Thursday, April 30, 2009
Patient Involvement in Decisions to Limit Treatment: The Crucial Role of Agreement Between Physician and Patient
"Conclusion Only half of the patients were involved in DLT. Surprisingly, the main predictor of patient involvement was not their medical condition, but agreement with physicians' palliative treatment goals. These results show that if physicians switch to comfort care in terminally ill patients and patients are not yet prepared to follow this line, treatment limitations are often decided without involving the patient."
Wednesday, April 29, 2009
Wait times for chemotherapy in Ontario growing, say advocacy groups
Working On IT! a book in progress: Dana Martinez (husband Ron)
I don't mind making this journey as long as I know that I am helping someone else. Every Cancer survivor I have ever met, has felt this way. There is something that happens to you once you have Cancer, you become part of a larger family-- a family bound by a common thread- "survival".
Tuesday, April 28, 2009
Let Me In!
power point presentation: Let Me In!
access link below:
www.scribd.com/doc/13044110/Ovarian-Cancer-Let-Me-In
Ovarian Cancer: Let Me In!
"Doc, Should I See You or My Oncologist?" A Primary Care Perspective
“Doc, Should I See You or My Oncologist?” A
Primary Care Perspective on Opportunities and
Challenges in Providing Comprehensive Care for
Cancer Survivors
Monday, April 27, 2009
Saturday, April 25, 2009
Friday, April 24, 2009
A Rapid and Reliable Test for BRCA1 and BRCA2 Founder Mutation Analysis in Paraffin Tissue Using Pyrosequencing
The founder mutations in BRCA (BRCA1*185delAG, BRCA1*5382insC, and BRCA2*6174delT) account for 95% of the detectable BRCA mutations in breast and ovarian cancer families of Ashkenazi Jewish ancestry.
Thursday, April 23, 2009
Intercepting pelvic cancer in the distal fallopian tube: theories and realities
This review summarizes the recent data supporting the distal fallopian tube as an important site for serous carcinogenesis, stressing both the presence of a novel precursor (the p53 signature) and the application of this model to all women irrespective of BRCA status. The challenges and unmet needs unmasked by this paradigm shift in ovarian cancer research are discussed.
Revisiting perioperative chemotherapy: the critical importance of targeting residual cancer prior to wound healing
Revisiting perioperative chemotherapy: the critical importance of targeting residual cancer prior to wound healing
Wednesday, April 22, 2009
Tuesday, April 21, 2009
April 21, 2009 - NCI Ovarian Cancer Markers Validated for Early Detection
NCI Cancer Bulletin for April 21, 2009 - National Cancer Institute: "The current guidelines of the U.S. Preventive Services Task Force do not recommend ovarian cancer screening with CA-125. Earlier this month another study using PLCO data concluded that screening women for ovarian cancer often led to unnecessary surgeries and failed to detect the disease in its early stages."
Monday, April 20, 2009
Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors
CO Early Release, published online ahead of print Apr 20 2009
Journal of Clinical Oncology, 10.1200/JCO.2008.20.4883
Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors
M. Elisabeth Del Giudice,* Eva Grunfeld, Bart J. Harvey, Eugenia Piliotis, and Sunil Verma
Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto; Sunnybrook Health Sciences Centre; Ontario Institute of Cancer Research and Cancer Care Ontario, Health Services Research Program; and Divisions of Hematology and Medical Oncology, Department of Medicine, Odette Cancer Centre, Toronto, Ontario, Canada.
* To whom correspondence should be addressed. E-mail: lisa.delgiudice@sunnybrook.ca
Purpose: Routine follow-up of adult cancer survivors is an important clinical and health service issue. Because of a lack of evidence supporting advantages of long-term follow-up care in oncology clinics, there is increasing interest for the locus of this care to be provided by primary care physicians (PCPs). However, current Canadian PCP views on this issue have been largely unknown.
Methods: A mail survey of a random sample of PCPs across Canada, stratified by region and proximity to urban centers, was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined.
Results: A total of 330 PCPs responded (adjusted response rate, 51.7%). After completion of active treatment, PCPs were willing to assume exclusive responsibility for routine follow-up care after 2.4 ± 2.3 years had elapsed for prostate cancer, 2.6 ± 2.6 years for colorectal cancer, 2.8 ± 2.5 years for breast cancer, and 3.2 ± 2.7 years for lymphoma. PCPs already providing this care were willing to provide exclusive care sooner. The most useful modalities PCPs felt would assist them in assuming exclusive responsibility for follow-up cancer care were (1) a patient-specific letter from the specialist, (2) printed guidelines, (3) expedited routes of rereferral, and (4) expedited access to investigations for suspected recurrence.
Conclusion: With appropriate information and support in place, PCPs reported being willing to assume exclusive responsibility for the follow-up care of adult cancer survivors. Insights gained from this survey may ultimately help guide strategies in providing optimal care to these patients.
Press release: Cochrane Library free access to all Canadians
Ottawa, April 15, 2009— The Canadian Cochrane Network and Centre announces today
that everyone in Canada with access to the Internet will be able to view the full content of
The Cochrane Library, an on-line resource that provides evaluations on health
treatments.
