Saturday, April 21, 2012
Phytoestrogens (soy) for menopausal symptoms: A review.
Wiki: Isoflavones
Wiki: Phytoestrogens
.....(food sources) "According to a study by Canadian researchers about the content of nine common phytoestrogens in a Western diet, foods with the highest relative phytoestrogen content were nuts and oilseeds, followed by soy products, cereals and breads, legumes, meat products, and other processed foods that may contain soy, vegetables, fruits, alcoholic, and nonalcoholic beverages. Flax seed and other oilseeds contained the highest total phytoestrogen content, followed by soybeans and tofu.[21] The highest concentrations of isoflavones are found in soybeans and soybean products followed by legumes, whereas lignans are the primary source of phytoestrogens found in nuts and oilseeds (e.g. flax) and also found in cereals, legumes, fruits and vegetables....."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Phytoestrogens for menopausal symptoms: A review
Maturitas. 2012 Apr 17;
Abstract
OBJECTIVE:
To review the evidence that isoflavones are effective treatments for menopausal symptoms and to present the safety data.
METHODS:
The databases Scopus, ScienceDirect and Primo Central Index were searched and preference was given to systematic reviews and meta-analyses.
RESULTS:
The available evidence suggests that isoflavones do not relieve menopausal vasomotor symptoms any better than placebo. Long-term safety studies suggest that women who consume a diet high in isoflavones may have a lower risk of endometrial and ovarian cancer.
CONCLUSIONS: Isoflavones cannot be recommended for the relief of hot flushes.
abstract: Effects on the immune system and toxicity of carboplatin/paclitaxel combination chemotherapy in patients with stage III-IV ovarian and non small cell lung cancer and its role in survival and toxicity.
Effects on the immune system and toxicity of carboplatin/paclitaxel combination chemotherapy in patients with stage III-IV ovarian and non small cell lung cancer and its role in survival and toxicity.
Abstract
Purpose:
To examine the impact of paclitaxel and carboplatin combination chemotherapy on the parameters of the immune system in patients with non small cell lung cancer (NSCLC) and with ovarian cancer before, during and after chemotherapy, and the effect of this combination on the overall patient survival.
Methods:
24 patients with NSCLC and 20 with ovarian cancer (all in stage IIIb-IV) treated with 6 courses of paclitaxel and carboplatin combination chemotherapy were separated into two groups according to their survival group A: long survival (> 12 months for NSCLC; > 30 months for ovarian cancer) group B: short survival (<12 months for NSCLC; <30 months for ovarian cancer).
At the same time we studied some immunological parameters (CD3, CD4, CD8, CD56, CD34, IL-3, IFN-γ) in relation with the induced toxicity during chemotherapy. The results were analysed using the ANOVA method.
Results:
We observed a statistically significant difference of CD4 and CD4/CD8 after chemotherapy between groups A and B (p<0.001 and p< 0.006 respectively), implying that the further increase of T-helper cells after chemotherapy had a positive impact on survival. In addition, statistically interesting was the difference in values of IFN-γ between patients of groups A and B before and after chemotherapy (p< 0.039 and p< 0.027, respectively). Patients with high IL-3 had little chance of toxicity.
Conclusion:
Our findings support that with carboplatin/ paclitaxel combination chemotherapy, important parameters of the immune system (IFN-γ, CD4, CD4/CD8) can be used as prognostic factors for survival, while others (IL-3) as indicators of toxicity.
abstract: Hormone Therapy and Different Ovarian Cancers: A National Cohort Study (postmenopausal women/does not include reference to clear cell ovarian)
Blogger's Note: the abstract makes no reference to clear cell ovarian, given the number of women followed this omission (in the abstract) is curious
Hormone Therapy and Different Ovarian Cancers: A National Cohort Study
Abstract
Postmenopausal hormone therapy use
increases the risk of ovarian cancer. In the present study, the authors
examined the risks
of different histologic types of ovarian cancer
associated with hormone therapy.
Using Danish national registers, the
authors
identified 909,946 women who were followed from
1995–2005. The women were 50–79 years of age and had no prior
hormone-sensitive
cancers or bilateral oophorectomy.
Hormone therapy
prescription data were obtained from the National Register of Medicinal
Product Statistics. The National Cancer and
Pathology Register provided data on ovarian cancers, including
information about
tumor histology......... In an average of 8.0 years of follow
up, 2,681 cases of epithelial ovarian cancer were detected.
Compared
with
never users, women taking unopposed oral estrogen
therapy had increased risks of both serous tumors and
endometrioid tumors but
decreased risk of mucinous tumors. Similar increased risks of serous and
endometrioid
tumors were found with estrogen/progestin therapy,
whereas no association was found with mucinous tumors.
Consistent with
results from recent cohort studies, the authors
found that ovarian cancer risk varied according to tumor histology. The
types
of ovarian tumors should be given attention in
future studies.
abstract: Unusual DNA mismatch repair-deficient tumors in Lynch syndrome: a report of new cases and review of the literature.
Unusual DNA mismatch repair-deficient tumors in Lynch syndrome: a report of new cases and review of the literature.
Hum Pathol. 2012 Apr 17;
Abstract
Immunohistochemical detection of DNA mismatch repair proteins and polymerase chain reaction detection of microsatellite instability have enhanced the recognition of mismatch repair-deficient neoplasms in patients with Lynch syndrome and, consequently, led to the identification of tumors that have not been included in the currently known Lynch syndrome tumor spectrum.
Here, we report 4 such unusual tumors. Three of the 4, a peritoneal mesothelioma, a pancreatic acinar cell carcinoma, and a pancreatic well-differentiated neuroendocrine tumor, represented tumor types that, to the best of our knowledge, have not been previously reported in Lynch syndrome. The fourth tumor was an adrenocortical carcinoma, which has rarely been reported previously in Lynch syndrome. Three of our 4 patients carried a pathogenic germ-line mutation in a mismatch repair gene. The unusual tumor in each of the 3 patients showed loss of the mismatch repair protein corresponding to the mutation. The fourth patient did not have mutation information but had a history of colonic and endometrial carcinomas; both lacked MSH2 and MSH6 proteins. Interestingly, none of the 4 unusual tumors revealed microsatellite instability on polymerase chain reaction testing, whereas an appendiceal carcinoma from 1 of the study patients who was tested simultaneously did. The recognition of such tumors expands the repertoire of usable test samples for the workup of high-risk families.
