Latest advances in medical oncology: highlights from Milan ESMO 2010 annual congress Therapeutic Advances in Medical Oncology January 2011 3: 3-9, doi:10.1177/1758834010390407
Monday, January 10, 2011
Survey: GCF/University of Texas MD Anderson Cancer Center (follow-up for those without a recurrence)
The
Gynecologic Cancer Foundation is cooperating with researchers at The
University of Texas MD Anderson Cancer Center to learn your opinion
about follow-up care after your initial treatment if you have not had a
recurrence of your cancer.
This online survey has been approved by the MD Anderson Institutional Review Board and will take about 15 minutes of your time.
The
Gynecologic Cancer Foundation does not share its mailing list and your
contact information, including your e-mail address, will not be placed
into any other database as a result of your participation in this
survey.
Because cancer treatments continue to improve, the number of women surviving is increasing. Researchers
at MD Anderson are interested in learning about how patients with
gynecologic cancers want to be followed after completing their
treatments and your participation in this survey will assist them.
If you have any questions about the survey, please contact Dr. Matthew Schlumbrecht at MD Anderson at 713-563-4583 or mpschlumbrecht@mdanderson.org.
Instructions and consent information are included in the survey information. To participate, please click here.
Sunday, January 09, 2011
full free access: AHRQ Patient Safety Network - Patient Safety in Primary Care (Canada)
Patient Safety in Primary Care.
Kingston-Riechers J, Ospina M, Jonsson E, Childs P, McLeod L, Maxted JM. Edmondton, AB, Canada: Canadian Patient Safety Institute; 2010. ISBN: 9781926541273.
This report analyzed patient safety in Canadian primary care practice to identify themes, priorities, gaps in research, and opportunities for improvement.
Breasts 'monopolising' cancer spotlight - Australia media report
Note: quotes from a 'plain speaking' physician (and advocate)
Saturday, January 08, 2011
Evidence Updates - Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database including professional commentaries
also: see PubMed link (abstract w/o commentary) to abstract
BACKGROUND: Treatment of cancer is increasingly more effective but is associated with short and long term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them. One of these side effects is oral mucositis (mouth ulcers).
Friday, January 07, 2011
Wednesday, January 05, 2011
Tuesday, January 04, 2011
Editorial :: The role of Cochrane Review authors in exposing research and publication misconduct - The Cochrane Library
Note: while important the real question is the root of the problem - cause
"At the Joint Colloquium of the Cochrane & Campbell Collaborations in Keystone in October 2010, we ran a workshop about the problems of detecting research misconduct,[1] and had a wonderful discussion with participants. The US Office of Research Integrity defines research misconduct as: "fabrication, falsification, or plagiarism in proposing, performing, or reviewing research, or in reporting research results; fabrication is making up data or results and recording or reporting them; falsification is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record; plagiarism is the appropriation of another person's ideas, processes, results, or words without giving appropriate credit; research misconduct does not include honest error or differences of opinion".[2] The Committee on Publication Ethics (COPE) also outlines publication and research misconduct in its flowcharts for editors, and highlights redundant (duplicate) publication, changes in authorship, undisclosed conflicts of interest, and ethical problems as additional types of misconduct.[3] Cochrane Review authors, as they analyse the entirety of primary research evidence in a specific area, are well placed to identify many of these types of research and publication misconduct. Indeed, Professor Sir Iain Chalmers urged systematic reviewers, not so long ago, to harness their unique opportunity to detect plagiarism.[4].....cont'd
Director's Page - National Cancer Institute - Update to the National Cancer Advisory Board (December 2010) 9 minutes
Also: To view the NCAB Meeting discussions in their entirety, visit http://videocast.nih.gov/launch.asp?16326 (5 hrs and 51 minutes)
abstract: Risk of colorectal and endometrial cancers in EPCAM deletion-positive Lynch syndrome: a cohort study : The Lancet Oncology (multi-national study)
Note: (abstract) study includes 194 mutation carriers with references to pancreatic and duodenal cancers; more information on EPCAM genetics can be found by searching this blog
Duodenal cancer - Wikipedia Duodenal cancer is a cancer in the beginning section of the small intestine. It is relatively rare compared to gastric cancer and colorectal cancer. en.wikipedia.org/wiki/Duodenal_cancer
Uncommon Knowledge: Sorry really isn't enough (apology) - The Boston Globe (breast and ovarian cancer gender comments...)
Note: comments regarding breast and ovarian cancer (gender issues)
"...From an early age, we’re taught to apologize. We’re also taught to accept apologies. In theory, an apology should set things right. But does it...."
Monday, January 03, 2011
MGH (blood) test for cancer gets backing - The Boston Globe
"Boston researchers plan to announce today that they are partnering with pharmaceutical giant Johnson & Johnson to develop and bring to market a sophisticated, noninvasive test that can detect tiny traces of cancer cells in a blood sample......."
Saturday, January 01, 2011
About INCTR - INCTR – International Network for Cancer Treatment and Research
INCTR is located in Brussels.
It currently has branches in Brazil, Canada, Egypt, France, Nepal and the USA and offices in Cameroon, India, Tanzania and the UK.
Reports:
2010 newsletter:
"In 2010, cancer overtook ischaemic heart disease as the leading cause of death in the world. While different groupings of diseases (e.g., combining all cardiovascular disease or dividing cancer into many different types) would produce a different rank order, the point should not be missed that cancer can no longer be ignored by global health policy-makers as a major cause of disability or death, as well as economic loss......."
