Saturday, March 07, 2009
Medical societies' recommendations for immunization with HPV and disclosure of conflicts of interest
"One of the Canadian documents did not include any conflict of interest statement, although Merck and GSK are listed among the sponsors.
CONCLUSIONS: Disclosure of conflicts of interest in documents where medical societies issue recommendations on HPV vaccination is very unusual. However, lack of disclosure is more frequent (near twice) when recommendations are in favour of the vaccination."
Breast and ovarian cancer risk perception after prophylactic salpingo-oophorectomy due to an inherited mutation in the BRCA 1 or BRCA 2 gene
Breast and ovarian cancer risk perception after prophylactic salpingo-oophorectomy due to an inherited mutation in the BRCA1 or BRCA2 gene
note:in the absence of the full paper, a small study which confuses the issues/results by using actual numbers and then % results
Friday, March 06, 2009
Inequalities, patient safety, and waste : The Lancet Oncology
"Fragmented decision-making by government departments, agencies, and insurers, often working in isolation and without a common framework of objectives, is causing an increasingly unfair distribution of cancer services. In the current global recession, a root and branch re-evaluation of services, focused on patient-centred medicine rather than government or insurer-imposed medicine, would undoubtedly improve care for patients with cancer; reduce polarisation in accessibility; and possibly even shrink healthcare budgets."
Thursday, March 05, 2009
Genetic Risks: Should Physicians Inform Relatives?
Genetic Risks: Should Physicians Inform Relatives?
Do physicians have an obligation to disclose genetic-risk information to relatives, even without the consent of the patient?
Wednesday, March 04, 2009
Bodies and barriers : The Lancet Oncology - review
Bodies and barriers : The Lancet Oncology
"Take the preface to Whose Life is it Anyway? which informs us that “the hero's actions are an assertion of those contractual rights [between doctor and patient] viewed in terms of current philosophical arguments which hold that the dual principles of autonomy and contract keeping, conceptually linked, provide the sole moral foundation for clinical practice consistent with the social context in which the practice occurs”. I've read this sentence at least twelve times now, and I'm still no nearer to knowing what it means."
"Presented together, the plays form an intriguing whole, each focussed on a different aspect of medicine and mortality. “We are discussing life and death, and not in the abstract either”, explains Vivian Bearing.
They've done a fine job."
Tuesday, March 03, 2009
Cancer Cell - Accelerated Metastasis after Short-Term Treatment with a Potent Inhibitor of Tumor Angiogenesis - Sunitinib/SU11248
definition: orthotopic = in the normal position
Accelerated Metastasis after Short-Term Treatment with a Potent Inhibitor of Tumor Angiogenesis
John M.L. Ebos,Christina R. Lee,William Cruz-Munoz,Georg A. Bjarnason,James G. Christensen and Robert S. Kerbel1
Molecular and Cellular Biology Research, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 2M9, Canada
Sunnybrook Odette Cancer Centre, Toronto, ON M5G 2M9, Canada
Pfizer Global Research and Development, La Jolla Labs, La Jolla, CA 92121, USA
Summary
Herein we report that the VEGFR/PDGFR kinase inhibitor sunitinib/SU11248 can accelerate metastatic tumor growth and decrease overall survival in mice receiving short-term therapy in various metastasis assays, including after intravenous injection of tumor cells or after removal of primary orthotopically grown tumors. Acceleration of metastasis was also observed in mice receiving sunitinib prior to intravenous implantation of tumor cells, suggesting possible metastatic conditioning in multiple organs. Similar findings with additional VEGF receptor tyrosine kinase inhibitors implicate a class-specific effect for such agents. Importantly, these observations of metastatic acceleration were in contrast to the demonstrable antitumor benefits obtained when the same human breast cancer cells, as well as mouse or human melanoma cells, were grown orthotopically as primary tumors and subjected to identical sunitinib treatments.
Epithelial ovarian cancer: Does the time interval between primary surgery and postoperative chemotherapy have any prognostic importance?
Worldwide, much effort is used every day to perform optimal surgery in the treatment of epithelial ovarian cancer. Treatment of ovarian cancer is a combination of surgery with optimal debulking followed by chemotherapy. However, the optimal timing of postoperative chemotherapy for ovarian cancer remains poorly defined. The literature is made up of seven studies performed in different ways and which have included varying prognostic factors. The general supposition is that the time interval (TI) does not have a prognostic influence but experimental studies have shown that it does affect the prognosis of the cancer. This commentary focuses on the importance of the TI between surgery and postoperative chemotherapy in this horrible disease.
Steps and Time to Process Clinical Trials at the Cancer Therapy Evaluation Program
At least 296 distinct processes are required for phase III trial activation: at least 239 working steps, 52 major decision points, 20 processing loops, and 11 stopping points. Of the 195 trials activated during the January 1, 2000, to December 31, 2007, study period, a sample of 167 (85.6%) was used for gathering timing data. Median calendar days from initial formal concept submission to CTEP to trial activation by a cooperative group was 602 days (interquartile range, 454 to 861 days). This time has not significantly changed over the past 8 years. There is a high variation in the time required to activate a clinical trial.
Monday, March 02, 2009
Has pain management in cancer patients with bone metastases improved? A seven year review at an outpatient palliative radiotherapy clinic
Sunday, March 01, 2009
Selection Endometrial Carcinomas for DNA Mismatch Repair Protein IMHC Using Patient Age and Tumor Morphology Enhances Detection of MMR Abnormalities
- Am J Surg Pathol. 2009 Feb 20
- Women with hereditary nonpolyposis colorectal cancer (HNPCC) (Lynch Syndrome) have a high risk for endometrial cancer (EC) and frequently present with a gynecologic cancer as their first or sentinel malignancy. Identification of these patients is important given their personal and family risk for synchronous and metachronous tumors........... more frequent synchronous clear cell carcinomas of the ovary..........cont'd
Saturday, February 28, 2009
Health Canada: Cancer
related Globe and Mail article with reader commentaries:
http://www.theglobeandmail.com/servlet/story/RTGAM.20090226.wcancer26/BNStory/specialScienceandHealth/home
Friday, February 27, 2009
Wednesday, February 25, 2009
Tuesday, February 24, 2009
Current role and future aspects of Topotecan in relapsed ovarian cancer
"A number of alternative dosing regimens and formulations have been investigated in an attempt to improve the toxicity profile of topotecan without compromising anti-tumour activity. A novel oral formulation of topotecan has shown clinical promise in patients with advanced and relapsed disease. Administration of i.v. topotecan on a weekly basis produced encouraging results in several phase II trials, with less haematological toxicity and similar response rates to the day 1-5 regimen."
