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Friday, August 28, 2015

Federal party statements on physician assisted dying - Dying With Dignity Canada

Federal party statements on physician assisted dying - Dying With Dignity Canada


Read how the major federal parties say they plan to do to respond to the Supreme Court's decision on physician assisted dying.

Dying With Dignity Canada supporters across the country ask us every passing day: What are the official positions of the major federal parties on physician assisted dying?
So, after the election was called in early August, we reached out to the big players — the Conservatives, the Liberals, the NDP and the Greens — and asked them to provide us with a statement on their plans to respond to the Supreme Court’s February decision to strike down the Criminal Code ban on physician assisted dying. Here’s an excerpt of what we told them:

“For many of our supporters, particularly those in urban and suburban ridings, this is an issue that could be the deciding factor in how they cast their ballots this fall. We will be mobilizing our supporter base in the coming weeks to ask political candidates in their riding to take a pledge in support of the implementation of the letter and spirit of the Carter case. We will be publicizing the names of candidates who take the pledge and those who do not. We request that you provide us with a written policy statement outlining the your party’s on the implementation of physician assisted dying with regards to the Carter case for the right to die with dignity.”

So far, we’ve received responses from the Liberals and the NDP. We have yet to hear from the Conservatives and the Green Party. (Though the Greens, to their credit, have a policy on assisted dying posted to their website.) Of course, we’ll post the outstanding responses if and when they’re sent our way.
The statements, published in both official languages, are available for download below. We hope you find them helpful as you consider how to vote on October 19.

Lynch syndrome and Lynch syndrome mimics: The growing complex landscape of hereditary colon cancer

open access


Bleomycin-Induced Pneumonitis in the Treatment of Ovarian Sex Cord-Stromal Tumors

abstract: Bleomycin-Induced Pneumonitis in the Treatment of Ovarian Sex Cord-Stromal Tumors: A Systematic Review and Meta-analysis


Adult ovarian sex cord-stromal tumors (SCSTs) are a rare histological subtype of ovarian cancer associated with a favorable prognosis. Bleomycin-containing regimens are standards of care, although pneumonitis may cause potentially fatal dose-limiting toxicity. We aimed to evaluate the safety of bleomycin in SCST treatment.


We performed a systematic literature review of all studies of bleomycin therapy for SCSTs that were referenced in MEDLINE (PubMed), EMBASE, and Cochrane Central Register of Controlled Trials and published from 1986 to 2014.


Eight studies totaling 221 patients were included. Rates of pneumonitis (7.7%; 95% confidence interval, 4.2-11.2) and mortality (1.8%; 95% confidence interval, 0.1-3.6) related to bleomycin were significant. However, these results were very similar to those reported for men who were treated with bleomycin for a male germ cell tumor, suggesting that women with ovarian SCSTs are not particularly vulnerable to bleomycin lung toxicity. The main risk factors of bleomycin-induced pneumonitis are high cumulative bleomycin dose (>400 U or mg), age older than 40 years, and impaired renal function. Whether granulocyte colony-stimulating factor is a risk factor remains controversial.


Bleomycin-induced pneumonitis frequently occurs in patients with SCSTs and lacks effective treatment. Prevention lies in limiting cumulative bleomycin dose, monitoring pulmonary function during treatment, discontinuing bleomycin at the onset of pulmonary symptoms or if pulmonary function is impaired, and avoiding bleomycin in older patients.

Hormone therapy for ovarian cancer survivors: systematic review and meta-analysis



Hormone therapy (HT) alleviates menopausal symptoms, but there is a lack of consensus regarding its use among premenopausal ovarian cancer survivors.


We systematically reviewed the literature and searched the Medline (1966-2014), Scopus (2004-2014), Popline (1974-2014), ClinicalTrials.gov (2008-2014), and Cochrane Central Register of Controlled Trials CENTRAL (1999-2014) databases and the reference lists of electronically retrieved studies. Statistical meta-analysis was performed using RevMan 5.1 software.