Friday, December 31, 2010
Clinical Care Options website: update includes Avastin - Ovarian Cancer
Note: full free access (requires free registration)
Authors: Maurie Markman, MD
Authors: Maurie Markman, MD
Released: 11/17/10
Last Reviewed: 12/2/10 (What's New)
- Introduction
- BRCA Mutations in Ovarian Cancer
- Screening for Ovarian Cancer
- Symptoms of Ovarian Cancer
- Surgical Staging of Ovarian Cancer
- Primary Surgical Cytoreduction in Ovarian Cancer
- Interval Surgical Cytoreduction and Neoadjuvant Chemotherapy
- Chemotherapy for High-Risk Early-Stage Ovarian Cancer
- Primary Chemotherapy of Advanced Stage Ovarian Cancer
- Second-Line Therapy of Ovarian Cancer
- Platinum-Sensitive vs Platinum-Resistant Recurrent Ovarian Cancer
- Treatment of Platinum-Sensitive Recurrent Ovarian Cancer
- Treatment of Platinum-Resistant Ovarian Cancer
- Intermediate Platinum Sensitivity
- Carboplatin Hypersensitivity Reactions
- Other Management Options in Recurrent/Resistant Ovarian Cancer
- Future Research Directions in Ovarian Cancer
- Tables and Figures
- References
abstract: Prognostic factors in women treated for ovarian yolk sac tumour: A retrospective analysis of 84 cases (typically young women)
Background
"Ovarian yolk sac tumour (OYST) is a very rare malignancy arising in young women. Our study aimed to evaluate long-term outcomes and to identify prognostic parameters likely to help make appropriate risk-based decisions about therapy in this disease....."Correspondence: mTOR Inhibitor Treatment of Pancreatic Cancer in a Patient With Peutz-Jeghers Syndrome
TO THE EDITOR:
"Recently, we successfully used everolimus to
achieve a partial remission in a patient with advanced pancreatic
cancer that was induced by Peutz-Jeghers syndrome (PJS). PJS has
been associated with an increased risk of GI, gynecologic, breast, and
pancreatic cancers. PJS is caused by a tumor-suppressor gene mutation
in the serine threonine kinase gene 11 (STK11, also known as
LKB1 gene), localized on chromosome 19p13.3.1,2 Up to 93% of
patients with PJS develop some form of cancer; 11% to 36% develop
pancreatic carcinoma.3,4......"
Metachronous colorectal cancer risk for mismatch repair gene mutation carriers: the advantage of more extensive colon surgery Gut - abstract (Lynch Syndrome)
Define: metachronous: Multiple separate occurrences, such as multiple primary cancers developing at intervals.
Conclusions: Patients with Lynch syndrome with first colon cancer treated with more extensive colonic resection have a lower risk of metachronous CRC than those receiving less extensive surgery. This finding will better inform decision-making about the extent of primary surgical resection.
Thursday, December 30, 2010
abstract: Ventral hernia following primary laparotomy for ovarian, fallopian tube, and primary peritoneal cancers
An incisional hernia occurs in an area of weakness caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are termed ventral hernias. ...
en.wikipedia.org/wiki/Ventral_hernia
OBJECTIVES: To evaluate the incidence and risk factors for ventral hernia development following primary laparotomy for ovarian, fallopian tube, and peritoneal cancers.
CONCLUSIONS: The development of ventral hernia is a significant postoperative morbidity in patients undergoing primary surgery for ovarian, tubal, or peritoneal cancer. Independent associations with hernia development include: BMI and IP chemotherapy by Year 1, and BMI, wound complications and advanced stage by Year 2.
abstract: CA 125 normalization with chemotherapy is independently predictive of survival in advanced endometrial cancer
Abstract
OBJECTIVE: Changes in CA 125 with chemotherapy predict outcome for epithelial ovarian cancer. There is no such data for advanced endometrial cancer.CONCLUSION: As with epithelial ovarian cancer, changes in CA 125 are highly predictive of outcome for advanced, chemotherapy treated endometrial cancer.
full free access: Guidelines Loading... American Society of Hematology Guidelines Epoetin and Darbepoetin
Guidelines
American Society of Hematology Guidelines
Epoetin and Darbepoetin"American Society of Hematology/American Society of Clinical Oncology 2010 clinical practice guideline update on the use of epoetin and darbepoetin"The latest research and evidence-based clinical guidelines about the use of epoetin for the treatment of cancer-related anemia.
- Data Supplement
"Future directions
There is clear evidence regarding the ability of ESAs to increase
Hb and avoid transfusions. There is also evidence of harm
associated with their use. Perhaps the most pressing need for
additional research is studies that further clarify the mechanisms of
harm and, particularly, the groups of patients or circumstances of
clinical use that are least associated with these risks. This understanding
is paramount to the ability of clinicians to extend the
benefit of these drugs while reducing the risks."
full free access: American Society of Clinical Oncology/American Society of Hematology Clinical Practice Guideline Update on the Use of Epoetin and Darbepoetin in Adult Patients With Cancer — JCO
"Editor's Note: This document represents an abridged version of the complete guideline update and contains updated recommendations with a brief discussion of the relevant literature. Readers should refer to the complete guideline update, which includes a comprehensive discussion and analysis of the literature and more evidence tables. The complete guideline is available at www.asco.org/guidelines/esa and http://www.hematology.org/guidelines/esa/."
Wednesday, December 29, 2010
abstract: Activity of Sorafenib in Recurrent Ovarian Cancer and Primary Peritoneal Carcinomatosis: A Gynecologic Oncology Group Trial — JCO
Conclusion: Sorafenib has modest antitumor activity in patients with recurrent OC, but the activity was at the expense of substantial toxicity.