Old Bones, New Data: Emmett Hall, Private Insurance and the Defeat of Pharmacare :: Vol. 4 No. 3 2009 :: Healthcare Policy / Politiques de Santé :: Longwoods Publishing
"The class war? We lost. Catastrophically."
pharma press release: Phenoxodiol/OVATURE
http://www.marketwatch.com/News/Story/Story.aspx?guid={40DC8D57-A36F-4DA7-A132-83469C5C89F8}&siteid=nbkh
Phase III Phenoxodiol Clinical Trial for Ovarian Cancer Continues
"The OVArian TUmor REsponse (OVATURE) trial is a major multi-center multinational Phase III clinical trial of orally administered phenoxodiol in combination with carboplatin in women with advanced ovarian cancer resistant or refractory to platinum-based drugs, to determine its safety and effectiveness when used in combination with carboplatin. More information on the trial can be found at http://www.OVATUREtrial.com.
The OVATURE trial is recruiting ovarian cancer patients whose cancer initially responded to chemotherapy, but has since become resistant or refractory to traditional platinum treatments. The trial consists of two double blind treatment arms. Patients in one trial arm are receiving weekly carboplatin and phenoxodiol. Patients in the other trial arm are also receiving weekly carboplatin, but a placebo (an inactive control pill) is substituted for phenoxodiol. Neither patients nor their doctors know to which trial arm the patients are randomly assigned.
A change from receiving platinum in the traditional dose pattern (every two to three weeks) to a weekly dosing regimen has been reported to provide a tumor response in some patients with recurrent ovarian cancer.(2-4) Thus, in addition to learning more about the safety and efficacy of phenoxodiol, researchers will learn more about the efficacy and safety of weekly carboplatin.
The primary outcome of the trial is the assessment of the relative time it takes for the ovarian cancer to progress. An analysis of interim results will be possible after patient recruitment to this study is completed and 95 patients have disease progression.
Patients are being recruited at hospital sites across the USA, UK, Europe and Australia. The trial design has been approved by the US Food and Drug Administration (FDA) under a Special Protocol Assessment (SPA) program, and provides for an interim analysis of the data, which, if statistically significant, can be used to support a request for accelerated marketing approval."
U.S. Patient Safety community - Tell It Like It Is!
Note: While this article is specific to the U.S., the basis/assumptions would be of significance to the many.
e-ESO Online educational resource - online - Advanced epithelial ovarian cancer: Are there improvements in first and second line treatment?
e-Grandrounds CME:
GR36 - 19 February 2009
Expert: Jan B. Vermorken, University Hospital of Antwerp, Edegem, Belgium
Discussant: Sergio Pecorelli, University of Brescia, Ospedali Civili, Brescia, Italy"
Monday, February 23, 2009
Surgery for Recurrent Ovarian Cancer: Role of Peritoneal Carcinomatosis: exploratory analysis DESKTOP 1 trial about risk factors, surgical .....
Surgery for Recurrent Ovarian Cancer: Role of Peritoneal Carcinomatosis: Exploratory Analysis of the DESKTOP I Trial About Risk Factors, Surgical Implications, and Prognostic Value of Peritoneal Carcinomatosis
ecancer.tv: Ovary and Gynaecology (5 video presentations)
Ovary and Gynaecology:
1) prophylactic surgery for BRCA Dr Wood U.S.;
2) executive summary (discussion of future ECCO congress) video;
3) Prof Douglas Easton 10 new genes increase risk of breast cancer UK; 4) Dr Monk (sea squirt also known as Trabectedin/Ecteinascidin/ET-743/Yondelis ) U.S.;
5) Prof Michael Friedlander (can't quite understand the therapy he speaks of) Australia (oral inhibitor antiogenesis).
For other videos select main page of website.
Sunday, February 22, 2009
Friday, February 13, 2009
Health Consumer Council
Health Consumer Council
"International Health Rights Consumers International
The Rights of Patients
Prescription for healthy consumers
All patients have the right to:
1. appropriate and accessible health care
2. freedom from discrimination
3. information and education
4. choose a doctor or other health worker
5. choose a health care establishment
6. informed consent about treatment
7. participate in their own health care
8. respect, privacy, confidentiality and dignity
9. complain
10. redress in the event of injury."
Wednesday, February 11, 2009
Tuesday, February 10, 2009
Cancer Patients Versus Cancer Survivors: Social and Emotional Consequences of Word Choice -- abstract
Cancer Patients Versus Cancer Survivors: Social and Emotional Consequences of Word Choice -- Mosher and Danoff-Burg 28 (1): 72 -- Journal of Language and Social Psychology
Cancer Patients Versus Cancer Survivors
Social and Emotional Consequences of Word Choice
State University of New York, Albany, mosherc@mskcc.org
State University of New York, Albany
Two studies examined the social and emotional implications of different linguistic classifications of individuals with cancer. Undergraduates were randomly assigned to rate their reactions to either cancer patients or cancer survivors. Across studies, participants held more favorable perceptions of the character of cancer survivors relative to cancer patients and displayed more positive attitudes toward the former group. In addition, participants in Study 1 reported greater willingness to interact with cancer survivors compared with cancer patients. Positive perceptions of prognosis did not appear to account for favorable attitudes toward cancer survivors; most participants in Study 2 did not assume that cancer survivors were beyond the treatment phase of their illness or cured of their disease. Findings point to a potentially powerful effect of word choice on reactions to individuals with cancer.
