Diagnosis Of Gynecologic Cancer Research Articles

Gynaecological cancer-related deaths in a tertiary hospital: A four-year retrospective review.

The aim of this study is to describe the profile, causes of death, and associated complications among women who died with a diagnosis of gynecological cancer during a four-year period in a gynae oncology unit in a tertiary hospital. The study is based on a retrospective review of clinical records of patients. There were 368 gynecological cancer admissions during the study period and 51 gynecological cancer-related deaths (13.8%); however, only 48 (13%) of the 51 files were available for analysis. The mean age of the women who died was 52.7 years (SD ±16.92). Most of the women who died were South African citizens (41, 85%), black (44, 91.7%) and unemployed (37, 77.1%). The most common comorbidities were hypertension and HIV which occurred at similar frequencies (20, 41.7%), followed by diabetes mellitus (7, 14,6%). The three most common cancers were cervical (18, 37.5%), ovarian (13, 27.1%), and endometrial (12, 25,0%). All women who died (48, 100%) had some form of cancer-related complications on admission to the hospital. The most common complication at presentation was obstructive uropathy (16, 31.3%) followed by ascites (11, 21.6%) and pleural effusion (8, 15.8%). Just less than half of the patients (22, 45.8%) received palliative treatment due to advanced-stage disease, and the remainder, (20, 41.6%) and (5, 10.4%) surgical and radiation therapy, respectively. The surgical procedure performed was staging laparotomy for ovarian and endometrial cancer (19, 95%) and radical hysterectomy and lymph node dissection for operatable cervical cancer (01, 5%). Forty-nine complications were recorded among the 20 women who underwent surgical treatment. The most common complications were sepsis and hemorrhage followed by organ injury.

Nanotechnological Advances in the Diagnosis of Gynecological Cancers and Nanotheranostics.

Gynecological cancers are one of the main causes of female mortality worldwide. Despite the various strategies to reduce mortality and improve quality of life, there are still many deficiencies in the diagnosis and treatment of gynecological cancers. One of the important steps to ensure optimal cancer treatment is the early detection of cancer cells and the use of drugs to reduce toxicity. Due to the increase in systemic toxicity and resistance to traditional and conventional diagnostic methods, new strategies, including nanotechnology, are being used to improve diagnosis and reduce the severity of the disease. Nanoparticles (NPs) provide exciting opportunities to improve Gynecological Cancers (GCs) diagnosis, particularly in the initial stages. In biomedical investigations and clinical settings, NPs can be used to increase the sensitivity and specificity of recognition and/or imaging of GCs with the help of their molecular and cellular processes. To design more efficient diagnostic NPs for gynecological cancer cells or tissues, determining the specific biomarkers is of great importance. NP-based imaging agents are another solution to trace cancer cells. This review highlights the potential of some NP-based diagnostic techniques in GC detection, which could be translated to clinical settings to improve patient care.

Cropsi study: Efficacy and safety of cryotherapy and cryocompression in the prevention of chemotherapy-induced peripheral neuropathy in patients with breast and gynecological cancer–A prospective, randomized trial

ObjectiveThis study aimed to demonstrate the superiority of cryocompression over cryotherapy alone in the prevention of chemotherapy-induced peripheral neuropathy (CIPN) grade 2 or above. MethodsThis prospective randomized study was conducted between May 2020 and January 2023 in Innsbruck. Eligible patients had a diagnosis of gynecological cancer and received a minimum of 3 cycles of taxane-based CT (neoadjuvant, adjuvant or palliative therapy). Patients were randomized 1:1 to receive either cryotherapy or cryocompression on their upper extremities during chemotherapy (CT). We performed temperature measurements, two QoL questionnaires and neurological tests during CT and at follow-up 3 and 6–9 months after the completion of CT. CIPN was assessed using the CTCAE score. ResultsOf 200 patients recruited, both groups showed a lower prevalence of CIPN in this study compared to recent literature. In the group receiving cryotherapy, the prevalence of grade 1 CIPN was 30.1 %, and that of grade 2 CIPN or above was 13.7 %; in the group treated with cryocompression, the prevalence of grade 1 CIPN was 32.8 %, and that of grade 2 or above CIPN was 17.2 %. We found a significant reduction in temperature in the cryotherapy and cryocompression groups. Regarding the two QOL questionnaires as well as the neurological tests no significant differences were found between the two groups. ConclusionOur study suggests that cryotherapy as well as cryocompression is a safe and effective way to cool patients’ extremities to lower the prevalence of CIPN. Cryocompression was not more effective than cryotherapy alone in the prevention of CIPN.