Phase I Study of Pazopanib in Combination with Weekly Paclitaxel in Patients with Advanced Solid Tumors -- Tan et al. 15 (12): 1253 -- The Oncologist
Note: one ovarian cancer patient was included in this phase 1 study (partial response)
2010 NCI Cancer Bulletin Reader Survey Results - National Cancer Institute - Who Reads the NCI Cancer Bulletin?(past survey)
NCI Cancer Bulletin Subscriber Details
Percent
| |
|---|---|
| Health care professional |
47.6
|
| Physician |
20.6
|
| Nurse or nurse practitioner |
15.7
|
| Other medical/health professional |
11.3
|
| Touched by cancer/General public |
24.5
|
| Cancer patient/survivor |
15.5
|
| Cancer patient family member/friend |
5.8
|
| Member of the general public |
2.0
|
| Student |
1.2
|
| Researcher/scientist |
18.7
|
| Principal investigator/lead researcher |
9.1
|
| Research manager/coordinator |
4.0
|
| Research analyst/associate |
1.9
|
| Research assistant |
1.1
|
| Other researcher |
2.5
|
| Other professional |
9.1
|
| Librarian/information professional |
0.6
|
| Information technology professional |
0.3
|
| Journalist |
0.5
|
| Administrator/manager |
3.0
|
| Communications professional |
1.7
|
| Teacher/educator |
0.4
|
| Advocate |
1.6
|
| Other professional |
1.0
|
Cancers | Free Full-Text | Surgery as a Double-Edged Sword: A Clinically Feasible Approach to Overcome the Metastasis-Promoting Effects of Surgery by Blunting Stress and Prostaglandin Responses
(This article belongs to the Special Issue Surgery induced tumorigenesis in breast and other cancers: An inconvenient truth?)
Cancers | Free Full-Text | Familial Pancreatic Cancer (extensive lain english review)
Note: see table 1 for spectrum of genes eg; MSH 1/2/6, FAMM, BRCA2....
Tuesday, December 28, 2010
NCI announces plans to reinvigorate clinical trials, December 23, 2010 News Release - National Institutes of Health (NIH)
Note: see second post for list of groups (international)
"Consolidation of cooperative group program is designed to bring enhanced efficiencies to oncological sciencesThe National Cancer Institute (NCI) has announced major changes to be made in the long-established Clinical Trials Cooperative Group Program ....."
http://www.cancer.gov/cancertopics/factsheet/NCI/clinical-trials-cooperative-group ...... For more information about cancer, please visit the NCI Web site at http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237)....."Trying to Estimate Cancer Rates in Ancient Times - NYTimes.com
Note: King Tut (died at the age of 19) is one example of inbreeding (genetics) in 'high society' with some recent and intriguing research findings regarding his family history, marriage and mummified remains of his apparent two children
Link to NY Times article
Link to Nature review (abstract)
Perspectives
Nature Reviews Cancer 10, 728-733 (October 2010) | doi:10.1038/nrc2914
Science and society: Cancer: an old disease, a new disease or something in between?
Monday, December 27, 2010
Histologic artifacts in abdominal, vaginal, laparoscopic, and robotic hysterectomy specimens: a blinded, retrospective review
"....Such artifacts impair the pathologists' interpretation of cell type requiring an increased use of IHC (immunohistochemistry), and displaced epithelial fragments present within vessels or artifactual clefts may result in the misinterpretation of prognostic and staging parameters. Furthermore, there is a significantly higher rate of positive peritoneal cytology in cases that are subjected to uterine manipulation, suggesting dissemination of malignant cells into the abdominal cavity. The clinical significance of this finding needs to be determined."
Canadian Doctors for Medicare - Defending (Canadian) Medicare
Canadian Doctors for Medicare advocates for the maintenance and improvement of Canada's universal, single-payer health care system. ...
full free access: Jnl Interprofessional Care - Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model
"Most shared decision-making (SDM) models to date have been limited to the patient–physician dyad. For that reason, they are not always relevant to the increasingly interprofessional nature of the delivery of care......"
Journal of Interprofessional Care - Summary: A critical examination of the role of appreciative inquiry within an interprofessional education initiative
Blogger's Note: any views on this?
"Based on these findings, the article goes on to argue that the
use of AI can overlook a number of structural factors, which will
ultimately limit its ability to actually secure meaningful and lasting
change within health care."
Sunday, December 26, 2010
Friday, December 24, 2010
new quick patient poll on Blog - clear cell/Lynch Syndrome
Missed opportunity ?? - take the poll if you have been diagnosed clear cell/Lynch Syndrome
abstract: Hospital costs associated with adverse events in gynecological oncology (patient safety)
excerpts:
BACKGROUND AND OBJECTIVE: Treatment for gynecological malignancies is complex and may cause unintended or accidental adverse events (AE)....RESULTS: A total of 369 patients had surgical procedures of which 95 patients (26%) had at least one AE.note Blogger's Comment/add yours - abstract: Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases (references Lynch Syndrome)
Blogger's comment/question: any other survivours (or not) of clear cell ovarian cancer and Lynch Syndrome NOT included in this study? A missed opportunity.....
note: absence of a direct reference to Lynch syndrome in abstract
Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases.
*Department of Pathology, Memorial Sloan-Kettering Cancer Center ‡Department of Pathology, Vancouver General Hospital, NY †Department of Pathology, Massachusetts General Hospital, MA §Department of Pathology, University of Calgary, Calgary, Canada.
