Pelvic floor functional outcomes after total abdominal versus total laparoscopic hysterectomy for endometrial cancer

Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer.To evaluate pelvic floor function in women who have had surgical treatment for early stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium (LACE) trial and to compare patients' outcomes who had total abdominal total versus total laparoscopic hysterectomy.Multinational, phase 3, randomized non-inferiority trial comparing disease-free survival of patients who had total abdominal hysterectomy versus total laparoscopic hysterectomy. This substudy analyses the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory (PFDI)) administered pre-operatively, and at follow-up visits 6, 18, 30, 42, and 54 months post-operatively.Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy n=195; total laparoscopic hysterectomy n=186). At 6-months post-surgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor wellbeing (total abdominal hysterectomy: mean change -11.17, 95% CI: -17.11 to -5.24; total laparoscopic hysterectomy mean change -10.25, 95% CI: -16.31 to -4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months post-surgery.These findings suggest that pelvic floor function in terms of urinary, bowel and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early stage endometrial cancer

Effect of total laparoscopic hysterectomy vs total abdominal hysterectomy on disease-free survival among women with stage I endometrial cancer: A randomized clinical trial

IMPORTANCE Current standard treatment for endometrial cancer involves removal of uterus, adnexa ± lymph nodes. Few randomized trials have compared disease-free survival outcomes for surgical approaches. OBJECTIVE To investigate whether total laparoscopic hysterectomy (TLH) is equivalent to total abdominal hysterectomy (TAH) in women with treatment-naive endometrial cancer. DESIGN, SETTING, AND PARTICIPANTS Multinational, randomized equivalence trial evaluating the laparoscopic approach to endometrial cancer (LACE). Between October 7, 2005 and June 30, 2010, 27 surgeons from 20 tertiary gynaecological cancer centres in Australia, New Zealand, and Hong Kong randomised 760 women with stage I endometrioid endometrial cancer to either TLH or TAH. Follow-up ended 3rd March 2016. INTERVENTIONS 353 patients were randomized to TAH, 407 to TLH. MAIN OUTCOMES AND MEASURES Analysis according to intention-to-treat assessed the primary outcome of disease-free survival (DFS, time interval between surgery and date of first recurrence including any new localized or distant endometrial cancer recurrence or any new cancers, at 4.5 years post-randomization). The pre-specified equivalence boundary was ∆=±7%. Among seven pre-specified secondary outcomes, disease recurrence and overall survival are reported. RESULTS Patients were followed for a median of 4.5 years. Of 760 patients who were randomized (mean age 63 years), 679 (89%) completed the trial. At 4.5 years follow-up, DFS was 81.3% in the TAH and 81.6% in the TLH group. Equivalence was established with a DFS rate difference of 0.3% (favoring TLH) [95% CI: -5.53% to 6.13], p for equivalence =0.007. There was no statistical difference in endometrial cancer recurrences between the two groups (TAH 28 of 353 (7.9%) and TLH 33 of 407 (8.1%), risk difference 0.2%, 95% CI: -3.7 to 4.0%, p=0.93) or in overall survival (TAH 24 of 353 (6.8%) and TLH 30 of 407 (7.4%), risk difference 0.6%, 95% CI: -3.0 to 4.2%, p=0.76). CONCLUSIONS AND RELEVANCE Among women with stage I endometrioid endometrial cancer, the use of TAH compared with TLH resulted in equivalent DFS at 4.5 years and no difference in overall survival was observed. These findings support the use of laparoscopic hysterectomy for stage 1 endometrial cancer

Use, access to, and impact of Medicare services for Australian women: findings from the Australian Longitudinal Study on Women’s Health

This major report from the Australian Longitudinal Study on Women’s Health (also known as Women’s Health Australia) adopts a life course approach to investigate changes in women’s health and health service use change across life stages. Women’s survey data were linked to Medicare Benefits Scheme (MBS) data, enabling analysis of women’s health, health behaviours and social circumstances over time, and how these relate to health care use at different life stages. Using these data, the report provides detailed information on how and when women use health services, and their costs, throughout the women’s life course

Whole brain radiotherapy after local treatment of brain metastases in melanoma patients - a randomised phase III trial

<p>Abstract</p> <p>Background</p> <p>Cerebral metastases are a common cause of death in patients with melanoma. Systemic drug treatment of these metastases is rarely effective, and where possible surgical resection and/or stereotactic radiosurgery (SRS) are the preferred treatment options. Treatment with adjuvant whole brain radiotherapy (WBRT) following neurosurgery and/or SRS is controversial. Proponents of WBRT report prolongation of intracranial control with reduced neurological events and better palliation. Opponents state melanoma is radioresistant; that WBRT yields no survival benefit and may impair neurocognitive function. These opinions are based largely on studies in other tumour types in which assessment of neurocognitive function has been incomplete.</p> <p>Methods/Design</p> <p>This trial is an international, prospective multi-centre, open-label, phase III randomised controlled trial comparing WBRT to observation following local treatment of intracranial melanoma metastases with surgery and/or SRS. Patients aged 18 years or older with 1-3 brain metastases excised and/or stereotactically irradiated and an ECOG status of 0-2 are eligible. Patients with leptomeningeal disease, or who have had previous WBRT or localised treatment for brain metastases are ineligible. WBRT prescription is at least 30 Gy in 10 fractions commenced within 8 weeks of surgery and/or SRS. Randomisation is stratified by the number of cerebral metastases, presence or absence of extracranial disease, treatment centre, sex, radiotherapy dose and patient age. The primary endpoint is the proportion of patients with distant intracranial failure as determined by MRI assessment at 12 months. Secondary end points include: survival, quality of life, performance status and neurocognitive function.</p> <p>Discussion</p> <p>Accrual to previous trials for patients with brain metastases has been difficult, mainly due to referral bias for or against WBRT. This trial should provide the evidence that is currently lacking in treatment decision-making for patients with melanoma brain metastases. The trial is conducted by the Australia and New Zealand Melanoma Trials Group (ANZMTG-study 01-07), and the Trans Tasman Radiation Oncology Group (TROG) but international participation is encouraged. Twelve sites are open to date with 43 patients randomised as of the 31st March 2011. The target accrual is 200 patients.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12607000512426.aspx">ACTRN12607000512426</a></p

