Medscape: Ovarian Cancer Survivors Experience Long-Term Distress

Ovarian Cancer Survivors Experience Long-Term Distress

 May 21, 2012 (San Diego, California) — Ovarian cancer survivors continue to have psychological distress even 5 or more years after completing their treatment and have undiagnosed anxiety about the possibility of recurrence, according to researchers here at the American Congress of Obstetricians and Gynecologists (ACOG) 60th Annual Clinical Meeting......

"Few women confided even to their family members or friends about their fears. More than 59% of survey respondents said they do not talk with others about their fears of recurrence, and only 6.3% had ever joined a support group for women with ovarian cancer."

Dual Eligible Demonstrations (U.S. Medicare/Medicaid): Resources for Advocates - The Commonwealth Fund

Dual Eligible Demonstrations: Resources for Advocates - The Commonwealth Fund

Overview

In April 2011, the Centers for Medicare and Medicaid Services (CMS) awarded $1 million grants to 15 states for the design of integrated service delivery and payment models for dual eligibles, people with high health care needs who are enrolled in both Medicare and Medicaid. CMS has emphasized that consumer stakeholders must be included in the planning processes. A new Commonwealth Fund–supported Web site, http://dualsdemoadvocacy.org/, offers educational resources for consumer groups and can serve as a platform for sharing ideas and strategies for improving care for dual eligibles.

The Problem

States are struggling to find ways to engage consumers in the development of integrated models of care for people with Medicare and Medicaid. At the same time, consumer representatives say they need resources to help them gain a better grasp of the technical design and implementation issues involved.

Audience

Health care consumers and state consumer advocates

The Intervention

The Web site http://dualsdemoadvocacy.org/ is a resource for consumers and advocates that provides background information, links to news and events, and, in the Advocate Tools section, concrete recommendations to help advocates work with state policymakers to ensure that new delivery models improve care for dual eligibles. The Advocate Tools cover such topics as the development of the appeals process if health plans or providers deny needed care; patient assessment and care planning; consumer protections; and provider payment models. The site also offers state-by-state information about the dual eligibles population and the demonstration projects that local policymakers are considering. The site also features a custom search tool to direct users to the most valuable resources on the Web about dual eligibles..

For More Information

Visit http://dualsdemoadvocacy.org/.

paywalled: Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Health Expectations

Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Wendt - 2011 - Health Expectations

Abstract

Objective  This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States.

Methods  The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models.

Results  Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon.

Conclusions  The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems.

paywalled: Postrecurrent Oncologic Outcome of Patients With Ovarian Clear Cell Carcinoma

Postrecurrent Oncologic Outcome of Patients With Ovarian Cle... : International Journal of Gynecological Cancer

Abstract

Objectives: 

To estimate the long-term clinical outcome of patients with recurrent clear cell carcinoma (RCCC) of the ovary in comparison with those with recurrent serous adenocarcinoma (RSAC).

Conclusions: The long-term clinical outcome of patients with RCCC was extremely poor. We confirmed that RCCC (recurrent clear cell carcinoma) should be investigated as a different malignancy compared with RSAC.

Twitter Emerges as Health Policy Sounding Board - in Meeting Coverage, AUA

Medical News: Twitter Emerges as Health Policy Sounding Board - in Meeting Coverage, AUA from MedPage Today

"Social media, such as Twitter, are a useful way to gauge public sentiment," said Prabhu, a medical student at New York University in New York City. "Social media may also have a role in influencing public sentiment and altering policy."

PLoS ONE: Conflict of Interest Policies for Organizations Producing a Large Number of Clinical Practice Guidelines

PLoS ONE: Conflict of Interest Policies for Organizations Producing a Large Number of Clinical Practice Guidelines

"COI policies among organizations producing a large number of CPGs (clinical practice guidelines) currently do not measure up to IOM standards. Policy-makers, guideline funders, sponsors, and developers, as well as users need to address and demand improvements. Patients and populations need trustworthy CPGs, and the accurate disclosure and subsequent management of COI is essential to achieve that goal."

Seth's blog: Ranking for signal to noise ratio

Ranking for signal to noise ratio:

A whisper in a quiet room is all you need. There's so little noise, so few distractions, that the energy of the whisper is enough to make a dent.
On the other hand, it's basically impossible to have a conversation (at any volume) in a nightclub.
Signal to noise ratio is a measurement of the relationship between the stuff you want to hear and the stuff you don't. And here's the thing: Twitter and email and Facebook all have a bad ratio, and it's getting worse.........

Until you remove the noise, you're going to miss a lot of signal.

Comparative Effectiveness of Filgrastim, Pegfilgrastim, and Sargramostim as Prophylaxis Against Hospitalization for Neutropenic Complications in Patients With Cancer Receiving Chemotherapy

Comparative Effectiveness of Filgrastim, Pegfilgrastim, and... : American Journal of Clinical Oncology

Conclusions: Risk of hospitalization for neutropenic complications during cancer chemotherapy is lower with pegfilgrastim prophylaxis than with filgrastim or sargramostim prophylaxis.

HERA Announces 2012 OSB Grant Recipients | HERA Women's Cancer Foundation

HERA Announces 2012 OSB Grant Recipients | HERA Women's Cancer Foundation

Dr Curiel/Viral Genetics' P-IND Clears FDA To Commence Clinical Trials (ovarian cancer/Sorafenib) in Humans - MarketWatch

Viral Genetics' P-IND Clears FDA To Commence Clinical Trials in Humans - MarketWatch

Viral Genetics' P-IND Clears FDA To Commence Clinical Trials in Humans 

Set to Begin First Ovarian Cancer Study Test Site for Metabolic Disruption Technology (MDT) Combination Therapy

 

SAN MARINO, Calif., May 21, 2012 (BUSINESS WIRE) -- A physician-initiated Investigational New Drug (P-IND) application submitted to the FDA in late April, 2012, has cleared the FDA's screening process with the requirement for a regular IND application being waived, resulting in the company being able to begin the first of at least two proposed clinical trial sites to investigate a potential oncology treatment developed from Viral Genetics' (pinksheets:VRAL) Metabolic Disruption Technology (MDT), which is licensed exclusively to the Company. The P-IND -- part of a larger, coordinated research effort -- was submitted by the first test site at the Cancer Therapy & Research Center (CTRC) at The University of Texas Health Science Center at San Antonio, which includes patient enrollment at Scott and White Hospital (S&W) in Temple, Texas. Additional test sites may also be added in the future.

Enrollment and treatment of patients is expected to commence upon completion of internal hospital Institutional Review Boards (IRBs), which are already underway. The UT Health Science Center portion of the study will commence when all approvals are finalized.

This clinical trial -- a milestone in the Company's transition from preclinical to clinical-stage -- will be the first for the intellectual property developed by Dr. M. Karen Newell Rogers, Viral Genetics' Chief Scientist and licensed exclusively by the Company. It will examine the safety and efficacy of one of Viral Genetics licensed MDT compounds in combination with an existing cancer drug, sorafenib (marketed as Nexavar(TM)) in the treatment of patients resistant or otherwise unsuitable for standard treatments for stage III or IV ovarian cancer and related carcinomas.