Abstract
Establishing a diagnosis of ovarian clear cell carcinoma (O-CCC) can be subject to significant interobserver variation. Accurately diagnosing this tumor is important because of its chemoresistance and reported association with Lynch syndrome. The spectrum of the morphologic features of O-CCC has not been well described in a series composed of immunohistochemically characterized cases. A total of 155 cases diagnosed as O-CCC were retrieved from the files of 3 institutions to analyze architectural and cytologic features. The immunohistochemical features of these cases have been reported earlier. A comprehensive list of features was recorded, including, but not limited to, architectural patterns, nuclear appearance, cytoplasmic characteristics, and mitotic index. Between 1 and 13 slides were available for review for each case. The cases were divided into 2 groups based on morphologic characteristics, those with features shared by the large majority (the first group, n=138) and those that showed unusual characteristics (second group, n=17). Tumors in the first group typically showed a mixture of architectural patterns, the most frequent being papillary and tubulocystic. Papillae, usually small and round and lacking hierarchical branching and tufting or stratification of more than 3 cells, were present at least focally in almost 3 of 4 cases. The cell shape was predominantly cuboidal, not columnar. Nuclear pleomorphism and prominent nucleoli were frequently present, but never diffusely. Clear cytoplasm was found in nearly every case and hobnail cells were common. Mitoses exhibited a range from 0 to 13 with an average of 3 to 4 per 10 high power fields. The second group of tumors showed numerous unusual morphologic characteristics, despite the presence of clear cytoplasm, including those typically seen in other ovarian epithelial tumors, such as serous and endometrioid carcinoma. Eighty-nine percent of tumors from the first group showed the expected "O-CCC immunophenotype" [hepatocyte nuclear factor (HNF) positive, and estrogen receptor (ER), progesterone receptor (PR), Wilms tumor 1 (WT1) and p53 negative], whereas 4% of tumors showed HNF positivity along with focal ER or PR expression. Seven percent of tumors were not immunoreactive with these markers. Twenty-nine percent of tumors in the second group showed the O-CCC immunophenotype, whereas 24% of tumors were p53 positive, 5% of tumors were WT1 positive, and the remaining cases were negative for all markers. Ninety-seven percent (112 of 117) of HNF-positive tumors in this series were classical O-CCC. Therefore, O-CCC has characteristic morphologic features and a specific, if not unique, immunophenotype in the vast majority of the cases. Clear cell-rich tumors with features that depart from the classical morphologic appearances described herein should suggest the possibility of an alternative diagnosis.Thursday, December 23, 2010
microRNA's - Revolutionizing Ovarian Cancer Treatment
"...That began to change earlier this decade as scientists discovered that microRNAs might actually be the hidden regulators that control the 30,000 genes in the human body by silencing gene expression.....One in particular, miR-31, discovered by Baylor collaborators and Gunaratne, shows promise as a potent tumor suppressor in ovarian cancer, glioblastoma, osteosarcoma and prostate cancer.......They discovered that miR-31 can specifically target and kill cancer cells that are deficient in p53, a crucial gene that guards the integrity of the genome and prevents cancer. More than half of all cancers and 90 percent of papillary serous tumors - the most common type of malignant ovarian cancer - are p53-deficient."
Reports of Serrated polyps of the colon - (references MSI/Lynch Syndrome) Mayo Clinic
Serrated polyps of the colon
Division of Gastroenterology & Hepatology and Division of Oncology, Mayo Clinic and Mayo College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
Corresponding author
F1000 Med Reports2010, 2:89 (doi: 10.3410/M2-89)
Published: 17 Dec 2010
"....Among the more important findings is that SSAs may be the precursor
lesions for MSI-H colon cancers. Furthermore, there is evidence that
serrated polyps are more likely to be missed during colonoscopy [10,11,22]. As a result, colonoscopic follow-ups for serrated adenomas should be the same as for conventional adenomatous polyps...." Wednesday, December 22, 2010
Ovarian Cancer and Us - updated blog stats - just checking to see who's with us :-)
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Why We Still Kill Patients: Invisibility, Inertia, And Income – Health Affairs Blog (re: patient safety movement....)
"......As Michael says, “There are no villains here.” Everybody means well. Unless assumptions like those above are explicitly exposed and challenged, though, another quotation might be apt: “The road to hell is paved with good intentions.”....
abstract: The Impact of Age on the Treatment and Survival of Ovarian Cancer Patients
Purpose: Although a significant number of patients diagnosed with ovarian cancer are over the age of 65, these patients are less likely to receive standard therapy and are underrepresented in clinical studies. The objective of our study was to evaluate the treatment and survival of patients over the age of 65 years.
abstract: An Internet Survey of Symptoms Associated With Intra-Abdominal Malignancies: Lack of Specificity for Ovarian Cancer
Conclusion: This analysis fails to support the hypothesis that focusing attention on a pattern of nonspecific symptoms will be helpful in the diagnosis of ovarian cancer.
Tuesday, December 21, 2010
abstract/full access: Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data : The Lancet
Note: Full access to article is free after registration (free)
"Background
Cancer survival is a key measure of the effectiveness of health-care systems. Persistent regional and international differences in survival represent many avoidable deaths. Differences in survival have prompted or guided cancer control strategies. This is the first study in a programme to investigate international survival disparities, with the aim of informing health policy to raise standards and reduce inequalities in survival.
Methods Data from population-based cancer registries in 12 jurisdictions in six countries were provided for 2·4 million adults diagnosed with primary colorectal, lung, breast (women), or ovarian cancer during 1995—2007, with follow-up to Dec 31, 2007.
Risk of colorectal and endometrial cancers in EPCAM deletion-positive Lynch syndrome: a cohort study : The Lancet Oncology
Interpretation
EPCAM deletion carriers have a high risk of colorectal cancer; only those with deletions extending close to the MSH2 promoter have an increased risk of endometrial cancer. These results underscore the effect of mosaic MSH2 deficiency, leading to variable cancer risks, and could form the basis of an optimised protocol for the recognition and targeted prevention of cancer in EPCAM deletion carriers.
Family History of Cancer and Cancer Risks in Women with BRCA1 or BRCA2 Mutations — J. Natl. Cancer Inst.
Note: some stats taken out for ease of reading
"...Among women with a BRCA1 mutation, the risk of breast cancer increased by 1.2-fold for each first-degree relative with breast cancer before age 50 years and the risk of ovarian cancer increased by 1.6 fold for each first- or second-degree relative with ovarian cancer ...cont'd
Cancer - NPCR - USCS - View Data Online - cancer stats U.S.
