cancer mortality. Less intensive screening is advised ≥60 years, although effectiveness is unknown. We identified BRCA1/2 mutation carriers without bilateral mastectomy before age 60 to determine for whom screening ≥60 is relevant, in the Rotterdam Family Cancer Clinic and HEBON: a nationwide prospective cohort study. Furthermore, we compared tumour stage at breast cancer diagnosis between different screening strategies in BRCA1/2 mutation carriers ≥60. Tumours >2 cm, positive lymph nodes, or distant metastases at detection were defined as “unfavourable.”

Of 548 BRCA1/2 mutation carriers ≥60 years in 2012, 395 (72%) did not have bilateral mastectomy before the age of 60. Of these 395, 224 (57%) had a history of breast or other invasive carcinoma. In 136 BRCA1/2 mutation carriers, we compared 148 breast cancers (including interval cancers) detected ≥60, of which 84 (57%) were first breast cancers. With biennial mammography 53% (30/57) of carcinomas were detected in unfavourable stage, compared to 21% (12/56) with annual mammography (adjusted odds ratio: 4·07, 95% confidence interval [1.79-9.28], p = 0.001). With biennial screening 40% of breast cancers were interval cancers, compared to 20% with annual screening (p = 0.016). Results remained significant for BRCA1 and BRCA2 mutation carriers, and first breast cancers separately.

Over 70% of 60-year old BRCA1/2 mutation carriers remain at risk for breast cancer, of which half has prior cancers. When life expectancy is good, continuation of annual breast cancer screening of BRCA1/2 mutation carriers ≥60 is worthwhile.
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Impact of a paternal origin of germline BRCA1/2 mutations on the age at breast and ovarian cancer diagnosis



abstract

Three studies have reported that BRCA1/2 mutations of paternal origin confer an earlier age at breast cancer diagnosis compared with maternal origin. The primary aim of this study was to investigate the impact of parental origin of BRCA1/2 mutations on age at breast and ovarian cancer diagnosis.

This study included 577 female BRCA1/2 mutation carriers. All BRCA1/2 mutation carriers belonged to families registered between 1993 and 2011 at the Oncogenetic Clinic at Skånes University Hospital, Lund, Sweden. Cox proportional hazard ratios were used to analyze time to breast or ovarian cancer diagnosis. A novel finding was that carriers of BRCA1 mutations of paternal origin were 4 years older at age of ovarian cancer (P = 0.009) compared with those carrying a BRCA1 mutation of maternal origin. BRCA1 carriers with mutations of paternal origin were 4 years younger at breast cancer diagnosis (P = 0.017) compared with those carrying a BRCA1 mutation of maternal origin, which is in agreement with three previous studies. Both findings were adjusted for of year of inclusion, birth date, and oral contraceptive pill use. No associations between parental origin of BRCA2 mutations and time to breast or ovarian cancer diagnosis were found. An attempt to handle a potential selection bias regarding use of oral contraceptives was made using multiple imputations by chained equations. The observed age difference may allow a greater understanding of mechanisms associated with the differences in cancer penetrance in BRCA1/2 mutation carriers, some of which may depend on paternal origin.
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Endogenous androgens and risk of epithelial invasive ovarian cancer by tumor characteristics



abstract

 The role of endogenous androgens and sex hormone-binding globulin (SHBG) in ovarian carcinogenesis is poorly understood.

Epithelial invasive ovarian cancer (EOC) is a heterogeneous disease and there are no prospective data on endogenous androgens and EOC risk by tumor characteristics (histology, grade, stage) or the dualistic model of ovarian carcinogenesis (i.e. type I vs. type II, leading to less or more aggressive tumors).

