An exploration of symptom burden among breast and gynaecological cancer patients accessing care at University of Ilorin teaching hospital, Ilorin, Kwara State, Nigeria

Background: Breast and gynaecological cancers are the leading causes of cancer morbidity and mortality among women in developing countries. Advanced stage diseases with limited availability for treatment imply significant symptom burden; the relief of which poses a challenge for the health care providers. Aim: This study was conducted to measure symptom burden and relief among breast and gynaecological cancer patients accessing care in a tertiary health institution in Nigeria. Objectives : 1)To determine the prevalence of symptoms among breast cancer and gynaecological cancer patients accessing care in UITH, Ilorin; 2) To determine the most distressing symptoms experienced by breast and gynaecological cancer patients accessing care in UITH, Ilorin and 3) To assess symptom relief in the two studied groups. Methods: Both inpatients and outpatients with breast and gynaecologic cancers accessing care during the study period were recruited. All patients completed an interviewer administered MSAS-SF which assesses a 7-day prevalence and distress/frequency of 32 physical/psychological symptoms. Symptom relief was assessed 7 days later. Demographics, cancer stages, treatments received and palliative care referrals were obtained from the case notes. Karnofsky Performance Status Scale was used to assess functional status. Results: Fifty breast and 49 gynaecological cancer patients were studied. Eighty percent of breast cancer and 91.9% of gynaecological cancer patients had advanced cancer. The overall mean number of symptoms was 5.8 ± 4.5 for breast cancer while gynaecological cancers had 8.1 ± 4.6. The top 5 symptoms in breast cancer patients were pain (62%), worrying (44%), feeling sad (42%), weight loss (40%) and difficulty sleeping (38%). Gynaecological cancers had weight loss (67.3%), pain (65.3%), worrying (53.1%), feeling sad (51.0%) and lack of energy (46.9%) as the top 5. The most distressing symptoms were cancer-site specific such as fungating breast masses in breast cancer patients and vaginal bleeding/discharges in gynaecological cancer patients. Both groups similarly had pain and "don't look like myself" as most distressing too. Symptoms reliefs were poor and comparable between the two groups and palliative care referrals were also generally low but worse among breast cancer patients. Gynaecological cancer patients had higher Global Distress Index (GDI= 0.88 Vs 0.48), were more physically distressed (MSAS-PHYS= 0.67 Vs 0.40) and had a poorer KPS (77 ± 17.41 Vs 85 ± 16.91) compared to breast cancer patients. Conclusions: This study shows higher symptom burden in gynaecological cancer patients, a comparably poor symptom relief in both groups and poorer palliative care referrals among breast cancer than the gynaecologic cancer patients. Gynaecological cancer patients had higher symptom prevalence and higher symptom distress scores and lower performance status compared to the breast cancer patients

Cervical cancer screening : an update

In many countries cervical cancer is the commonest gynaecological cancer. In Malta and in the United States, it is the third most common gynaecological cancer. Countries which introduced organised cervical screening programmes saw a dramatic decrease in incidence and mortality from this cancer.1 In Malta however, its incidence and mortality has remained relatively constant in the last few decades, in keeping with the fact that we lack a national organised call and re-call cervical screening programme.2 Our cervical screening is largely opportunistic and most of it is carried out in the private sector. Although incidence and mortality has not decreased, our present imperfect screening must however have prevented a significant rise in incidence and mortality, because the detection (and treatment) of premalignant cervical lesions has risen over recent decades, in keeping with increased sexual promiscuity.peer-reviewe

Impact of Multiple COVID-19 Waves on Gynaecological Cancer Services in the UK

Funding: This research was funded by the British Gynaecological Cancer Society (EMSG1L5R) and Ovacome charity. It is supported by the National Cancer Research Institute Gynaecological Cancer Clinical Studies Group and the British Association of Gynaecological Pathologists. The funding bodies had no role in the study design, data collection, analysis, interpretation or writing of the report, or decision to submit for publication. The research team was independent of funders. Acknowledgments: The study is supported by researchers at the Barts Cancer Research United Kingdom Centre for Excellence, Queen Mary University of London (C16420/A18066). We are grateful for the endorsement and support from charities and patient support groups such as Ovacome, The Eve Appeal, Target Ovarian Cancer, Ovarian Cancer Action, Jo’s Cervical Cancer Trust, and GO Girls. We are grateful for the support received from the Royal College of Obstetricians and Gynaecologists, the National Cancer Research Institute Gynaecological Cancer Clinical Studies Group, and the British Association of Gynaecological Pathologists.Peer reviewedPublisher PD

Study of sociodemographic profile and pattern of gynaecological malignancies in a tertiary care center

