Keeping it simple: Genetics referrals for all invasive serous ovarian cancers

Blogger's Note: in the absence of the full paper (subscriber-based $$) the disparities in genetic referrals is specific to invasive serous ovarian cancer which may preclude early and/or other cell types; it is known that serous cell types in ovarian cancer represent a higher % of ovarian cancer cases, however, the results may be even further understated as the focus is narrow

Abstract

Purchase $39.95

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Highlights

•

In Ontario, all women diagnosed with invasive serous ovarian cancer are eligible for genetic testing, irrespective of family history.

•

Only 23% of women with invasive serous ovarian cancer at a large Canadian gynaecologic cancer program attended genetic counselling.

•

99% of women who had genetic counseling pursued genetic testing; 16% of carriers had no family history of breast/ovarian cancer.

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Objective

In the province of Ontario, all women diagnosed with invasive serous ovarian cancer are eligible for genetic testing for mutations in the BRCA1 and BRCA2 genes. This study aimed to determine the proportion of these women who are seen for genetic counseling and to identify potential predictors and barriers to having genetic counseling.

Methods

All women who were diagnosed with invasive serous ovarian cancer and had genetic counseling at Princess Margaret Hospital (PMH) between 2002 and 2009 were identified. Logistic regressions and trend analyses explored age at diagnosis, year at diagnosis, and the time between diagnosis and genetic counseling. Genetic counseling outcomes were also examined.

Results

Of 623 women diagnosed with invasive serous ovarian cancer, 144 (23%) were seen for genetic counseling. As age at diagnosis increased, the likelihood of genetic counseling decreased (p=0.005). With a more recent date of diagnosis, the probability of having genetic counseling increased (p=0.032) while the time to genetic counseling decreased (p=0.001). Of women who pursued genetic testing, 31% were found to have a BRCA1 or BRCA2 mutation, 16% of whom had no family history of breast or ovarian cancer.

Conclusions

Despite the availability of genetic testing, only a small proportion of women with invasive serous ovarian cancer were seen for genetic counseling. Over time, an improvement in the proportion of women being seen for genetic counseling was noted; however barriers to seeing women with a later age at diagnosis or those with no family history of breast or ovarian cancer clearly exist.

Correspondence (+references): Cancer survivorship: Why labels matter; Beyond semantics

open access

Reply to P. Tralongo et al

"We endorse many of the points Tralongo et al1 make in their
response to our recent article 2 regarding the problems with the label
“cancer survivor.” As they note, “Finding a term that…can interpret
all the aspects of the problem is not merely a matter of semantics. The
term must identify a condition that may already be considered chronic
upon diagnosis, yet characterized by a fluid rather than a flat chronicity.”
1 We agree. As we noted, cancer has never fit the acute/chronic
disease divide particularly well; the present definitional issues around
what to label those who have lived through cancer thus speak to larger
inadequacies in our framework for conceptualizing this collection of
diseases. However, although we applaud the intent of Tralongo
et al to take seriously the problems with existing frameworks, we
are not sure that the solution they have devised moves us beyond
the present situation......


REFERENCES
1. Tralongo P, Annunziata MA, Tirelli U, et al: Beyond semantics: The need to better categorize patients with cancer. J Clin Oncol doi: 10.1200/
JCO.2013.50.0850
2. Bell K, Ristovski-Slijepcevic S: Cancer survivorship: Why labels matter. J Clin Oncol 31:409-411, 2013
3. Mullan F: Seasons of survival: Reflections of a physician with cancer. N Engl J Med 313:270-273, 1985
4. Frank A: At the Will of the Body: Reflections on Illness. Boston, MA,
Houghton Mifflin, 1991
5. Jain SL: Living in prognosis: Toward an elegiac politics. Representations 98:77-92, 2007
6. Tritter JQ, Calnan M: Cancer as a chronic illness? Reconsidering categorization and exploring experience. Eur J Cancer Care 11:161-165, 2002

After Cancer: Debate About Terminology Beyond Treatment

medscape

"The debate over labels has heated up again when it comes to describing cancer patients and their experience through and beyond the disease. Should they be described generically as "living with cancer" or as "cancer survivors"? Or should there be more of a distinction made, between for instance, someone who has "acute cancer," "cured cancer," and "chronic cancer," as a group of Italian researchers suggest?
"Until we have resolved this underlying issue of how to conceptualize cancer, then all the new labels in the world will not move us beyond the present situation, in which terminology serves to potentially alienate those so labeled and inadequately captures (or actively disguises key features of) the experience of life with and beyond cancer," write Kirsten Bell and Svetlana Ristovski-Slijepcevic (published online ahead of print on May 20 in the Journal of Clinical Oncology)...........

Development of a supportive care measure for economic evaluation of end-of-life care using qualitative methods

open access

Conclusion: Economic evaluation should reflect the broader benefits of end-of-life care. Although the supportive care measure developed here requires validation and valuation, it provides a substantial step forward in appropriate economic evaluation of end-of-life care. 

Dying at home – is it better: A narrative appraisal of the state of the science

Blogger's Note/Opinion: the 'elephant in the room' (eg. how the question was asked)

open access

 "....Longitudinal studies of place of death preferences in patients approaching the end of life have shown that some patients shift their preference, away from home and towards inpatient hospice or other inpatient setting. Nonetheless, even in these studies, home remained the preference for the majority,^36,37 with some variation probably due to how the question was asked........"

Nanoparticle albumin-bound paclitaxel for second-line treatment of metastatic urothelial carcinoma: phase 2 study (Lynch Syndrome patients)

Blogger's Note: this abstract does not indicate if Lynch Syndrome mutations were included, nor, does it differentiate the response in the scope of urothelial tumors (bladder, renal pelvis, ureter), the Lancet is most often paid-subscription-based

Abstract

Background

No standard treatment exists for patients with platinum-refractory urothelial cancer. Taxanes and vinflunine are commonly used, but response is less than 20% with no survival benefit. In this phase 2 study, we assessed efficacy and tolerability of nanoparticle albumin-bound (nab) paclitaxel in platinum-refractory urothelial cancer.....

Double heterozygosity for BRCA1 and hMLH1 gene mutations in a 46-year-old woman with five primary tumors

Abstract

Germline mutations in BRCA1 and BRCA2 genes predispose to hereditary breast cancer, whereas carriers of mutations in any of the mismatch repair genes (MMR; hMLH1, hMSH2, hMSH6, hPMS2) are highly susceptible to Lynch syndrome. In the present study, we describe a woman affected by unilateral breast cancer at the age of 35 years. After 4 years, during the follow-up she developed synchronous (and asymptomatic) endometrial cancer, ovarian carcinoma and renal clear cell carcinoma. After 7 years (at age 46), the patient developed an infiltrating carcinoma of the contralateral breast and died in a few months of metastatic disease. Initial investigations led to the detection of a constitutional mutation in the BRCA1 gene. The extended genealogical tree disclosed a suspected history of colorectal carcinoma in the maternal branch. Endometrial cancer of the proband was investigated for microsatellite instability (MSI) and immunohistochemical expression of MLH1, MSH2 and MSH6 proteins. An high MSI status and lack of expression of MLH1 protein were detected. hMLH1 gene sequencing revealed the presence of a constitutional mutation, which was also found in the mother of the proband. Loss of the wild-type hMLH1 allele was detected in both breast tumors, thus suggesting that the MMR defect contributed to the development of the breast cancer.