As yet, however, there are no data to support the inclusion of these tumors into general screening guidelines for detecting Lynch syndrome, nor are there data to warrant surveillance for these tumors in patients with Lynch syndrome.
Friday, April 20, 2012
abstract: High scores on the Edmonton Symptom Assessment Scale identify patients with self-defined high symptom burden.
High scores on the Edmonton Symptom Assessment Scale identify patients with self-defined high symptom burden.
Abstract:
The terms symptom burden and symptom distress are frequently seen in palliative care literature yet are used in multiple ways ranging from addition of symptom scores to more in-depth assessments of interference in function. Patient input to date has had little role in these varied definitions yet previous reviews have suggested the importance of such input. This mixed qualitative and quantitative prospective study was conducted to seek patient input into the definition of 'symptom burden' and to correlate burden self-ranked scores with symptom scores on the Edmonton Symptom Assessment Scale (ESAS).
Results suggest that patients with advanced disease followed by palliative care providers are a group with a high level of self-defined burden. Further, any patient rating one or more symptoms on the ESAS ≥7 is at high risk of self-defined burden and likely to be experiencing significant impact on physical, emotional and social functioning. Further work should look at which aspects of symptom management best promote a lessening of perceived burden.
Medscape: Colonoscopy No Help in Finding Melena Source - in Gastroenterology, General Gastroenterology
Wiki: Melena
Medical News: Colonoscopy No Help in Finding Melena Source - in Gastroenterology, General Gastroenterology
"Colonoscopy had a lower-than-expected yield when used after a negative upper endoscopy in stable patients with melena, researchers found.
The procedure diagnosed a suspected source of the bleeding in just 4.8% of patients with melena in a retrospective case-control study by Jason P. Etzel, MD, of Oregon Health and Science University, Portland, and colleagues......
Medscape: (Avastin) Bevacizumab: First-Line Therapy in Ovarian Cancer?: Evidence for First-Line Therapy Dr's Markman, Burger, Swenterton
Bevacizumab: First-Line Therapy in Ovarian Cancer?: Evidence for First-Line Therapy
Editor’s Note:
Two phase 3 trials published in the New England Journal of Medicine on December 29, 2011, found bevacizumab to be active as first-line therapy in advanced ovarian cancer. Although both trials showed an increase in progression-free survival [PFS], not enough time has elapsed to determine whether the drug extends overall survival. Furthermore, it is unclear whether bevacizumab in ovarian cancer is best used as first-line or second-line therapy. Recently, Drs. Robert Burger and Kenneth Swenerton participated in a Medscape virtual debate via email to address this question: "Should bevacizumab be used as first-line therapy in patients with advanced ovarian cancer?" Dr. Maurie Markman served as moderator. What follows is their conversation......
how to.....follow Ovarian Cancer and Us via email alerts (many options)
Ovarian Cancer and Us - Blogger's Note:
Looks hard but is not - using this post as an example or you can just use the email link or others on the blog, lots of options for those interested:
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abstract: Preoperative PET/CT in early-stage breast cancer (including ovarian cancer primary/metastases)
Preoperative PET/CT in early-stage breast cancer
Abstract
Background: The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and
computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer.
Patients and methods: A
total of 103 consecutive patients with newly diagnosed operable breast
cancer with tumors ≥2 cm were independently examined
preoperatively with conventional assessment
(mammography, breast/axillary ultrasound, chest X-ray and blood samples)
and PET/CT with no prior knowledge of the other.
Results: PET/CT identified a primary tumor in all but three patients (97%). PET/CT
solely detected distant metastases (ovary, bones and lung) in 6
patients and new primary cancers (ovary, lung) in another
two patients, as well as 12 cases of
extra-axillary lymph node involvement. In 15 patients (15%),
extra-axillary malignancy
was detected by PET/CT only, leading to an upgrade of initial staging in 14% (14/103) and ultimately a modification of planned treatment in 8% (8/103)
of patients.
Conclusions: PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases and other occult primary
cancers. Preoperative 18F-fluorodeoxyglucose–PET/CT has a substantial impact on initial staging and on clinical management in patients with early-stage breast cancer with tumors
≥2 cm.
Aspirin and cancer risk: a quantitative review to 2011
Aspirin and cancer risk: a quantitative review to 2011:
Background:
Aspirin has been associated to a reduced risk of colorectal and possibly of a few other common cancers.
Methods:
To provide an up-to-date quantification of this association, we conducted a meta-analysis of all observational studies on aspirin and 12 selected cancer sites published up to September 2011.
Results:
Regular aspirin is associated with a statistically significant reduced risk of colorectal cancer and of other digestive tract cancers, for squamous cell esophageal cancer, for esophageal and gastric cardia adenocarcinoma,, for gastric cancer), with somewhat stronger reductions in risk in case–control than in cohort studies. Modest inverse associations were also observed for breast and prostate cancer, while lung cancer was significantly reduced in case–control studiesbut not in cohort ones. No meaningful overall associations were observed for cancers of the pancreas, endometrium, ovary, bladder, and kidney.
Conclusions:
Observational studies indicate a beneficial role of aspirin on colorectal and other digestive tract cancers; modest risk reductions were also observed for breast and prostate cancer. Results are, however, heterogeneous across studies and dose–risk and duration–risk relationships are still unclear.
2011 Dec open access: Nuclear Medicine and Radiation Therapy - 18FDG-PET/CT Definition of Clinical Target Volume for Robotic Stereotactic Body Radiosurgery Treatment of Metastatic Gynecologic Malignancies
Blogger's Note: investigative research; study of 27 gyn patients of whom 15 were ovarian cancer patients
18FDG-PET/CT Definition of Clinical Target Volume for Robotic Stereotactic Body Radiosurgery Treatment of Metastatic Gynecologic Malignancies
"As stereotactic body radiosurgery for abdominopelvic sites
of metastatic gynecologic cancers becomes more mainstream,
accumulated 18F-FDG PET and CT data will better guide treating
physician target contouring. Future research directions by our group
will study better radiosurgical target delineation, as modified by the
extent of respiratory motion, by four-dimensional (4D)-CT scanners
or by single 18F-FDG PET-magnetic resonance imaging (PET/MRI)
scanners."
