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Thursday, October 22, 2015
BRCA1 Protein Expression Predicts Survival in Glioblastoma Multiforme | PracticeUpdate
health news
....Dr. Vassilakopoulou concluded that BRCA1 protein expression was an important predictive factor in this cohort of glioblastoma multiforme patients.
This result implies that low BRCA1 in the tumor, and the consequent low level of DNA repair, may increase glioblastoma multiforme vulnerability to treatment. Prospective validation of these results is necessary.
Physicians Thwart Guidelines, Choose Menopause Bioidenticals
medscape
According to a recent survey conducted by the North American Menopause Society (NAMS), 41% of patients are choosing compounded, non-FDA-approved preparations, despite society recommendations against them, as previously reported by Medscape Medical News.
Anemia and Functional Disability in Older Adults With Cancer
Abstract
Objectives: Anemia is associated with functional disability among older adults in general. However, the relationship between anemia and functional disability has not been well characterized among older adults with cancer. Therefore, we examined the association between anemia and functional disability in patients with cancer aged 65 years or older.
Patients and Methods: We conducted cross-sectional analysis of data derived from a multicenter prospective study of 500 patients with cancer aged 65 years or older. The primary outcome was functional disability at chemotherapy initiation, defined as the need for assistance with at least one instrumental activity of daily living. Anemia (using WHO criteria) was defined as a hemoglobin (Hb) level of less than 12 g/dL in women and less than 13 g/dL in men. Multivariable logistic regression was used to examine the association between anemia and functional disability.
Results: Among 491 evaluable patients (median age, 73.1 years [range, 65–91 years]), the prevalence of functional disability and anemia was 43% and 51%, respectively.
Survival in Patients With Severe Lymphopenia Following Treatment With Radiation and Chemotherapy for Newly Diagnosed Solid Tumors
abstract
Background: The immune system plays an important role in cancer surveillance and therapy. Chemoradiation can cause severe treatment-related lymphopenia (TRL) (<500 cells/mm3) that is associated with reduced survival.
Materials and Methods: Data from 4 independent solid tumor studies on serial lymphocyte counts, prognostic factors, treatment, and survival were collected and analyzed. The data set included 297 patients with newly diagnosed malignant glioma (N=96), resected pancreatic cancer (N=53), unresectable pancreatic cancer (N=101), and non–small cell lung cancer (N=47).....
Conclusions: Increased attention and research should be focused on the cause, prevention, and reversal of this unintended consequence of cancer treatment that seems to be related to survival in patients with solid tumors.
Putting an End to It! (assisted suicide) NCCN
(Opinion Piece NCCN) Putting an End to It!
....I recognize that the public can have a twisted notion of what the journey is like for a patient with cancer.....
The reporting of adverse events in oncology phase III trials: a comparison of the current status vs the expectations of the EORTC members
abstract
Background
Determination of drug safety and tolerability is usually based on the
frequency of certain key adverse events (AEs) rather
than the frequency of all-grade toxicities. We
assessed the reporting of key AEs in oncology randomized controlled
trials
(RCTs) and compared that to the expectations of
the EORTC membership.
Materials and Methods
RCTs reports published between 2007 and 2011 were reviewed regarding the
reporting of key AEs, namely: grade 3/4 AEs; grade
5 AEs; and AEs resulting in study withdrawal or
in dose reduction. Study characteristics associated with better
reporting
of key AEs were investigated. Finally, a survey
was conducted among the EORTC membership to determine their expectations
on
key AEs reporting.
Conclusions These
findings suggest that current practice of key AEs reporting remains
highly variable and sometimes inadequate in oncology
RCTs reports. Current standards for safety
reporting in RCTs should be revised to highlight the importance of key
AEs reporting.
Early Initiation of Chemotherapy following Complete Resection of Advanced Ovarian Cancer Associated with Improved Survival: An NRG Oncology/Gynecologic Oncology Group Study
abstract
Background To determine whether time from surgery to initiation of chemotherapy impacts survival in advanced ovarian carcinoma.