Search results: 'ovarian' (2013) Cancer Quality Council of Ontario

Search (copied 2013 results)

Showing 1 - 10 of 28 Results Sort by: Relevance Date

Survival and Mortality  (Tue, Apr 30, 2013 08:14 PM)

Patient Experience with Outpatient Cancer Care  (Mon, May 06, 2013 04:11 PM)

Technical Information  (Tue, Apr 16, 2013 03:40 PM)

Technical Information  (Mon, Apr 15, 2013 02:48 PM)

Modifiable Risk Factors  (Thu, Apr 11, 2013 07:36 PM)

5-31-3-patientsatisfaction-coordinationandcontinuity.xls  (Wed, Apr 24, 2013 06:13 PM) 5-31-3-patientsatisfaction-coo

1-5-16-patientsatisfaction-coordinationandcontinuity.xls  (Wed, Apr 24, 2013 06:13 PM) 1-5-16-patientsatisfaction-coo

CSQI 2013 report - Cancer Quality Council of Ontario, Canada

 Blogger's Note: the full report is extensive but searchable according to numerous quality indices including patient satisfaction, some areas include ovarian cancer specifics (eg. stats...)


CSQI 2013

Cancer System Quality Index (CSQI) 2013

Safe		Fair, but more work needs to be done. Some processes for a safe cancer system are in place, and action is under way to address concerns. Better system measures are needed to understand complications of care, across all aspects of cancer treatment and from the patient’s perspective.
Effective		Very good. Cancer services are generally effective and evidence based, and more Ontarians are receiving treatment based on the best available evidence. Continued effort is required to achieve targets and consistency across regions.
Accessible		Very good. More Ontarians are accessing the services they need despite increases in demand. A focus on patient-centred waits is required.
Responsive		Good, but the cancer system requires more focus on patients’ and survivors’ quality of life, and consideration of the whole person and family, both during and after active treatment.
Equitable		Poor. Cancer burden is still higher among those with lower socioeconomic status. Some variation exists in the use of guidelines for patients over 70 years old. More work needs to be done, using a whole-of-society approach to ensure equity.
Integrated		Poor. Services across the system need to be coordinated to support seamless and effective patient transitions regardless of location or provider.
Efficient		Fair. Better measures are needed to determine value for money for all services, while maintaining good health outcomes and seamless patient care. Use of acute care hospital services at the end of life remains high, suggesting patients and families may not have adequate access to appropriate resources and supports.

*

Very Good

Good

Fair

Poor

Incomplete Data

^* These symbols provide an overall assessment of cancer system performance for each dimension of quality. They include at an aggregate level, an assessment of performance over time, performance against annual programmatic targets, jurisdictional comparisons and/or clinical aims for those measures available in the index. Breadth and depth of indicators across the patient continuum and type of indicator are taken into account in the assessment.

A microRNA signature defines chemoresistance in ovarian (serous) cancer through modulation of angiogenesis

open access (technical)

The ASCO Post - Managing Female Reproductive Complications after Cancer Treatment in Children and Young Adults

ASCO

The ASCO Post - University of Michigan Launches New Cardio-oncology Program

 ASCO

Contralateral breast cancer after radiotherapy among BRCA1 and BRCA2 mutation carriers: A WECARE Study Report

multi-national study - abstract

Findings

Among women treated with radiation, the mean radiation dose was 1.1 Gy (range = 0.02–6.2 Gy). Risk of developing CBC was elevated among women who carried a deleterious BRCA1/BRCA2 mutation (rate ratio, RR = 4.5, confidence interval, CI = 3.0–6.8), and also among those treated with RT (RR = 1.2, CI = 1.0–1.6). However, among mutation carriers, an incremental increase in risk associated with radiation dose was not statistically significant.

Interpretation

Multiplicative interaction of RT with mutation status would be reflected by a larger association of RT with CBC among carriers than among non-carriers, but this was not apparent. Accordingly, there was no clear indication that carriers of deleterious BRCA/BRCA2 mutations were more susceptible to the carcinogenic effects of radiation than non-carriers. These findings are reassuring and have important clinical implications for treatment decisions and the clinical management of patients harbouring deleterious BRCA1/BRCA2 mutations.

Thrifty Merrimack developing new cancer drugs at lower cost | Reuters

Reuters

".....French drugmaker Sanofi acquired global rights to the Merrimack drug MM-121, being tested in lung, breast and ovarian cancer."

Value-based healthcare in Lynch syndrome

 Blogger's Note: in absence of the full text further explanation is required as to the type/extent of gyn cancer surveillance

Abstract

Lynch syndrome (LS), one of the most frequent forms of hereditary colorectal cancer (CRC), is caused by a defect in one of the mismatch repair (MMR) genes. Carriers of MMR defects have a strongly increased risk of developing CRC and endometrial cancer. Over the last few years, value-based healthcare has been introduced as an approach to the cost-effective delivery of measurable patient value over complete cycles of care. This requires all involved stakeholders to formulate and validate 'patient value' for Lynch syndrome, as well as to identify targets and associated costs. The aim of this study was to develop a value-based care model for Lynch syndrome that can determine patient value and associated costs, and to design a coordinated care pathway from existing guidelines. All specialists in our hospital involved in the management of LS patients evaluated the care delivered to these patients at their department and formulated outcome measures relevant to patient value.

Ovarian serous cystadenofibromas associated with a low-grade serous carcinoma of the peritoneum

Abstract

Case Report

Purchase $31.50

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"Ovarian serous cystadenofibromas are benign neoplasms that sometimes have focal areas of borderline serous tumor and rarely have been associated with epithelial proliferations in the peritoneum, resembling implants. We are reporting 2 cases of ovarian serous cystadenofibromas with serous peritoneal lesions of higher grade than the ovarian tumor: 1 case had a serous carcinoma and another 1 a serous borderline tumor."

Infection Site Predicts Death in Septic Shock

medpage

"Heterogeneity is a major problem," he said. "Some of these patients have cancer, some do not; some are older, some are younger. All these patients are in an intensive care unit. They are all critically ill."



PHILADELPHIA -- The anatomic site where an infection originates seems to predict mortality among patients diagnosed with septic shock, researchers reported at the American Thoracic Society conference.
In scouring a database that includes 8,000 septic shock patients in the U.S., Canada, and Saudi Arabia, those ICU patients with hydronephrosis, for instance, had a mortality of 21.1%, said Peter Dodek, MD, MHSc, professor of medicine at the University of British Columbia in Vancouver. But patients with ischemic bowel-caused infections experienced a mortality of 77.8%, he said.
"As many people realize, septic shock is a big issue in critical care medicine," Dodek said at a press conference sponsored by ATS. "Septic shock is associated with a high mortality -- in this study overall mortality was 52.4%."
He said that recently the mortality is decreasing, but "there are a lot of concerns because we haven't found a silver bullet to help treat septic shock."

