Coping with Covid

Adapting and avoiding coping strategies for women with ovarian cancer during the COVID-19 pandemic

https://tinyurl.com/yy95gmu5

 

         The impact of the Covid 19 pandemic on the physical and psychological well being of women with ovarian cancer has been dramatic. This study looks at coping strategies these women have used during this difficult time

         An online survey of 600 women with ovarian cancer during March and April of 2020 produced 400 responses with relevant information. Active cancer treatment was ongoing for 40% of the respondents, who had a median age of 58.

         Two different coping strategies were noted: adaptive, with acceptance, or dysfunctional, with self-harm. From the survey it seemed that 64% of the women used adaptive strategies such as spirituality, hobbies or exercise. 

          Dysfunctional coping strategies employed included substance abuse, binge eating, and inappropriate use of prescription medication. There was no report of denial.

         With the likelihood being that the pandemic will continue for the foreseeable future, it is important that support services for women with ovarian cancer recognise their special needs. 

Sex after ovarian cancer

Psychosexual morbidity in women with ovarian cancer

https://tinyurl.com/y3rge7z3

         Thanks to improved treatment, women with ovarian cancer are living longer. There is an increasing attention to the quality of life rather than a fixation on survival.

         One of the priorities for women, usually not fully appreciated by medical attendants, is the pleasure of intimate sexual activity. There has been a dearth of information about what women experience after ovarian cancer treatment and a failure to appreciate the inevitable changes that occur.

         This paper from the UK is revelatory; the study is a retrospective analysis of all available literature. The findings are that up to 65% of women before surgery were sexually active. After surgery 75% reported adverse effect, the reasons were both physical and psychological with pain and loss of pleasure.

         The paper is very important and I would encourage full study of the detail. The loss of body image, change in interpersonal relationships from partner to carer, together with the disability of surgery are important but misunderstood consequences of ovarian cancer care.

Incidental salpingectomy does not decrease cancer risk

Ovarian cancer risk after salpingectomy for ectopic pregnancy or hydrosalpinx: results of the OCASE nationwide population-based database study

https://tinyurl.com/yywquctm

 

         Most epithelial ovarian cancer (the commonest and most lethal) starts in the fallopian tube and spreads to the ovary. For those women with a pre-disposition to develop ovarian cancer, due to inherited genetic mutation, risk reduction surgery is being recommended with removal of the fallopian tubes (salpingectomy).

         There is another large group of women who have had at least one tube removed; these are women who developed an ectopic pregnancy and who had surgical therapy. It would seem likely that these women should have a subsequent decreased ovarian cancer risk.

         This retrospective study using the Dutch pathology dataset looked at more than 21,000 women who had salpingectomy, usually unilateral, and compared their cancer risk with a similar size control group. No significant reduction of cancer risk was noted, the authors note that this is a young population and ovarian cancer usually presents later in life.

Dutch Public Pathology Database

Osteoporosis and ovarian cancer

Effect of gynecological cancer and its treatment on bone mineral density and the risk of osteoporosis and osteoporotic fracture

https://tinyurl.com/y3bxbfu2

 

         243 women with ovarian and endometrial cancer had their bone density measured before and during treatment. Their bone density measurements were compared to a control group of healthy post-menopausal women without cancer.

         All women with ovarian cancer had low bone density before and continuing during therapy.  Osteoporosis, which is a bone density less than two standard deviations below the normal mean, is commonly associated with many types of cancer probably due to a hormonal effect.

         Osteoporosis often causes pain and fracture with loss of function and deformity. Appropriate testing and treatment for osteoporosis should be part of the management of ovarian cancer. Treatment such as with bisphosphonates or denosumab, does not affect chemotherapy.