The Canadian Cochrane Network and Centre, in partnership with the Canadian Health
Libraries Association, has successfully secured a national license to The Cochrane
Library. In essence, the license provides a subscription for every Canadian with access to
the Internet to benefit from the immense volume of health information found in The
Cochrane Library. Everybody will be one click away from the best available evidence on
the effectiveness of treatment procedures including which ones may be harmful.
Sunday, April 19, 2009
Hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms.
Hum Pathol. 2009 Apr 13
Hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms.
Ohishi Y, Oda Y, Kurihara S, Kaku T, Yasunaga M, Nishimura I, Okuma E, Kobayashi H, Wake N, Tsuneyoshi M.
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; Department of Diagnostic Laboratory, Kyushu University Hospital at Beppu, Beppu 874-0838, Japan.
Hobnail-like cells, which suggest a diagnosis of clear cell carcinoma, are also focally observed in serous borderline tumor of the ovary, causing diagnostic confusion. However, the precise nature of hobnail-like cells in serous borderline tumor has not been well characterized. The purpose of this study was to clarify whether or not hobnail-like cells in serous borderline tumor represent concomitant incipient clear cell neoplasms. First, we carefully reviewed hematoxylin and eosin slides taken from 115 ovarian tumors diagnosed as clear cell carcinoma (73 cases), mixed adenocarcinoma containing clear cell carcinoma (5 cases), and serous borderline tumor (37 cases) to clarify the frequency of coexistence of typical clear cell carcinoma and serous borderline tumor. Through the hematoxylin and eosin review, we paid special attention to the cytologic features of hobnail-like cells in serous borderline tumor and serous borderline tumor-like papillary areas in clear cell carcinoma. Second, we selected 19 serous borderline tumors and 16 clear cell carcinomas, in which hobnail-like cells were easily recognizable, and investigated the immunohistochemical expression of estrogen receptor and Wilms tumor gene protein. No coexistence of clear cell carcinoma and serous borderline tumor was evident in any of the above 115 ovarian tumors. Hobnail-like cells were focally positive for estrogen receptor and Wilms tumor gene protein in nearly all serous borderline tumors. Hobnail-like cells in all clear cell carcinomas were completely negative for estrogen receptor and Wilms tumor gene protein, although estrogen receptor expression was very focally observed (less than 5% area) in non-hobnail cells of only one clear cell carcinoma. In conclusion, hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms because (1) clear cell carcinoma and serous borderline tumor do not coexist and (2) hobnail-like cells in clear cell carcinoma and serous borderline tumor are immunophenotypically distinct. Recognition of our conclusion may protect a patient with "conspicuous hobnail-like cells in serous borderline tumor" from an erroneous overdiagnosis of "concomitant clear cell carcinoma admixed with serous borderline tumor."
Saturday, April 18, 2009
article: Guidelines needed for optimal vitamin D supplementation in cancer patients
"There may be specific benefits and harms associated with vitamin D supplementation in cancer patients that are not present in the general population, despite the fact that these benefits and harms have not been conclusively demonstrated,” Dr. Goodwin writes. “As a result, oncologists making recommendations to individual patients should take a cautious approach.”
Bias in the exchange of arguments: the case of scientists' evaluation of lay viewpoints- Public Understanding of Science
Note: a bit off topic but the last point taken:
"Abstract
Most perspectives on public participation share the notion that dialogues should be open, allowing participants to articulate and evaluate different views and knowledge claims. We hypothesize that participants' evaluation of claims may be biased because participants have a preference for a particular type or source of a claim. This would hamper an open dialogue.....
Contrary to our expectation, scientists evaluated claims of the public more positively than claims of experts."
The risk of colorectal cancer with symptoms at different ages and between sexes: a case-control study
Differences with age and sex are important; current guidance for referral ignores age
The diagnosis of colorectal cancer in patients with symptoms: finding a needle in a haystack
Table 1. Presenting symptoms and signs for 194 patients with colorectal cancer
Symptom Percentage of patients:
Fecal occult blood test positive 77
Rectal bleeding 58
Anemia* 57
Abdominal pain 52
Weight loss 39
Anorexia 27
Constipation 27
Altered stools 25
Fatigue 25
Diarrhea 22
Nausea and vomiting 22
Tenesmus 8
Mucus in stools 6
Rectal pain 5
Obstruction 4
Adapted from . Majumdar et al. [1].
*Anemia = a hemoglobin of <13.4g/dl in men or <12.3g/dl in women.
Friday, April 17, 2009
Inhibition of functional HER family members increases the sensitivity to docetaxel in human ovarian cancer cell lines.
In conclusion, a combination of docetaxel with inhibitors of HER family members, such as cetuximab plus pertuzumab, may be considered for a clinical trial in ovarian carcinomas with functional receptors.
Parity and the risk of breast and ovarian cancer in BRCA1 and BRCA2 carriers
This is the third independent study to find that, as in the general population, parity appears to be associated with protection from breast cancer in women with mutations in BRCA1 and BRCA2. Parity appears to be protective for ovarian cancer in BRCA1 mutation carriers, but its role in BRCA2 mutation carriers remains unclear. Whether later age at first birth is also protective for ovarian cancer in mutation carriers requires further confirmation.