Seth's Blog: Let's start with "sorry"

Seth's Blog:

"By the time the phone rings, there's already trouble. When that manager is called or this department is reached, it's because someone is disappointed, angry or stuck. Illness, broken promises or a real urgency have led to this new conversation even taking place.
So don't start with, "[Name of company] mumble mumble" as if there's a blank slate just waiting to be written on. There's already a lot of writing on that slate. Don't demand to know the record number or begin with doubt and an edge of dismissal. Be on our team.....

Treating Gynecologic Malignancies in Elderly Patients (79 yrs+)

Abstract

AIM:: To determine the relative benefits of full and partial treatment for gynecologic malignancies in elderly patients.
METHODS:: A retrospective cohort study of all consecutive patients (n=169) aged 79 and older (median age 82 y; range, 79 to 94 y), diagnosed between 1971 and 2007 with various types of gynecologic malignancies (endometrial, 52%; ovarian, 26%; vulvar, 11%; cervical, 5%; other, 6%) was conducted. Stages were I to II (47%), III to IV (35.5%), and unknown (17.5%). Major comorbidities were hypertension (51%), diabetes (17%), cardiac diseases (34%), and other malignancy (12%). Regardless of age or chronic illnesses, patients were grouped on the basis of having been treated optimally (100 patients; 59.2%), defined as the accepted standard for each diagnosis and stage including surgery and adjuvant radiation or chemotherapy as indicated; or suboptimally (69 patients; 40.8%), that is, no or only partial treatment. Kaplan-Meier survival analysis and Cox proportional hazard models, univariate and multivariable were conducted.
RESULTS:: For all patients with suboptimal treatment, the age-and-stage-adjusted hazard ratio for death was 1.76 (95% CI, 1.203-2.570; P=0.004) compared with optimal treatment. Age-adjusted hazard ratio was 2.15 (95% CI, 1.127-4.114; P=0.02) and 2.3 (95% CI, 1.415-3.779; P=0.001) for ovarian and endometrial cancer patients, respectively. Age-adjusted and stage-adjusted hazard ratio was 2.8 (95% CI, 1.099-5.157; P=0.028) and 1.53 (95% CI, 0.867-2.702; P=0.1420) for ovarian and endometrial cancer patients, respectively.
CONCLUSIONS:: Optimal treatment in patients with gynecologic malignancies evidently improves survival in elderly patients at any age, and in patients with ovarian cancer at any stage. Regardless of chronological age, the aim should be to deliver optimal treatment.

Simplifying clinical use of the genetic risk prediction model BRCAPRO -

Blogger's Note: this abstract refers to alternative BRCA genetic testing tools which brings to surface the current legal patent issues,  specifically in the U.S. court system; in particular, as noted in prior 'patent' postings, an observation was made that the current litigation underway will not have a wide impact (BRCA 1/2) as many other patients exist which is reflected as the one described here:

abstract

"...The simpler versions, especially BRCAPROLYTE-Plus and BRCAPROLYTE-Simple, lead to only modest loss in overall discrimination compared to BRCAPRO in this dataset. Thus, we conclude that simplified implementations of BRCAPRO can be used for genetic risk prediction in settings where collection of complete pedigree information is impractical."

also:  2012 JSM (Joint Statistical Meetings) conference abstract:
A Two-Stage Approach to Genetic Risk Prediction in Primary Care 

Toll-like receptor 8: augmentation of innate immunity in platinum resistant ovarian carcinoma (VTX-2337)

open access

Received:	16 November 2012
Accepted:	07 March 2013

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California, Irvine, Orange, CA, USA

Abstract: 

Ovarian cancer is the most deadly gynecologic cancer, with 15,000 anticipated deaths within the United States alone in 2012, and new treatment strategies are needed. Ovarian cancer tumors are known to host an immunosuppressive microenvironment. This suppression may be reversible via activation of the innate immune response. Toll-like receptor 8 activates innate immunity while simultaneously inhibiting the effects of regulatory T cells within the ovarian cancer tumors. VTX-2337 is a novel small molecule ligand of Toll-like receptor 8 and is currently the subject of a Phase II randomized, double-blind, placebo-controlled trial Gynecologic Oncology Group (GOG)-3003 for patients with recurrent platinum-resistant ovarian cancer. We look forward to the results of this trial as support for the paradigm of process therapy in the treatment of ovarian cancer..........

Dr. Saul Rivkin leaves Swedish practice to focus on Marsha Rivkin Ovarian Cancer Research Center - Puget Sound

Puget Sound Business Journal

Seattle Dr. Saul Rivkin, 77, hematologist and oncologist renowned in the field of ovarian cancer treatment and research, will be stepping away on July 1 from the direct patient care he has been giving at Swedish since 1971.
Rivkin, along with his five grown daughters, founded the Marsha Rivkin Ovarian Cancer Research Center at Swedish, named for his wife, who died from the disease at the age of 49 after battling it for four years..........

SGO Calls for Broad Changes in Managing Patient Care

 
onclive

 
Blogger's Note: refers to previously posted blog item:

Creating a New Paradigm in Gynecologic Cancer Care:Policy Proposals for Delivery, Quality and ReimbursementA Society of Gynecologic OncologyWhite PaperFebruary 2013

http://tinyurl.com/bh32rro.

The Curious Case Of Human Gene Patents (BRCA's/Myriad) - Forbes

Forbes

financial - Immunovaccine is on Track to Advance Clinical Programs - Analyst Blog

Blogger's Note: includes history and future of the clinical trials 

financial news

NICE guidance on bevacizumab in combination with gemcitabine and carboplatin for treating the first recurrence of platinum-sensitive advanced ovarian cancer

Blogger's Note: register to view (free)

open access: The Lancet Oncology

 "........At its second meeting, the Committee considered responses to its preliminary recommendations from the manufacturer and patient groups.9 The Committee was aware that, because a proportion of patients in both treatment groups from the OCEANS trial received bevacizumab after disease progression, confounding of overall survival results might have occurred. However, the Committee remained unable to draw any firm conclusions as to which of the three potential explanations explained the difference between the progression-free survival and overall survival results, and to what extent. Consequently, the Committee did not recommend bevacizumab in combination with gemcitabine and carboplatin for the treatment of the first recurrence of platinum-sensitive advanced ovarian cancer. A final appraisal determination was issued.10 Stakeholders were given the opportunity to request changes to the document or to appeal against its recommendations. No appeals were received and the guidance was published by NICE on May 22, 2013."

pharma Article > Final NICE no for Avastin in ovarian cancer

Article > Final NICE no for Avastin in ovarian cancer

FindZebra - The search engine for difficult medical cases

 Blogger's Note: tested 'MSH2' with appropriate findings; also searched for a specific mutation with results (better than Google etc...)