A prospective multicenter (phase IIIb) trialstudy of Treosulfan in elderly patients with recurrent ovarian cancer: results of a planned safety analysis
A prospective multicenter study of treosulfan in elderly patients with recurrent ovarian cancer: results of a planned safety analysis
This open-label multicenter phase-IIIb trial was conducted at 47 German institutions; the first 25 patients analyzed in this safety analysis were recruited in 10 centers.
Background
Treosulfan,
an alkylating agent, has demonstrated activity in recurrent ovarian
carcinoma. It is equieffective as oral (p.o.)
and intravenous (i.v.) formulation. To explore the
preference and compliance of elderly patients regarding p.o. or i.v.
treosulfan
for the treatment of relapsed ovarian carcinoma, women
aged 65 years or older were included in this prospective multicenter
study. Since elderly patients usually have several
concomitant diseases and experience more treatment toxicity, an interim
safety analysis was planned and performed after 25
patients finished therapy to assess the tolerability of the treatment
regimens.
Table 1 - 6
Conflict of interest The trial was supported by Medac GmbH.
Table 1 - 6
- Patient characteristics
- Concomitant diseases
- Treatment delivery
- Reasons for early therapy discontinuation [less than 12 cycles (i.v.) or 12 months of therapy
- Non-hematological toxicities: highest grade per patient (in alphabetic order)
- Hematological toxicities: highest grade per patient
"In summary, the observed toxicities were in the same range as reported in previous studies with significantly younger patients
and less comorbidity or with old women having received fewer previous lines of chemotherapy.
There were no unexpected hematological or
non-hematological toxicities. Based on this safety analysis, treosulfan
proved to
be a safe and tolerable therapeutic option in elderly,
heavily pretreated patients and the next step of study recruitment
was initiated. Of note, the majority of patients in the
interim safety population chose i.v. treosulfan over the oral
application.
Detailed analysis after completion of the trial will
hopefully yield new insight into therapy preference and compliance of
elderly patients with recurrent ovarian cancer."
Thursday, April 19, 2012
Emerging Therapies for Ovarian Cancer - Chemotherapy Advisor
Emerging Therapies for Ovarian Cancer - Chemotherapy Advisor
Bevacizumab
Other Antiangiogenesis Agents
Poly(ADP-ribose) Polymerase Inhibitors
Other Novel Agents in Ovarian Cancer
printer-friendly (view all on one page): link
Phase I Stereotactic Body Radiation for Metastatic or Recurrent Platinum-Resistant Ovarian Cancer - Full Text View - ClinicalTrials.gov
Phase I Stereotactic Body Radiation for Metastatic or Recurrent Platinum-Resistant Ovarian Cancer - Full Text View - ClinicalTrials.gov
Phase I Stereotactic Body Radiation for Metastatic or Recurrent Platinum-Resistant Ovarian Cancer
This study is currently recruiting participants.
Verified April 2012 by Stanford University
First Received on December 13, 2011.
Last Updated on April 18, 2012
History of Changes
| Sponsor: | Stanford University |
|---|---|
| Information provided by (Responsible Party): | Stanford University |
| ClinicalTrials.gov Identifier: | NCT01494012 |
Purpose
This
phase I trial studies the side effects and the best dose of stereotactic
body radiation therapy (SBRT) in treating patients with metastatic or
recurrent ovarian cancer or primary peritoneal cancer. SBRT may be able to send x-rays directly to the tumor and cause less damage to normal tissue.
FDA (U.S.) Safety Alert > Morphine Sulfate Injection USP, 4 mg/mL (C-II), 1 mL fill in 2.5 mL Carpuject by Hospira, Inc: Recall - May Contain More Than Intended Fill Volume
Safety Alerts for Human Medical Products > Morphine Sulfate Injection USP, 4 mg/mL (C-II), 1 mL fill in 2.5 mL Carpuject by Hospira, Inc: Recall - May Contain More Than Intended Fill Volume
[Posted 04/18/2012]
AUDIENCE: Risk Manager, Pain Management
ISSUE: Customer report of two Carpujects syringes containing more than the 1 mL labeled fill volume. Opioid pain medications such as morphine have life-threatening consequences if overdosed. Those consequences can include respiratory depression (slowed breathing or suspension of breathing), and low blood pressure.
BACKGROUND: The affected product is a prefilled glass cartridge for use with the Carpuject Syringe system. The affected lot number is 10830LL, with an expiration date of April 1, 2013. Morphine Sulfate Carpujects 4 mg/mL are packaged in Slim-Pak tamper detection packages with each box containing 10 Carpujects (NDC 0409-1258-30).
The affected lot was distributed in January 2012. It was initially distributed to wholesalers and a limited number of hospitals in Arizona, Colorado, Hawaii, Illinois, Indiana, Michigan, Minnesota, Ohio, Texas and Virginia.
RECOMMENDATION: Anyone with an existing inventory of affected product should stop use and distribution and quarantine the product immediately and call Stericycle at 1-888-912-7088 to arrange for the return of the product.
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
- Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
- Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
abstract + links/podcast: Prevention of Pegfilgrastim-Induced Bone Pain: A Phase III Double-Blind Placebo-Controlled Randomized Clinical Trial of the University of Rochester Cancer Center Clinical Community Oncology Program Research Base
Prevention of Pegfilgrastim-Induced Bone Pain: A Phase III Double-Blind Placebo-Controlled Randomized Clinical Trial of the University of Rochester Cancer Center Clinical Community Oncology Program Research Base
Conclusion
Our phase III randomized placebo-controlled clinical trial demonstrated that naproxen at a dose of 500 mg twice per day is
effective in reducing the incidence and severity of pegfilgrastim-induced bone pain.
Footnotes
-
See accompanying editorial doi: 10.1200/JCO.2011.41.3146 and article doi: 10.1200/JCO.2011.39.2381;
- listen to the podcast by Dr Von Hoenn at www.jco.org/podcasts
Seth's Blog: Bandits and philanthropists
Bandits and philanthropists:
The web is minting both, in quantity.