The Primary Investigator on the trial is Tyler Curiel, M.D., MPH, a medical oncologist affiliated with the CTRC at the UT Health Science Center. Dr. Curiel is leading this study as he investigates the efficacy of combining two compounds in a cancer treatment that is hoped to cause the starvation of tumor cells and enhanced anti-tumor immunity, leading to the reduction of tumor size and reduced disease progression.....

paywalled - Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer

Gynecologic Oncology - Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer

Purchase

---

Abstract

Introduction

The aim of this study was to assess the influence of video-assisted thoracic surgery (VATS) on our treatment decisions in FIGO III and IV ovarian cancer patients.

Highlights

► Preoperative chest CTs is not an appropritate staging tool for the evaluation of intrathoracic tumorload in advanced Ovarian Cancer patients
► Video-assisted thoracic surgery can be performed quickly and safely before deciding about primary cytoreduction or neodadjuvant chemotherapy in advanced Ovarian Cancer patients

The Women's Health Initiative study and hormone therapy -- what have we learned 10 years on? (note blogger's opinion)

 Blogger's Note/Opinion: at the time of the initial publication this blogger attended numerous meetings which critically analyzed the WHI study; fear, poor communication and media hype led to many poor choices without any indepth analysis even at the time; most often the WHI/media were quoted to refer patients to their physicians;  those physicians were in the same dilemma as the patients - a mess, in fact;  to this day patients/consumers, led by fear, choose to ignore/not believe (?) post-WHI findings and analyses - more on these issues in this article as below

                               ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Women's Health Initiative study and hormone therapy -- what have we learned 10 years on?

Public release date: 21-May-2012
International Menopause Society

The Women's Health Initiative study and hormone therapy -- what have we learned 10 years on?

In July 2002 the publication of the first Women's Health Initiative (WHI) report caused a dramatic drop in Menopausal Hormone Therapy (HT ) use throughout the world. Now a major reappraisal by international experts, published as a series of articles in the peer-reviewed journal Climacteric (the official journal of the International Menopause Society), shows how the evidence has changed over the last 10 years, and supports a return to a "rational use of HT, initiated near the menopause".

The reappraisal has been carried out by some of the world's leading experts in the field, including clinicians who worked on the original WHI study. Summarising the findings of the special issue, authors Robert Langer, JoAnn Manson, and Matthew Allison conclude that "classical use of HT" – MHT initiated near the menopause – will benefit most women who have indications including significant menopausal symptoms or osteoporosis.

Dr. Robert Langer, Principal Scientist at the Jackson Hole Center for Preventive Medicine, Jackson Wyoming, was the Principal Investigator of the WHI Clinical Center at the University of California, San Diego. He said
"With 10 years hindsight we can put the lessons learned from the WHI HT trials into perspective. In some ways we've come full circle – studies in recently menopausal women that suggested protection against major diseases led to testing whether that would carry over to older women who have even greater risks of heart attacks and fractures. That hope proved false. Unfortunately the results were wrongly generalized back to women like those who inspired the study. Information that has emerged over the last decade, shows that for most women starting treatment near the menopause, the benefits outweigh the risks, not just for relief of hot flashes, night sweats and vaginal dryness, but also for reducing the risks of heart disease and fractures".
Langer continued:
"Overgeneralizing the results from the women who were -- on average -- 12 years past menopause to all postmenopausal women has led to needless suffering and lost opportunities for many. Sadly, one of the lessons from the WHI is that starting HT 10 years or more after menopause may not be a good idea, so the women who were scared away by the WHI over this past decade may have lost the opportunity to obtain the potential benefits."

Professor JoAnn Manson (Harvard Medical School and Brigham and Women's Hospital, Boston, MA), who has been one of the WHI Principal Investigators since the study started, said:
"An important contribution of the WHI was to clarify that, for older women at high risk of cardiovascular disease, the risks of HT far outweighed the benefits. This halted the increasingly common clinical practice of prescribing HT to women who were far from the onset of menopause. Unfortunately, these findings were extrapolated to newly menopausal and healthy women who actually had a favourable benefit: risk ratio with HT. The WHI results point the way towards treating each woman as an individual. There is no doubt that HT is not appropriate for every woman, but it may be appropriate for many women, and each individual woman needs to talk this over with her clinician".

The authors note that the initial press reaction, following the lead of the WHI press release, over-emphasised a relatively small increase in breast cancer, so distorting the overall view of the report. 

WHI researcher Professor Matthew Allison (University of California, San Diego), said:
"It is important to put the results of the WHI trials into context. That is, being obese, not exercising or excess alcohol consumption confer higher absolute risks for breast cancer than HT use."

###

Note that a brief summary of the papers in this special issue of Climacteric appears below.
This special issue, "The Women's Health Initiative – a decade of progress" will appear in the June 2012 issue of Climacteric (vol 15, issue 3). This goes on line on 22nd May, at this URL: http://informahealthcare.com/cmt. Climacteric is the official journal of the International Menopause Society (IMS).


ABSTRACT:
Have we come full circle-or moved forward? The Women's Health Initiative 10 years on", by R.D Langer, J.E Manson, and M.A. Allison, Climacteric Vol15 no 3 pp206-213

In mid-summer 2002, the announcement that the Women ' s Health Initiative (WHI) trial of combination hormone therapy (HRT) had stopped jolted the field of women's health. It set off a cascade that first stunned, then meaningfully changed the future for millions of women, their partners, and tens of thousands of clinicians and scientists. With 10 years' hindsight, we can begin to put the lessons learned from the WHI HRT trials into perspective. These trials were primarily designed to test whether women initiating HRT considerably past menopause, and mostly asymptomatic, experienced treatment benefits from HRT expected from studies of generally symptomatic women who started near menopause. The definitive answer was ' no ' . Unfortunately, the findings were generalized to all postmenopausal women regardless of age. Data accumulated from the WHI and other studies over the past decade have shown that, in women with symptoms or other indications, initiating HRT near menopause – the classic pattern of use – will probably provide a favourable benefit : risk ratio. Spurred by the WHI, many hypotheses and some insights about potential mechanisms for HRT effects on diverse organ systems have emerged, along with new perspectives on regimens, compounds, and routes of administration. This overview provides an historical perspective on the WHI design and the evolution of its message; summarizes current perspectives and insights contributed by eminent colleagues; reviews the state of the art; and looks to the future. We have come full circle in some ways, with mounting evidence supporting benefit for HRT started near menopause and with hard lessons learned about pathophysiology, publicity and interpreting data. Now we move on.

