What is whole genome sequencing? How is it used, and how does it apply to
you? Learn more on the Genes in Life blog, and have your questions
answered by our featured experts!....
Saturday, November 16, 2013
Mixed-polarization phenotype of ascites-associated macrophages in human ovarian carcinoma: Correlation of CD163 expression, cytokine levels and early relapse
abstract
Ovarian cancer is typically accompanied by the occurrence of malignant ascites containing large number of macrophages. It has been suggested that these tumor-associated macrophages (TAMs) are skewed to alternative polarization (M2) and thereby play an essential role in therapy resistance and metastatic spread. In our study, we have investigated the nature, regulation and clinical correlations of TAM polarization in serous ovarian cancer. Macrophage polarization markers on TAMs and ascites cytokine levels were analyzed for 30 patients and associated with relapse-free survival (RFS) in a prospective study with 20 evaluable patients. Surface expression of the M2 marker CD163 on TAMs was inversely associated with RFS (p < 0.01). However, global gene expression profiles determined for 17 of these patients revealed a mixed-polarization phenotype unrelated to the M1/M2 classification. CD163 surface expression also correlated with the ascites levels of IL-6 and IL-10 (p < 0.05), both cytokines induced CD163 expression, and their ascites levels showed a clear inverse association with RFS (p < 0.01). These findings define a subgroup of patients with high CD163 expression, high IL-6 and/or IL-10 levels and poor clinical outcome.
Genetic, epigenetic and stem cell alteration in endometriosis: new insights and potential therapeutic perspectives
abstract
Human
endometrium is a highly dynamic tissue, undergoing periodic growth and
regression at each menstrual cycle. Endometriosis is a frequent chronic
pathological status characterized by endometrial tissue with an ectopic
localization, causing pelvic pain and infertility and a variable
clinical presentation. In addition, there is well-established evidence
that, although endometriosis is considered benign, it is associated with
an increased risk of malignant transformation in approximately 1.0% of
affected women, with the involvement of multiple pathways of
development. Increasing evidence supports a key contribution of
different stem/progenitor cell populations not only in the cyclic
regeneration of eutopic endometrium, but also in the pathogenesis of at
least some types of endometriosis. Evidence has arisen from experiments
in animal models of disease through different kinds of assays (including
clonogenicity, the label-retaining cell approach, the analysis of
undifferentiation markers), as well as from descriptive studies on
ectopic and eutopic tissue samples harvested from affected women.
Changes in stem cell populations in endometriotic lesions are associated
with genetic and epigenetic alterations, including imbalance of miRNA
expression, histone and DNA modifications and chromosomal aberrations.
The present short review mainly summarizes the latest observations
contributing to the current knowledge regarding the presence and the
potential contribution of stem/progenitor cells in eutopic endometrium
and the aetiology of endometriosis, together with a report of the most
recently identified genetic and epigenetic alterations in endometriosis.
We also describe the potential advantages of single cell molecular
profiling in endometrium and in endometriotic lesions. All these data
can have clinical implications and provide a basis for new potential
therapeutic applications.
Microbiological quality and characteristics of probiotic products in China
abstract
Source
State Key Laboratory of Food Science and Technology, Nanchang University, Jiangxi, 330047, China; Penn Ovarian Cancer Research Center, Center for Research on Reproduction and Women's Health (CRRWH), Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, 19104, USA; Institute of Translational Medicine, Nanchang University, People's Republic of China, 999 Xuefu Rd, Honggu District, Nanchang, China.BACKGROUND:
Probiotics are widely used in the food industry and medicine fields in China, but few studies have been conducted to evaluate the actual microbial amounts and species in probiotic products, which may conflict with the labels and mislead consumers to choose inappropriate foods or medicines.RESULTS:
Twenty commercial dairy products and eight commercial 'healthcare' samples were collected from markets in China and tested using culture-dependent and culture-independent methods. The results suggested that the total bacterial counts of most commercial products met the minimum quantitative requirement of the Chinese national standard (6.00 log colony-forming units g(-1) ). However, the bacterial counts of specific species were inconsistent with the labelling. In parallel, denaturing gradient gel electrophoresis analysis indicated that some probiotic-containing products were wrongly labelled; no Bifidobacterium species were detected in the products claiming to contain bifidobacteria, and the probiotic characteristics (antimicrobial activity, acid resistance and bile resistance) of some isolates had degraded. Moreover, some contaminating bacteria, e.g. Enterobacter sp., Klebsiella sp. and Serratia sp., were also detected in these products.CONCLUSION:
The combination of culture-dependent and culture-independent methods was proven to quickly and conveniently detect the microbial diversity in probiotic products, and more effort is required to regulate the probiotic market in ChinaClinical ovarian cancers display extensive genetic heterogeneity, study suggests multiple treatment
Science Codex
"The divergence of mutation profiles within tumors from individual women suggests that sequencing of multiple samples from a single patient may be necessary before a drug treatment protocol can be devised," said Paul Billings, Chief Medical Officer for Life Technologies. "Very different evolutionary pathways for each woman were observed in the study, which would have been missed if only one section of the primary tumor or just one of the metastatic lesions had been sequenced. The data suggest that if only one metastasis were to be biopsied and sequenced, a number of relevant driver mutations and druggable targets would likely be missed, which would be expected to lead to poor treatment outcomes."
SGO: 2014 Registration and housing for Annual Meeting now open
SGO
Registration and housing is currently open for the SGO 45th Annual Meeting on Women’s Cancer in Tampa, FL, March 22 – 25, 2014. A preliminary schedule is also available online.
