Friday, January 30, 2015
Coffee, tea, and caffeine consumption and risk of epithelial ovarian cancer and borderline ovarian tumors: Results from a Danish case-control study
abstract
Background. Epidemiological studies that have investigated the association between coffee, tea and caffeine consumption and ovarian cancer risk have produced conflicting results. Furthermore, only few studies have examined the role of coffee and tea consumption separately for borderline ovarian tumors...........
Conclusions. Our results indicate that coffee consumption and total caffeine consumption from coffee and tea combined is associated with a modest decreased risk of ovarian cancer. However, more biological studies are needed to identify bioactive chemical compounds in coffee that potentially could affect ovarian cancer development.
Thursday, January 29, 2015
GINA, Genetic Discrimination, and Genomic Medicine — NEJM
open access
....As all medicine in a sense becomes genomic medicine, perhaps the genetic nondiscrimination secured by GINA will translate into nondiscrimination in all of medicine.
Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update 2014
Purpose
To provide current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer.
Methods
PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from November 2012 through July 2014. An update committee reviewed the identified abstracts.
Results
Of the 53 publications identified and reviewed, none prompted a change in the
2013 recommendations.
Recommendations
Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization. Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low–molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at
least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis (at least 6 months). Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer. Anticoagulation should not be used to extend survival of patients with cancer in the
absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should educate patients about the signs and symptoms of VTE.
Symptomatic Toxicities Experienced During Anticancer Treatment: Agreement Between Patient & Physician Reporting in 3 Randomized Trials
abstract
Purpose Information
about symptomatic toxicities of anticancer treatments is not based on
direct report by patients, but rather on
reports by clinicians in trials. Given the
potential for under-reporting, our aim was to compare reporting by
patients and
physicians of six toxicities (anorexia, nausea,
vomiting, constipation, diarrhea, and hair loss) within three randomized
trials.
Patients and Methods
In one trial, elderly patients with breast cancer received adjuvant
chemotherapy; in two trials, patients with advanced non–small-cell
lung cancer received first-line treatment.
Toxicity was prospectively collected by investigators (graded by
National Cancer
Institute Common Toxicity Criteria [version 2.0]
or Common Terminology Criteria for Adverse Events [version 3]). At the
end
of each cycle, patients completed the European
Organisation for Research and Treatment of Cancer quality-of-life
questionnaires,
including toxicity-related symptom items.
Possible answers were “not at all,” “a little,” “quite a bit,” and “very
much.”
Analysis was limited to the first three cycles.
For each toxicity, agreement between patients and physicians and
under-reporting
by physicians (ie, toxicity reported by patients
but not reported by physicians) were calculated.
Results Overall, 1,090
patients (2,482 cycles) were included. Agreement between patients and
physicians was low for all toxicities.
Toxicity rates reported by physicians were
always lower than those reported by patients. For patients who reported
toxicity
(any severity), under-reporting by physicians
ranged from 40.7% to 74.4%. Examining only patients who reported “very
much”
toxicity, under-reporting by physicians ranged
from 13.0% to 50.0%.
Conclusion Subjective
toxicities are at high risk of under-reporting by physicians, even when
prospectively collected within randomized
trials. This strongly supports the incorporation
of patient-reported outcomes into toxicity reporting in clinical
trials.
Biomarker for PARP inhibitor responsiveness in ovarian cancer patients - video
video (2014)
Prof Swisher talks to ecancertv at the 26th EORTC-NCI-AACR Symposium about data from a phase II trial, ARIEL2, which aims to identify patients with ovarian cancer likely to respond to rucaparib.
Population Distribution of Lifetime Risk of Ovarian Cancer in the United States
abstract
Background:
In U.S. women, lifetime risk of ovarian cancer is 1.37%, but some women are at a substantially lower or higher risk than this average.
Methods:
We have characterized the distribution of lifetime risk in the general population.
Published data on the relative risks and their variances for five well-accepted risk and protective factors for ovarian cancer, oral contraceptive (OC) use, parity, tubal ligation, endometriosis and first degree family history of ovarian cancer in conjunction with a genetic risk score using genome-wide significant common, low penetrance variants were used. The joint distribution of these factors (i.e., risk/protective factor profiles) were derived using control data from four US population-based studies, providing a broad representation of women in the US.
Results: A total of 214 combinations of risk/protective factors were observed and the lifetime risk estimates ranged from 0.35% (95% CI 0.29-0.42) to 8.78% (95% CI 7.10-10.9). Among women with lifetime risk ranging from 4-9%, 73% had no family history of ovarian cancer; most of these women had a self-reported history of endometriosis.
Conclusions:
Profiles including the known modifiable protective factors of OC use and tubal ligation were associated with a lower lifetime risk of ovarian cancer. OC use and tubal ligation were essentially absent among the women at 4-9% lifetime risk.
Impact:
This work demonstrates that there are women in the general population who have a much higher than average lifetime risk of ovarian cancer. Preventive strategies are available. Should effective screening become available, higher than average risk women can be identified.
Epigenetic analysis of sporadic and Lynch-associated ovarian cancers reveals histology-specific patterns of DNA methylation
open access
Abstract
Diagnosis
and treatment of epithelial ovarian cancer is challenging due to the
poor understanding of the pathogenesis of the disease. Our aim was to
investigate epigenetic mechanisms in ovarian tumorigenesis and,
especially, whether tumors with different histological subtypes or
hereditary background (Lynch syndrome) exhibit differential
susceptibility to epigenetic inactivation of growth regulatory genes.
Gene candidates for epigenetic regulation were identified from the
literature and by expression profiling of ovarian and endometrial cancer
cell lines treated with demethylating agents. Thirteen genes were
chosen for methylation-specific multiplex ligation-dependent probe
amplification assays on 104 (85 sporadic and 19 Lynch
syndrome-associated) ovarian carcinomas. Increased methylation (i.e.,
hypermethylation) of variable degree was characteristic of ovarian
carcinomas relative to the corresponding normal tissues, and
hypermethylation was consistently more prominent in non-serous than
serous tumors for individual genes and gene sets investigated. Lynch
syndrome-associated clear cell carcinomas showed the highest frequencies
of hypermethylation. Among endometrioid ovarian carcinomas, lower
levels of promoter methylation of RSK4, SPARC, and HOXA9 were significantly associated with higher tumor grade; thus, the
methylation patterns showed a shift to the direction of high-grade
serous tumors.
In conclusion, we provide evidence of a frequent
epigenetic inactivation of RSK4, SPARC, PROM1, HOXA10, HOXA9, WT1-AS, SFRP2, SFRP5, OPCML,
and MIR34B in the development of non-serous ovarian carcinomas of Lynch
and sporadic origin, as compared to serous tumors. Our findings shed
light on the role of epigenetic mechanisms in ovarian tumorigenesis and
identify potential targets for translational applications.
