What’s New in Genetic Testing for Cancer Susceptibility? open access

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What’s New in Genetic Testing for Cancer Susceptibility?

The dilemma for clinicians is how best to understand and manage this rapidly growing body of information to improve patient care. With millions of genetic variants of potential clinical significance and thousands of genes associated with rare but well-established genetic conditions, the complexities of genetic data management clearly will require improved computerized clinical decision support tools, as opposed to continued reliance on traditional rote, memory-based medicine.



 

Proceedings of the Strategy Meeting for the Development of an International Consortium for Chinese Medicine and Cancer

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Proceedings of the Strategy Meeting for the Development of an International Consortium for Chinese Medicine and Cancer

Office of Cancer Complementary and Alternative Medicine, Division of Cancer Treatment and Diagnosis, National Cancer Institute

 

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Common Sites of Metastasis

Cancer Type	Main Sites of Metastasis
Ovary:            Liver, lung, peritoneum

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How patients take control of their precision cancer care by accessing their own molecular profiling data

Martin Naley

Index: (journal) Gynecologic Oncology (October 2016) (subscriber based)

(October 2016)

Impact of postoperative intensity-modulated radiation therapy (IMRT) on the rate of bowel obstruction in gyn malignancy

abstract:
Impact of postoperative intensity-modulated radiation therapy (IMRT) on the rate of bowel obstruction in gynecologic malignancy
 

Conclusions (cervical/endometrial)

The use of postoperative IMRT for cervical and endometrial cancer was associated with significant reduction in the rate of bowel obstruction. This difference maintained its statistical significance on multivariate analysis. Such finding if confirmed by others will help further solidify the benefit of IMRT in gynecologic cancers.

Highlights

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IMRT is associated with lower rate of bowel obstruction.

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Lower bowel obstruction rate was independent of other prognostic factors.

•

Results of this study add further credence to the role of IMRT in gynecologic cancers.

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Objective

The purpose was to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologic malignancies undergoing postoperative pelvic RT.

Methods

We performed a retrospective review of all patients with endometrial or cervical cancer who received postoperative pelvic RT at our institution from 2000 to 2012. Patients who received definitive or palliative RT, or those with BO due to disease progression, were excluded. Standard two-sided statistical tests were used to evaluate for associated risk factors. Kaplan-Meier, Log rank and Cox proportional hazards regression analysis tests were performed for actuarial analysis.

Results

A total of 224 patients were identified, 120 (54%) received postoperative pelvic IMRT and 104 (46%) 3-dimentional (3-D) RT. Median follow-up time was 67 months. BO was grade 1 (asymptomatic) in 2/228 (0.9%), grade 2 (conservative management) in 4 (1.8%), and grade 3 ≥ in 4 (1.8%). Overall, the 5-year actuarial rate of BO was 4.8%. The 5-year rate of BO in the IMRT group was 0.9% compared to 9.3% for 3-D RT (p = 0.006). Patients with BMI ≥ 30 kg/m² were less likely to develop BO (2.6% vs. 8.3; p = 0.03). On multivariate analysis, only IMRT retained its significance as an independent predictor of less BO (p = 0.022).

Conclusions

The use of postoperative IMRT for cervical and endometrial cancer was associated with significant reduction in the rate of bowel obstruction. This difference maintained its statistical significance on multivariate analysis. Such finding if confirmed by others will help further solidify the benefit of IMRT in gynecologic cancers.

(paywalled) Editorial: Intensity modulated radiation therapy for women with gyn cancers: this horse is also already out of the barn

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Cancer and treatment-related symptoms are associated with mobility disability in women with ovarian cancer

abstract:
Cancer and treatment-related symptoms are associated with mobility disability in women with ovarian cancer: A cross-sectional study
  

Highlights

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Mobility disability is endorsed by over half of women with ovarian cancer.

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Poor appetite, bloating, fatigue, pain, numbness correlate with disability.

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Clinicians should assess for mobility disability in women with ovarian cancer.

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Objective

To examine the prevalence of symptom-related mobility disability and identify specific symptoms and other factors associated with mobility disability among a national sample of ovarian cancer (OC) survivors.