Summary of papers This special issue of Climacteric contains a series of articles reviewing the position of HRT, 10 years after the WHI. There is a wealth of information here, which is impossible to communicate in a single press statement. Here are simplified summaries of each article, please refer to each individual article for more details.
Quality of Life The WHI study suggested that HRT use led to minimal improvement in quality of life (QoL). As the WHI study wasn't designed to look at women going through the menopause, it underestimated the real extent of effect of HRT on QoL. This has caused suffering to many women (Pines et al).
HRT for Urogynecological and sexual health Around 50% of postmenopausal women will suffer urogenital atrophy. Studies indicate that locally applied hormone therapy is generally more effective than systemic HRT for urogenital symptoms, including dyspareunia, which can be a critical determinant of a woman's interest in sex.(Nappi & Davis)
Timing of HRT initiation, and cost effectiveness The weight of evidence now supports a ' window-of-opportunity ' for women taking HRT before the age of 60 and/or within 10 years of the menopause. This reduces the risk of coronary heart disease and overall mortality. HRT is more effective for this than other medicines such as statins and aspirin, and is cost-effective. Starting HRT later than this increases risks to women (Hodis et al).
Stroke There is a modest increase in stroke risk with HRT use if stated near the menopause. This risk rises considerably in women who start at older ages. There is some evidence that use of HRT patches (as opposed to pills) may not increase stroke risk, but this needs to be confirmed (Henderson and Lobo).
Venous Thromboembolism There is an increased risk of venous thromboembolism with oral HRT. This may be increased with age and obesity, and may vary by the progestogen used. Observational studies suggest that it may not be associated with transdermal HRTs (patches), but this needs confirmation (Archer and Ogar).
Breast cancer There is an increase in breast cancer with E+P HRT, but this is small. It has also been exaggerated by press reports, causing fear in many women. They conclude that large numbers of women with substantial menopausal symptoms and low breast cancer risk will benefit from HRT use (Gompel and Santen).
Colorectal Cancer This is the second most common cancer in women (after breast cancer). Evidence from the WHI and other trials suggests that current HRT users have a 40% reduction in colorectal cancers. The authors say that it is too early to consider HRT use in the prevention of colon cancer (Barnes and Long) Dementia Initial WHI results showed an increase in dementia for both E+P and E alone users. This review including recent publications from other studies suggests that this may be influenced by the timing of the HRT initiation, with benefits for those starting nearer the menopause, but increased risks for women starting at older ages (Maki and Henderson).
Fractures The WHI "Global Index", which looked at the balance of risks and benefits, inappropriately downgraded the importance of fractures. The authors argue for a more rounded view. They say that that HRT gives more bone benefits than many other drugs (e.g. bisphosphonates), and so restrictions on HRT use as a first-line therapy are not appropriate (de Villiers and Stevenson)
Overall effects of the drop in HRT use This is difficult to gauge, because data varies from country to country. In one large study HRT discontinuation led to a 55% increase in fractures after 6.5 years. There was also a small drop in breast cancers after the drop in use in HRT, most notably in the US, but not seen in all countries, that was consistent with an effect on existing tumours. HRT discontinuation may lead to an increase in cardiovascular disease, but given the long lag time for cardiovascular events this would take substantial time to become apparent (Burger et al)

The WHI and media The author suggests that the WHI's dramatic presentation of the initial findings set the subsequent tone for the way that the media came to view the HRT issue (Simon Brown).

JAMA: Effect of an Indwelling Pleural Catheter vs Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients With Malignant Pleural EffusionThe TIME2 Randomized Controlled TrialIndwelling Pleural Catheters vs Talc Pleurodesis

 Effect of an Indwelling Pleural Catheter vs Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients With Malignant Pleural EffusionThe TIME2 Randomized Controlled Trial Indwelling Pleural Catheters vs Talc Pleurodesis

case report - Granulosa cell tumor of the ovary after long-term use of tamoxifen and toremifene - Journal of Obstetrics and Gynaecology Research

Granulosa cell tumor of the ovary after long-term use of tamoxifen and toremifene - Tanaka - 2012 - Journal of Obstetrics and Gynaecology Research

Abstract

The relation between the use of tamoxifen and gynecologic tumors has been documented. In this case, a 58-year-old postmenopausal woman had been treated with tamoxifen for 5 years followed by toremifene for 1.5 years due to the presence of stage II estrogen receptor-positive breast cancer. The patient was found to have a stage Ic granulosa cell tumor of the ovary despite undergoing annual gynecologic examinations. This report presents a case of granulosa cell tumor of the ovary after the long-term use of tamoxifen and toremifene

JCO The Art of Oncology "Blindness: Looking but Not Seeing"

JCO:  Blindness: Looking but Not Seeing

"...Blindness can be a metaphor for failed communication.
To see can mean to look with one’s eyes,
but it can also mean to understand. Thus, a person
may be symbolically blind (ie, not understanding,
not connecting) or may be physically without sight....."

Addressing Spirituality Within the Care of Patients at the End of Life: Perspectives of Patients With Advanced Cancer, Oncologists, and Oncology Nurses [Palliative and Supportive Care]

Addressing Spirituality Within the Care of Patients at the End of Life: Perspectives of Patients With Advanced Cancer, Oncologists, and Oncology Nurses [Palliative and Supportive Care]:

Purpose
Attention to patients' religious and spiritual needs is included in national guidelines for quality end-of-life care, but little data exist to guide spiritual care.

Conclusion
Most patients with advanced cancer, oncologists, and oncology nurses value spiritual care. Themes described provide an empirical basis for engaging spiritual issues within clinical care.

Editorial: Pseudomyxoma Peritonei: More Questions Than Answers (appendix/ovarian

JCO: Pseudomyxoma Peritonei: More QuestionsThan Answers

"Chances are, if you ask most physicians and surgeons about
pseudomyxoma peritonei (PMP), they will respond with more questions
than answers. The confusion that surrounds PMPis not surprising
because the origin, pathology, treatment, prognosis, and very
definition of PMP are still under debate. PMP is a clinical syndrome
that is characterized by mucinous ascites that result from rupture of a
mucin-producing neoplasm, typically of appendiceal origin....."

"...The appendix is the primary cause of PMP; the ovaries are typically
only secondarily involved...."

"Very Superstitious" JCO - the Art of Oncology

Very Superstitious

paywalled: Original Article Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients

Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients

Purpose  

Febrile neutropenia (FNP) is a frequent complication of cancer care and evaluation often fails to identify a cause. [¹⁸  F]FDG PET/CT has the potential to identify inflammatory and infectious foci, but its potential role as an investigation for persistent FNP has not previously been explored. The aim of this study was to prospectively evaluate the clinical utility of FDG PET/CT in patients with cancer and severe neutropenia and five or more days of persistent fever despite antibiotic therapy.

Conclusion  

This study supports the utility of FDG PET/CT scanning in severely neutropenic patients with five or more days of fever. Further evaluation of the contribution of FDG PET/CT in the management of FNP across a range of underlying malignancies is required.

'Discharge bias' disproportionally hurts large and academic hospitals

'Discharge bias' disproportionally hurts large and academic hospitals

"State and national programs that use in-hospital mortality to benchmark hospitals should note how discharge bias unfairly disadvantages certain types of hospitals," concluded Dr. Reineck. "Discharge bias must be accounted for to prevent unfair performance assessments."
Future studies are planned to assess the effects that using this measure in public reporting has on outcomes of ICU patients"

Scope to improve: a multi-centre audit of 16 064 colonoscopies looking at caecal intubation rates, over a 2-year period - Frontline Gastroenterology

Scope to improve: a multi-centre audit of 16 064 colonoscopies looking at caecal intubation rates, over a 2-year period -- Frontline Gastroenterology

Conclusion 

"....Endoscopists performing low volume colonoscopy (<100 per annum), have CIR of <90%. Endoscopists with low volume practice who do not meet the quality standards should engage in skills augmentation plus further training and increase volume of colonoscopy with local mentorship, or stop performing colonoscopy."