Bandits want something for nothing. They take. They take free content where they can find it. They fight for anonymity, for less community involvement. They want more than their fair share, and they walk past the busker, because they can hear him playing real good, for free.
The spammer is a bandit, stealing your attention because he can get away with it, and leaving nothing in return.
Philanthropists see a platform for giving. They support the tip jar. They argue for community standards and yes, for taxes that are more fair to the community. They support artists online, and when they can, they buy the book.
The artist who creates a video that touches you, or an infographic that informs you--she's giving more than she gets, leaving the community better than it was before she got there.
Both types have been around forever, of course. But the web magnifies the edges. It's easier than ever to be a free rider, to make your world smaller and to take. And easier than ever to be a big time contributor, even if you don't have any money. You can contribute your links or your attention or your energy...
The fascinating thing for me is how much more successful and happy the philanthropists are. It turns out that when you make the world smaller, you get to keep more of what you've got, but you end up earning a lot less (respect, connections, revenue) at the same time.
Bandits want something for nothing. They take. They take free content where they can find it. They fight for anonymity, for less community involvement. They want more than their fair share, and they walk past the busker, because they can hear him playing real good, for free.
The spammer is a bandit, stealing your attention because he can get away with it, and leaving nothing in return.
Philanthropists see a platform for giving. They support the tip jar. They argue for community standards and yes, for taxes that are more fair to the community. They support artists online, and when they can, they buy the book.
The artist who creates a video that touches you, or an infographic that informs you--she's giving more than she gets, leaving the community better than it was before she got there.
Both types have been around forever, of course. But the web magnifies the edges. It's easier than ever to be a free rider, to make your world smaller and to take. And easier than ever to be a big time contributor, even if you don't have any money. You can contribute your links or your attention or your energy...
The fascinating thing for me is how much more successful and happy the philanthropists are. It turns out that when you make the world smaller, you get to keep more of what you've got, but you end up earning a lot less (respect, connections, revenue) at the same time.
Canadian breast implant cohort: Extended follow-up of cancer incidence
Blogger's Note: prior Canadian patient-led lawsuits failed
~~~~~~~~~~~~~~~~~
Canadian breast implant cohort: Extended follow-up of cancer incidence:
Abstract
Cosmetic breast implants are not associated with increased breast cancer incidence, but variations of risk according to implant characteristics are still poorly understood. As well, the assessment of cancer risk for sites other than breast needs to be clarified. The purpose of this study was to fill these research gaps. This study presents an extended analysis of 10 more years of follow-up of a large Canadian cohort of women who received either cosmetic breast implants (n=24,558) or other cosmetic surgery (15,893). Over 70% of the implant cohort was followed for over 20 years. Cancer incidence among implant women was compared to those of controls using multivariate Poisson models and the general female population using the Standardized Incidence Ratios (SIRs). Women with breast implants had reduced rates of breast and endometrial cancers compared with other surgery women. Subglandular implants were associated to a reduced rate of breast cancer compared to submuscular implants (Incidence Rate Ratio (IRR) = 0.78, 95% CI= 0.63-0.96) and this reduction persisted over time. We observed a 7-fold increased rate (IRR = 7.36, 95% CI= 1.86-29.12) of breast cancer in the first five years after the date of surgery for polyurethane-coated subglandular implant women but this IRR decreased progressively over time (p value for trend = 0.02). We also observed no increased risk of rarer forms of cancer among augmented women. A reduction in breast cancer incidence was observed for women with subglandular implants relative to women with submuscular implants. Possible increase of breast cancer incidence shortly after breast augmentation with polyurethane implants needs to be verified.
FDA (U.S.) Press Announcements > U.S. Marshals seize ultrasound gel product at a New Jersey company
Press Announcements > U.S. Marshals seize ultrasound gel product at a New Jersey company
FDA NEWS RELEASE
For Immediate Release: April 18, 2012
Media Inquires: Sarah Clark-Lynn, 301-796-9110, sarah.clark-lynn@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA
U.S. Marshals seize ultrasound gel product at a New Jersey companyProduct samples revealed bacterial contamination
JCO Editorial (re: Ontario/Pritchard et al) [18F]Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography in Breast Cancer: When… and When Not?
[18F]Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography in Breast Cancer: When… and When Not?
"....It has taken a relatively long time to generate the data needed to guide appropriate use of FDG PET/CT for breast cancer for all phases of the disease. The task is still not quite complete but is propelled by studies such as Pritchard et al.6 We hope that the approach for directing new imaging procedures into clinical practice will continue to improve and be ready when the next imaging breakthrough emerges."
"Diagnostic imaging plays an important role in the care of patients with breast cancer and is used for breast cancer detection, diagnosis, staging, and therapeutic response evaluation.1 Advances in imaging technology, especially relatively newer technologies such as magnetic resonance imaging (MRI) and positron emission tomography without or with integrated computed tomography (PET or PET/CT) provide powerful diagnostic tools, but also generate questions and controversy regarding where and when to use these new modalities. Early studies of new imaging approaches most often come from centers that are scientifically invested in the development of the technology. Typically, small and highly selected patient populations are evaluated, and these preliminary studies often indicate excellent diagnostic performance. Later on, when large multicenter trials are performed with more clinically representative patient populations, the new test invariably performs less well. Nevertheless, the excitement surrounding early results from a new imaging technology and the increasing public access to these early results fuel the desire by patients for access to new forms of diagnostic imaging. Physicians and patients share the wish for diagnostic certainty in excluding cancer spread at the time of diagnosis and may reason that a purely diagnostic procedure, even if untested, can do no harm. These factors, combined with the challenge and expense of carrying out larger scale diagnostic imaging trials, can lead to the early adoption of new imaging studies into clinical practice, often before their performance and optimal use have been fully determined. However, ......."
abstract: Prospective Study of 2-[18F]Fluorodeoxyglucose Positron Emission Tomography in the Assessment of Regional Nodal Spread of Disease in Patients With Breast Cancer: An Ontario Clinical Oncology Group Study
Prospective Study of 2-[18F]Fluorodeoxyglucose Positron Emission Tomography in the Assessment of Regional Nodal Spread of Disease in Patients With Breast Cancer: An Ontario Clinical Oncology Group Study
Purpose 2-[18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) is potentially useful in assessing lymph nodes and detecting distant metastases in women with primary breast cancer.
