Tuesday, January 29, 2013
Life After Gynecologic Cancer—A Review of Patients Quality of Life, Needs, and Preferences in Regard to Follow-up
Life After Gynecologic Cancer—A Review of Patients Quality of Life, Needs, and Preferences in Regard to Follow-up
Abstract
Objective: This article reviews the literature on
quality of life (QoL) of gynecologic cancer survivors, their needs and
preferences regarding follow-up, and possible predictors of long-term
QoL.
Methods: A systematic literature search was made in
the following databases: MEDLINE (PubMed), Bibliotek.dk, CINAHL,
Cochrane, EMBASE, PsycINFO, and SveMed+. We searched the period
1995–2012 for English-language literature. The search was made during
July 2011 to February 2012. When possible, the search was made using
MeSH terms. Additional reports were collected by systematically viewing
the reference lists of the retrieved articles.
Results: Overall studies indicate that survivors after
gynecologic cancer do not have impaired QoL in the long term. In
general, the patients are highly satisfied with the follow-up program.
The patients’ greatest concern is fear of recurrence. The most frequent
reported unmet need is help in dealing and living with the fear of
recurrence. It seems that psychosocial status at time of diagnosis is
determining for QoL and well-being in the long term. Association has
been found between coping style and QoL, risk of depression, and anxiety
in the long term after cancer.
Conclusions: Even though long-term QoL does not seem
to be impaired, the patients are struggling with fear of recurrence, and
the way of coping with this fear is a possible predictor for long-term
QoL after cancer. However, there is a lack of evidence on QoL, needs,
and preferences regarding follow-up of the survivors after gynecologic
cancer. The quality of the follow-up regimen is questionable, and it is
not evidence based. Thus, it is extremely important to optimize the
follow-up program and move focus to life quality. There is a need for an
evidence-based strategy regarding follow-up for low-risk gynecologic
cancer patients.
Physicians’ attitudes and behaviour toward screening mammography in women 40 to 49 years of age
Physicians’ attitudes and behaviour toward screening mammography in women 40 to 49 years of age
Setting Women’s College Hospital and Sunnybrook Health Sciences Centre, both in Toronto, Ont.
" Most physicians promoted BA (81%), and suggestions for age of BA initiation ranged from 16 to 40 years with almost half recommending beginning at age 20 (42%), followed by age 30 (23%) and age 18 (19%). Among physicians who supported BA, 69% were from WCH versus 31% from SHSC (P < .03)."
"Limitations
The limitations of this study include the small sample size and lack of generalizability. This study might not be generalizable to male physicians or to community practice settings, as female physicians were overrepresented and the study was conducted at 2 urban academic family practice centres...."
Conclusion
This survey of predominantly female
physicians practising in an urban setting suggests that many 40- to
49-year-old women
at average risk of breast cancer are not being
offered the opportunity to discuss and initiate screening mammography
unless
they specifically request it, and most
physicians are now recommending BA rather than BSE.
open access: Intravenous chemotherapy preparation errors: Patient safety risks identified in a pan-Canadian exploratory study
Intravenous chemotherapy preparation errors: Patient safety risks identified in a pan-Canadian exploratory study
Introduction
Medication errors have long been established as among the most common preventable adverse events.1–3
Research on medication errors has been extensive in a variety of
settings, including cancer chemotherapy. For example, chemotherapy
error rates have been estimated to occur in 3% of
patients4 and 7.1% of outpatient visits.5 Although these rates could be considered relatively low, the narrow therapeutic range of chemotherapy means that errors are
potentially very harmful and are therefore a concern to the oncology community (Blogger's Note - and the patients)....
Fertility in cancer patients after cryopreservation of one ovary
Fertility in cancer patients after cryopreservation of one ovary.