FindZebra

Canadian Health Care Wait Times 'Manufactured' Says Latest Research

press release

Concern for Pain in the Pre-Operative Period- Is the Internet Being Used for Information By Patients?

Abstract

Objectives

This study was conducted to provide information regarding prevalence of pain, type of provider managing pain, and use of Internet for information regarding pain, among patients coming for presurgical anesthesia consultation at a major academic institution.

Results

A total of 1039 patients were asked to complete the survey and 670 patients returned their responses (response rate = 64.5%). 83% of patients had a history of prior surgery. 57% were concerned about postoperative pain. 30% of patients had chronic pain for more than 3 months pre-operatively. 16% of patients had looked online for information regarding pain. Pain physicians were involved in pain management only in 3.8% of these patients.

Discussion

Patients are presenting for surgery with significant pre-operative pain issues. Knowing this information pre-operatively will help healthcare personnel manage postsurgical pain more effectively. Patients are also using the Internet to obtain information regarding pain. As providers, there may be value to directing patients to reliable information online during consultation. As all physicians will eventually be managing chronic pain in their patients, pain education should be given priority in medical school curriculum.

A Molecular Explanation for Age-Related Fertility Decline in Women (BRCA1)

Blogger's Note:  continual reference to BRCA1 as a breast cancer gene

eMedicine
SOURCE: NIH, May 21, 2013

A prospective investigation of fish, meat and cooking-related carcinogens with endometrial cancer incidence

 Blogger's Note: of interest to those with dual malignancies (endometrial (uterine)/ovarian and/or Lynch Syndrome patients)

Abstract

Background:

There are limited prospective studies of fish and meat intakes with risk of endometrial cancer and findings are inconsistent.

Methods:

We studied associations between fish and meat intakes and endometrial cancer incidence in the large, prospective National Institutes of Health-AARP Diet and Health Study

Conclusion:

Our findings do not support an association between meat or fish intakes or meat mutagens and endometrial cancer.

Distress in unaffected individuals who decline, delay or remain ineligible for genetic testing for hereditary diseases: a systematic review

Abstract

Conclusions

The small number of studies and methodological limitations preclude definitive conclusions. Nevertheless, subgroups of those who remain untested appear to be at increased risk for psychological morbidity. As the majority of unaffected individuals do not undergo genetic testing, further research is needed to better understand the psychological impact of being denied the option of testing, declining and delaying testing.

Saint Germain Catering Sponsors Dog Training for Ovarian Cancer Detection at Penn Vet’s Working Dog Center

press release

"......In a unique, interdisciplinary collaboration, the Penn Vet Working Dog Center, Penn Physics Department, Penn Medicine’s Division of Gynecologic Oncology, and the Monell Chemical Senses Center have joined together to study ovarian cancer detection by dogs and e-sensors. A grant of $80,000 from Kaleidoscope of Hope Ovarian Cancer Foundation has been awarded to fund this collaborative project.........

Study Raises Doubt About Thromboembolism Prophylaxis

medscape

Increased platelet reactivity in patients with late-stage metastatic cancer - Cooke - 2013 - Cancer Medicine - Wiley Online Library

open access

Abstract

Platelet hyperreactivity is associated with an increased risk of thrombosis. Cancer patients are at an increased risk of thrombosis, a risk that increases with disease progression. While cancer patients show evidence of platelet activation in vivo, few studies have extensively assessed whether these patients display platelet hyperreactivity. We hypothesized that patients with metastatic cancer would display platelet hyperreactivity, reflecting their associated high risk of thrombosis.......

Study design

....As thrombosis is associated with a wide range of cancer types [7], we choose a heterogeneous cohort of patients, all of whom had disseminated malignancy, to critically examine the effect of metastasis on platelet function. In total, we studied 10 different cancer types, including sex-specific cancers (e.g., metastatic ovarian cancer).......

"...Together these data show significant evidence of global platelet hyperreactivity in patients with metastatic cancer. Further studies are warranted to elucidate the molecular mechanism underlying platelet hyperreactivity in these patients. Also, it remains largely unclear if these observations reflect the effect of malignancy on platelet hyperreactivity, or the effect of platelet hyperreactivity on malignancy, or if indeed both. Global platelet hyperactivity could explain the associated high level of adverse thrombotic events in this patient cohort. Clinical trials of currently available antiplatelet agents may represent a novel therapeutic strategy for the treatment of cancer-associated thrombosis.

Impairment-driven cancer rehabilitation: An essential component of quality care and survivorship 2013

Blogger's Note: search term 'death':  results = 0

open access

 "Adult cancer survivors suffer an extremely diverse and complex set of impairments, affecting virtually every organ system. Both physical and psychological impairments may contribute to a decreased health-related quality of life and should be identified throughout the care continuum. Recent evidence suggests that more cancer survivors have a reduced health-related quality of life as a result of physical impairments than due to psychological ones......

Table 3: Identifying Physical Impairments in Patients With Cancer (includes ovarian cancer)