Cochrane Collaboration: Interval debulking surgery for advanced epithelial
* Rates of toxic reactions to chemotherapy were similar in both arms (RR = 1.3, 95%CI: 0.4 to 3.6), but little information is available for other adverse events.
* Only one trial reported quality of life (QOL), which was generally similar in both treatment arms.
* No conclusive evidence was found to determine whether IDS between cycles of chemotherapy would improve or decrease the survival rates of women with advanced ovarian cancer, compared with conventional treatment of primary surgery followed by adjuvant chemotherapy. IDS appeared to yield benefit only in the patients whose primary surgery was not performed by gynecologic oncologists or was less extensive.
OCATS: Cancer survivor helps launch awareness campaign
media article:
Cancer survivor helps launch awareness campaign
e-letter of response:
Now, after close to a decade as one of the minority who has survived ovarian cancer, it is apparent that the message concerning this highly lethal woman's cancer, still is not receiving the respect nor attention it deserves. How, as a society, is it that we fail and continue to fail not only ovarian cancer women/families, but, all those who envision best care for this woman's cancer? The impact of hearing: "well, they are going to die anyway" is distressingly commonplace even today. Those are infuriatingly painful words to hear time and time again. Yet, here we have a small group of women fighting not only for themselves but for the future of Saskatchewan's children - your children. Each time we lose an ovarian cancer woman to this deadly cancer, a part of us dies with her - again and again. In good and bad economic times, little has changed, so it should be obvious that funding is not the issue. Policy makers need to be reminded that these women are not number-crunching statistics, but walking, breathing, caring Mothers, Sisters, Grandmothers and Citizens who have much Hope in the face of extreme adversity. Stick your neck out on this issue and make the obvious right decisions! You could make worse decisions. Sandi Pniauskas
OCATS: Cancer survivor helps launch awareness campaign
media article:
Cancer survivor helps launch awareness campaign
e-letter of response:
Now, after close to a decade as one of the minority who has survived ovarian cancer, it is apparent that the message concerning this highly lethal woman's cancer, still is not receiving the respect nor attention it deserves. How, as a society, is it that we fail and continue to fail not only ovarian cancer women/families, but, all those who envision best care for this woman's cancer? The impact of hearing: "well, they are going to die anyway" is distressingly commonplace even today. Those are infuriatingly painful words to hear time and time again. Yet, here we have a small group of women fighting not only for themselves but for the future of Saskatchewan's children - your children. Each time we lose an ovarian cancer woman to this deadly cancer, a part of us dies with her - again and again. In good and bad economic times, little has changed, so it should be obvious that funding is not the issue. Policy makers need to be reminded that these women are not number-crunching statistics, but walking, breathing, caring Mothers, Sisters, Grandmothers and Citizens who have much Hope in the face of extreme adversity. Stick your neck out on this issue and make the obvious right decisions! You could make worse decisions. Sandi Pniauskas
Thursday, April 16, 2009
Caring for the Morbidly Obese GYN Oncology Patient - Oncology Nursing News
"“In addition, there are obesity bias issues,” Ms Stuckwisch revealed, explaining that many studies exist indicating that nurses view obese patients as overindulgent, lazy, noncompliant, and unsuccessful. Other research shows 31% of nurses would prefer not to care for an obese patient and 24% say obese patients repulse them."
“Obesity can happen to anyone,” Ms. Stuckwisch reminded the attendees. “Overweight is a product of many factors. Overweight is not just related to overeating. There are multiple issues and no real answer to what causes people to cross over to extreme morbid obesity.”
Wednesday, April 15, 2009
Novogen 'Ovature' trial hit by crisis - Phenoxodiol
Novogen 'Ovature' trial hit by crisis
April 15, 2009 - 2:54PM
Biotech Novogen Ltd's US subsidiary has decided to undertake an interim analysis of its phase III "Ovature" trial, saying slowing patient recruitment rates and the global financial crisis has made it imprudent to fund the trial to completion.
The Ovature (Ovarian Tumour Response) study is trialling the anti-cancer drug phenoxodiol in women with advanced ovarian cancer to determine its safety and effectiveness when used in combination with chemotherapy drug carboplatin.
Novogen said its US subsidiary, Marshall Edwards Inc, had announced that new patient recruitment to the Ovature trial would cease and available data from the 141 completed and current patients would be analysed for safety and efficacy outcomes.
"The company has decided to assess these data from the Ovature trial at this time as the current downturn in the global financial markets makes raising further equity or debt in the near term to fund the trial through to completion most unlikely," Marshall Edwards said....cont'd
Tuesday, April 14, 2009
Monday, April 13, 2009
PharmaLive: Manhattan Research Releases Digital DTC Relevance Rankings, Revealing Which Condition Groups Are Most Likely to Adopt eHealth
New York, April 8, 2009 - More than 60% of U.S. adults turn to the Internet as a decision support tool in healthcare and disease management, and certain condition groups are more likely to use online health resources than others, according to pharmaceutical and healthcare market research company Manhattan Research.