Employment Status and Chronic Diseases: A Cross-sectional Study among 60-64 Year-old Men and Women

This study aims to investigate the association between chronic conditions [diabetes, asthma, and arthritis] and current employment status for men and women aged 60 – 64 years old. The study used the baseline data from the NSW 45 and Up Study, restricted to 41,754 participants aged 60 -64 years old. The participants were prioritized into mutually exclusive employment categories – full time employed, part time employed, self-employed, disabled/sick, and not in paid work. The association between current employment status and chronic conditions was evaluated separately for men and women, before and after adjustment for relevant groups of covariates [socio-demographic factors, health risk factors, and health capacity factors]. Current employment was associated with having a chronic disease, specifically diabetes, asthma, or arthritis. Participants who were not in paid work or disabled/sick were more likely to report chronic conditions; while having some form of paid employment was associated with decreased risk of having a chronic condition [diabetes or arthritis]. However, this effect diminished once socio-demographic conditions, health risk factors [smoking, BMI, alcohol] and health capacity factors [SF-36 physical function and needing help for daily tasks] were taken into account. There were significant associations between different employment patterns and chronic diseases [diabetes and arthritis]. Better understanding of these associations and related risk factors could inform policies and guidelines for preventing the decline in employment in males and females of pre-retirement age

Women, work, and illness: a longitudinal analysis of workforce participation patterns for women beyond middle age

Background: Labor policies and economic incentives encourage women to work beyond middle age. However, women exhibit complex patterns of workforce participation over this life stage. This study examined transitions in and out of paid work across the life course of middle-aged women over a 14-year period and investigated associations between work and chronic diseases. Methods: Latent class analysis identified dominant workforce participation patterns among 11,551 middle-aged women from the 1946-1951 birth cohort of Australian Longitudinal Study on Women's Health. Multinomial logistic regression examined associations between work patterns and chronic diseases (diabetes, asthma, depression, and arthritis), while adjusting for health risk factors, sociodemographic factors and competing activities. Results: Five latent classes were identified: "mostly in paid work" (48%), "early paid work" (9.4%), "increasingly paid work" (8.9%), "gradually not in paid work" (11.4%), and "mostly not in paid work" (22.3%). Results showed that women with chronic diseases (diabetes, asthma, depression, and arthritis) were less likely to be in paid work. These associations remained mostly unchanged after adjustments for other factors. Conclusions: The findings of this study provide better understanding of workforce participation patterns in women's late working life. This has important implications for policy design, aimed to engage middle-aged women in paid employment for longer in spite of chronic diseases and their complications. We suggest that there is a need for work place programs that support people with chronic diseases. Policies are also needed to facilitate better prevention and management of chronic health issues over the life course for women, in order to encourage workforce participation over later years

Lower preoperative quality of life increases postoperative risk of adverse events in women with endometrial cancer: Results from the LACE trial

Objective: To examine the association between preoperative quality of life (QoL) and postoperative adverse events in women treated for endometrial cancer. Methods: 760 women with apparent Stage I endometrial cancer were randomised into a clinical trial evaluating laparoscopic versus open surgery. This analysis includes women with preoperative QoL measurements, from the Functional Assessment of Cancer Therapy- General (FACT-G) questionnaire, and who were followed up for at least 6 weeks after surgery (n=684). The outcomes for this study were defined as (1) the occurrence of moderate to severe AEs adverse events within 6 months (Common Toxicology Criteria (CTC) grade ≥3); and (2) any Serious Adverse Event (SAE). The association between preoperative QoL and the occurrence of AE was examined, after controlling for baseline comorbidity and other factors. Results: After adjusting for other factors, odds of occurrence of AE of CTC grade ≥3 were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.00-1.03, p=0.030), which was driven by physical well-being (PWB) (OR=1.09, 95% CI 1.04-1.13, p=0.0002) and functional well-being subscales (FWB) (OR=1.04, 95% CI 1.00-1.07, p=0.035). Similarly, odds of SAE occurrence were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.01-1.04, p=0.011), baseline PWB (OR=1.11, 95% CI 1.06-1.16, p<0.0001) or baseline FWB subscales (OR=1.05, 95% CI 1.01-1.10, p=0.0077). Conclusion: Women with early endometrial cancer presenting with lower QoL prior to surgery are at higher risk of developing a serious adverse event following surgery. Funding: Cancer Council Queensland, Cancer Council New South Wales, Cancer Council Victoria, Cancer Council, Western Australia; NHMRC project grant 456110; Cancer Australia project grant 631523; The Women and Infants Research Foundation, Western Australia; Royal Brisbane and Women’s Hospital Foundation; Wesley Research Institute; Gallipoli Research Foundation; Gynetech; TYCO Healthcare, Australia; Johnson and Johnson Medical, Australia; Hunter New England Centre for Gynaecological Cancer; Genesis Oncology Trust; and Smart Health Research Grant QLD Health