Improving Care and Support for Unpaid Caregivers in Ontario - Citizen Brief
This Citizen Brief was produced by the McMaster Health Forum to serve as the basis for discussions by a citizen panel about improving care and support for unpaid caregivers in Ontario.
The need to identify how to improve care and support for unpaid caregivers has attracted a lot of attention from governments, media and the public, in part because of the increasing number of people who are acting as unpaid caregivers. In 2012, it was estimated that 8.1 million Canadians provided care to a family member or friend with a long-term health condition (most commonly cancer) or aging-related needs. In Ontario, about 20% of the population serve as a caregivers to family members and provide the majority of care needed.
Much of the burden of continuing care falls on unpaid caregivers. In 2012, it was estimated that 8.1 million Canadians provided care to a family member or friend with a long-term health condition or aging-related needs.
A citizen panel is an innovative way to seek public input on high-priority issues. Each panel brings together 10-14 citizens from all walks of life. Panel members share their ideas and experiences on an issue, and learn from research evidence and from the views of others. The discussions of a citizen panel can reveal new understandings about an issue and spark insights about how it should be addressed.
This brief includes information on this topic, including what is known about:
- the underlying problem;
- three possible options to address the problem; and
- potential barriers and facilitators to implementing these options.
2015 Ovarian Cancer National Conference –scholarships/agenda
OCNA
Here's our other can't-miss news about the National Conference:
- We are now accepting scholarships to attend the National Conference. Our scholarship program allows patients and caregivers to learn about ovarian cancer and connect with others who share their experiences. A limited number of scholarships are available for travel, hotel and/or registration fees. Click here to apply for a 2015 scholarship. Please note: the last day to apply is Friday, April 3, 2015.
Have Insurers Found Way Around Obamacare 'Pre-Existing Conditions' Rule? (U.S.)
MedNews
WEDNESDAY Jan. 28, 2015, 2015 -- Some insurance companies may be using high-dollar pharmacy co-pays to flout the Affordable Care Act's (ACA) mandate against discrimination on the basis of pre-existing health problems, Harvard researchers claim.
These insurers may have structured their drug coverage to discourage people with HIV from enrolling in their plans through the health insurance marketplaces created by the ACA, sometimes called "Obamacare," the researchers contend in the Jan. 29 issue of the New England Journal of Medicine......
'... It's important for consumers to know that if they find themselves in plans like this, they should be reporting it to their state insurance commissioner, the HHS Office of Civil Rights, and their health insurance marketplace," she said.
More information
For more on the Affordable Care Act, visit the U.S. Department of Health and Human Services.
Wednesday, January 28, 2015
Coexistent ARID1A-PIK3CA mutations promote ovarian clear-cell tumorigenesis through pro-tumorigenic inflammatory cytokine signalling
abstract
Ovarian
clear-cell carcinoma (OCCC) is an aggressive form of ovarian cancer
with high ARID1A mutation rates. Here we present a mutant mouse model of
OCCC. We find that ARID1A inactivation is not sufficient for tumour
formation, but requires concurrent activation of the phosphoinositide
3-kinase catalytic subunit, PIK3CA. Remarkably, the mice develop highly
penetrant tumours with OCCC-like histopathology, culminating in
haemorrhagic ascites and a median survival period of 7.5 weeks.
Therapeutic treatment with the pan-PI3K inhibitor, BKM120, prolongs
mouse survival by inhibiting the tumour cell growth. Cross-species gene
expression comparisons support a role for IL-6 inflammatory cytokine
signalling in OCCC pathogenesis. We further show that ARID1A and PIK3CA
mutations cooperate to promote tumour growth through sustained IL-6
overproduction. Our findings establish an epistatic relationship between
SWI/SNF chromatin remodelling and PI3K pathway mutations in OCCC and
demonstrate that these pathways converge on pro-tumorigenic cytokine
signalling. We propose that ARID1A protects against inflammation-driven
tumorigenesis.
Tuesday, January 27, 2015
Assessment of published models and prognostic variables in ovarian cancer at Mayo Clinic
Abstract
OBJECTIVES:
Epithelial ovarian cancer (EOC) is an aggressive disease in which first line therapy consists of a surgical staging/debulking procedure and platinum based chemotherapy. There is significant interest in clinically applicable, easy to use prognostic tools to estimate risk of recurrence and overall survival. In this study we used a large prospectively collected cohort of women with EOC to validate currently published models and assess prognostic variables.METHODS:
Women with invasive ovarian, peritoneal, or fallopian tube cancer diagnosed between 2000-2011 and prospectively enrolled into the Mayo Clinic Ovarian Cancer registry were identified. Demographics and known prognostic markers as well as epidemiologic exposure variables were abstracted from the medical record and collected via questionnaire. Six previously published models of overall and recurrence-free survival were assessed for external validity. In addition, predictors of outcome were assessed in our dataset.RESULTS:
Previously published models validated with a range of c-statistics (0.587-0.827), though application of models containing variables not part of routine practice were somewhat limited by missing data; utilization of all applicable models and comparison of results is suggested. Examination of prognostic variables identified only the presence of ascites and ASA score to be independent predictors of prognosis in our dataset, albeit with marginal gain in prognostic information, after accounting for stage and debulking.CONCLUSIONS:
Existing prognostic models for newly diagnosed EOC showed acceptable calibration in our cohort for clinical application. However, modeling of prospective variables in our dataset reiterates that stage and debulking remain the most important predictors of prognosis in this setting.Borderline epithelial tumors of the ovary: Experience of 55 patients.
abstract
The objective of the present study was to evaluate the clinicopathological features and the survival time estimates in patients treated for borderline ovarian tumors (BOTs). A retrospective review of all patients treated for BOTs at the University of Bari (Bari, Italy) between 1991 and 2011 was performed. Data were obtained from hospital records and gynecological oncology charts. A total of 55 patients were identified. The median age was 40 years (range, 13-79 years). The majority of the patients (85.5%) exhibited International Federation of Obstetrics and Gynecology (FIGO) stage I disease and the remainder exhibited FIGO stage II/III (7.3% in each stage). Serous histology was found in 60.0% of the cases and an elevation of the cancer antigen-125 serum level occurred in 23.6% of the cases. All patients underwent surgery and 3.7% received chemotherapy. In total, 10.9% exhibited recurrence and the median survival rate was 39 months. The median survival time and the five-year survival rate were 42 months (range, 16-84 months) and 97%, respectively. Therefore, BOTs have an excellent prognosis. Conservative surgery should be considered for patients of reproductive age who desire preservation of fertility. A long-term follow-up is highly recommended for these tumors.
