Care for all

Improving LGBTQ+ Inclusivity in Ovarian Cancer Care

https://tinyurl.com/yx5schcr

 

         Equity and inclusion are fundamental for good health care. It is clear that there is bias against the diverse LGBTQ+ community in cancer care and also a perception by members of the community that they will be discriminated against when they seek medical assistance.

         This article by the CEO of the world ovarian cancer coalition seeks to address these issues. Education is needed to explain that the use of oral contraceptives, pregnancy and breast-feeding are protective against ovarian cancer. Non-heterosexual women are therefore disadvantaged. Risk reduction surgery may be appropriate, but needs careful discussion and understanding.

         Failure to include diverse minority groups in cancer research, most notably in the design of clinical trials, is common and applies not only to the LGBTQ+. Change is required. The author suggests individual care for everyone, together with a commitment to act in good faith.

 

Recurrence pre-determined

DNA methylation and transcriptomic features are preserved throughout disease recurrence and chemoresistance in high grade serous ovarian cancers

https://tinyurl.com/4yvhprf7

 

         Progress in the treatment of ovarian cancer is slow and often occurs in small steps. This study uses whole genome data to show the genetic signature of ovarian cancer is unchanged after recurrence.

         Previously it was thought that recurrence of ovarian cancer is due to resistance to chemotherapy, as a result of a yet to be described genetic mutation. This small study suggests that this is not the case.

         Whole genome sequencing was obtained from 28 women, with data before treatment and after recurrence.. No change likely to cause resistance was detected; suggesting that resistance and recurrence of ovarian cancer is pre-determined at presentation. As whole genome sequencing becomes more readily available, the understanding of ovarian cancer will increase.

Pumping iron, dubious benefit

Independent and joint associations of weightlifting and aerobic activity with all-cause, cardiovascular disease and cancer mortality in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial

 

https://tinyurl.com/bdzkstr9

 

         Often data obtained from one trial has other uses. The Prostate, Lung, Colorectal and Ovarian Cancer screening trial (PLCO) involved 1.5 million people, over a period of 13 years, with the aim of demonstrating the benefit of screening. No survival benefit for ovarian cancer was found.

         Analysis of the data continues, it is seen that moderate to vigorous physical exercise is associated with a significant (32%) lower risk of all-cause mortality. Adding weight training to the exercise routine did not significantly improve the benefit.

         Although the exercise routines improved overall mortality, no benefit was seen for those people with cancer. 

 

Maybe no surgery?

 

Measure of CA-125 Elimination May Guide Interval Debulking Surgery Selection in High-Grade Serous Ovarian Cancer

https://tinyurl.com/mpwbajh2

 

         Change in treatment for cancer often occurs when conventional treatment protocols are challenged. Ovarian cancer survival is  determined by the completeness of initial surgical excision. It is now usual for this surgery to be preceded by chemo in a procedure called neoadjuvant therapy (neo).

         This article looks at whether all patients who have neo need to have surgery, measuring the speed at which the marker; CA125 is eliminated, shown by testing blood serum. The rate of elimination is called KELIM, the patient group (254 women), fell into two groups those who had high KELIM (90 women, i.e. good responders), and those who did not.

         For patients with high KELIM, debulking surgery was not done in the immediate post chemo stage; those who responded slowly to neo had immediate surgery post chemo. Patients with high KELIM scores and who did not have surgery showed no significant disadvantage in overall survival and progression free survival when compared to the other group. When the possible mortality and morbidity of cancer surgery is taken into consideration the importance of this finding increases.