Ovarian Cancer Clinical Trial Endpoints: Society of Gynecologic Oncology White Paper
abstract
Highlights
- •
- Ovarian cancer has unique considerations for clinical trial endpoint selection
- •
- Optimal endpoint selection should reflect true patient benefit
- •
- PFS as a surrogate has significant advantages and disadvantages in ovarian cancer
Clinical
trial endpoints have profound effects on late phase clinical trial
design, results interpretation, drug development, and regulatory
approval of therapeutics. Selection of the optimal clinical trial
endpoint is particularly provocative in ovarian cancer where long
overall survival (OS) is observed even for those who present with
advanced disease stages. The lack of new regulatory approvals and the
lack of harmony between regulatory bodies globally for ovarian cancer
therapeutics are of concern. The advantages and disadvantages of the
numerous endpoints available are herein discussed within the unique
context of ovarian cancer where both crossover and post-progression
therapies potentially uncouple the surrogacy between progression-free
survival (PFS) and OS, the two most widely supported and utilized
endpoints. The roles of patient reported outcomes (PRO) and health
related quality of life (HRQoL) are discussed, but even these widely
supported parameters are affected by the unique characteristics of
ovarian cancer where a significant percentage of patients may be
asymptomatic. Original data regarding the endpoint preferences of
ovarian cancer advocates is presented.
Endpoint
selection in ovarian cancer clinical trials should reflect the impact on
disease burden and unique characteristics of the treatment cohort while
reflecting true patient benefit. Both OS and PFS have led to regulatory
approvals and are clinically important. However, current regulatory
approval guidance by the FDA indicates that surrogates for overall
survival, while acceptable, must be clinically meaningful. OS remains
the most objective and accepted endpoint because it is least vulnerable
to bias; however, the feasibility of OS in ovarian cancer is compromised
by the requirement for large trial size, prolonged time-line for final
analysis, and potential for unintended loss of treatment effect from
active post-progression therapies. A large magnitude of effect in PFS
improvement should establish benefit, and further communication with
regulatory authorities to clarify acceptable endpoints should be
undertaken.
Synergistic inhibition of ovarian cancer cell growth by combining selective PI3K/mTOR and RAS/ERK pathway inhibitors
abstract
Background
Ovarian
cancer is the major cause of death from gynaecological malignancy with a
5 year survival of only ∼30% due to resistance to platinum and
paclitaxel-based first line therapy. Dysregulation of the
phosphoinositide 3-kinase/mammalian target of rapamycin (PI3K/mTOR) and
RAS/extracellular signal-regulated kinase (ERK) pathways is common in
ovarian cancer, providing potential new targets for 2nd line therapy.
Methods
We
determined the inhibition of proliferation of an extensive panel of
ovarian cancer cell lines, encompassing all the major histotypes, by the
dual PI3K/mTOR inhibitor PF-04691502 and a MEK inhibitor, PD-0325901.
In addition, we analysed global gene expression, mutation status of key
PI3K/mTOR and RAS/ERK pathway members and pathway activation to identify
predictors of drug response.
Conclusions
These
studies identify dual targeted inhibitors of PI3K/mTOR in combination
with inhibitors of RAS/ERK signalling as a potentially effective new
approach to treating ovarian cancer.
Oct 29, 2013: First-year progress in MD Anderson's Moon Shots Program
video
Description:The University of Texas MD Anderson Cancer Center in September 2012 announced its Moon Shots Program, an unprecedented effort to dramatically accelerate the pace of converting scientific discoveries into clinical advances that reduce cancer deaths. The program initially targets acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS); chronic lymphocytic leukemia (CLL); lung cancer; melanoma; prostate cancer; and triple-negative breast and high-grade serious ovarian cancers. Elizabeth Grimm, Ph.D., interim director and chief scientific officer for MD Anderson's Moon Shots Program, discusses progress since the effort launched one year ago.
ICON7 Trial Update - Dr. Amit Oza
video
Dr. Amit Oza with an update from ECC 2013 on the final overall survival results in the GCIG phase III randomized trial of bevacizumab in women with newly diagnosed ovarian cancer.
Public reporting of surgeon outcomes: low numbers of procedures lead to false complacency
The Lancet
Summary
The
English National Health Service published outcome information for
individual surgeons for ten specialties in June, 2013. We looked at
whether individual surgeons do sufficient numbers of procedures to be
able to reliably identify those with poor performance. For some
specialties, the number of procedures that a surgeon does each year is
low and, as a result, the chance of identifying a surgeon with increased
mortality rates is also low. Therefore, public reporting of individual
surgeons' outcomes could lead to false complacency. We recommend use of
outcomes that are fairly frequent, considering the hospital as the unit
of reporting when numbers are low, and avoiding interpretation of no
evidence of poor performance as evidence of acceptable performance.
Future Oncology - selected abstracts - ovarian cancer (repost)
Future Oncology - Vol. 9
December 2013, Vol. 9, No. 12s, Pages 1-1
Foreword
 Trabectedin plus pegylated liposomal doxorubicin: the return of a treatment option for ovarian cancerCitation | Full Text | PDF (197 KB) | PDF Plus(198 KB) | Reprints & Permissions |
Symposium Paper
Introduction: 1 year of silence?
Andrés Poveda, Eric Pujade-LauraineCitation | Full Text | PDF (221 KB) | PDF Plus(222 KB) | Reprints & Permissions |
Trabectedin mechanism of action: what’s new?