Conclusion
FDG-PET is not sufficiently sensitive to detect positive axillary lymph nodes, nor is it sufficiently specific to appropriately identify distant metastases. However, the very high positive predictive value (96%) suggests that PET when positive is indicative of disease in axillary nodes, which may influence surgical care.
JCO: Palliative Sedation: When and How? Commentary including references
Blogger's Note:
“Not everything that can be counted counts and not everything that counts can be counted.” Albert Einstein
~~~~~~~~~~~~~~
Commentary (on Maltoni et al): Palliative Sedation: When and How?
REFERENCES
abstract: Postoperative venous thromboembolism predicts survival in cancer patients
Postoperative venous thromboembolism predicts survi... [Ann Surg. 2012]
OBJECTIVES:
To determine whether a postoperative venous thromboembolism (VTE) is associated with a worse prognosis and/or a more advanced cancer stage and to evaluate the association between a postoperative VTE and cancer-specific survival when known prognostic factors, such as age, stage, cancer type, and type of surgery, are controlled.CONCLUSIONS:
Postoperative VTE in oncology patients with limited disease and a complete surgical resection is associated with an inferior cancer survival. A postoperative VTE remains a poor prognostic factor, even when controlling for age, stage, cancer type, and surgical procedure further supporting an independent link between hypercoagulability and cancer survival.
JNCI J Natl Cancer Inst - audio/podcast - JNCI PODCAST News Summaries for Issue 9 The Efficacy of Cancer Vaccines - Dr. Jeffrey Schlom talks about therapeutic cancer vaccines
Blogger's Note: comments in interview include references to prostate, FAP (genetics/colorectal cancer) & high risk ovarian/breast; note also comments regarding the use of cancer vaccines in early stage cancers
JNCI PODCAST
The Efficacy of Cancer Vaccines- Dr. Jeffrey Schlom talks about therapeutic cancer vaccines
abstract: If patient-reported outcome measures are considered key health-care quality indicators, who is excluded from participation? - Health Expectations
If patient-reported outcome measures are considered key health-care quality indicators, who is excluded from participation? - Health Expectations
Abstract
Patient-reported
outcome measures have received increasing attention with regard to
ensuring quality improvement across the health service. However, there
is a risk that people with disabilities and low literacy are
systematically excluded from the development of these measures as well
as their application in clinical practice. This editorial highlights
some of these risks and the potential consequences of exclusion for
these groups.
Wednesday, April 18, 2012
A Evaluation of Metformin, Targeting Cancer Stem Cells for the Prevention of Relapse in Patients With Stage IIC/III/IV Ovarian, Fallopian Tube, and Primary Peritoneal Cancer - Full Text View - ClinicalTrials.gov
A Evaluation of Metformin, Targeting Cancer Stem Cells for the Prevention of Relapse in Patients With Stage IIC/III/IV Ovarian, Fallopian Tube, and Primary Peritoneal Cancer - Full Text View - ClinicalTrials.gov
A Evaluation of Metformin, Targeting Cancer Stem Cells for the Prevention of Relapse in Patients With Stage IIC/III/IV Ovarian, Fallopian Tube, and Primary Peritoneal Cancer
This study is currently recruiting participants.
Verified March 2012 by University of Michigan Cancer Center
First Received on March 30, 2012.
Last Updated on April 16, 2012
History of Changes
| Sponsor: | University of Michigan Cancer Center |
|---|---|
| Information provided by (Responsible Party): | Ronald Buckanovich, University of Michigan Cancer Center |
| ClinicalTrials.gov Identifier: | NCT01579812 |
Purpose
The
primary objective of this study is to determine if metformin
administered as the time of traditional adjuvant chemotherapy to women
with advanced ovarian, primary peritoneal or fallopian tube cancer will improve recurrence-free survival at 18 months compared to controls.
Acetyl-L-Carnitine Hydrochloride in Preventing Peripheral Neuropathy in Patients With Recurrent Ovarian Epithelial Cancer, Primary Peritoneal Cavi - GOGty Cancer, or Fallopian Tube Cancer Undergoing Chemotherapy - Full Text View - ClinicalTrials.gov
WebMd: ACETYL - L - CARNITINE (including other names)
~~~~~~~~~~~~~~~~~~~~
This study is not yet open for participant recruitment.
Verified April 2012 by National Cancer Institute (NCI)
First Received on December 14, 2011.
Last Updated on April 17, 2012
History of Changes
Acetyl-L-Carnitine Hydrochloride in Preventing Peripheral Neuropathy in Patients With Recurrent Ovarian Epithelial Cancer, Primary Peritoneal Cavity Cancer, or Fallopian Tube Cancer Undergoing Chemotherapy - Full Text View - ClinicalTrials.gov
Purpose
RATIONALE:
Acetyl-L-carnitine hydrochloride may prevent or lessen peripheral
neuropathy caused by chemotherapy. It is not yet known whether
acetyl-L-carnitine hydrochloride is more effective compared to a placebo
in preventing peripheral neuropathy caused by chemotherapy.
PURPOSE: This randomized
phase III trial studies how well acetyl-L-carnitine hydrochloride works
compared to a placebo in preventing peripheral neuropathy in patients
with recurrent ovarian epithelial cancer, primary peritoneal cancer, or fallopian tube cancer undergoing chemotherapy.
Does “Cancer” – The Word – Properly Explain “Cancer” – the Disease?
Does “Cancer” – The Word – Properly Explain “Cancer” – the Disease?:
by Jonathan Klein, MDOften times, after explaining a diagnosis and treatment plan to a patient, physicians hear some variation on “my brother/sister/parent/friend/co-worker had cancer and received radiation/surgery/phase I clinical trial medication. Why am I not receiving this?” The answer may revolve around the idea that different cancers, even different cancers arising from the same part of the body, can be wildly different in biology, treatment, and prognosis. We obviously want to ensure that patients understand their options so that they can make informed decisions about their own care, but couldn’t the medical community do a better job of conveying this concept to the public even before people end up in our clinics?
