One less cause to worry

The impact of inter-cycle treatment delays on overall survival in patients with advanced-stage ovarian cancer

https://tinyurl.com/mrxpksk9

Many patients with ovarian cancer have interruption of their chemo. This may occur because of adverse side effects of treatment, or external factors such as other priorities and logistic issues.

This interruption may cause anxiety which can be expressed as concern that the chemo is less effective.

This retrospective study looked at more than 1500 women with advanced ovarian cancer first diagnosed during the period 2015-2019. The two-year survival for women who had an uninterrupted chemo course was compared to those whose chemo was unavoidably disrupted. Disruption is common with 37% having breaks of at least 7 days. No difference in survival was seen in the two groups.

Knowledge that chemo is just as effective despite interruption means that factors which affect the patient's quality of life can be addressed without fear of harm.

The real financial cost

Study Finds Nearly $70 Billion in Socioeconomic Losses Across 11 Countries Attributable to Ovarian Cancer

https://tinyurl.com/4spw37yz

Ovarian cancer is extremely costly to the individual, the state and the family of each patient. This study uses a true cost of illness approach to assess the annual economic burden of each case of ovarian cancer in high-, middle-, and low-income countries.

Factors included in this determination include cost of treatment, the opportunity cost of loss of productivity for the individual and the carers and the often-forgotten cost of unpaid carer time.

The sums are mind-boggling with an estimate of almost $70 Billion total annual expenditure and individual costs of up to 120 times the usual health expenditure per capita for low-income countries.

Obviously, there is concern about whether this is sustainable and shows the urgent need to reduce the incidence of ovarian cancer.

Alternative therapy ineffectual

Impact of metformin, statins, and beta blockers on survival in patients with primary ovarian cancer: combined analysis of four prospective trials of AGO-OVAR and ENGOT/GCIG collaborators

https://tinyurl.com/597m54hb

Anecdotal experience has previously suggested that off-label use of some commonplace drugs may improve survival for patients with ovarian cancer. This meta-analysis of 4 prospective randomised trials looks at the effect of some of these.

Data was obtained from the trials which recorded use of the additional drug treatment. The prime purpose of the trials having been assessment of efficacy of the enzyme inhibitor, Pazopanib. From the data, patients could be subdivided into two groups; those who had received additional drug therapy and those who had not.

Finding from the results show that use of off-label drugs was associated with greater co-morbidity. Neither metformin or statin therapy had any effect on survival. Use of betablockers had a negative effect, those patients had worse survival outcomes.

Serendipity

Incidental Findings of Borderline Ovarian Tumour or Ovarian Cancer -Real-World Data on Surgical and Oncological Outcome

https://tinyurl.com/5n8284dj

Sometimes ovarian cancer is found by chance during surgical procedures performed for other reasons. The standard of care for such cases is to undergo a repeat surgical procedure at a specialised surgical oncology centre. This study looks at real-world cases and seeks to determine whether this course of action results in worse outcomes. 

This retrospective survey of 390 patients at Bern Hospital during a 10-year period from 2010 showed 228 cases of either borderline ovarian tumour or ovarian cancer. The outcomes for these women were compared to those for women who were known to have ovarian cancer prior to single stage surgery at the same centre.

Apart from a small delay in starting chemo for those women who has a second operation, no difference in outcomes which include morbidity, mortality, and recurrence intervals was noted. 

Comorbidity, poisoned soil

Charlson’s comorbidity and remission outcomes in women diagnosed with epithelial ovarian cancer.

https://tinyurl.com/2hmnmvp9

Any surgery carries risk. Complex surgery such as that required for total clearance of ovarian cancer has a mortality of 4%. For some women this risk is increased by pre-existing medical conditions known as comorbidity.

This retrospective cohort study seeks to measure the risk increase in the presence of comorbidity. Using the Charlson comorbidity index, which shows associated significant pre-existing disease as a risk factor, even the lowest measure at more than 1 significantly decreased the prospect of complete remission and survival from ovarian cancer.

This means that patients who have one or more other major health issues are less likely to benefit from intensive primary treatment and that maybe alternative therapy, such as maintenance with personalised care should be considered?

AI, the way forward

LITERARY REVIEW OF ARTIFICIAL INTELLIGENCE IN OVARIAN CANCER: TRANSFORMING DIAGNOSIS, TREATMENT, AND FUTURE ADVANCEMENTS

https://tinyurl.com/yc85bx44

Artificial intelligence (AI) has the potential to change the management and improve survival for women with ovarian cancer. This review looks at what is possible now and what may be possible soon in the use of AI for this difficult disease.

Increasingly women with ovarian cancer are receiving personalised therapy base on the genetic, metabolic, and systemic nature of their cancer. More and more information cause problems with the understanding of the relevance and interconnection of the data. The great strength of AI is the ability to quickly correlate information and suggest appropriate measures to address the correct therapy path.

Using AI for the diagnosis of ovarian cancer will increase the sensitivity and avoid unnecessary intervention in some cases. Increasingly AI is being used for drug research, currently existing chemical compounds can be quickly scanned to determine likely effectiveness against ovarian cancer. Any relevant research can be processed and may provide alternative therapy suggestions. 

It seems likely that because of the complexity of ovarian cancer and the increasing amount of information being collected it will soon be essential to use AI as a standard of care. Caution is needed when using AI. There is increasing awareness of potential bias due to inequitable clinical trials and pre-conceived algorithms and constraints.

Suspicions confirmed

Differences in cancer rates among adults born between 1920 and 1990 in the USA: an analysis of population-based cancer registry data

https://tinyurl.com/wzaxy5w5

Anecdotal experience has suggested that cancer is becoming more common for younger patients. This suggests that lifestyle changes and environmental effects are causing more cancer. Using data from population-based cancer registry this study looks at the increase in cancer risk for younger cohorts.

Information is available from this huge study with data from more than 23 million patients, of whom more than 7 million developed cancers. Comparing cancer rates from 5-year birth cohorts showed that for 9 of the 34 different cancers included in the study there was an increase for patients born in the 1990 cohort compared to the 1955 cohort. The mortality has decreased, with better treatment options.

Some cancers notably smoking affected cancers such as lung cancer, show a decrease due to changed lifestyle. Ovarian cancer also is less, probably due to medical intervention with hormonal contraception.

Understanding of these changes suggest a need for modification of lifestyle and environmental factors with more research into underlying causes.