ACE inhibitors protect

Antihypertensive Drug Use and the Risk of Ovarian Cancer Death among Finnish Ovarian Cancer Patients—A Nationwide Cohort Study

https://tinyurl.com/xyz8fnw9

 

         Ovarian cancer and hypertension are health hazards. Women with ovarian cancer have 5 years relative survival of about 50%. Similarly aged women with treated hypertension still have a 20% increase in deaths due to cardiovascular events such as stroke or myocardial infarct.

         Previous anecdotal evidence has suggested that women with ovarian cancer who are receiving anti-hypertension therapy have better survival. This large study from Finland looks at more than 12000 women with ovarian cancer, of whom about 7000 received antihypertensive drugs.

         After making allowance for the associated risk of death due to hypertension, the findings confirmed that over the longer period (up to 19 years), the use of ACE inhibitors was protective. Diuretic or beta-blocker therapy had a negative impact with slight increase in hazard. ACE inhibitors have a pharmacological action via the renin/aldosterone pathway. The authors suggest this may be a factor in death from ovarian cancer.

Some die too soon

Factors determining ultra-short-term survival and the commencement of active treatment in high-grade serous ovarian cancer: a case comparison study

https://tinyurl.com/8tye27az

         Overall survival from ovarian cancer is gradually improving by about 2% each year. In Australia women with ovarian cancer have a 5-year’s survival rate of around 50%. There is however a sub-group of women who have very short survival after diagnosis, with 13% of women in this study dying within 100 days from diagnosis.

         Previous studies have suggested that the reasons for such a short survival include advanced stage, delay in diagnosis, older age, and general frailty. Included in this study were 208 women all treated at the same centre of excellence and of whom 28 died within 100 days following initial diagnosis, which meant that none of these short-term survivors completed first-line treatment.

         Findings from the study show that there is no difference in age, stage or frailty between short-term survivors and those who live longer. There were differences in blood parameters with significant changes to platelets, white blood cell count and albumin levels.

Unfair

 

Trends and racial disparities in aggressive end of life care for a national sample of women with ovarian cancer

https://tinyurl.com/mv2drbpy

 

         End of life care for patients with cancer should be better. Hospice and Palliative care are now standard for patients who have entered the terminal stages of their disease. However, it seems that certain demographic groups do not receive appropriate treatment enabling death with dignity.

         This retrospective study looked at almost 8000 women who died from ovarian cancer during the period 2007 to 2016. Several indicators of sub-standard care were selected; late admission or no admission to palliative care, attendance at emergency departments, and futile chemotherapy or invasive procedures administered during the last 14 days of life.

         Findings from the study showed disparity between the care provided for wealthy white women of higher socio-economic status who were less likely to experience sub-standard care than non-whites or the poor. Obviously those responsible for clinical care of disadvantaged ovarian cancer patients need to be mindful of this.

Selective surgery

Appropriate triage allows aggressive primary debulking surgery with rates of morbidity and mortality comparable to interval surgery after chemotherapy

https://tinyurl.com/422ynkuc

 

         Surgery for ovarian cancer is hazardous, with mortality rates of approximately 2% within 90 days and morbidity causing extended hospital stays beyond 10 days of up to 30%. There is a trend to more radical or extended surgery at initial presentation. Because of the hazard, surgery is frequently delayed with chemotherapy being used as initial treatment to decrease tumour bulk.    

         This retrospective study from the Mayo looks at 650 women with stage III/IV ovarian cancer and used triage evaluation to assess operative risk. The triage involve a measure of serum protein (albumin), the age of the patient >75, and mobility.       

         If women had low scores using the triage assessment, there was a significant increase in mortality to about 6%. It is suggested that these women, who are at high risk, should have delayed primary surgery.

Imperfect care

Does Time-to-Chemotherapy after Primary Complete Macroscopic Cytoreductive Surgery Influence Prognosis for Patients with Epithelial Ovarian Cancer?

https://tinyurl.com/ypxbr7j6

 

         No woman with ovarian cancer has a perfect treatment course. Clinicians aim to manage the cancer as well as possible. However, very often internal and external factors have an effect to alter the management. None more so than during the current pandemic, which has caused many changes to best clinical care, often with delays to surgery and chemotherapy.

         This study from France looks at the impact of delaying the onset of chemo following previous surgical resection of ovarian cancer. 233 patient’s records were surveyed, the median time before chemo commenced was 43 days. Overall survival time was recorded, the median being 77 months.

         If the onset of chemo was delayed to longer than 8 weeks after surgery, there was deterioration in the overall survival with a median time of 59 months. No difference in survival was recorded for any of the women if the chemo commenced at any time within 6 weeks after surgery. The authors suggest that chemo should be commenced as soon as possible, but a short delay will not be harmful.