“What you're hearing from all of us is simplify the language”: A focus group study on biomarker testing in oncology.

e13540 Background: In oncology, somatic biomarker testing is increasingly driving treatment decision-making. Exploration of patients’ understanding of, and perspectives on, biomarker testing has been limited, yet these are needed to improve health education and communication about biomarkers. Our objectives were to explore the perspectives of patients with gynecologic cancers on biomarker and genetic testing and to identify factors that influenced their decision-making on testing. Methods: Patients with gynecologic cancer enrolled in the University of Pennsylvania’s Biobank were invited to participate. Of the 82 patients contacted, 7 participated in 3 focus groups in fall 2023. Participants reviewed educational materials (pamphlet, slide set) about biomarker testing based on the Cancer Precision Medicine Commons’ patient education materials, explored understanding and perspectives around biomarker testing, and then discussed barriers and facilitators to testing. Thematic analyses by two researchers were performed using verbatim transcripts. Results: All patients strongly agreed that both genetic and biomarker testing were important after a gynecologic cancer diagnosis and impacted their treatment options. However, patients did not understand what a biomarker was and expressed confusion over terms and testing methods, labeling unknown terms as “jargon.” 85% of participants had received germline genetic testing, and 85% received biomarker testing, with the remaining participants uncertain about testing status. Participants utilized a variety of resources such as the Internet, peer forums, articles on the patient portal, discussions with clinicians, and scientific papers to understand their cancer diagnosis and the role of genetic and biomarker testing. They mentioned fear (i.e., seeing low survival rates for ovarian cancer online as a “death sentence”) and financial circumstances as key barriers to accessing genetic or biomarker testing. Patients desired simple tailored written materials that were relevant from diagnosis to across the disease course. Conclusions: Patients understand the importance of biomarker testing in oncology but reported difficulties understanding existing resources. Current online resources had jargon and induced fear in some participants. Work to develop patient-centered resources on biomarker testing is needed.

Association of enrollment in Medicare Advantage plans versus fee-for-service in patients with a late-stage diagnosis of gynecologic cancer.

11140 Background: In the United States, uterine cancer is the most common gynecologic (GYN) cancer; and ovarian cancer causes more deaths each year than any other GYN cancer. There are currently no recommended population-wide screening tests for ovarian or uterine cancer, which are heavily concentrated in older women. Medicare is the primary health insurer for 97% of Americans aged 65 years and older. This study is the first to examine the association between Medicare enrollment plan – Medicare Advantage (MA) versus fee-for-service (FFS) – and stage at diagnosis among older women newly diagnosed with ovarian or uterine cancer. Methods: Using the linked Surveillance, Epidemiology, and End Results (SEER) registries and Medicare enrollment data, we identified 101,193 women aged 65 years and older with newly diagnosed ovarian or uterine cancer between 2007-2019. We categorized patients into two groups: 1) those continuously enrolled in Medicare MA for six months prior to their diagnosis, through the diagnosis month, and the month following diagnosis; 2) those continuously enrolled in Medicare FFS within the same eight-month window. Late-stage was defined as “Distant” stage (with “Local” and “Regional” stages representing an earlier-stage diagnosis) using the SEER Summary Stage variable. The association between Medicare enrollment plan and stage was examined through multivariable logistic regression modeling that adjusted for sociodemographic characteristics. The influence of each predictor on the difference in the probability of late stage was summarized as an adjusted marginal effect (ME). Results: Among uterine cancer patients, 37% had MA insurance. Compared with Medicare FFS enrollees, the adjusted percentage of late-stage diagnosis was 0.6 percentage points (ppt) lower for MA enrollees (95% CI = -1.1-(-0.1); P<0.05). Notably, patients were more likely to have a late-stage uterine diagnosis if they were: non-Hispanic Black or Hispanic (vs. non-Hispanic White); age 75 and older (vs. between 65 -74); and residing in a lower SES neighborhood. Among ovarian cancer patients, 34% had MA insurance. We found no significant difference between Medicare MA and FFS enrollees in ovarian cancer stage at diagnosis. Of note, Non-Hispanic Black patients were significantly more likely to be diagnosed with late-stage disease compared to Non-Hispanic White, and likewise for patients aged 75 and older (vs. between 65-74). Conclusions: Among Medicare beneficiaries (age 65+) diagnosed with uterine cancer, those enrolled in an MA plan were significantly less likely to be diagnosed at a later stage. In similar analyses for ovarian cancer, there was no such MA - FFS difference in the probability of late-stage. As enrollment in Medicare Advantage plans continues to grow, it becomes increasingly important to identify whether there are significant outcome differences between MA and FFS plans.