Six studies were included in our systematic review, which involved 1,521 women. Among them, 451 women (29.6%) received HT, whereas the remaining 1,070 women (70.4%) did not receive any treatment. We noticed a statistically significant reduction of ovarian cancer-related deaths among women who received HT (odds ratio, 0.47; 95% CI, 0.28-0.80); however, disease recurrence rates did not differ between the two groups (odds ratio, 0.71; 95% CI, 0.45-1.14). Studies included in the present systematic review did not report a significant difference in overall survival and disease-free survival rates among women receiving HT and controls.


Based on the results of meta-analysis, HT does not influence the odds of ovarian cancer recurrence; however, this conclusion must be confirmed separately because of significant limitations in the methodological quality of the studies included.

Olaparib in the management of ovarian cancer

Open access

Ovarian cancer mortality and industrial pollution


 We investigated whether there might be excess ovarian cancer mortality among women residing near Spanish industries, according to different categories of industrial groups and toxic substances. An ecologic study was designed to examine ovarian cancer mortality at a municipal level (period 1997-2006). Population exposure to pollution was estimated by means of distance from town to facility. Using Poisson regression models, we assessed the relative risk of dying from ovarian cancer in zones around installations, and analyzed the effect of industrial groups and pollutant substances. Excess ovarian cancer mortality was detected in the vicinity of all sectors combined, and, principally, near refineries, fertilizers plants, glass production, paper production, food/beverage sector, waste treatment plants, pharmaceutical industry and ceramic. Insofar as substances were concerned, statistically significant associations were observed for installations releasing metals and polycyclic aromatic chemicals. These results support that residing near industries could be a risk factor for ovarian cancer mortality.

Wednesday, August 26, 2015

Women with double primary cancers of the colorectum & endometrium: do they have Lynch syndrome?



The aim of this study was to determine the clinical characteristics of women with double primary cancers of the colorectum and endometrium and assess the probability of Lynch syndrome.

Study design

We identified 15 women with paraffin-embedded blocks available who were diagnosed, treated and followed for double primary colorectal and endometrial cancers at in a single institution (Korea) between 1994 and 2014. If there was a family history that met the revised Amsterdam criteria for Lynch syndrome, the woman was considered to have ‘clinically defined Lynch syndrome’. If immunohistochemical (IHC) loss of expression of mismatch repair genes (MLH1, MSH2, MSH6, or PMS2) or high microsatellite instability (MSI) was demonstrated in molecular testing, the case was considered ‘suspected Lynch syndrome’.


The incidence of clinically defined Lynch syndrome according to the revised Amsterdam criteria was 66% (8 of 15). All 8 of the women clinically diagnosed with Lynch syndrome had either abnormal IHC loss or MSI-high, indicating a suspected Lynch syndrome. Furthermore, 27% (4 of 15) experienced second primary colorectal cancer or other Lynch syndrome-related cancers. Overall, 66% (10 of 15) met the criteria for clinically defined Lynch syndrome or suspected Lynch syndrome.


Based on our findings, a large percentage (66%) of women with double primary cancers of the colorectum and endometrium are likely to be diagnosed with Lynch syndrome.

Randomized study of sequential cisplatin-topotecan/carboplatin-paclitaxel vs carbo-paclitaxel: effects on QOL

 Randomized study of sequential cisplatin-topotecan/carboplatin-paclitaxel versus carboplatin-paclitaxel: effects on quality of life.


A recent phase III trial compared the efficacy of cisplatin-topotecan (a topoisomerase I inhibitor) followed by carboplatin-paclitaxel (Arm 1) versus paclitaxel-carboplatin (Arm 2) in women with newly diagnosed stage IIB or greater ovarian cancer. There was a significantly lower response rate in the experimental arm compared to standard treatment, and less likelihood of normalized CA125 within the first 3 months. At 43 months follow-up, there were no significant group differences in progression-free survival. There were also significantly more side effects in the experimental arm.

