open access (pdf)
Thursday, October 15, 2015
Wednesday, October 14, 2015
The effect of pre-diagnostic vitamin D supplementation on cancer survival in women
Full text
The effect of pre-diagnostic vitamin D supplementation on cancer survival in women: a cohort study within the UK Clinical Practice Research Datalink
Table 1 shows the baseline characteristics of the study cohort. We identified 11,112 breast, 4122 colorectal, 3352 lung and 2979 gynaecological (ovarian and uterine) cancer cases.
Background
There remains uncertainty in whether vitamin D status affects cancer survival. We
investigated whether vitamin D (± calcium) supplementation affects cancer survival
in women.
Methods
Participants were women aged ≥55 years identified from the UK Clinical Practice Research
Datalink (CPRD) with a first diagnosis of breast, colorectal, lung, ovarian or uterine
cancer between 2002 and 2009, and at least 5 years of CPRD data prior to diagnosis.
Cox proportional hazards were used to estimate hazard ratios (HR) and 95 % confidence
intervals (CI) of the relationship between pre-diagnostic vitamin D supplementation
and all-cause mortality. To avoid confounding by indication, the primary analysis
compared women with 3+ to 1–2 (but no more) vitamin D prescriptions. Models were adjusted
for pre-diagnostic body mass index, smoking, alcohol and deprivation. A sensitivity
analysis excluded supplements prescribed in the year prior to diagnosis.
Results
Exposure to 3 or more versus 1 to 2 prescriptions of vitamin D was not associated
with survival from any of the cancers studied. Any vitamin D prescription, compared
to never having been prescribed one, was associated with a better survival from breast
cancer (HR 0.78, 95 % CI 0.70 to 0.88). The sensitivity analysis suggested a possible
detrimental effect of vitamin D supplementation on lung cancer outcomes (HR for 3
versus 1 or 2 prescriptions 1.22 (95 % CI 0.94 to 1.57); HR for any versus no prescriptions
1.09 (0.98 to 1.22)).
Conclusions
We found no evidence that vitamin D supplementation is associated with survival among
women with cancer. Previous observational findings of beneficial effects of vitamin
D supplementation on cancer survival may be confounded.
Background
The benefits of vitamin D have received much attention, deriving primarily from observational data, which suggest that low vitamin D status is associated with higher mortality [1], [2]. Key to understanding this association is to determine whether low vitamin D levels cause premature death, or whether the vitamin D levels are a consequence of poor health. If vitamin D is simply a marker of health status, supplementation is unlikely to have a direct benefit on mortality. If the association is causal, then vitamin D supplementation is likely to be of some benefit in reducing mortality......Tuesday, October 13, 2015
Patient Perceptions of Telephone vs. In-Person BRCA1/BRCA2 Genetic Counseling
Blogger's Note: see abstract for associated stats
abstract
Telephone genetic counseling (TC) for hereditary breast/ovarian cancer risk has been associated with positive outcomes in high risk women. However, little is known about how patients perceive TC. As part of a randomized trial of TC versus usual care (UC; in-person genetic counseling), we compared high risk women's perceptions of: (1) overall satisfaction with genetic counseling; (2) convenience; (3) attentiveness during the session; (4) counselor effectiveness in providing support; and (5) counselor ability to recognize emotional responses during the session. Among the 554 participants delivery mode was not associated with self-reported satisfaction. However, TC participants found counseling significantly more convenient than UC participants while also perceiving lower levels of support ) and emotional recognition ). In exploratory analyses, we found that non-Hispanic white participants reported higher counselor support in UC than in TC , while minority women perceived less support in UC vs. TC . We discuss potential research and practice implications of these findings which may further improve the effectiveness and utilization of TC.
Cognitive function during and six months following chemotherapy for front-line treatment of ovarian, pp or ft cancer
Abstract
Cognitive function during and six months following chemotherapy for front-line treatment of ovarian, primary peritoneal or fallopian tube cancer: An NRG oncology/gynecologic oncology group study.