Note: ovarian cancer - 8th in incidence rate; 5th in death rate |
eHealthServer.com | European Commission Signs eHealth Agreement with US Department of Health
"...The partnership between the EU and the US, the two world leaders in eHealth, sends a strong signal to all stakeholders that common standards and interoperability bring opportunities for a global approach for the benefit of patients, health systems and the market"
Monday, December 20, 2010
Expert Commentaries: Promoting Transparent and Actionable Clinical Practice Guidelines: Viewpoint from the National Guideline Clearinghouse/National Quality Measures Clearinghouse (NGC/NQMC) Editorial Board
eg:
"..........The NGC/NQMC Editorial Board recommends avoiding vague or ambiguous recommendation statements (such as "Physicians may offer…" or "When possible…").
Recommendation statements containing vague or ambiguous language and expressions are not actionable, at least not consistently. This problem fosters subjective and potentially erroneous interpretation and thus can impede decision-making.
* Example:
..."Frequency of follow-up visits is based on the severity of disease presentation, etiology, and treatment.
Wide Genetic Testing for Lynch Syndrome Cost Effective online teleconference from AACR mp3 download Nov 18th, 2010
The American Association for Cancer Research hosted a teleconference on these findings on Thursday, Nov. 18, 2010, at 3:00 p.m. ET.
Download * the mp3 of the teleconference (10.5 MB, 46 minutes and 13 seconds)
*On a PC, right mouse click on the "Download" link and select "Save link as..." in Firefox or "Save Target as..." in Internet Explorer.
Patients Right to Know - Patient Safety U.S. - Transparency laws
The following states currently have some form of Transparency Law on the books:
Arizona
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Georgia
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New York
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Texas
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|---|---|---|---|
California
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Idaho
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North Carolina
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Vermont
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Colorado
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Indiana
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North Dakota
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Virginia
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Connecticut
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Maryland
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Oregon
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West Virginia
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District of Columbia
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Massachusetts
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Rhode Island
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Florida
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New Jersey
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Tennessee
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Salzburg Global Seminar - selected articles
Session Media:
Session Schedule Session Directory
Activating Seniors to Improve Chronic Disease Care: Results from a Pilot Intervention Study (Dominick L. Frosch, David Rincon, Socorro Ochoa, and Carol M. Mangione)
Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient Choice (Benjamin Moulton and Jaime S. King)
Communicating Evidence for Participatory Decision Making (Ronald M. Epstein, Brian S. Alper and Timothy E. Quill)
Helping Doctors and Patients Make Sense of Health Statistics (Gerd Gigerenzer, Wolfgang Gaissmaier, Elke Kurz-Milcke, Lisa M. Schwartz, and Steven Woloshin)
How Do US Journalists Cover Treatments, Tests, Products, and Procedures? An Evaluation of 500 Stories (Gary Schwitzer)
Implementing shared decision making in the NHS. (Glyn Elwyn and colleagues)
Improving productivity in the NHS. Reducing practice variation through better decision making is key (Albert Mulley) - [Article No. 5, if you scroll down the document]
Launching the Century of the Patient (Gerd Gigerenzer and J. A. Muir Gray)
Policy Support For Patient- Centered Care: The Need For Measurable Improvements In Decision Quality (Karen R. Sepucha, Floyd J. Fowler Jr., and Albert G. Mulley Jr.)
Reactions of Potential Jurors to a Hypothetical Malpractice Suit Alleging Failure to Perform a Prostate-Specific Antigen Test (Michael J. Barry, Pamela H. Wescott, Ellen J. Reifler, Yuchaio Chang, and Benjamin W. Moulton)
Rethinking Informed Consent: The Case for Shared Medical Decision- Making (Jaime Staples King and Benjamin Moulton)
Session Schedule
SHARED DECISION-MAKING IN THE MEDICAL ENCOUNTER: WHAT DOES IT MEAN? (OR IT TAKES AT LEAST TWO TO TANGO) by CATHY CHARLES, AMIRAM GAFNV and TIM WHELAN
The Future of Health Journalism (Gary Schwitzer)
The need to confront variation in practice (Albert G Mulley)
Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making (Caldon LJ, Collins KA, Reed MW, Sivell S, Austoker J, Clements AM, Patnick J, Elwyn G; BresDex Group)
(http://www.ncbi.nlm.nih.gov/pubmed/21029281)
HEALTH CROSSROADS / HEALTH DIALOG: Prostate Cancer Screening
(https://www.healthcrossroads.com/example/crossroad.aspx?contentGUID=fc326615-5b29-47f1-87c3-9a3e2d946919)
HEALTH DIALOG: Getting the Healthcare That’s Right for You
(http://www.healthdialog.com/Main/Personalhealthcoaching/Shared-Decision-Making/Getting-The-Care-Thats-Right-For-You)
I Believe, Therefore I Do. (Frosch DL, Elwyn G.)
(http://www.ncbi.nlm.nih.gov/pubmed/21061083)
Implementing shared decision making in the NHS (Elwyn G, Laitner S, Coulter A, Walker E, Watson P, Thomson R.)