Maurizio D’IncalciSummary | Full Text | PDF (1476 KB) | PDF Plus(1477 KB) | Reprints & Permissions |
Biology of ovarian cancer and trabectedin mechanism of action
Isabelle Ray-CoquardSummary | Full Text | PDF (1472 KB) | PDF Plus(1473 KB) | Reprints & Permissions |
Optimizing treatment of the partially platinum-sensitive ovarian cancer patient
Nicoletta ColomboSummary | Full Text | PDF (493 KB) | PDF Plus(494 KB) | Reprints & Permissions |
Discussion: session 1
Jalid Sehouli, Josep M del Campo, Domenica LorussoCitation | Full Text | PDF (367 KB) | PDF Plus(367 KB) | Reprints & Permissions |
Increasing the chances for platinum-sensitive ovarian cancer patients
Antonio GonzálezSummary | Full Text | PDF (946 KB) | PDF Plus(947 KB) | Reprints & Permissions |
Thursday, November 14, 2013
Simplified staging laparotomy in FIGO stage 1 epithelial ovarian cancer: Follow-up and outcomes in South Wales, UK
abstract
We
have conducted a retrospective analysis of FIGO stage 1 ovarian cancer
patients in South Wales, who underwent a simplified staging laparotomy
without routine nodal sampling and peritoneal biopsies. Patient records
from January 2004 to December 2010 were analysed. A total of 116
patients were included in the final analysis. Adjuvant chemotherapy was
offered to patients with risk factors for relapse (grade > 1, clear
cell histology, or stage > Ia); overall, 89 patients (76.7%) received
adjuvant single agent carboplatin (n = 54, 46.5%) or combination
chemotherapy (n = 35, 30.2%). After a median follow up of 41 months
(range 12-95), 18 patients have relapsed (15.5%), of these 17 had risk
factors and 16 had received adjuvant chemotherapy. Eighteen patients
have died, of whom 6 of non-cancer related causes without prior relapse.
5-year overall and relapse free survival were 80%.
In conclusion, in situations where there are limited resources and operating time constraints, our data suggest that a simplified staging laparotomy approach may be a reasonable compromise in apparently early stage ovarian cancer: this may result in a more aggressive use of chemotherapy, but survival outcomes seem comparable to other series.
In conclusion, in situations where there are limited resources and operating time constraints, our data suggest that a simplified staging laparotomy approach may be a reasonable compromise in apparently early stage ovarian cancer: this may result in a more aggressive use of chemotherapy, but survival outcomes seem comparable to other series.
Wednesday, November 13, 2013
request to participate in a survey: Risks, Triggers, and Protective Factors Related to the Expression of Ovarian Cancer
survey and request:
My name is Dr. Sandra Cesario and I am on the faculty in the College of Nursing at Texas Woman’s University in Houston, Texas. Almost 40 years experience as a women’s health nurse and losing a 29-year old daughter to ovarian cancer have led me on a path of research about the risk factors for ovarian cancer.
The purpose of the proposed project titled Risks, Triggers, and Protective Factors Related to the Expression of Ovarian Cancer, is to collect information from women who have been diagnosed with ovarian cancer, as well as women who do not have the disease, to determine if there is clustering of risk or protective factors that increase or decrease a woman’s chances of developing ovarian cancer. The research question to be addressed is: What is the constellation of factors that predisposes a woman to be at increased risk for developing ovarian cancer?
I am requesting your assistance in recruiting participants for this study. As a support group leader or ListServ monitor, you are likely to be in contact with ovarian cancer survivors and their families who may be interested in completing this anonymous online survey. Study participation is completely voluntary and women are free to discontinue their participation at any time. I am primarily seeking English-speaking women, over the age of 18, who have been diagnosed with ovarian cancer. However, ALL women, with or without cancer, are welcome to complete the survey. This study has been approved by the Institutional Review Board (IRB) of Texas Woman’s University in Houston.
Would you be willing to post the url for the internet survey on your website, include it in your newsletter, distribute to your email list, and/or offer the opportunity to women at your next in-person contact?
If so, please advise the women to click on the following link (or copy and paste it into your web browser)
<https://www.psychdata.com/s.
to complete the survey via the secure PsychData system. It is estimated that the survey can be completed in 20-25 minutes.
An email address developed specifically for this study has been created if you have additional questions.
Cesario-Research@hotmail.com<
I value your time and interest in this topic. If you make the decision to participate, thank you very much for your input that is crucial to the outcome of this study.
Sincerely,
Dr. Sandra K. Cesario
PhD Program Coordinator and Professor
College of Nursing, Texas Woman’s University
6700 Fannin Street
Houston, TX 77030-2367
Office Phone: 713-794-2110
Access, Affordability, and Insurance Complexity Are Often Worse in the United States Compared to 10 Other Countries - The Commonwealth Fund
open access
About the Study
Approximately 20,000 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., and the U.S. were surveyed between February and June 2013. The survey focused on people’s experiences with their country’s health care system, particularly those related to accessing and affording health care.Downloads
Commentary: Addressing the American Health-Care Cost Crisis: Role of the Oncology Community
Abstract
Health-care cost growth is unsustainable,
and the current level of spending is harming our economy and our
patients. This
commentary describes the scope of the health-care
spending problem and the particular factors in cancer care that
contribute
to the problem, reflecting in part presentations
and discussions from an Institute of Medicine National Cancer Policy
Forum
Workshop held in October 2012. Presenters at the
workshop identified a number of steps that the oncology community can
take
to reduce the rate of growth in cancer-care costs
while maintaining or improving upon the quality of care. This commentary
aims to highlight opportunities for the oncology
community to take a leadership role in delivering affordable,
high-quality
cancer care.
