- •We define and validate an ovarian cancer risk classifier for post-menopausal women using data from the Women's Health Initiative study.
- •Serum markers and epidemiologic factors classified 13% of women as elevated risk and identified 30% of ovarian cancers (HR = 2.6, p-value < 0.001).
Tuesday, September 15, 2015
A pilot study of JI-101, an inhibitor of VEGFR-2, PDGFR-β, and EphB4 receptors, in combination with everolimus and as a single agent in an ovarian cancer expansion cohort
Abstract
A pilot study of JI-101, an inhibitor of VEGFR-2, PDGFR-β, and EphB4 receptors, in combination with everolimus and as a single agent in an ovarian cancer expansion cohort.
JI-101 is an oral multi-kinase inhibitor that targets vascular endothelial growth factor receptor type 2 (VEGFR-2), platelet derived growth factor receptor β (PDGFR-β), and ephrin type-B receptor 4 (EphB4). None of the currently approved angiogenesis inhibitors have been reported to inhibit EphB4, and therefore, JI-101 has a novel mechanism of action. We conducted a pilot trial to assess the pharmacokinetics (PK), tolerability, and efficacy of JI-101 in combination with everolimus in advanced cancers, and pharmacodynamics (PD), tolerability, and efficacy of JI-101 in ovarian cancer.
Ovarian Chat: #GenomicsChat Sept 16th 12 pm EST
Cancer Treatment Centers of America
Sign Up Today For Our #GenomicsChat
Join CTCA expert Dr. Markman on September 16th at 12 p.m. EST
Thursday, September 10, 2015
Wednesday, September 09, 2015
September Is (teal) National Ovarian Cancer Awareness Month
September
1 In 72 Women Are Diagnosed With Ovarian Cancer
85% Of Women Are Diagnosed In The Later Stages
Learn the signs of early detection and more about SROCF and their events at www.sandyovarian.org.
Releasing the Brakes on Cancer Immunotherapy — NEJM
full text
.... In the history of cancer treatment, there will be a full chapter dedicated to unleashing the immune system by releasing its negative regulatory checkpoints. That chapter will start with the seminal studies by Allison involving blocking CTLA-4 in mouse models. As the successful clinical development of ipilimumab and PD-1 and PD-L1 blocking antibodies has shown, Allison's early insight was correct: “What we needed to do was to release the brakes of the immune system to fight cancer.” The obvious risk as we push the limits of this approach to cancer treatment is the appearance of autoimmune side effects, which can be serious. But by learning how to safely utilize combinations of immune activators and checkpoint inhibitors, we should be able to expand the potential of immunotherapy for cancer.
Safety and Antitumor Activity of Anti–PD-1 Antibody, Nivolumab, in Patients With Platinum-Resistant Ovarian Cancer
abstract
Purpose Programmed
death-1 (PD-1), a coinhibitory immune signal receptor expressed in T
cells, binds to PD-1 ligand and regulates
antitumor immunity. Nivolumab is an anti–PD-1
antibody that blocks PD-1 signaling. We assessed the safety and
antitumor activity
of nivolumab in patients with platinum-resistant
ovarian cancer.
Patients and Methods
Twenty patients with platinum-resistant ovarian cancer were treated with
an intravenous infusion of nivolumab every 2 weeks
at a dose of 1 or 3 mg/kg (constituting two
10-patient cohorts) from October 21, 2011. This phase II trial defined
the primary
end point as the best overall response. Patients
received up to six cycles (four doses per cycle) of nivolumab treatment
or
received doses until disease progression
occurred. Twenty nivolumab-treated patients were evaluated at the end of
the trial
on December 7, 2014.
Results Grade 3 or 4
treatment-related adverse events occurred in eight (40%) of 20 patients.
Two patients had severe adverse events.
In the 20 patients in whom responses could be
evaluated, the best overall response was 15%, which included two
patients who
had a durable complete response (in the 3-mg/kg
cohort). The disease control rate in all 20 patients was 45%. The median
progression-free
survival time was 3.5 months (95% CI, 1.7 to 3.9
months), and the median overall survival time was 20.0 months (95% CI,
7.0
months to not reached) at study termination.