Is There a Role for Oral or Intravenous Ascorbate (Vitamin C) in Treating Patients With Cancer?
abstract plus free full text
Conclusion. There is no high-quality evidence to suggest that
ascorbate supplementation in cancer patients either enhances
the antitumor effects of chemotherapy or reduces its toxicity.
Given the high financial and time costs to patients of this
treatment, high-quality placebo-controlled trials are needed.
This Article
-
The Oncologist January 2015 theoncologist.2014-0381
- » Abstract
- Full Text (PDF)
Monday, January 26, 2015
Causes of Diagnosis Errors & Prevention - CRICO risk Management
Blogger's Note: includes surgery and (selected) cancers; infographs
Causes of Diagnosis Errors & Prevention
CRICO Strategies, a division of the Risk Management Foundation of the Harvard Medical Foundation, just released the 2014 Annual Benchmarking Reporting: Malpractice Risks in the Diagnosis Process. This report analyzes more than 8,400 factors from 2,685 ambulatory diagnosis-related malpractice cases. The analysis helps to identify where and when diagnosis-related errors most commonly occur and what changes are needed to prevent them. This 20-page report is available on the CRICO Strategies website.
Malnutrition at Hospital Admission—Contributors and Effect on Length of Stay (Canada)
abstract
Background:
In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS.
Materials and Methods:
This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization.
Results:
One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%–48%) were malnourished, and based on BMI, 32% (95% CI, 29%–35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1–117) days. After controlling for demographic, socioeconomic, and disease-related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62–0.86). Other nutrition-related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor.
Conclusion: Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age-related social factors are contributors.
Will Cancer Society's Redo Be Its Undoing? (U.S.)
Medpage Today
"... "When I joined the Board funding for external research grants was 22% and when I left it was down to 10%,"...
Sunday, January 25, 2015
Case Report: METASTASIS OF OVARIAN CANCER TO BREAST: THE IMPORTANCE OF PATHOLOGIC FEATURES IN THE DIAGNOSIS OF RECURRENCES
open access(pdf)
.....We suggest that, in patients with history of ovarian cancer who present with axillary or breast mass, every effort should be made to have an accurate histological diagnosis since this has a great impact on treatment. It is critical to recognize histologic pattern and distinguish it from de novo ductal carcinoma in situ. Immunohistochemistry is essential when the diagnosis is still vague.
Cytologic features of ovarian granulosa cell tumors in pleural and ascitic fluids
abstract
Adult granulosa cell tumor (AGCT) is an uncommon neoplasm of the ovary with potential for aggressive behavior and late recurrence. The most important prognostic factor for AGCT is tumor stage. Thus, cytological assessment of pleural or ascitic fluids is crucial for initial staging and subsequent patient management. We report herein two cases of ovarian AGCT presenting with exfoliated tumor cells in pleural and ascitic fluid. The first case involved a 61-year-old woman who presented with stage Ic (a) AGCT. Seven years after initial diagnosis, pleural effusion and pleural dissemination were identified. The second case involved a 50-year-old woman who presented with stage IV AGCT with massive ascites and right pleural effusion. Fluid cytology from both cases showed cohesive or loose clusters of small uniform neoplastic cells with round-to-oval nuclei, coffee-bean-shaped nuclear grooves, small nucleoli, and scant cytoplasm. Call-Exner bodies were also observed in these cytologic specimens. In the differential diagnosis of small monomorphic tumor cells in pleural effusion or ascites, coffee-bean-shaped nuclear grooves and cell clusters forming Call-Exner bodies are diagnostic clues of AGCT.
Saturday, January 24, 2015
Relationship Between Surgical Oncologic Outcomes and Publically Reported Hospital Quality and Satisfaction Measures
abstract / editorial
Abstract
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
Background:
Hospital-level measures of patient satisfaction and quality are now
reported publically by the Centers for Medicare and Medicaid
Services. There are limited metrics specific to
cancer patients. We examined whether publically reported hospital
satisfaction
and quality data were associated with surgical
oncologic outcomes.
Methods: The
Nationwide Inpatient Sample was utilized to identify patients with solid
tumors who underwent surgical resection in 2009
and 2010. The hospitals were linked to Hospital
Compare, which collects data on patient satisfaction, perioperative
quality,
and 30-day mortality for medical conditions
(pneumonia, myocardial infarction [MI], and congestive heart failure
[CHF]). The
risk-adjusted hospital-level rates of morbidity
and mortality were calculated for each hospital and the means compared
between
the highest and lowest performing hospital
quartiles and reported as absolute reduction in risk (ARR), the
difference in risk
of the outcome between the two groups. All
statistical tests were two-sided.
Results: A total of
63197 patients treated at 448 hospitals were identified. For patients at
high vs low performing hospitals based
on Hospital Consumer Assessment of Healthcare
Providers and Systems scores, the ARR in perioperative morbidity was
3.1% (blogger note: see abstract for stats -abbreviated for easy reading). Similarly, the ARR for mortality based on the same measure was -0.4% . High performance on perioperative quality measures resulted in an ARR of 0% to 2.2% for perioperative morbidity . Similarly, there was no statistically significant
association between hospital-level mortality rates for
MI , heart
failure or pneumonia and complications for
oncologic surgery patients.
Conclusion: Currently available measures of patient satisfaction and quality are poor predictors of outcomes for cancer patients undergoing
surgery. Specific metrics for long-term oncologic outcomes and quality are needed.
Correspondence: Are we ready for conservative treatment in ovarian cancer?
Correspondence: open access
In conclusion, we think we are ready for fertility-sparing surgery in early epithelial ovarian cancer as an effective alternative to conventional radical surgery in younger women but just for selected cases where recurrence rate is very low such as FIGO stage IA/IB-G1/G2, and we need to be very careful with stages IC and G3 individualizing every case.
Original article: open access
[brain tumors] Glioblastomas, astrocytomas and oligodendrogliomas linked to Lynch syndrome
abstract
Glioblastomas, astrocytomas and oligodendrogliomas linked to Lynch syndrome
Background and purpose
Brain tumors represent a rare and relatively uncharacterized tumor type in Lynch syndrome.
Methods
The
national Danish Hereditary Nonpolyposis Colorectal Cancer Register was
utilized to estimate the cumulative life-time risk for brain tumors in
Lynch syndrome, and the mismatch repair (MMR) status in all tumors
available was evaluated.