Table 3 lists the myriad impairments that may occur in patients with cancer, impacting virtually every organ system, and Table 1 lists some examples of validated tools that may be used to identify physical impairments in this population. These impairments can be due to tumor compression, treatment side effects, or paraneoplastic phenomena. While they can be sudden, catastrophic events such as spinal cord compression, Cheville et al noted that in patients with metastatic breast cancer, disablement is more frequently “driven by the accrual of multiple physical impairments, adverse symptoms, and their interactions rather than by discrete and functionally catastrophic impairments.”[29] In order to limit the scope of this review, several common impairments will be presented as examples. This article focuses on rehabilitation interventions; the reader should refer to specific treatment guidelines for the medical and surgical management of these conditions.

 ~~~~~~~~~~

"A leading cause or perhaps even the leading cause of emotional distress in cancer survivors is physical disability. Banks et al investigated distress in cancer survivors and found that the major cause was disability.[14] They concluded, “The risk of psychological distress in individuals with cancer relates much more strongly to their level of disability than it does to the cancer diagnosis itself.”[14] Ponto et al observed that, in women living with ovarian cancer, a predictor of distress was poor performance status.[15] A study of 112 Jordanian patients receiving chemotherapy found that lower scores in emotional and physical functioning were associated with higher reports of distress.[16] In fact, the link between physical and psychological function is becoming so important that, in a recent study of screening in an inpatient setting, researchers advised, “…routinely screening for psychological and physical distress should become a first step in the assessment of the biopsychosocial needs of people receiving inpatient treatment for cancer.”[17]

16.

Ponto JA, Ellington L, Mellon S, Beck SL. Predictors of adjustment and growth in women with recurrent ovarian cancer. Oncol Nurs Forum. 2010;37:357-364.

• CrossRef,
• Web of Science® Times Cited: 1

Lynch syndrome testing in ethnically diverse patients: Mutation spectrum and performance of prediction models

ASCO Abstracts


Background:

Lynch syndrome (LS) is characterized by deficiency in DNA mismatch repair (MMR). Several models can predict the probability of MMR gene mutations, but all were derived from populations in Northern Europe and America. We aimed to characterize MMR mutations and to evaluate the performance of 4 models (Leiden, MMR_predict, MMR_pro, and PREMM_1,2,6) in an ethnically diverse high-risk population.  

Methods:

Mutation and pedigree data from 387 distinct probands tested for germline MMR mutations at a single center between 2003-2012 were analyzed. Mutation testing was triggered by suggestive tumor microsatellite results and/or clinical/family history. Race/ethnicity was self-reported: 84 (22%) were ethnically-diverse (African American, 19; Hispanic, 29; Asian/Arabic, 34; and other, 2) and 303 (78%) were white. Area under the receiver operating curve (AUC) for all 4 models was analyzed by logistic regression.  

Results:

Pathogenic mutations were detected in 152 patients (39%; MLH1 in 37, MSH2/EPCAM in 84, MSH6 in 21, and PMS2 in 10). The detection rate was significantly lower in ethnically-diverse patients when compared to white patients (30 vs. 42%; p=0.04). The mutation frequency of the major MMR genes MLH1 and MSH2 differed, although the overall mutation distribution did not reach statistical significance (MLH1, 40 vs. 22%; MSH2: 36 vs. 59%; MSH6: 20 vs. 13%; and PMS2: 4 vs. 7%; p=0.10 vs. white). The Leiden, MMR_predict, MMR_pro, and PREMM_1,2,6 models trended toward inferior discrimination for the ethnically diverse patients, with AUCs of 0.63, 0.64, 0.63, and 0.66 respectively (vs. AUCs of 0.71, 0.69, 0.72, and 0.76 for white patients), but the difference was not statistically significant(p=0.11, 0.17, 0.09, and 0.08, respectively). Adjusting for family size did not significantly alter results.

Conclusions:

In ethnically-diverse patients, the overall detection rate for pathogenic MMR mutations is significantly lower, with associated differences in mutation frequencies and in predictive model performance. We caution against relying solely on predictive scores, as high-risk ethnically-diverse patients without an identified mutation may deserve to be followed as clinical LS patients.

 

Personalized Cancer Care: N-of-1 | Dr. Robert A. Nagourney - Rational Therapeutics - Blog

Blogger's Note: ovarian cancer patients will know only too well the results of being 'lumped into' clinical research findings which do not at all reflect their own personal situation; while recent research notes changes in treatments/clinical trial specifics to individuals, the reality is still that most patients are receiving 1st line treatments applicable to general research findings (we can use serous cell type as an example); aside from clinical trials, which the vast majority of patients do not enrol in (justifiable),  we have a long way to go in this extraordinarily complex chain of events in patient diagnosis and treatments

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

Personalized Cancer Care: N-of-1

"...So what about an N-of-1? This disrupts every tenet of cancer research, upends every power analysis, and completely rewrites the book of developmental therapeutics. Every patient is his or her own control. Their good outcome reflects the success or failure of “the trial.” There is no power analysis. It is an “N” of 1."

Microsatellite Instability and TARBP2 Mutation Study in Upper Urinary Tract Urothelial Carcinoma (MLH1/MSH2)

Abstract

Microsatellite instability (MSI) contributes to the tumorigenesis of upper urinary tract urothelial carcinomas (UUT-UCs). In this study, we first used MLH1 and MSH2 immunohistochemistry to identify patients with loss of expression of either or both of these proteins in 132 UUT-UCs. We found a total loss of MSH2 expression in 4 patients. MSI was evaluated using 5 markers in these 4 cases. All of the tumors had high MSI (MSI-H) status. Trans-activation responsive RNA-binding protein 2, an integral component of DICER1-containing complex, was a putative target of DNA mismatch repair deficiency. Truncating mutation has been identified in gastrointestinal cancers with MSI. No previous study has evaluated the mutation status of this gene in MSI UUT-UCs. In this study, we analyze the mutation of TARBP2 in MSI-H UUT-UCs with reverse transcription polymerase chain reaction. No truncating mutations were identified in the MSI-H UUT-UCs.

No Link Between Anesthesia and Dementia (however.....)

Medscape

 Exposure to general anesthesia during medical procedures after age 45 years is not a risk factor for dementia, results of a new study suggest.
The lack of association between anesthesia and dementia was also quite robust in several of the study's sensitivity analyses exploring factors such as the timing of anesthetic exposure before the dementia diagnosis and the age at the time of anesthetic exposure, researchers report.
"The message from this paper is very simple: Anesthesia is not a risk for dementia," said one of the study authors David S. Knopman, MD, Department of Neurology, Mayo Clinic, Rochester, Minnesota.
However, the study does not settle the controversy surrounding the concept of postoperative cognitive decline (POCD), the researchers caution.
The retrospective, population-based, nested case-control study was published online May 3 in the Mayo Clinic Proceedings.....

Health sites too complex, full of cliches: study | Reuters

 Reuters


(Reuters Health) - The importance of health literacy hit home for Lisa Gualtieri when a Cambodian refugee diagnosed with cancer asked her to act as a patient advocate.
She played the role of a "salty tongue," a Cambodian expression that paints outspokenness in a positive light. But even though the patient's family was in the room when doctors took the time to answer every last question about test results and treatment options, the refugee's family would call Gualtieri hours later to review what doctors had said.
A new study, published Monday in JAMA Internal Medicine, suggests one potential reason for the family's confusion: Despite good intentions, many experts may be creating educational materials that are too difficult for patients and their families to grasp........

Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary

Abstract

PURPOSE Continuity of care among different clinicians refers to consistent and coherent care management and good measures are needed. We conducted a metasummary of qualitative studies of patients’ experience with care to identify measurable elements that recur over a variety of contexts and health conditions as the basis for a generic measure of management continuity.