Conclusion This study,
to our knowledge, is the first to explore the effects of nivolumab
against ovarian cancer. The encouraging safety
and clinical efficacy of nivolumab in patients
with platinum-resistant ovarian cancer indicate the merit of additional
large-scale
investigations (UMIN Clinical Trials Registry
UMIN000005714).
Identifying post-menopausal women at elevated risk for epithelial ovarian cancer
abstract
Highlights
Abstract
Objective
We developed and validated a hybrid risk classifier combining serum markers and epidemiologic risk factors to identify post-menopausal women at elevated risk for invasive fallopian tube, primary peritoneal, and ovarian epithelial carcinoma.Methods
To select epidemiologic risk factors for use in the classifier, Cox proportional hazards analyses were conducted using 74,786 Women's Health Initiative (WHI) Observational Study (OS) participants. To construct a combination classifier, 210 WHI OS cases and 536 matched controls with serum marker measurements were analyzed; validation employed 143 cases and 725 matched controls from the WHI Clinical Trial (CT) with similar data.Results
Analyses identified a combination risk classifier composed of two elevated-risk groups: 1) women with CA125 or HE4 exceeding a 98% specificity threshold; and 2) women with intact fallopian tubes, prior use of menopausal hormone therapy for at least two years, and either a first degree relative with breast or ovarian cancer or a personal history of breast cancer. In the WHI OS population, it classified 13% of women as elevated risk, identifying 30% of ovarian cancers diagnosed up to 7.8 years post-enrollment (Hazard Ratio [HR] = 2.6, p < 0.001). In the WHI CT validation population, it classified 8% of women as elevated risk, identifying 31% of cancers diagnosed within 7 years of enrollment (HR = 4.6, p < 0.001).Conclusion
CA125 and HE4 contributed significantly to a risk prediction classifier combining serum markers with epidemiologic risk factors. The hybrid risk classifier may be useful to identify post-menopausal women who would benefit from timely surgical intervention to prevent epithelial ovarian cancer.Nutrients: The Diverse Forms of Lactose Intolerance and the Putative Linkage to Several Cancers
open access
Abstract
Keywords:
lactase-phlorizin hydrolase; alactasia; adult type of hypolactasia;
lactose intolerance; colorectal cancer; ovarian cancer; prostate cancer1. Introduction
The main sources of energy in our daily diet are carbohydrates, like starch, sucrose or lactose. The breakdown of starch molecules requires preliminary digestion by salivary and pancreatic amylases......Colorectal, ovarian and prostate cancers are the most common cancer types in which a protective or adverse effect of milk and dairy foods has been investigated and discussed for a long time [104,105,106,107].
.....On the other side, several publications are found that do not support a correlation of milk consumption with ovarian cancer......
Tuesday, September 08, 2015
Efficacy & Safety Assessment of the Addition of Bevacizumab to Adjuvant Therapy Agents in Cancer Patients
open access:
Efficacy and Safety Assessment of the Addition of Bevacizumab to Adjuvant Therapy Agents in Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Aim
To evaluate the efficacy and safety of bevacizumab in the adjuvant cancer therapy setting within different subset of patients.
Abstract
A novel POLE mutation associated with cancers of colon, pancreas, ovaries and small intestine
open access
..... The first predisposing mutation identified in POLE (c.1270C>G, p.Leu424Val) was associated with colorectal cancer only, but another mutation with a broader tumour spectrum (c.1089C>A, p.Asn363Lys) has recently been reported. In the family described in the present study, carriers generally have multiple colorectal adenomas and cancer of colon, pancreas, ovaries and small intestine which represents an important broadening of the tumour spectrum of POLE mutation carriers...