We use the catch-all term “cancer” to refer to diseases within the body arising from uncontrollably dividing cells. It is a term familiar to everyone, and a diagnosis of cancer is a useful shorthand – it’s concise, easy to understand, and conveys a sense of seriousness around what lies ahead. But beyond that initial purpose, it’s largely insufficient.
Potentially Dangerous Complementary and Alternative Medicine (CAM) Use by Ovarian Cancer Patients | Abstract
Potentially Dangerous Complementary and Alternative Medicine (CAM) Use by Ovarian Cancer Patients
Abstract
Objective:
The use of complementary or alternative medicine (CAM) has increased
greatly over the last decade. Although many CAM activities are unlikely
to increase a patient's risk for adverse events with conventional
treatment for cancer, this is not necessarily true of ingestible CAM
treatments such as herbal remedies, teas, and other supplements. This
study surveyed women with ovarian cancer in order to evaluate the use of
herbs and supplements that might place them at increased risk at the
time of their surgery for ovarian cancer.
Methods:
A total
of 219 women with ovarian cancer, who had received care from one of two
participating oncology practices, were surveyed.
Results:
Of the women who reported having had surgery to treat their ovarian cancer (n=209),
65 (31%) reporting using one or more herbs or supplements that have
been hypothesized to increase their risk for adverse outcomes. In almost
all cases the risks associated with these substances were elevated
risks for excessive bleeding.
Conclusions:
The use of
herbs and supplements that might increase risks associated with
excessive bleeding during gynecologic cancer surgery is common. Further
research is needed to better understand the risks associated with use of
herbs and supplements among women approaching surgery
. (J GYNECOL SURG
28:1)
Medscape: New Map of Breast Cancer Identifies 10 Disease Subtypes
Blogger's Note: references Oncotype DX and MammaPrint
New Map of Breast Cancer Identifies 10 Disease Subtypes
Oncofertility Education Modules: A presentation by Dr. Hananel Holzer
Oncofertility Education Modules: A presentation by Dr. Hananel Holzer:
Resident Module – Fertility#1
Resident Module – Fertility#2a
Resident Module – Fertility#2b
Resident Module – Fertility#3
by Monisha Sudarshan, MD
As one walks into Dr.Holzer’s office, his passion and love for helping patients with fertility issues is clear. Among the many honors and thank you notes, sits a small decorative baby carriage with the words engraved “Doctors are known to heal, you are known to create miracles”. Dr. Holzer is the Medical Director of the MUHC (McGill University Health Centre) Reproductive Centre and one of the pioneers in oncofertility. In fertility management, he describes every couple as a “new story” however, oncofertility presents its own unique challenges and complexities for the patient and physician population. Dr.Holzer advises his patients that the first and foremost importance is to fight the cancer; fertility represents an important aspect but is not the primary priority. One of his goals is also to educate and bring awareness to cancer physicians and residents about the options of fertility preservation for the younger oncology population and is working on creating easy, timely access for referral of these patients to expert centers. Continuing his educational endeavour, he has designed expert teaching modules targeted for resident education in oncology and fertility and to spark interest in this interesting and rapidly growing field. Modules begin with basic physiological changes with chemotherapy and radiotherapy, progress to current options in fertility preservation and the experience at the McGill University Health Center. Continue to stay tuned for more knowledge on this important and stimulating topic within oncology.
Where the Oldest Die Now - NYTimes.com
Where the Oldest Die Now - NYTimes.com
".... But if people are being shuttled from home to hospital to nursing home (and possibly around again) during their last days and weeks, that’s nothing to celebrate. “Site-of-death data only tells you where you are at time of death, but nothing about the transitions leading to that point,” Dr. Teno said....."
Opinion: Data to Knowledge to Action (pizza? lost friend? genomics.....)
Opinion: Data to Knowledge to Action:
Pizza on Tuesday within 2 miles of home? There is a search for that. Find a long lost high school friend or an out of print book? There are searches for that. Correlating genomic information with proteomics data, patient information, and drug trial results? You’re on your own. It is ironic and lamentable that internet queries can get you information on so many things, yet the scientific data that are crucial to finding cures for numerous diseases are often buried in an unusable format on a hard drive in somebody’s garage.
press release: Problems in cancer care are not uncommon
Blogger's Opinion: although this article focuses on breast cancer, there is of course a common theme, attention is deserved for those with less common/rare cancers as the dichotomies in care (access, research, outcomes.....) should be obvious
~~~~~~~~~~~~~~~~~
Problems in cancer care are not uncommon
Public release date: 17-Apr-2012
Difficulties occur more often in communication than in medical care
Cancer care is increasingly complex, and as many as one in five cancer patients may experience "breakdowns" in their care, according to a new study in the Journal of Clinical Oncology. Such breakdowns include communication problems between patients and their care providers, as well as more traditional medical errors; both types of problems can create significant harms. In the study, communication problems outnumbered problems with medical care.Kathleen Mazor, EdD, Assistant Director of the Meyers Primary Care Institute, in Worcester, MA, led the study, with researchers from the University of Washington, Group Health, and Kaiser Permanente. Their study was a project of the Cancer Research Network's Cancer Communication Research Center. They found that problematic events led to varied consequences, such as additional medical care, delayed recovery, emotional distress, and persistent damage to the relationship between patients and their doctors.
"For me, the take-home message is it's critical for us to listen to patients as we try to improve care," Dr. Mazor said. "The patients we spoke with were generous, articulate, and thoughtful in recounting their experiences, and were glad to share their stories because they wanted to make a difference. We also heard a lot of stories about physicians, nurses, and others who really helped make things better—in the aftermath of a problem or even in the absence of a problem."
Examining actions patients took following a breakdown, the research team found that only 13 percent formally reported the problem, choosing instead to focus on their health and their future. Nearly all patients indicated that the problem spurred them to take positive steps in their health care behaviors, such as asking more questions or researching symptoms and treatments. However, 10 percent of patients reported they became more hesitant to seek care.
The study used telephone interviews rather than medical-chart documentation to understand how patients perceived their care experiences.