Background: Gynaecological malignancies are second most common cancer of females after cancer breast. Carcinoma cervix is the commonest gynaecological malignancy in developing countries while in developed countries, ovarian cancer is the commonest gynaecological malignancy. Appropriate screening and timely diagnosis can save many lives. The objective of this study was to study socio-demographic profile of patients presenting with gynaecological malignancy. And to study presenting symptoms and pattern of gynaecological malignancies in themMethods: It was a retrospective record based study from December 2011 to December 2015. Various parameters from Case records of patients with gynaecological malignancies who visited outpatient department of unit IV were retrieved and analysis done.Results: In our study, most of the patients (30.52%) belonged to age group of 51-60 years, were multiparous (94.21%), Illiterate (67.3%) and belonged to rural background (65.28%). Most of the patients of cancer cervix had their presenting complaint as post-menopausal bleeding (48.38%), followed by excessive white discharge (33.87%). Majority of patients (65.26%) had cancer cervix, were in FIGO stage II .Commonest histopathological type was squamous cell carcinoma.Conclusions: Most common gynaecological malignancy in India is carcinoma cervix. Proper screening and timely diagnosis can save many lives

Non‑pregnancy related gynaecological causes of death in a Nigerian Tertiary Hospital

Background: Most gynaecological causes of death are related to pregnancy such as ectopic pregnancy, unsafe abortion, septic incomplete abortion, and gestational trophoblastic diseases. Hence, it was necessary to review the non‑pregnancy related causes of gynaecological deaths in our centre.Aims and Objectives: The aim of this study was to review gynaecological deaths due to non‑pregnancy related causes among women in our centre at the University of Calabar Teaching Hospital (UCTH).Materials and Methods: This was a 5‑year retrospective review of case notes of women who died in the gynaecological ward of UCTH. The demographic profile of the women, the diagnosis and the cause of death were extracted for analysis. All those whose diagnoses were pregnancy related were excluded.Results: There were 38 gynaecological deaths, which were not pregnancy related. Of these, ovarian cancer (19) and cervical cancer (11) constituted 30 cases or 78.9% of causes of death. Endometrial cancer (3), uterovaginal prolapse (3), uterine leiomyosarcoma (1), and vulvovaginal cancer (1) constituted 8 cases or 21.1% of deaths. No deaths were recorded from uterine fibroids, dysfunctional uterine bleeding, pelvic inflammatory disease, etc.,Conclusion: Cancers constitute the majority of causes of gynaecological deaths in women who are not pregnant. This emphasises the need for cancer prevention, early diagnosis and effective treatment.Keywords: Death; gynaecological disease; non‑pregnant women; University of Calabar Teaching Hospita

Review of gynaecological cancer among Aboriginal and/or Torres Strait Islander people in Australia

Gynaecological cancers bear a significant burden on the health of Australians. Whilst Australia has made great strides in reducing the overall gynaecological cancer burden nationally, Aboriginal and/or Torres Strait Islander women continue to experience disproportionately high rates of gynaecological cancers. This review focuses on the social, cultural, and historical contexts that contribute to inequitable gynaecological cancer rates among Aboriginal and/or Torres Strait Islander women. An in-depth discussion on cervical cancer, ovarian cancer, and uterine cancer are described; including the incidence, mortality, survival, and management of these diseases for Aboriginal and/or Torres Strait Islander women. It highlights both the persistent barriers and facilitators relating to Aboriginal and/or Torres Strait Islander women’s uptake of preventative measures and treatments, including their use of services and programs relating to the management of gynaecological cancers. This review summarises past and current policies and strategies implemented by the Australian Government and other cancer related peak bodies that aim to address this health issue. It recommends that critical attention be given to risk reduction, participation in cancer screening programs, and improved access to culturally appropriate, high quality primary health care and tertiary specialist services. This would address inequitable differences faced by Aboriginal and/or Torres Strait Islander people and reduce the overall burden of gynaecological cancers

Summary of gynaecological cancer among Aboriginal and/or Torres Strait Islander people in Australia

This publication, in plain language, is based on information presented in the Review of gynaecological cancer among Aboriginal and/or Torres Strait Islander people in Australia (2023). This short, visual report summarises the key findings and concepts from the review to provide a holistic picture of gynaecological cancer among Aboriginal and/or Torres Strait Islander women. It is a quick source of information covering: the social, cultural and historical contexts that contribute to inequitable gynaecological cancer rates among Aboriginal and/or Torres Strait Islander women the extent of gynaecological cancer, specifically cervical cancer, ovarian cancer and uterine cancer, including the incidence, mortality, survival and burden of disease the management of these diseases for Aboriginal and/or Torres Strait Islander women past and current policies and strategies implemented by the Australian Government and other cancer related peak bodies (including international organisations) that aim to address this health issue. It recommends that critical attention be given to risk reduction, participation in cancer screening programs, and improved access to culturally appropriate, high quality primary health care and tertiary specialist services. This would address inequitable differences faced by Aboriginal and/or Torres Strait Islander people and reduce the overall burden of gynaecological cancers

Evaluating PET-CT in the detection and management of recurrent cervical cancer: Systematic reviews of diagnostic accuracy and subjective elicitation