Clinical characterization and mutation spectrum in Caribbean Hispanic families with Lynch syndrome
Cabstract
Lynch syndrome (LS) is an inherited form of colorectal cancer (CRC) caused by germline mutations in the mismatch repair (MMR) genes. It accounts for approximately 5 % of all CRCs. The prevalence of LS among US Hispanics is unknown. The objective of this study was to describe the germline mutations of LS in Caribbean Hispanics from Puerto Rico and Dominican Republic. A total of 89 subjects were recruited through the Puerto Rico Familial Colorectal Cancer Registry and were classified according to Amsterdam and Bethesda clinical guidelines. For those tumors with lack of expression of MMR protein, gene sequencing was ordered. A total of 35 individuals with deficient MMR system were identified: 22 had MMR mutations and 13 had tumors with absent MMR protein expression. Our results show that the mutation spectrum of Caribbean Hispanic LS patients was composed mostly of MSH2 (66.7 %) mutations, followed by MLH1 (25.0 %). One mutation was identified in MSH6 (8.3 %). A previously unidentified mutation in MLH1 gene c.2044_2045del was found in one Caribbean Hispanic family. MMR mutation-positive individuals were found to be more likely to have a prominent family history of CRC and tumors located at the proximal colon. Compared to MSH2 mutation carriers, MLH1 mutation-positive individuals were more likely to have a strong family history of CRC and LS associated cancers. Furthermore, insurance coverage for genetic testing was found to be limited in the study population with 65.1 % of the individuals recruited were denied coverage. This report presents the first description of the mutation spectrum and clinicopathologic characteristics of LS Caribbean Hispanics patients.
Validation of an online questionnaire for identifying people at risk of familial and hereditary colorectal cancer
open access
Lynch syndrome associated tumors: carcinoma of the endometrium, stomach, small intestines, pancreas, bile ducts, renal pelvis, ureters, ovaries, brain and carcinoma or adenoma of the sebaceous gland
Introduction
Colorectal cancer (CRC) is the
second most prevalent type of cancer in the Netherlands with more than
13.000 newly diagnosed patients per year [1]. The lifetime risk of developing CRC in a Western population is 5–6 % [1–3]. Of all CRC cases, 15–20 % are related to familial or hereditary factors [4–6].
The most common form of inherited CRC is Lynch syndrome, which comprises 2–4 % of all CRC cases [7].
This syndrome is caused by an inherited mutation in one of the mismatch
repair genes and is characterized by a predisposition to develop CRC
and several extra-intestinal malignancies, such as endometrial, gastric
and ovarian cancer, at a relatively young age [8, 9].
Lynch syndrome is usually suspected based on the internationally used
Amsterdam I and II criteria and the Revised Bethesda criteria [10, 11].
Other hereditary types of CRC include several polyposis syndromes, such
as familial adenomatous polyposis (FAP) and MUTYH-associated polyposis.
In familial CRC patients no genetic
mutation can be found. The definition of this syndrome is based on the
number and age at diagnosis of relatives with CRC. Patients who are
suspected of having an inherited CRC syndrome in whom no genetic
mutation is found can also be referred to as familial CRC patients [10, 11]. These patients have a threefold or higher risk of developing CRC [10, 11].
International guidelines recommend surveillance colonoscopies for both patients with familial CRC or Lynch syndrome [10–13]....." We believe online questionnaires are to be preferred over paper questionnaires as they are easier and less expensive to use and can be used on a large scale [25, 38, 40, 41]. In several studies self-administered answers in online questionnaires were shown not to differ from answers to paper questionnaires [42, 43]."
Risk factors for endometrial cancer among women with a BRCA1 or BRCA2 mutation: a case control study
abstract
BRCA
mutation carriers may use tamoxifen for breast cancer prevention or
treatment. Hormone replacement therapy is often prescribed after
surgical menopause and oral contraceptives are recommended for ovarian
cancer prevention. The objective of this study was to assess the impact
of these medications and other risk factors on endometrial cancer risk
in BRCA carriers. Women with a BRCA1 or BRCA2
mutation were identified from a registry of mutation carriers. Cases
were 83 women who had a diagnosis of endometrial cancer. Controls were
1027 matched women who did not develop endometrial cancer and who had an
intact uterus. All women completed a baseline questionnaire, which
included questions about ages at menarche and menopause, oral
contraceptive use, hormone replacement therapy use, hysterectomy,
oophorectomy, breast cancer history and tamoxifen use. We estimated the
odds ratio associated with each risk factor in a multivariate analysis.
No differences were found between cases and controls in terms of age at
menarche, BMI, smoking, or oral contraceptive use. In a multivariate
analysis, for women taking estrogen-only hormone replacement therapy,
the odds ratio was 0.23 (95 % CI 0.03–1.78, p = 0.16), and for women taking progesterone-only hormone replacement therapy the odds ratio was 6.91 (95 % CI 0.99–98.1, p = 0.05).
