U.S. 2014 - Women’s Health Care Chartbook - National Healthcare Quality and Disparities Report

Women’s Health Care Chartbook - open access

Organization of the Chartbook on Women’s Health Care

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Part of a series related to the National Healthcare Quality and Disparities Report (QDR).

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Contents:

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Overview of the QDR

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Overview of women, one of the priority populations of the QDR

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Summary of trends in health care quality and disparities for females

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Tracking of access and quality measures for rural females:

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Access to Health Care

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Patient Safety

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Person- and Family-Centered Care

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Communication and Care Coordination

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Effective Treatment of Leading Causes of Morbidity and Mortality

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Healthy Living

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Affordability

Lynch syndrome in the gynecologic population

open access

Increased public awareness on cancer prevention has focused efforts on inherited cancer predispositions. Risk assessment and mitigation are integral components in this prevention strategy. Most inherited cancer syndromes cross multiple disciplines and require a collaborative approach to management. In the gynecologic cancer arena, hereditary breast and ovarian cancer (HBOC) and Lynch syndrome (LS) have garnered the most attention. Inherited disorders that are associated with both colorectal cancer and gynecologic malignancies include LS and less commonly, Peutz-Jeghers syndrome, Li-Fraumeni syndrome, and Cowden syndrome. Significantly, approximately half of women with LS will have an endometrial cancer as their sentinel malignancy with a median of 11 years prior to a colon cancer diagnosis (1). Therefore, an understanding of the associated cancers and recommended screening and management guidelines are critical to optimize patient care and ultimately outcomes. In this review, we will specifically focus on LS and its implications for the gynecologist......

.....LS-related ovarian cancer is diagnosed at a younger age than sporadic cases, and is more likely to be early stage. Endometrioid and clear cell histologies are more common in the Lynch cases. In a histopathologic study of cases with nonserous ovarian cancer, 21% were determined to have loss of mismatch repair on immunohistochemistry, and in their cohort of Lynch-associated ovarian cancers, there were no serous or mucinous cancers (11). There is very limited information regarding survival comparing the sporadic and familial cases, but it appears there are no significant differences (5,12). Synchronous primary endometrial cancer is found in approximately 22% of LS-associated ovarian cancer (5). Conversely, about 7% of patients with synchronous primary endometrial and ovarian cancer at time of diagnosis are found to have LS (13).....

Adding Dimensions to the Analysis of the Quality of Health Information of Websites Returned by Google: Cluster Analysis Identifies Patterns of Websites According to their Classification and the Type of Intervention Described | Digital Health

open access
 

Introduction

As more patients search for health information on the Internet, many studies have analyzed the quality of health information available on the web for different pathological conditions. There is a concern that, because the Internet is practically not controlled or regulated, this might expose the public to misinformation, particularly those with low information literacy, which is the ability to critically appraise the information (1, 2). This could potentially result in patients turning to non-approved therapies, whose efficacy (and risks associated) has not been scientifically proven. Furthermore, in recent years, there have been an increasing number of commercial websites selling counterfeit medicines, with additional risks for vulnerable patients (3).

Although there are a number of specialized health websites, most patients will use generic search engines, such as Google, to search for health-related information (4), and several studies have tried to address the quality of health information available on the Internet using various methods...............Performing a cluster analysis of websites, based on their classification and the intervention described, can identify patterns of websites pointing patients toward one or more treatments. In the specific example of health-related query studied here, we were surprised that commercial websites ranked low in the search list. In terms of the type of intervention recommended, complementary/alternative medicine occurred more often than approved, EBM-based drugs, but the latter were more frequent in the top 10 results, possibly due to the intrinsic higher IQ features of these websites......

Editorial: Cancer and Cardiovascular Disease: The Complex Labyrinth

open access

 As our population ages, there has been an increase in the prevalence of cancer and heart disease [1]. Modern treatment strategies have led to improvement in the chances of surviving a diagnosis of cancer; however, these treatments can come at a cost [2]. Cardiotoxicity, a relatively new term in the medical literature, refers to the impact of cancer therapies on the heart and cardiovascular system [3, 4]. Cohort studies in pediatric cancer survivors have shown that cardiotoxicity is the second leading cause (after cancer recurrence) of morbidity and mortality in cancer survivors [5]. The potential negative impact of cancer drugs on the heart, however, is not new. In fact, we have known for years that cancer drugs, such as the anthracyclines, can cause severe and permanent heart damage including heart failure (HF). So why is there growing interest now?....