"It's vital that we hear directly from the patients," noted study co-author Sarah M. Greene, MPH. "The communication problems probably wouldn't have appeared in their medical record. But to the patient, they are as significant as a clinical adverse event, like a wrong dose of chemotherapy." Ms. Greene is a research associate at Group Health Research Institute in Seattle.
Both patients and clinicians need new ways to provide negative and positive feedback about cancer care, according to the authors, and these systems should include some patient and clinician education. Additionally, the study team noted that patients' perceptions of problems may differ from clinicians' perspectives, so educating clinicians is equally critical. The health systems in this study are currently exploring strategies to encourage both patients and clinicians to openly communicate about their care experiences and expectations.
This study "reminds us that substantial work is needed to optimize breast cancer care and, most importantly, communication," Jeffrey Peppercorn, MD, MPH, of Duke University Medical Center, wrote in an accompanying editorial.
###
The National Cancer Institute funded the study.Dr. Mazor's and Ms. Greene's co-authors were Douglas Roblin, PhD, and Josephine Calvi, MPH, of Kaiser Permanente Georgia, in Atlanta; Kathryn Horner, MPH, of Group Health Research Institute; Celeste Lemay, RN, and Cassandra Firneno, BS, of Meyers Primary Care Institute, in Worcester, Massachusetts; and Thomas H. Gallagher, MD, an affiliate investigator at Group Health Research Institute who is based at the University of Washington School of Medicine's Department of Medicine.
Journal of Clinical Oncology The Journal of Clinical Oncology serves its readers as the single most credible, authoritative resource for disseminating significant clinical oncology research. In print and in electronic format, JCO strives to publish the highest quality articles dedicated to clinical research. Original Reports remain the focus of JCO, but this scientific communication is enhanced by appropriately selected Editorials, Commentaries, Reviews, and other work that relate to the care of patients with cancer. For more information, see http://jco.ascopubs.org/
HMO Research Network The HMO Research Network is a consortium of 19 health care delivery organizations with both defined patient populations and formal, recognized research capabilities. The Network's vision is to be the research partner of choice for those seeking to shape health and health care delivery. For more information, see http://www.hmoresearchnetwork.org
Meyers Primary Care Institute The Meyers Primary Care Institute was established in 1996 as a joint venture of Fallon Clinic (now Reliant Medical Group), Fallon Community Health Plan, and the University of Massachusetts Medical School. The Institute's mission is to promote primary care practice through innovative research and educational initiatives. For more information, see http://www.umassmed.edu/meyers/index.aspx
Kaiser Permanente Georgia's Center for Health Research Kaiser Permanente Georgia's Center for Health Research conducts professionally independent, public domain research and disseminates its findings in the scholarly literature and scientific community. For more information, see http://www.kpchr.org/research/public/default.aspx
Group Health Research Institute Group Health Research Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. Since 1983, the Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding. For more information, see http://www.grouphealthresearch.org
UW Medicine The UW Medicine health system includes Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, UW Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine, and Airlift Northwest. UW Medicine also shares in the ownership and governance of Children's University Medical Group and Seattle Cancer Care Alliance, a partnership among UW Medicine, Fred Hutchinson Cancer Research Center, and Seattle Children's. UW Medicine has major academic and service affiliations with Seattle Children's, Fred Hutchinson Cancer Research Center, the Veteran's Affairs Puget Sound Health Care System in Seattle, and the VA Hospital in Boise, Idaho. The UW School of Medicine is the top public institution for biomedical research in funding received from the National Institutes of Health. For more information about UW Medicine, visit http://uwmedicine.washington.edu.
abstract: [Clinical aspects of familial ovarian cancer - current status and issues in Japan] (focus on brca)
Blogger's Note: the [ ] indicates translated version
[Clinical aspects of familial ovarian cancer - current status and issues in Japan]
Abstract
Familial ovarian cancer occurs as part of two genetically distinct syndromes: hereditary breast and ovarian cancer(HBOC) and hereditary nonpolyposis colorectal cancer(HNPCC) (Lynch Syndrome) .
HBOC caused by inherited mutations of BRCA1/2 and HNPCC caused by mismatch-repair genes are considered responsible for about 65 to 75% and 10 to 15% of familial ovarian cancers, respectively. Germline mutations of BRCA1 are considered responsible for about 50% of ovarian cancer families and 80% of breast-ovarian cancer families. BRCA2 mutations are less common than BRCA1 mutations in ovarian cancer families. A high proportion of serous adenocarcinomas at an advanced stage has been reported with BRCA-related ovarian cancers in several studies. It is controversial whether BRCA-related ovarian cancer patients carry a better prognosis despite the aggressive tumor-pathological characteristics of their disease, compared to sporadic cases. However, a good therapeutic response may be attributable to platinum-based chemotherapy. Recently in Japan, gene testing of BRCA1/2 has been available as a routine clinical test for diagnosing ovarian cancer families. Because the mutation spectrum of BRCA1/2 in Japanese was different from that of non-Ashkenazi individuals, the clinical application of BRCA1/2 gene testing for Japanese has been advocated. Approximately 1-5% of ovarian cancer pa-tients in Japan are thought to have a family history of breast and/or ovarian cancer. The prevalence of deleterious mutations of BRCA1/2 in Japanese was reportedly significantly higher than that of non-Ashkenazi individuals despite the low frequency of familial cases in Japan. Although the age at diagnosis of ovarian cancers with BRCA1/2 mutation in the United States was earlier than those of the sporadic cases, there were no differences among Japanese. These results suggest that clinical and genetic aspects of BRCA-related ovarian cancer of the Japanese are different from those of Caucasians.
A serious issue in this field is how the results will lead to a basis for the clinical application of a cancer prevention strategy targeting BRCA mutation carriers in Japanese.
Progress against cancer in the Netherlands since the late 1980s: An epidemiological evaluation.