Evaluation of the Hematologic Safety of Same Day Versus Standard Administration (24- to 72-Hour Delay) of Pegfilgrastim

 febrile neutropenia (FN)

abstract/open access
 Evaluation of the Hematologic Safety of Same Day Versus Standard Administration (24- to 72-Hour Delay) of Pegfilgrastim in Gynecology Oncology Patients Undergoing Cytotoxic Chemotherapy

..... The current data available on efficacy and safety on pegfilgrastim administration appear to be variable and based on several factors, including tumor types, disease sites, and chemotherapy regimens. The literature appears to be inconclusive overall. Our study sought to determine the safety and efficacy of pegfilgrastim administration scheduling in a population of women with gynecologic malignancies, and the results of this investigation have a potentially overarching impact on the primary and secondary prophylaxis of FN in this disease group. These results demonstrate no increased risk for the development of FN associated with pegfilgrastim administration on the same day as chemotherapy. However, the incidence of FN was low, and the aRRs could not be calculated. This is particularly exciting for the outpatient treatment of gynecologic malignancy in patients required to travel large distances to and from their treating facilities as it will eliminate a clinic visit. This change in practice to same-day administration of pegfilgrastim has potential financial ramifications, but further investigation is needed before this can be confirmed. Definitive evidence to support same-day administration of pegfilgrastim can be provided only with a prospective study. However, our findings support that same-day administration of pegfilgrastim is not inferior to standard administration in terms of treatment delay; however, this cannot be said for dose modification and hematologic toxicities. Our results support the option of same-day dosing to clinicians and patients who accept a possible decrement in dose modification and hematologic toxicity in exchange for convenience of administration. These data do contribute to the existing literature and can be utilized to support same-day use, which may improve patient satisfaction without compromising timing of delivery of treatment, an important goal of health care administration.

European Network of Gyn Oncological Trial Groups’ Requirements

abstract/open access

 European Network of Gynaecological Oncological Trial Groups’ Requirements for Trials Between Academic Groups and Industry Partners—First Update 2015

 Abstract: The first version of ENGOT’s Requirements for Trials Between Academic Groups and Industry Partners in Europe was published 2010. This first update integrates the experiences made by the ENGOT network and the cooperative group studies while performing, analyzing, and publishing -among others - three large phase III trials. Furthermore, progress in European legislation and its impact on clinical studies in Europe have been considered in this update process.

Laparoscopic Debulking Surgery in the Management of Advanced Ovarian Cancer After Neoadjuvant Chemotherapy

abstract/open access


Objective: The purpose of this study was to evaluate the feasibility and morbidity of total laparoscopic debulking surgery in the treatment of advanced ovarian cancer after neoadjuvant chemotherapy.

Differences in Clinical and Biological Features Between Type I and Type II Tumors in FIGO Stages I-II Epithelial Ovarian Carcinoma

Dabstract/open access

Objective: The objective of this study was to compare immunohistochemical profile for the apoptosis regulators p53, C-MYC, bax, PUMA, and PTEN and the cell cycle regulatory proteins p21 and p27, as well as clinical factors between types I and II tumors.
Methods: In total, 131 patients in FIGO (International Federation of Gynecology and Obstetrics) stages I-II were divided into 2 groups of patients after type I tumors (n = 79) and type II tumors (n = 52). Differences in the immunohistochemical profile for the cell cycle–related proteins, detected by tissue microarrays and immune-histochemistry, were compared.