Results
One-thousand-seven-hundred-eighteen evaluable patients were randomized
(stage III (n=1,237); stage IV (n=477), including
those with complete resection (stage IV only,
n=81), low volume residual (<1cm, n=701), and suboptimal (>1cm,
n=932). On multivariate
analysis, time to chemotherapy initiation was
predictive of overall survival (p<0.001), with the complete resection
group
(ie., stage IV) encountering an increased risk
of death when time initiation of chemotherapy exceeded 25 days (95% CI
16.6–49.9
days).
The association between overweight, obesity and ovarian cancer: a meta-analysis
abstract
Objective
Epidemiological studies have reported an inconsistent association
between obesity and ovarian cancer. To update the current
knowledge of and further qualify the association
between overweight, obesity and ovarian cancer risk, we conducted a
meta-analysis
of published observational studies.
Methods Using the
PubMed, MEDLINE and EMBASE databases, we performed a literature search
of all of the case–control and cohort studies
published as original articles in English before
March 2015. We included 26 observational studies, of which 13 were
case–control
studies (7782 cases and 21 854 controls) and 13
were cohort studies (5181 cases). Fixed- and random-effects models were
used
to compute summary estimates and the
corresponding 95% confidence intervals. Subgroup analyses were also
performed.
Conclusions Increased body weight was associated with
an increased risk of ovarian cancer; in particular, severe obesity
demonstrated
a stronger risk effect. No statistically
significant association was observed in the postmenopausal period, but
was in the
premenopausal period.
Wednesday, October 21, 2015
ESGO 19th 2015 - October 24-27th
ESGO 19th 2015
Scientific Programme
ESGO 19th 2015
Abstract Submission Deadline: May 5, 2015
Early Registration Deadline: July 7, 2015
Join over 2500 gynaecology oncology specialists in the beautiful city of Nice for the 19th International Meeting of the European Society of Gynaecological Oncology (October 24-29, 2015), a truly European Gynaecological Oncology Congress. ESGO 2015 will be a unique educational experience, where you will benefit and learn about the newest developments, innovative techniques and advanced practices in gynaecological oncology.
The ESGO 2015 scientific programme covers all of the major topics in gynaecological oncology using a variety of session formats: Plenary Sessions, State of the Art Lectures, Best Oral and Poster Sessions plus a wide variety of Oral Sessions, Video and Tumour Board Sessions as well as new innovative activities.
Scientific Programme Higlights:
• Keynote lecture: Image guided surgery
• Sentinel note in gynaecologcal cancer
• Rare peritoneal tumors
• Debate Robot versus laparoscopy
• Selection of ovarian cancer patients for debulking surgery
• Management of intermediate risk stage I of ndometrial cancer
Prognostic impact of mismatch repair genes germline defects in colorectal cancer patients: are all mutations equal?
open access
Table 1: Clinical and pathological characteristics of patients according to mutational status
Presence of synchronous, metachronous colorectal or other HNPCC-associated tumours (mutation + vs -)
|
19 (50%)
|
59 (23.4%)
|
....The identification of the “clinical relevance” of the mutation that has been identified will be even more crucial if we consider that, with the introduction of next-generation-sequencing methods, a greater number of mutations of unknown clinical significance will be identified. In particular, recent published works point out at other genes implied in colorectal cancer pathogenesis (APC, MUTYH, STK11 and BRCA1/2) as explanations of familial colorectal cancer syndromes in patients who do not present mutations in standard MMR protein gene system [25]......