PLoS ONE: Multiple Miscarriages Are Associated with the Risk of Ovarian Cancer: Results from the European Prospective Investigation into Cancer and Nutrition

PLoS ONE: Multiple Miscarriages Are Associated with the Risk of Ovarian Cancer: Results from the European Prospective Investigation into Cancer and Nutrition

Study Population

EPIC is a prospective cohort study initiated in 1992 in 10 European countries: Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom. Between 1992 and 2000, a total of 519,978 men and women were recruited.......

Abstract (and full text)

While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010......

Discussion 

In this large prospective cohort study, we observed a 2-fold increased risk of epithelial ovarian cancer among women with 4 of more miscarriages.
This is the first prospective study that investigated the association of multiple miscarriages with ovarian cancer. Most case-control studies only investigated ever versus never had a miscarriage and did not observe an association [5].......

paywalled: Meta-analysis of gene expression profiles associated with histological classification and survival in 829 ovarian cancer samples - International Journal of Cancer

Meta-analysis of gene expression profiles associated with histological classification and survival in 829 ovarian cancer samples - Fekete - 2011 - International Journal of Cancer

Abstract

Transcriptomic analysis of global gene expression in ovarian carcinoma can identify dysregulated genes capable to serve as molecular markers for histology subtypes and survival. The aim of our study was to validate previous candidate signatures in an independent setting and to identify single genes capable to serve as biomarkers for ovarian cancer progression. As several datasets are available in the GEO today, we were able to perform a true meta-analysis. First, 829 samples (11 datasets) were downloaded, and the predictive power of 16 previously published gene sets was assessed. Of these, eight were capable to discriminate histology subtypes, and none was capable to predict survival. To overcome the differences in previous studies, we used the 829 samples to identify new predictors. Then, we collected 64 ovarian cancer samples (median relapse-free survival 24.5 months) and performed TaqMan Real Time Polimerase Chain Reaction (RT-PCR) analysis for the best 40 genes associated with histology subtypes and survival. Over 90% of subtype-associated genes were confirmed. Overall survival was effectively predicted by hormone receptors (PGR and ESR2) and by TSPAN8. Relapse-free survival was predicted by MAPT and SNCG. In summary, we successfully validated several gene sets in a meta-analysis in large datasets of ovarian samples. Additionally, several individual genes identified were validated in a clinical cohort.

Three Abstracts on the ChemoFx(R) Drug Response Marker Accepted by ASCO - MarketWatch

Three Abstracts on the ChemoFx(R) Drug Response Marker Accepted by ASCO - MarketWatch

".....The third abstract titled, In Vitro Chemoresponse Assay Results and Population Clinical Response Rates in Women with Ovarian Cancer, determines whether in vitro platinum sensitivity rates are similar to published population response rates for ovarian cancer and examines differences in platinum sensitivity across histologic subtypes."

"We are very pleased with the outcomes to date from these three studies," says Dr. Karl Williams, Chief Medical Director for Precision Therapeutics, Inc. "We look forward to watching these projects progress and further analyzing the value of ChemoFx for these difficult to treat patients." 

For more information, visit: www.precisiontherapeutics.com or www.chemofx.com .

SOURCE: Precision Therapeutics Inc.

Editorial: Why You Should Care about Screening Flexible Sigmoidoscopy — NEJM

Blogger's Note: read the whole editorial for further information regarding colonoscopies, this blog also has trial data on colonoscopies/research/opinions

Why You Should Care about Screening Flexible Sigmoidoscopy — NEJM

"...The real question for U.S. (blogger's note: and others)  clinicians is whether we are prepared to refocus attention on a screening strategy that has been likened to performing mammography on one breast..."

...Where does this leave us with regard to screening flexible sigmoidoscopy? First, it should be acknowledged that flexible sigmoidoscopy reduces colorectal-cancer incidence and mortality for the portion of the colon that it is designed to examine. Next, high-quality evidence must show the superiority of colonoscopy over other screening tests before we dismiss the use of flexible sigmoidoscopy and fecal occult-blood testing, both of which have randomized, controlled trials supporting their benefit. Especially critical are data that confirm the ability of colonoscopy to reduce mortality from proximal cancers. Finally, patient preferences for screening tests should be identified and respected — in this case, the best test is the one that gets done.

New Data Concludes Wait Times for Patients With Gastrointestinal Disease Are Increasing Across Canada - MarketWatch

New Data Concludes Wait Times for Patients With Gastrointestinal Disease Are Increasing Across Canada - MarketWatch

OAKVILLE, ONTARIO, May 17, 2012 (MARKETWIRE via COMTEX) -- The Canadian Association of Gastroenterology (CAG) today joined the Ontario Association of Gastroenterology (OAG) in voicing their objection to the Government of Ontario's May 7, 2012 decision to overhaul the fee structure for approximately 40 medical procedures and services that Ontario doctors provide. Colonoscopies are among the medical tests for which professional fees face a cut of 10%.

Pointing to new initial data gathered in April 2012 from the Canadian Association of Gastroenterology Survey of Access to GastroEnterology (SAGE), Desmond Leddin, Lead of the SAGE, says "a comparison of data from surveys performed in 2005 and 2008 shows that wait times for patients with gastrointestinal disease have increased across Canada."

"This CAG national survey information combined with the new fee structure in Ontario gives us cause for concern about patient safety," says CAG President Dan Sadowski.

"With evidence in hand that patient wait times have been increasing over the past seven years, we can't support any government decision - in Ontario or elsewhere in Canada - that results in reduced access to, or longer wait times for, important medical procedures including colonoscopy, which can prevent and reduce cancer rates.".....

Roche will report new data on important progress for people with advanced cancers at ASCO 2012 - AURELIA trial ovarian/Avastin+

Roche will report new data on important progress for people with advanced cancers at ASCO 2012

Data from AURELIA, the first Phase III study of Avastin plus chemotherapy in people with platinum-resistant recurrent ovarian cancer will be presented. This study will be highlighted as part of ASCO’s official press program.

Another coffee observational study - another round of misplaced emphasis - Health News Review

Another coffee observational study - another round of misplaced emphasis - Health News Review

Trying to keep up with health care ethics (mis)adventures - Health News Review

Trying to keep up with health care ethics (mis)adventures - Health News Review

Petitions | The White House re: free access to scientific journal articles....

Petitions | The White House

we petition the obama administration to:

Require free access over the Internet to scientific journal articles arising from taxpayer-funded research.

Genetic Testing and Counseling Nevada Surgery and Cancer Care

Genetic Testing and Counseling | NVSCC: Nevada Surgery and Cancer Care

 Genetic Testing and Counseling

We offer:

Genetic Counseling and Genetic Screening for Breast, Ovarian and Colorectal Cancer.

• Personal or Family History of Breast and Ovarian Cancer*

Do you have any of the following?......
( * Hereditary Breast and Ovarian Cancer (HBOC) syndrome is an inherited condition that causes an increased risk for ovarian, breast, pancreatic and prostate cancer. The vast majority of hereditary breast and ovarian cancer is due to an alteration or gene mutation in either the BRCA1 or BRCA2 genes. These gene mutations can be inherited from either your mother or father.)

