paywalled: Emergency department visits for symptoms experienced by oncology patients: a systematic review

Emergency department visits for symptoms... [Support Care Cancer. 2012] - PubMed - NCBI

CONCLUSIONS:

Individuals with cancer present to emergency departments with a myriad of symptoms. Over half of emergency department visits resulted in hospital admissions. Few symptoms were defined adequately to compare data across studies, thereby revealing an important gap in cancer symptom reporting.

Medscape: Ovarian Cancer Clinical Presentation - overview including symptoms

Ovarian Cancer Clinical Presentation

Screening of symptomatic women for ovarian cancer: 4 articles (correspondence -RECAP OF LINKS) : The Lancet Oncology : Volume 13, Number 4, 1 April 2012

Blogger's Note: with some exceptions, the Lancet is a subscriber based journal ($$$), registration (free) may be required to view abstracts and/or articles

The Lancet Oncology : Volume 13, Number 4, 1 April 2012

e137 - open access

Screening of symptomatic women for ovarian cancer

Christopher P Crum

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e137 - open access

Screening of symptomatic women for ovarian cancer

Alicia A Tone, David G Huntsman, Dianne M Miller

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e138 - open access

Screening of symptomatic women for ovarian cancer

Aleksandra Gentry-Maharaj, Jatinderpal Kalsi, Matthew Burnell, Ranjit Manchanda, Usha Menon

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e139 - open access (authors' response)

Screening of symptomatic women for ovarian cancer – Authors' reply

Lucy Gilbert, Olga Basso, for the DOvE Study Group

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abstract: All’s Well That Ends Well? Quality of Life and Physical Symptom Clusters in Long-Term Cancer Survivors Across Cancer Types (Australia/Canada)

 Blogger's Note:  search blog for other posts on 'symptom cluster' research, note that the abstract does not discuss the current status of the 5/6 year survivors (eg. in treatment,  type/s of treatments, # prior treatments, stage.....

Blogger's Opinion:   short answer - no, back to the 'drawing' board on this one

 abstract: "Cancer patients also will welcome the news that only a minority of five-year survivors experience long-term and late effects."

All’s Well That Ends Well? Quality of Life and Physical Symptom Clusters in Long-Term Cancer Survivors Across Cancer Types:

Publication year: 2012

Source: Journal of Pain and Symptom Management, Volume 43, Issue 4

Context 
Little is known about the presentation of multiple concurrent symptoms (symptom clusters) in long-term cancer survivors, with few studies adequately powered to compare quality of life (QoL) and symptom presentation by cancer type.

Objectives 
This research aimed to 1) assess patient-reported QoL and 2) identify clusters of cancer-related physical symptoms by cancer type among long-term breast, prostate, colorectal, and melanoma cancer survivors.

Methods
A population-based cross-sectional sample of 863 adult cancer survivors five to six years post-diagnosis completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), assessing global QoL and frequency of presentation of cancer-related physical symptoms.

Results
Long-term survivors reported higher levels of global QoL than 1) the general population (age-adjusted mean=79.4 vs. 71.1, small clinical difference) and 2) cancer patients early in the care trajectory (age-adjusted mean=77.1 vs. 61.3, moderate clinical difference). The majority (71%) did not report any cancer-related physical symptoms; 18% reported multiple (two or more) symptoms in the past month. Factor analysis found that cognitive functioning, fatigue, insomnia, pain, dyspnea, appetite loss, constipation, diarrhea, nausea, and vomiting formed a cluster (α =0.48). No symptom clusters were identified that were specific to just one cancer type. However, individual symptoms (including diarrhea, pain, constipation, and insomnia) modestly discriminated between cancer types.

Conclusion
Contrary to expectations, no symptom clusters specific to one type of cancer were identified and survivors reported few cancer-related symptoms and high QoL. These results convey a strong “good news” message, providing health professionals with a sound foundation for making encouraging predictions about their patients’ long-term physical recovery after cancer. Cancer patients also will welcome the news that only a minority of five-year survivors experience long-term and late effects.

The Cause and Effect of Migraines

Blogger's Note:
due to hormonal flucuations and onset of female cancers, it is interesting that the migraine connection (eg symptoms, neurology, pathology (?)) has not been a topic of wider discussion/research/debate in cancer research
             ~~~~~~~~~~~~~~~~~~~~~~~

The Cause and Effect of Migraines

"“Hormonal changes are a big contributor to the higher female incidence,” said Michael A. Moskowitz, MD, Professor of Neurology at Harvard Medical School at the Massachusetts General Hospital in Boston. “There are lines of evidence that support this from lab to clinical evidence and a decrease (although not abolished) incidence in post-menopausal females.”"

repost from December 2011: A study of symptoms described by ovarian cancer survivors

A study of symptoms described by ovarian cancer survivors: Publication year: 2012

Symptom indices 'should be reassessed' in ovarian cancer treatment | International Federation of Gynecology and Obstetrics (FIGO)

open access - JNCI: Finding Ovarian Cancer (correspondence in response to Lim et al.)