BACKGROUND:
Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome, caused by germline mutations in MisMatch Repair (MMR) genes, particularly in MLH1, MSH2 and MSH6. Patients with LS seem to have a more favourable prognosis than those with sporadic CRC, although the prognostic impact of different mutation types is unknown.Aim of our study is to compare survival outcomes of different types of MMR mutations in patients with LS-related CRC.Perspective: Breast cancer screening panels continue to confuse the facts and inject their own biases
Perspective: Current Oncology (open access - requires registration (free))
Letter(s) to the Editor
| Response to: “Counterpoint re: ‘Mammography screening—sticking to the science’” | PDF HTML |
| M.J. Yaffe | e400 |
| Response to: “Beyond the mammography debate: a moderate perspective” | PDF HTML |
| M.J. Yaffe | e401-e403 |
| Mammography, Martin Yaffe, and me: response and appreciation | PDF HTML |
| C. Kaniklidis | e404-e408 |
| Current definition of locally advanced breast cancer | PDF HTML |
| P.K. Garg, G. Prakash | e409-e410 |
| Response to: “Current definition of locally advanced breast cancer” | PDF HTML |
| M. Brackstone | e411 |
Monday, October 19, 2015
Imaging findings after radiotherapy to the pelvis
Blogger's Note: this paper reflects on a specific gyn cancer but adverse effects are worth noting for those having undergone or considering pelvic radiotherapy
open access
Introduction
Radiotherapy technique
Genitourinary changes (Urinary tract)
Gastrointestinal changes
Bone and Soft Tissue Changes
Conclusion
Carcinoma cervix is the second most common malignancy in women worldwide, and it remains a leading cause of cancer-related death in women in developing countries. The use of radiation therapy to treat cancer inevitably involves exposure of normal tissues. As a result, patients may experience symptoms associated with damage to normal tissue during the course of therapy for a few weeks after therapy or months or years later. Here we describe few cases developed normal tissue complications following radiotherapy to the pelvis. Many factors contribute to risk and severity of normal tissue reactions; these factors are site specific and vary with time after treatment. Treatments that reduce the risk or severity of damage to normal tissue or that facilitate the healing of radiation injury are being developed. These could greatly improve the quality of life of patients treated for cancer.....
Sunday, October 18, 2015
Evolving paradigms in the treatment of opioid-induced bowel dysfunction
abstract
In recent years prescription of opioids has increased significantly. Although effective in pain management, bothersome gastrointestinal adverse effects are experienced by a substantial proportion of opioid-treated patients. This can lead to difficulties with therapy and subsequently inadequate pain relief. Collectively referred to as opioid-induced bowel dysfunction, these adverse effects are the result of binding of exogenous opioids to opioid receptors in the gastrointestinal tract. This leads to disturbance of three important gastrointestinal functions: motility, coordination of sphincter function and secretion. In the clinic this manifests in a wide range of symptoms such as reflux, bloating, abdominal cramping, hard, dry stools, and incomplete evacuation, although the most known adverse effect is opioid-induced constipation. Traditional treatment with laxatives is often insufficient, but in recent years a number of novel pharmacological approaches have been introduced. In this review the pathophysiology, symptomatology and prevalence of opioid-induced bowel dysfunction is presented along with the benefits and caveats of a suggested consensus definition for opioid-induced constipation. Finally, traditional treatment is appraised and compared with the latest pharmacological developments. In conclusion, opioid antagonists restricted to the periphery show promising results, but use of different definitions and outcome measures complicate comparison. However, an international working group has recently suggested a consensus definition for opioid-induced constipation and relevant outcome measures have also been proposed. If investigators within this field adapt the suggested consensus and include symptoms related to dysfunction of the upper gut, it will ease comparison and be a step forward in future research.