The adjusted odds ratio for endometrial cancer associated with a
history of tamoxifen use was 3.50 (95 % CI 1.51–8.10, p = 0.003). The observed increased risk of endometrial cancer associated with progesterone-only therapy merits further study.
Sunday, September 06, 2015
Diagnostic outcome of ureteroscopy in urothelial carcinoma of the upper urinary tract
Blogger's Note: genetic component/s was not part of this study
Full text
Diagnostic outcome of ureteroscopy in urothelial carcinoma of the upper urinary tract: Incidence of later cancer detection and its risk factors after the first examination
Background
To determine the incidence of later cancer detection and its risk factors after the
first diagnostic ureteroscopy.
Conclusion
Later cancer detection of UC of the UUT was not uncommon after the first examination.
Risk analysis revealed that episodes of gross hematuria (p = 0.0048) and abnormal
cytological findings (p = 0.0335) during the follow-up and a male sex (p = 0.0316)
were adverse risk factors.
Treatment of climacteric symptoms in survivors of gynaecological cancer (menopause symptoms)
abstract
Different treatments (surgery, radiotherapy, chemotherapy) for gynaecological cancers may cause ovarian failure or increase menopausal symptoms. There is a widespread reluctance among physicians to prescribe hormone replacement therapy (HRT) to the survivors of gynaecological cancer. This review analyses the use of HRT and of alternative therapies in such women. Squamous cervical cancer is not estrogen dependent and thus HRT is not contraindicated. While a cautious approach to hormone-dependent cancer is warranted, for women treated for non-hormone-related tumours alternative treatments for menopausal symptoms should be given due consideration, as any reluctance to prescribe HRT for them has neither a biological nor a clinical basis. In studies of HRT for survivors of endometrial and ovarian cancer, for instance, no evidence of increased risk was found, although no definitive conclusions can yet be formulated. The positive effect of HRT on quality of life seems to outweigh the unfounded suspicion of an increased risk of recurrence of non-hormone-related tumours. Effective non-hormonal alternatives for vasomotor symptoms are selective serotonin reuptake inhibitors and selective serotonin-norepinephrine reuptake inhibitors.
A Model for Estimating Ovarian Cancer Risk: Application for Preventive Oophorectomy
Abstract
OBJECTIVE:
It is important to identify women in the population who have a high risk of ovarian cancer and who might benefit from prophylactic bilateral salpingo-oophorectomy. The probability that a woman will develop ovarian cancer depends on her current age, her reproductive history and her genetic status.METHODS:
We simulated the distribution of ovarian cancer risk for the 2011 Ontario female population. We generated (at random) individual risks of ovarian cancer to age 80 for 6,301,340 women, based on the published risk factors, mutation frequencies and population age-specific incidence rates (SEER database). Risk factors included parity, breastfeeding, oral contraceptives, tubal ligation and family history. Genetic factors included 11 single nucleotide polymorphisms (SNPs) and BRCA1/2 mutations.RESULTS:
Of the 6,301,340 women simulated as the general population of Ontario, the (complete) model predicts that 65,805 women (1.0%) will develop ovarian cancer by age 80. There were 46,069 women (0.7%) with a risk of ovarian cancer above 5%. BRCA1/2 mutation carriers accounted for 67.4% of the women at greater than 5% risk (31,028 women). Among ovarian cancer patients at greater than 5% risk, a BRCA1/2 mutation was present in 89.2%. In contrast, SNPs contribute to a very small proportion of the ovarian cancer patients who were at greater than 5% risk.CONCLUSIONS:
Approximately 12.9% of all ovarian cancers in Ontario occur in the 0.7% of women in the general population who have a lifetime ovarian cancer risk in excess of 5%, the majority of whom carry a mutation in BRCA1 or BRCA2.Saturday, September 05, 2015
Recurrence of Venous Thromboembolism in Patients With Cancer Treated With Warfarin
abstract
Venous thromboembolism (VTE) is a common complication in patients with cancer. Previous randomized studies have demonstrated that the rates of recurrent VTE are lower in patients treated with low-molecular-weight heparin compared to warfarin. We performed a retrospective analysis of 236 patients with cancer managed by a dedicated oncology anticoagulation management service to compare “real-world” rates of recurrent VTE and bleeding in patients treated with warfarin versus parenteral anticoagulants. Initial anticoagulant regimen included a parenteral agent with transition to warfarin in 132 (55.9%) patients, enoxaparin in 53 (22.5%), dalteparin in 37 (15.7%), and fondaparinux in 14 (5.9%). Taking into account the competing risk of death, cumulative incidence of VTE recurrence at 6 months was 4.0% with warfarin, 10.3% with enoxaparin, 3.0% with dalteparin, and 7.7% with fondaparinux (P = .004). Bleeding complications occurred in 10.6% of patients on warfarin, 17.0% on enoxaparin, 27.0% on dalteparin, and 14.3% on fondaparinux (P = .089). In a dedicated anticoagulation clinic, specific for patients with cancer, warfarin may be an acceptable treatment for first thrombotic events in patients with cancer.