OBJECTIVES:
Changes in cognitive function have been identified in and reported by many cancer survivors. These changes have the potential to impact patient quality of life and functional ability. This prospective longitudinal study was designed to quantify the incidence of change in cognitive function in newly diagnosed ovarian cancer patients throughout and following primary chemotherapy.METHODS:
Eligible patients had newly diagnosed, untreated ovarian cancer and had planned to receive chemotherapy. Web-based and patient reported cognitive assessments and quality of life questionnaires were conducted prior to chemotherapy, prior to cycle four, after cycle six, and six months after completion of primary therapy.RESULTS:
Two-hundred-thirty-one evaluable patients entered this study between May 2010 and October 2011. At the cycle 4 time point, 25.2% (55/218) of patients exhibited cognitive impairment in at least one domain. At the post-cycle 6 and 6-month follow up time points, 21.1% (44/208) and 17.8% (30/169) of patients, respectively, demonstrated impairment in at least one domain of cognitive function. There were statistically significant, but clinically small, improvements in processing speed (p<0.001) and attention (p<0.001) but not in motor response time (p=0.066), from baseline through the six-month follow up time period.CONCLUSIONS:
This was a large, prospective study designed to measure cognitive function in ovarian cancer. A subset of patients had evidence of cognitive decline from baseline during chemotherapy treatment in this study as measured by the web-based assessment; however, changes were generally limited to no more than one domain.Skeletal Muscle Depletion and Markers for Cancer Cachexia Are Strong Prognostic Factors in Epithelial Ovarian Cancer
open access
Objective
Tumor cachexia is an important prognostic parameter in epithelial ovarian cancer (EOC). Tumor cachexia is characterized by metabolic and inflammatory disturbances. These conditions might be reflected by body composition measurements (BCMs) ascertained by pre-operative computed tomography (CT). Thus, we aimed to identify the prognostically most relevant BCMs assessed by pre-operative CT in EOC patients....Palliative Care Versus Spiritual Care
Correspondence
To the Editor:
The investigators from ENABLE (Educate, Nurture, Advise, Before Life Ends) III1,2 extended the rigorous scientific efforts to proactively implement early palliative care programs.3,4
Those of us interested in launching palliative care platforms for
patients with cancer and their caregivers would be interested
to know if spiritual care played a role in the
ENABLE III intervention. Were chaplains or pastoral care providers
involved?
Did the participants—especially the 20% who were
not affiliated with organized religion—consider themselves spiritual?
Were
there correlations between spirituality and
outcomes? Was spiritual well-being measured with any of the available
tools, such
as FACIT-Sp, the Functional Assessment of Chronic
Illness Therapy–Spiritual Well-Being Scale?5 and, can spiritual care even be conveyed in the context of a telehealth environment? Colleagues who aspire to adopt the sacred
work of the ENABLE III researchers would value such information.
REFERENCES
Precision Oncology Framework for Investigation of Exercise as Treatment for Cancer
open access
Introduction
In recent years, a new line of
investigation has emerged that addresses the novel question of whether
exercise has an impact
on cancer outcomes. Advances in genomic
profiling have increased our understanding of the molecular and genetic
complexity
of human cancer and, although many challenges
remain,1,2 several scenarios suggest that successfully matching a genomic alteration with drug therapies that target the alteration
can result in striking durable responses.2,3
Critical prerequisites underlying these successes include having an
adequate understanding of the biologic mechanisms of
the drug's action, identifying the biologically
effective dose, and determining the predictors of response to guide
patient
selection. Arguably, elucidation of these
prerequisites is required to optimize the efficacy of any therapeutic
strategy,4 including exercise treatment.
Almost a decade ago, the National
Cancer Institute published a framework outlining a sequence of steps to
facilitate the advancement
of candidate lifestyle interventions, including
exercise, from early discovery to definitive phase III trials in cancer
control.5 Unfortunately, research in exercise-oncology, in general, has not adhered to the National Cancer Institute's recommendations
nor has it taken advantage of the recent developments in genomic medicine.....
the Art of Oncology: Incognito
Incognito
Seated at the computed tomography console, I have just finished dictating a report and ready myself to review the next case. What does the requisition say? “Assessment of recently discovered liver metastases.” The requesting physician has attached a handwritten note adding the patient has no known medical problems.
I scroll through the images on the screen.