"For decades, investigators have sought a strategy for finding ovarian cancer early enough to reduce the risk of dying of ovarian cancer. In this issue of the Journal, Lim et al. (1) report on their study in which women answered a dozen simple questions such as whether they felt pelvic or abdominal pain in the recent past and, if so, when, how frequently, and how severely. Symptom indices like this are being promoted as easier or better ways to find ovarian cancer early, under the assumption that early therapy can achieve a better outcome than if the women wait until more or worse symptoms prompt them to see a physician. The study revealed that symptom indices as ovarian cancer screeners can be sensitive to the presence of cancer in the period between 3 and 14 months before clinical diagnosis......

open access: Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm | BMJ (note reference to recent NICE guidelines)

Objective
To derive and validate an algorithm to estimate the absolute risk of having ovarian cancer in women with and without symptoms.

Main outcome
The primary outcome was incident diagnosis of ovarian cancer recorded in the next two years.

Conclusion
The algorithm has good discrimination and calibration and, after independent validation in an external cohort, could potentially be used to identify those at highest risk of ovarian cancer to facilitate early referral and investigation. Further research is needed to assess how best to implement the algorithm, its cost effectiveness, and whether, on implementation, it has any impact on health outcomes.

.......As there are few established risk factors, targeted screening of asymptomatic patients at risk of developing ovarian cancer is unlikely to be cost effective at present (although further information is likely to become available when the UK ovarian cancer screening trial reports in 2015-6). The challenge presented by ovarian cancer, therefore, is to make the correct diagnosis as early as possible, despite the non-specific nature of symptoms and signs.4 This is particularly the case in primary care, where general practitioners need to differentiate those patients for whom further investigation is warranted from those who require reassurance or a “watch and wait” policy. Moreover, primary care clinicians need to decide which patients require urgent investigation or referral and which require routine tests or referral.........

Summary of key findings

We have developed and validated a new algorithm designed to estimate the absolute risk of having existing but as yet undiagnosed ovarian cancer based on a combination of symptoms and simple variables such as age and family history of ovarian cancer, which the patient is likely to know and which will increase the baseline absolute risk.....
.................................................................................................................................

What is already known on this topic

• Ovarian cancer is the second most common gynaecological cancer and most women are diagnosed with late stage disease, which has a poor survival rate
• Earlier diagnosis could improve with more targeted investigation of symptomatic patients and increased public awareness of symptoms, which is a major challenge given the non-specific nature of some of the symptoms

What this study adds

• An algorithm based on simple clinical variables such as age, family history of ovarian cancer, anaemia, abdominal pain, abdominal distension, rectal bleeding, postmenopausal bleeding, appetite loss, and weight loss, which the patient is likely to know or which are routinely recorded in general practice computer systems, can estimate absolute risk of ovarian cancer in women with and without symptoms in primary care
• The algorithm could be integrated into general practice clinical computer systems and used to assess risk in women presenting with and without symptoms

open access: BMJ - Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm | BMJ

Objective 

To derive and validate an algorithm to estimate the absolute risk of having ovarian cancer in women with and without symptoms.

Main outcome The primary outcome was incident diagnosis of ovarian cancer recorded in the next two years.

The incidence rate in our population was higher than published national data based on cancer registries.2

What is already known on this topic

• Ovarian cancer is the second most common gynaecological cancer and most women are diagnosed with late stage disease, which has a poor survival rate
• Earlier diagnosis could improve with more targeted investigation of symptomatic patients and increased public awareness of symptoms, which is a major challenge given the non-specific nature of some of the symptoms

What this study adds

• An algorithm based on simple clinical variables such as age, family history of ovarian cancer, anaemia, abdominal pain, abdominal distension, rectal bleeding, postmenopausal bleeding, appetite loss, and weight loss, which the patient is likely to know or which are routinely recorded in general practice computer systems, can estimate absolute risk of ovarian cancer in women with and without symptoms in primary care
• The algorithm could be integrated into general practice clinical computer systems and used to assess risk in women presenting with and without symptoms

A study of symptoms described by ovarian cancer survivors

"There was a marked discordance between questionnaire-reported symptoms and those recorded in hospital notes."

Symptoms of Ovarian Cancer - Survivors' Debate - selected file

Menopause Symptoms Common After Gyn Cancer - Medpage (3/2010)

"However, Huang and colleagues found no studies in the medical literature documenting the frequency and nature of menopausal symptoms in gynecologic cancer survivors."