Conscience vs. Conscience - Blog - NYTimes
The clause, called the Provider Refusal Rule, allows heath care providers to refuse to participate in procedures they find objectionable for moral or religious reasons.
It is called the “conscience clause” because it affirms the claims of conscience — one’s inner sense of what is right — against the competing claims of professional obligations.
Saturday, April 11, 2009
Chemotherapy toxicity in gynecologic cancer patients with a body surface area (BSA) >2m(s)
"...women with a BSA>2 m(2) on paclitaxel dosed by ABW do not experience excess toxicity in comparison to women on paclitaxel capped at a maximum BSA or women in published trials of adjuvant P/C. Empiric dose reduction is unnecessary and may result in suboptimal treatment...."
Ovarian Cancer Screening Resulted in Many Unnecessary Surgeries
Screening women for ovarian cancer often led to unnecessary surgeries and failed to detect the disease in its early stages, according to new results from the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. The analysis focused on the 34,000 women in the NCI-sponsored trial who were screened annually for signs of ovarian cancer using transvaginal ultrasound and/or the CA-125 blood test.
Friday, April 10, 2009
Prognostic and predictive factors in epithelial ovarian cancer (Bull)
[Prognostic and predictive factors in epithelial ovarian cancer.]
[Article in French]
Comité de gynécologie, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94800 Villejuif, France.
Even if prognosis of epithelial ovarian cancer remains very bad, survival and response to treatment are variable according to the patients. Determination of new prognostic markers helps us to adapt therapeutics for each patient and is necessary for the elaboration and the interpretation of clinical research studies. Many prognostic factors related to the tumor, the patient or the treatment, have been evaluated. The goal of this work is to review these parameters. So far, the most powerful variables are volume of residual disease after cytoreductive surgery, FIGO tumor stage, histologic type and grade of differentiation. The progress and accessibility to novel technologies applied to biology will make possible in the future the assessment of new prognostic profiles-based on genetic and/or proteomic tumor characteristics. The future also relies on the identification of predictive factors of response to treatment, but force is to note that on the last hundred publications testing predictive factors (p53, HER2, Topo-2-alpha, BRCA...), none have modified today our clinical practices.
Thursday, April 09, 2009
Alcohol intake and cigarette smoking and risk of a contralateral breast cancer: the Women's Environmental Cancer and Radiation Epidemiology Study
Microarray Analysis of Early Stage Serous Ovarian Cancers Shows Profiles Predictive of Favorable Outcome
"Conclusions: These data suggest that serous ovarian cancers detected at an early stage generally have a favorable underlying biology similar to advanced-stage cases that are long-term survivors. Conversely, most late-stage ovarian cancers seem to have a more virulent biology. This insight suggests that if screening approaches are to succeed it will be necessary to develop approaches that are able to detect these virulent cancers at an early stage."
New ACOG Guidelines Recommend Routine Genetic Risk Assessment
Some families are at particularly high risk of cancer due to hereditary cancer syndromes. These families often have multiple family members with cancer and are more likely to develop cancer at a young age. In the case of breast and ovarian cancers, inherited mutations in two genes—BRCA1 and BRCA2—have been found to greatly increase the lifetime risk of developing breast and ovarian cancer. Mutations in these genes can be passed down through either the mother’s or the father’s side of the family. The lifetime risk of ovarian cancer is estimated to be 39-46% among women with a BRCA1 mutation and 12-20% among women with a BRCA2 mutation. Lifetime risk of breast cancer among BRCA1 or BRCA2 carriers is 65-74%.[1]
An estimated 1 in 300 to 1 in 800 people in the United States have a BRCA1 or BRCA2 mutation. Questions about personal and family history of breast and ovarian cancer can help identify women who are at increased risk of carrying a BRCA mutation.Tuesday, April 07, 2009
On the Rock, in a Hard Place: Challenges in Working with Advocacy and Care Provider Groups :: Vol. 2 No. 1 2006 :: Healthcare Policy / Politiques de Santé :: Longwoods Pub
"Lessons Learned
This experience taught us valuable lessons about KT in practice. Decision-making and knowledge translation occur in a complex, dynamic environment where the partners' interest in, and perspective towards, the research findings, the researchers, and other partners continually evolve. The desire to use evidence in decision-making competes with other organizational and personal motivations, not the least of which are self-preservation and self-promotion."
Monday, April 06, 2009
Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma
Published Online: 28 Mar 2008 © Japanese Cancer Association
Review Article
Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma
Clear cell carcinoma (CCC) accounts for 4% to 12% of epithelial ovarian cancer in Western countries and, for some unknown reasons, it comprises more than 20% of such cancers in Japan. CCC shows unique clinical features such as a high incidence of stage I disease, a large pelvic mass, an increased incidence of vascular thromboembolic complications, and hypercalcemia. It is frequently associated with endometriosis.
Compared to serous adenocarcinoma (SAC), CCC is relatively resistant to conventional platinum, or taxane-based chemotherapy which is associated with its poor prognosis. However, the mechanisms underlying CCC's resistance to chemotherapy have not been understood...... Therefore, lower proliferation of the tumor cells may contribute to their resistance to chemotherapy...."