Methods

Descriptive, correlational secondary analysis of a National Ovarian Cancer Coalition mailed survey of women with a history of OC (n = 713). We used the Symptom Representation Questionnaire (SRQ), the MD Anderson Symptom Inventory (MDASI) Interference Scale, and medical and demographic information to determine prevalence of symptom-related mobility disability. We constructed a multiple linear regression model to determine the relative contributions of specific symptoms and other factors to mobility disability.

Results

A majority of the sample (60.0%) reported symptom-related mobility disability. Independent predictors included: > one comorbidity, active OC, abdominal bloating, fatigue, lack of appetite, numbness/tingling, and pain. The model explained 41.5% of the variance in symptom-related mobility disability. Unexpectedly, age and current chemotherapy were not significant predictors.

Conclusions

Symptom-related mobility disability is common among women with OC and is associated with medical comorbidities, abdominal bloating, fatigue, lack of appetite, numbness/tingling, and pain. Longitudinal research should clarify the relationship of these symptoms to mobility disability and determine whether effective symptom management minimizes disability.

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Electronic patient-reported outcomes from home in patients recovering from major gyn cancer surgery

abstract:
Electronic patient-reported outcomes from home in patients recovering from major gynecologic cancer surgery: A prospective study measuring symptoms and health-related quality of life
 

• Memorial Sloan Kettering Cancer Center, New York, NY, USA
•  The University of Texas MD Anderson Cancer Center, Houston, TX, USA
•  Icahn School of Medicine at Mount Sinai, New York, NY, USA
•  University of Washington School of Medicine, Seattle, WA, USA
•  University of Connecticut School of Medicine, Hartford Hospital, Hartford, CT, USA
•  Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA

Highlights

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A Web-based model for assessing patient reported outcomes is feasible in the immediate post-operative period.

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Many patients feel empowered by documenting and reporting PROs (PRO - patient reported outcomes) during the post-operative recovery period.

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A Web-based system for capturing PROs may require additional resources for clinically useful application.

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Purpose

We previously reported on the feasibility of a Web-based system to capture patient-reported outcomes (PROs) in the immediate postoperative period. The purpose of this study was to update the experience of these patients and assess patient and provider satisfaction and feedback regarding the system.

Methods

This is a prospective cohort study of patients scheduled to undergo laparotomy for presumed gynecologic malignancy. Patients completed a Web-based Symptom Tracking and Reporting (STAR) questionnaire preoperatively and weekly during a 6-week postoperative period. Email alerts were sent to study nurses when concerning patient responses were entered. The patient and the nurse assessments of STAR's usefulness were measured via an exit survey.

Results

The study enrolled 96 eligible patients. Of these, 71 patients (74%) completed at least four of seven total sessions. Of the patients who completed the exit satisfaction survey, 98% found STAR easy to use; 84% found it useful; and 82% would recommend it to other patients. Despite positive feedback from patients, clinical personnel found that the STAR system increased their current workload without enhancing patient care.

Conclusions

Application of an electronic program for PROs in those recovering from major gynecologic cancer surgery is feasible, and acceptable to most patients. While most clinicians did not find STAR clinically helpful, the majority of patients reported a positive experience with the system and would recommend its use. The program helped many patients feel more empowered in their postoperative recovery.

Dairy, calcium, vitamin D and ovarian cancer risk in African American women

Abstract
 

Background:

No previous study has evaluated the associations of dairy products, lactose, calcium and vitamin D with the risk of ovarian cancer in African–American women, who are known to have high mortality from the disease, as well as to be at risk for calcium and vitamin D deficiency.

Methods:

We evaluated these associations among 490 ovarian cancer cases and 656 age- and site-matched controls of African–American descent recruited into the African American Cancer Epidemiology Study, a population-based case-control study in 11 geographical areas in the US. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results:

An increased ovarian cancer risk was observed for whole milk consumption and lactose intake (highest quartile vs lowest: OR=1.97. Calcium intake was associated with a decreased risk of ovarian cancer OR=0.51, but vitamin D intake was not. Longer sun exposure in summer months was found to predict a lower risk (OR=0.71).

Conclusions:

Our findings suggest that a high-calcium, low-lactose diet, and sun exposure in summer months may reduce the risk of ovarian cancer in African–American women.