Prevalence and Predictors of Anxiety and Depression among Gynaecological Cancer Patients at a Tertiary Health Facility in Southern Nigeria

Background: Cancer patients frequently suffer from mental health problems because of their reactions to their cancer diagnosis, cancer type, treatment effects, recurrence, fear of the end-of-life, survival, and financial burden. Some hospitals have integrated mental health assessments into cancer care, but our centre has little experience with this practice. Aim and Objectives: To ascertain the prevalence and predictors of anxiety and depression in patients with gynaecological cancer at a tertiary health facility in southern Nigeria. Materials and Methods: This was a facility-based cross-sectional descriptive study of 75 women with histologically confirmed gynaecological cancer managed at the University of Port Harcourt Teaching Hospital, Port Harcourt, from January 1, 2022, to December 31, 2022. Individuals having a history of drug addiction, severe cognitive impairment, non-consenting patients, and those with communication difficulties were excluded from the study. A data collection form was used to obtain socio-demographic, reproductive, and clinical characteristics, while the Hospital Anxiety and Depression Scale (HADS) was used to assess for anxiety and depression. Data was analyzed using descriptive statistics to determine the association of variables with anxiety and depression. Results: Most 27 (36.0%) of the respondents were in 40 - 49 age group with a mean age of 50.4 ± 12.3 years. The study showed that 39 (52.0%) of the respondents exhibited symptoms of anxiety, of which 14 (35.9%) were mild, 20 (51.3%) had moderate anxiety and 5 (12.8%) experienced severe anxiety. In addition, 46 (61.3%) of them showed symptoms of depression, of which 17 (37.0%) were mild, 15 (32.6%) were moderate and 14 (30.4%) experienced severe depression. The ratio of respondents who showed anxiety to those that showed symptoms of depression was 5: 6. The factors associated with anxiety were partner’s educational level (X2 = 4.745, p = 0.029), parity (X2 = 6.651, p = 0.036) and duration of diagnosis (X2 = 8.321, p = 0.004), while partner’s educational level (X2 = 6.810, p = 0.009), parity (X2 = 7.129, p = 0.028), age of coitarche (X2 = 6.512, p = 0.039) and duration of diagnosis (X2 = 4.955, p = 0.026) were significantly associated with depression. Conclusion: More than half of the respondents experienced anxiety, while about two-thirds experienced depression. There is a need to incorporate psychological evaluation into the care of gynaecological cancer patients.

Burden of gynaecological cancers in developing countries

Approximately 1：4 of all cancers in women in develop-ing countries （excluding non-melanoma skin cancer） is a gynaecological cancer. The gynaecological cancer burden in developing countries is huge primarily due to the high incidence and mortality of cervical cancer. Cervical cancer accounts for over 60% of the gynaeco-logical cancer burden in developing countries despite being preventable by current technologies. This is due to the absence of effective nationally organized screening programmes in most developing countries. Institution of such programmes, therefore, has the potential to dramatically reduce gynaecological cancer burden in these countries. Subsidized human papil-loma virus （HPV） vaccine and HPV typing as well as cheap screening techniques such as visual inspection aided with acetic acid hold the key to effective preven-tion of cervical cancer in these countries. This is be-cause a signifcant proportion of patients in developing countries are unable to access and avail themselves of the few available preventive, diagnostic and treatment services because of poverty. Although, advocacy and the political will to invest in the development of human resources and healthcare infrastructure appear criti-cal to gynaecological cancer control and reducing the burden of disease in many developing countries, the proposition assumes that resources are truly available for this investment. This may not be true. Many devel-oping countries rely on foreign aids for developmental programmes and these aids have dwindled signifcantly with the current global economic meltdown.