Related articles
Family History and BRCA1/BRCA2 Status Among Japanese Ovarian Cancer Patients and Occult Cancer in a BRCA1 Mutant Case (BRCA/Lynch Syndrome)
abstract
BACKGROUND:
This study aimed to examine family history among Japanese ovarian cancer patients and to investigate the TP53 status of fallopian tube epithelial and ovarian cancer cells in a Japanese BRCA1 mutant case that may be associated with the transformed state in hereditary ovarian cancer.METHODS:
One hundred and two primary ovarian cancer patients were retrospectively evaluated in this cross-sectional study. The family history of cancer was determined in probands. In a BRCA1 mutant case, p53 immunostaining and direct sequencing, followed by laser-capture microdissection, were performed for the fallopian tube, considered the origin of ovarian cancer.RESULTS:
Nine of 102 (8.8%) families were regarded as having hereditary breast-ovarian cancer syndrome, two families (2.0%) were diagnosed with Lynch syndrome and six patients harbored BRCA1 or BRCA2 mutations. One case underwent risk-reductive salpingo-oophorectomy as a BRCA1 mutant carrier was retrospectively diagnosed as occult cancer. Common TP53 mutations were detected in cancer and fallopian tube epithelial cells in the case.CONCLUSIONS:
Here, we integrate family cancer history and histology in ovarian cancer cases as well as TP53 status in a BRCA1 mutant case into a discussion regarding carcinogenesis in a Japanese population. The TP53 status for the BRCA1 mutant case examined here supports the recently proposed theory that ovarian cancer develops because of BRCA1 or BRCA2 inactivation and/or TP53 mutations.Tuesday, November 12, 2013
Antegrade repositioning of Memokath stent in malignant ureteroileal anastomotic stricture (in an ovarian cancer patient)
open access
Case report
A 64-year-old lady was diagnosed to have locally advanced ovarian carcinoma 5 years prior to presentation. She had undergone debulking surgery with colostomy as well as ileal conduit diversion surgery. She had also undergone two courses of chemotherapy, and was also treated with fulguration that entailed tissue ablation using high-frequency electric sparks. Despite the aggressive treatment of the disease, she developed tumor recurrence that caused right hydronephrosis (and) and hydroureter. Endoscopic examination performed via the ileal conduit showed a 5-cm stricture of the ureteroileal junction caused by tumor infiltration. Balloon dilatation of the malignant stricture was performed, but there was still persistent contrast hold-up seen in the right collecting system. Subsequently, antegrade stenting of the malignant stricture was performed using a 6F double J stent. Unfortunately, there was recurrent distal migration of the double J stent into the conduit, requiring repeated repositioning of the stent under fluoroscopic guidance in the radiology department.....define: ureteroileal
Circulating U2 Small Nuclear RNA Fragments as a Novel Diagnostic Tool for Patients with Epithelial Ovarian Cancer
abstract
Background: Ovarian
cancer is the leading cause of death among malignancies in women.
Despite advances in treatment, >50% of patients
relapse. For disease monitoring, the
identification of a blood-based biomarker would be of prime interest. In
this regard,
noncoding RNAs, such as microRNA (miRNA) or
small nuclear RNA (snRNA), have been suggested as biomarkers for
noninvasive cancer
diagnosis. In the present study, we sought to
identify differentially expressed miRNA/snRNA in sera of ovarian cancer
patients
and investigate their potential to aid in
therapy monitoring.
Methods: miRNA/snRNA abundance was investigated in serum (n = 10) by microarray analysis and validated in an extended serum set (n
= 119) by reverse-transcription quantitative PCR.
Results: Abundance of U2-1 snRNA fragments (RNU2-1f) was significantly increased in sera of ovarian cancer patients (P < 0.0001) and paralleled International Federation of Gynecology and Obstetrics stage as well as residual tumor burden after
surgery (P < 0.0001 and P = 0.011, respectively). Moreover, for patients with suboptimal debulking, preoperative RNU2-1f concentration was associated
with radiographic response after chemotherapy and with platinum resistance (P = 0.0088 and P
= 0.0015, respectively). Interestingly, according to the RNU2-1f
abundance dynamics, persistent RNU2-1f positivity before
surgery and after chemotherapy identified a
subgroup of patients with high risk of recurrence and poor prognosis.
Conclusions: This is
the first report to suggest that a circulating snRNA can serve as an
auxiliary diagnostic tool for monitoring tumor
dynamics in ovarian cancer. Our results provide a
rationale to further investigate whether this high-risk patient group
may
benefit from additional therapies that are
directly applied after chemotherapy.