Results
Primary
brain tumors developed in 41/288 families at a median age of 41.5
(range 2–73) years. Biallelic MMR gene mutations were linked to brain
tumor development in childhood. The risk of brain tumors was
significantly higher (2.5%) in MSH2 gene mutation carriers compared to patients with mutations in MLH1 or MSH6.
Glioblastomas predominated (56%), followed by astrocytomas (22%) and
oligodendrogliomas (9%). MMR status was assessed in 10 tumors, eight of
which showed MMR defects. None of these tumors showed
immunohistochemical staining suggestive of the IDH1 R132H mutation.
Conclusion
In Lynch syndrome brain tumors occurred in 14% of the families with significantly higher risks for individuals with MSH2 gene mutations and development of childhood brain tumors in individuals with constitutional MMR defects.
Reporting and Grading Financial Toxicity (the Art of Oncology series)
open access
Proposed Financial Toxicity Grading Criteria
| Grade | Description |
|---|---|
| 1 | Lifestyle modification (deferral of large purchases or reduced spending on vacation and leisure activities) because of medical expenditure |
| Use of charity grants/fundraising/copayment program mechanisms to meet costs of care | |
| 2 | Temporary loss of employment resulting from medical treatment |
| Need to sell stocks/investments for medical expenditure | |
| Use of savings accounts, disability income, or retirement funds for medical expenditure | |
| 3 | Need to mortgage/refinance home to pay medical bills |
| Permanent loss of job as a result of medical treatment | |
| Current debts > household income | |
| Inability to pay for necessities such as food or utilities | |
| 4 | Need to sell home to pay for medical bills |
| Declaration of bankruptcy because of medical treatment | |
| Need to stop treatment because of financial burden | |
| Consideration of suicide because of financial burden of care |
Exceptions to the Rule: Case Studies in the Prediction of Pathogenicity for Genetic Variants in Hereditary Cancer Genes
abstract
Based on current consensus guidelines and standard practice, many genetic variants detected in clinical testing are classified as disease-causing based on their predicted impact on the normal expression or function of the gene in the absence of additional data. However, our laboratory has identified a subset of such variants in hereditary cancer genes for which compelling contradictory evidence emerged after the initial evaluation following the first observation of the variant. Three representative examples of variants in BRCA1, BRCA2 and MSH2 that are predicted to disrupt splicing, prematurely truncate the protein, or remove the start codon were evaluated for pathogenicity by analyzing clinical data with multiple classification algorithms. Available clinical data for all 3 variants contradicts the expected pathogenic classification. These variants illustrate potential pitfalls associated with standard approaches to variant classification as well as the challenges associated with monitoring data, updating classifications, and reporting potentially contradictory interpretations to the clinicians responsible for translating test outcomes to appropriate clinical action. It is important to address these challenges now as the model for clinical testing moves towards the use of large multi-gene panels and whole exome/genome analysis, which will dramatically increase the number of genetic variants identified.
Usefulness of Diagnostic Indices Comprising Clinical, Sonographic, and Biomarker Data for Discriminating Benign From Malignant Ovarian Masses
abstract
J Ultrasound Med. 2015 Feb
Pazopanib and Liposomal Doxorubicin in the Treatment of Patients with Relapsed/Refractory Epithelial Ovarian Cancer: A Phase Ib Study of the Sarah Cannon Research Institute
abstract
Purpose:
To investigate the combination of liposomal doxorubicin/pazopanib in
advanced relapsed/refractory ovarian cancer.
Patients and Methods: Twenty-two patients received liposomal doxorubicin/pazopanib. Initial doses (liposomal doxorubicin, 40 mg/m2 monthly; pazopanib, 400 mg daily) were too toxic; three subsequent groups received lower doses/altered schedules.
Results: The maximum tolerated doses (MTD) were liposomal doxorubicin, 30 mg/m2, and pazopanib, 400 mg daily. Severe toxicity included neutropenia (18%), rash/desquamation (14%), hypertension (9%), and hand-foot syndrome (9%). Five of the eight patients treated with MTD had grade 3 toxicity during the first two cycles. Dose reductions were frequently required.
Conclusions: Further development of the liposomal doxorubicin/pazopanib combination is not recommended.
Patients and Methods: Twenty-two patients received liposomal doxorubicin/pazopanib. Initial doses (liposomal doxorubicin, 40 mg/m2 monthly; pazopanib, 400 mg daily) were too toxic; three subsequent groups received lower doses/altered schedules.
Results: The maximum tolerated doses (MTD) were liposomal doxorubicin, 30 mg/m2, and pazopanib, 400 mg daily. Severe toxicity included neutropenia (18%), rash/desquamation (14%), hypertension (9%), and hand-foot syndrome (9%). Five of the eight patients treated with MTD had grade 3 toxicity during the first two cycles. Dose reductions were frequently required.
Conclusions: Further development of the liposomal doxorubicin/pazopanib combination is not recommended.
Friday, January 23, 2015
International Profiles of Health Care Systems, 2014: Australia, Canada, Denmark, England, France, Germany, Italy, Japan, The Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the US
The Commonwealth Fund
Overview
This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views. Read the report.video: Future of cancer treatment at the World Economic Forum
video CBS news
|CBS News medical contributor Dr. David Agus speaks with Dr. Jose Baselga, physician-in-chief and chief medical officer of Memorial Sloan Kettering Cancer Center, about the future of cancer treatment and genome mapping.
ASCO launches big data effort to study cancer
media
The American Society of Clinical Oncology is teaming up with SAP on an big data initiative that will use EHRs to examine previously inaccessible information that may lead to early identification on potential cancer patients.....
Unexpected Gynecologic Malignancy Diagnosed After Hysterectomy Performed for Benign Indications
abstract
OBJECTIVE: To define the incidence of unexpected
gynecologic malignancies among women who underwent hysterectomy for
benign indications.
METHODS: We conducted a data analysis of hysterectomy
cases from a quality and safety database maintained by the Michigan
Surgical Quality Collaborative, a statewide group of hospitals that
voluntarily reports perioperative outcomes. Cases were abstracted from
January 1, 2013, through December 8, 2013. Benign preoperative surgical
indications included pelvic mass, family history of cancer, hyperplasia
without atypia, prolapse, endometriosis, pelvic pain, abnormal uterine
bleeding, or leiomyomas. Women with a surgical indication of cancer,
cervical dysplasia, or hyperplasia with atypia were excluded.
Costs and Benefits of Opportunistic Salpingectomy as an Ovarian Cancer Prevention Strategy
abstract/full text
OBJECTIVE: To conduct a cost-effectiveness analysis of
opportunistic salpingectomy (elective salpingectomy at hysterectomy or
instead of tubal ligation).