Managing Cancer And Living Meaningfully: study protocol for a randomized controlled trial (Toronto)
Trials | Full text
Background
We have developed a novel and brief semi-structured psychotherapeutic intervention
for patients with advanced or metastatic cancer, called Managing Cancer And Living
Meaningfully. We describe here the methodology of a randomized controlled trial to
test the efficacy of this treatment to alleviate distress and promote well-being in
this population.
Inclusion/Exclusion Criteria
The inclusion criteria are: 1) ≥ 18 years of age; 2) fluency in English; 3) no cognitive
impairment indicated in the medical record or by the attending oncologist; and 4)
a confirmed diagnosis of stage III or IV lung cancer, any stage of pancreatic cancer
(due to the aggressiveness of this disease), unresectable cholangiocarcinoma, unresectable
liver cancer, unresectable ampullary or peri-ampullary cancer or other stage IV (metastatic)
gastrointestinal cancer, stage III or IV ovarian and fallopian tube cancers, or other
stage IV gynecological cancer; and stage IV breast, genitourinary, sarcoma, melanoma,
or endocrine cancers (all of the above with expected survival of 12–18 months). Patients
meeting inclusion criteria undergo a brief interview with a research staff member
to identify the following exclusion criteria: 1) major communication difficulties;
2) inability to commit to the required 3–6 psychotherapy sessions (i.e., too ill to
participate, lack of transportation, insufficient motivation due to lack of distress);
3) cognitive impairment as indicated by a score < 20 on the Short Orientation-Memory-Concentration
(SOMC) test [31], unless deemed suitable at the recruiter’s discretion, or due to brain metastases;
4) actively receiving psychiatric or psychological intervention in the Department
of Supportive Care (formerly the Department of Psychosocial Oncology and Palliative
Care) at the Princess Margaret Cancer Centre at the time of study approach; 5) refusal
to accept randomization; and 6) prior treatment with CALM therapy during an earlier
phase of the study.....
Relationships between cancer pattern, country income and geographical region in Asia
Full text
....The most common female-specific cancer in Asia is breast cancer, which is also the most common cancer among Asian women; this is followed by cervical, endometrial and ovarian cancer. This pattern is similar to those of the developed countries except for endometrial cancer which is more common than cervical cancer in the developed countries [1], [3].....