Not only is the liver invaded, but small nodules are scattered
throughout both
lungs, there is diffuse lymphadenopathy, and many
vertebrae have collapsed. From the base of the skull down to the pubis,
not a single one of the 800 millimetric slices is
normal.
The patient just got up from the examination table, the technician accompanies him to the changing room. I see him from the
back, wearing the green paper hospital gown, and 5 minutes later, I hear him leave the room.
It is a morbid curiosity, even a kind of voyeurism. But I need to know: what does someone so close to death look like? If
I walked past him on the street, would I notice something?
I turn toward him, and together with my colleagues, I say goodbye.
He is wearing a dark gray suit, a sky blue
shirt, and a striped tie. His salt-and-pepper hair is tousled after the
exam. Of
his face I catch a glimpse of black circular glasses
and acne scars on his cheeks. He is in his fifties, slightly overweight.
He holds himself straight, a briefcase in his hand. He
greets and thanks us with a polite smile.
It is downright scary. Search as I may, I see absolutely nothing.
He is just like you and me.
the Art of Oncology: Making Peace With Cancer (ovarian cancer/physician)
open access
..... Why did they not want to do genetic testing when I asked them to do so years ago, because seven relatives (all maternal side) had developed breast cancer? I was refused because my mother and sister did not have breast or ovarian cancer. Now, in the final stage of my ovarian cancer, I have made peace with all of this...
Saturday, October 10, 2015
The Angelina effect revisited: Exploring a media-related impact on public awareness
abstract
BACKGROUND
In 2013, Angelina Jolie's double mastectomy and publication of her personal treatment choice for BRCA1
positivity generated considerable media attention. To the authors’
knowledge, the current study is the first prospective survey conducted
among the general public to measure a quantifiable media-related effect
on public awareness.
Ovarian cancer and antidepressants
abstract
Conclusions
There was no association between risk of ovarian cancer and use of antidepressant drugs. Whether or not there is possible risk of using antidepressant whose mechanism of action involves dopamine and norepinephrine warrants further investigation
Depression and risk of epithelial ovarian cancer: Results from two large prospective cohort studies
Blogger's Note: it would be crucial to view the full text (subscriber-based $$$) before making any conclusion based on this abstract; hormones??
abstract
Highlights
- •This study includes 183,903 women from two prospective US cohorts with about 700 ovarian cancer cases.
- •Depression assessed 2–4 years before cancer diagnosis was associated with about 30% increased risk of ovarian cancer.
- •Women with persistent positive depression status had a higher risk of ovarian cancer.
Editorial: To Treat or Not to Treat: The Use of HRT in Patients With Ovarian Cancer
JCO open access
Few studies have addressed the issue of HRT in women with EOC.
The surgical treatment of epithelial ovarian cancer (EOC) results in the abrupt induction of menopause in pre- and perimenopausal women, who account for approximately 20% of all patients with ovarian cancer.1 The loss of ovarian estrogen results in disruptive vasomotor symptoms, which can negatively affect quality of life.......In the article that accompanies this editorial, Eeles et al16 present the results of a long-awaited multinational, randomized, nonblinded phase III trial of HRT in pre- and postmenopausal women receiving a recent diagnosis of EOC.....
Eeles et al: The primary end point for this study was overall survival (OS), and the main secondary end point was relapse-free survival (RFS). Other specified secondary end points were compliance with HRT, myocardial infarction, fracture, transient ischemic attack, cerebrovascular accident, and second cancer.....The trial was closed early as a result of difficulty in accruing the 570 patients projected for the OS .analysis.