(Canada) MMR Deficiency Testing for Patients with Colorectal Cancer: A Clinical and Cost-Effectiveness Evaluation
open access
Surveyed Canadian laboratory managers and directors have
identified DNA mismatch repair (dMMR) testing as a laboratory test that
is potentially over-utilized. According to clinical experts, dMMR
testing appears to be transitioning from an approach aimed at
identifying patients and families with Lynch syndrome into a tumour
phenotyping procedure that can be used to predict the prognosis of
colorectal cancer (CRC) and to guide decisions for adjuvant
chemotherapy. The use of a test with a prognostic and predictive value
falls under the realm of “personalized medicine.” According to oncology
and pathology experts, this recent application of dMMR testing is the
major driver of new test requisitions. This transition has led to an
increased demand for the test, with unclear benefits for the patient or
family members. In general, there is a lack of clarity regarding when
the tests should be ordered and the impact of dMMR status on CRC
outcomes in the current era of oxaliplatin- and irinotecan-based
chemotherapy. The central question, however, is whether universal dMMR
testing of primary CRC tumours is a viable and desirable option given
the known limitations of Lynch syndrome pre-selection criteria based on
age, history, and pathology, and recognizing the potential utility of
dMMR for personalizing cancer therapy. Missed cases of Lynch syndrome
resulting from a targeted dMMR testing strategy that is restricted to
pre-selected high-risk individuals (e.g., selected based on the Revised
Bethesda Guidelines) can be problematic and costly for the system, which
would potentially support broader (universal) dMMR testing of all CRC
tumours. Alternatively, universal testing carries with it additional
costs associated with testing all CRC patients, most of whom will not
have Lynch syndrome.
Contents
- CONTEXT AND POLICY ISSUES
- RESEARCH QUESTIONS
- METHODS
- REFERENCES
- APPENDIX 1 TESTING CRITERIA FOR MSI/MMR IHC ACROSS CANADA
- APPENDIX 2 LITERATURE SEARCH STRATEGY FROM THE PREVIOUS SCOPING PROJECT
- APPENDIX 3 LITERATURE SEARCH STRATEGIES
- APPENDIX 4 TITLE AND ABSTRACT SCREENING CHECKLIST
- APPENDIX 5 FULL-TEXT SCREENING CHECKLISTS
- APPENDIX 6 DATA ABSTRACTION FORMS
- APPENDIX 7 QUALITY ASSESSMENT INSTRUMENTS
- APPENDIX 8 DETAILS OF OUTCOME MEASURES FOR THE ASSESSMENT OF DIAGNOSTIC TEST PERFORMANCE
Germline BRCA1/2 testing practices in ovarian cancer: Current state and opportunities for new directions
abstract
PURPOSE:
Given the implications for clinical care and prevention in identifying a BRCA1/2 mutation, the objective of this study was to determine current BRCA1/2 testing practices in ovarian cancer and to identify future directions.METHODS:
Two parallel complementary web-based surveys were sent by email to representatives of Gynecologic Cancer InterGroup (GCIG) and to referral centers in countries with and without GCIG membership. Questions posed addressed indications of BRCA1/2 testing for ovarian cancer; the implication of genetic counseling; and prevention strategies employed.RESULTS:
Among the GCIG, 22 collaborative groups from 19 countries answered the survey. For the complementary survey, 22 referral centers replied. Findings show criteria to offer germline BRCA1/2 testing are mixed; 55% of GCIG members based testing decisions on histology and, among all respondents the main testing criterion remains family history. Typically, genetic counseling is scheduled prior to the genetic testing; however, if negative, results may not be communicated by the genetic counselor. Time between testing and communicating results varies widely between the groups. Lastly, recommendations to relatives regarding risk reduction surgery are inconsistent.CONCLUSION:
Our study highlights the need for collaborative efforts to devise international guidelines around BRCA1/2 testing in ovarian cancer to ensure consistent BRCA1/2 screening practices are adopted. Clinical practice is evolving rapidly and as BRCA1/2 testing is expected to become more widespread, new approaches are required. Coordinating BRCA1/2 testing practices is crucial in terms of care for the patient diagnosed with ovarian cancer but also towards cancer prevention for affected family members.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......Improved Survival of a Patient with Gastric and Other Multiple Metastases from Ovarian Cancer by Multimodal Treatment: A Case Report
open access
Gastric metastasis from ovarian carcinoma is extremely rare and the prognosis for patients is poor. We report a case of multimodal treatment improving the survival time of a patient with gastric metastasis from ovarian cancer. A 73-year-old woman with known serous ovarian cancer was admitted to the hospital due to epigastric pain and dyspepsia.....