Immunohistochemical characterization of appendiceal mucinous neoplasms & value of SATB2 in their distinction from primary ovarian mucinous tumors

abstract

Aims

The distinction between primary ovarian mucinous tumors and appendiceal mucinous neoplasms metastatic to the ovary can be challenging given the overlap of morphologic features and immunohistochemical expression of traditional markers. SATB2 has been recently described as a sensitive and specific marker of colorectal epithelium. Its expression in appendiceal mucinous tumors and its role in their distinction from ovarian neoplasms have not been fully characterized.

Methods and results

Immunohistochemistry was performed in tissue microarrays from 32 primary appendiceal mucinous tumors (25 low grade appendiceal mucinous neoplasms and 7 adenocarcinomas) and 40 ovarian mucinous neoplasms (20 borderline tumors and 20 adenocarcinomas).

Risk factors and biomarkers of life-threatening cancers (CARF)

open access

 Risk factors for cancer occurrence and for cancer death

Cancers affecting the same organ are no longer considered as a single disease entity. The wisdom that risk factors for cancer occurrence would be the same as for the risk for aggressive cancer or of cancer death is not correct. For instance, reproductive factors have a strong influence on the risk of breast cancer but little influence on the risk of breast cancer death [2]. Adiposity is associated with reduced breast cancer risk in premenopausal women. However, the risk of death from breast cancer in premenopausal women increases with adiposity [3]. High fertility is associated with reduced risk of breast cancer. However, women giving birth in their 40s have become increasingly common, and breast cancer occurring in the first 2 years after childbirth is known to be more lethal [4]. Another example is smoking in prostate cancer. If smoking is not a risk factor for prostate cancer occurrence, it seems to be associated with the occurrence of fatal prostate cancer [5].

The search for hereditary, lifestyle, and environmental factors that would be involved in the occurrence of potentially life-threatening cancers has really started only after 2000, mainly because of the longstanding false impression that risk factors for cancer occurrence and for cancer death were similar.....

Under-treatment of elderly patients with ovarian cancer: a population based study

open access
 
 Our results are in line with several previous studies [4], [5], [11], [13], [14], [22], and in particular, our findings are concordant with two recent studies [11], [13] showing that age is an independent predictor of non-administration of either surgery or chemotherapy.

Background

Ovarian cancer is the fourth most common cancer among women in France, and mainly affects the elderly. The primary objective of this study was to compare treatment of ovarian cancer according to age.

Clinical Oncology News - The Current State of Cancer in the United States

video

 Dr. Frederick Greene speaks with David P. Winchester about the current and future state of the National Cancer Database, sponsored by the American College of Surgeons.

Association of Coffee Consumption With Overall and Cause-Specific Mortality in a Large US Prospective Cohort Study

Abstract

 Concerns about high caffeine intake and coffee as a vehicle for added fat and sugar have raised questions about the net impact of coffee on health. Although inverse associations have been observed for overall mortality, data for cause-specific mortality are sparse. Additionally, few studies have considered exclusively decaffeinated coffee intake or use of coffee additives. Coffee intake was assessed at baseline by self-report in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Hazard ratios were estimated using Cox proportional hazards models. Among 90,317 US adults without cancer at study baseline (1998–2001) or history of cardiovascular disease at study enrollment (1993–2001), 8,718 deaths occurred during 805,644 person-years of follow-up from 1998 through 2009. Following adjustment for smoking and other potential confounders, coffee drinkers, as compared with nondrinkers, had lower hazard ratios for overall mortality (<1 cup/day: hazard ratio (HR) = 0.99 (95% confidence interval (CI): 0.92, 1.07); 1 cup/day: HR = 0.94 (95% CI: 0.87, 1.02); 2–3 cups/day: HR = 0.82 (95% CI: 0.77, 0.88); 4–5 cups/day: HR = 0.79 (95% CI: 0.72, 0.86); ≥6 cups/day: HR = 0.84 (95% CI: 0.75, 0.95)). Similar findings were observed for decaffeinated coffee and coffee additives. Inverse associations were observed for deaths from heart disease, chronic respiratory diseases, diabetes, pneumonia and influenza, and intentional self-harm, but not cancer. Coffee may reduce mortality risk by favorably affecting inflammation, lung function, insulin sensitivity, and depression.