(http://www.ncbi.nlm.nih.gov/pubmed/20947577)
SESSION BLOG: e-Patient Dave: A Voice of Patient Engagement (Dave deBronkart)
(http://epatientdave.com/2010/11/29/a-radical-view-of-complianceadherence-from-1977/)
Session Position Paper - with thanks to the British Medical Journal: Do patients want a choice and does it work? by co-chair of the session, Angela Coulter, Director of Global Initiatives, Foundation for Informed Medical Decision Making
(http://www.bmj.com/content/341/bmj.c4989.full.html?ijkey=icrFYTXpKpvq5Bc&keytype=ref&siteid=bmjjournals)
TED: Sheena Iyengar on the art of choosing
(http://www.ted.com/talks/sheena_iyengar_on_the_art_of_choosing.html)
The New Yorker: The Cost Conundrum. What a Texas town can teach us about health care (Atul Gawande June 1, 2009)
(http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all)
Tracking Medicine (John Wennberg)
(http://www.trackingmedicine.com/)
Sunday, December 19, 2010
Genetic Variation at 9p22.2 and Ovarian Cancer Risk for BRCA1 and BRCA2 Mutation Carriers — J. Natl. Cancer Inst.
Conclusion: Common genetic variation at the 9p22.2 locus was associated with decreased risk of ovarian cancer for carriers of a BRCA1 or BRCA2 mutation.
Genomics|Update|Current - Recommendation on Genetic Testing for Risk of Cardiovascular Disease
Recommendation on Genetic Testing for Risk of Cardiovascular Disease
This month the independent Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group
has released a new evidence-based recommendation on the use of “cardiogenomic profiles” (or “heart health”) genetic tests. These tests are being marketed to physicians and the general public as a way to find out a person’s risk for cardiovascular disease, and some can be ordered online without the involvement of a physician. The EGAPP Working Group did not find enough evidence to indicate whether these tests should or should not be used to determine future cardiovascular risk in the general population, and currently discourages the use of this testing except in research settings. Access the EGAPP recommendation. Read more about the EGAPP recommendation.
Docetaxel plus trabectedin appears active in recurrent or persistent ovarian and primary peritoneal cancer after up to three prior regimens: A phase II study of the Gynecologic Oncology Group
CONCLUSIONS: This combination was well tolerated and appears more active than the historical control of single agent taxane therapy in those with recurrent ovarian and peritoneal cancer after failing multiple lines of chemotherapy. Further study is warranted
Saturday, December 18, 2010
full free access: PLoS Medicine: Which Path to Universal Health Coverage? Perspectives on the World Health Report 2010
Box 1. Key Recommendations of the World Health Report 2010
- There is no single path or magic bullet to achieve universal health coverage: each country needs to devise its own route to achieve this goal.
- All countries, but particularly poorer ones, need to reduce reliance on direct, out-of-pocket payments for health care by increasing risk pooling and prepayment for services.
- Countries should address barriers to health care other than direct payments for care: transport costs and lost income can be substantial obstacles to care seeking.
- There is substantial scope to raise further domestic resources for health care, particularly through innovative approaches to financing.
- 20%–40% of health care expenditure is wasted; improved health system efficiency can make a substantial contribution to the achievement of universal health coverage.
- Wealthier countries should provide financial support to low income countries in order for them to achieve universal health care coverage.
- Despite some progress, development assistance for health remains fragmented and unpredictable; efforts to improve the efficiency and coordination of aid must be intensified.
new research: ICON7 Results May Change Practice in Ovarian Cancer | Cancer Survivors Network
OncologySTAT: Dr. Cervantes, what were the most important studies in ovarian cancer that were presented at this year’s ESMO Congress?
Nov 2010: Health Council of Canada / Conseil canadien de la santé - How Do Canadians Rate the Health Care System?
full free access: Clinical Cancer Advances 2010: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology — JCO
Note: includes discussion on ovarian cancer (Avastin/disparities/screening)
Pathologic findings following false-positive screening tests for ovarian cancer in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening
Abstract
OBJECTIVE: In the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), ovarian cancer screening with transvaginal ultrasound (TVU) and CA-125 produced a large number of false-positive tests. We examined relationships between histopathologic diagnoses, false-positive test group, and participant and screening test characteristics.CONCLUSIONS: False-positive ovarian cancer screening tests were associated with a range of histopathologic diagnoses, some of which may be related to patient and screening test characteristics. Further research into the predictors of false-positive ovarian cancer screening tests may aid efforts to reduce false-positive results.
The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review
CONCLUSION: Ultimately, serial imaging and the CA-125 assay detected the highest number of ovarian cancer and PCC progressive disease cases in comparison to physical examination and vaginal cytology, but nevertheless, all of the procedures were conducted at a considerable financial expense.
Mechanism of action and toxicities of purgatives used for colonoscopy preparation
Take home message: Although generally safe and effective, colonic purgatives have both acute and permanent toxicities. The safest preparations utilize PEG combined with a balanced electrolyte solution. Limitations of this preparation center on the volume required and poor taste. Alternative formulations are now available; however, those using sodium phosphate have fallen out of favor due to a risk of renal toxicity
Read More: http://informahealthcare.com/doi/abs/10.1517/17425255.2011.542411
Read More: http://informahealthcare.com/doi/abs/10.1517/17425255.2011.542411
Friday, December 17, 2010
BRCA1 mRNA expression and outcome to neoadjuvant cisplatin-based chemotherapy in bladder cancer
Abstract
Background: Neoadjuvant
chemotherapy has shown a modest benefit in muscle-invasive bladder
cancer patients; however, the subset of patients
most likely to benefit has not been identified.
BRCA1 plays a central role in DNA repair pathways and low BRCA1
expression
has been associated with sensitivity to cisplatin
and longer survival in lung and ovarian cancer patients.
Patients and methods: We
assessed BRCA1 messenger RNA expression levels in paraffin-embedded
pre-treatment tumor samples obtained by transurethral
resection from 57 patients with locally advanced
bladder cancer subsequently treated with neoadjuvant cisplatin-based
chemotherapy.
BRCA1 levels were divided into terciles and
correlated with pathological response and survival....
"Primary peritoneal" high-grade serous carcinoma is very likely metastatic from serous tubal intraepithelial carcinoma: Assessing the new paradigm of ovarian and pelvic serous carcinogenesis and its implications for screening for ovarian cancer.