Association of levonorgestrel-releasing intrauterine device with gynecologic and breast cancers: a national cohort study in Sweden

BackgroundThe levonorgestrel-releasing intrauterine device (LNG-IUD) is widely used for the treatment of menorrhagia, dysmenorrhea, and for contraception. However, the association between the use of LNG-IUD and the risk of site-specific gynecologic and breast cancers remains inconclusive. ObjectiveWe aim to address this knowledge gap by investigating whether the use of LNG-IUD is associated with a significant risk of site-specific gynecologic and breast cancers. This will be achieved by accessing the nationwide Swedish Registers, with consideration given to the influence and potential interaction of family history of cancer. Study DesignA total of 514719 women aged 18 to 50 years who have used LNG-IUD between July 2005 and December 2018 were identified from the Swedish Prescribed Drug Register and randomly matched with 1544157 comparisons who did not use LNG-IUD at a ratio of 1:3. The propensity score was calculated and matched among women who used LNG-IUD and the matched comparisons. The follow-up period started from the date of the first prescription of LNG-IUD for users as well as for their matched comparisons and ended at the date of diagnosis of gynecologic and breast cancers, date of death from any cause, and the end of the study period, whichever came first. The Cox proportional hazard model with a competing risk analysis was used to calculate hazard ratios and 95% confidence intervals. Additive interaction was calculated as the relative excess risk for interaction, while multiplicative interaction was calculated by including a product term in the regression model. ResultsThe use of LNG-IUD was associated with a 13% higher risk of breast cancer (adjusted HR, 1.13; 95% CI, 1.10-1.17), a 33% lower risk of endometrial cancer (adjusted HR, 0.67; 95% CI, 0.56-0.80), a 14% lower risk of ovarian cancer (adjusted HR, 0.86; 95% CI, 0.75-0.99) and a 9% reduced risk of cervical cancer (adjusted HR, 0.91; 95% CI, 0.84-0.99) compared to women who did not use LNG-IUD. A significant additive interaction between LNG-IUD use and family history of cancer was observed in breast cancer, indicating a relative 19% excess risk for interaction (P < 0.002), and 1.63 additional cases per 10,000 person-years. ConclusionsThe risk of gynecologic and breast cancers exhibits a site-specific effect among LNG-IUD users. It's important to note that the observed effect is small for breast cancer and the results are limited by the observational study design. Clinical recommendations regarding the use of LNG-IUD should carefully weigh its potential benefits and risks. Close monitoring is advisable for the potential development of breast cancer, particularly among women with a family history of breast cancer.

Survivorship concerns among individuals diagnosed with metastatic cancer: Findings from the Cancer Experience Registry.