CDC - Gynecologic Cancers - Inside Knowledge Campaign
Inside Knowledge Campaign
Inside Knowledge Campaign
The Inside Knowledge: Get the Facts About Gynecologic Cancer campaign raises awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. It encourages women to pay attention to their bodies and know what is normal for them, so they can recognize the warning signs of gynecologic cancers and seek medical care. When gynecologic cancers are found early, treatment is most effective.Campaign Materials
Inside Knowledge has created a suite of materials in English and Spanish for patients and health care providers. Fact sheets, a symptoms diary,
[PDF-503KB] and posters on the five most common gynecologic cancers can be viewed, printed, and ordered online. Television and radio PSAs can be viewed and heard online; transcripts are available....Promoting Gynecologic Cancer Awareness at a Critical Juncture—Where Women and Providers Meet - Online First - Springer
abstract
$39.95 / €34.95 / £29.95*
Given the absence of
effective population-based screening tests for ovarian, uterine,
vaginal, and vulvar cancers, early detection can depend on women and
health care providers recognizing the potential significance of
symptoms. In 2008, the Centers for Disease Control and Prevention’s
(CDC) Inside Knowledge campaign began
distributing consumer education materials promoting awareness of
gynecologic cancer symptoms. We investigated providers’ in-office use of
CDC gynecologic cancer materials and their recognition of the symptoms
highlighted in the materials. We analyzed data from a national 2012
survey of US primary care physicians, nurse practitioners, and
gynecologists (N = 1,380). Less than a
quarter of providers (19.4 %) reported using CDC gynecologic cancer
education materials in their offices. The provider characteristics
associated with the use of CDC materials were not consistent across
specialties. However, recognition of symptoms associated with
gynecologic cancers was consistently higher among providers who reported
using CDC materials. The possibility that providers were educated about
gynecologic cancer symptoms through the dissemination of materials
intended for their patients is intriguing and warrants further
investigation. Distributing consumer education materials in health care
provider offices remains a priority for the Inside Knowledge campaign, as the setting where women and health care providers interact
is one of the most crucial venues to promote awareness of gynecologic
cancer symptoms.
An aspirin a day? Aspirin use across a spectrum of risk: cardiovascular disease, cancers and bleeds, Expert Opinion on Pharmacotherapy, Informa Healthcare
Abstract
"Aspirin or acetylsalicylic acid (ASA) is commonly used in the
general population for primary prevention of cardiovascular disease
(CVD). Strong evidence supports the use of ASA in secondary prevention
of CVD; however, for primary prevention, potential benefits are offset
by potential harms (primarily major bleeds), with no benefit in overall
mortality. Anti-platelet agents, including ASA, are one of the most
commonly implicated medications for hospital admissions related to
adverse medication events. Studies of primary prevention in patients
with risk factors for CVD also fail to show a benefit with ASA. Finally,
evidence supporting ASA use for cancer prevention is limited. Health
care providers should be aware of the benefits and risks associated with
ASA use in primary and secondary prevention and discuss these with
their patients in the context of individual patient values and
preferences."
Bridging Efforts to Longitudinally Improve and Evaluate VEnous thromboembolism prophylaxis uptake in hospitalized cancer patients through Interprofessional Teamwork
abstract
INTRODUCTION:
Despite demonstrable risk of venous thromboembolism (VTE), thromboprophylaxis continues to be underutilized in hospitalized cancer patients. Our study evaluated institutional VTE prophylaxis rates after devising a series of strategic interventions to longitudinally improve adherence rates over a period of eight years.METHODS AND MATERIALS:
Between 2004 and 2012, a series of interventions were implemented to improve the thromboprophylaxis rate among patients with solid tumours hospitalized at our institution using quality improvement methodology. Interventions included development of guidelines and institutional policies coupled with educational in-services for physicians, nurses and pharmacists and engagement of the Cancer Quality Committee. Thromboprophylaxis rates were monitored to assess response to interventions.RESULTS:
At the outset in 2004, 11 of 57 (19.3%) eligible patients received appropriate pharmacological prophylaxis and formed the baseline of our analysis. Post-2009 policy implementation and educational sessions, 46.5% of an eligible 185 inpatients were administered thromboprophylaxis. Following a two-year grace period to allow for policy acceptance, three audits were conducted in 2011 for which an average prophylaxis rate of 62.3% resulted. In 2012, following another round of educational sessions, a 96.7% rate was achieved and maintained ten weeks later. Minimal bleeding risk was observed during this eight year initiative.CONCLUSION:
A reproducible 96.7% prophylaxis uptake rate was the result of our perseverance and persistence in believing that culture change was inevitable through continuously collaborating with stakeholders at all levels.Egypt: Outcome of fertility preserving surgery in early stage ovarian cancer
Blogger's Note: it is not clear if the 2 patients lost in follow-up was due to death or lack of communication
Two patients (6.7%) were lost during follow up
abstract
AIM:
To assess the role of fertility preserving surgery in treatment of patients with stage IA, G1 or G2 ovarian carcinoma without adjuvant chemotherapy.PATIENTS AND METHODS:
From 2006 to 2008, a prospective non-randomized study recruited 150 women, with suspicious early malignant ovarian mass.RESULTS:
Among the 150 explored patients, only 43 (28.6%) patients underwent exploration. Only 32/150 (21.3%) patients had proven stage IA, either G1 or G2, epithelial ovarian cancer. Among the 32 patients, 22 (68.7%) patients were nullipara while 10 (32.1%) had one child. All patients had unilateral tumors; 26 (81.25%) patients had G1 and 6 (18.75%) patients had G2 tumors; 24/32 (75.0%) tumors were serous, 6/32 (18.7%) were mucinous and 2/32 (6.2%) were endometrioid, and none was clear cell type. The median follow up period was 58.5months (ranged: 48-72months). Two patients (6.7%) were lost during follow up; data will be presented for the remaining 30 patients. One patient, at 27th month of follow up, had open abdominal exploration to investigate abnormal pelvic mass on routine ultrasound follow up examination. Frozen section revealed recurrent invasive mucinous tumor. She underwent radical surgery with pelvic and para-aortic lymph node dissection, followed by adjuvant chemotherapy, and remained free of disease, for the remaining 29months of the follow up period. Neither distant metastases nor mortality were reported among our patients.CONCLUSION:
Fertility preserving surgery can be considered a safe treatment strategy in patients with stage IA, G1 or G2 ovarian carcinoma.(Paris) Complications of presumed benign ovarian tumors
abstract
The
main risk factor of adnexal torsion is a previous adnexal torsion
(LE3). There is no clinical, biological or radiological sign that may
exclude the diagnosis of adnexal torsion (LE3). The presence of flow at
color Doppler imaging does not allow exclusion of the diagnosis (LE2).