METHODS From an initial list of 514 potential studies (1997–2007), 33 met our criteria of using qualitative methods and exploring patients’ experiences of health care from various clinicians over time. They were coded independently. Consensus meetings minimized conceptual overlap between codes.

RESULTS For patients, continuity of care is experienced as security and confidence rather than seamlessness. Coordination and information transfer between professionals are assumed until proven otherwise. Care plans help clinician coordination but are rarely discerned as such by patients. Knowing what to expect and having contingency plans provides security. Information transfer includes information given to the patient, especially to support an active role in giving and receiving information, monitoring, and self-management. Having a single trusted clinician who helps navigate the system and sees the patient as a partner undergirds the experience of continuity between clinicians.

CONCLUSION Some dimensions of continuity, such as coordination and communication among clinicians, are perceived and best assessed indirectly by patients through failures and gaps (discontinuity). Patients experience continuity directly through receiving information, having confidence and security on the care pathway, and having a relationship with a trusted clinician who anchors continuity.

legal (media report) ovarian cancer legal case - West Cobb, GA Patch

Court Rules in WellStar's Favor - West Cobb, GA Patch

"Jordan claimed that his wife’s fallopian tubes and ovaries should have been removed at the time of her hysterectomy because she had a family history of cancer."

Efficacy of Contact Needle Therapy for Chemotherapy-Induced Peripheral Neuropathy

open access

Abstract

Cancer chemotherapy-induced peripheral neuropathy (CIPN) often results in discontinuation of treatment with potentially useful anticancer drugs and may deteriorate the patient’s quality of life. This study investigated the effect of contact needle therapy (CNT) on CIPN caused by responsible chemotherapeutic agents as taxanes and oxaliplatin. Six patients with CIPN were treated with CNT. The severity of CIPN was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) version 4 and FACT/GOG-Ntx before and after CNT. After the treatment, all of the patients showed some improvement. Four patients showed apparent improvement in breakthrough pain. One of the cases had difficulty in walking because of CIPN in lower extremities, but after 2 times of CNT, he could walk without pain and could continue the chemotherapy.
Although its putative mechanisms remain elusive, CNT has strong potential as an adjunctive therapy in CIPN. Well-designed clinical trials with adequate sample size and power are necessary to confirm the findings of this study.


Introduction

With the increasing numbers of patients with cancer and cancer survivors and the development of multidisciplinary cancer therapy, treatment that considers the quality of life (QOL) of patients together with prognostic improvement is demanded. Multidisciplinary cancer therapy consists of surgical treatment, radiotherapy, and chemotherapy. Chemotherapy often causes side effects such as myelosuppression, digestive symptoms, renal failure, or peripheral neuropathy. Cancer chemotherapy-induced peripheral neuropathy (CIPN) is one of the most serious problems in clinical practice, and it sometimes results in the discontinuation of subsequent treatment [1, 2]. CIPN is well known in taxanes, platinum analogues, vinca alkaloids, and molecular target drugs such as bortezomib [3]. Neuropathy by taxanes stems from damage to microtubules of the neuraxis, mainly developing from gloves-and-socks type sensory disturbance [4]. Platinum analogues such as cisplatin and oxaliplatin damage nerve cells directly, followed by damage to the neuraxis [5].......

Network Pharmacology: A New Approach for Chinese Herbal Medicine Research

open access

 Introduction

Over the past decades, drug discovery has followed the dominant paradigm of the “one gene, one drug, one disease” and mainly focused on designing exquisitely selective ligands which could avoid side effects [1]. However, owing to the lack of efficacy and safety, the clinical attrition rate of new drug candidates reached up to 30% [2]. Moreover, the large-scale functional genomics studies have revealed that many single-gene knockouts exhibit little effect on the phenotype [3], and only 34% of single-gene knockout resulted in sickness or lethality [4]. Systems biology is a recent trend in bioscience research which focuses on the complex interactions in biological systems from a holistic perspective, rather than altering the single molecular component [5, 6]. Network pharmacology [7, 8], a system biology-based methodology, replaces the corollary of rational drug design of “magic bullets” by the search for multitarget drugs that act on biological networks as “magic shotguns” [9]. Network biology analysis has also revealed that the deletion of individual nodes has little effect on the disease networks [10]. The increased understanding of the role of network biology systems challenges the dominant assumption of single-target drug discovery [11, 12]. Chinese herbal medicines (CHM) include natural medicines that were discovered by the ancient Chinese and evolved through at least 3000 years of uninterrupted clinical practice. Generally, CHM cures diseases by the synergistic effects of multiple compounds and herbal formula, which is mainly based on the integrative and holistic ways [13]. However, with the growing popularity and great promise of CHM, the ever-increasing demand for illuminating pharmacological mechanisms, potential drug efficacy, and clinical toxicity are major issues that need to be addressed. As a methodology and technology, network pharmacology offers a new approach to integrate the notion of drug discovery based on comprehensive research and synthetic assessment. Obviously, this principle coincides with the characteristics of syndrome differentiation by traditional Chinese medicine (TCM) and holistic view of CHM treatment [14]................

U.K. to Pilot Illumina Genetic Test for Breast, Ovarian Cancer - Bloomberg

 Bloomberg

The U.K. is piloting a new genetic test developed by Illumina Inc. (ILMN) to help cancer patients and their doctors better identify appropriate treatments and help determine if relatives have cancer risk.
Illumina’s TruSight test, to be introduced in 2014 at the Royal Marsden hospitals in London and Sutton, can analyze 97 genes that are linked to cancer within a few weeks for a few hundred dollars, the Wellcome Trust said in a statement today. The pilot program will start for women with breast and ovarian cancer and may eventually be rolled out to the rest of the U.K. National Health Service and for other types of cancers, it said......

(UK) New model for genetic testing in cancer patients launched | Wellcome Trust

UK

"A research programme that will lay the foundations for anyone with cancer to have access to genetic testing has been launched with £2.7 million funding from the Wellcome Trust......... 

Prognostic analysis of endometrioid epithelial ovarian cancer with or without endometriosis: A 12-year cohort study of Chinese patients

Abstract

Purchase $31.50

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Objectives

Clinico-pathological characteristics and possible prognostic factors among women with endometrioid epithelial ovarian cancer (EEOC) with or without concurrent endometriosis were investigated.

Study design

A search of medical charts at Peking Union Medical College Hospital from 2000 to 2012 identified patients with EEOC with or without endometriosis.

Results

Of 188 patients with EEOC, concurrent endometriosis was identified in 32 (17.0%). Patients with concurrent endometriosis were approximately 5 years younger, more likely to be premenopausal, more likely to have an early stage of EEOC, and less likely to have high grade tumors compared to those without endometriosis. The univariate analysis showed that concurrent endometriosis was a significant prognostic factor for disease-free survival, but this association did not remain in the multivariate analysis.

Conclusions

Women with EEOC and concurrent endometriosis showed distinct characteristics and had longer disease-free survival when compared with those without endometriosis.

When All You Have Is A Hammer: The Problem With Outsourcing Primary Care To Non Physicians - Better Health

 Better Health

(oral contraceptives) Hormonal and Reproductive Risk Factors for Sporadic Microsatellite Stable and Unstable Endometrial Tumors