Individuals with metastatic cancer experience many medical, physical, and emotional challenges due to changing medical regimens, oscillating disease states, and side effects. The purpose of this study was to describe the type and prevalence of survivorship concerns reported by individuals with metastatic cancer, and their associations with cancer diagnosis, treatment, and socio-demographic variables. This study utilized data from the Cancer Support Community's Cancer Experience Registry. Individuals were included if they self-reported a solid tumor metastatic cancer and completed CancerSupportSource, which evaluates five domains of concerns (emotional well-being, symptom burden, body image/healthy lifestyle, healthcare team communication, and relationships/intimacy). Multivariable linear regression examined associations between independent predictors of each survivorship concern domain. Of the 403 included participants, individuals reported a metastatic diagnosis of breast (43%), colorectal (20%), prostate (7%), lung (7%), gynecologic cancer (6%) and other. Nearly all (96%) reported at least one survivorship concern, with the most prevalent concern about cancer progression or recurrence. Survivorship concerns were higher across multiple domains for individuals unemployed due to disability. Individuals who were less than five years since diagnosis reported higher concerns related to emotional well-being, symptom burden, and healthcare communication compared to those more than five years since diagnosis. Individuals with metastatic cancer experience a variety of moderate-to-severe survivorship concerns that warrant additional investigation. As the population of individuals with metastatic cancer lives longer, future research must investigate solutions to address modifiable factors associated with survivorship concerns, such as unemployment due to disability.

Familial and Social Implications of Breast and Gynaecological cancer in Kerala, India

BackgroundDue to the paucity of reliable data to determine the components of family-based comprehensive care for cancer in India, we explored the familial implications of gynaecological and breast cancer diagnosis and treatment through a mixed-method study. MethodsThe mixed method study included 130 women aged above 18 with a confirmed diagnosis of gynaecological or breast cancer recruited from three selected tertiary hospitals in Kerala, India. Information on quality of life (36-Item Short Form Survey (SF-36)), psychological distress (distress thermometer), and the familial, interpersonal, social, and community impacts of cancer (semi-structured interview guide) were elicited. Linear regression was used to identify the factors associated with distress and the factors were explored further using thematic analysis. ResultsPatients included in the study (n = 130; mean age 57.5 years) had moderate or mild (66.9%) to severe (25.4%) distress. Concerns about work (93%), difficulty in; home care and housing (82%), care for dependents (65%), unempathetic family (87.6%), isolation (70%), and body image (65%) were major reasons for their distress. Physiological, social, and family-related stressors among the respondents included challenges in physical functioning, intense physical symptoms like fatigue, loss of appetite and sleep, role restrictions, alterations in family responsibilities, functional dependency, inadequate family support, challenges in social and interpersonal interactions, and an unsupportive work environment. ConclusionCancer is a health crisis that involves psychological, social, and economic distress, compelling professionals to design multifaceted individualized care packages rather than only concentrating on medical management to alleviate their distress.

PET-CT with 18F-FDG in Gynecological Malignancies. Prognostic Significance of the Standardized Uptake Value

"Gynecologic cancers are among the most common cancers in women and are a significant cause of mortality in women worldwide. FDG-PET images play a critical role in several areas of oncology and are an essential tool for the diagnosis and staging of gynecologic cancer, providing information about tumor metabolism. Aim: The aim of this study was to investigate the relationship between tumor differentiation, type of malignancy, and glucose metabolism in patients with confirmed gynecologic cancer. Materials and Methods We performed a retrospective review of 60 consecutive patients (ages 31-76) with histopathologically confirmed gynecologic cancer who underwent PET-CT in our department between January 2021 and March 2022. Quantitative data on glucose metabolism were collected using the maximum standardized uptake value normalized by lean body mass (SULmax). We reviewed a total of 60 patients with a mean age of 60±9 years, and a median of 62. Results: 14 patients were diagnosed with cervical cancer, 20 with endometrial cancer, and 26 with ovarian cancer; 13 patients had well-differentiated cancer, 11 had moderately differentiated cancer, and 36 had poorly differentiated cancer. A positive correlation was observed between the measured SULmax and the degree of tumor differentiation, indicating higher glucose uptake in poorly differentiated cancer. When examining the relationship between the type of cancer and SULmax, we found that endometrial cancer exhibited the highest mean SULmax (8.36±6.75), followed by ovarian cancer and cervical cancer. Additionally, we noted that glucose uptake was higher in patients aged over 62 years. Regardless of the tumor differentiation, the findings in endometrial cancer showed the highest mean SUVmax values in all grades of tumor differentiation. Conclusion: Our study showed that glucose consumption correlates not only with the degree of differentiation but also with age and type of tumor, with the highest values in patients older than 62 years with endometrial cancer. Given the correlation between glucose consumption and tumor aggressiveness, this finding may be important for prognostic evaluation of patients with gynecologic malignancies."

