Patient empowerment

Patient-Initiated Follow-Up in Ovarian Cancer

https://tinyurl.com/p428mjdb

 

      Sometimes the management of ovarian cancer is stereotyped being usually what has always been done. This means a schedule of repeat consultations is used to follow up patients after initial successful treatment of the cancer.

      This prospective pilot study looked at giving women the choice to either seek follow up when they thought they needed it, or the usual routine schedule. Both patient groups had serial CA125 testing as normal.    

      Just over 40% chose to take that choice. They reported no increased anxiety or lack of support. Results of blood tests were made available by encrypted messaging. When making their own decisions, women had half as many follow up visits. No significant delay in detecting and managing recurrence occurred.

Lynch syndrome facts

Mortality by age, gene and gender in carriers of pathogenic mismatch repair gene variants receiving surveillance for early cancer diagnosis and treatment: a report from the prospective Lynch syndrome database

https://tinyurl.com/4t3h7vak

 

       Often forgotten as a significant cause for ovarian cancer, Lynch syndrome is now with the advantage of genotyping becoming clearer. A large database is available with input from 25 countries. Using this information the incidence and mortality of cancer associated with Lynch syndrome is now recorded for the first time.

       The reason for cancer for patients with Lynch is defective DNA repair through mismatch repair. There are several subtypes of genetic variation. Cancer arising with Lynch is divided into two groups; colon and the rest. Knowledge of the presence of Lynch syndrome has enabled close surveillance with routine colonoscopy.

       Colon cancer is more likely. However those patients who have been screened by colonoscopy had a low mortality. Ovarian or endometrial cancer is slightly less common but the mortality is worse meaning Lynch patients are more likely to die of ovarian cancer than colon cancer.

Hidden predictors of survival

Predicting the Survival of Patients With Cancer From Their Initial Oncology Consultation Document Using Natural Language Processing

https://tinyurl.com/4b29s2kz

 

       Never underestimate the power of words; often the unconscious choice of language has hidden meanings. This study using Artificial Intelligence looked at the initial report of oncology consultations and compared the language used with the prospect of survival for individual patients.

       This retrospective survey took the data from almost 50,000 consultations and used a form of artificial intelligence called natural language processing, to search for certain key words or part words. The endpoints for survival were at 6, 36 and 60 months. 

       Using the key words which included “Palliat”, “No”, and location such as lung vs. prostate, it is possible to accurately predict that an individual patient may survive 6 months after diagnosis but not 60 months. This has significant implications for informed discussions about possible oncology care.

What do women think about prevention?

Identifying preferences that may motivate choice of ovarian cancer risk prevention strategies using a discrete choice experiment

https://tinyurl.com/yestypma

      In the context of slow progress in the cure for ovarian cancer, there is a push to persuade young women to have preventative surgery with tube and possibly ovary removal, at the time of elective abdominal surgery.

      Informed consent before such a procedure requires the warning that this increases the risk of osteoporosis and coronary artery disease.

      This prospective study looked at the responses of almost 400 women, who have an increased risk of ovarian cancer, when asked to weigh the benefits of surgery versus the risk. 

      Women have a strong preference for a natural age for menopause. Those who chose surgery sought both tube and ovary removal. Understanding these motivating factors will help in the design of prevention strategy.

Is saving fertility worthwhile?

Oncologic and obstetric outcomes of early-stage epithelial ovarian cancer patients who underwent fertility-sparing surgery (a retrospective study)

https://tinyurl.com/2p96s27h

 

      For young women with low-stage ovarian cancer, it is common to offer fertility-sparing surgery, which usually involves the removal of one ovary and fallopian tube. 

      This retrospective survey looks at the outcomes. Did the tumour recur? Did they conceive and deliver?

      Out of 68 patients, 23 tried for pregnancy, 15 succeeded and there were 12 live births. Recurrence of ovarian cancer occurred in 22%, the overall survival was 83%.

      The survival chances are similar to other studies. It seems that offering the chance of pregnancy is a safe alternative and successful delivery is possible.