The risk of female malignancies after fertility treatments: a cohort study with 25-year follow-up
abstract
OBJECTIVE:
To investigate whether an association exists between a history of fertility treatments and future risk of female malignancies.STUDY DESIGN:
A population-based study compared the incidence of long-term female malignancies in a cohort of women with and without a history of fertility treatments including in vitro fertilization (IVF) and ovulation induction (OI). Deliveries occurred between the years 1988-2013, with a mean follow-up duration of 12 years. Excluded from the study were women with known genetic predisposition for malignancies or known malignancies prior to the index pregnancy. Female malignancies were divided into specific types including ovarian, uterine, breast and cervix. Kaplan-Meier survival curve was used to estimate cumulative incidence of malignancies. Cox proportional hazard models were used to estimate the adjusted hazard ratios (HRs) for female malignancy.RESULTS:
During the study period, 106,031 women met the inclusion criteria; 4.1 % (n = 4363) occurred in patients following fertility treatments. During the follow-up period, patients with a history of IVF treatments had a significantly increased risk of being diagnosed with ovarian and uterine cancer as compared to patients after OI and patients with no history of fertility treatments. Cox proportional hazard models were constructed for ovarian and uterine cancer separately, controlling for confounders such as maternal age and obesity. A history of IVF treatment remained independently associated with ovarian and uterine cancer (adjusted HR 3.9; 95 % CI 1.2-12.6; P = 0.022 and adjusted HR 4.6; 95 % CI 1.4-14.9; P = 0.011; respectively).CONCLUSION:
IVF treatments pose a significant risk of subsequent long-term ovarian and uterine cancer.Thursday, September 03, 2015
Identification of a Variety of Mutations in Cancer Predisposition Genes in Patients With Suspected Lynch Syndrome (BRCA...)
Blogger's Note: stats deleted for ease of reading, see full text for further details
Consistent with prior studies, the following were considered LS-associated cancers: CRC, endometrial cancer (EC), ovarian cancer, gastric cancer, pancreatic cancer, small intestine cancer, urinary tract cancer, hepatobiliary cancer, sebaceous adenomas/carcinomas, and brain tumors.12
Prior studies have shown no increased CRC risk in BRCA1/2 probands, and traditional thinking thus has been that LS and HBOC are phenotypically distinct syndromes, aside from both conferring increased risks of ovarian cancer.44 In this study, however, BRCA1/2 probands had phenotypes that were markedly more “Lynch-like” than “HBOC-like,” suggesting that standard clinical evaluation would not have identified most of these individuals as needing BRCA1/2 testing......
.... Furthermore, with expanded use of panel testing, the question as to how patients with unexpected, high-penetrance germline mutations identified by panel testing (eg, BRCA1/2 mutations in individuals with a clinical history suggestive of hereditary colorectal cancer) should be managed is likely to become an increasingly common dilemma for practicing clinicians.....
open access
Article Outline
Materials and Methods
Study Population
Clinical Data
Germline Sequencing/Interpretation
Statistical Methods
Results
Clinical Characteristics
Germline Findings
PREMM1,2,6 Scores and NCCN Criteria
Discussion
Supplementary Materials and Methods
NCCN Guideline Classification
Design of Custom Primer Library for NGS Target Enrichment
Sample Preparation and Next-Generation Sequencing
NGS Data Analysis
Pathogenicity Classification
Validation of the Multigene Panel
Background & Aims
Multigene panels are commercially available tools for hereditary cancer risk assessment that allow for next-generation sequencing of numerous genes in parallel. However, it is not clear if these panels offer advantages over traditional genetic testing. We investigated the number of cancer predisposition gene mutations identified by parallel sequencing in individuals with suspected Lynch syndrome.
Trials May Close Gap in Genomic Cancer Therapy (TAPUR/NCI-MATCH)
Clinical Oncology News
Chicago—Two large-scale cancer trials with uncommon designs may substantially advance the paradigm of personalized medicine. The therapies being tested in both trials were selected for their activity on a specific molecular target, independent of tumor site and histology, and both trials are seeking the participation of community-based practitioners to help yield real-world information about safety and efficacy.
The studies are independent but address a similar goal. One study, which is the first-ever clinical trial sponsored by the American Society of Clinical Oncology (ASCO), aims to capture data when clinicians select a commercially available targeted therapy to treat an advanced cancer with the appropriate genomic variant. This off-label practice is becoming increasingly common but is not well studied, according to Richard L. Schilsky, MD, ASCO’s chief medical officer. The ASCO study provides a formal way to capture data from this practice.
The details of the ASCO-sponsored study, called TAPUR (Targeted Agent and Profiling Utilization Registry), and the second trial, which is being sponsored by the National Cancer Institute (NCI) and is called NCI-MATCH (Molecular Analysis for Therapy Choice), were outlined during a press conference at the 2015 ASCO annual meeting......