An emergent laparoscopy is recommended for adnexal untwisting (Grade B),
except in postmenopausal women where oophorectomy is recommended (grade
C). A persistent black color of the adnexa after untwisting is not an
indication for systematic oophorectomy (grade C), since a functional
recovery is possible (LE3). Ovariopexy is not routinely recommended
following adnexal untwisting (grade C). The clinical signs of
intra-cystic hemorrhage and those of rupture of the corpus luteum are
not specific (LE4). MRI is not recommended to confirm the diagnosis of
intra-cystic hemorrhage (grade C). Malignant transformation of an
ovarian cyst is very rare. The presence of a benign ovarian cyst is not
associated with an increased risk of ovarian cancer at long-term
follow-up (LE2). For these women, an ultrasound follow-up is not
recommended (grade C). Dermoid ovarian cyst containing nerve tissue can
trigger the production of pathogenic auto-antibody-anti-NMDA, leading to
encephalitis. A high proportion of thyroid tissue in a mature teratoma
(struma ovarii) may cause hyperthyroidism.
(Paris) Ovarian tumor markers of presumed benign ovarian tumors
abstract
Cancer
Antigen 125 (CA125) and Human Epididymis Protein 4 (HE4) are the most
studied ovarian tumor markers. Their diagnostic performance for
identification of ovarian cancer are superior to CA19-9, CA72-4, and
carcinoembryonic antigen, which are no more recommended for the
diagnosis of presumed benign ovarian tumor. HE4 (>140pmol/L) is
superior to CA125 (>30U/mL) in terms of specificity and positive
likelihood ratio. CA125 and HE4 can be combined into an algorithm ROMA,
or associated to clinical information (composite index), biological data
(OVA1) or imaging (Risk for Malignancy Index (RMI), LR2). ROMA
algorithm is an exponential equation combining plasmatic concentrations
of HE4 and CA125. ROMA is more sensitive and less specific than HE4 in
predicting epithelial ovarian cancer. ROMA is more accurate in
post-menopausal women. The performance of ROMA is lower than the
ultrasound model LR2 in differentiating malignant from benign ovarian
tumors, whatever the hormonal status. The composite index combining
CA125 with a symptoms index (pain, abdominal distension, bloating,
difficulty eating) has a good sensitivity in a screening program, but
because of a 12% false positive rate, ultrasound is required before
management. The RMI algorithm is based on serum CA125, ultrasound
findings (septation, solid zones, metastases, ascite, bilaterality) and
menopausal status. RMI is less sensitive, but more specific than ROMA or
OVA1 for the classification of ovarian masses. The addition of HE4 to
RMI seems to be the most accurate. The subjective evaluation of ovarian
cysts by sonography and color Doppler is better than ROMA and RMI
algorithms, and not affected by the hormonal status.
Lymph node metastasis in patients with epithelial ovarian cancer macroscopically confined to the ovary: review of a single-institution experience (Istanbul)
abstract
BACKGROUND:
To evaluate the patterns of lymphatic spread in epithelial ovarian cancer (EOC) macroscopically confined to the ovary and to determine risk factors for lymph node metastasis.MATERIALS AND METHODS:
All patients with clinically apparent stage IA/B/C EOCs who underwent staging surgery between January 2003 and February 2013 were retrospectively identified.RESULTS:
Two hundred and thirty-six (n = 236) consecutive patients were operated for primary epithelial ovarian carcinoma. Sixty-two of these patients (26.2 %) who underwent a comprehensive staging procedure including pelvic and paraaortic lymphadenectomy were diagnosed with tumors confined to one or two ovaries (stage IA/B/C). Of these 62 patients, 17 (27.4 %) had upstaged disease and 8 (12.9 %) had lymph node metastasis. Tumor histology was serous in 25 patients (40.3 %), mucinous in 23 patients (37 %), endometrioid in 9 patients (14.5 %), and clear cell in 5 patients (8 %). Positive lymph node status was found in 20 % (5/25) of those with serous histology while this rate was only 8.1 % (3/37) in those with non-serous disease. Although the presence of ascites was not associated with an increased risk of lymph node involvement (p = 0.24), positive peritoneal cytology (p = 0.001) and grade 3 disease (p = 0.001) were significant predictors of lymph node involvement.CONCLUSION:
All patients diagnosed with EOC macroscopically confined to the ovary should be considered for comprehensive staging surgery including pelvic and paraaortic lymphadenectomy.Tumor Mutation Burden Forecasts Outcome in Ovarian Cancer with BRCA1 or BRCA2 Mutations
open access (technical)
Background
Increased number of single nucleotide substitutions is seen in breast and ovarian cancer genomes carrying disease-associated mutations in BRCA1 or BRCA2. The significance of these genome-wide mutations is unknown. We hypothesize genome-wide mutation burden mirrors deficiencies in DNA repair and is associated with treatment outcome in ovarian cancer.