Ovarian cancer molecular stratification and tumour heterogeneity; a necessity and a challenge (serous)
Opinion - open access
Introduction
Only two new drugs have been licensed for the treatment of epithelial ovarian cancer in the last 5 years (bevacizumab and olaparib). These are also the only two molecularly-targeted agents licensed in this disease. As we continue to move into the genomic era of cancer therapy, it is clear that optimal therapy is going to depend on molecular stratification and that the stratification itself is going to need to contend with tumour heterogeneity. In this article, we discuss molecular stratification and tumour heterogeneity in the context of high grade serous ovarian cancer.
The development of bevacizumab and olaparib have provided contrasting examples of stratification in molecularly targeted agents.....
The future
Clearly future optimal therapy for high-grade serous ovarian cancer will depend on optimal molecular stratification and this is just as true for bevacizumab and olaparib as it will be for future agents. While this will help rise to the challenge of optimising therapy for inter-patient molecular heterogeneity, monotherapy may never overcome intra-patient heterogeneity. If we want to improve the durability of responses, that pool of resistant clones may need to be narrowed by using combination therapies. Indeed, recent clinical data for the addition of the VEGFR inhibitor, cedirinib, to olaparib has shown a significant increase in response rate and a near-doubling of progression free survival [47]. The majority of this benefit was in the BRCA1/BRCA2 wild-type (or unknown) group, perhaps demonstrating that combinations can overcome monotherapy dependencies but also highlighting that there is still a lot to learn about biomarkers for anti-angiogenic and PARP inhibitor agents in ovarian cancer.
Initial Results of Multigene Panel Testing for HBOC and Lynch Syndrome
abstract
Multigene panel testing for hereditary cancer risk has recently become commercially available; however, the impact of its use on patient care is undefined. We sought to evaluate results from implementation of panel testing in a multidisciplinary cancer center. We performed a retrospective review of consecutive patients undergoing genetic testing after initiating use of multigene panel testing at Loma Linda University Medical Center. From February 13 to August 25, 2014, 92 patients were referred for genetic testing based on National Comprehensive Cancer Network guidelines. Testing was completed in 90 patients. Overall, nine (10%) pathogenic mutations were identified: five BRCA1/2, and four in non-BRCA loci. Single-site testing identified one BRCA1 and one BRCA2 mutation. The remaining mutations were identified by use of panel testing for hereditary breast and ovarian cancer. There were 40 variants of uncertain significance identified in 34 patients. The use of panel testing more than doubled the identification rate of clinically significant pathogenic mutations that would have been missed with BRCA testing alone. The large number of variants of uncertain significance identified will require long-term follow-up for potential reclassification. Multigene panel testing provides additional information that may improve patient outcomes.
Route of hysterectomy and surgical outcomes from a state-wide gynecologic oncology population
Abstract: Route of hysterectomy and surgical outcomes from a state-wide gynecologic oncology population: is there a role for vaginal hysterectomy?