• Personal and Family History of Colorectal Cancer

Do you have any of the following?.......
(* Lynch Syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), is an inherited condition that causes an increased risk for early onset colorectal cancer (often before age 50) as well as other related cancers†. The majority of Lynch Syndrome is due to a mutation in the MLH1, MSH2 or MSH6 genes. These mutations can be inherited from either your mother or father.
† colorectal, endometrial, stomach, ovarian, kidney/urinary tract, brain, small bowel, pancreatic, sebaceous adenoma/carcinoma)

U.S. Medicare - new - 'Blue Button' MyMedicare.gov: Portal of Personalized Information

MyMedicare.gov: Portal of Personalized Information

 What's New?

Blue Button is here! Blue Button allows you to download your data to a text file. Look for the Blue Button as you search claims and view your On the Go Report.

• Learn More

What does it mean to say that something causes 16% of cancers? | Not Exactly Rocket Science | Discover Magazine

What does it mean to say that something causes 16% of cancers? | Not Exactly Rocket Science | Discover Magazine

Loss of ARID1A expression is related to shorter progression-free survival and chemoresistance in ovarian clear cell carcinoma.

 Blogger's Note: varying studies show different %'s of ARID1A gene expression in clear cell ovarian cancer
                         ~~~~~~~~~~~~~~~~~~~~~~~~
Loss of ARID1A expression is related to shorter progression-free survival and chemoresistance in ovarian clear cell carcinoma.:

Mod Pathol. 2012 Feb;25(2):282-8

Abstract
Recently, the ARID1A gene has been identified as a novel tumor suppressor in ovarian clear cell carcinoma. The prognostic significance of the loss of ARID1A expression is not known. The current study was designed to evaluate whether ARID1A was a prognostic factor for progression, survival, and chemoresistance in ovarian clear cell carcinoma.

Microscopic Hematuria Not Predictive of Cancer

Microscopic Hematuria Not Predictive of Cancer

"In 4414 patients with asymptomatic microscopic hematuria, the rate of urinary tract cancer was 2.1%, (compared with the 0.43% the researchers previously found)."

American Urological Association (AUA) 2012 Annual Scientific Meeting: Abstract 62. Presented May 19, 2012

Canadian breast implant cohort: Extended follow-up of cancer incidence - Pan - 2012 - International Journal of Cancer - Wiley Online Library

Canadian breast implant cohort: Extended follow-up of cancer incidence -  International Journal of Cancer

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 to 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% confidence interval (CI) = 0.63–0.96] and this reduction persisted over time. We observed a sevenfold increased rate (IRR = 7.36, 95% CI = 1.86–29.12) of breast cancer in the first 5 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.

paywalled: Quality of Life After Surgery for Colon Cancer in Patients With Lynch Syndrome: Partial Versus Subtotal Colectomy.

Quality of Life After Surgery for Colon Cancer in Patients With Lynch Syndrome: Partial Versus Subtotal Colectomy

BACKGROUND:: Lynch syndrome is a disorder caused by mismatch repair gene mutations. Mutation carriers have a high risk of developing colorectal cancer. In patients with Lynch syndrome in whom colon cancer has been diagnosed, in general, subtotal colectomy instead of partial colectomy is recommended because of the substantial risk of metachronous colorectal cancer. However, the effect of more extensive surgery on quality of life and functional outcome is unknown. 

 OBJECTIVE:: The aim of this study was to investigate quality of life and functional outcome in patients with Lynch syndrome after partial colectomy and subtotal colectomy.

paywalled: Antigen-specific immunotherapy in ovarian cancer and p53 as tumor antigen.

Antigen-specific immunotherapy in ovarian cancer and p53 as tumor antigen.:

Abstract
Immunotherapy for ovarian cancer is one of the new treatment strategies currently investigated in epithelial ovarian cancer. This review discusses the results of different immunization strategies, identifies possible drawbacks in study design and provides potential solutions for augmentation of clinical efficacy. A potential target for cancer immunotherapy is p53, as approximately 50% of ovarian cancer cells carry p53 mutations. Therefore we review the immunological and clinical responses observed in ovarian cancer patients vaccinated with p53 targeting vaccines in particular. In most studies antigen-specific vaccine-induced immunological responses were observed. Unfortunately, no clinical responses with significant reduction of tumor-burden have been reported. Based on the currently available results we emphasize the necessity of multimodality treatment of ovarian cancer, combining classical cytoreductive surgery, (neo) adjuvant chemotherapy, immunotherapy and/or targeted therapy.

paywalled: Models of care in outpatient cancer centers [Nurs Econ. 2012 Mar-Apr] - PubMed - NCBI

Nurs Econ. 2012 Mar-Apr;30(2):108-16.

Models of care in outpatient cancer centers.

Abstract

While rapid changes in the treatment of cancer have been driven by research-based evidence, innovations in cancer care delivery have lagged behind that seen in cancer treatment. A literature review and ten semi-structured interviews were conducted to identify models of care in the ambulatory oncology setting to be adopted by a comprehensive cancer center. Four models were identified from the literature review but none were widely recognized or adopted by administrators. Findings suggested some common themes that should be included in an optimal model of care. These themes are in support of the burgeoning efforts seen in the promotion of interprofessional education and practice for quality improvement. Unique challenges related to the contextual factors in the ambulatory oncology settings suggest quality improvement interventions should be tailored to meet the specific needs of the care facility and its workforce.

2nd report: Stats Canada - Conditional survival analyses across cancer sites

 Blogger's Note: html version; stop reading if looking for ovarian cancer specfic references

Conditional survival analyses across cancer sites

For this article...

• Abstract
• News release in The Daily
• Tables and figures
• References
• To extract charts and tables
• Download PDF of article

"Survival statistics are an indicator of the effectiveness of cancer detection and treatment.¹  These statistics are used to compare cancer control over time² and across jurisdictions.^3,4  They are also of interest to clinicians providing direct care and to patients, who usually want an estimate of their prognosis.⁵
Survival estimates are typically presented as the probability—or the ratio of observed and expected probabilities in the case of relative survival—of surviving a given length of time (for example, five years) after diagnosis.  However, these estimates are less informative for people who have survived one or more years, as the risk of death due to cancer is often greatest in the first few years.  After this initial period, the prognosis can improve substantially, so the earlier estimates no longer apply.⁶ The outlook for such people can be estimated more appropriately using conditional survival.
For the first time in Canada, predicted conditional relative survival estimates are presented for a large number of cancers.  Cancers with the greatest relative improvement in prognosis since diagnosis are highlighted.  Cancers showing less improvement are also identified. (See The data)

2012 Canadian trends in cancer prevalence - Stats Canada

Blogger's Note: aside from 2 lines of stats, there is no specific reference/s to ovarian cancer (use search term: ovary)

(html version) http://www.statcan.gc.ca/pub/82-003-x/2012001/article/11616-eng.htm

 pdf - Canadian trends in cancer prevalence

"In Canada, the rate at which new cancer cases are diagnosed continues to
rise,4 and survival is also increasing.5-7 A recent study provided a detailed report of cancer prevalence in Canada as of January 1, 2005.8 However, cancer prevalence trends are rarely published, and until now, have not been reported for Canada......