Background: Positron emission tomography-computed tomography (PET-CT) is recommended to triage women for exenterative surgery and surveillance after treatment for advanced cervical cancer. Objective: To evaluate diagnostic accuracy of additional whole body PET-CT compared with CT/magnetic resonance imaging (MRI) alone in women with suspected recurrent/persistent cervical cancer and in asymptomatic women as surveillance. Design: Systematic reviews. Subjective elicitation to supplement diagnostic information. Search strategy/Selection criteria/Data collection and analysis: Searches of electronic databases were performed to June 2013. Studies in women with suspected recurrent/persistent cervical cancer and in asymptomatic women undergoing follow up with sufficient numeric data were included. We calculated sensitivity, specificity and corresponding 95% confidence intervals. Meta-analyses employed a bivariate model that included a random-effects term for between-study variations (CT studies) and univariate random effects meta-analyses (PET-CT studies) for sensitivity and specificity separately. Subjective elicitation: Prevalence of recurrence and the accuracy of imaging elicited using the allocation of points technique. Coherence of elicited subjective probabilities with estimates in the literature examined. Results: We identified 15 relevant studies; none directly compared additional PET-CT with MRI or CT separately. Most CT and MRI studies used older protocols and the majority did not distinguish between asymptomatic and symptomatic women. Meta-analysis of nine PET-CT studies in mostly symptomatic women showed sensitivity of 94.8 (95% CI 91.2-96.9), and specificity of 86.9% (95% CI 82.2-90.5). The summary estimate of the sensitivity of CT for detection of recurrence was 89.64% (95% CI 81.59-94.41) and specificity was 76% (95% CI 43.68-92.82). Meta-analysis for MRI test accuracy studies was not possible because of clinical heterogeneity. The sensitivity and specificity of MRI in pelvic recurrence varied between 82 and 100% and between 78 and 100%, respectively. Formal statistical comparisons of the accuracy of index tests were not possible. Subjective elicitation provided estimates comparable to the literature. Subjective estimates of the increase in accuracy from the addition of PET-CT were less than elicited increases required to justify the use in PET-CT for surveillance. Conclusion: Evidence to support additional PET-CT is scarce, of average quality and does not distinguish between application for surveillance and diagnosis. Guidelines recommending PET-CT in recurrent cervical cancer need to be reconsidered in the light of the existing evidence base

The prevalence and risk factors of major depressive disorders in gynaecological cancer patients

Major Depressive Disorder (MDD) in gynaecological cancer patients is a disabling illness with significant mental and physical suffering. Determining the risk factors of MDD in cancer patients enables us to pay more attention to those who are vulnerable and to device effective strategies for prevention, early detection, and treatment. The objective of the study is to determine the prevalence of MDD and its associated risk factors in gynaecological cancer patients at Hospital Sultanah Bahiyah, Alor Star. This is a hospital-based cross-sectional descriptive study of 120 gynaecological cancer patients in Gynae-Oncology Unit in Hospital Sultanah Bahiyah, Alor Star. Mini International Neuropsychiatry Interview (MINI) was used for diagnosis of MDD. Socio-demographic data and clinical variables were collected. MVFSFI (Malay version Female Sexual Function Index) was used to determine sexual dysfunction, and WHOQOL-BREF (World Health Organization – Quality of Life-26) was performed to assess quality of life. The prevalence of MDD in gynaecological cancer patients in the study was 18%. The variables found to be significantly associated with MDD were lack of perceived social support, greater physical pain perception, presence of past psychiatric history, and poorer quality of life. Meanwhile, sexual dysfunction was not associated with MDD. Logistic regression analysis revealed that only the psychological health domain of QOL was significantly associated with MDD, and contributed to 60% of the variation in MDD. The prevalence of MDD in gynaecological cancer patients is higher than those in the general population. In view that MDD can compromise cancer prognosis and patient’s well-being, psychosocial intervention is recommended as a part of multi- disciplinary and comprehensive management of gynaecological cancer

Cellular landscaping of COVID-19 and gynaecological cancers: An infrequent correlation

COVID-19 resulted in a mortality rate of 3-6% caused by SARS-CoV-2 and its variant leading to unprecedented consequences of acute respiratory distress septic shock and multiorgan failure. In such a situation, evaluation, diagnosis, treatment, and care for cancer patients are difficult tasks faced by medical staff. Moreover, patients with gynaecological cancer appear to be more prone to severe infection and mortality from COVID-19 due to immunosuppression by chemotherapy and coexisting medical disorders. To deal with such a circumtances oncologists have been obliged to reconsider the entire diagnostic, treatment, and management approach. This review will provide and discuss the molecular link with gynaecological cancer under COVID-19 infection, providing a novel bilateral relationship between the two infections. Moreover, the authors have provided insights to discuss the pathobiology of COVID-19 in gynaecological cancer and their risks associated with such comorbidity. Furthermore, we have depicted the overall impact of host immunity along with guidelines for the treatment of patients with gynaecological cancer under COVID-19 infection. We have also discussed the feasible scope for the management of COVID-19 and gynaecological cancer