Novel Perspectives for the Diagnosis and Treatment of Gynecological Cancers using Dysregulation of PIWI Protein and PiRNAs as Biomarkers.

The term "gynecological cancer" is used for a group of cancers occurring in the female reproductive system. Some of these cancers are ranked as the leading causes of death in developed and developing countries. The lack of proper diagnostic strategies is one of the most important reasons that make them lethal. PIWI-interacting RNAs or piRNAs are a class of small non-coding RNAs, which contain 24-32 nucleotides. These RNAs take part in some cellular mechanisms, and their role in diverse kinds of cancer is confirmed by accumulative evidence. In this review, we gather some information on the roles of these RNAs and members of the PIWI protein family to provide new insight into accurate diagnostic biomarkers and more effective anti-cancer drugs with fewer side effects.

The Impact of Covid-19 on the Diagnosis of Gynecological Cancers in the Post-Pandemic Era: An Integrative Review

The COVID-19 pandemic has impacted the dynamics of health systems, including limiting activities to prevent and diagnose gynecological cancers in primary care. This study aims to understand the extent of the consequences of the pandemic period on gynecological cancers in terms of diagnosis and prognosis. The method in this research was an integrative review based on the search of publications in PubMed, SciELO, and BVS from January 2020 to June 2023, with three exclusion moments and a final sample of 9 articles. The results indicated avoidance of consultations due to fear of the virus, postponement of evaluation exams, interruptions of screening and vaccination procedures, establishment of non-priority staging, postponement of surgeries, priority to conservative treatments, and decline in diagnoses during the pandemic. It is concluded that the pandemic event impaired women’s health care in the context of gynecological cancers, which calls for measures to adapt to primary and secondary care.

Deep-learning models for image-based gynecological cancer diagnosis: a systematic review and meta- analysis.

Gynecological cancers pose a significant threat to women worldwide, especially those in resource-limited settings. Human analysis of images remains the primary method of diagnosis, but it can be inconsistent and inaccurate. Deep learning (DL) can potentially enhance image-based diagnosis by providing objective and accurate results. This systematic review and meta-analysis aimed to summarize the recent advances of deep learning (DL) techniques for gynecological cancer diagnosis using various images and explore their future implications. The study followed the PRISMA-2 guidelines, and the protocol was registered in PROSPERO. Five databases were searched for articles published from January 2018 to December 2022. Articles that focused on five types of gynecological cancer and used DL for diagnosis were selected. Two reviewers assessed the articles for eligibility and quality using the QUADAS-2 tool. Data was extracted from each study, and the performance of DL techniques for gynecological cancer classification was estimated by pooling and transforming sensitivity and specificity values using a random-effects model. The review included 48 studies, and the meta-analysis included 24 studies. The studies used different images and models to diagnose different gynecological cancers. The most popular models were ResNet, VGGNet, and UNet. DL algorithms showed more sensitivity but less specificity compared to machine learning (ML) methods. The AUC of the summary receiver operating characteristic plot was higher for DL algorithms than for ML methods. Of the 48 studies included, 41 were at low risk of bias. This review highlights the potential of DL in improving the screening and diagnosis of gynecological cancer, particularly in resource-limited settings. However, the high heterogeneity and quality of the studies could affect the validity of the results. Further research is necessary to validate the findings of this study and to explore the potential of DL in improving gynecological cancer diagnosis.

