False diagnosis depresssion

Rethinking depression diagnosis in ovarian cancer: The role of somatic symptoms

https://tinyurl.com/3e2d6jmc

A diagnosis of depression is common for patients with ovarian cancer. The risk is said to be three times that of the general population. This prospective study seeks to assess the role of physical symptoms often seen in these women, which may have led to false diagnoses.

Following treatment, depression diminishes. There is speculation that the depression is an adaptive response to illness rather than a clinical entity.

Psychosociological assessments were undertaken on 428 women with ovarian cancer. They were performed before treatment and a year later and compared to a healthy comparison group of 713 women. Many of the symptoms experienced by ovarian cancer patients, such as fatigue, loss of appetite and brain fog, are criteria that are used to diagnose depression. These symptoms diminish over time, which may account for the reduced severity of depression.

Results from the assessments confirmed the greater risk of clinical depression. However, for many of these women, the high prevalence of somatic symptoms caused a false diagnosis of severe depression. The authors suggest that increased awareness of the possible false diagnosis is required, with education of carers and patients as to the possibility.

MHT may be protective for ovarian cancer patients

Estrogen hormone therapy use in ovarian cancer patients under age 60 at diagnosis

https://tinyurl.com/4uc8sbpa

For many women, the effects of surgical menopause following standard treatment of ovarian cancer is an added insult. Menopause with diminished hormonal circulation can cause a significant decrease in the quality of life.

The impact of the menopause can be reduced by hormone replacement. Previously, there has been some reluctance to prescribe menopausal hormone therapy (MHT) for women with ovarian cancer due to concerns about promoting cancer spread.

This retrospective population study, using data from the BC population database together with information from the pharmacy records, looks at survival for women with ovarian cancer who received MHT compared to those who did not.

Of all the women in British Columbia aged 60 or younger who developed ovarian cancer during the period 1997-2020, about one-sixth of them received MHT. Most of these women had undergone a hysterectomy, meaning that oestrogen therapy only was appropriate.

Results from the study showed improved survival with MHT for women with epithelial and clear cell cancers. Those women who had endometrioid cancer of the ovary had worse survival if exposed to MHT.

The authors suggest that MHT is safe for women with ovarian cancer

and it may improve their quality of life.

Covid-19 and ovarian cancer a lethal combination

COVID-19 mortality risk among women with ovarian cancer: a matched case-control study

https://tinyurl.com/yxr7zb49

Women with ovarian cancer are immunocompromised any additional disease will have a significant impact. This retrospective study from Brazil looks at the risk of death for women with ovarian cancer who are infected with the COVID-19 virus.

During the period 2020-2024, data was collected for 474 patients with ovarian cancer and compared to 1896 controls without ovarian cancer. Both groups had severe COVID-19 infections with Severe Adult Respiratory Syndrome. The ovarian cancer cases were matched for other comorbidities.

Results from the study showed significantly higher mortality, with more than 2.5 times the risk of death for women with ovarian cancer who developed COVID-19. Encouragingly, the death rate was greatly reduced (by 65%) for those women who had been completely vaccinated.

The authors suggest early intervention with antiviral treatment is mandatory for these women and stress the importance of booster vaccination for the latest COVID-19 subtypes.

Is minimal invasive surgery for ovarian cancer hazardous?

Minimally Invasive Surgery, Intraoperative Capsule

Rupture, and Survival in Early Ovarian Cancer

https://tinyurl.com/mp9c87u8

Minimally invasive surgery is increasingly the method of choice for treatment of ovarian cancer either by laparoscopic approach or through use of robotic assistance. Reasons for this include reduced perioperative morbidity and mortality, rapid rehabilitation and reduced scarring or deformity.

In this study using data from the Clinical Cancer National Registry about half of more than 11000 women with ovarian cancer had minimally invasive surgery. Of those women, the intraoperative complication of rupture of the capsule with consequent intraperitoneal spill of cancer cells was 17 % greater for the minimal group compared to open surgery.

Overall survival after 3 years was significantly decreased for women who experienced capsule rupture with 13% increase in death. Although the rate of rupture is low at about 20% for both open and minimal procedures, it is important that this risk be included in informed consent discussions and further improvement of surgical procedure be sought.

Home environment may be cause of ovarian cancer

Residential Radon Levels and Ovarian Cancer Among Postmenopausal Women

https://tinyurl.com/ycxwyvy3

It has long been known that radiation exposure can result in ovarian cancer. Women exposed to the atomic bomb explosions in Japan during World War 2 had an increased incidence of the cancer.

This study looks at exposure to radon gas from naturally occurring sources and correlates the degree of exposure to the risk of developing ovarian cancer.

Radon gas arises from radioactive decay of isotopic material found in rocks most often uranium and thorium. High levels occur in different locations due to the geology, the highest being associated with granite or bluestone. The radiation emitted is of low intensity as alpha radiation which becomes harmful when inhaled.

Using data from the US geological survey areas of high, intermediate, and low levels of radon gas exposure were plotted. A prospective study using information from the women’s Health Initiative measured the risk of ovarian cancer and found that women who lived in high radon gas locations have about a one third greater risk.

Knowing this it may be possible to monitor women who live in these locations to ensure early diagnosis, and possibly reduce the risk by using safer house construction materials to avoid domestic exposure.

Re-purposed drug has FDA approval

FDA approves Relacorilant as combination treatment for platinum resistant ovarian cancer

https://tinyurl.com/2sjzmu7k

Following the success of the ROSELLA trial the FDA has approved the use of Relacorilant in combination with standard chemo for treatment of platinum resistant ovarian cancer.

This is an example of re-purposing of the drug Relacorilant, which was intended for use in adrenal insufficiency. The drug acts by glucocorticoid receptor blockade which also prevents the side effect of cortisol suppressing the immune response to ovarian cancer, by blocking cellular access.

The ROSELLA trial involving 381 patients with platinum resistant ovarian cancer showed a 35% increase in overall survival for the treatment group with a median survival of 16 months compared to 12 months for the control group.

Re-purposing of drugs is expected to become more frequent with the advent of artificial intelligence, which can quickly identify other possible uses. It is obviously beneficial to already know potential adverse effects prior to clinical trials and hopefully reduce costs for new therapy.

Sometimes being early is bad news

Diagnostic Timing and Ovarian Cancer Survival

https://tinyurl.com/3aekcbad

Common wisdom has it that the shorter the time before diagnosis of ovarian cancer, the better the outcome. This retrospective survey using data from the UNC cancer registry looked at the interval before diagnosis and compared the outcome of overall survival.

2309 women were included in the survey, the median delay in diagnosis was 33 days after investigation of a relevant presenting symptom. The group was divided into three according to the delay in diagnosis, early with intervals of less than 10 days, a standard group with a median delay of 80 days, and a delayed group whose diagnosis was delayed by more than 120 days.

Results from the survey showed that the early diagnosis and the late diagnosis groups had significantly worse survival outcomes. This finding appears counterintuitive in that the expectation is that a shorter diagnosis delay would result in smaller more confined disease. However, the authors suggest that many of those women diagnosed early may have more aggressive cancer and be sicker.

As in many aspects of ovarian cancer this study demonstrates the complexity of the management dilemma. It has been thought that applying scarce resources to enable early diagnosis would always improve cancer survival. Unfortunately, the study shows this to be debatable. However, it is still important to avoid a long delay before diagnosis which does shorten survival.