We conducted a nested case–control study in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort evaluating androgens and SHBG and invasive EOC risk by tumor characteristics. Female participants who provided a blood sample and were not using exogenous hormones at blood donation were eligible (n = 183,257). A total of 565 eligible women developed EOC; two controls (n = 1,097) were matched per case. We used multivariable conditional logistic regression models. We observed no association between androgens, SHBG and EOC overall. A doubling of androstenedione reduced risk of serous carcinomas by 21% (odds ratio (OR)log2 = 0.79, 95% confidence interval [CI] = [0.64–0.97]). Moreover, associations differed for low-grade and high-grade carcinomas, with positive associations for low-grade and inverse associations for high-grade carcinomas (e.g. androstenedione: low grade: ORlog2 = 1.99 [0.98–4.06]; high grade: ORlog2 = 0.75 [0.61–0.93], phet  ≤ 0.01), similar associations were observed for type I/II tumors.

This is the first prospective study to evaluate androgens, SHBG and EOC risk by tumor characteristics and type I/II status. Our findings support a possible role of androgens in ovarian carcinogenesis. Additional studies exploring this association are needed.
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HIPEC ROC I: A phase 1 study of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion followed by postop IV platinum-based chemo in pts with platinum-sensitive recurrent OC



abstract

This phase I study tested the safety, feasibility, pharmacokinetics and pharmacodynamics of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion (HIPEC) in patients with platinum-sensitive recurrent epithelial ovarian cancer (EOC) undergoing secondary cytoreductive surgery followed by postoperative platinum-based intravenous chemotherapy. Twelve patients with operable, recurrent platinum-sensitive EOC (recurrence ≥6 months after first-line therapy) were included according to the classical 3+3 dose-escalation design at three dose levels—60, 80 and 100 mg/m2. After surgical cytoreduction, a single dose of cisplatin was administered via HIPEC for 90 min at 41–43°C.

Postoperatively, all patients were treated with standard intravenous platinum-based combination chemotherapy. One of six patients experienced a dose-limiting toxicity (grade 3 renal toxicity) at a dose of 100 mg/m2. The remaining five patients treated with 100 mg/m2 tolerated their treatment well. The recommended phase II dose was established at 100 mg/m2. The mean peritoneal-to-plasma AUC ratio was 19·5 at the highest dose level. Cisplatin-induced DNA adducts were confirmed in tumor samples.

Common postoperative grade 1–3 toxicities included fatigue, postoperative pain, nausea, and surgical site infection. The ability to administer standard intravenous platinum-based chemotherapy after HIPEC was uncompromised. Cisplatin administered as HIPEC at a dose of 100 mg/m2 has an acceptable safety profile in selected patients undergoing secondary cytoreductive surgery for platinum-sensitive recurrent EOC. Favorable pharmacokinetic and pharmacodynamic properties of HIPEC with cisplatin were confirmed at all dose levels, especially at 100 mg/m2. The results are encouraging to determine the efficacy of HIPEC as a complementary treatment in patients with EOC.
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Canadians want patient online healthcare options



 Longwoods


Eight in 10 Canadian adults want online access to their own health information yet fewer than one in 10 currently have it, according to a new study published in HealthcarePapers.
The gap is just as wide for other patient online services, such as booking appointments, e-visits, or requesting prescription renewals or refills online; Canadians want them all, but most aren't getting them......

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Tuesday, November 18, 2014

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Monday, November 17, 2014

Do Movember and other charity campaigns really help raise awareness?



medical news
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Swiss biotech starts breakthrough anti-cancer clinical trial based on active immunotherapy - MVX-ONCO-1



medical news

.... The phase 1 trial in Geneva is due for completion in the middle of 2015. Assuming a successful outcome, the company plans to conduct multi-centre clinical phase IIa trials in Europe in 2015-2017. The goal is to establish the cancer-specific treatment efficacy and safety of MVX-ONCO-1 in larger lung, ovarian and pancreatic cancer patient populations. The company is conducting a new financing round with existing and new private investors to support these clinical programs.......