Conclusion
This study presents the f rst Canadian cancer prevalence trend estimates to be reported. Trends in prevalence for an extensive list of cancers by time since diagnosis, sex and age group signachanges in the extent of disease in the Canadian population. Rising cancer prevalence proportions are due to increases in incidence, which partly result from the aging of the population, and to improvements in survival. Information about the degree to which changes in prevalence are occurring, and for which cancers in particular, is valuable for
resource planning

Chapter 22: Integration of Herbal Medicine into Evidence-Based Clinical Practice - Herbal Medicine - NCBI Bookshelf

Integration of Herbal Medicine into Evidence-Based Clinical Practice - Herbal Medicine - NCBI Bookshelf

In this Page

• INTRODUCTION
• CURRENT STATUS AND MAJOR ISSUES OF INTEGRATION OF HERBAL MEDICINE IN EVIDENCE-BASED MEDICAL THERAPY
• FACTORS RELEVANT TO/AFFECTING INTEGRATION OF HERBAL MEDICINE INTO MODERN MEDICAL PRACTICES
• RESEARCH NEEDS
• CONCLUSIONS
• REFERENCE

"....However, proof of efficacy or safety for the vast majority of herbal medicine has not been fully established through an evidence-based approach. Further, other issues, such as scientific, cultural, educational, economical, and legal, need to be addressed. In this chapter, we examine the current status and major scientific issues or factors that affect the integration of herbal medicine into evidence-based medical therapy."

 

ACKNOWLEDGMENTS

The authors wish to thank the WHO Collaborating Centre for Traditional Medicine at the School of Health Sciences, RMIT University, Bundoora, Victoria, Australia, and the WHO Collaborating Centre for Traditional Medicine at the College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, for their consent and encouragement to undertake the present collaboration.

 

Multiple VEGF Family Members are Simultaneously Expressed in Ovarian Cancer: a Proposed Model for Bevacizumab Resistance

Multiple VEGF Family Members are Simultaneously Expressed in Ovarian Cancer: a Proposed Model for Bevacizumab Resistance.:


Curr Pharm Des. 2012 May 14;

Abstract
Objective Insight into the expression of multiple vascular endothelial growth factor (VEGF) family members can support the implementation of anti-angiogenic therapy. This study aimed to assess VEGF family member expression in ovarian cancers and related omental metastases.

Methods Tissue microarrays encompassing 270 primary cancers and 112 paired metastases were immunostained for VEGF-A, VEGF-B, VEGF-C and VEGF-D. Staining intensities were categorized as absent, weak, moderate or strong. Expression was related to clinicopathological characteristics and survival.

Results Immunohistochemical positivity (defined as moderate or strong expression) was observed for VEGF-A in 90%, VEGF-B in 4%, VEGF-C in 41% and VEGF-D in 55% of the primary ovarian cancers. ....... VEGF family member expression showed no independent prognostic significance in multivariate survival analysis.

Conclusion VEGF-A, VEGF-C and VEGF-D are widely and often simultaneously expressed in ovarian cancer, which may contribute to bevacizumab resistance. Measuring their expression could support a rational, individualized choice of anti-angiogenic therapy and might be of predictive value. Studies are warranted to determine whether combinatorial analysis of VEGF family member expression can be used to predict anti-angiogenic drug efficacy.

The role of bevacizumab in advanced epithelial ovarian cancer.

The role of bevacizumab in advanced epithelial ovarian cancer.:

The role of bevacizumab in advanced epithelial ovarian cancer.
Curr Pharm Des. 2012 May 14;

Abstract
Background: There is a strong rationale for usage of anti-angiogenic agents in epithelial ovarian cancer. Bevacizumab is the most widely investigated anti-VEGF agent and has shown promising results in recent clinical trials.

Objective: To review the rationale and usage of bevacizumab in advanced epithelial ovarian cancer; as mono-therapy, in combination with chemotherapy both as first line and for recurrent ovarian cancer as well as in combination with other targeted therapies.

Results: In epithelial ovarian cancer, angiogenesis promotes tumor growth, ascites formation and metastasis. Targeting VEGF in ovarian cancer patients may have indirect and direct cytotoxic effects. Results of placebo controlled phase III trials, the GOG-218 and ICON7, of carboplatin-paclitaxel alone or combined with bevacizumab in chemo-naive patients and the OCEAN trial comparing carboplatin-gemcitabine with or without bevacizumab in women with recurrent platinum-sensitive epithelial ovarian cancer all suggest a benefit for the addition of bevacizumab on progression free survival. Additionally, bevacizumab in combination with other targeted therapies, such as sorafenib and everolimus are under investigation in phase II trials and the current knowledge of molecular predictors is discussed.

In conclusion: Until now no survival benefit has been observed, but bevacizumab is the first anti-angiogenic agent demonstrating a progression free survival benefit in addition to standard chemotherapy regimens in advanced epithelial ovarian cancer, both in the upfront and recurrent setting. Mature overall survival data and the search for predictive biomarkers are important for the future role of bevacizumab in epithelial ovarian cancer.

paywalled: Guideline-Based Peer-to-Peer Consultation Optimizes Pegfilgrastim Use With No Adverse Clinical Consequences [Original Contributions]

Guideline-Based Peer-to-Peer Consultation Optimizes Pegfilgrastim Use With No Adverse Clinical Consequences [Original Contributions]:

Purpose:
Practice guidelines do not recommend the routine use of colony-stimulating factors when there is a low risk (< 10%) of febrile neutropenia (FN). We prospectively determined whether expert peer-to-peer consultation with prescribing oncologists would improve adherence to guidelines and whether there would be any adverse events associated with that adherence.

Methods:
Commencing in March 2010, we reviewed requests for pegfilgrastim from 22 community oncology practices comprising 78 physicians providing service to approximately 97,000 Medicare members. Paid claims data on all chemotherapy and supportive care medications were reviewed from fourth quarter (Q4) 2009 through third quarter (Q3) 2010. In total, 82 patients received pegfilgrastim. If the prescribed chemotherapy was associated with a low risk (< 10%) for FN, then a peer review was initiated. The treating physician made the final decision to use, or not use, pegfilgrastim, and no denials were issued.

Results:
A total of 245 units (1 unit = 6 mg) of pegfilgrastim were administered during the four quarters analyzed. Use in the low-risk category decreased from 52 units in Q4 2009 to 15 units in Q3 2010. The per-member per-month (PMPM) cost of pegfilgrastim decreased across quarters, with an average cost of $1.07 PMPM for Q4 2009 and $0.57 PMPM for Q3 2010. No studied patient was admitted for neutropenic fever.

Conclusion:
Active expert peer-to-peer consultation with prescribing oncologists can promote adherence to guidelines and potentially lead to significant cost reductions without significant risk of neutropenic fever, with or without hospitalization, for patients with cancer.

paywalled: Patient Out-of-Pocket Payments for Oral Oncolytics: Results From a 2009 US Claims Data Analysis [Original Contributions]

Patient Out-of-Pocket Payments for Oral Oncolytics: Results From a 2009 US Claims Data Analysis [Original Contributions]:

Purpose:
Oral oncolytics are an increasingly important treatment option for cancer. These agents often fall within the pharmacy benefit, with the potential for increased out-of-pocket (OOP) cost burden for patients. The purpose of this study was to evaluate patient OOP payments for oral oncolytic therapies in US managed care plans.