Key Words: cancer • perceptions • attitudes
Monday, February 09, 2009
UK - Target Ovarian Cancer Pathfinder study
http://tinyurl.com/cglvlf
02.02.09
Target Ovarian Cancer Pathfinder Study Advisory Panel announced Women with ovarian cancer and senior healthcare professionals and researchers are joining together to shape this important study.
Target Ovarian Cancer today announced the members of the independent advisory panel who are overseeing the groundbreaking Target Ovarian Cancer Pathfinder Study. They include patient and relative representation in addition to a wide range of senior healthcare professionals and researchers involved in diagnosing, treating and caring for women with ovarian cancer......cont'd
............................................................................................
Media resources (click on link to Media): Note the last sentence for the call for ovarian cancer participants:
Welcome to the Target Ovarian Cancer media hub. You'll find a host of media friendly materials here such as the stories of women living with ovarian cancer plus our latest news releases.
In the coming months we will be adding more and more unique data to this section making it a genuine 'hub' of ovarian cancer news and real life stories.
Right now, we are asking media to assist in our search for women with ovarian cancer, specialist gynae cancer nurses, clinicians and researchers to take part in the Target Ovarian Cancer Pathfinder Study. It is the first national study of its kind devoted to mapping the gaps in current patient care, clinical research, funding and identifying the routes forward for ovarian cancer management. All working towards our aim of a long and good life for every woman with ovarian cancer.
Nationally, March is Ovarian Cancer Awareness Month, so if you are planning a feature, please do include a 'call to action' for people to enroll in the Target Ovarian Cancer Pathfinder Study via www.targetovarian.org.uk . Our recruitment will continue on an ongoing basis.
Progestins in HRT: Sufferance or desire?
ScienceDirect - Maturitas : Progestins in HRT: Sufferance or desire?
".... recent epidemiological data may have been not only wrongly translated in relation to the clinical settings, but also to the whole class of therapies. The various progestins available for hormonal therapy exert different partial effects at cellular level according to the biochemical composition."
Markman: Intraperitoneal chemotherapy in the management of ovarian cancer: focus on carboplatin
article: http://www.dovepress.com/intraperitoneal-chemotherapy-in-the-management-of-ovarian-cancer-focus-peer-reviewed-article
open text pdf file: http://www.dovepress.com/getfile.php?fileID=4267
Worth noting:
Finally, as it is known that patients with “high risk”
early stage ovarian cancer have a 30% to 50% chance of
experiencing recurrence of the disease process, and those
recurrences are largely within the peritoneal cavity, it is
perhaps reasonable to consider delivering some, or perhaps
all, of a planned adjuvant chemotherapy approach via the
intraperitoneal route.
"N.E.D." :: UNC doctor-rockers score record deal
WRAL.com :: UNC doctor-rockers score record deal
N.E.D's music is rock, but with a niche all its own: It's Gynecologic Oncology rock – with a mission.
Sunday, February 08, 2009
Role of surgical outcome as prognostic factor in AEOC: a combined exploratory analysis of 3 prospectively randomized ph 3 trials
Wiley InterScience :: JOURNALS :: Cancer
CONCLUSIONS:The goal of primary surgery should be complete resection. The prognostic impact of tumor biology seemed to be partially overruled by residual tumor and further evaluation of biologic factors should stratify for residual tumor.
Saturday, February 07, 2009
Friday, February 06, 2009
globeandmail.com: Breast cancer risk, HRT link confirmed - Comments
globeandmail.com: Breast cancer risk, HRT link confirmed - Comments
(S Pniauskas, from Canada) wrote: Most of these unresolved issues stem from the well know publication of the WHI study (Women's Health Initiative). It is important to view this related research as it applies to oneself and in conjunction with a knowledgeable health care provider. The WHI publication authors acknowledged the media events were damaging and did not adequately relay pertinent or clear information to neither the consumer/public nor health care providers - so a lesson not well learned.
Further, there is a significant population of women for whom the WHI did not address which includes pre-menopausal women and those surgically and/or treatment-related induced menopause. For these women, and in particular, for those with surgically induced menopause, a one-size fits all - does not. There are significant differences between natural menopause and surgically/treatment-related menopause.
This Future Medicine editorial may be of interest:
http://tinyurl.com/cmgxek
HRT/ERT/MRT is an area of concern not only to breast cancer women (those at risk of whom there are many) but also those genetically predisposed to breast, ovarian, uterine (endometrial) and colo-rectal women.
A blanket statement on definitve implications is impossible at the moment. While some criticize the many post analyses in sub-groups of the WHI, it is necessary due to the often critical and criticized absences of important information that was not included in the WHI.
Wednesday, February 04, 2009
Commentary: The National Pharmaceuticals Strategy: Rest in peace, revive or renew?
cmaj.082087v1.pdf (application/pdf Object)
Table 1: International comparisons of prescription drug access, affordability, quality and safety
Tuesday, February 03, 2009
PLoS Medicine - Ovarian Carcinoma Subtypes Are Different Diseases: Implications for Biomarker Studies
PLoS Medicine - Ovarian Carcinoma Subtypes Are Different Diseases: Implications for Biomarker Studies
Note: (funding) Cheryl Brown was an ovarian cancer survivour and was one of the original founders of Ovarian Cancer Canada.
"Cheryl Brown Ovarian Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, British Columbia, Canada"
Why Was This Study Done?