About MVX-ONCO-1
MaxiVAX' novel Immuno-Oncology therapy is based on triggering the patient's own natural immune response mechanism via an innovative and proprietary technology in order to eliminate the cancer cells. MVX-ONCO-1 has been classified as an Advanced Therapeutic Medicinal Product by the European Medicines Agency.
MVX-ONCO-1 consists of a two-component system:
1) Vaccine: administered by sub-cutaneous injection, this uses the patient's own irradiated cancer cells as vaccine antigens, with a key benefit of using the entire set of tumor antigens from the patient's cell
2) Immune boosting agent: an immune boosting agent (GM-CSF: granulocyte-macrophage colony stimulating factor) is continuously delivered via encapsulated cells. The capsule, a small hollow fibre, is placed underneath the skin at the same site as the vaccine injection.
The vaccine and the immune-booster are both being administered 6 times over a period of 8 weeks in this first clinical trial.
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Clinicopathological heterogeneity in ovarian clear cell adenocarcinoma: a study on individual therapy practice (Japan)



abstract


 Ovarian clear cell adenocarcinoma (CCA) has been believed to be a lethal histological subtype of an epithelial ovarian adenocarcinoma (EOA); its precursor has been assumed to be endometriosis. However, it has been reported that CCAs occasionally exhibit different clinical behaviors, suggesting that CCAs might not belong to a single category. We focused on CCAs combined with other histological types of EOAs; we re-evaluated the pathology of 46 CCAs and divided them into two subgroups: 35 CCAs alone (pure-type CCAs); and 11 CCAs with other histological types, endometrioid adenocarcinomas (EAs) or/and serous adenocarcinomas (SAs) (mixed-type CCAs). Immunohistochemical analysis for expression of ARID1A, p53, PTEN, Annexin 4, hepatocyte nuclear factor-1β (HNF-1β), and WT-1 was employed.

We identified that patients with endometriosis were younger than those without endometriosis in pure-type CCAs (P < 0.005). In mixed-type CCAs, the immunohistochemical-staining patterns revealed internal transition of each histological component. In pure-type CCAs, expressions of ARID1A and p53 were mutually altered, and altered expression of p53 was associated with worse prognosis than that of ARID1A (P < 0.001). Our results provide evidence that CCAs would have clinicopathological heterogeneity, determining the patient's prognosis. Furthermore, immunohistochemical analysis may shed light on the selection of appropriate treatment, including chemotherapy.
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Quality of Cancer Pain Management: An Update of a Systematic Review of Undertreatment of Patients With Cancer



abstract

Conclusion Analysis of 46 articles published from 1994 to 2013 using the PMI to assess the adequacy of analgesic therapy suggests the quality of pharmacologic pain management has improved. However, approximately one third of patients still do not receive pain medication proportional to their pain intensity. 
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Prognosis and Conditional Disease-Free Survival Among Patients With Ovarian Cancer



abstract

Purpose Traditional disease-free survival (DFS) does not reflect changes in prognosis over time. Conditional DFS accounts for elapsed time since achieving remission and may provide more relevant prognostic information for patients and clinicians. This study aimed to estimate conditional DFS among patients with ovarian cancer and to evaluate the impact of patient characteristics. 

Patients and Methods Patients were recruited as part of the Hormones and Ovarian Cancer Prediction case-control study and were included in the current study if they had achieved remission after a diagnosis of cancer of the ovary, fallopian tube, or peritoneum (N = 404). Demographic and lifestyle information was collected at enrollment; disease, treatment, and outcome information was abstracted from medical records. DFS was calculated using the Kaplan-Meier method. Conditional DFS estimates were computed using cumulative DFS estimates. 

Results Median DFS was 2.54 years (range, 0.03-9.96 years) and 3-year DFS was 48.2%. The probability of surviving an additional 3 years without recurrence, conditioned on having already survived 1, 2, 3, 4, and 5 years after remission, was 63.8%, 80.5%, 90.4%, 97.0%, and 97.7%, respectively. Initial differences in 3-year DFS at time of remission between age, stage, histology, and grade groups decreased over time. 

Conclusion DFS estimates for patients with ovarian cancer improved dramatically over time, in particular among those with poorer initial prognoses. Conditional DFS is a more relevant measure of prognosis for patients with ovarian cancer who have already achieved a period of remission, and time elapsed since remission should be taken into account when making follow-up care decisions.