Blogger's Note: will be of interest to those with dual maligancies (endometrial/ovarian)and/or Lynch Syndrome patients

Abstract

Hormonal and reproductive factors modulate bioavailable estrogen to influence endometrial cancer risk. Estrogen affects the microsatellite status of tumors, but the relation between these estrogen-related factors and microsatellite status of endometrial tumors is not known. We evaluated associations between hormonal and reproductive factors and risks of microsatellite stable (MSS) and microsatellite instable (MSI) endometrial cancer among postmenopausal women (MSS cases=258, MSI cases=103 and controls=742) in a population-based case-control study in Alberta, Canada (2002-2006)........ We observed a significant trend in risk reduction for MSI (P-trend=0.005), but not MSS (P-trend=0.23), cancer with oral contraceptive (OC) use; with ≥5 years use, the risk reduction was stronger for MSI (OR=0.42, 95%CI=0.23-0.77) than for MSS cancer (OR=0.80, 95%CI=0.54-1.17; P-heterogeneity=0.05). For more recent use (<30 years), the risk reduction was stronger for MSI (OR=0.36, 95%CI=0.19-0.69) than for MSS cancer (OR=0.77, 95%CI=0.51-1.15; P-heterogeneity=0.032). No differential risk associations were observed for menopausal hormone use, parity and age at menarche, menopause or first pregnancy. We found limited evidence for statistical heterogeneity of associations of endometrial cancer risk with hormonal and reproductive factors by MSI status, except with OC use. This finding suggests a potential role for the MMR system in the reduction of endometrial cancer risk associated with OC use, although the exact mechanism is unclear. This study shows for the first time that OC use is associated with a reduced risk for MSI, but not for MSS, endometrial cancer.

Case Reports - Extensive Cutaneous Metastases of Ovarian Cancer After Prolonged Response to Liposomal Doxorubicin

open access

Highlights

•

Cutaneous (skin) metastases are rare and clinically challenging to manage. When present, they often represent end-stage disease.

•

Treatments for cutaneous metastases are limited, and primarily palliative in nature.

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INTRODUCTION

In 2012, an estimated 22,280 women will be diagnosed with ovarian cancer and 15,500 will die of the disease.¹ Approximately seventy-five percent of women diagnosed with ovarian cancer in the United States have stage III or more advanced disease at diagnosis. Although most patients respond to initial treatment, the rate of recurrence after initial treatment of ovarian cancer is as high as 65% to 75%. The most common site of recurrence is within the peritoneal cavity. In a postmortem study, Rose et al. evaluated the patterns of ovarian cancer metastasis and found that the most common sites of metastasis were the peritoneal cavity, paraaortic lymph nodes, large intestine, pelvic lymph nodes, and liver.²

Ovarian cancer can metastasize by direct extension and transport throughout the peritoneal cavity and/or through lymphatic or hematogenous spread. Cutaneous metastases are rare, occurring in 1.9% to 5.1% of patients.³ Cutaneous metastases are often a late manifestation of the disease and have a propensity to occur within previous surgical scars, although cases of cutaneous metastases to the limbs have also been reported. Cutaneous metastases most commonly manifest as small nodular lesions but can also manifest as herpetiform erythematous lesions and scarring plaques.

Treatment of recurrent metastatic ovarian cancer involves systemic chemotherapy with agents chosen on the basis of previously demonstrated platinum sensitivity or resistance. Pegylated liposomal doxorubicin (PLD) is a cytotoxic agent that has demonstrated efficacy in the treatment of recurrent platinum-sensitive and platinum-resistant ovarian cancer. In patients with platinum-resistant ovarian cancer, PLD as a single agent has shown a survival benefit nearly equal to what is observed with other cytotoxic agents but is associated with less toxicity. Given these findings and its relatively convenient dosing, PLD is often chosen as the preferred agent for patients with recurrent platinum-resistant ovarian cancer.

Case

 

Case

A 64-year-old woman was diagnosed with at least stage IA high-grade serous ovarian carcinoma following a laparoscopic bilateral salpingo-oophorectomy. The patient was subsequently referred to The University of Texas MD Anderson Cancer Center for further treatment. After review of pathology slides, the patient was treated with six cycles of paclitaxel (175 mg/m²) and carboplatin (AUC = 5), which were completed in May 2006. She had no evidence of disease upon completion of therapy.

Approximately 5 months after completion of therapy, computed tomography (CT) revealed disease recurrence in the form of a 1-cm subcutaneous nodule involving the left rectus abdominus muscle and a 1-cm peritoneal deposit within the pelvis. The serum CA-125 level was 7.1 U/mL. Given that disease had recurred after platinum-based therapy, the decision was made to treat the patient with single-agent PLD (40 mg/m²) every 28 days............

Serrated adenoma of the stomach: MSH2 Case report and literature review

open access


Gastric (stomach) serrated adenomas are histologically characterized by protruding glands with lateral saw tooth-like indentations lined with stratified dysplastic cells containing abundant eosinophilic cytoplasm. Since the first case of gastric serrated adenoma found in 2001, 18 additional cases have been reported. Gastric serrated adenomas have a particular proclivity to progress to invasive carcinoma; 75% or 15 of the 20 cases now in record - including the present one - exhibited invasive carcinoma. The 20^th case of gastric serrated adenoma reported here differs from the preceding ones in as much as it evolved in a patient with Lynch syndrome, implying that this adenoma phenotype may develop not only sporadically but also in patients with hereditary traits.

"....Here, we report the first case of serrated adenoma of the stomach in a patient with Lynch syndrome. Lynch syndrome is an autosomal dominant genetic condition which has a high risk of colon cancer as well as other cancers including endometrium, ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain, and skin. The increased risk for these cancers is due to inherited mutations that impair DNA mismatch repair. The occurrence of this case of gastric serrated adenoma in a patient with Lynch syndrome implies that this adenoma phenotype may develop not only sporadically but also in patients with hereditary traits.....

media - very key comment from Dr Steven Narod (internally known expert genetics/BRCA) worth reading

media

'If you have to get two cases of cancer in the family to

qualify for testing, you’re only going to prevent the

third [cancer]. We should be preventing the first one.'—

Cancer researcher Dr. Steven Narod

"While her story transfixed people the world over, Narod says Jolie’s case has particular relevance to Canadians because her mother, Marcheline Bertrand, was French-Canadian. "

".....Dr. Stephen Narod, a senior scientist at Women’s College Hospital in Toronto, has followed the debate about the article, but says that in scrutinizing Jolie’s decision, pundits and readers are missing a broader lesson about access to genetic testing.
“I heard so many dumb opinions over the last couple of days, [but] no one asks: why aren’t we efficiently offering this to Canadians?”  says Narod, who believes that people should have equal access to genetic tests......"

(Blogger's Note: this (access) issue is not, of course, just a Canadian issue, but it does say something about universal/healthcare systems)

Editorial :: Is The Cochrane Collaboration prepared for the era of patient-centred outcomes research? - The Cochrane Library

Editorial :: open access

..........Given the experience with involvement of consumers and patients in Cochrane Reviews, the Collaboration is well equipped to advance the field of patient-centered outcomes research. It is the largest single producer of systematic reviews worldwide, it is a leader in the field of systematic review methods, and its backbone is individuals driven by the motivation to improve health care. In addition, the Collaboration has an active consumer group. Nevertheless, a bit more attention to the vantage points that patients face when making healthcare decisions and some thinking 'outside the Cochrane box' might be required to face these new challenges.
Specifically, the strong focus on RCTs and readily accessible endpoints restricts many Cochrane Reviews to outcomes that are important to trial designers and sponsors but not necessarily important to patients.

Interventions to improve professional adherence to guidelines for prevention of device-related infections - The Cochrane

Abstract