Conclusion:
Among 21 oral oncolytics, average OOP cost ranged from $15 to > $500. These results confirm previous findings showing OOP payments differing widely among oral oncolytic options. As cost for therapy becomes a greater part of treatment decisions, an understanding of patient OOP cost will be critical in informing choices.

paywalled: Visit Duration for Outpatient Physician Office Visits Among Patients With Cancer

Visit Duration for Outpatient Physician Office Visits Among Patients With Cancer

Conclusion:
Higher use of performance-based payment mechanisms and capitated arrangements are associated with a decrease in the amount of time physicians spend with their patients with cancer. It is unclear whether shorter visit times impact the quality of medical care provided or whether physicians in these settings have become more proficient in caring for their patients.

paywalled: Meat and fish consumption and risk of pancreatic cancer – results from the european prospective investigation into cancer and nutrition - International Journal of Cancer

Blogger's Note: implications for all cancers/research

Meat and fish consumption and risk of pancreatic cancer – results from the european prospective investigation into cancer and nutrition - Rohrmann - International Journal of Cancer

Conclusion:

Our results do not support the conclusion of the World Cancer Research Fund that red or processed meat consumption may possibly increase the risk of pancreatic cancer. The positive association of poultry consumption with pancreatic cancer might be a chance finding as it contradicts most previous findings.

UPDATE: New Website Selling Miracle Mineral Solution Sodium Chlorite Solution Not Authorized for Oral Consumption by Humans

 Blogger's Note: the website is still active as of the date of this positing

UPDATE: New Website Selling Miracle Mineral Solution Sodium Chlorite Solution Not Authorized for Oral Consumption by Humans

Information Update
2012-74
May 18, 2012
For immediate release
OTTAWA - Further to our previous communications, Health Canada is advising Canadians that a new website has been identified selling "MMS", also known as Miracle Mineral Solution or Miracle Mineral Supplement. The website is http://www.buymms.biz
When new websites or retailers are identified, Health Canada will continue to update our current list of MMS products. Canadians are advised to monitor this list of affected products for any possible updates.
Health Canada continues to remind Canadians that there are no therapeutic products containing sodium chlorite authorized for oral consumption by humans. MMS may cause serious health problems that include poisoning, kidney failure and harm to red blood cells that reduces the ability of the blood to carry oxygen. Additional health problems may also include abdominal pain, nausea, vomiting, and diarrhoea.
Consumers should consult their health care practitioner if they have used or are using MMS products and report any adverse reaction to Health Canada.
Health Canada has notified distributors identified to date that the sale of sodium chlorite for human consumption is in contravention of the Food and Drugs Act. We have also requested that identified distributors remove product from the Canadian market. As such, this website (http://www.buymms.biz) may or may not be operational. (Blogger's Note: is active)

May 21 Webinar: Steps to Addressing Health Disparities

May 21 Webinar: Steps to Addressing Health Disparities:

Michelle Yeboah of FDA's Office of Minority Health tells how the agency is addressing health disparities among minority populations in America.

Google goes cancer: Researchers use search engine algorithm to find cancer biomarkers

Google goes cancer: Researchers use search engine algorithm to find cancer biomarkers:

The strategy used by Google to decide which pages are relevant for a search query can also be used to determine which proteins in a patient's cancer are relevant for the disease progression. Researchers from Dresden University of Technology, Germany, have used a modified version of Google's PageRank algorithm to rank about 20,000 proteins by their genetic relevance to the progression of pancreatic cancer. In their study, published in PLoS Computational Biology, they found seven proteins that can help to assess how aggressive a patient's tumor is and guide the clinician to decide if that patient should receive chemotherapy or not.
read more

Cancerworld.org: GrandRound - A second opinion, because there’s no second chance

 A second opinion, because there’s no second chance

Patients want the option of consulting a second doctor, and the evidence shows that, for a minority of them, treatment decisions have altered significantly as a result. But could granting every patient the legal right to a second opinion tie up precious resources as each one ‘shops around’ in search of the opinion they want to hear?.....

"The fear that many have about ‘upsetting’ their doctor should not be underestimated"


IN SHORT

• Women, especially breast cancer patients, are among the most likely to seek second opinions, probably because of the many different treatment options for breast cancer and its high visibility in the media.

• Computers networks are obvious second opinion enablers. The European Union’s e-Health

• action plan predicts that by 2008 the majority of European health organisations should have the technical capability to provide online teleconsultation services for second opinions and other needs.

• More than a quarter (29%) of US adults reported that they or a member of their family received a second medical opinion from a doctor in the past five years, according to a 2005 Harris Interactive survey. In 30% of these, the diagnosis differed from the original. Another Harris poll in 2006 found that 36% of US adults never get a second opinion and nearly one in ten (9%) ‘rarely or never understand’ their diagnosis.

• Australian researchers have found that ‘Googling’ symptoms on the Internet came up with the right diagnosis in 15 out of 26 cases (reported in the New England Journal of Medicine). At Duke University in the US, medical physicists are using a Google-like approach to compare mammograms with the most highly ranked images returned from a database.

Organisation of European Cancer Institutes (OECI): Mahasti Saghatchian: pioneering a quality mark for Europe's cancer centres

Mahasti Saghatchian: pioneering a quality mark for Europe's cancer centres - Cover Story -  Cancer World

Genetic Testing May Not Drive Up Health Costs - in Genetics, Genetic Testing from MedPage Today

Genetic Testing May Not Drive Up Health Costs - in Genetics, Genetic Testing from MedPage Today

Patient-Centered Outcomes Research Institute PCORI: What Is It? How Does It Work? The Director Explains

PCORI: What Is It? How Does It Work? The Director Explains

In this segment of Medscape One-on-One, Joseph Selby, MD, talks with Eli Adashi, MD, about his new role as head of the Patient-Centered Outcomes Research Institute, its mission, and how physicians might benefit from this institute created under the Affordable Care Act.

excerpt: 

"How Does PCORI Differ From the Cochrane Collaboration?

Dr. Adashi: A question you almost certainly have heard before and that some of our viewers almost certainly contemplated has to do with the distinction between PCORI and other undertakings, such as the Cochrane Collaboration and programs that engage in systematic reviews or meta-analysis of data. In what way does PCORI stand out to other efforts? Where is it unique and distinct?

Dr. Selby: I think the most striking difference is that we are a research funding institution. The Cochrane Collaboration collects, disseminates, and guides the creation of evidence syntheses. We will fund some evidence syntheses, but we'll also fund a lot of empirical research, including observational research and randomized comparisons. So, we are a funding institute of substantial size in distinction to, as you mentioned, the Cochrane Collaboration and several European organizations that synthesize data and go beyond synthesis to supporting policymaking.
The other distinguishing characteristic is that we don't make policy; we generate information....

Experts Report Little Certainty in Vitamin D’s Potential Benefits « news@JAMA

Experts Report Little Certainty in Vitamin D’s Potential Benefits « news@JAMA

Conclusions in the statement include the following:

• Topical or oral vitamin D may help treat psoriasis, but more evidence is needed to determine its efficacy in treating other skin disorders or preventing skin cancer.
• No strong evidence exists to support the theory that vitamin D supplements reduce the risk of type 2 diabetes or the metabolic syndrome.
• Clinical trial evidence does not support taking vitamin D supplements to lower cardiovascular disease risk.
• Observational studies linking vitamin D with reduced cancer incidence are strongest for colorectal cancer but weak or inconsistent for breast, prostate, and all cancers combined.

The statement will be published in the June issue of the Endocrine Society’s Endocrine Reviews.

