Showing posts with label surgery. Show all posts
Showing posts with label surgery. Show all posts

Wednesday, June 3, 2020

Disparity Research - #ASCO20 Virtual Annual Meeting

For the past year, I have been a member of Community Action Board at the Rutgers Cancer Institute. The Board advises the Center of Health Equity and Engagement led by Dr. Anita Kinney. The Center's role is to improve patient engagement for underserved and underrepresented communities in NJ in order to improve screening, prevention and access to treatment and clinical trials.

With that role in mind I took some time during the ASCO annual meeting to review studies related to cancer disparities. Here are just a few of the studies I viewed.

Uterine Cancer
Abstract 6089
Impact of Obesity Ovarian Cancer
e18067


Opiod Access / End Of Life Care 
Abstract 7005


Gender based disparities in clinical trials
Abstract # 2058



Survival outcomes by race minimally invasive versus open surgery
 Abstract #6029


Financial Toxicity
Abstract 6079
Geography and Cancer Care
Poster  1574
This study assessed overall survival (OS) of patients with all cancers, chronic myeloid leukemia (CML), and lung cancer while assessing distance from each county to the one (NCI-CC) in Georgia. Researchers conclude that disparity in cancer care exists between geographic conditions.




Black and white disparities in triple negative breast cancer ... Nurses’ Health Study
Poster 1655
This study examined disparities in triple negative breaset cancer by socioeconomic position, reporductive factors and diabete.  " observed racial differences in TNBC diagnoses may be at least partially mediated by differences in socioeconomic position and reproductive patterns, namely breastfeeding."
 
Breast and cervical cancer screening disparities among transgender patients
Poster 7024
About 1 million Americans identify as transgender. Limited primary care access and poor adherence to breast and cervical cancer screening are evident for transgender populations.


I look forward to next year's annual meeting whose theme was announce by incoming ASCO President , Dr Lori Pierce. 
We as advocates have a role to play to insure all patients receive appropriate and timely cancer care.

Dee
Every Day is a Blessing! 

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Wednesday, June 5, 2019

Gyn Cancer Education Sessions at #ASCO19

Here is a short summary( Tweets) and notes from the Gyn Cancer Education Sessions I attended at this year's ASCO Annual Meeting. Please note these sessions were not necessarily only ovarian cancer sessions.
Abstracts are available online at https://abstracts.asco.org/239/IndexView_239.html

6/1/2019 Pharma to Table
Levinson  - Immunotherapy in Gyn Cancers


Rubin- Recognizing and Managing Immun-related Toxicities
irAE = immun-related Adverse Events
Events could include - cough, colitis, endocrine issues, pneumonitis
With adverse events is was recommended to not reduce the dose but rather hold the dose

Moore - Response Predictions and Signatures for Immuntherapy
Tumor Burden is number of mutations in a tumor.


Dorigo - The Future of Immunotherapy in Gyn Cancers
TIL - Tumor Infiltrating Lymphocytes
Trials ongoing with HPV positive ovarian cancer ( yes , HPV can cause more than cervical and head and neck cancers. ) , CAR-T cells and vaccines
Trials like this one opening soon.
6/2/2019 Are We Hitting the Bull's -eye with Targeted Therapy
Clinical Science Symposium
This session reviewed a number of Abstracts.
Abstract 5509 - Sex hormone, Insulin and insulin-like growth factors in High stage endometrial cancers
Drs Huang, Bae-Jump


Abstract 5010 - Phase 2 trial ribociclib and letrozole in ER positive ovarian and endometrial cancers Drs  Colon-Otero and Mackay


Abstract 5011 - Phase 2 avelumab plus entinostat or placebo in epithelial ovarian cancer
Drs. Cadoo and Hays



6/2/2019 Wanna Get Away - Continuous treatment vs Treatment Holidays in Gyn Cancers
Dr Buckanovich - Successful Maintenance?

Dr  Oza - Maintenance Standard of Care


 Dr Rustin - Maintenance - Not Ready for Prime Time

Dr. Trent - Sarcoma Perspective

6/2/2019 Gyn Cancers is it Time to Put Away the Knife? 
For this session I did not have a good view of the screen so here are the high points from my notes.

Dr. Duska  - Adv OC -Time to Put Away the Knife?
NACT ( Neoadjuvent chemotherapy) is a viable option for a certain population of patients with ovarian cancer

Dr Pfisterer  We need a sharper smarter knife
Residual Tumor is an independent prognostic indicator. The Goal is R0 ( no visible disease left) . What prevents R0 . Factors that influence R0 are Inoperability (sugery not tolerated), Insufficiency (surgeon not capable of performing surgery . Patient survival better when surgery is done by a gyn onc.) Irresectability ( surgery not possible due to location of tumor.)