Plain language summary

Healthcare-associated infections (HAIs) are a major threat to patient safety, and are associated with mortality rates varying from 5% to 35%. Important risk factors associated with HAIs are the use of invasive medical devices (e.g. central lines, urinary catheters and mechanical ventilators) that breach the body's normal defence mechanisms, and poor staff adherence to infection prevention practices during insertion and care for the devices when in place.
We identified 13 studies: one cluster randomised controlled trial (CRCT) and 12 interrupted time series (ITS) studies, involving 40 hospitals, 51 intensive care units (ICUs), 27 wards and more than 1406 healthcare professionals and 3504 patients, which assessed the impact of different interventions to reduce the occurrence of device-related infections for inclusion in this review. We judged all studies to be at moderate to high risk of bias.
The effect sizes were small with the largest median effect for studies addressing central line associated blood stream infections (CLABSIs) occurring immediately after the implementation of an intervention to improve adherence to guidelines, in the majority of studies this change was not sustained over longer follow-up times. The median effect for studies aiming to reduce ventilator-associated pneumonia (VAP) was somewhat greater and was sustained up to 12 months follow-up. The results of six studies that reported adherence/non-adherence with infection control recommendations showed very varying adherence scores ranging from 14% to 98%.
The low to very low quality of the evidence of the studies included in this review provides insufficient evidence to determine with certainty which interventions are most effective in changing professional behaviour and in what contexts. However, interventions that may be worth further study are educational interventions consisting of more than one active element and that are repeatedly administered over time, and interventions employing dedicated personnel, who are focused on a certain aspect of care that is supported by evidence e.g. dentists/dental auxiliaries providing oral care. If healthcare organisations and policy makers wish to improve professional adherence to guidelines for the prevention of device-related infections, funding of well designed studies to generate high quality evidence is needed to guide policy.

Replacing a peripheral venous catheter when clinically indicated versus routine replacement | Cochrane Summaries

Summary

Most hospital patients receive fluids or medications via an intravenous catheter at some time during their hospital stay. An intravenous catheter (also called an IV drip or intravenous cannula) is a short, hollow tube placed in the vein to allow administration of medications, fluids or nutrients directly into the bloodstream. These catheters are often replaced every three to four days to try to prevent irritation of the vein or infection of the blood. However, the procedure may cause discomfort to patients and is quite costly. This review included all of the randomised controlled trials which have compared routine catheter changes with changing the catheter only if there were signs of inflammation or infection. We found no evidence of benefit to support current practice of changing catheters routinely every three to four days.

Authors' conclusions: 

The review found no evidence to support changing catheters every 72 to 96 hours. Consequently, healthcare organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would spare patients the unnecessary pain of routine re-sites in the absence of clinical indications. To minimise peripheral catheter-related complications, the insertion site should be inspected at each shift change and the catheter removed if signs of inflammation, infiltration, or blockage are present.

Health News - Mapping a route to stem cell therapies

Health News

"Dr Polo said these and many more complexities must be understood before stem cell therapy can move effectively into the clinical arena."

Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis : The Lancet

Abstract

Interpretation

PICCs are associated with a higher risk of deep vein thrombosis than are CVCs, especially in patients who are critically ill or those with a malignancy. The decision to insert PICCs should be guided by weighing of the risk of thrombosis against the benefit provided by these devices.

Wiley Online Library: Search Results "Lynch Syndrome" (12 months) Page

Search Results 

There are 19 results for: lynch in Article Titles AND syndrome in All Fields in the last 12 months

VIEW

1. 1 - 19

ASCO: Lynch Syndrome: A Multitude of Predispositions (note ovarian and breast cancer risk %)

The ASCO Post

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(Lynch Syndrome in women)

"In addition to endometrial cancer, cancers that occur in excess in germline mutation carriers for Lynch syndrome are the aforementioned colon and ovary cancers; cancers of the stomach, small bowel, pancreas, upper uroepithelial tract (ureter and renal pelvis), breast, and prostate; sebaceous adenomas, sebaceous carcinomas, multiple keratoacanthomas, and possibly other skin cancers in the Muir-Torre syndrome variant; and glioblastoma multiforme in the Turcot syndrome variant."
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"The current uncertainty regarding the relative frequencies of cancers of various anatomic sites in Lynch syndrome poses a difficulty in commenting on the syndrome’s overall cancer spectrum. It is even more vexing to address the order in which these cancers are prone to occur. What we do know is that there is an enormous lifetime risk of cancer at multiple anatomic sites in Lynch syndrome....... Lynch syndrome has become known to be the most frequent hereditary colorectal cancer–prone disorder, but is also now known to predispose to cancers of an almost unlimited number of other sites.....

"In addition, compared with the general population, women carrying a mismatch repair gene mutation have a 19-fold greater risk of developing ovarian cancer and a 4-fold increased risk of developing breast cancer.<sup>5"

"Given the excess of gynecologic cancer (endometrium and ovary) in Lynch syndrome and the respective limitations of their screening, which has virtually no benefit for ovarian cancer and is of only limited use in endometrial cancer, in our opinion a better choice is the option for prophylactic hysterectomy and bilateral salpingo-oophorectomy, once family is completed and the patient is fully accepting."</sup>  

 

Palliative Care Education in Gynecologic Oncology: A Survey of the Fellows

Abstract

Purchase $39.95

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Highlights

•

Gynecologic oncology fellows rate training in palliative care and end-of-life care significantly less than overall training.

•

Gynecologic oncology fellows feel prepared to provide palliative care despite reporting deficiencies in training.

•

Gynecologic oncology fellows feel palliative care training is important.

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Introduction

Gynecologic oncologists regularly care for patients at the end of life, yet little is known about their training or preparedness to deal with issues of palliative care. We sought to examine the training provided to gynecologic oncology fellows as well as their perceived preparedness to provide palliative care.

Methods

A self-administered survey was distributed to all fellows enrolled in all gynecologic oncology fellowships during the 2009 academic year. The instrument assessed attitudes, training, experience, and preparedness regarding caring for patients at the end of life. Descriptive, bivariate and multivariable analyses were performed.

Results

Sixty-one percent (103/168) of fellows completed the survey. Most (89%) feel that palliative care is integral to their training, but few (11%) have had any palliative care training, including either a rotation or fellowship. Using a scale of 1–10, fellows rated teaching quality on two common training opportunities, specifically managing postoperative complications (7.8) and endometrial cancer patients (8.7), as significantly higher than teaching on managing patients at the end of life (5.5; p < 0.001). Fellows rated the quality of end of life teaching as significantly lower than overall teaching (55% vs. 92%; p = 0.001). Their self-assessment regarding overall preparedness to deal with end of life issues was associated with higher end of life teaching quality and experience caring for more than 10 dying patients.

Conclusions

The quantity and quality of training in palliative care is lower compared to other common procedural and oncological issues. Gynecologic oncology fellowship programs need to incorporate a palliative care training curriculum.