The Disparity of Motivational Drivers in International Health Care Systems

OMICS Publishing Group | Full-text | The Disparity of Motivational Drivers in International Health Care Systems

Abstract

Healthcare systems are highly convoluted and nontransparent systems that face the immense challenge of disparaging economic and ethical drivers from each player in this complicated continuum. Economic slack is a critical obstacle that is generated through the misalignment of needed outcomes for each of these silos. Understanding the economic needs of each additional and overlapping player in the continuum is the first important step toward universal health care sustainability.

Editorial

".......Undeniably, some industrialized countries, particularly in Europe, are far closer to attaining sustainable, universal (timely) healthcare access than others and yet no country can claim perfection.....

An alternative approach to identify women at risk for colorectal cancer. | 2012 ASCO Annual Meeting Abstracts

An alternative approach to identify women at risk for colorectal cancer. | 2012 ASCO Annual Meeting Abstracts

Abstract:
Background: 
Hereditary colorectal cancer (CRC) is preventable; however, identification of individuals at sufficiently high risk to warrant heightened surveillance is difficult. Lynch Syndrome (LS) is an inherited cancer syndrome due to germline mutation in a DNA mismatch repair gene. For women with LS, the lifetime risk of endometrial cancer (EC) is 64% and CRC is 54%. Fifty percent of women with LS will present with EC or ovarian cancer prior to CRC. Therefore, women with LS associated EC represent an ideal group for CRC prevention. The optimal method to identify women with LS associated EC is not known. The purpose of this study was to determine the utility of Amsterdam II and Society of Gynecologic Oncology (SGO) Criteria (modified Bethesda criteria that use EC as the sentinel cancer) in identifying women with LS associated EC. Our ultimate goal is to identify women at increased risk of CRC.


Our data suggest that classic clinical screening criteria are inadequate to detect patients with LS who present with EC, potentially missing up to 25% of these patients.

Gene	MLH1	MSH2	MSH6	PMS2	Total
Total number	14	27	11	7	59
Median age at diagnosis (range)	52 (42-79)	44 (33-81)	56 (31-76)	66 (45-87)	50 (31-87)
Diagnosis at greater than 50 years	7	8	9	6	30
FH CRC	3	16	4	3	26
Amsterdam criteria	3	13	0	1	17
SGO criteria	11	22	7	4	44

2012 ASCO Annual Meeting Abstracts (searchable)

2012 ASCO Annual Meeting Abstracts

Welcome to the 2012 ASCO Annual Meeting abstracts home. Abstracts published in the Annual Meeting Proceedings Part I will be available on this site at 6:00 PM EDT May 16, 2012. Plenary Abstracts, Late-Breaking Abstracts, and Clinical Review Abstracts (published in the Annual Meeting Proceedings Part II) will be available at 12:01 AM EDT on the date of their presentation at the 2012 ASCO Annual Meeting.

SEARCH    2012 Abstracts       Help EXPRESS PRINT    Abstracts by Meeting Track BROWSE    Abstracts by Meeting Track

paywalled: Lipid Profiles and Risk of Breast and Ovarian Cancer in the Swedish AMORIS Study

WIKI: Lipid metabolism refers to the processes that involve the intercourse and degradation of lipids.
The types of lipids involved include:

• Bile salts
• Cholesterols
• Eicosanoids
• Glycolipids
• Ketone bodies
• Fatty acids - see also fatty acid metabolism
• Phospholipids
• Sphingolipids
• Steroid - see also steroidogenesis
• Triacylglycerols (fats) - see also lipolysis and lipogenesis

                                                ~~~~~~~~~~~~~~~~~
Lipid Profiles and Risk of Breast and Ovarian Cancer in the Swedish AMORIS Study

Background: 

Obesity is a risk factor for breast (BCa) and ovarian cancer (OCa); the mechanisms of action are not completely understood. Perturbed lipid metabolism often accompanies obesity; we therefore ascertained the associations between lipid components and BCa and OCa risk in a prospective cohort study. 

Methods: 

234,494 women with baseline measurements of triglycerides (TG) and total cholesterol(TC) and glucose were selected from the AMORIS database. 27,394 had measurements of HDL,LDL, apolipoprotein (Apo) B and A-I. Associations between quartiles and dichotomized values of lipid components and BCa and OCa risk were analysed using Cox proportional hazard models.

Results: 

We identified 6,105 women diagnosed with BCa and 808 women diagnosed with OCa. A weak trend was observed between TG and BCa (HR: 1.01 (CI95% 0.94-1.09), 0.93 (0.86-1.00) 0.91 (0.84-0.99) 2nd 3rd and 4th quartiles; P = 0.01). No other associations between lipid components and risk of BCa or OCa showed statistical significance. 

Conclusions: 

A weak protective association was found between levels of TG and risk of BCa. 

Impact: An analysis including information on tumour characteristics of OCa and BCa may provide more insight in possible links between lipid metabolism and the risk of these cancers.

paywalled: CT diagnosis of intrasplenic metastasis from ovarian carcinoma

CT diagnosis of intrasplenic metastasis from ovarian carcinoma

 We concluded that CT can demonstrate intraparenchymal and infiltrative splenic metastasis in patients with ovarian cancer even in the absence of increased CA 125 levels.

Many US cancer survivors still lost in transition : The Lancet (U.S. / Canada....)

Many US cancer survivors still lost in transition : The Lancet

2012 CDC/NCI report - United States Cancer Statistics (USCS)

Cancer - NPCR - USCS - View Data Online

The 1999–2008 United States Cancer Statistics (USCS): Incidence and Mortality Web-based Report marks the tenth time that the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) have jointly produced official federal cancer incidence statistics for each state having high-quality cancer data. The report is produced in collaboration with the North American Association of Central Cancer Registries. This year's report features information on more than one million invasive cancer cases diagnosed during 2008 among residents of all 50 states, six metropolitan areas, and the District of Columbia. Incidence data are from CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology and End Results (SEER) Program. Data from population-based central cancer registries in these states and metropolitan areas meet the selected criteria for inclusion in this report. The report also provides cancer mortality data collected and processed by CDC's National Center for Health Statistics (NCHS). Mortality statistics, based on records of deaths that occurred during 2008, are available for all 50 states and the District of Columbia. Report Highlights Cancer rates by race and ethnicity (all cancers combined) Cancer rates by state (all cancers combined) Cancer among men Cancer among women Racial or ethnic variations Geographic variations   United States Cancer Statistics (USCS) View Data Online 1999–2008 Cancer Incidence and Mortality Data This Web-based report includes the official federal statistics on cancer incidence from registries that have high-quality data and cancer mortality statistics for each year and 2004–2008 combined. It is produced by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), in collaboration with the North American Association of Central Cancer Registries (NAACCR).

---------------------------- See Also • Help for new users • Contact information ----------------------------

Graphs Top Ten Cancers State vs. National Comparisons Selected Cancers Ranked by State      Maps The Interactive Cancer Atlas (InCA) shows USCS data from 1999–2008 in a dynamic format. Interactive Cancer Atlas (InCA)

Tables Cancer Types Grouped by Race and Ethnicity Cancers Grouped by State and Region Childhood Cancer Brain Cancers by Tumor Type  Cancer Data by State Use the dropdown menu to view cancer information for a selected state.