Increasingly Questionable Oncology ‘Outcome’ Data
Clinical Oncology News
Increasingly Questionable Oncology ‘Outcome’ Data
Time for a Serious Discussion
Increasingly Questionable Oncology ‘Outcome’ Data
Time for a Serious Discussion
- See more at:
http://www.clinicaloncology.com/ViewArticle.aspx?ses=ogst&d=Current+Practice&d_id=155&i=September+2015&i_id=1224&a_id=33509#sthash.0gydzfwZ.dpuf.....In fact, in a recent provocative paper examining what has been labeled “conditional disease-free survival,” investigators examined the statistical likelihood that an ovarian cancer patient would not have progression of cancer based on the duration of time she had already not exhibited evidence of progression.4 In this analysis, at diagnosis, the probability that an ovarian cancer patient would be disease-free at 5 years was 44.6%. However, if the patient had gone 2 years without experiencing evidence of recurrent disease, the 5-year disease-free survival increased to 80.5%; and if the individual did not exhibit progression for 3 years, the 5-year figure was 92.4%.4 Of course, each of these figures is substantially superior to the baseline recurrence risk of more than 50%.....
In fact, in a recent provocative paper examining what has been labeled
“conditional disease-free survival,” investigators examined the
statistical likelihood that an ovarian cancer patient would not have
progression of cancer based on the duration of time she had already not
exhibited evidence of progression.4 In this analysis, at diagnosis, the
probability that an ovarian cancer patient would be disease-free at 5
years was 44.6%. However, if the patient had gone 2 years without
experiencing evidence of recurrent disease, the 5-year disease-free
survival increased to 80.5%; and if the individual did not exhibit
progression for 3 years, the 5-year figure was 92.4%.4 Of course, each
of these figures is substantially superior to the baseline recurrence
risk of more than 50% - See more at:
http://www.clinicaloncology.com/ViewArticle.aspx?ses=ogst&d=Current+Practice&d_id=155&i=September+2015&i_id=1224&a_id=33509#sthash.0gydzfwZ.dpuf
In fact, in a recent provocative paper examining what has been labeled
“conditional disease-free survival,” investigators examined the
statistical likelihood that an ovarian cancer patient would not have
progression of cancer based on the duration of time she had already not
exhibited evidence of progression.4 In this analysis, at diagnosis, the
probability that an ovarian cancer patient would be disease-free at 5
years was 44.6%. However, if the patient had gone 2 years without
experiencing evidence of recurrent disease, the 5-year disease-free
survival increased to 80.5%; and if the individual did not exhibit
progression for 3 years, the 5-year figure was 92.4%.4 Of course, each
of these figures is substantially superior to the baseline recurrence
risk of more than 50% - See more at:
http://www.clinicaloncology.com/ViewArticle.aspx?ses=ogst&d=Current+Practice&d_id=155&i=September+2015&i_id=1224&a_id=33509#sthash.0gydzfwZ.dpuf
Oncologists' Perceptions of Recurrent Ovarian Cancer Patients' Preference for Participation....
abstract
Oncologists' Perceptions of Recurrent Ovarian Cancer Patients' Preference for Participation in Treatment Decision Making and Strategies for When and How to Involve Patients in This Process.
Objectives: The treatment decision-making (TDM) process
in the medical encounter in ovarian cancer (OC) is directed by
oncologists. There is little information on oncologists' perceptions of
this process. Our objectives were to explore oncologists' perceptions
concerning (1) patients' preference for involvement in TDM, (2) factors
that affect when to introduce this discussion, and (3) strategies used
for engaging women in TDM.
Methods: We adopted a qualitative descriptive approach.
Individual in-person interviews were used to collect data; themes were
identified.
Results: Fifteen gynecologic and 5 medical oncologists
from Ontario, Canada, participated. We found that oncologists made the
assumption that women with recurrent OC were interested in being
involved in TDM but rarely reported attempting to validate this
assumption. The oncologists timed the initiation of the TDM discussion
based on their degree of certainty of recurrent OC and their perception
of the patient's readiness to be involved in TDM. Oncologists reported
using strategies to engage women such as getting the women to take
ownership of the decision, verbalize their priorities, lead the
discussions, and giving the opportunity to gather information.
Conclusions: Oncologists need to listen to each patient rather than make assumptions about the person based on her disease.
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