Aurora Kinase Inhibitors in Oncology Clinical Trials: Current State of the Progress. - PubMed - NCBI

Abstract

Sarah Cannon Research Institute at HealthONE, Denver, CO
Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
Center for Personalized Cancer Therapy, Moores Cancer Center, University of California San Diego, La Jolla, CA


The Aurora kinase family of kinases (Aurora A, B, and C) are involved in multiple mitotic events, and aberrant expression of these kinases is associated with tumorigenesis. Aurora A and Aurora B are validated anticancer targets, and the development of Aurora kinase inhibitors has progressed from preclinical to clinical studies. A variety of Aurora A, B and pan-Aurora kinase inhibitors have entered the clinic. The main side effects include febrile neutropenia, stomatitis, gastrointestinal toxicity, hypertension, and fatigue. Responses including complete remissions have been described in diverse, advanced malignancies, most notably ovarian cancer and acute myelogenous leukemia. This review highlights the biologic rationale for Aurora kinase as a target, and clinical trials involving Aurora kinase inhibitors, with particular emphasis on published early phase studies, and the observed anti-tumor activity of these agents. 

The utility of web mining for epidemiological research: studying (obituaries) the association between parity and cancer risk

abstract

Background The World Wide Web has emerged as a powerful data source for epidemiological studies related to infectious disease surveillance. However, its potential for cancer-related epidemiological discoveries is largely unexplored.

Methods Using advanced web crawling and tailored information extraction procedures, the authors automatically collected and analyzed the text content of 79 394 online obituary articles published between 1998 and 2014. The collected data included 51 911 cancer (27 330 breast; 9470 lung; 6496 pancreatic; 6342 ovarian; 2273 colon) and 27 483 non-cancer cases. With the derived information, the authors replicated a case-control study design to investigate the association between parity (i.e., childbearing) and cancer risk. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for each cancer type and compared to those reported in large-scale epidemiological studies.

Results Parity was found to be associated with a significantly reduced risk of breast cancer (OR = 0.78, 95% CI, 0.75-0.82), pancreatic cancer (OR = 0.78, 95% CI, 0.72-0.83), colon cancer (OR = 0.67, 95% CI, 0.60-0.74), and ovarian cancer (OR = 0.58, 95% CI, 0.54-0.62). Marginal association was found for lung cancer risk (OR = 0.87, 95% CI, 0.81-0.92). The linear trend between increased parity and reduced cancer risk was dramatically more pronounced for breast and ovarian cancer than the other cancers included in the analysis.

Conclusion This large web-mining study on parity and cancer risk produced findings very similar to those reported with traditional observational studies. It may be used as a promising strategy to generate study hypotheses for guiding and prioritizing future epidemiological studies.

U.S. FDA Announces Glades Drugs' Nationwide Voluntary Recall Of Compounded Multivitamins Containing High Amounts Of Vitamin D3

Recalls

 Contact

Consumers

Faith Washington, Pharmacist
 (866) 597-3296

Firm Press Release

The U.S. Food and Drug Administration is alerting health care professionals and patients of a voluntary recall of compounded multivitamin capsules containing high amounts of Vitamin D3 (Cholecalciferol), distributed nationwide by Glades Drugs in Pahokee, Florida. FDA has received reports of several adverse events potentially associated with these compounded capsules made by Glades Drugs.
Consumption of this product may result in vitamin D toxicity, which may be severe and may lead to life-threatening outcomes if left untreated. Patients suffering adverse effects from high Vitamin D levels (Cholecalciferol) may not initially show symptoms. Therefore, patients who have received these compounded capsules should stop taking this medication and immediately seek medical attention.
Symptoms of short-term vitamin D toxicity are due to high calcium levels (also known as hypercalcemia) and include confusion, increased urination, increased thirst, loss of appetite, vomiting, and muscle weakness. Acute hypercalcemia may intensify tendencies for heart arrhythmias and seizures and may increase the effects of certain heart drugs. Long-term toxicity may cause kidney failure, increase in calcium deposits in the blood and soft tissue, bone demineralization and pain. Patients with conditions such as liver disease or chronic kidney failure may be at increased risk for developing vitamin D toxicity.....