Sunday, April 05, 2009
eMJA: What is the health service for?
"To the Editor: “What is the health service for?”1 In essence, this is a question of definition and ownership. What is the definition of quality health care and who decides how it is defined? Who are the recipients of health services, the funders, those who stand to lose or benefit from the way in which health care is delivered? The answer is citizens"
Saturday, April 04, 2009
Cystic and Adenofibromatous Clear Cell Carcinomas of the Ovary: Distinctive Tumors That Differ in Their Pathogenesis and Behavior: 122 cases
Friday, April 03, 2009
The Clearity Foundation - Improving Treatment Options For Ovarian Cancer Patients
"The Clearity Foundation seeks to improve treatment outcomes in recurrent and progressive patients by providing diagnostic services that determine the molecular profile of the individual patient. Having this profile may help match your patient with an appropriate clinical trial or other treatment. We also maintain a database of results that over time, may help identify new treatments. The Clearity Foundation is a 501(c)(3) not-for-profit and sponsors molecular profiling diagnostic tests at no cost to patients."
Thursday, April 02, 2009
news item: Medical skeptic wins top award Dr David Sackett - Gairdner Wightman Award
Medical skeptic wins top award
A pioneer of McMaster University's medical school has been recognized with a prestigious international award for his groundbreaking research, which he dedicated to the millions of patients in history who have been wronged by doctors prescribing "dumb treatments."
Wednesday, April 01, 2009
Comparisons of Patient and Physician Expectations for Cancer Survivorship Care
Purpose: To compare expectations for cancer survivorship care between patients and their physicians and between primary care providers (PCPs) and oncologists.
Conclusion: Patients and physicians have discordant expectations with respect to the roles of PCPs and oncologists in cancer survivorship care. Uncertainties around physician roles and responsibilities can lead to deficiencies in care, supporting the need to make survivorship care planning a standard component in cancer management.
2009 publication: American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008 (including risk categories)
Alternatively, reference the NCCN Guidelines (http://www.nccn.org)
2009 Hon Justice Margaret A. Cameron: Commission of Inquiry on Hormone Receptor Testing Canada
About the Inquiry
The Commission of Inquiry on Hormone Receptor Testing was established by the Government of Newfoundland and Labrador under the Public Inquiries Act, 2006 on July 3, 2007. The Honourable Margaret A. Cameron was appointed Commissioner.
Genetic testing for Lynch Syndrome in the first year of colorectal cancer: a review of the psychological impact
Conclusion:
This review identifies the psychological impact of colorectal
cancer during the first year after treatment and
indicates specific subgroups of patients with colorectal
cancer who could be vulnerable for genetic-testing-related
distress. Most of the retrieved studies on diagnostic genetic
testing for Lynch syndrome exclusively measured distress
prior to genetic test disclosure and focused on patients who
were diagnosed with colorectal cancer several years ago.
Therefore, we are still unable to identify the psychological
impact of genetic testing for Lynch syndrome in recently
diagnosed patients with colorectal cancer.
Vancouver Coastal Health Research Institute - News Releases - $15 Million Donation Launches Research Centre at VGH - Wed Apr 1, 2009
The seven-storey, 69,350 sq. ft. (6,442 sq.m.) facility will house three of VGH's key research programs: the Vancouver Prostate Centre at VGH; the Centre for Hip Health and Mobility; and the Ovarian Cancer Research Initiative.
Tuesday, March 31, 2009
Management of extracolonic tumours in patients with Lynch syndrome : The Lancet Oncology
Management of extracolonic tumours in patients with Lynch syndrome : The Lancet Oncology
The Lancet Oncology, Volume 10, Issue 4, Pages 400 - 408, April 2009
Summary
Hereditary nonpolyposis colorectal cancer, or Lynch syndrome, is responsible for 2—3% of all colorectal cancers. Lynch syndrome is also associated with a high risk of extracolonic cancers, including endometrial, stomach, small bowel, pancreas, biliary tract, ovary, urinary tract, brain, and skin cancer. In this Review, we discuss the risks, surveillance tests, and guidelines for the management of extracolonic tumours associated with Lynch syndrome. For all types of extracolonic cancer, evidence supporting surveillance is scarce. A benefit of surveillance is evident only for endometrial cancer, where transvaginal ultrasound and endometrial sampling detect tumours in early stages. Surveillance is generally recommended for urinary tract and gastric cancer, especially in families with more than one member with these types of cancer. For the other types of cancer, surveillance is typically not recommended. Prophylactic hysterectomy and bilateral salpingo-oophorectomy should be considered for women with Lynch syndrome who are past childbearing age, especially during surgery for colorectal cancer. No data show efficacy of chemopreventive drugs in reducing the risk of extracolonic cancers for patients with Lynch syndrome.
UK vs Canada: Accessing unfunded cancer drugs in publicly funded hospitals : The Lancet Oncology
Accessing unfunded cancer drugs in publicly funded hospitals : The Lancet Oncology
Providing life extending treatments to some, but not all patients on the same ward could be considered an insult to human dignity.
Editorial note (mine): must be considered
Monday, March 30, 2009
Big Cancer Bill Aims to Increase Biomarker Research and Use - U.S.