......."Our results are based on a relatively small set of patients carrying BRCA1 ...and BRCA2 mutations, and should be considered hypothesis generating until confirmed in a larger cohort. In addition, tumors may possess de novo mechanisms leading to resistance to chemotherapy and targeted treatments. Our preliminary results suggest low tumor Nmut may identify BRCA-associated primary tumors in which the original deficiency of BRCA1 and BRCA2 pathways, including impaired DNA repair, is compensated for by alternative pathways."
Conclusions
Tumor Nmut (non-synonymous exome mutations) was associated with treatment response and with both PFS and OS in patients with high-grade serous ovarian cancer carrying BRCA1 or BRCA2 mutations. In the TCGA cohort, low Nmut predicted resistance to chemotherapy, and for shorter PFS and OS, while high Nmut forecasts a remarkably favorable outcome in mBRCA-associated ovarian cancer. Our observations suggest that the total mutation burden coupled with BRCA1 or BRCA2 mutations in ovarian cancer is a genomic marker of prognosis and predictor of treatment response. This marker may reflect the degree of deficiency in BRCA-mediated pathways, or the extent of compensation for the deficiency by alternative mechanisms.
Editorial: Conventional evaluations of improvement interventions: more trials or just more tribulations?
open access
......Many of the challenges we regard as unique to QI (quality improvement) in fact exist in clinical research and have been recognised for decades.22 In some cases, we need to choose the right time for an RCT (once the intervention is sufficiently mature). In other cases, we may need to adopt alternative designs, such as step-wedge randomisation, to accommodate the realities of implementing complex interventions in the midst of other institutional activities or adaptive randomisation to minimise the number of sites assigned to the control group. But, we also have to remember that many of the misgivings we feel as providers of healthcare asked to participate in RCTs of improvement interventions echo those made by patients all the time. Our enthusiasm for assignment to active treatment carries no more weight than theirs. Rather than so often avoiding multi-site RCTs in QI, we may just need to find the right spoonful of sugar for ourselves when we end up in the control group.
Characteristics of Adverse Drug Events Originating During the Hospital Stay, 2011 (U.S)
Characteristics
Highlights
|
|
Monday, November 11, 2013
(repost) Learn More About Cancer: Lifestyle Link (evidence or not) By Cancer Site | American Institute for Cancer Research (AICR)
American Institute for Cancer Research (AICR)
By Cancer Site
Evidence shows that our risk for many types of cancer is related to diet, physical activity and weight. But for some types, it is not yet possible to determine if lifestyle plays a role. This does not mean such links are impossible, simply that more research is needed.The AICR/WCRF Expert Report and Continuous Update Project examines the evidence linking various lifestyle factors to cancers at 17 different body sites using a rigorous and objective process called Systematic Literature Reviews (SLRs).
Strong Evidence of Lifestyle Link
For 12 of these cancers, strong evidence emerged that diet, weight and physical activity can raise or lower risk. They are:- Colorectal Cancer — Updated Content
- Breast Cancer — Updated Content
- Endometrial (Lining of the Uterus) Cancer — Updated Content
- Esophageal Cancer — Updated Content
- Gallbladder Cancer
- Kidney Cancer
- Liver Cancer
- Lung Cancer
- Cancers of the Mouth, Pharynx and Larynx
- Pancreatic Cancer
- Prostate Cancer — Updated Content
- Stomach Cancer
No Strong Evidence of a Lifestyle Link
The expert panel also examined the available evidence for five other cancers using the same exacting SLR method. The results are as follows*:- Cervical Cancer
The expert panel concluded that there is as yet no strong evidence that any aspect of diet, physical activity and weight influences the risk of cervical cancer. - Bladder Cancer
The expert panel concluded that there is as yet no strong evidence that any aspect of diet, physical activity and weight influences the risk of bladder cancer. - Ovarian Cancer
To date, the strongest evidence linking any aspect of lifestyle to this cancer is related to adult attained height. This does not mean that being tall is a cause of ovarian cancer, however. Instead, it is believed that various genetic, hormonal and nutritional factors that contribute to adult attained height are likely the true underlying causes of ovarian cancer. - Skin Cancer
That skin cancer is directly caused by excessive sun exposure is well-established. The expert panel specifically examined the evidence linking skin cancer to aspects of diet, weight and physical activity. No strong evidence emerged, with the exception of arsenic in drinking water, for which a probable link to skin cancer was found. - Nasopharyngeal Cancer
This cancer is rare in the United States but common in Southern China. The panel, which examined the global evidence, concluded that consumption of Cantonese-style salted fish is probably a cause of this cancer.
Other Cancers
For the following cancers, evidence was too limited to examine using SLRs. For this reason, the Panel did not issue conclusions about them, but flagged the need for further research on possible lifestyle links*.- Thyroid Cancer
- Testicular Cancer
- Lymphoma (Hodgkin’s and Non-Hodgkin’s)
- Leukemia
- Multiple Myeloma
- Cancers of the Musculoskelatal System (Liposarcoma, fibrosarcoma, osteosarcoma, myosarcoma)
- Cancers of the Nervous system (Glioblastoma, meningoma, sellar tumor, cranial tumor, spinal nerve tumor, central nervous system lymphoma)
*NOTE: Although there is currently insufficient evidence to definitively determine if these cancers are related to diet, weight and physical activity, AICR funds innovative research involving these cancers that seeks to find and map such links.
Treatment of Dexamethasone-Induced Hiccup in Chemotherapy Patients by Methylprednisolone Rotation
abstract
Background.
Dexamethasone-induced hiccup (DIH) is an underrecognized symptom in
patients with cancer, and little information is available
about its treatment. The aims of this study were
to investigate the feasibility of methylprednisolone rotation as
treatment
and to confirm the male predominance among those
with cancer who experienced DIH during chemotherapy.