Tyrosine Kinase Inhibitors as Potential Therapeutic Agents in the Treatment of Granulosa Cell Tumors of the Ovary

abstact/open access


Objective: Granulosa cell tumors of the ovary (GCTs) represent a specific subset of malignant ovarian tumors, of which there are 2 distinct subtypes, the juvenile and the adult form. Aside from surgery, no reliable therapeutic options currently exist for patients with GCT. This study sought to investigate the potential role of small molecule tyrosine kinase inhibitors (TKIs) as novel therapeutics in the clinical management of GCT.
Materials and Methods: Using TKI with distinct but overlapping multitargeted specificities, cellular proliferation, viability, and apoptosis were evaluated in 2 human GCT-derived cell lines, COV434 and KGN.
Results: Sunitinib, which targets the imatinib-inhibited tyrosine kinases of VEGFR, KIT, PDGFR, and FLT-3, was without effect in COV434 and KGN cell lines. Sorafenib, which has a high affinity for RAF1 and BRAF, dose dependently inhibited cellular proliferation and viability in both cell lines at concentrations equivalent to that seen in other systems.

Impact of Age on 30-Day Mortality and Morbidity in Patients... : International Journal of Gynecological Cancer

abstract/open access


Objective: To examine the effect of age on postoperative 30-day morbidity and mortality after surgery for ovarian cancer.
Methods: The American College of Surgeons National Surgical Quality Improvement Program files were used to identify patients with ovarian cancer who underwent surgery in 2005 to 2011. Women were divided into 4 age groups: <60, 60 to 69, 70 to 79, and ≥80 years. Multivariable logistic regression models were performed.

Survival of Patients With Mucinous Ovarian Carcinoma and Ovarian Metastases: A Population-Based Cancer Registry Study

abstract/open access


Objectives: Patients with mucinous ovarian carcinoma (MOC) generally have a favorable prognosis, although in advanced stage, prognosis is significantly worse compared to patients with serous ovarian carcinomas (SOCs). This might be due to the difficulties in distinguishing MOC from metastatic tumors. In the current study, we investigate prognosis of MOC compared to other types of ovarian cancer and to synchronous metastases to the ovary (sMO).

Should All Cases of High-Grade Serous Ovarian, Tubal, and Primary Peritoneal Carcinomas Be Reclassified as Tubo-Ovarian Serous Carcinoma?

abstract/open access

Introduction: The dualistic theory of ovarian carcinogenesis proposes that epithelial “ovarian” cancer is not one entity with several histological subtypes but a collection of different diseases arising from cells of different origin, some of which may not originate in the ovarian surface epithelium.
Methods: All cases referred to the Pan-Birmingham Gynaecological Cancer Centre with an ovarian, tubal, or primary peritoneal cancer between April 2006 and April 2012 were identified from the West Midlands Cancer Registry. Tumors were classified into type I (low-grade endometrioid, clear cell, mucinous, and low-grade serous) and type II (high-grade serous, high-grade endometrioid, carcinosarcoma, and undifferentiated) cancers.
Results: Ovarian (83.5%), tubal (4.3%), or primary peritoneal carcinoma (12.2%) were diagnosed in a total of 583 woman. The ovarian tumors were type I in 134 cases (27.5%), type II in 325 cases (66.7%), and contained elements of both type I and type II tumors in 28 cases (5.7%). Most tubal and primary peritoneal cases, however, were type II tumors: 24 (96.0%) and 64 (90.1%), respectively. Only 16 (5.8%) of the ovarian high-grade serous carcinomas were stage I at diagnosis, whereas 240 (86.6%) were stage III+. Overall survival varied between the subtypes when matched for stage. Stage III low-grade serous and high-grade serous carcinomas had a significantly better survival compared to clear cell and mucinous cases, P = 0.0134. There was no significant difference in overall survival between the high-grade serous ovarian, tubal, or peritoneal carcinomas when matched for stage (stage III, P = 0.3758; stage IV, P = 0.4820).
Conclusions: Type II tumors are more common than type I and account for most tubal and peritoneal cancers. High-grade serous carcinomas, whether classified as ovarian/tubal/peritoneal, seem to behave as one disease entity with no significant difference in survival outcomes, therefore supporting the proposition of a separate classification of “tubo-ovarian serous carcinoma”.