"ALERT (Act) also would have NCI report annually on its plans and progress regarding research on cancers with low incidence and survival rates, and would establish a grants program to conduct research on such cancers.
Among other measures, the act also would establish a grant program for the states that would fund colorectal cancer screening and referrals for medical treatment that is similar to the national breast and cervical cancer programs.
The bill also includes a number of measures and programs aimed at the issues surrounding patients and health insurance coverage, including a provision that would enable patients to continue to receive coverage for treatment while they are in clinical trials."
2009 Evidence Updates: Meat Intake and mortality: a prospective study of over a half a million people including commentaries
full free pdf file original article:
http://archinte.ama-assn.org/cgi/reprint/169/6/562.pdf
abstract + commentary:
http://plus.mcmaster.ca/EvidenceUpdates/HitParade.aspx?A=26486
Sunday, March 29, 2009
Early Cancer Detection Fizzles Again Newsweek article
How much less threatening are cancers detected early? Last November, scientists reported that about one quarter of breast cancers detected (early) on mammograms vanish spontaneously. Yet breast-cancer survivors swear early detection saved their life. Some melanomas, kidney cancers and neuroblastomas perform a similar vanishing act, says Kramer. Will doctors' enthusiasm and patients' demand for cancer screening diminish as a result of the science? After the PSA studies came out, a scientist told clinicians he assumed so. They looked at him as if he were crazy. No matter what science says, it will be a cold day in hell before patients let go of the one slender hope they feel they have to beat cancer.
Saturday, March 28, 2009
Cancer incidence in vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford) -- Key et al., 10.3945/ajcn.2009.26736M -- American Journal of Clinical Nut
"Conclusions: The overall cancer incidence rates of both the vegetarians and the nonvegetarians in this study are low compared with national rates. Within the study, the incidence of all cancers combined was lower among vegetarians than among meat eaters, but the incidence of colorectal cancer was higher in vegetarians than in meat eaters."
Friday, March 27, 2009
Knowledge about (Lynch Syndrome) hereditary nonpolyposis colorectal cancer; mutation carriers and physicians at equal levels
Two thirds of physicians and family members alike failed to recognize the increased risk of ovarian cancer in HNPCC
Conclusions
In summary, this study reveals weaknesses in HNPCC knowledge, particularly among physicians. By tradition, the medical perspective dominates and decides on relevant and evidence based interventions. When a majority of the physicians misinterpret hereditary mechanisms, underestimate the risk of cancer, and fail to recognize HNPCC associated tumor types the likelihood of misinformation is high. Physician behaviour may also influence patient adherence to surveillance programmes, and our findings strongly suggest that improved education in genetic medicine is needed for physicians responsible for diagnosis and management of the growing number of individuals at increased risk of cancer [31-33].
Thursday, March 26, 2009
AJG - Abstract of article: Incidence of Right-Sided Colorectal Cancer After Breast Cancer: A Population-Based Study (Manitoba)
note: right sided colorectal cancer specific
Microcystic stromal tumor of the ovary: report of 16 cases of a hitherto uncharacterized distinctive ovarian neoplasms
"These tumors, to date, have occurred over a wide age range in postpubertal females, are characteristically unilateral, and confined to the ovary at presentation. They represent, in addition to the sclerosing stromal tumor (segregated out 3 decades ago), a distinctive subtype of ovarian tumor, likely also belonging to the stromal category based on current evidence."
Wednesday, March 25, 2009
Ovarian cancers detected early may be less aggressive, questioning effectiveness of screening
For this study, researchers examined samples of advanced ovarian cancers from patients who had experienced long-term survival -- over seven years -- and patients who had done extremely poorly, and died within three years of diagnosis.
"We found that certain patterns predicted long-term survival and others predicted a poorer prognosis in advanced stage cases," Berchuck said. "Cancers that were detected at an early stage almost always shared gene expression characteristics with advanced stage cases that were long-term survivors, suggesting a shared favorable biology."
Tuesday, March 24, 2009
Medical News: JAMA Announces Gag Rule on Conflict-of-Interest Whistleblowers
CHICAGO, March 23 -- "Individuals who spot undisclosed conflicts of interest by authors published in the Journal of the American Medical Association are invited to inform the journal's editors -- but telling anyone else is forbidden under a new JAMA policy....."
Monday, March 23, 2009
WISE: Policies of Exclusion, Poverty & Health: Stories from the Front
"We will not give you statistics. We will not say how many of us are
students, retired, single mothers, living alone or living with a spouse,
working or on government assistance. We will say that we have all
those covered. We will not give our ages, since age is irrelevant to
who we are."
Sunday, March 22, 2009
Saturday, March 21, 2009
Quality of Care Review: Some Progress, and Toward What Goal? -- Chu (Correspondence JCO)
"However, patient and family involvement in the decision-making process has been peripheral."