CONCLUSIONS: At least half the cases of primary peritoneal high-grade serous carcinoma are associated with intraepithelial carcinoma of the fallopian tube, usually involving the fimbriae. These findings support the view that, like "primary ovarian carcinoma," what has been traditionally classified as "primary peritoneal carcinoma" is probably derived from occult high-grade serous carcinoma in the fallopian tube. These findings have important implications for ultrasound screening trials for ovarian cancer which are based on the assumption that an enlarged ovary is a very early manifestation of disease.
Echocardiographic imaging of tricuspid and pulmonary valve abnormalities in primary ovarian carcinoid tumor-abstract
Abstract
Carcinoid is a rare malignancy originating from enterochromaffin cells and is clinically characterized by flushing, diarrhea and bronchospasm, due to secretion of vasoactive substances. A dreaded complication is carcinoid heart disease, which mainly affects right cardiac chambers, resulting in thickened, immobile and retracted tricuspid and pulmonary valves. In the current report, a case of a 60-year old female presenting with symptoms of right heart failure is described. Transthoracic two-dimensional and real-time three-dimensional echocardiography findings, as well as biochemical markers, including pro-BNP and NT-pro-BNP, were consistent with carcinoid syndrome. The histological diagnosis of carcinoid was confirmed after surgical resection of an ovarian mass.
Risk of contralateral breast cancer associated with common variants in BRCA1 and BRCA2: potential modifying effect of BRCA1/BRCA2 mutation carrier sta
"....The association between common variants in BRCA1 and BRCA2 and risk of CBC may differ depending on BRCA1 and BRCA2 mutation carrier status."
Sex cord stromal tumors of the ovary in children - abstract (sertoli-leydig most aggressive cell type)
CONCLUSIONS: Completeness of resection and histology were important prognostic factors; in our series the Sertoli-Leydig Cell tumor was the most aggressive variety. Hormonal signs (precocious puberty, telarca, menarche) were common in younger patients and led to an early diagnosis. Cisplatin based chemotherapy seemed to be effective for locally advanced tumors.
Wednesday, December 15, 2010
Search of: ovarian cancer | Open Studies | Adult | received from 10/01/2010 to 12/15/2010 - List Results - ClinicalTrials.gov
Search of: ovarian cancer | Open Studies | Adult | received from 10/01/2010 to 12/15/2010 - List Results (34) - ClinicalTrials.gov
EGEN, Inc. Announces That Phase II Clinical Trial For Advanced Ovarian Cancer Is Open For Enrollment (IL-12)
"EGEN, Inc. announced that the first Phase II clinical trial utilizing EGEN-001 for the treatment of recurrent ovarian cancer is now open for enrollment. The trial is sponsored by the Gynecologic Oncology Group (GOG) under an agreement between the GOG and EGEN, Inc., and is being conducted by a network of researchers led by the GOG at member institutions. The University of Alabama at Birmingham (UAB) Hospital is the first member institution to open enrollment. Dr. Ronald Alvarez, of UAB Hospital, is the Study Chair for the trial. The GOG Principal Investigator at UAB Hospital is Dr. Mack Barnes....The product utilizes the Company's proprietary TheraPlas® delivery technology and is composed of interleukin-12 (IL-12) gene formulated with a biocompatible delivery polymer. IL-12 is a potent cytokine which works by enhancing the body's immune system against cancer and inhibiting tumor blood supply. We expect a number of the leading cancer centers in the U.S. to participate in this study and planning is underway to initiate additional Phase II trials in 2011, including the evaluation of EGEN-001 in treatment of colorectal cancer patients."...cont'd
Second Look at Estrogen in Breast Cancer Protection - NYTimes.com (re: WHI)
Blogger's Note: a similar issue was reported and largely ignored regarding colorectal cancer
“The data were absolutely missed. They weren’t emphasized, and they weren’t brought to the attention of oncologists,”...
NCI Cancer Bulletin: Statistical Strength in Numbers: International Clinical Trials for Rare Cancers
“International trials for rare cancers offer many advantages over separate trials done in different countries or regions,” explained Dr. Jack Welch of the Clinical Investigations Branch in NCI’s Cancer Therapy Evaluation Program (CTEP). “By bringing patients together, international trials can accrue faster, and they offer lower collective administrative costs, shared infrastructure, centralized resources, and use of existing networks.”.....On December 10, NCI and the American Society of Clinical Oncology (ASCO) convened a meeting of international stakeholders to explore ways to collaborate across borders on clinical trials for rare cancers. Nearly 100 representatives from 75 institutions participated in the day-long meeting, which was supported by CTEP, NIH’s Office of Rare Diseases Research (ORDR), NCI’s Office of Advocacy Relations (OAR), and ASCO. In addition to representatives from NIH, the FDA, the HHS Office for Human Research Protections, and NCI’s Clinical Trials Cooperative Group Program, attendees included investigators from Canada, France, Italy, Japan, Korea, the United Kingdom, the European Organisation for Research and Treatment of Cancer, and representatives of patient advocacy organizations and the pharmaceutical industry....cont'd
Level of Scientific Evidence Underlying Recommendations Arising From the National Comprehensive Cancer Network Clinical Practice Guidelines — JCO
Conclusion: Recommendations issued in the NCCN guidelines are largely developed from lower levels of evidence but with uniform expert opinion. This underscores the urgent need and available opportunities to expand evidence base in oncology.
Components of family history associated with women's disease perceptions for cancer: A report from the Family Healthware™ Impact Trial - abstract
PURPOSE: To determine the specific components of family history and personal characteristics related to disease perceptions about breast, colon, and ovarian cancers.
