Vascular endothelial growth factor and its relationship to the prognosis and treatment of breast, ovarian, and cervical cancer.

Tumor neovascularization is a complex process that plays a crucial role in the development of many different types of cancer. Vascular endothelial growth factor (VEGF) is a potent mitogen that is involved with mitogenesis, angiogenesis, endothelial survival, and the induction of hematopoiesis. By increasing vascular permeability in endothelial cells, it helps tumors recruit wound-healing proteins fibrin and fibrinogen from the plasma, suggesting that tumor formation is a process of abnormal wound healing dependent on the ability to generate a blood supply. The human female reproductive tract is highly dependent on VEGF for normal functions such as endometrial proliferation and development of the corpus luteum. The unique influence of female sex steroid hormones on the expression and activity of VEGF deems angiogenesis an important facet of the development of breast and ovarian cancer. Additionally, the up-regulation of VEGF by the E6 oncoprotein of the human papillomavirus suggests that VEGF plays an important role in the development of cervical cancer. Clinical trials have investigated the humanized monoclonal antibody bevacizumab as potential treatment for all three forms of cancer; the data show that in breast cancer, the use of bevacizumab may lengthen the disease-free survival for women with advanced breast cancer, but does not appear to change their overall survival. It may have a role as salvage chemotherapy for ovarian and cervical cancer, though further research is needed to establish it as a definitive form of treatment.

Content Validation of Advanced Illness Criteria of a Palliative Care Screening Tool.

BACKGROUND: Early identification of patients appropriate for palliative care continues to be a challenge for healthcare systems. Danbury Hospital embedded a palliative care screening tool (PCST) in the nursing admission assessment of the electronic medical record to screen a patient's appropriateness for a palliative care consult. Although the screening tool was helpful in early identification of patients, feedback from healthcare providers indicated lack of clarity in determining "advanced illness" outside of the oncology population. OBJECTIVES: To (1) validate sections 1 and 2 of the PCST to a broader patient population, using the content validity ratio (CVR) and (2) determine the presence of a correlation between the PCST and an existing validated tool. METHODS: An online survey was distributed to collect feedback on five categories of basic disease processes as major criterion for determination for a PCST score. SETTING/SUBJECTS: Healthcare providers and content experts were within Western Connecticut Health Network. MEASUREMENTS: Surveys evaluated basic disease processes as major criteria to determine whether a palliative care consultation was needed. RESULTS: A total of 120 healthcare providers participated: 27 nurses and 93 physicians. Respondents identified poor or limited functional status as essential items upon identifying high-risk patients appropriate for palliative services. Advanced illnesses concurrent with complete activities of daily living dependence yielded the highest positive CVRs. The functional assessments, Eastern Cooperative Oncology Group, and Karnofsky are significantly correlated (p = 9.999*10-05). The Karnofsky scale score was determined to be significantly negatively correlated with the PCST score (p = 4.314*10-45). CONCLUSION: Cross-sectional feedback of healthcare professionals validated criteria of advanced illness in the PCST.