Friday, March 20, 2009
Clinical Follow-up and Presence of Visceral Tumors in 12 Patients With Sebaceous Gland Tumors (Lynch Syndrome & Muir-Torre Syndrome & clear cell)
Excerpts:
Reports of MTS in families with hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch
syndrome,8 appeared for the first time in the 1980s. It was subsequently discovered that patients with MTS and HNPCC had the same genetic defect involving proteins responsible for DNA mismatch repair.9,10 It is now believed that MTS is a clinical form of HNPCC.11
Visceral malignancies in HNPCC typically affect the colon, but they can also be found in the endometrium, the ovary, the stomach, the small intestine, the ureter, the renal pelvis, and the brain.12 Other features of MTS include the presence of multiple tumors, early-age onset of tumors, and, in some cases, improved prognosis when tumors appear spontaneously.11
Nonetheless, it should be borne in mind that breast cancer and indeed other cancers described
in patients with MTS have not been definitively associated with HPNCC,25 meaning that their existence may, on occasions, be purely coincidental. Another group of authors proposed performing a computed tomography scan of the abdomen and pelvis every 2 to 5 years19 because 35% of abdominal tumors in MTS occur at sites other than the colon.27
Dermatologists play a key diagnostic role in MTS. Our findings suggest that some dermatologists underestimate the potential severity of sebaceous tumors, disregard the importance of family history of cancer, and fail to order additional studies to exclude visceral malignancies.
Thursday, March 19, 2009
OWHN - e-Bulletin - archives
Written for the Ontario Women's Health Network with special attention to this section:
IN YOUR OWN WORDS:
(Sandi Pniauskas - Editorial note: These stories are unedited and while some of the details are difficult to imagine, we recognize in each and every one the actual goodness, caring and strengths of the human spirit.)
survivours helping survivours: "I am alive today because of my guardian angel.
My angel {who is an ovarian cancer survivor herself with the courage to learn and lobby for what should be our GIVEN rights) saved my life by validating my condition and personally fighting the system on my behalf."
Alicia : Ovarian cancer for twenty-something "dummies"
Barb B : The first time I saw him I knew I would be in trouble (since died)
Barb L : Our Mom, Faith and Alternatives
Beth : A nurse and her guardian angels
Bonnie: I am a survivour (since died)
David: Heroism....from a husband and an admirer and the goodness within
Donna: Closer bonds: hats, hats and more hats
Heidi: Being adopted complicates the decision-making process
Irene: Written off due to age - Living alone - Supporting Others
Lynda: Same year x 2: Mom and Me
Noreen: Surviving breast cancer twice, ovarian cancer and no options (since died)
Penny: Single, taking charge, my dog and it must have been the rum (since died)
Phil: Married between chemo #3 and #4
Phase II Evaluation of Nanoparticle Albumin–Bound Paclitaxel in Platinum-Sensitive Patients With Recurrent Ovarian, Peritoneal, Fallopian Tube Cancer
Main inclusion criteria were histologically or cytologically confirmed epithelial cancer of the ovary, fallopian tube, or peritoneum (any stage, grade 2 to 3 if stage I) and measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST) or elevated CA-125 (> 70 U/mL) in patients without measurable disease.
Wednesday, March 18, 2009
Tuesday, March 17, 2009
Patient Destiny: One Patient, One Record (OPOR) Symposium
By invitation only - April 21, 2009 symposium (Toronto)
Yet, even though the patient group represents the fundamental foundation of the healthcare system, patients have seldom been viewed as more than a “by-product” or “side-effect”. To illustrate, patients are not typically involved in (i) setting healthcare policy; (ii) conducting and disseminating research; (iii) coordinating patient networks; (iv) providing or managing individual care; and (v) evaluating the performance and outcomes of varied healthcare delivery plans.
Editorial: Health Behaviors Influence Cancer Survival
To date, however, no trial has tested a multiple-component intervention that includes smoking cessation, diet, exercise, and possibly alcohol components
among individuals diagnosed with cancer.
Monday, March 16, 2009
Early Detection Remains Key in Updated NCCN Guidelines for Ovarian Cancer
Press release from NCCN conference
see also: http://www.nccn.org
Sunday, March 15, 2009
eMJA: The benefits of oestrogen following menopause: why hormone replacement therapy should be offered to postmenopausal women
Abstract
Recently, two major epidemiological studies found that hormone replacement therapy (HRT) in postmenopausal women increased the risk of breast cancer. One of the studies also found that HRT increased the risk of cardiovascular disease and thrombosis. As a consequence, women were advised to cease this therapy.
However, detailed analysis of these studies suggests that the conclusions may be erroneous. Other studies suggest that the timing of initiation of HRT for healthy women is critical to achieving a beneficial outcome.
When begun within 5 years of menopause in healthy women, oestrogen-based HRT results in far greater benefits than adverse outcomes.
There is substantial objective evidence that the benefits of HRT include:
Reduced distressing symptoms of menopause.
Reduced risk of osteoporotic fractures, dementia and colorectal cancer.
Improved wellbeing, quality of life; improved vaginal epithelium, sexual enjoyment and bladder capacity.
Improved cardiovascular system, with reduced myocardial ischaemia and cardiovascular-related death.
Increased longevity.
The adverse effects of HRT include:
Oral HRT doubles the risk of thromboembolism.
HRT promotes growth of pre-existing breast cancer.