Although it is usually regarded as a single disease, there are actually several distinct subtypes of ovarian carcinoma. These are classified according to their microscopic appearance as high-grade serous, low-grade serous, clear cell, endometrioid, and mucinous ovarian carcinomas. These subtypes develop differently and respond differently to chemotherapy. Yet scientists studying ovarian carcinoma usually regard this cancer as a single entity, and current treatment protocols for the disease are not subtype specific. Might better progress be made toward understanding ovarian carcinoma and toward improving its treatment if each subtype were treated as a separate disease? Why are some tumors confined to the ovary, whereas the majority spread beyond the ovary at time of diagnosis? In this study, the researchers address these questions by asking whether correlations between the expression of “biomarkers” (molecules made by cancer cells that can be used to detect tumors and to monitor treatment effectiveness) and the stage at diagnosis or length of survival can be explained by differential biomarker expression between different subtypes of ovarian carcinoma. They also address the question of whether early stage and late stage ovarian carcinomas are fundamentally different.
PLoS Medicine - Ovarian Cancer: A Clinical Challenge That Needs Some Basic Answers
PLoS Medicine - Ovarian Cancer: A Clinical Challenge That Needs Some Basic Answers
From a clinical perspective, epithelial ovarian cancer is something of an enigma. Despite improvements in aggressive debulking surgery and the initial good response of patients to platinum-based chemotherapies, there has been little improvement in the survival rates for over three decades..... About 65% of women with epithelial ovarian cancer will die within five years of their diagnosis [1].
Unfortunately, there are no effective biomarkers that can identify early-stage disease and no reliable prognostic markers for predicting clinical response and guiding treatment regimes. Furthermore, there remains intense debate about the cellular origins, precursor lesions, and histological classification of the disease. With so many unknowns, it is perhaps not surprising that progress in reducing mortality in women diagnosed with ovarian cancer has been so limited.
Sunday, February 01, 2009
Anlaysis of hMLH1 and hMSH2 expression Cisplating-treated ovarian cancer patients
HighWire Press -- Medline Abstract
"CONCLUSION: The immunohistochemical expression of hMLH1 and hMSH2 proteins in ovarian cancer has no predictive value in resistance to cisplatin."
Dietary patterns and ovarian cancer risk
Dietary patterns and ovarian cancer risk -- Kolahdooz et al. 89 (1): 297 -- American Journal of Clinical Nutrition
"Conclusions: A diet characterized by high meat and fat intake may increase the risk of epithelial ovarian cancer. A diet high in fruit and vegetables was not associated with reduced risk."
The Surprisingly Complex World of e-Communities -
The Surprisingly Complex World of e-Communities -
CHAPTER FOUR (See Summary)
Contents
[hide]- 1 The Surprisingly Complex World of e-Communities
- 1.1 Online Support Communities
- 1.2 This is Crazy! This Information Needs to be Saved!
- 1.3 Braintalk: An e-Patient-driven Online Educational and Support Community
- 1.4 Building from the Bottom Up
- 1.5 Online Groups Supplement, but Don't Replace, Doctors
- 1.6 Forgotten Heroes
- 1.7 Evidence of the Effectiveness of Online Groups
- 1.8 Putting a Human Face on Medical Information
- 1.9 Practical Day-to-Day Illness Management Advice
- 1.10 e-Groups Are Always There
- 1.11 Providing Continuing Support for the Incurable
- 1.12 Special Benefits for Those with Rare Conditions
- 1.13 A Godsend for Those with Limited Access to Professional Care
- 1.14 Keeping Up on the State of the Art for Your Condition
- 1.15 References
REPOST: e-Patients: How they can help us heal healthcare
Main Page -
Table of Content
- Editors' Note and Dedication
- Acknowledgements
- Foreword by Lee Rainie and Susannah Fox
- Preface
- Introduction
- Hunters and Gatherers of Medical Information
- Content, Connectivity, and Communityware
- Patient-Centered Networks: Connected Communities of Care
- The Surprisingly Complex World of e-Communities
- e-Patients as Medical Researchers
- Learning from e-Patients
- The Autonomous Patient and the Reconfiguration of Medical Knowledge
Abstract | Large family with both parents affected by distinct BRCA1 mutations: implications for genetic testing
Abstract | Large family with both parents affected by distinct BRCA1 mutations: implications for genetic testing
Ideally, all family members affected by breast or ovarian tumor disease have to be subjected to the DNA testing, and failure to detect the mutation in any of them calls for the search of the second cancer-associated allele."
Saturday, January 31, 2009
Genetic classification of ovarian carcinoma based on microsatellite analysis: Relationship to clinicopathological features and patient survival
abstract:
Genetic classification of ovarian carcinoma based on microsatellite analysis: Relationship to clinicopathological features and patient survival
These findings suggest that some ovarian carcinomas have a significant degree of overlap between the two pathways of genomic instability and that the genetic classification using microsatellite markers may represent a potential new biomarker of risk prediction in ovarian carcinoma.
Distribution of microsatellite instability in Danish ovarian tumor patients and the prognositic value in ovarian cancer patients
Distribution of microsatellite instability in Dani...[Oncol Res. 2008] - PubMed Result
In conclusion, we found no association to any of the clinical parameters evaluated, although a tendency of a higher frequency of MSI was observed among serous OC.
Systematic Review and Meta-analysis of Ovarian Cancers: Estimation of Microsatellite-High Frequency and Characterization of Mismatch Repair Deficient Tumor Histology
abstract:
Systematic Review and Meta-analysis of Ovarian Cancers: Estimation of Microsatellite-High Frequency and Characterization of Mismatch Repair Deficient Tumor Histology -- Pal et al. 14 (21): 6847 -- C
The frequency of the MSI-H phenotype in unselected ovarian cancers approximates 12%. MMR-deficient ovarian cancers also seem to be characterized by an overrepresentation of nonserous histologic subtypes. Knowledge of histologic subtype may aid clinicians in identifying the relatively large proportion of ovarian cancers due to MMR defects; such knowledge has potential implications for medical management.
Friday, January 30, 2009
Thursday, January 29, 2009
news article: Self-diagnosis can be risky - Dee Williams/ACOR ovarian listserv
Self-diagnosis can be risky | courier-journal | The Courier-Journal
"And she's found camaraderie by connecting with other ovarian cancer patients through such sites as The Association of Cancer Online Resources.