-
See accompanying article doi:10.1200/JCO.2015.60.9719
REFERENCES
Friday, October 09, 2015
Dermatologic Manifestations of Metastatic Carcinomas: Overview, Distinguishing Metastases From Primary Tumors, Etiology
medscape
Summary
Common cutaneous metastasis sites and their probable primary sites are as follows:-
Metastasis to scalp - Breast, lung, kidney
-
Metastasis to neck - Oral squamous cell carcinoma
-
Metastasis to face - Oral squamous cell carcinoma, renal cell, lung
-
Metastasis to extremities - Malignant melanoma, breast, lung, renal, intestinal
-
Metastasis to chest - Breast, lung, malignant melanoma
-
Metastasis to abdomen - Colon, lung, stomach, breast, ovary
-
Metastasis to umbilicus - Stomach, pancreas, colon, ovary, kidney, breast
-
Metastasis to pelvis - Colon
-
Metastasis to back - Lung
55-Year-Old Female with Estrogen-Receptor-Positive Scalp Lesion
abstract
Cutaneous metastases are described in the literature as an occasional manifestation of metastatic cancer, usually in advanced situations, with the initial presenting manifestation of cancer estimated roughly less than 1% of incidences. The type of skin metastases has been shown to vary by age, sex, and primary tumor type. Skin metastases may occur from various tumor sites of origin in both children and adults (including rhabdomyosarcomas, adenocarcinomas various solid tumors from lung, breast, ovarian, uterine, and other sarcomas),1–6 and have often heralded more widely metastatic disease as well as a poorer outcome.
Risk Adjusting Survival Outcomes in Hospitals That Treat Patients With Cancer Without Information on Cancer Stage
JAMA Network open access
At a Glance
- This study examined outcomes of patients with cancer treated at different types of hospitals and to assess if cancer registry data are needed for case-mix adjustment.
- Comparative analysis was performed of outcomes of patients treated at various types of cancer hospitals as was parallel analysis testing if information on cancer stage was needed for risk adjustment.
- Patients treated at specialty cancer hospitals have a 10% lower chance of dying in the first year than those at community hospitals after adjusting for case mix.
- Whether or not cancer-specific data about patients are included in the case mix, performance rankings of hospitals are highly consistent.
Improving Patient Safety in Clinical Oncology: Applying Lessons From Normal Accident Theory
JAMA Network
The Institute of Medicine (IOM) has highlighted patient safety as an urgent health care quality problem,1,2 estimating that 44 000 to 98 000 Americans die annually from preventable medical errors,1,3 and more recent estimates are even higher.....
SAFETY CONCERNS WITHIN CLINICAL ONCOLOGY
The medication error rate in the outpatient chemotherapy setting has been reported to be approximately 3% to 19%,6,7
depending on the specific practice setting. In a survey of adult
outpatients receiving chemotherapy, 42 (22%) of 193 believed that they
had experienced unsafe care.8 A survey of 1013 health care professionals from 9 oncology departments in Switzerland9
reported that 54% observed their colleagues making potentially harmful
errors. Seventy percent reported sometimes remaining silent about safety
concerns, and 37% reported remaining silent when they could have helped
prevent an incident. The same research group10
surveyed patients and found that 16% reported experiencing an error in
their care, and 11% were very concerned about the errors.10
Radiotherapy-associated
errors were noted to occur in about 1% to 4% of patient treatments in
single-institution reports, with most errors being not clinically
serious.11
Registry data note a much lower error rate (about 1 to 4 in 10 000)
because only a small fraction of errors cross the threshold triggering
reporting.11 In a survey of radiation therapists, 16% reported being personally reprimanded for raising concerns about safety.12
These
data are concerning both for the prevalence of safety issues and the
apparent “suppression” of reporting them. National professional
societies have recognized these issues, published white papers to
describe best practices, and hold annual safety meetings.....
Usefulness of Multigene Testing: Catching the Train That’s Left the Station
JAMA Network (requires $$ subscription to view full text)
This Invited
Commentary outlines the benefits and challenges of multigene testing,
which is rapidly becoming the norm for genetic cancer risk assessment,
and emphasizes the importance of meaningful guidelines for
cancer-preventive care for those with less common genetic findings.
In the mid-1990s, clinical testing for BRCA1 and BRCA2 mutations rapidly followed gene cloning. Given the lack of clinical experience with BRCA1 and BRCA2
testing, many cancer genetics experts spoke against clinical testing,
advocating that testing be done in the research setting only.
Increasingly, women and their physicians ignored those recommendations,
and testing expanded beyond very high-risk families to include patients
with only a moderate likelihood of testing positive. In this way,
millions of women worldwide were tested for BRCA1 and BRCA2 mutations, leading to the accumulation of large amounts of clinical data, which have in turn confirmed the utility of BRCA1 and BRCA2 testing and, most importantly, our ability to decrease the mortality of mutation carriers through guided cancer prevention
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