Factors related to Nursing workload in the Oncology assistance provided to hospitalizedwomen.

to evaluate the Nursing workload and its related factors in the assistance provided to hospitalized women with gynecological and breast cancers, according to the Nursing Activities Scores adapted for cancer patients. a cross-sectional and epidemiological study. The participants were women with gynecological and/or breast cancer, over 18 years of age, and hospitalized for a minimum period of 24 hours. The following was collected from the medical records: sociodemographic and clinical data, Karnofsky Performance Status and workload, according to the adapted Nursing Activities Score. The factors related to workload were analyzed by means of multiple linear regression. the mean Nursing Activities Scores was 29.3%, denoting seven hours of daily care per patient. The factors related to workload differed according to the breast or gynecological cancer diagnosis (β=-0.01; p<0.001), clinical or surgical treatment (β=-0.03; p<0.001) and functional capacity at admission (β=0.07; p<0.001), as per the Karnofsky Performance Status. there was greater workload for the care of women with gynecological cancer undergoing clinical treatment and with lower functional capacity at admission. The findings reveal directions for optimization of resources and improvements in work processes and flows, in order to promote a favorable work environment and good quality assistance. (1) A pioneer study in using the NAS instrument, adapted for Hospital Oncology. (2) The clinical treatment of gynecological/breast cancer demands a greater workload. (3) Functional capacity at the admission of women with cancer influences workload. (4) Gynecological cancer demands a greater Nursing workload than breast cancer.

The Effectiveness of Metabolic Bariatric Surgery in Preventing Gynecologic Cancer - from Pathophysiology to Clinical Outcomes.

Obesity and cancer represent two pandemics of current civilization, the progression of which has followed parallel trajectories. To time, thirteen types of malignancies have been recognized as obesity-related cancers, including breast (in postmenopausal women), endometrial, and ovarian cancer. Pathophysiologic mechanisms that connect the two entities include insulin resistance, adipokine imbalance, increased peripheral aromatization and estrogen levels, tissue hypoxia, and disrupted immunity in the cellular milieu. Beyond the connection of obesity to carcinogenesis at a molecular and cellular level, clinicians should always be cognizant of the fact that obesity might have secondary impacts on the diagnosis and treatment of gynecologic cancer, including limited access to effective screening programs, resistance to chemotherapy and targeted therapies, persisting lymphedema, etc. Metabolic bariatric surgery represents an attractive intervention not only for decreasing the risk of carcinogenesis in high-risk women living with obesity but most importantly as a measure to improve disease-specific and overall survival in patients with diagnosed obesity-related gynecologic malignancies. The present narrative review summarizes current evidence on the underlying pathophysiologic mechanisms, the clinical data, and the potential applications of metabolic bariatric surgery in all types of gynecologic cancer, including breast, endometrial, ovarian, cervical, vulvar, and vaginal.

Ethnic disparities in the incidence of gynecologic malignancies among Israeli Women of Arab and Jewish Ethnicity: a 10-year study (2010-2019).

Ethnic disparities in healthcare outcomes persist, even when populations share the same environmental factors and healthcare infrastructure. Gynecologic malignancies are a significant health concern, making it essential to explore how these disparities manifest in terms of their incidence among different ethnic groups. To investigate ethnic disparities in the incidence of gynecologic malignancies incidence among Israeli women of Arab and Jewish ethnicity. Our research employs a longitudinal, population-based retrospective cohort design. Data on gynecologic cancer diagnoses among the Israeli population from 2010 to 2019 was obtained from a National Registry. Disease incidence rates and age standardization were calculated. A comparison between Arab and Jewish patients was performed, with Poisson regression models being used to analyze significant rate changes. Among Jewish women, the age-standardized ratio (ASR) for gynecologic malignancies decreased from 288 to 251 (p < 0.001) between 2014 and 2019. However, there was no significant change in the ASR among Arab women during the same period, with rates going from 192 to 186 (p = 0.802). During the study period, the incidence of ovarian cancer decreased significantly among Jewish women (p = 0.042), while the rate remained stable among Arab women (p = 0.102). A similar trend was observed for uterine cancer. The ASR of CIN III (Cervical Intraepithelial Neoplasia Grade 3) in Jewish women notably increased from 2017 to 2019, with an annual growth rate of 43.3% (p < 0.001). A similar substantial rise was observed among Arab women, with an annual growth rate of 40.5% (p < 0.001). In contrast, the incidence of invasive cervical cancer remained stable from 2010 to 2019 among women of both ethnic backgrounds. Our findings indicate that Arab women in Israel have a lower incidence rate of gynecologic cancers, warranting further investigation into protective factors. Both ethnic groups demonstrate effective utilization of cervical screening.

