Thursday, October 27, 2016
(France) Does the Number of Neoadjuvant Chemotherapy Cycles before Interval Debulking Surgery Influence Survival in Advanced Ovarian Cancer
Does the Number of Neoadjuvant Chemotherapy Cycles before Interval Debulking Surgery Influence Survival in Advanced Ovarian Cancer - Abstract
Objective: To evaluate the overall survival (OS) of patients with initially inoperable advanced ovarian cancer, tubal carcinoma, or primary peritoneal carcinoma of stages III or IV undergoing neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery, according to the number of cycles performed.
Methods: This retrospective study was conducted in three main oncology centres in the east of France, reviewing the charts of all patients who underwent NAC between January 1, 1998 and October 31, 2012. We performed an OS analysis using multivariate Cox regression models adjusted for potential confounders. We also analysed progression-free survival (PFS) as well as chemotherapy- and surgery-related morbidity.
Results: Of the 204 patients included, 75 (36.8%) underwent ≤4 NAC cycles and 129 (63.2%) ≥5 NAC cycles. Characteristic data were similar in the two groups. Five-year OS was 35.0 and 25.8%, respectively. This difference was non-significant [HR = 1.06 (0.70-1.59), p = 0.79]. We also found no differences in PFS or morbidity between the two groups.
Conclusions: The number of NAC cycles does not seem to play a role in the OS of patients with advanced ovarian cancer. Further evidence and prospective data are needed to assess the value of a high/low number of NAC cycles among these patients.
insurance status was not significant
Cancer history.Cancer survivor status was assessed through the question, “Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind?” A positive response was followed by an opportunity to specify up to three different cancer diagnoses. Respondents were asked their age at the time of each cancer diagnosis. All cancer survivors were postdiagnosis, but some could have been receiving cancer treatment at the time of the survey.
Among cancer survivors, if more than one cancer was reported, we chose the cancer type corresponding to the most recent cancer diagnosis in our analysis.....Consistent with previous research, cancers with a relative 5-year survival of < 25% (ie, esophagus, liver, gall bladder, lung, pancreas, and stomach) were combined as “short survival cancers.”23
Among cancer survivors, the lowest percentages of medication use for anxiety (ie, < 10%) were seen in those with a history of prostate cancer, whereas the highest rates (ie, > 20%) were seen in survivors who were 40 to 64 years old, those who were never married, and those who had a history of ovarian, uterine, or short survival cancers.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Among more than 3,000 adult cancer survivors, 19 percent reported taking medication for anxiety, depression or both, researchers found.
But when the research team looked at nearly 45,000 adults with no history of cancer, they found just one in 10 used these medications.
"Overall, these findings are sobering," said lead researcher Nikki Hawkins, a behavioral scientist at the U.S. Centers for Disease Control and Prevention.
"We've come a long way in treating cancer medically, but these data tell us cancer can take a serious psychological and emotional toll for many years, even after treatment is complete," she said.
Hawkins said it's remarkable that nearly one in five cancer survivors is taking medications for anxiety and depression. This adds up to approximately 2.5 million survivors in the United States taking these drugs, she said.
"We know very little about how or when these rates got so high, whether these survivors' mental health needs are being adequately treated, and how these rates of medication use will affect survivors' health and well-being in the long run," Hawkins said.
The findings show it's not only newer cancer patients using medications to manage distress. Survivors who were a decade or more past their cancer diagnosis are also using these medications at a rate about double the general population, she said.
The American Cancer Society said it was unaware of this high rate of mental health treatment.
"This is important information that we didn't have before," said Kevin Stein, vice president of the cancer society's Behavioral Research Center.
Anxiety and depression can have a significant effect on a patient's quality of life "and even survival," he said.
"We can manage anxiety and depression with a combination of medications and interventions like stress management training," Stein said.
However, "we need to do a better job of understanding who's at risk for anxiety and depression, and we need to intervene early," Stein said.
He added that physicians can screen patients for anxiety and depression simply by asking, "How distressed are you?" Then they can refer patients to appropriate mental health services, Stein said.
"It should be asked about at every visit," he added.
Patients also should speak up, Stein said. "It's not uncommon to feel anxious or depressed after you have cancer, but it's OK to ask your doctor for help."
That's how you can learn about options for support and treatment, Hawkins said.
"Survivors might feel uneasy or stigmatized talking about the toll cancer takes on their emotions, but their psychological health is as important as their physical health and deserves the same level of attention," she said.
Using data from the U.S. National Health Interview Survey for 2010 to 2013, Hawkins and her colleagues analyzed more than 48,000 records to estimate the number of cancer survivors taking medication for anxiety or depression.
Patients most likely to use antidepressants included those under 65, whites, people with public insurance and a usual source for medical care, and those with multiple chronic health conditions, the researchers found.
The report was published Oct. 26 in the Journal of Clinical Oncology (open access).
The researchers cautioned that because these statistics were self-reported, information about when patients started taking medication or how long they took it isn't known. It is also not known if the patients were diagnosed with an anxiety disorder or depression.
What is known is this: "We clearly have more work to do to better understand and treat the psychological and emotional burdens of cancer in addition to the physical effects of the disease," Hawkins said.
open access link: JCO Use of Medications for Treating Anxiety and Depression in Cancer Survivors in the United States
(Japan) A Retrospective Case Study of Combination Chemotherapy with Bevacizumab for Recurrent Ovarian Cancer
OBJECTIVES:Treatment for ovarian cancer with bevacizumab(Bmab)has been covered by public medical insurance in Japan since November 2013. It is recommended that the use of Bmab is limited to the first treatment for FIGO stage III or IV ovarian cancer. The OCEAN trial for platinum sensitivity in relapsed patients and the AURELIA trial for platinum-resistance in relapsed patients were performed, and both significantly improved progression-free survival.
METHOD:We retrospectively studied patients receiving Bmab with an anticancer agent for recurrent ovarian cancer. Written informed consent was obtained from all patients.
RESULTS:Between November 2013 and September 2015, Bmab at 15mg/kg/3-4 week was administered to 20 patients with recurrent ovarian cancer. The median age was 58 years(range 32-81)and the median performance status was 0-2. Platinum-sensitive recurrence occurred in 6 patients. The response rate and disease control rate of combination chemotherapy with Bmab was 50.0% and 57.1%. However, 11 patients stopped treatment with Bmab due to serious adverse events.
CONCLUSION:Combination chemotherapy with Bmab for recurrent ovarian cancer may be feasible.
Wednesday, October 26, 2016
open access: Follow-up of patients who are clinically disease-free after primary treatment for fallopian tube, primary peritoneal, or epithelial ovarian cancer (Ontario/review)
Follow-up of patients who are clinically disease-free after primary treatment for fallopian tube, primary peritoneal, or epithelial ovarian cancer: a Program in Evidence-Based Care guideline adaptation
Figure 1 shows a flow diagram of the search for eligible rcts or systematic reviews published after January 2010. No articles were found that met the inclusion criteria, and the Working Group members therefore agreed to endorse the recommendations from Follow Up of Women with Epithelial Ovarian Cancer with some consensus-based modifications.
ConclusionsThe recommendations provided in this guidance document have a limited evidence base. Recommendations should be updated as further information becomes available.
TABLE III Summary of recommendations