BACKGROUND:
Recent policy changes by insurance companies have been instituted to encourage vaginal hysterectomy as the preferred route for removal of the uterus. It is not known if advantages of vaginal hysterectomy for benign indications apply to women with gynecologic cancer.OBJECTIVE:
The goal of this study was to assess trends in surgical approach to hysterectomy among gynecologic cancer patients and to evaluate outcomes by approach. We hypothesized that, among gynecologic oncology patients, postoperative complications and hospital stay would differ by surgical approach, and that advantages of vaginal hysterectomy for benign indications may not apply to gynecologic cancer patients.STUDY DESIGN:
We performed a population-based retrospective cohort study of cervical, endometrial, or ovarian/fallopian tube cancer patients treated surgically in Washington State from 2004 to 2013 using the Comprehensive Hospital Abstract Reporting System (CHARS). Surgery was categorized as abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or vaginal hysterectomy (VH). We determined rate of surgical approach by year and the association with length of stay (LOS), 30-day readmission rate, and perioperative complications.RESULTS:
We identified 10,117 patients who underwent surgery for gynecologic cancer, with 346 (3.4%) VH, 2,698 (26.6%) LH, and 7,073 (69.9%) AH. Patients undergoing AH had more comorbidities than VH or LH (CCI ≥2 11.3%, 7.9% and 8.1% respectively, P<.001). From 2004 to 2013 AH and VH declined (94.4% to 47.9% and 4.4% to 0.8% respectively; P<.001) while LH increased from 1.2% to 51.4% in 2013 (P<.001). Mean LOS was 4.6 days for women undergoing an AH and was 1.9 days shorter for VH (95% CI, 1.6-2.3 days) and 2.6 days shorter for LH (95% CI, 2.4-2.7 days) (P<.001). Risk of 30-day readmission for patients undergoing LH was 40% less likely compared to AH but not different for VH versus AH.CONCLUSION:
AH and LH remain the preferred routes for hysterectomy in gynecologic oncology. Over the past decade, there has been a significant shift to LH with lower 30-day readmission and complication rates. There may be a limited role for VH in select patients. Current efforts to standardize the surgical approach to hysterectomy should not apply to patients with known or suspected gynecologic cancer.Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis
Abstract
The aim of the present systematic review and meta-analysis of observational studies was to gain further insight into the effects of adherence to Mediterranean Diet (MD) on overall cancer mortality, incidence of different types of cancer, and cancer mortality risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and EMBASE until 2 July 2015. We included either cohort (for specific tumors only incidence cases were used) or case-control studies. Study specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effect model. The updated review process showed 23 observational studies that were not included in the previous meta-analysis (total number of studies evaluated: 56 observational studies). An overall population of 1,784,404 subjects was included in the present update. The highest adherence score to an MD was significantly associated with a lower risk of all-cause cancer mortality (RR: 0.87, 95% CI 0.81-0.93, I2 = 84%), colorectal cancer (RR: 0.83, 95% CI 0.76-0.89, I2 = 56%), breast cancer (RR: 0.93, 95% CI 0.87-0.99, I2 =15%), gastric cancer (RR: 0.73, 95% CI 0.55-0.97, I2 = 66%), prostate cancer (RR: 0.96, 95% CI 0.92-1.00, I2 = 0%), liver cancer (RR: 0.58, 95% CI 0.46-0.73, I2 = 0%), head and neck cancer (RR: 0.40, 95% CI 0.24-0.66, I2 = 90%), pancreatic cancer (RR: 0.48, 95% CI 0.35-0.66), and respiratory cancer (RR: 0.10, 95% CI 0.01-0.70). No significant association could be observed for esophageal/ovarian/endometrial/and bladder cancer, respectively. Among cancer survivors, the association between the adherence to the highest MD category and risk of cancer mortality, and cancer recurrence was not statistically significant. The updated meta-analyses confirm a prominent and consistent inverse association provided by adherence to an MD in relation to cancer mortality and risk of several cancer types.
Prior oral contraceptive use in ovarian cancer patients: assessing associations with overall and progression-free survival
Full text
Background
Prior studies have described a reduced risk of developing ovarian cancer with the
use of oral contraceptives. In this context, we decided to examine if oral contraceptive
use prior to a diagnosis of ovarian cancer is associated with better overall and progression-free
survival.