"Note that the percentage of gynecologic cancer survivors who reported menopausal symptoms was extremely high regardless of whether they received hormonal therapy."

abstract: Metastatic neoplasms of the ovaries: a clinicopathological study of 97 cases (metastatic breast, GI neoplasms....)

OBJECTIVE: To present the clinicopathological features of metastatic ovarian neoplasms with emphasis in the diagnostic challenge.
METHODS: This is a retrospective study including 97 patients with pathological diagnosis of metastatic ovarian neoplasms, examined during the decade 2000-2009. The gross, microscopical and immunohistochemical characteristics as well as the clinical data (age of the patients, origin of the neoplasm, symptoms, treatment options) and 5-year survival rates were examined.
RESULTS: The mean age of the patients is 55 years (range 26-78 years). 62.89% of the tumors were metastatic from extragenital organs (from stomach 21.65%, breast 15.46%, colon 15.46%, appendix 3.09%, pancreas 2.06%, lung 1.03% and kidney 1.03%, sarcoma 1.03% melanoma 1.03%) and 37.11% tumors originated from the genital tract. The 3-year survival rates ranged from 25.39% for metastatic ovarian neoplasms originating outside the genital tract up to 29.41% for those originating from the genital tract. Tumor immunohistochemistry is a helpful aid in the differential diagnosis mainly between primary mucinous ovarian tumors and metastatic colon cancers and in the recognition of metastatic breast cancers and other neoplasms of the GI tract.
CONCLUSION: The management of metastatic ovarian neoplasms should include specific immunohistochemical methods in order to identify the primary neoplasm site. The differential diagnosis of a pelvic mass should always include metastatic neoplasms of the ovaries.

clinical trial: Pathway to Diagnosis of Ovarian Cancer - Full Text View

Purpose

The purpose of this study is to describe the prediagnostic symptoms and the events along the pathway to diagnosis of women with ovarian cancer, referred for first-line chemotherapy.

abstract: An Internet Survey of Symptoms Associated With Intra-Abdominal Malignancies: Lack of Specificity for Ovarian Cancer

Conclusion: This analysis fails to support the hypothesis that focusing attention on a pattern of nonspecific symptoms will be helpful in the diagnosis of ovarian cancer.

Physical symptoms prevalent no matter what stage of cancer including remission

"....The study of 405 patients was reported in the Oct. 11, 2010, issue of the Archives of Internal Medicine. Numerous physical symptoms, rather than just a few, were prevalent in patients with cancer and this prevalence did not diminish after completion of therapy. "We found that regardless of where they are in the course of their diseases, many individuals with cancer have a high symptom burden," said Kurt Kroenke, M.D...."cont'd

Australian women's awareness of ovarian cancer symptoms, risk and protective factors and estimates of own risk - abstract

Blogger's Note: similar studies and public polls over the past few years, irrespective of country, have noted the same results. As in the past, the conclusion/s beg many questions regarding not only funding/donations but the reality of existing campaigns.

 

Australian women's awareness of ovarian cancer symptoms, risk and protective factors, and estimates of own risk.

Jones SC, Magee CA, Francis J, Luxford K, Gregory P, Zorbas H, Iverson DC.

Centre for Health Initiatives, University of Wollongong, Wollongong, 2522, Australia, sandraj@uow.edu.au.

Abstract

OBJECTIVE: To examine Australian women's perceived risk of ovarian cancer, reasons for perceived risk levels, and knowledge of ovarian cancer symptoms at two timepoints (2003 and 2007).
METHODS: A computer-assisted telephone (CATI) survey of 2,954 Australian women with no history of ovarian cancer was conducted.
RESULTS: Approximately 60% of women perceived their risk of ovarian cancer was similar to other women of their age; 10% indicated an increased risk, and 30% indicated a lower risk. These figures were similar in 2003 and 2007. Logistic regression found that lower income, increased age, being born overseas, and being retired were significantly associated with lower perceived risk (accounted for only 7.5% of the variance). Common reasons for higher perceived risk included family history of ovarian/other cancers, increasing age, and having had other types of cancer or health problems. Reasons for lower than average risk included absence of family history, having a hysterectomy, and having regular Pap smears (indicating confusion between ovarian and cervical cancer). There appeared to be substantial confusion in women's understanding of ovarian cancer symptoms; this was similar in 2003 and 2007.
CONCLUSION: The observed misperceptions and confusion regarding ovarian cancer symptoms and risk factors suggest ongoing public education campaigns are needed to improve knowledge and awareness.

JAMA -- Abstract: Effect of Telecare Management on Pain and Depression in Patients With Cancer: A Randomized Trial, July 14, 2010

Conclusion
Centralized telecare management coupled with automated symptom monitoring resulted in improved pain and depression outcomes in cancer patients receiving care in geographically dispersed urban and rural oncology practices.

Second Opinion - In Reporting Symptoms, Don’t Patients Know Best? - NYTimes.com