Abstract
This questionnaire study describes the fertility and ovarian function in 143 adult female cancer survivors with only one ovary due to cryopreservation of the other. The women were asked about their ovarian function (as defined by the presence of a spontaneous menstrual cycle), pregnancies and their outcome. The mean follow-up time was 58months after cryopreservation (range 24-129months). The risk of premature ovarian failure was high in the group of patients with leukaemia (13/15; 87%) but low in the breast cancer group (5/54; 9%). Fifty-seven women had actively tried to become pregnant after end of treatment; of these, 41 women obtained a total of 68 pregnancies resulting in 45 live births and five ongoing pregnancies, 15 spontaneous abortions, one ectopic pregnancy and two elective abortions. In the remaining 86 women without a pregnancy wish, there had been five elective abortions. Ninety-three per cent of the pregnancies were after natural conception and only four cases were a result of fertility treatment. The overall risk of premature ovarian failure was low (22%). Patients who retain their ovarian function after treatment of a malignant disease have a good chance of becoming pregnant. The purpose of this study was to assess the function of the ovaries in a group of Danish women who had received treatment for a cancer disease and who had had one ovary taken out and cryopreserved for future use. The women were older than 18years at the time of investigation and more than 2years had passed since the operation. They were sent a questionnaire asking them about their menstrual cycles (or lack of), whether they had been pregnant after treatment and, if so, the course of the pregnancy. A total of 143 women returned the questionnaire. The overall risk of ovarian failure in this group of cancer survivors was 22%. The highest risk of losing the ovarian function was seen in those who had been treated for leukaemia, in whom 87% had lost their ovarian function, but lowest in those treated for breast cancer, in whom only 9% had lost their ovarian function. Fifty-seven of the 143 women had actively tried to become pregnant after treatment and 41 of these (72%) succeeded, obtaining a total of 68 pregnancies resulting in 45 live births, five ongoing pregnancies, 15 spontaneous abortions, one tubal pregnancy and two elective abortions. Ninety-three per cent of these pregnancies were after natural conception and two-thirds occurred within the first 3months of trying. In conclusion, young female cancer survivors who keep their ovarian function despite cancer treatment have a good chance of becoming pregnant after treatment. Having only one ovary does not seem to affect their fertility.paywalled: Outcomes of fertility-sparing surgery for women of reproductive age with FIGO stage IC epithelial ovarian cancer (small study)
Outcomes of fertility-sparing surgery for women of reproductive age with FIGO stage IC epithelial ovarian cancer.
Abstract
OBJECTIVE:
To report the clinical outcomes of patients with FIGO stage IC epithelial ovarian cancer (EOC) treated by fertility-sparing surgery (FSS).METHODS:
A retrospective review was conducted of 18 women who underwent FSS at Niigata University Hospital, Japan, between December 15, 1986, and December 31, 2010.RESULTS:
Tumors were mucinous (n=9), clear cell (n=4), endometrioid (n=3), and serous (n=2). Median follow-up was 78.0months (range, 9.3-181.3months). Five patients (27.8%) developed tumor recurrence at 7.4-19.2months after initial surgery. The sites of recurrence were peritoneal lymph nodes (n=2), contralateral ovary (n=1), contralateral ovary and peritoneal cavity (n=1), and brain (n=1). In all, 7 full-term singleton pregnancies were recorded among 5 of the 10 women who attempted to conceive after FSS.CONCLUSION:
Favorable reproductive outcomes were observed following FSS, suggesting that this procedure may be a valid treatment option for women with FIGO stage IC EOC who wish to conceive.open access: Risk factors, pathophysiology, and treatment of hot flashes in cancer (men and women)
Risk factors, pathophysiology, and treatment of hot flashes in cancer - Fisher - 2013 - CA: A Cancer Journal for Clinicians
"Hot flashes are prevalent and severe symptoms that can interfere with mood, sleep, and quality of life for women and men with cancer. The purpose of this article is to review existing literature on the risk factors, pathophysiology, and treatment of hot flashes in individuals with cancer...."
Brain Metastasis as an Initial Manifestation of Ovarian Carcinoma: A Case Report
Blogger's Note: discusses other cancers/brain mets; mucinous
Brain Metastasis as an Initial Manifestation of Ovarian Carcinoma: A Case Report
Insight: Think preventive medicine will save money? Think again | Reuters
Blogger's Note: references ovarian cancer screening
Insight: Think preventive medicine will save money? Think again | Reuters
Monday, January 28, 2013
Patient Education and Counseling - ‘They’ve just got symptoms without science’: Medical trainees’ acquisition of negative attitudes towards patients with medically unexplained symptoms
‘They’ve just got symptoms without science’: Medical trainees’ acquisition of negative attitudes towards patients with medically unexplained symptoms
Abstract
Objective
Doctors find patients
with medically unexplained symptoms (MUS) challenging to manage and some
hold negative attitudes towards these patients. It is unknown when and
how these views form. This study examines medical trainees’ beliefs and
influences about MUS.