'The ovarian list is very active,' she said. 'Every day there's probably at least 50-60 posts. Someone will say, 'Hey, I'm starting this chemo treatment. What can you tell me about it?' and women will reply, 'Oh, I've been on it and it made me sick,' or 'It gave me diarrhea.' '
Women from inside and outside the United States participate, sometimes sharing journal articles and recommending doctors to each other, in addition to offering support, Edwards said.
Thanks to them, she said, 'I feel like I have a local support group and then I have my global support group' on the Internet."
Hanging in the Balance: Making Decisions About the Benefits and Harms of Breast Cancer Screening Among the Oldest Old Without a Safety Net of Scientific Evidence
Hanging in the Balance: Making Decisions About the Benefits and Harms of Breast Cancer Screening Among the Oldest Old Without a Safety Net of Scientific Evidence -- Mandelblatt and Silliman 27
Editorial:
"Aside from the acknowledged methodological caveats and the potentially misleading press surrounding the article by Badgwell et al,5 the study's investigators and the Journal of Clinical Oncology are to be commended for raising difficult questions in gero-oncology, especially when the answers are imperfect. The intensity about the controversy that followed this publication reflects the fact that we are ill-prepared from a scientific knowledge perspective to provide health care rationally, ethically, equitably, and humanely to the 'booming' older population."
When Informed, All Women Do Not Prefer Breast Conservation
When Informed, All Women Do Not Prefer Breast Conservation -- Throckmorton and Esserman 27 (4): 484 -- Journal of Clinical Oncology
The key to offering a choice is respecting the choices patients make. Some people will choose one path, others a different one. We need to accept that women will have different values and want different choices. Our job should be to make sure patients have the choices, the information, the time, and environment in which to make an informed, value-driven decision.
Should patient-rated performance status affect treatment decisions - ECOG score
PS=performance status
Should patient-rated performance status affect tre...[J Thorac Oncol. 2008] - PubMed Result
"CONCLUSIONS: Pt-PS and MD-PS were not congruent in over half of the cases, with Pt-PS scores usually poorer. Almost half the patients would have excluded themselves from a hypothetical clinical trial (Pt-PS >/=2). This requires prospective evaluation."
Wednesday, January 28, 2009
Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingo-oophorectomy in BRCA1 or BRCA2 Mutation Carriers
note: Table 4 does not include self image etc in gyn cancers but does in breast cancer
Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingo-oophorectomy in BRCA1 or BRCA2 Mutation Carriers -- Rebbeck et al. 101 (2): 80 -- JNCI Journal of the National Cancer
Tuesday, January 27, 2009
Monday, January 26, 2009
HE4 Test with CA125 for Risk Stratification of Women with Suspected Ovarian Cancer
Pivotal Data Published For First Biomarker Combination Test to Determine Risk of Ovarian Cancer in Women Who Present With Pelvic Mass
ZAIDA - Caring Bridge journal
(Posted with permission of Mom): Zaida (ZAY-da) turned 4 in September. We learned she has cancer on 10/31/07, after six very emotional days in the hospital. Two days later we learned it was ovarian cancer. More recently, the diagnosis is mesothelioma of the peritoneum, with an ovarian promotor.
Older Patients and the Shifting Focus of Cancer Care
Older Patients and the Shifting Focus of Cancer Care - Cancer Network
"Conclusions
Society has treated elderly cancer patients poorly, even in cases where curative therapy exists."
Sunday, January 25, 2009
Diversity of participants in clinical trials in an academic medical center
Wiley InterScience :: JOURNALS :: Cancer
Further research also should consider whether differentially recruiting
good patients
can impact the ethnic/racial diversity or other characteristics of trial participants in ways that may bias the outcomes or conclusions of therapeutic trials.
Friday, January 23, 2009
webcast presentation: Menopause and Osteoporosis | January 22, 2009 | Media Advisories | Media Centre | SOGC
Prevalence, distress, management, and relief of pain during the last 3 months of cancer patients' life - Italian mortality follow-back survey
Annals of Oncology Advance Access published online on January 22, 2009
Annals of Oncology, doi:10.1093/annonc/mdn700
| |
Prevalence, distress, management, and relief of pain during the last 3 months of cancer patients' life. Results of an Italian mortality follow-back survey
1 Regional Palliative Care Network, National Cancer Research Institute, Genoa
2 Palliative Care Unit, IRCCS Foundation, National Cancer Institute, Milan
3 Department of Epidemiology, National Cancer Research Institute, G. Pascale Foundation, Naples
4 ASP Lazio, Rome
5 Liguria Cancer Registry, Descriptive Epidemiology, National Cancer Research Institute, Genoa
6 Clinical Epidemiology, Center for the Study and Prevention of Cancer, Florence, Italy
* Correspondence to: Dr M. Costantini, Regional Palliative Care Network, National Cancer Research Institute, Largo R. Benzi, 10 16132 Genova, Italy. Tel: +39-010-5737482; Fax: +39-010-354103; E-mail: massimo.costantini@istge.it
Background: This study estimates prevalence, management, and relief of pain during the last 3 months of life of a representative sample of dying cancer patients in Italy.
Patients and methods: This is a mortality followback survey (the Italian Survey of the Dying of Cancer). Caregivers were interviewed, after the patient's death, about pain experienced by the patients in all settings of care.
Results: According to caregivers' reports, 82.3% [95% confidence interval (CI) 79.9% to 84.4%] patients experienced pain, and 61.0% (95% CI 57.9% to 64.0%) very distressing pain. The younger population experienced a higher prevalence of pain in respect to older patients (P <> central nervous system experienced the lowest prevalence (51.9%). According to caregivers' reports, only 59.5% (95% CI 3.7% to 65.0%) received analgesic treatment with opioids for moderate to severe pain. Not surprisingly, pain was ‘only partially relieved’ or ‘not relieved at all’ in 54% of the patients with very distressing pain.