Gynecologic Surgical Subspecialty Training Decreases Surgical Complications in Benign Minimally Invasive Hysterectomy

Study ObjectiveTo evaluate the impact of gynecologic subspecialty training on surgical outcomes in benign minimally invasive hysterectomies (MIH) while accounting for surgeon volume. DesignRetrospective cohort study of patients who underwent a MIH between 2014 and 2017. SettingSingle community hospital system. PatientsPatients were identified via CPT (Current Procedural Terminology) codes for MIH: vaginal, laparoscopic or robotic. Exclusion criteria included a gynecologic cancer diagnosis or concomitant major procedure at the time of hysterectomy. One thousand six hundred and thirty-one patients underwent a benign MIH performed by a gynecologic generalist or a subspecialist in Minimally-Invasive Gynecologic Surgery (MIGS), Urogynecology and Pelvic Reconstructive Surgery (URPS), or Gynecologic Oncology. 125 hysterectomies were vaginal, 539 were conventional laparoscopic, and 967 were robotic. InterventionsN/A Measurements and Main ResultsSurgical outcomes including intraoperative complications, operative outcomes, and postoperative readmissions and reoperations, were compared between generalists and subspecialists and stratified by surgeon volume status, with “high-volume” defined as performing 12 or more hysterectomies annually. Odds ratios for the primary outcome, Clavien-Dindo Grade III complications (which included visceral injuries, conversions, and reoperations within 90 days), were calculated to evaluate the impact of subspecialty training while accounting for surgeon volume status. 855/1631 (52.4%) MIH were performed by generalists and 776/1631 (47.6%) by subspecialists. High-volume generalists performed 618/1631 (37.9%) of MIH, 14.5% (237/1631) were performed by low-volume generalists. All subspecialists were high-volume surgeons; 38.1% of generalists were high-volume.The odds of a Clavien-Dindo Grade III complication was 0.39 (0.25-0.62) for hysterectomies performed by subspecialists compared to high-volume generalists after adjusting for potential confounding variables (p < .001). Subspecialists and high-volume surgeons had significantly lower incidence of visceral injuries, transfusions, blood loss over 500 mL, and conversions compared to generalists and low-volume surgeons, respectively. ConclusionBoth subspecialty training and high surgeon volume status are associated with a lower risk of surgical complications in benign MIH. Subspecialty training is associated with a reduction in surgical complications even after accounting for surgeon volume.

Projeto de extensão Mulher Saudável: ações educativas no ambiente ocupacional e sua interface com a saúde ginecológica

The study focuses on the importance of cervical and breast cancer as public health issues for working women, highlighting the Woman Healthy Extension Project in a pediatric hospital in Curitiba-PR. The project conducts screenings and educational activities to prevent these cancers, raising the central question: "Do educational activities in the workplace impact gynecological health?" Using an integrative literature review, the study analyzed seven articles from November 2022 to March 2023. It emphasizes that extension projects contribute to academic development, promoting a critical perspective. The lack of preventive practices in gynecological health is related to various factors, underscoring the importance of discussing exams such as Pap smears and mammography. The study concludes that integrating extension projects into the curriculum promotes health education, benefiting female workers through the prevention and early diagnosis of gynecological cancers.

Anxiety in oncology outpatients is associated with perturbations in pathways identified in anxiety focused network pharmacology research

