It may not be as bad as you think

Association of patient-reported outcomes and ovarian cancer recurrence

https://tinyurl.com/5edcadrs

         A common misconception of cancer care is that negative thoughts result in negative outcomes. In this prospective study women with ovarian cancer were assessed regularly during the disease to test the concept.    

         196 women with ovarian cancer were recruited following initial treatment. Patient reported outcomes with respect to physical and psychological deterioration were recorded at 3-month intervals for 15 months. The study was terminated after 3 years.

         About 50% of the women had a recurrence, with a mean progression free survival of 10 months. All women prior to recurrence reported deterioration of wellbeing. However, the results show patient reported outcomes information did not help in the diagnosis of which women would have a recurrence.

Radical cancer resection

Total parietal peritonectomy in primary debulking surgery for advanced ovarian cancer

https://tinyurl.com/4bvbc5m5

 

         With any new treatment course a period of evaluation is appropriate after the initial enthusiasm. It is well known that women who have complete resection of ovarian cancer and any distant metastasis have better outcomes. Often distant metastatic deposits are microscopic, it has been reported that frequently microscopic deposits of ovarian cancer have been demonstrated in seemingly normal peritoneum (the lining of the abdominal wall).

         To address this a surgical procedure (total parietal peritonectomy) has been promoted. This review is of 16 patients who underwent this major surgery and looks at the risk-benefit ratio.

         The subjects all had advanced ovarian cancer (stage III/IV). There was a high incidence of early post-operative complications in 11 of the 16 patients, one woman died in the early post-operative period. Progression free survival during the 3 years of the study was 63% with two women dying of the disease. 

         Limitations due to the small size of the sample and possible selection bias are noted. However the authors suggest this radical surgery is beneficial in the right clinical context.

Ovarian resection causes problems

Risk of de novo severe carpal tunnel syndrome after bilateral oophorectomy

https://tinyurl.com/rbh4ds2n

         

    No medical treatment is without consequence. Many women have ovaries removed for non malignant conditions. Sometimes those with a genetic predisposition to have ovarian cancer are being offered preventative surgery with removal of the fallopian tubes and ovaries. 

         It has already been shown that premature menopause due to ovary removal increases the risk of subsequent heart attack, osteoporosis, dementia and mental illness.This study adds the increased risk of severe carpal tunnel syndrome, caused by compression of the median nerve at the wrist, with pain and loss of function. It is not known why this occurs but the authors speculate a hormonal effect.

       For most women with ovarian cancer ovarian removal is inevitable. Informed consent requires discussion of these possible complications. If elective risk reduction surgery is recommended, delayed ovary resection may be preferable.

DVT hazard

Venous thromboembolism in patients receiving neoadjuvant chemotherapy for advanced ovarian cancer and impact on survival

https://tinyurl.com/3naxu328

 

         Deep Venous Thrombosis (DVT) is a common side effect of medical treatment and may be fatal due to pulmonary embolism. Many women who undertake therapy for ovarian cancer will have DVT.

         This retrospective survey looked at the incidence of DVT for women who received neoadjuvant chemotherapy prior to surgery, for ovarian cancer. 286 women were included in the study from Canada. Overall survival was recorded and compared with those patients who did not have DVT.

         During the neoadjuvant chemo almost 14% of these women had DVT. They had worse outcomes, with the mean overall survival being reduced by 45% to 15 months. It is noted that patients who had DVT often had lower serum albumen levels and were more likely to not proceed to surgery.