Ovarian Cancer | Guide for Patients | ESMO

ESMO (main page ovarian cancer)

pdf file

Future Directions for NCI’s Surveillance Research Program - National Cancer Institute

NCI

Cochrane Review: Platelet transfusions are used to prevent bleeding in people with low platelet counts due to treatment-induced bone marrow failure

Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation - The Cochrane Library 


Findings from this review were based on three studies and 499 participants. Without further evidence, it is reasonable to continue with the current practice of administering prophylactic platelet transfusions using the standard trigger level (10 x 10⁹/L) in the absence of other risk factors for bleeding.

 

Plain language summary

Platelet transfusions are used to prevent bleeding in people with low platelet counts due to treatment-induced bone marrow failure

Review question
We evaluated the evidence about whether platelet transfusions given to prevent bleeding in people with lower platelet counts (for example 5 x 10⁹/L or below) were as effective and safe as the current standard (10 x 10⁹/L or below), or whether higher platelet count levels (20 x 10⁹/L or below, 30 x 10⁹/L or below, or 50 x 10⁹/L or below) were safer than the current standard (10 x 10⁹/L or below). Our target population was people with blood cancers (for example leukaemia, lymphoma, myeloma) who were receiving intensive (myelosuppressive) chemotherapy treatments or stem cell transplantation.
Background
People with blood cancers may have low platelet counts due to their underlying cancer. Blood cancers may be treated with chemotherapy and stem cell transplantation, and these treatments can cause low platelet counts. Platelet transfusions may be given to prevent bleeding when the platelet count falls below a prespecified threshold platelet count (for example 10 x 10⁹/L), or may be given to treat bleeding (such as a prolonged nosebleed or multiple bruises). Giving platelet transfusions at a lower prespecified threshold platelet count may increase the chance that bleeding will occur, which may be harmful, whereas giving platelet transfusions at a higher prespecified threshold platelet count may mean that people receive unnecessary platelet transfusions. Platelet transfusions can have adverse effects and have cost and resource implications for health services, so unnecessary transfusions should be avoided.
Study characteristics
The evidence is current to July 2015. We found no new studies in this update of the review. This review identified three randomised controlled trials that compared giving platelet transfusions to prevent bleeding when the platelet count is 10 x 10⁹/L (the current standard) or below versus giving platelet transfusions to prevent bleeding at higher platelet count levels (20 x 10⁹/L or below or 30 x 10⁹/L or below). None of the studies compared a lower trigger or alternative trigger to the current standard. These trials were conducted between 1991 and 2001 and included 499 participants. Two trials included adults with leukaemia who were receiving chemotherapy. One trial included children and adults receiving a stem cell transplant.
Two of the three studies reported sources of funding. Neither of the studies that reported funding sources were industry sponsored.
Key results
Giving platelet transfusions to people with low platelet counts due to blood cancers or their treatment to prevent bleeding when the platelet count was 10 x 10⁹/L or below did not increase the risk of bleeding compared to giving a platelet transfusion at higher platelet counts (20 x 10⁹/L or below or 30 x 10⁹/L or below).
Giving platelet transfusions to prevent bleeding only when the platelet count was 10 x 10⁹/L or below resulted in a reduction in the number of platelets given. We found no evidence to demonstrate that giving a platelet transfusion when the platelet count was 10 x 10⁹/L or below decreased the number of transfusion reactions compared to giving platelet transfusions at higher platelet counts (20 x 10⁹/L or below or 30 x 10⁹/L or below).
None of the three studies reported any quality of life outcomes.
Findings from this review were based on three studies and 499 participants. Without further evidence, it is reasonable to continue using platelet transfusions to prevent bleeding based on the current standard transfusion threshold (10 x 10⁹/L).
Quality of the evidence
The evidence for most of the findings was of low quality. This was because participants and their doctors knew which study arm the participant had been allocated to, and also the estimate of the treatment effect was imprecise.