Conclusions: Although potentially slightly biased, the results from this survey regarding undermedication and poor treatment results for cancer related pain are unequivocal. The research agenda should focus on testing the effectiveness of interventions to improve the quality of pain assessment and management.
cancer, effectiveness, opioids, pain, prevalence, treatment
Received for publication March 25, 2008. Revision received August 1, 2008. Accepted for publication October 7, 2008.
Thursday, January 22, 2009
Canada NewsWire Group
Canada NewsWire Group: "The webcast will explain key findings from the clinical review, with a focus on hormone therapy, osteoporosis, cardiac health and cognitive function.'"
The effect of obesity on survival in patients with ovarian cancer
Conclusion
Although obesity has been reported as an independent prognostic factor for survival, this data demonstrates that survival rates are similar between obese and non-obese patients when optimal debulking statuses are the same. Therefore, maximal effort should be directed towards optimal debulking obese patients with EOC.
Wednesday, January 21, 2009
Tuesday, January 20, 2009
Monday, January 19, 2009
Information exchange between provider and patient -- Brown 180 (2): 207 -- Canadian Medical Association Journal
Information exchange between provider and patient -- Brown 180 (2): 207 -- Canadian Medical Association Journal
"Emerging technologies such as patient-accessible electronic health records should be considered as a means of facilitating the transmission of information not only between providers but also between provider and patient to address gaps in the continuity of care."
CDC Issues Cancer Genetic Test Recommendations | GenomeWeb
CDC Issues Cancer Genetic Test Recommendations | GenomeWeb
"After conducting an evidence-based analysis, the CDC's Evaluation of Genomic Applications in Practice and Prevention Working Group, or EWG, said it could recommend offering genetic testing for Lynch syndrome to newly diagnosed colorectal cancer patients, but that it did not find enough evidence to recommend for or against two other types of genetic tests, for breast cancer and metastatic colorectal cancer."
Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingo-oophorectomy in BRCA1 or BRCA2 Mutation Carriers -- Rebbeck et al., 10.1093/jnci/djn442 -- JNCI Journal of the National
Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingo-oophorectomy in BRCA1 or BRCA2 Mutation Carriers -- Rebbeck et al., 10.1093/jnci/djn442 -- JNCI Journal of the National
In conclusion, the summary risk reduction estimates presented here confirm that BRCA1/2 mutation carriers who have been treated with RRSO have a substantially reduced risk of both breast and ovarian cancer. However, residual cancer risk remains after surgery. Therefore, additional cancer risk reduction and screening strategies are required to maximally reduce cancer incidence and mortality in this high-risk population.
The HPV Vaccine Controversy
The HPV Vaccine Controversy
"Gardasil was fast-tracked and received FDA approval before its final safety evaluation trials were complete, and its final safety evaluation trials won’g be concluded until September 2009. Despite this, the drug is being aggressively mass-marketed on TV and at the movies in adverts pitched to young girls, including preteens, and state legislators were heavily lobbied to make the drug mandatory for school girls ages 11 and up. Parents are understandably reluctant to give the shots to daughters who are not yet sexually active, and the long-term impacts of which are entirely unknown."
Sunday, January 18, 2009
Awards of excellence 2008 CANO: Pamela J. West
Awards of excellence
CANO/NOCA Award for Excellence in Gynecology-Oncology Nursing
Previous recipients of this award include:
2008 Pamela West
2007 Lynne Jolicoeur
2006 Joanne Brodeur
Australia What changes are needed to the current direction and interpretation of clinical cancer research to meet the needs of the 21st century?
Abstract
In this 21st century, we will need to better analyse the outcomes of our spending on newer and more expensive anticancer drugs, particularly through postmarketing assessment, to ensure that these investments are justified.
Evidence-based medicine is only as good as the evidence available, and we advocate for more independently designed and funded trials that concentrate on the minimum effective dose and duration of therapies to reduce toxicity to patients and to control costs. There is a place for governments to provide funding for these studies in the public good.
Although improving survival over standard care is the gold standard for proving the efficacy of a new therapy, surrogate endpoints such as early biological marker changes, functional imaging changes or earlier measures such as progression-free survival must be investigated to enable drug therapies to be discontinued earlier if they are ineffective.
Studies searching for the presence of biological targets must be funded to exploit the potential advantage of targeted therapies.
Treatment guidelines are best written by experts who are independent of the pharmaceutical industry.
Existing databases should be linked to better monitor the outcomes of new therapies. Privacy safeguards are important, but privacy legislation may need to be modified to serve the greater public good from the information gained from linking databases.
Friday, January 16, 2009
Medical News: Final Medicare Rule Shuts Off Payment for Erroneous Surgeries
Medical News: Final Medicare Rule Shuts Off Payment for Erroneous Surgeries - in Geriatrics, Medicare from MedPage Today
"The surgical mistakes join 12 categories of errors and preventable complications already on the CMS blacklist, which went into effect on Oct. 1:
* Objects left in after surgery
* Air embolisms
* Blood incompatibility
* Pressure ulcers
* Falls in the hospital
* Catheter-associated urinary tract infections
* Catheter-associated vascular infections
* Mediastinitis after CABG
* Inadequate glycemic control
* Surgical site infections
* Deep vein thrombosis and pulmonary embolism
* Drug-induced delirium
For those 12 errors, however, CMS is denying claims only for hospital inpatient reimbursements."
Thursday, January 15, 2009
Wednesday, January 14, 2009
Clinical Patterns and Biological Correlates of Cognitive Dysfunction Associated with Cancer Therapy
Clinical Patterns and Biological Correlates of Cognitive Dysfunction Associated with Cancer Therapy -- Dietrich et al. 13 (12): 1285 -- The Oncologist
ABSTRACT
Standard oncological therapies, such as chemotherapy and cranial radiotherapy, frequently result in a spectrum of neurocognitive deficits that includes impaired learning, memory, attention, and speed of information processing. In addition to classical mechanisms of neurotoxicity associated with chemo- and radiotherapy, such as radiation necrosis and leukoencephalopathy, damage to dynamic progenitor cell populations in the brain is emerging as an important etiologic factor. Radiation- and chemotherapy-induced damage to progenitor populations responsible for maintenance of white matter integrity and adult hippocampal neurogenesis is now believed to play a major role in the neurocognitive impairment many cancer survivors experience.