Prevention of chemotherapy-induced peripheral neuropathy by the small-molecule inhibitor pifithrin-μ
abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment. It is the most frequent cause of dose reduction or treatment discontinuation in patients treated for cancer with commonly used drugs including taxanes and platinum-based compounds. No FDA-approved treatments for CIPN are available. In rodents, CIPN is represented by peripheral mechanical allodynia in association with retraction of intraepidermal nerve fibers. The mechanism of chemotherapy-induced neurotoxicity is unclear, but it has been established that mitochondrial dysfunction is an important component of the dysregulation in peripheral sensory neurons. We have shown earlier that inhibition of mitochondrial p53 accumulation with the small compound pifithrin-μ (PFT-μ) prevents cerebral neuronal death in a rodent model of hypoxic-ischemic brain damage. We now explore whether PFT-μ is capable of preventing neuronal mitochondrial damage and CIPN in mice. We demonstrate for the first time that PFT-μ prevents both paclitaxel- and cisplatin-induced mechanical allodynia. Electron microscopic analysis of peripheral sensory nerves revealed that PFT-μ secured mitochondrial integrity in paclitaxel-treated mice. In addition, PFT-μ administration protects against chemotherapy-induced loss of intraepidermal nerve fibers in the paw. To determine whether neuroprotective treatment with PFT-μ would interfere with the antitumor effects of chemotherapy, ovarian tumor cells were cultured in vitro with PFT-μ and paclitaxel. Pifithrin-μ does not inhibit tumor cell death but even enhances paclitaxel-induced tumor cell death. These data are the first to identify PFT-μ as a potential therapeutic strategy for prevention of CIPN to combat one of the most devastating side effects of chemotherapy.
Friday, October 16, 2015
Acupuncture for cancer pain in adults
Abstract - Cochrane updated review
BACKGROUND:
Forty per cent of individuals with early or intermediate stage cancer and 90% with advanced cancer have moderate to severe pain and up to 70% of patients with cancer pain do not receive adequate pain relief. It has been claimed that acupuncture has a role in management of cancer pain and guidelines exist for treatment of cancer pain with acupuncture. This is an updated version of a Cochrane Review published in Issue 1, 2011, on acupuncture for cancer pain in adults.OBJECTIVES:
To evaluate efficacy of acupuncture for relief of cancer-related pain in adults.SEARCH METHODS:
For this update CENTRAL, MEDLINE, EMBASE, PsycINFO, AMED, and SPORTDiscus were searched up to July 2015 including non-English language papers.SELECTION CRITERIA:
Randomised controlled trials (RCTs) that evaluated any type of invasive acupuncture for pain directly related to cancer in adults aged 18 years or over.DATA COLLECTION AND ANALYSIS:
We planned to pool data to provide an overall measure of effect and to calculate the number needed to treat to benefit, but this was not possible due to heterogeneity. Two review authors (CP, OT) independently extracted data adding it to data extraction sheets. Data sheets were compared and discussed with a third review aMAIN RESULTS:
We included five RCTs (285 participants). Three studies were included in the original review and two more in the update. The authors of the included studies reported benefits of acupuncture in managing pancreatic cancer pain; no difference between real and sham electroacupuncture for pain associated with ovarian cancer; benefits of acupuncture over conventional medication for late stage unspecified cancer; benefits for auricular (ear) acupuncture over placebo for chronic neuropathic pain related to cancer; and no differences between conventional analgesia and acupuncture within the first 10 days of treatment for stomach carcinoma. All studies had a high risk of bias from inadequate sample size and a low risk of bias associated with random sequence generation. Only three studies had low risk of bias associated with incomplete outcome data, while two studies had low risk of bias associated with allocation concealment and one study had low risk of bias associated with inadequate blinding. The heterogeneity of methodologies, cancer populations and techniques used in the included studies precluded pooling of data and therefore meta-analysis was not carried out. A subgroup analysis on acupuncture for cancer-induced bone pain was not conducted because none of the studies made any reference to bone pain. Studies either reported that there were no adverse events as a result of treatment, or did not report adverse events at all.AUTHORS' CONCLUSIONS:
There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.
Thursday, October 15, 2015
Personalized medicine in cancer: where are we today?
open access
| Section: Making the most of targeted therapy |
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