Genetics in Medicine - Abstract: March 2009 The impact of patents on the development of genome-based clinical diagnostics: an analysis of case studies
2009 abstract: The impact of patents on the development of genome-based clinical diagnostics: an analysis of case studies.
Saturday, March 14, 2009
Genetics in Medicine - Abstract: Volume 10(9) September 2008 p 648-654 Economic methods for valuing the outcomes of genetic testing: beyond cost-effectiveness analysis.
Genetics in Medicine - Abstract: Volume 10(9) September 2008 p 648-654 Economic methods for valuing the outcomes of genetic testing: beyond cost-effectiveness analysis.
Genetics in Medicine - Fulltext: Volume 11(1) January 2009 p 3-14 The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) initiative: methods of the EGAPP Working Group.
Genetics in Medicine - Fulltext: Volume 11(1) January 2009 p 3-14 The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) initiative: methods of the EGAPP Working Group.
Genetics in Medicine - Fulltext: Volume 11(1) January 2009 p 35-41 Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aime
Genetics in Medicine - Fulltext: Volume 11(1) January 2009 p 35-41 Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch Syndrome in relatives
Genetics in Medicine - Abstract: Verification of consumers' experiences and perceptions of genetic discrimination and its impact on utilization of genetic testing
"Conclusion: These first cases of verified genetic discrimination make it essential for policies and guidelines to be developed and implemented to ensure appropriate use of genetic test results in insurance underwriting, to promote education and training in the financial industry, and to provide support for consumers and health professionals undertaking challenges of adverse decisions."
Cancer surveillance behaviors in women presenting presenting for clinical BRCA genetic susceptibility testing
"About 60% of participants engaged in at least the minimum recommended breast cancer surveillance behaviors, but 70% had suboptimal ovarian cancer surveillance behaviors. Lack of physician recommendation was the most frequently reported reason for not having surveillance procedures."
Friday, March 13, 2009
Treatments of epithelial ovarian cancer by histological subtype
note specific reference to clear cell ovarian cancer international trial
Cumulative lifetime incidence of extracolonic cancers in Lynch Syndrome: a eport of 121 families with proven mutations
Cumulative risk for females of an extracolonic tumour is 47.4% (95% CI 43.9-50.8). The risk to males is 26.5% (95% CI 22.6-30.4). There was no reduction in gynaecological malignancies due to gynaecological screening (examination, transvaginal ultrasound scan, hysteroscopy and endometrial biopsy).
Thursday, March 12, 2009
Wednesday, March 11, 2009
Medical News: SGO: Novel Drug Combination Shows Promise in Advanced Ovarian Cancer - in Meeting Coverage, SGO from MedPage Today
Oxaliplatin (Eloxatin), Docetaxel (Taxotere) and Bevacizumab (Avastin)
CBC news report: Tests may detect ovarian cancer sooner: study
Comment: spniauskas
Posted 2009/03/11
at 3:42 PM ET
Dr Jacobs published a randomised trial in the Lancet in 1999. This study was again specific to screening/early detection of ovarian cancer. In this study, now a decade old, 22,000 women enrolled. The abstract can be viewed at: http://www.ncbi.nlm.nih.gov/pubmed/10217079?holding=ukpmc
or: http://tinyurl.com/alo2st
Similar results were found in that of the 22,000 in the prior study (1998), 468 women had an elevated CA125 with 6 actual detections of malignancy. The current study indicates that of the 50,000 women screened with a CA125, 38 were found to have a malignancy. Without having read the full paper recently published, but relying on the abstracts, it would seem the 1999 and 2009 results do not differ in any appreciable way. The only question I might have would be in any technological advances in the ultrasounds which were used. There are several issues here which will and have always impacted decision-making specific to ovarian cancer. One is based on the fact that a public screening (meaning all women) of the CA125 will not be adopted, such as the PSA, because the cost are too high and the results are two low. Even the PSA test for public screening has been debated widely over the years. Assuming patients symptoms are acknowledged and there is a suspicion of ovarian cancer then nothing really has changed as it is the responsibility of the health care professional to order the appropriate tests. This brings us back to the same issues we have faced in ovarian cancer (forever) and that is recognizing the symptoms, however, complicated this may be. Lastly, Australia/UK today are using a test called the HE4 which, when added to the CA125, apparently improves detection of ovarian cancer. It would be most interesting for someone to compare the 2 Jacob trials.
IGF2BP3 (IMP3) Expression Is a Marker of Unfavorable Prognosis in Ovarian Carcinoma of Clear Cell Subtype
"The same prognostic significance is shown and validated here for ovarian clear cell carcinomas, but not other subtypes of ovarian carcinoma, suggesting a unique role of IGF2BP3 in these morphologically similar tumors."
Tuesday, March 10, 2009
AcademyHealth Issues: Consumer Choice
also: 2009 Robert Wood Johnson Foundation - Increasing consumer engagement
http://www.rwjf.org/qualityequality/af4q/focusareas/consumer.jsp
Monday, March 09, 2009
Management of women with clear cell endometrial cancer: a SGO review
"It shares many similarities with clear cell neoplasms of the ovary and kidney."
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
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