Timing of Palliative Care, End-of-Life Quality Indicators, and Health Resource Utilization https://tinyurl.com/yc2bf5p3 For most  ovarian  cancer patients  and their carers  there comes a time for acceptance and a need for support and compassion.  This is best provided through Palliative  C are  (PC) . This study looks at the benefits to the individual and  community  which result from earlier referral to  P C . Retrospective analysis of the outcomes of more than 8000 women with ovarian cancer showed   survival of  about 3 years with death around the age of  Seventy .  98%   of these women received P C .  One third of the women did not start PC before the last 3 months of life There was a significant difference in the amount of aggressive end-of - life care ,  with f ewer admissions to ICU, consultations with specialists ,  and  less  late  stage  chemotherapy  for those wo...

Regulatory histories of recently withdrawn ovarian cancer treatment indications of 3 PARP inhibitors in the US and Europe: lessons for the accelerated approval pathway https://tinyurl.com/3mrm6z4r The recent decision by the FDA to withdraw  access to PARP inhibitors for patients with recurrent ovarian cancer has raised issues about the  approval process and questions about the efficacy of these drugs Personalised therapy with enzyme inhibitors such as  PARPi  has revolutionised the treatment of  ovarian cancer. The success, in terms of increased survival ,  led to pressure for the use of such drugs to be expanded beyond the  initial   target group to more women. Real-world experience often causes reappraisal of the  benefits  and it is now clear that use of  PARPi  for treat ment of recurrent ovarian cancer increases  the likelihood  of major adverse effects such as marrow suppression .   A   decrease in su ...

Ovarian cancer risk among older patients with stable adnexal masses https://tinyurl.com/5fytnf57 Benign ovarian masses are common .  About  30% of women  with a normal menstrual cycle will develop an ovarian mass .   F or women with irregular menstruation   this figure increases to 50%. It is important to recognise this and avoid invas ive surgery. This study looks at older women  of  over 50 years  in  age and  demonstrates  that ,   for   s table  tumours smaller than 10 cm in size ,  there is a low likelihood of cancer . Almost   5000  women  in this age group ,   presented to one community health organisation with ovarian masses ,  during the period  2016-2020 . Of whom, more than 4000  had a stable appearance at  repeat ultrasound examination 6 weeks  later .   Those women ,  with stable appearances ,  did not have surgery.  During the almost 4...

Reducing ovarian cancer mortality through screening: an impossible dream? https://tinyurl.com/4524jh8f The history of screening tests for ovarian cancer is not good. Two huge trials; the UKCTOCS with  more than 200,000 recruits over 20 years and the PLCO trial with more than 3 million pathology samples  sho wed no benefit in terms of survival from ovarian cancer. This article addresses the stages of ovarian cancer using  an alternative approach called the clinical continuum,  which divides cancer into 3 phases ,  no disease, pre-clinical  (detectable disease) , and  clinical (overt cancer). Obviously for a screening test to be effective ,   cancer needs to be detected before the clinical  phase. However, ovarian cancer is unlike other cancer in that the precursor occurs in the fallopian tube and the re is an argument to say that ,  by the time ovarian cancer has occurred ,  it is always advanced and metastatic .   T his time in...

The Gut Microbiome in Ageing and Ovarian Cancer https://tinyurl.com/yk8nt6w6 Ovarian cancer is mostly a disease of the seventh decade. The reasons for this are unclear. One suggestion is that changes in the Gut bacterial flora or microbiome may be associated. This review looks at which bacteria become more common with age and which decrease. Using data from previously published material, it is clear that bacteria which increase inflammatory change become more common, and that bacteria which assist oestrogen metabolism decrease. The overall complexity of the microbiome changes with age, with some loss of diversity. However, no correlation of ovarian risk to bacterial diversity has been shown. Most women with ovarian cancer receive antibiotic therapy during chemo, this has been shown in mice to change the microbiome and decrease survival from ovarian cancer. No definite association between ovarian cancer and the aged microbiome is known but the inflammatory changes and altered oestrogen ...

FIGO position statement on opportunistic salpingectomy as an ovarian cancer prevention strategy https://tinyurl.com/4db8sj3y The importance of pre-cancerous change in the fallopian tubes as a precursor to ovarian cancer has  led to suggest that removal of the fallopian tubes at the time of other abdominal surgery is  a significant protective measure. Now FIGO ,  (The Internationa l Federation of Obstetrics and Gynaecology) have  issued a position statement saying they firmly support this. Evidence for this position is linked to  pilot studies in Canada which showed significant reduction in subsequent ovarian cancer  rates  when the tubes were removed at the time of hysterectomy, (this is not usual pra ctice).  In addition ,  an Austrian study showed good acceptance of additional surgery .   W hen women facing gallbladder removal were offered tube resection ,  60% accepted .   T he  average increase in operating time was 13...

The impact of inter-cycle treatment delays on overall survival in patients with advanced-stage ovarian cancer https://tinyurl.com/mrxpksk9 Many patients with ovarian cancer have interruption of their chemo. This may occur because of adverse side effects of treatment,  or  external factors  such as other priorities  and  logistic issues. This interruption may cause anxiety which can be expressed as concern that the chemo is less effective. This retrospective study looked at more than 1500 women with advanced ovarian cancer first diagnosed  during the period 2015-2019. The two-year survival for women who had an  uninterrupted chemo  course was  compared to those whose chemo was unavoidably  disrupted. Disruption is common with 37% having breaks of at least 7 days . No difference in survival was seen in the two groups. Knowledge that chemo is just as effective despite interruption means that factors which affect the patient's quality of l i...