METHODS: A Markov Monte Carlo simulation model
estimated the costs and benefits of opportunistic salpingectomy in a
hypothetical cohort of women undergoing hysterectomy for benign
gynecologic conditions or surgical sterilization. The primary outcome
measure was the incremental cost-effectiveness ratio. Effectiveness was
measured in terms of life expectancy gain. Sensitivity analyses
accounted for uncertainty around various parameters. Monte Carlo
simulation estimated the number of ovarian cancer cases associated with
each strategy in the Canadian population.
RESULTS: Salpingectomy with hysterectomy was less
costly ($11,044.32±$1.56) than hysterectomy alone ($11,206.52±$29.81) or
with bilateral salpingo-oophorectomy ($12,626.84±$13.11) but more
effective at 21.12±0.02 years compared with 21.10±0.03 and 20.94±0.03
years, representing average gains of 1 week and 2 months, respectively.
For surgical sterilization, salpingectomy was more costly
($9,719.52±$3.74) than tubal ligation ($9,339.48±$26.74) but more
effective at 22.45±0.02 years compared with 22.43±0.02 years (average
gain of 1 week) with an incremental cost-effectiveness ratio of $27,278
per year of life gained. Our results were stable over a wide range of
costs and risk estimates. Monte Carlo simulation predicted that
salpingectomy would reduce ovarian cancer risk by 38.1% (95% confidence
interval [CI] 36.5–41.3%) and 29.2% (95% CI 28.0–31.4%) compared with
hysterectomy alone or tubal ligation, respectively.
CONCLUSION: Salpingectomy with hysterectomy for benign
conditions will reduce ovarian cancer risk at acceptable cost and is a
cost-effective alternative to tubal ligation for sterilization.
Opportunistic salpingectomy should be considered for all women
undergoing these surgical procedures.
Over the past decade, there is increasing evidence that the majority of
ovarian cancers arise in the fallopian tube and not primarily in the
ovary.1–4
Consequently, in 2010 the British Columbia Ovarian Cancer Research
Group
Dying with Dignity | It's your life. It's your choice. - Take action (Ontario)
Dying with Dignity
Toolkit for Submissions on CPSO's Draft Policy on End-of-Life Care
Looking
to provide feedback on the College of Physicians and Surgeons of
Ontario's draft policy of end-of-life care? We've put together a toolkit
to help you craft a forceful appeal.
As we've said, the CPSO has made it easy to provide feedback on its proposed end-of-life care policies. You can submit your thoughts in the following ways:
2) Include a forceful opening statement. In clear, concise language, tell committee members why the CPSO needs to play a strong role in developing a legal and regulatory framework for assisted dying in Ontario. This can take the form of a short introductory paragraph or a list of bullet points.
3) Stress the importance of timing. With the Supreme Court set to weigh in on the future of the Criminal Code ban on assisted dying, and with end-of-life bills on the table in Parliament, Canadian doctors face the very real possibility that the practice could become legal this year.
4) Bring up Quebec. Physicians were instrumental in the crafting of Bill 52, an end-of-life care bill that passed through Quebec’s National Assembly last year. Set to come into force at the end of 2015, the law ensconces palliative care as a right and grants Quebecers the option to choose medically assisted dying so long as they fulfill certain criteria.
4) Use personal experience. If possible, include a personal anecdote to illustrate why it’s important for the CPSO to take a stand. Have you encountered physicians who were ill-equipped or simply unwilling to discuss a wide range of end-of-life care options, including assisted dying, with you or members of your family? Are you worried that the orders you’ve made in your Advance Care Plan won’t be respected? It is our experience personal stories carry a lot of weight in consultations like these.
5) Include your professional qualifications/background, if appropriate. Do you have a background in the healthcare profession? If so, note it. In addition, state how your work has shaped your perspective on end-of-life care. If you don’t work in health field, feel free to state your professional background affects your point of view, too. The CPSO is asking for the input from people from all walks of life — not just medical practitioners
- By posting to the CPSO's end-of-life care discussion forum;
- By firing off an e-mail to ;
- By filling out a quick and easy online survey (there are text boxes in which you can elaborate on your responses);
- By sending a letter through the mail. (To: College of Physicians and Surgeons of Ontario, 80 College St., Toronto, Ont., M5G 2E2)
Toolkit for written submissions to the College of Physicians and Surgeons of Ontario
1) Read the CPSO’s draft policy, “Planning for and Providing Quality of End-of-Life Care.” It’s not long — only 15-pages, and the font is large. Knowing what’s in the document will help you respond to, and expand upon, the organization’s new policies.2) Include a forceful opening statement. In clear, concise language, tell committee members why the CPSO needs to play a strong role in developing a legal and regulatory framework for assisted dying in Ontario. This can take the form of a short introductory paragraph or a list of bullet points.
3) Stress the importance of timing. With the Supreme Court set to weigh in on the future of the Criminal Code ban on assisted dying, and with end-of-life bills on the table in Parliament, Canadian doctors face the very real possibility that the practice could become legal this year.
4) Bring up Quebec. Physicians were instrumental in the crafting of Bill 52, an end-of-life care bill that passed through Quebec’s National Assembly last year. Set to come into force at the end of 2015, the law ensconces palliative care as a right and grants Quebecers the option to choose medically assisted dying so long as they fulfill certain criteria.
4) Use personal experience. If possible, include a personal anecdote to illustrate why it’s important for the CPSO to take a stand. Have you encountered physicians who were ill-equipped or simply unwilling to discuss a wide range of end-of-life care options, including assisted dying, with you or members of your family? Are you worried that the orders you’ve made in your Advance Care Plan won’t be respected? It is our experience personal stories carry a lot of weight in consultations like these.
5) Include your professional qualifications/background, if appropriate. Do you have a background in the healthcare profession? If so, note it. In addition, state how your work has shaped your perspective on end-of-life care. If you don’t work in health field, feel free to state your professional background affects your point of view, too. The CPSO is asking for the input from people from all walks of life — not just medical practitioners
Salpingectomy as a Means to Reduce Ovarian Cancer Risk
PDF] Salpingectomy as a Means to Reduce Ovarian Cancer Risk
Cancer Prevention 2015
ABSTRACT
Bilateral salpingo-oophorectomy (BSO) has become the standard of care for risk
reduction in women at hereditary risk of ovarian cancer. While this procedure significantly
decreases both the incidence of and mortality from ovarian cancer, it impacts quality of life, and the premature cessation of ovarian function may have long term health hazards. Recent advances in our understanding of the molecular pathways of ovarian cancer point to the fallopian tube epithelium as the origin of most high grade serous cancers (HGSC). This evolving appreciation of the role of the fallopian tube in HGSC has led to the consideration of salpingectomy alone as an option for risk management, especially in premenopausal women. In addition, it is postulated that bilateral salpingectomy with ovarian retention (BSOR), may have a public health benefit for women undergoing benign gynecologic surgery. In this review we provide the rationale for salpingectomy as an ovarian cancer risk reduction strategy.