'Triple negative' epithelial ovarian cancer and pathologic markers for prognosis
Abstract
PURPOSE OF REVIEW: To summarize the recent evidence for 'triple negative' epithelial ovarian cancer (TNEOC), characterized by lack of expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor type 2 (HER2), and to discuss its potential pathologic markers for prognosis and targeted therapy.
RECENT FINDINGS: 'Triple negative' phenotype is traditionally referred to as a specific subtype of breast cancer negative for estrogen receptor, progesterone receptor and HER2 expression. Recent studies have shown that such 'triple negative' phenotype also exists in ovarian and endometrial cancer. TNEOC accounts for about 15% of epithelial ovarian carcinoma. This specific subtype tends to exhibit more aggressive characteristics and a worse prognosis. The molecular features of TNEOC are similar to those of 'triple negative' breast cancer (TNBC), a widely studied histological subtype. Recently, a panel of specific pathologic biomarkers has been identified in TNBC. Currently, phase I and phase II trials to examine the safety and efficacy of a poly (ADP-ribose) polymerase inhibitor (olaparib) and angiogenesis inhibitors (sunitinib and bevacizumab) in TNBC are ongoing. These TNBC-associated pathologic markers could be used to screen for novel prognostic factors and therapeutic targets in TNEOC.
SUMMARY: 'Triple negative' phenotype has important implications for clinical management of patients with ovarian cancer.
RECENT FINDINGS: 'Triple negative' phenotype is traditionally referred to as a specific subtype of breast cancer negative for estrogen receptor, progesterone receptor and HER2 expression. Recent studies have shown that such 'triple negative' phenotype also exists in ovarian and endometrial cancer. TNEOC accounts for about 15% of epithelial ovarian carcinoma. This specific subtype tends to exhibit more aggressive characteristics and a worse prognosis. The molecular features of TNEOC are similar to those of 'triple negative' breast cancer (TNBC), a widely studied histological subtype. Recently, a panel of specific pathologic biomarkers has been identified in TNBC. Currently, phase I and phase II trials to examine the safety and efficacy of a poly (ADP-ribose) polymerase inhibitor (olaparib) and angiogenesis inhibitors (sunitinib and bevacizumab) in TNBC are ongoing. These TNBC-associated pathologic markers could be used to screen for novel prognostic factors and therapeutic targets in TNEOC.
SUMMARY: 'Triple negative' phenotype has important implications for clinical management of patients with ovarian cancer.
abstract: Induction of cytotoxic T lymphocytes against ovarian cancer-initiating cells.
Abstract
The majority of patients with stage III/IV ovarian carcinoma that respond initially to standard therapies ultimately undergo relapse due to the survival of small populations of cells with tumor-initiating potential. These ovarian cancer-initiating cells (OCIC) are sometimes called cancer stem cells (CSC) since they express stem cell markers, and can survive conventional therapies such as chemotherapy, which usually target rapidly replicating tumor cells, and give rise to recurrent tumors that are more chemo-resistant and more aggressive. Thus it would be desirable to develop a therapy that could selectively target OCIC and be used to complement the conventional therapies. In the present study, we isolated a subset of ovarian cancer cells with a CD44(+) phenotype in samples from patients with ovarian cancer that possess CSC properties including the formation of spheroids in culture, self-renewal and the ability to be engrafted in immune-compromised mice. We next explored the use of immunotherapy using fusions of dendritic cells (DC) and OCIC to specifically target the OCIC sub-populations. Fusion cells prepared in this way activated T cells to express elevated levels of IFN-γ with enhanced killing of CD44(+) ovarian cancer cells. We envision a combined approach where conventional therapies such as chemotherapy kill the bulk of tumor cells, whereas OCIC-reactive CTL target the resistant OCIC fraction. A combined therapy such as this may represent a promising approach for the treatment of ovarian cancer.Development of an ovarian cancer screening decision model that incorporates disease heterogeneity: implications for potential mortality reduction.
Abstract
BACKGROUND: Pathologic and genetic data suggest that epithelial ovarian cancer may consist of indolent and aggressive phenotypes. The objective of the current study was to estimate the impact of a 2-phenotype paradigm of epithelial ovarian cancer on the mortality reduction achievable using available screening technologies.CONCLUSIONS: The current analysis suggested that reductions in ovarian cancer mortality using available screening technologies on an annual basis are likely to be modest. A model that incorporated 2 clinical phenotypes of ovarian carcinoma into its natural history predicted an even smaller potential reduction in mortality because of the more frequent diagnosis of indolent cancers at early stages.
abstract: Aspiration cytology of ovarian cystic masses: histologic correlation and review of the literature.
Objective: To determine the diagnostic accuracy of cytologic evaluation of ovarian cystic masses.
Study Design: Sixty-seven ovarian cystic masses with fine needle aspiration cytology and concurrent or subsequent cystectomy/oophorectomy with histology were examined. Correlations with malignancy were made with 4 parameters: serum CA-125, radiographic size and architecture, and cytology.
Sunday, December 12, 2010
Uterine cancer screening effective, but not yet recommended – The Chart - CNN.com Blogs (Lynch Syndrome)
"..However Smith notes many postmenopausal women receive a late diagnosis because they overlook a very important warning sign. "The American Cancer Society places a great deal of emphasis of being aware that postmenopausal bleeding is not normal and if it occurs, contact a doctor immediately," he advises."
Tuesday, December 07, 2010
Monday, December 06, 2010
Canada - Fraser Institute:The Dollar Cost of Medicare | Fraser Institute
The Dollar Cost of Medicare |
|
| Appeared in the New Brunswick Telegraph Journal | |
| Authors: | |
| Release Date: | November 16, 2010 |
|
The true cost of Medicare for individuals and families in
Canada is often misunderstood, with many people thinking it’s either
free or covered by our provincial health insurance premiums....cont\d
| |
Sunday, December 05, 2010
Friday, December 03, 2010
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