Tuesday, January 13, 2009
18F-FDG PET and PET/CT in the Evaluation of Cancer Treatment Response - The Journal of Nuclear Medicine
18F-FDG PET and PET/CT in the Evaluation of Cancer Treatment Response -- Ben-Haim and Ell 50 (1): 88 -- The Journal of Nuclear Medicine
Note: Ovarian Cancer is discussed under the Miscellaneous section.
WHI Participant website
WHI Participant website
January 2009 New results from the Women’s Health Initiative Memory Study of Magnetic Resonance Imaging (WHIMS-MRI)
Monday, January 12, 2009
The effect of obesity on survival in patients with ovarian cancer (repost from 2008)
Conclusion
Although obesity has been reported as an independent prognostic factor for survival, this data demonstrates that survival rates are similar between obese and non-obese patients when optimal debulking statuses are the same. Therefore, maximal effort should be directed towards optimal debulking obese patients with EOC.
news item: Colonoscopy Fails to Identify Many Colorectal Cancers
Daily Cancer News - CancerConsultants.com
While researchers have long estimated that colonoscopy reduces colorectal cancer deaths by 90%, the results of this analysis indicate that the reduction might be closer to 60%. More research is needed to understand the implications of this analysis. In the meantime the researchers caution that the results of this study should not change the colonoscopy screening recommendations. A 60% reduction in mortality is still an important benefit; in comparison, mammography reduces breast cancer mortality by only 25%.
Globe and Mail: 2 articles: Obesity and Ovarian Cancer and McHealth stories leave us all hungry
globesports.com: McHealth stories leave us all hungry
Media articles of interest:In fact, the paper Body Mass Index and Risk of Ovarian Cancer (2009 American Cancer Society/Cancer Journal) as published:
Obesity / Ovarian cancer article: http://tinyurl.com/9ak8st
McHealth stories: http://tinyurl.com/7xmwsf
My online response as below: http://tinyurl.com/9554b6
(S Pniauskas, from Canada) wrote:
A prime example of the ethical, moral and professional duty of apparent
medical reporting is Andre's recent article: "Obesity raises risk of ovarian cancer".
"Conclusions: Based on the results of the current study, the authors SUSPECT that obesity....As observed in numerous previous investigations summarized in a recent meta-analysis of the available literature, BMI at baseline was associated with a modest but statistically NONSIGNIFICANT INCREASE IN RISK for ovarian cancer in our cohort as a whole... "
The whole article in the Globe regarding Obesity and Risk of Ovarian Cancer is significantly pathetic including the fact that the last sentence regarding risk of recurrence/higher rate of death is not accurate. What is accurate is the fact that if chemotherapy treatments are given according to BMI then the risk is Nil.
Ovarian Cancer and most cancers cannot simply be explained away by simple one page articles and to try to do so places additional burdens on our populations which are in fact fighting for and often losing the challenge of trying to live with life threatening cancers. Research communities publish their work as a 'work in progress' and not as the final solution to extremely complicated issues. Many factors influence the onset and risk of ovarian and other cancers and we simply are not there yet in understanding the full implications of any particular one or two potential issues.
It is an old lesson yet learned that medical reporting has a duty to understand the full context of the issues, as well as a duty to do no harm, which is not exclusively held to medical professionals but to also to medical reporting.
There are educational courses available to medical journalists and consumers, one being through the Cochrane Collaboration.
Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis
"...Sometime before diagnosis, 63% were told nothing was wrong with them."
(Editorial note: since there is a known connection between endometrioid and clear cell ovarian cancer cell types to endometriosis, it would be interesting to note followup on those subsequently diagnosed not only with endometriosis but also with ovarian cancer)
The government’s role in health care | Health Innovation Forum
The government’s role in health care | Health Innovation Forum
"More importantly, after nearly 30 years of overt attempts to manage provincial systems, they are still not stable or sustainable. This worrisome outcome results from the convergence of three probably uncontrollable and partially self-imposed factors I like to call the “Bermuda Triangle” of health care."
Sunday, January 11, 2009
Toronto Star: Disclose Charity Pay
Disclose charity pay
January 11, 2009
In these tough times, Canadian charities are working harder than ever to raise money for their good works.
But for charities, as for any business, it costs money to raise money.
To help maintain public confidence in charity work, the Canada Revenue Agency regulates fundraising by requiring the disclosure of what percentage of donations is spent on administration costs. Under proposed CRA guidelines released last year, charities should keep fundraising costs below 35 cents on the dollar. The goal is to reassure donors that most of their money is going to help deserving causes, rather than paying expenses and salaries.
Yet Ottawa is still lagging behind the U.S. in its regulation of the vital fundraising sector.
As the Star's Kevin Donovan reminded us in his recent story about a change of the guard at one of Toronto's biggest charities, most fundraisers won't say how much money they are paying their own top people. He reported that the departing president of SickKids Foundation, Michael O'Mahoney, earned a remarkable $624,103 in salary and benefits last year, more than the president of the Hospital for Sick Children for which he was raising money.
The Star discovered O'Mahoney's salary only because of disclosure documents filed with the Internal Revenue Service in the U.S., where SickKids Foundation arm does business, not the CRA.
Canada had long lagged behind the U.S. in disclosure of corporate salaries but, belatedly, shone a light on something shareholders have every right to know. Fundraising has become a big business, and the donors who have a stake in Canada's 83,000 charities deserve no less transparency than shareholders in big corporations.
Critical Care Canada Forum
Critical Care Canada Forum
Presentations
* 'Substitute Decision Making: Conflicts and Controversies in Practice' by Mark Handelman (Flash Movie)
* 'Unilateral Withdrawal: An 11th Commandment?' by Anand Kumar (Flash Movie)
* 'When is Enough Enough? An Ethical Perspective' by Robert Sibbald (Flash Movie)
* 'Legal Framework & Cases Affecting Critical Care in Ontario' by Joan Gilmour (Flash Movie)
Saturday, January 10, 2009
Journal of Ovarian Research | Full text | Can Subjective Global Assessment of Nutritional Status Predict Survival in Ovarian Cancer?