A Systematic Review of the Bimanual Examination as a Test for Ovarian Cancer
Abstract
Context
An
annual bimanual pelvic examination remains widely recommended for
healthy women, but its inclusion may discourage attendance. Our goal was
to determine the accuracy of the pelvic examination as a screening test
for ovarian cancer and to distinguish benign from malignant lesions.
Evidence acquisition
PubMed
was searched to identify studies evaluating the accuracy of the
bimanual pelvic examination for ovarian cancer diagnosis. Data regarding
study design, study quality, and test accuracy were abstracted.
Heterogeneity was evaluated and meta-analysis performed where
appropriate, including bivariate receiver operating characteristic
curves.
Evidence synthesis
Eight studies in screening populations (n=36,599) and seven studies in symptomatic patients (n=782)
were identified. Search was completed in November 2013; included
studies were published between 1988 and 2009. Screening studies were
homogeneous; the summary estimates of sensitivity and specificity of the
pelvic examination as a screening test for ovarian cancer were 0.44 and
0.98 (positive likelihood ratio, 24.7; negative likelihood ratio,
0.57). For distinguishing benign versus malignant lesions, there was
considerable heterogeneity, with a range of sensitivity from 0.43 to
0.93 and specificity from 0.53 to 0.91.
Conclusions
The
bimanual pelvic examination lacks accuracy as a screening test for
ovarian cancer and as a way to distinguish benign from malignant
lesions. In a typical screening population, the positive predictive
value of an abnormal pelvic examination is only 1% (95% CI=0.67%, 3.0%).
Its inclusion in a health maintenance examination cannot be justified
on the basis of using it to screen for ovarian cancer.
Bilateral ovarian metastases from ureteric urothelial cancer: Initial case report and distinguishing role of immunohistochemistry
Blogger's Note: of interest to Lynch Syndrome patients
abstract
Full Text: PDF
Abstract
Urothelial cancers of the upper tract are aggressive malignancies
with a propensity for distant metastases. Transitional cell carcinoma
can also develop de novo in the ovaries and differentiation between
these lesions requires immunohistochemistry. We report a case of right
lower ureteric urothelial carcinoma with metastases to both ovaries. To
our knowledge, this is the first reported case of bilateral ovarian
metastases from an upper tract primary, diagnosed with
immunohistochemistry.
case, the ovarian lesions were positive for CK7 and CK20,
and negative for WT1, indicating the primary was in the
urinary tract. Differentiation is important as ovarian primaries
are more chemosensitive and have a better prognosis.5"
Paradoxes of follow-up – health professionals’ views on follow-up after surgical treatment in gynecological cancer care
Blogger's Note: "shift in focus is needed from relapse to quality of life after cancer"
In absence of the full text, a case could be made for prevention and/or early detection of second primary cancers. Myriad Genetics recently published stats on Lynch Syndrome patients of which 50% will face a second primary within 15 years of original diagnosis.
abstract
Objective. Evidence now reveals that attending a
follow-up program may not improve survival for low-stage gynecological
cancer patients. The aim of this study was to explore health
professionals’ experiences with the follow-up programs and their views
on follow-up in the future.
Methods. A qualitative approach was undertaken with semi-structured focus group interviews. Three focus group interviews were conducted at neutral ground. One group with onco-gynecologists, one group with specialist nurses, and one mixed group. The main themes of the interviewguide were: Existing follow-up program, life after cancer and future follow-up. The interviews were transcribed verbatim. Patterns and themes were uncovered from the data inspired by interpretive description.
Results. The doctors described most advantages, such as: Quality control of their own work, detection of sequelae after surgery, and credit and appraisal from the patients. A disadvantage was the inadequate use of the nurses’ main competencies. Some dilemmas were described by the nurses as well as doctors: First, both groups were aware of the existing evidence that attendance of follow-up programs may not improve survival and yet, health professionals still performed the follow-ups and most often did not address this paradox for the patients. Second, the existing follow-up program seemed to bring the patients comfort and security on one hand, but on the other hand it seemed to induce insecurity and anxiety. The health professionals agreed that future follow-up should be individualized with focus on the single patients’ needs and psychological wellbeing. The health professionals identified a great challenge in communicating the evidence and the forthcoming changes in the follow-up programs to the patients.
Methods. A qualitative approach was undertaken with semi-structured focus group interviews. Three focus group interviews were conducted at neutral ground. One group with onco-gynecologists, one group with specialist nurses, and one mixed group. The main themes of the interviewguide were: Existing follow-up program, life after cancer and future follow-up. The interviews were transcribed verbatim. Patterns and themes were uncovered from the data inspired by interpretive description.
Results. The doctors described most advantages, such as: Quality control of their own work, detection of sequelae after surgery, and credit and appraisal from the patients. A disadvantage was the inadequate use of the nurses’ main competencies. Some dilemmas were described by the nurses as well as doctors: First, both groups were aware of the existing evidence that attendance of follow-up programs may not improve survival and yet, health professionals still performed the follow-ups and most often did not address this paradox for the patients. Second, the existing follow-up program seemed to bring the patients comfort and security on one hand, but on the other hand it seemed to induce insecurity and anxiety. The health professionals agreed that future follow-up should be individualized with focus on the single patients’ needs and psychological wellbeing. The health professionals identified a great challenge in communicating the evidence and the forthcoming changes in the follow-up programs to the patients.
Conclusions.
This study revealed that the existing follow-up regime contains several
dilemmas. According to the health professionals, future follow-up must
be more individualized, and a shift in focus is needed from relapse to
quality of life after cancer.
Thursday, January 22, 2015
Editorial: Cancer: mixed messages, common purpose (Lancet)
full text
On Jan 2, a research paper published in Science by Cristian Tomasetti and Bert Vogelstein proclaimed that most individual cancers, 65%, could be attributed to “bad luck”—random events such as errors in DNA replication—rather than to environmental or inherited risk factors. This eyecatching message has drawn comment, partly because of the inbuilt uncertainty in the study's methods and headline estimate (with its 95% confidence interval of 39–81) and partly because of the conclusion's incompatibility with public health evidence and thinking......
Breast Cancer Patients Referred for Genetic Testing Likely to Have Mutations Other Than BRCA1/2
Mutations
Results
revealed that 1608 (9.5%) of females and 32 (16.2%) of males were
positive for at least one deleterious or suspected deleterious mutation.
