Limited understanding

Shared decision making for ovarian cancer survivors with different levels of health literacy: a qualitative interview study on knowledge and comprehension

https://tinyurl.com/n8ubvxhz

Management of ovarian cancer is best when the patient and the carer can share decision making. For this to occur both parties need to be fully informed and able to understand the process.

This shared decision making involves choice of therapy and detection of recurrence. A small retrospective study shows that many women have a limited understanding of medical terms and jargon, making decisions difficult.

A group of 17 women with ovarian cancer were asked about their understanding of the care they had received. They also answered a questionnaire aiming to determine their basic medical knowledge and confidence about sharing decisions.

Results from the study showed limited understanding about the course of their illness with false confidence in physical examination as a means of detecting recurrence. In general, there is a low level of medical literacy which makes shared decisions difficult.

Cataract and Ovarian Cancer

Ovarian Cancer and the Risk of Cataract Episodes: A Nationwide Cohort Study 

https://tinyurl.com/449xa994

Both cataracts and ovarian cancer are found in the elderly. It has been known that cataracts may develop in patients with cancer who have therapy, most often due to radiation but also as a side-effect of chemo.

One of the important causes of cataract is high oxidative stress, which is an imbalance of free oxygen and antioxidants. This is also linked to many cancers including ovarian cancer.A retrospective survey looks at the incidence of cataract in patients with ovarian cancer compared to the general population.

Using data from the Taiwan National Health Insurance database, 5000 women with ovarian cancer were matched with 20,000 women who were cancer free. About 10% of the cancer group had cataract, of whom less than half required surgery. Comparison with the control group showed a slight increase in cataract diagnosis of about 7%, for those women with cancer.

This study is limited by the small ethnic variation with most of the women being Han Taiwanese. However, the authors suggest that routine eye examination should be part of standard care for women with ovarian cancer.

Improvement, slow but real

Demographic trends in mortality due to ovarian cancer in the United States, 1999-2020

https://tinyurl.com/2py9489j

Progress in care for patients with ovarian cancer can be slow. It often seems that a cure is impossible and that there has been no improvement in the outcomes for women who face this great challenge.

However, it is important to recognise that change is occurring and that survival has significantly increased over recent times. This survey looks at mortality due to ovarian cancer and the trend of improvement in the US over the current century.

Using data from the CDC epidemiological database the decrease in deaths from ovarian cancer is shown with a reduction from the initial rate of 14.6/100,000 in 1999 to 10.2/100,000 in 2020. This dramatic change no doubt reflects better care and earlier detection of disease.

Sadly, the data also shows that this improvement is not universal. Somewhat surprisingly the death rate is highest in non-Hispanic white women at 13.5/100,000, whereas Asian women deaths from ovarian cancer declined to 7.5/100,000 over this time interval.

This disparity may be due to differences in BRCA mutation and age. Overall, it is encouraging to note the changing prognosis for ovarian cancer.

Ovarian cancer during pregnancy

Epithelial ovarian cancer and borderline tumours during pregnancy: a report from the International Network on Cancer, Infertility, and Pregnancy

https://tinyurl.com/4fbdzz6w

Any cancer found during pregnancy causes great concern, with possible damage to the foetus and mother being the main worry, although change in the progression of disease due to altered immunology also is a factor.

Fortunately, ovarian cancer is not common during pregnancy. This article looks at the available information with respect to maternal and foetal outcomes. 

About 1% of all pregnancies have an incidental finding of an adnexal mass. This is more often found now that ultrasound examination is part of the normal standard of care. There is a very low incidence of these masses being found to be malignant (0.2 -3/100,000). Of the malignant masses, three quarters are due to borderline tumours and one quarter invasive ovarian cancer usually epithelial.

Using the INCIP database 129 women were identified as having ovarian cancer discovered prior to childbirth. About half had invasive cancer the others, borderline tumours. 64% of these women had standard care with resection and chemo, the others had treatment deferred.

Birth weights of infants whose mother had received chemo were significantly reduced. Women who had standard treatment for ovarian cancer had better survival. Most cancers were early-stage, overall survival of 80% at 5 years was good. The numbers of cases are small but support active treatment of ovarian cancer during pregnancy.

HIPEC dubious benefit

Hyperthermic intraperitoneal chemotherapy in recurrent ovarian cancer: An updated systematic review and meta-analysis. 

https://tinyurl.com/5n6ujj6a

As knowledge increases there is more understanding of the treatment of ovarian cancer. One of the special characteristics of ovarian cancer is the early metastasis especially to the peritoneal lining of the abdomen. As an attempt to treat this spread, which is often microscopic, an invasive and painful therapy called Hyperthermic intraperitoneal chemotherapy. (HIPEC) has been promoted. 

This article is a review of all the available data relating to clinical trials of HIPEC when compared to standard chemo without HIPEC. The endpoints for the study are progression free survival (PFS), overall survival (OS) and post operative complications.

Only 4 trials were shown to fit the criteria with 801 participants of whom 398 received HIPEC in addition to standard care. The results were discouraging with no improvement in OS or PFS. Post operative complications were significantly increased for the treatment group, especially infection and anaemia.

Obviously, these are small numbers of cases with significant exclusions and possible bias. However, there is doubt that such an invasive procedure is warranted.

New Targeted therapy

The antibody–drug conjugate targeting ROR1, NBE-002, is active in high-grade serous ovarian cancer preclinical models

https://tinyurl.com/2h8jthp9

New pre-clinical research from Sydney Australia has shown a possible new therapy for ovarian cancer. The research identifies the effectiveness of inhibition of a cell membrane receptor named the receptor tyrosine kinase orphan receptor 1 (ROR1). This receptor becomes more active with ovarian cancer. Usually, ROR1 has an important part in early embryonic development and is suppressed later. In the presence of cancer increased ROR1 activity promotes cancer growth and spread.

An antibody/drug combination labelled NBE 002 has been shown to block the receptor with restriction of cell metabolism causing cell death. This early study showed about half the cell types used which had been previously grown from human ovarian cancer had increased ROR1 activity.

If the therapeutic effect can be reproduced in human clinical trials, this drug combination may be yet another example of the possible benefits of targeted cancer treatment.

Biosynthetic Taxol

New method of Taxol production has the potential to greatly reduce the cost

https://tinyurl.com/3hrrx7x4

Since 1996 Taxol, a growth suppressant has been used, together with carboplatin, a cytotoxic, in the initial chemo treatment of ovarian cancer. Originally extracted from the bark of the Pacific Yew tree, Taxol is the most expensive in terms of raw ingredients of any drug in common use.

The original process required the bark from two trees for each individual treatment killing the tree which took 100 years to mature. Subsequently it has been extracted from the harvested Yew needles at a cost of US$20000/ Kg. These too are in short supply.

Now a biosynthetic process using cloned yeast cells has been developed, thereby ensuring an adequate supply at much less cost. Hopefully this will make this essential treatment more readily available, especially in third world countries.