Dr Ramirez Has Laparoscopy Sung its Final Song in Cervix Cancer
Reported on LACC Study (https://www.nejm.org/doi/full/10.1056/NEJMoa1806395)  Study found that radical hysterectomy by MIS (minimally invasive survery ) lead to lower rates of disease free survival compared to open hysterectomy.

Dr Boggess - There is still a Role of MIS in Cervical Cancer 

6/3/2019 The More Things Change the Ovarian Cancer Edition
Monk - Is It Time to Change Upfront Chemotherapy For Ovarian Cancer

Dr Randall HIPEC: Standard of Care or Hype



Dr. Grisham - Low Grade Ovarian Carcinoma: Fitting the Square Peg in the Round Hold



 Tomorrow  I will share information from sessions dealing with communication ( Tweets Chats & Posts and Navigating a New Cancer Diagnosis).


Dee
Every Day is a Blessing!

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Wednesday, September 13, 2017

Day 13 A Month of Teal : OC Treatment- Surgery

Surgery is the main treatment for ovarian cancer.

Surgery for ovarian cancer should done by a gynecologist oncologist. A gynecologic oncologist is a physician who specializes in diagnosing and treating cancers that are located on a woman’s reproductive organs. Studies have found that women diagnosed with ovarian cancer  have better outcomes when the surgery is done by a gynecologic oncologist.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046749/)

For the most common ovarian cancer, epithelial,  surgery is done for staging and debulking. Debulking surgery removes as much of the tumor as possible wherever it may be in the abdomen.  The goal is to achieve optimum debulking or no visible tumors.

Surgery may include:
Hysterectomy
bilateral salpingo-oophorectomy ( both ovaries and fallopian tubes). A Unilateral salpingo-oophorectomy may be done if a woman wishes to have children.
omentectomy ( removal of the tissue covering the organs in the abdomen) .
Lymph nodes ( Lymphadenectomy )
Debulking surgery may include removing tissue from other organs, such as the spleen, gallbladder, stomach, bladder, or colon. 

Most ovarian cancers are treated by surgery and chemotherapy. The order of those treatments depends on the stage at diagnosis. If a women is diagnosed late stage - III or IV your doctor may give you chemotherapy, then complete the surgery and then give you more chemotherapy.

Check the sources below for more information and diagrams. 

Tomorrow I will share information on chemotherapy treatments on initial diagnosis.

Dee
Every Day is a Blessing!

Sources:
https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq#section/_184
https://www.cancer.org/cancer/ovarian-cancer/treating/surgery.html
http://www.cancer.net/cancer-types/ovarian-fallopian-tube-and-peritoneal-cancer/treatment-options
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Friday, September 11, 2015

Ovarian Cancer Treatment: Surgery

There are a number of treatments for ovarian cancer including surgery, chemotherapy and targeted therapies. The next few days posts will focus on each type of treatment.

The stage and grade will help determine how your ovarian cancer will be treated.


Surgery:

Surgery is the main treatment for ovarian cancer . Studies have found that women whose surgery is completed by a gynecologic oncologist will have better outcomes.( http://www.nytimes.com/2013/03/12/health/ovarian-cancer-study-finds-widespread-flaws-in-treatment.html?_r=0) Studies have also found that survival increases when the gynecologic oncologist is able to remove all of the visible disease.

Depending on the extent of the disease  the gynecologic oncologist will remove the uterus ( hysterectomy), one or both ovaries and fallopian tubes ( Salpingo-oopherectomy) ,and fatty tissue in the pelvis( oomentum) as well as lymph nodes. ( Please see http://www.cancer.gov/images/cdr/live/CDR612116.jpg for an image of  the organs that may be removed.) You may hear the term debulking surgery . This is the term used for the removal of as much tumor as possible.

Most women will have surgery before chemotherapy but in the case of advanced disease at diagnosis (Stage 3C,  Stage 4) women may be offered chemotherapy ( neoadjuvant) first and then surgery after 3-4 chemotherapy treatments.

Dee
Every Day is a Blessing!

Sources:
NCI: http://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq#section/_156
MD Anderson: http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-types/ovarian-cancer/treatment/index.html
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Wednesday, June 10, 2015

ASCO: Knowledge Part II, Managing OC in Older Women


This early Sunday morning education session presented information on how to manage ovarian cancer in the older women. Many women including myself do get diagnosed at an early age but the median age for diagnosis of ovarian cancer in women is 63 years of age.