Footnotes

  • (6.29 minutes) Listen to the podcast by Dr. Iasonos at www.jco.org/podcasts
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Impact of Spin in the Abstracts of Articles Reporting Results of Randomized Controlled Trials in the Field of Cancer: The SPIIN Randomized Controlled Trial



abstract


Purpose We aimed to assess the impact of spin (ie, reporting to convince readers that the beneficial effect of the experimental treatment is greater than shown by the results) on the interpretation of results of abstracts of randomized controlled trials (RCTs) in the field of cancer.

Conclusion Spin in abstracts can have an impact on clinicians' interpretation of the trial results.
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Racial and Ethnic Disparities in Patient-Provider Communication, Quality-of-Care Ratings, and Patient Activation Among Long-Term Cancer Survivors



abstract


Purpose We examined racial and ethnic disparities in patient-provider communication (PPC), perceived care quality, and patient activation among long-term cancer survivors. 

Methods In 2005 to 2006, survivors of breast, prostate, colorectal, ovarian, and endometrial cancers completed a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic white (white) survivors who had seen a physician for follow-up care in the past 2 years (n = 1,196) composed the analytic sample........

Conclusion Asian survivors report poorer follow-up care communication and care quality. More research is needed to identify contributing factors beyond PPC, such as cultural influences and medical system factors.

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PISCES Trial: The End Does Not Always Justify the Means (patient preferences)



Note: interesting commentary-  debatable of course (not specific to OC but an example of research/patient preferences

Correspondence

Original study
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American Society of Clinical Oncology Policy Statement on Medicaid Reform



open access
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imbedded video (Lynch Syndrome patients) Colon Cancer Surgery Live on Twitter (Dr Shady Ashamalla et al)



I
Follow @Sunnybrook #SBcancer - Sunnybrook Hospital

Note: (repost) also included is short video: Dr Shady Ashamalla  

 
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add your opinions Ashamalla , Sunnybrook , tweet

Sunday, November 16, 2014

Oncolytic measles virus expressing the sodium iodide symporter to treat drug-resistant ovarian cancer



abstract


Edmonston vaccine strains of measles virus (MV) have significant antitumor activity in mouse xenograft models of ovarian cancer (OvCa). MV engineered to express the sodium iodide symporter gene (MV-NIS) facilitates localization of viral gene expression and offers a tool for tumor radiovirotherapy......

.....Here we report results from a clinical evaluation of MV-NIS delivery in patients with taxol and platinum resistant OvCa. MV-NIS was given intraperitoneally every 4 wk for up to 6 cycles. ........... Our findings support further clinical evaluation of MV-NIS as an effective viral immunotherapy.
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open access: (EMBRACE) Germline mutation in BRCA1 or BRCA2 and ten-year survival for women diagnosed with epithelial ovarian cancer



open access
(see below)

Purpose:To analyse the effect of germline mutations in BRCA1 and BRCA2 on mortality in ovarian cancer patients up to ten years after diagnosis. 

Conclusions: BRCA1/2 mutations are associated with better short-term survival, but this advantage decreases over time and, in BRCA1 carriers is eventually reversed. This may have important implications for therapy of both primary and relapsed disease and for analysis of long-term survival in clinical trials of new agents, particularly those that are effective in BRCA1/2 mutation carriers. 

 Published OnlineFirst November 14, 2014; doi: 10.1158/1078-0432.CCR-14-2497
  1. » Abstract
  2. Full Text (PDF)
  3. Supplementary Data
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Sandi Pniauskas Ovarian Cancer and Us

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Read This:

  • 1: Not Qualified A Patient's Perspective Author: Sandi Pniauskas published Journal of Gynecologic Oncology
  • 2: Wait Times in the Real World
  • 3. Ovarian Cancer: Let Me In!
  • 4. Ovarian Cancer presentation: Survivors' Debate presentation
  • 5. Canadian Survivor Awarded "Pulitzer Prize" of Ovarian Cancer Advocacy
  • 6. IN YOUR OWN WORDS : unedited stories by ovarian cancer women and their carers (OWHN)

SURVIVORS' DEBATE: The Past Decade in Ovarian Cancer

  • Video excerpts: Survivors' Debate: The Past Decade in Ovarian Cancer

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