Interestingly, among these mutations:
- 48.9% were detected in the Hereditary Breast and Ovarian Cancer (HBOC) genes BRCA1 and BRCA2.
- 42.1% were detected in other genes associated with breast cancer.
- 6.6% were detected in Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2, EPCAM).
- 2.3% were detected in other genes not associated with breast cancer (APC, MUTYH, RAD51D, CDKN2A, SMAD4).
Results
revealed that 1608 (9.5%) of females and 32 (16.2%) of males were
positive for at least one deleterious or suspected deleterious mutation.
Interestingly, among these mutations:
- 48.9% were detected in the Hereditary Breast and Ovarian Cancer (HBOC) genes BRCA1 and BRCA2.
- 42.1% were detected in other genes associated with breast cancer.
- 6.6% were detected in Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2, EPCAM).
- 2.3% were detected in other genes not associated with breast cancer (APC, MUTYH, RAD51D, CDKN2A, SMAD4).
Cancer mortality trends in Mexico, 1980-2011
abstract
Objective. To evaluate trends in cancer mortality in Mexico between 1980-2011.
Material and methods. Through direct method and using World Population 2010 as standard population, mortality rates for all cancers and the 15 most frequent locations, adjusted for age and sex were calculated. Trends in mortality rates and annual percentage change for each type of cancer were estimated by joinpoint regression model.
Results. As a result of the reduction in mortality from lung cancer (-3.2% -1.8% in men and in women), stomach (-2.1% -2.4% in men and in women) and cervix (-4.7%); since 2004 a significant (~1% per year) decline was observed in cancer mortality in general, in all ages, and in the group of 35-64 years of both sexes. Other cancers such as breast and ovarian cancer in women; as well as for prostate cancer in men, showed a steady increase.
Conclusions. Some of the reductions in cancer mortality may be partially attributed to the effectiveness of prevention programs. However, adequate records of population-based cancer are needed to assess the real impact of these programs; as well as designing and evaluating innovative interventions to develop more cost-effective prevention policies.
Wednesday, January 21, 2015
Environmental (nongenetic) factors in gynecological cancers: update and future perspectives
abstract
Globally, gynecological cancers comprise three of the seven most common female cancers and are responsible for more than 1,000,000 new cases and 500,000 deaths annually. This review summarizes current knowledge regarding the role of environmental factors in gynecological cancer etiology and survival, focusing on those that are potentially amenable to intervention. Strong associations with use of exogenous hormones are countered by opposing risks of breast cancer, thus current hormonal preparations are not an option for prevention. Weight control would reduce risk of endometrial cancer but this and other lifestyle modifications are unlikely to have a major effect on gynecological cancer mortality rates. There is little information regarding the potential for lifestyle changes to improve outcomes for women with gynecological cancer.
Ovarian stimulation and in-vitro fertilization outcomes of cancer patients
abstract
CONCLUSIONS:
Most IVF outcomes appear comparable for cancer patients and age-matched controls. Higher twin pregnancy rates in cancer patients may reflect lack of underlying infertility or need for cancer-specific transfer guidelines.Population-Based Lynch Syndrome Screening by Microsatellite Instability in Patients ≤50 (Louisiana, U.S.)
abstract
Population-Based Lynch Syndrome Screening by Microsatellite Instability in Patients ≤50: Prevalence, Testing Determinants, and Result Availability Prior to Colon Surgery.
Objectives:As there are no US population-based studies examining Lynch syndrome (LS) screening frequency by microsatellite instability (MSI) and immunohistochemistry (IHC), we seek to quantitate statewide rates in patients aged ≤50 years using data from a Centers for Disease Control and Prevention-funded Comparative Effectiveness Research (CER) project and identify factors associated with testing. Screening rates in this young, high-risk population may provide a best-case scenario as older patients, potentially deemed lower risk, may undergo testing less frequently. We also seek to determine how frequently MSI/IHC results are available preoperatively, as this may assist with decisions regarding colonic resection extent.
Methods:
Data from all Louisiana colorectal cancer (CRC) patients aged ≤50 years diagnosed in 2011 were obtained from the Louisiana Tumor Registry CER project. Registry researchers and physicians analyzed data, including pathology and MSI/IHC.
Results:
Of the 2,427 statewide all-age CRC patients, there were 274 patients aged ≤50 years, representing health care at 61 distinct facilities. MSI and/or IHC were performed in 23.0% of patients. Testing-associated factors included CRC family history (P<0.0045), urban location (P<0.0370), and care at comprehensive cancer centers (P<0.0020) but not synchronous/metachronous CRC or MSI-like histology. Public hospital screening was disproportionately low (P<0.0217). Of those tested, MSI and/or IHC was abnormal in 21.7%. Of those with abnormal IHC, staining patterns were consistent with LS in 87.5%. MSI/IHC results were available preoperatively in 16.9% of cases.
Conclusions:
Despite frequently abnormal MSI/IHC results, LS screening in young, high-risk patients is low. Provider education and disparities in access to specialized services, particularly in underserved populations, are possible contributors. MSI/IHC results are infrequently available preoperatively
Randomized trial of oral cyclophosphamide and veliparib in high-grade serous ovarian, primary peritoneal, or fallopian tube cancers, or BRCA-mutant ovarian cancer
abstract
Purpose: Veliparib, a poly(ADP-ribose) polymerase (PARP) inhibitor, demonstrated clinical activity in combination with oral cyclophosphamide in patients with BRCA-mutant solid tumors in a phase 1 trial. To define the relative contribution of PARP inhibition to the observed clinical activity, we conducted a randomized phase 2 trial to determine the response rate of veliparib in combination with cyclophosphamide compared to cyclophosphamide alone in patients with pretreated BRCA-mutant ovarian cancer or in patients with pretreated primary peritoneal, fallopian tube, or high-grade serous ovarian cancers (HGSOC).
Experimental Design: Adult patients were randomized to receive cyclophosphamide alone (50 mg orally once daily) or with veliparib (60 mg orally once daily) in 21-day cycles. Crossover to the combination was allowed at disease progression.
Results: Seventy-five patients were enrolled and 72 were evaluable for response; 38 received cyclophosphamide alone and 37 the combination as their initial treatment regimen. Treatment was well tolerated. One complete response was observed in each arm, with three partial responses (PR) in the combination arm and six PRs in the cyclophosphamide alone arm. Genetic sequence and expression analyses were performed for 211 genes involved in DNA repair; none of the detected genetic alterations were significantly associated with treatment benefit.
Conclusions: This is the first trial that evaluated single agent, low dose cyclophosphamide in HGSOC, peritoneal, fallopian tube, and BRCA-mutant ovarian cancers. It was well tolerated and clinical activity was observed; the addition of veliparib at 60 mg daily did not improve either the response rate or the median progression free survival.