Methods
Semi-structured
interviews with 43 medical trainees. Using an iterative approach,
initial emergent themes were explored in subsequent interviews. Data
generation continued until thematic saturation was achieved.
Results
Participants
had received no training in MUS but had developed views about causes
and management. They struggled with the concept of ‘diagnosis by
exclusion’. Attitudes towards patients had developed through informal
clinical observation and interactions with doctors. Many welcomed formal
training but identified a need to integrate theoretical learning with
clinical application.
Conclusion
Despite
limited teaching, medical trainees are aware of the challenges in
diagnosing and managing patients with MUS, acquiring attitudes through a
hidden curriculum. To be welcomed, training must be evidence-based,
theoretically informed, but clinically applicable.
Practical implications
Current
medical training fails to equip doctors to engage with MUS and
potentially fosters the development of unhelpful views of these
patients. Informed teaching on diagnosis and management of MUS is
necessary at a trainee level to limit the development of negative
attitudes.
Sunday, January 27, 2013
The American Journal of Pathology - The DNA Methylomes of Serous Borderline Tumors Reveal Subgroups With Malignant- or Benign-Like Profiles
The American Journal of Pathology - The DNA Methylomes of Serous Borderline Tumors Reveal Subgroups With Malignant- or Benign-Like Profiles
Serous
borderline tumors (SBOTs) are a challenging group of ovarian tumors
positioned between benign and malignant disease. We have profiled the
DNA methylomes of 12 low-grade serous carcinomas (LGSCs), 19 SBOTs, and
16 benign serous tumors (BSTs) across 27,578 CpG sites to further
characterize the epigenomic relationship between these subtypes of
ovarian tumors. Unsupervised hierarchical clustering of DNA methylation
levels showed that LGSCs differ distinctly from BSTs, but not from
SBOTs. Gene ontology analysis of genes showing differential methylation
at linked CpG sites between LGSCs and BSTs revealed significant
enrichment of gene groups associated with cell adhesion, cell-cell
signaling, and the extracellular region, consistent with a more invasive
phenotype of LGSCs compared with BSTs. Consensus clustering highlighted
differences between SBOT methylomes and returned subgroups with
malignant- or benign-like methylation profiles. Furthermore, a two-loci
DNA methylation signature can distinguish between these SBOT subgroups
with benign- and malignant-like methylation characteristics. Our
findings indicate striking similarities between SBOT and LGSC
methylomes, supporting a common origin and the view that LGSC may arise
from SBOT. A subgroup of SBOTs can be classified into tumors with a
benign- or a malignant-like methylation profile that may help in
identifying tumors more likely to progress into LGSCs.
repost: Clinical Oncology News - Extracolonic Cancer Risk Rises With Lynch Syndrome
Clinical Oncology News - Extracolonic Cancer Risk Rises With Lynch Syndrome
"...This study represents one of the largest registries and adds to the growing literature detailing risk estimates for specific cancers in this population. The increased risks for breast and prostate cancers are not as widely known (these risks should be added to future versions of the National Comprehensive Cancer Network [NCCN] guidelines) compared with other cancers, such as urinary tract and upper gastrointestinal (GI) cancers. The risk for dermatologic cancers was not even reported in this study...."
Clinical Oncology News - The Relevance of Quality-of-Life Studies in Cancer
Clinical Oncology News - The Relevance of Quality-of-Life Studies in Cancer
"... It may be argued that quality-of-life scores represent a subjective interpretation of the impact of side effects on patients, but we should ask: Is there actually any other perspective that is more important than that of the patient?...."
Clinical Oncology News - Poor Cancer Prognosis: A Need for Greater Clarity
Blogger's Note: view full text with registration (free)
Clinical Oncology News - Poor Cancer Prognosis: A Need for Greater Clarity
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