PurposeEvaluate for perturbed signaling pathways associated with subgroups of patients with low versus high levels of state anxiety. These pathways were compared to the pathways identified across eight network pharmacology studies of the anxiolytic effect(s) of a variety of compounds.MethodsAdult outpatients had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct anxiety profiles based on Spielberger State Anxiety Inventory scores that were obtained six times over two cycles of chemotherapy. Blood samples were processed using RNA sequencing (i.e., RNA-seq sample, n = 244) and microarray (i.e., microarray sample; n = 256) technologies. Pathway perturbations were assessed using pathway impact analysis. Fisher’s combined probability method was used to combine test results using a false discovery rate of 0.01.ResultsIn the RNA-seq sample, 62.3% and 37.7% of the patients were in the low- and high-anxiety classes, respectively. In the microarray sample, 61.3% and 38.7% were in the low and high-anxiety classes, respectively. Forty-one perturbed signaling pathways were identified. Eight of these pathways were common to those identified in the network pharmacology studies.ConclusionsFindings increase our knowledge of the molecular mechanisms that underlie anxiety in patients receiving chemotherapy. This study provides initial insights into how anxiety in patients with cancer may share common mechanisms with anxiety in patients with other clinical conditions.

Effect of virtual mind-body fitness program on reduction in unplanned hospitalizations among patients undergoing active cancer treatments: A pragmatic randomized clinical trial.

473 Background: Despite the inclusion of mind-body approaches, such as yoga, meditation, exercise, and music therapy, into various clinical guidelines for managing cancer-related symptoms, there is no scalable approach to integrate these guidelines into oncology care delivery. This study aimed to evaluate the effectiveness of Integrative Medicine at Home (IM@Home), a virtual mind-body fitness program, on unplanned hospitalizations and urgent care visits among patients undergoing active cancer treatment. Methods: We conducted a pragmatic randomized clinical trial using a novel basket study design among patients with a diagnosis of breast, thoracic, gynecological, head/neck, or melanoma cancer who reported moderate or greater fatigue while receiving active cancer treatment. Eligible participants were randomized to IM@Home (choice of 20+ weekly virtual live mind-body and fitness classes) or enhanced usual care (EUC; standard of care plus access to 20+ pre-recorded online meditation resources) and were on the study for 12 weeks. Utilization of hospital services over the study period was collected from electronic medical records and compared between arms. Results: Among 200 patients (mean age 59.9 years) 181 (90.5%) were female, 155 (77.5%) white, 18 (9.0%) Black, 14 (7.0%) Asian, and 178 (89.0%) non-Hispanic. 73 (36.5%) patients had breast, 49 (24.5%) thoracic, 43 (21.5%) gynecological, 25 (12.5%) head/neck, and 10 (5.0%) melanoma cancer. 99 patients were randomized to IM@Home and 101 to EUC. During the study period, patients in the IM@Home group were less likely to be hospitalized (5 [5.1%] vs. 14 [13.9%], p=0.034) and spent fewer days in the hospital (5.4 vs. 9.4 days per patient, p=0.009). The proportion of patients with urgent care visits was similar between the study arms (9 [9.1%] IM@Home vs. 12 [11.9%] EUC, p=0.52), but the number of urgent care visits per patients was almost half in IM@Home vs. in the EUC arm (rate ratio=0.52, 95% confidence interval: 0.26, 0.98). Conclusions: Participation in the virtual IM@Home program reduced unplanned hospitalizations, number of hospitalization days, and urgent care visits among people with cancer undergoing active treatment. Future research with long term follow-up is needed to determine whether IM@Home may be a scalable solution for implementing evidence-based mind-body fitness programing to improve patient survival outcomes and reduce health care costs. Clinical trial information: NCT05053230 .

Describing Self-Advocacy in Underrepresented Women With Advanced Cancer.

To describe the self-advocacy experiences of women from underrepresented groups who have advanced breast or gynecologic cancer. To be eligible for the study, participants had to self-identify as vulnerable, which was defined as a member of a group considered at risk for poor cancer outcomes and underrepresented in clinical research. This descriptive, longitudinal, qualitative study consisted of one-on-one interviews of women within three months of an advanced breast or gynecologic cancer diagnosis. 10 participants completed 25 interviews. The average age of participants was 60.2 years (range = 38-75 years). Three major themes emerged: (a) speaking up and speaking out, (b) interacting with the healthcare team, and (c) relying on support from others. Women with advanced cancer who are from underrepresented groups self-advocated in unique ways, learning over time the importance of how to communicate their needs and manage their healthcare team. Future research should incorporate these findings into tailored self-advocacy interventions.