Stopping ovarian cancer screening in BRCA1/2 mutation carriers: Netherlands
abstract
Stopping ovarian cancer screening in BRCA1/2 mutation carriers: Effects on risk management decisions & outcome of risk-reducing salpingo-oophorectomy specimens
Impact of investigations in general practice on timeliness of referral for patients subsequently diagnosed with cancer: UK
open access
"....We analysed data on patients with lung (1494), colorectal (2111), stomach (246), oesophagus (513), pancreas (327), and ovarian (345) cancer. These six cancer sites were selected because they each have a range of presenting symptoms from high to low risk, and because for each there is one or more investigation that may be appropriately ordered as part of the patient’s assessment in primary care and that is generally available to GPs in England.....
"Occult" ovarian Leydig cell tumor: when laboratory tells more than imaging
abstract
Hyperandrogenism
is a common finding in premenopausal age and is generally caused by
polycystic ovarian syndrome or other benign disease. Androgen-secreting
tumors represent only 0.2 % of the causes of hyperandrogenism and
usually present with severe clinical features, abrupt onset, and very
high androgens levels. We describe here three cases of occult ovarian
Leydig cell tumors suspected on the basis of severe clinical features of
hyperandrogenism rapidly worsening, with elevated serum total
testosterone levels, in which bilateral ovariectomy was performed and
tumor was confirmed by post-operative histology. In all three cases,
imaging was negative for ovarian tumor. Moreover, in one case the
confounding concomitant finding of bilateral adrenal masses posed an
additional challenge. Our experience highlights that testosterone levels
represent the most helpful marker in the diagnosis of
androgen-secreting ovarian tumor. In the absence of imaging findings,
bilateral ovariectomy should be indicated, if supported by unequivocal
clinical and laboratory data.
Is There a Role for Oral or Intravenous Ascorbate (Vitamin C) in Treating Patients With Cancer?
A Systematic Review
Conclusion. There is no high-quality evidence to suggest that ascorbate supplementation in cancer patients either enhances the antitumor effects of chemotherapy or reduces its toxicity. Given the high financial and time costs to patients of this treatment, high-quality placebo-controlled trials are needed.
A Meta-Analysis on the Impact of Platinum-Based Adjuvant Treatment on the Outcome of Borderline Ovarian Tumors With Invasive Implants
Gynecologic Oncology
The Oncologist first published on January 19, 2015; doi:10.1634/theoncologist.2014-0144
Borderline ovarian tumors
(BOTs) have been a challenge for patients, pathologists, and
oncologists. For the group of patients with invasive implants, there is
no consensus regarding standard therapy. This meta-analysis examines the
benefits, or lack thereof, of platinum-based adjuvant treatment for
BOT, showing that at present there is no evidence to support this
treatment form.
Editorial: Breaking Down the Evidence for Bevacizumab in Ovarian Cancer
Editorial
Breaking Down the Evidence for Bevacizumab in Ovarian Cancer
The Oncologist first published on January 19, 2015; doi:10.1634/theoncologist.2014-0302
Bevacizumab has been
FDA-approved for use in combination with single-agent chemotherapy for
platinum-resistant ovarian cancer; however, its optimal role remains
unclear. In this editorial, the timing, efficacy, safety, and rationale
for use of bevacizumab in ovarian cancer are discussed.
Tuesday, January 20, 2015
A Note about DWD Canada's Charity Status | Dying with Dignity
Dying with Dignity
Dying
with Dignity Canada (DWD Canada) has learned it will lose its
registered charity status as the result of recent political-activity
audits by the Canada Revenue Agency (CRA).
In
a letter dated January 16, the CRA said DWD Canada’s charitable status
will be annulled as soon as next month because the organization, in the
federal agency’s view, had been “registered in error” in 1982 and again
when DWD Canada was re-registered in 2011.“Based on our findings, it is our opinion that the Organization was, in fact, registered in error and, as a result, its registration under the [Income Tax Act] should be annulled,” the letter reads.
Founded in 1982, DWD Canada is a health and educational charity focused on promoting choice and dignity at end of life. The organization educates about the case for physician assisted dying, provides information about patient rights and advance care planning, and offers one-on-one support to individuals who are dying and want to do so on their own terms. In addition to making the case for the legalization of physician assisted dying, the charity had categorized a number of its activities as advancing education, such as its: • workshops and presentations
• quarterly newsletter,
• website and
• advance care planning resource kits.
However, the CRA determined that DWD Canada does not conduct “any activities advancing education in the charitable sense”. DWD Canada has a small staff (there were four staff positions during the audit period) and relies on volunteers for much of its work. In 2013, supporters donated approximately 8,000 volunteer-hours to the cause.
After fully assessing all options, the charity’s board of directors has voted not to oppose the annulment, which is expected to come into effect on or after February 15. The change in status will not affect the tax deductibility of any donations made to DWD Canada prior to that date. Until the annulment is finalized, DWD Canada will remain a registered charity to which Canadians can make tax-deductible donations. After that point, the organization will become a non-profit without registered charity status.
Because the CRA is proposing to annul DWD Canada’s registered status — as opposed to revoking it — all assets belonging to DWD Canada will remain with the organization. As a result, DWD Canada will not only be able to continue its important work in the area of promoting choice and dignity at end of life, but it will also, after its conversion to a non-profit, be free to focus on political advocacy without constraints.
More information about DWD Canada's next steps will be forthcoming in the weeks ahead. If you have any immediate concerns, please call us at 1-800-495-6156 or send an e-mail
Saturday, January 10, 2015
Small Bowel Cancer: Scoping Out a Rarity
medscape
Medscape: What predisposing factors are associated with an increased risk for small bowel adenocarcinoma?
Michael J. Overman, MD: There are three big factors. The first is hereditary nonpolyposis colorectal cancer (HNPCC), or Lynch syndrome, which predisposes not only to colorectal cancer but also to a number of other cancers, including small bowel adenocarcinoma. The second is inflammatory bowel disease (IBD), particularly Crohn's disease; these patients can have involvement of the distal small bowel (ileal adenocarcinoma). Celiac disease would be the third factor. Celiac disease is a gluten-associated enteropathy in which you have an autoimmune attack against gluten in your diet. You'll have inflammation in the epithelial lining of your small bowel as your body reacts to the gluten in your diet, and that inflammation can lead to an increased risk for small bowel adenocarcinoma. Those are the big three predisposing factors. However, the majority of small bowel adenocarcinomas, approximately 70%, are sporadic and have unclear factors associated with them.
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