Follow-up in Gynecological Malignancies: A State of Art (open access)

The main concerns about follow-up could be summarized as: Who? When? How? And What?

abstract/full text
Article Tools - open access:
Objective: The main purpose of this article is to explore the current practice for follow-up of gynecological cancer, pointing out the different procedures, to determine the most clinically and cost-effective surveillance strategies after the primary treatment.
Materials and Methods: We analyzed the follow up strategies for ovarian, endometrial, and cervical cancer. All of the topics discussed below arose from the “ESGO State of Art Conference—Follow-up in gynaecological malignancies” in Turin, (September 11–13, 2014; http://torino2014.esgo.org/).
Results: Physical but these practices should be integrated with biomarkers or imaging strategies. Currently, most recommendations about follow-up are based on retrospective studies and expert opinion, and there is some disagreement on surveillance strategies due to lack of evidence-based knowledge.
Conclusions: All surveillance procedures should be evidence-based with a clearly defined purpose: there is a need for prospective studies to compare the effectiveness of different follow-up regimens measuring overall survival, detection of recurrence, quality of life (QoL), and costs as outcomes.

Economic Considerations on the Follow-Up Practice in Gynecologic Cancers: Few Lights and Many Shadows From a Literature Review

open access/open access

Article Tools- open access:
Objective: The aim of this review was to analyze the existing literature on the cost of follow-up in gynecology oncology.
Methods/materials: We performed a literature search in Medline and NHS CRD (University of Oxford) databases.......
Results: Finally, the reviewing process selected 2 studies on gynecologic cancers in general, including uterine and ovarian cancers, 3 specific on ovarian cancer, 7 on endometrium, and 9 on cervix. The identified economic literature on economic evaluation of gynecologic cancer follow-up procedures showed to be based on weak evidence of effectiveness and to lack formal methodological approaches. In general, such literature is quite recent, relies on small sample observational studies, and suffers from a lack of financial support.
Conclusions: There are few available lights in economic considerations on gynecologic cancer follow-up, represented by all the published studies, and many shadows that require to be clarified by properly designed randomized trials including cost-effectiveness analysis.

A Patient`s History of Medicine | Health and Everything


Ureteric Injury Risk With Hysterectomy Up 2001 to 2010

health news / abstract

Changes in BMI in long-term childhood cancer survivors (underweight)


The BMI at diagnosis is one of the most important predictors for the BMI at follow-up, and this suggests an important genetic or environmental cause. Adult CCSs are at high risk for developing severe underweight at follow-up. Future studies should focus on the causes and clinical consequences of underweight.

Mayo Clinic researchers find new code that makes reprogramming of cancer cells possible (PLEKHA7)

press release

United States Cancer Statistics


United States Cancer Statistics

The 1999–2012 United States Cancer Statistics (USCS): Incidence and Mortality Web-based Report includes the official federal statistics on cancer incidence from registries that have high-quality data, and cancer mortality statistics. It is produced by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI). This report shows that in 2012, 1,529,078 Americans received a new diagnosis of invasive cancer, and 582,607 Americans died of this disease (these estimates do not include in situ cancers or the more than 1 million cases of basal and squamous cell skin cancers expected to be diagnosed).
This year’s report features information on invasive cancer cases diagnosed during 2012 among residents of 49 states, six metropolitan areas, and the District of Columbia—geographic areas in which about 99% of the U.S. population resides. Incidence data are from CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results (SEER) Program. Data from population-based central cancer registries in these states and metropolitan areas meet the criteria for inclusion in this report.
The report also provides cancer mortality data collected and processed by CDC’s National Center for Health Statistics. Mortality statistics, based on records of deaths that occurred during 2012, are available for all 50 states and the District of Columbia.
New Data Added to the Report
The report now includes—
  • Five-year relative survival data for selected cancer sites by race, sex, and age group for 2001 through 2011.
  • Incidence rates and counts for Puerto Rico for 2008 through 2012 by sex and age, as well brain tumor and childhood cancer data.
USCS data are presented in the following applications—