Methods. Persons with
cancer who experienced hiccups during chemotherapy treatment and who
were receiving treatment with dexamethasone
were presumed to have DIH. The following
algorithmic practice was implemented for antiemetic corticosteroid use:
rotation
from dexamethasone to methylprednisolone in the
next cycle and dexamethasone re-administration in the second cycle of
chemotherapy
after recognition of hiccups to confirm DIH. All
other antiemetics except corticosteroid remained unchanged. Patients (n = 40) were recruited from eight cancer centers in Korea from September 2012 to April 2013. Data were collected retrospectively.
Results. Hiccup
intensity (numeric rating scale [NRS]: 5.38 vs. 0.53) and duration
(68.44 minutes vs. 1.79 minutes) were significantly
decreased after rotation to methylprednisolone,
while intensity of emesis was not increased (NRS: 2.63 vs. 2.08). Median
dose
of dexamethasone and methylprednisolone were 10
mg and 50 mg, respectively. Thirty-four (85%) of 40 patients showed
complete
resolution of hiccups after methylprednisolone
rotation in the next cycle. Of these 34 patients, 25 (73.5%) had
recurrence
of hiccups after dexamethasone
re-administration. Compared with baseline values, hiccup intensity (NRS:
5.24 vs. 2.44) and
duration (66.43 minutes vs. 22.00 minutes) were
significantly attenuated after dexamethasone re-administration. Of the
40
eligible patients, 38 (95%) were male.
Conclusion. DIH during
chemotherapy could be controlled without losing antiemetic potential by
replacing dexamethasone with methylprednisolone.
We also identified a male predominance of DIH.
Further prospective studies are warranted.
FDA Documents Paint Disturbing Picture Of Burzynski Cancer Clinic (antineoplastons)
Burzynski Cancer Clinic
....Earlier this year, the FDA finally visited the Burzynski Clinic to take a peek around. Through FOIA request, a number of bloggers have been looking over the documents for a few months, but now they have been released publicly. The findings are very disturbing and paint a picture of a clinic that fails to follow even basic practices to protect patients. Among the published observations:.......
Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force
open access
"We developed an analytic framework (Appendix Figure 1 of the Supplement) with 4 key questions that we adapted from a 2006 review by Huang and colleagues (6). Our full report describes our methods in detail (7). We specifically sought studies of the following vitamins and minerals: vitamins A, B1, B2, B6, B12, C, D, and E; calcium; iron; zinc; magnesium; niacin; folic acid; β-carotene; and selenium. We included studies that evaluated single, paired, and combinations of three or more vitamins and minerals; we use the term “multivitamin” to refer to these combinations of vitamins and minerals."
.....In conclusion, we found no evidence of an effect of nutritional doses on CVD, cancer, or mortality in healthy individuals without known nutritional deficiencies for most supplements we examined. In most cases there are insufficient data to draw any conclusion, although for vitamin E and β-carotene a lack of benefit is consistent across several trials. We identified 2 multivitamin trials that both found lower overall cancer incidence in men (19, 21). Both these trials were both methodologically sound, but the lack of an effect for women (albeit in 1 trial), the borderline significance in men in both trials, and the lack of any effect on CVD in either study makes it difficult to conclude that multivitamin supplementation is beneficial."
A Double-Blind, Randomized Phase II Study to Evaluate the Safety and Efficacy of Acetyl-L-Carnitine in the Prevention of Sagopilone-Induced Peripheral Neuropathy
Acetyl-L-Carnitine
Background. Peripheral neuropathy (PN) is a recognized side effect of microtubule-targeting agents and the most clinically relevant toxicity observed with the epothilone sagopilone (SAG). Studies suggest that acetyl-L-carnitine (ALC) may prevent chemotherapy-induced PN. We conducted a prospective, placebo (PBO)-controlled, double-blind, randomized trial to investigate the safety and efficacy of ALC for the prevention of SAG-induced PN.
Methods. Patients with ovarian cancer (OC) or castration-resistant prostate cancer (CRPC) and no evidence of neuropathy received SAG
(16 mg/m2 intravenously over 3 hours every 3 weeks) with ALC (1,000 mg every 3 days) or placebo (PBO). The primary endpoint was incidence
of PN within six or fewer cycles in both treatment groups.
Results. Overall, 150
patients enrolled (98 OC patients, 52 CRPC patients), with 75 per
treatment arm. No significant difference in
overall PN incidence was observed between
treatment arms. The incidence of grade ≥3 PN was significantly lower in
the ALC
arm in OC patients. Median duration of
neuropathy was similar between treatment arms. The best overall response
(according
to the modified Response Evaluation Criteria in
Solid Tumors), response according to tumor markers, time-to-event
variables,
and discontinuations because of adverse events
(AEs) were comparable between treatment arms.
Conclusion.
Administration of ALC with SAG did not result in a significant
difference in overall PN incidence compared with a PBO. OC
patients in the SAG/ALC arm had a significantly
lower incidence of grade 3 or 4 PN compared with OC patients in the
SAG/PBO
arm.
Reported Reasons for Non-Use of an Internet-Based Patient-Provider Communication Service: Qualitative Interview Study | Varsi | Journal of Medical Internet Research
JMIR--Patients
Background: The adoption of Internet-based patient–provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients.
Objective: The goal of our study was to investigate patients’ views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service.
Methods: This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC.
Results: Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems.
Conclusions: Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use.
Subscribe to:
Posts
(
Atom
)