Ovarian Cancer Surgery in the Older Woman : Keep It Short and Sweet
Dr Linda Duska

Chronologic age is not the same as physiologic age and age does not define the ability of a woman to undergo surgery or medical treatment. Retrospective studies have showed that women with ovarian cancer who have no gross residual disease after surgery have better outcomes. Older women overall have a worse prognosis stage for stage than younger women. The GOG182 study found that there was a lower chemo completion rate among older women and that toxicity was higher. It has also been found that for women of age 65 and older surgery complications increase and there is higher mortality. It was recommended that an assessment tool like ones for frailty be used before considering surgery in women over 65. It was found that frail women were more likely to be obese and to have post-op complications.


Ovarian Cancer in the Older Women : Less is More
Dr Kathleen Moore

Studies that focus on the older woman are limited. SEER Medicare data shows that the use of chemotherapy in women decreases as age increases. Women > age 70 have higher hematologic toxicity and stop treatment early. A study done in France showed that while in pre-treatment and during treatment the geriatric assessment showed that depression was a poor prognostic factor. A US study, GOG 273 (women age 70 +)  showed that dose modifications , timing changes and variations on chemo schedule may help the older woman complete chemotherapy.
The EWOC ( Elderly Women with OC) studies showed that chemo toxicity could be predicted by 3 factors – depression, dependence and performance status.  The MITO-5 and MITO -6 studies found that weekly carbo taxol was associated with lower toxicity and higher quality-of-life scores.

Clinical Trials in the Older Patient: Who,When and Why?
Dr William Tew

There are not many clinical trials for older patients.
Dr Tew stated that it is important to define who your patient is and what they want. He also recommended assessing functional age not chronologic age. The Cancer and Aging Research Group has developed and assessment tool that can be used before starting chemotherapy. The assessment tool looks at factors that can predict grade 3-5 toxicities in older patients. Some of the tool variables are age, impaired hearing, inability to walk a block, decreased social activity etc.


From this session I learned that:
  • better outcomes occur when older women finish chemotherapy- even if that means the dosage/timing needs to  need modified.
  • Depression and poor functional ability can impact treatment success
  • Age itself does not predict whether or not a woman can undergo surgery or treatment .
  • Assessment tools ( fraility / performance status) should be used before surgery

Tomorrow’s post will be on Value Concepts in the Management of Ovarian Cancer

Dee
Every Day is a Blessing!
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Monday, August 5, 2013

Surgery Vs Neoadjuvant Chemotherapy

In the July 2013 European Journal of Cancer there appears a article titled:

Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial.


The Abstract appears here.

The study looked at data from the European Organisation for Research and Treatment of Cancer (EORTC) trial which randomized  670 women to receive surgery first or neoadjuvant chemotherapy. Neaoadjuvant treatment is a treatment given to shrink a tumor before treatment. The treatment could be chemotherapy, hormone therapy, radiation. In this study only chemotherapy was used as the neoadjuvant treament. The study also examined biomarkers to see if they could predict whether surgery or neoadjuvant chemotherapy was best. The study endpoint was overall survival.

Results: The study found women staged IIIC or less and smaller ( < 45 mm) metastatic tumors had higher survival rates with surgery first. Women at stage IV with large ( >45mm) metastatic tumors had better survival with neoadjuvant chemotherapy. For other patients the treatments were comparable.


Dee
Every Day is a Blessing!
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Saturday, September 8, 2012

OC Awareness Month #8 -Treatments

Today I will review the treatment that a women diagnosed with ovarian cancer might receive. Of course every woman is different so your actual treatment might differ.

*A women diagnosed with ovarian cancer should see a  gynecologic oncologist ( gyn-onc) . Research has shown that women who receive surgery and treatment by a gyn-onc have higher survival rates.

There are different treatments offered to women diagnosed with ovarian cancer. Such as :

Surgery :
Hysterectomy- removal of the uterus and sometimes the cervix
Oopherectomy - removal of the ovaries and fallopian tubes
Oomectomey - removal of the oomentum the fatty covering of the abdomen
Lymph node biopsy-removal of lymph nodes which are examined for cancer

Chemotherapy:
Chemotherapy drugs disrupt the multiplication of cancer cells or kills them outright.The chemotherapy may be give IV, intravenously, where the drug is introduced into a vein or IP , intraperitoneal where the drug is introduced into the peritoneal cavity. Women may receive a combination of two drugs.

The most common drugs given to women with OC are carboplatin, cisplatin and paclitaxel. Additional drugs may be found on this NCI site http://www.cancer.gov/cancertopics/druginfo/ovariancancer.You might also receive targeted therapy , drugs or biologics. Targeted therapy will affect cancer cells but leave normal cells alone.

Radiation:
Radiation may be used to kill cancer cells in some cases of OC. The level depends on the type of OC cancer and stage of the disease.

 Source : http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/Patient/page4


Tomorrow the stages of ovarian cancer

Dee
Every Day is a Blessing!
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