Progress against cancer in the Netherlands since the late 1980s: An epidemiological evaluation.:
Progress against cancer through prevention and treatment is often measured by survival statistics only instead of analyzing trends in incidence, survival and mortality simultaneously because of interactive influences. This study combines these parameters of major cancers to provide an overview of the progress achieved in the Netherlands since 1989 and to establish in which areas action is needed. The population-based Netherlands Cancer Registry and Statistics Netherlands provided incidence, 5-year relative survival and mortality of 23 major cancer types. Incidence, survival and mortality changes were calculated as the estimated annual percentage change. Optimal progress was defined as decreasing incidence and/or improving survival accompanied by declining mortality, and deterioration as increasing incidence and/or deteriorating survival accompanied by increasing mortality rates. Optimal progress was observed in 12 of 19 cancer types among males: laryngeal, lung, stomach, gallbladder, colon, rectal, bladder, prostate and thyroid cancer, leukemia, Hodgkin and non-Hodgkin lymphoma. Among females, optimal progress was observed in 12 of 21 cancers: stomach, gallbladder, colon, rectal, breast, cervical, uterus, ovarian and thyroid cancer, leukemia, Hodgkin and non-Hodgkin lymphoma. Deterioration occurred in three cancer types among males: skin melanoma, esophageal and kidney cancer, and among females six cancer types: skin melanoma, oral cavity, pharyngeal, esophageal, pancreatic and lung cancer. Our conceptual framework limits misinterpretations from separate trends and generates a more balanced discussion on progress.
Tuesday, April 17, 2012
press release: Consumer Activity on Social Media Sites Dwarfs That of Healthcare Companies, Finds New PwC Study on Social Media in Healthcare
Consumer Activity on Social Media Sites Dwarfs That of Healthcare Companies, Finds New PwC Study on Social Media in Healthcare
NEW YORK, April 17, 2012 /PRNewswire/ -- Social media is changing the nature of healthcare interaction, and health organizations that ignore this virtual environment may be missing opportunities to engage consumers, according to a new report by the Health Research Institute (HRI) at PwC US entitled, "Social media likes healthcare: From marketing to social business." The report found that social media activity by hospitals, health insurers and pharmaceutical companies is miniscule compared to the activity on community sites......
The consumer survey found:
- One-third of consumers now use social media sites such as Facebook, Twitter, YouTube and online forums for health-related matters, including seeking medical information, tracking and sharing symptoms, and broadcasting how they feel about doctors, drugs, treatments, medical devices and health plans.
- Four in 10 consumers say they have used social media to find health-related consumer reviews (e.g. of treatments or physicians); one in three have sought information related to other patients' experiences with their disease; one in four have "posted" about their health experience; and one in five have joined a health forum or community.
- When asked how information found through social media would affect their health decisions, 45 percent of consumers said it would affect their decision to get a second opinion; 41 percent said it would affect their choice of a specific doctor, hospital or medical facility; 34 percent said it would affect their decision about taking a certain medication; and 32 percent said it would affect their choice of a health insurance plan.
- While 72 percent of consumers said they would appreciate assistance in scheduling doctor appointments through social media channels, nearly half said they would expect a response within a few hours.
- As is the case more broadly, young adults are leading the social media healthcare charge. More than 80 percent of individuals between the ages of 18 and 24 said they were likely to share health information through social media channels and nearly 90 percent said they would trust information they found there. By comparison, less than half (45 percent) of individuals between the ages of 45 and 64 said they were likely to share health information via social media.
Diffusion-weighted Imaging Study in Cancer of the Ovary - Full Text View - ClinicalTrials.gov
Diffusion-weighted Imaging Study in Cancer of the Ovary - Full Text View - ClinicalTrials.gov
Diffusion-weighted Imaging Study in Cancer of the Ovary (DISCOVAR)
This study is not yet open for participant recruitment.
Verified March 2012 by Institute of Cancer Research, United Kingdom
First Received on November 18, 2011.
Last Updated on March 30, 2012
History of Changes
| Sponsor: | Institute of Cancer Research, United Kingdom |
|---|---|
| Collaborators: | Cancer Research UK Royal Marsden NHS Foundation Trust Cambridge University Hospitals NHS Foundation Trust Imperial College Healthcare NHS Trust Northumbria Healthcare NHS Foundation Trust |
| Information provided by (Responsible Party): | NdeSouza, Institute of Cancer Research, United Kingdom |
| ClinicalTrials.gov Identifier: | NCT01505829 |
Purpose
This
project seeks to develop a quantitative imaging biomarker for evaluating
and monitoring treatment response in ovarian cancer metastases and
assess its potential in monitoring treatment response. This will involve
standardising DW-MRI for the abdomen and pelvis across multiple centres
and platforms, assessing reproducibility of the measurement in patients
planned for neoadjuvant chemotherapy and assessing its utility as an
early response biomarker in patients with platinum-sensitive relapse due
to receive therapy with carboplatin. Scanning measurements will be
correlated with histopathological markers in tumour samples in order to
link the biomarker with response mechanisms.
| Condition |
|---|
| Ovarian Cancer Peritoneal Metastases |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Official Title: | Assessing Treatment Response of Peritoneal Metastases in Ovarian Cancer Using Diffusion Weighted Magnetic Resonance Imaging. |
financial news: ImmunoGen Says IND For Anticancer Compound IMGN853 Is Now Active
ImmunoGen Says IND For Anticancer Compound IMGN853 Is Now Active
(RTTNews.com) - ImmunoGen, Inc. (IMGN) announced that the Investigational New Drug, or IND, application for its IMGN853 product candidate is now active. IMGN853 is a potential new therapeutic for ovarian cancer, non-small cell lung cancer and other epithelial malignancies which over-express folate receptor 1, or FOLR1.
The company expects Phase I evaluation of IMGN853 to commence in the middle of 2012.....
Health Imaging: Uptick in colorectal cancer among under-50 crowd poses questions for researchers (Lynch Syndrome....)
Uptick in colorectal cancer among under-50 crowd poses questions for researchers
....Whatever the cause, the rate of colorectal cancer in young adults has increased to the point where nearly 10 percent of new diagnoses are in patients younger than 50. Most of these patients were diagnosed in their forties, but the disease has been found in patients in their twenties and thirties.......Another troubling recent finding is that when colorectal cancers are diagnosed in younger patients, they are more likely to be at an advanced stage of the disease. A study published Feb. 13 online in Archives of Internal Medicine found 63 percent of colon cancers and 57 percent of rectal cancers are stage III or IV at diagnosis......“The important thing for radiologists would be the notion that certain individuals, because of their age, may be denied radiology procedures by insurance companies,” she said.......
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