Journal of Ovarian Research | Full text | Can Subjective Global Assessment of Nutritional Status Predict Survival in Ovarian Cancer?
"Background
Malnutrition is a significant problem in patients with ovarian cancer. The goal of this study was to investigate the prognostic role of Subjective Global Assessment (SGA) in patients with ovarian cancer treated in an integrative cancer treatment setting."
Thursday, January 08, 2009
CSDH Conference 2008 video: Health as a Human Right (a Human Rights Report)
CSDH Conference
global inequality and discrimination and poverty - Universal Declaration of Human Rights
Readers as research detectives abstract + free full text
Abstract | Readers as research detectives
"Commentary - Readers as research detectives
Peter C Gøtzsche
Trials 2009, 10:2doi:10.1186/1745-6215-10-2
Published: 7 January 2009
Abstract (provisional)
Flaws in research papers are common but it may require arduous detective work to unravel them. Checklists are helpful, but many inconsistencies will only be revealed through repeated cross-checks of every little detail, just like in a crime case. As a major deterrent for dishonesty, raw data from all trials should be posted on a public website. This would also make it much easier to detect errors and flaws in publications, and it would allow many research projects to be performed without collecting new data. The prevailing culture of secrecy and ownership to data is not in the best interests of the patients."
Wednesday, January 07, 2009
Dietary patterns and ovarian cancer risk -- Kolahdooz et al. 89 (1): 297 -- American Journal of Clinical Nutrition
Dietary patterns and ovarian cancer risk -- Kolahdooz et al. 89 (1): 297 -- American Journal of Clinical Nutrition
"Conclusions: A diet characterized by high meat and fat intake may increase the risk of epithelial ovarian cancer. A diet high in fruit and vegetables was not associated with reduced risk."
Tuesday, January 06, 2009
Monday, January 05, 2009
Cytoreductive surgery for recurrent ovarian cancer: A meta-analysis
Conclusions
Among patients undergoing operative intervention for recurrent ovarian cancer, the proportion of patients undergoing complete cytoreductive surgery is independently associated with overall post-recurrence survival time. For this select group of patients, the surgical objective should be resection of all macroscopic disease.
Central East LHIN (Ontario)- Integration-Process slide/pdf file
Integration-Process_for_website.pdf (application/pdf Object)
There is no requirement of the LHIN or HSP provider to conduct a community engagement process
Sunday, January 04, 2009
Tragic results of suboptimal gynecologic cancer operations
Tragic results of suboptimal gynecologic cancer op...[Eur J Gynaecol Oncol. 2008] - PubMed Result
"CONCLUSION: If a gynecologist does not have enough experience or expertise about gynecological cancer operations, he or she must consider the possible harm that any surgical intervention might do, as the latin phrase 'primum non nocere' means and should refer patients to a gynecological oncology center without performing any surgery."
Prospective study of physical activity and the risk of ovarian cancer
Prospective study of physical activity and the ris...[Cancer Causes Control. 2008] - PubMed Result
"CONCLUSIONS: Neither moderate nor vigorous physical activity showed a statistically significant association with ovarian cancer in this large cohort of women."
Consideration of hereditary nonpolyposis colorectal cancer (HNPCC/Lynch Syndrome) in BRCA mutation negative familial ovarian cancers
Consideration of hereditary nonpolyposis colorecta...[Cancer. 2008] - PubMed Result
"CONCLUSIONS:: HNPCC should be considered when evaluating patients with suspected hereditary ovarian cancer who have had negative BRCA mutation testing"
Clinical trials in Canada: whose interests are paramount?
Clinical trials in Canada: whose interests are par...[Int J Health Serv. 2008] - PubMed Result
Clinical trials in Canada: whose interests are paramount?
More than 80 percent of clinical drug trials in Canada are funded by the pharmaceutical industry. This article evaluates the overall state of clinical trials in Canada and looks at the interplay between public and private interests. Health Canada has adopted standards developed by the International Conference on Harmonization, a body that is heavily influenced by industry. Commercial interests are increasingly involved in recruiting patients into clinical trials and in running these trials. It is in industry's interests to conduct drug tests on people for which it is easiest to see benefits. These interests are not fundamentally challenged by Health Canada's policy of issuing nonmandatory guidelines on who should and should not be included in clinical trials. The outcome of clinical trials is heavily influenced by commercial sponsorship, with the result that trials may favor corporate interests rather than the interests of the public. How Health Canada deals with that possibility is not known, because of its strict policy of treating clinical trial data as private property. If clinical trials are to serve the purpose for which they are designed, developing reliable and objective information about new drugs, then commercial interests cannot be allowed to take precedence over health interests.
Medical students' experiences with addicted patients: a web-based survey
Medical students' experiences with addicted patien...[Subst Abus. 2008] - PubMed Result
"Students reacted strongly to the psychosocial impact of addictions on patients, yet they viewed addiction as a personal choice, not an illness. Conclusion: Medical students are not being trained to diagnose addiction or provide advice and counseling. Medical schools need to provide students with positive clinical experiences supervised by physicians experienced in addictions."
Saturday, January 03, 2009
Can the preoperative Ca-125 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? A single institution cohort study
Can the preoperative Ca-125 level predict optimal ...[Gynecol Oncol. 2009] - PubMed Result: "Can the preoperative Ca-125 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? A single institution cohort study"
A contemporary analysis of ability of pre-op serum CA-125 to predict primary cytoreductive outcome in patients advanced ovarian, tubal & peritoneal
A contemporary analysis of the ability of preopera...[Gynecol Oncol. 2009] - PubMed Result
"A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma"
Wednesday, December 31, 2008
Tuesday, December 30, 2008
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