Epidemiology and Clinical Signs of Gynecological Cancers in an African Country South of the Sahara: Case of the Republic of Benin in 2022

Introduction: Gynaecological cancers are the deadliest of the women’s cancers in the Republic of Benin. Late diagnosis is the most common reason. Objective: This paper aims to describe the epidemiological characteristics, and clinical and pathological signs of gynaecological cancers treated in the Republic of Benin between 2018 and 2022. Patients and Methods: This was a cross-sectional, descriptive, retrospectively collected study of patient data treated between 2018 and 2022 in two university gynaecology departments in Cotonou. All gynaecological cancers that have histological evidence were included. The epidemiological, clinical and pathological characteristics of the cancers were assessed. Results: Cervical, endometrial and ovarian cancers were the most common in the proportions of 62.0%, 24.1%, 12.0% and 1.8% respectively. The mean age at diagnosis was 54 years. The victims were uneducated and had low economic power in 81% and 85% of cases, respectively. The consultation was late in 82.1% of cases. Metrorrhagia, postmenopausal metrorrhagia and pelvic cluster headache were the common reasons for consultation for cervical, endometrial and ovarian cancer, respectively. Diagnosis was late in 66.7% (n = 71). The most common histological types were squamous cell carcinoma, endometrioid adenocarcinoma, and serous cystadenocarcinoma for cervical, endometrial, and ovarian cancers, respectively. Conclusion: Gynaecological cancers were common and their consultation time was delayed. The diagnosis was made at the advanced stage and there were several reasons for this.

Associated with Knowledge, Attitude, Practice of Women of Childbearing Age towards Gynecological and Breast Cancer in Glazoue, Benin in 2021

Introduction: Gynaecological and breast cancers (GBC) are the most frequent and most serious cancers of women. They are frequent in Benin with an average of 108.5 cases per year. Objective: To identify factors associated with women’s knowledge, attitudes and practices regarding GBC. Methods: This was a cross-sectional, prospective, descriptive and analytical study. Women of childbearing age residing in the commune of Glazoué in Benin for at least six months were included. The WHO cluster sampling technique was used. The Bruno De Finetti postulate and the Likert scale were used to study women’s knowledge, attitudes and practices. Data were collected and analysed using Epi Data 3.1 and Epi info 7.2.2.6 software. Results: A total of 540 women were registered. The mean age was 27.1 ± 8.84 years with extremes of 15 and 49 years. They were married (61.1%), had secondary education (40.2%) and lived in urban areas (61.9%). They had a low level of knowledge (75.4%), an adapted attitude (93.0%) and poor practice (88.9%). Occupation (p = 0.000), level of education (p = 0.007) and place of residence (p = 0.001) significantly influenced knowledge of GBC. The attitude was adequate (93%) and the practice was poor (88.9%). Inappropriate attitude was significantly associated with the level of education (p = 0.006). Conclusion: Women in the commune of Glazoué in Benin have a low level of knowledge of GBC with an adapted attitude and poor practice. Several factors are associated, hence the need to take them into account to facilitate GBC screening.

Evolution of radical hysterectomy for cervical cancer along the last two decades: single institution experience

Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas. Our aim was to describe the historical evolution of the technique after the introduction of laparoseopy at our institution. Methods： We performed a retrospective review of medical records of patients who underwent RH, grouped in three periods according to the year of surgery： 1990-1999, 2000-2009 and 2010-2013. Patients＇ characteristics, pathologic details, intraoperative and postoperative complications were analyzed and comoared throughout the time periods. Results： A total of 102 cases of RH were performed at our center during the study period. Among all data collected, the presence of necrosis, age, number of lymph nodes, surgery route, operating time, hospital stay, blood loss and transfusion requirement were statistically significant different among groups. Conversion to laparotomy rate was 19% for the second period compared to the absence of cases in the last one. No significant differences （P=0.124） were observed in the adjuvant treatment received among the three different groups. At the time of the last contact the patients free of disease were 12 （85.7%）, 53 （91.3%） and 26 （86.6%） respectively （P=0.406）. Regarding the disease-free interval, we found significant better outcomes in the group of laparotomy compared to laparoscopy （P=0.015）.Conclusions： Laparoscopic RH is an acceptable surgery with advantages like magnified vision of the operation＇s field, lower surgical complications, shorter hospital stay and earlier resumption to daily activities.

Cancer in Women and Its Relation to Work Systematic Review

Nowadays, cancer is one of the main worldwide causes of death and an increasing issue in public health. In the European Union, it is the first work-related cause of death. Studies about occupational risk exposure are a useful field of investigation to determine cancerous elements;special attention is paid to the relationship between cancer and work in women, who must constantly adapt to the working market and the new working fields, with their diverse degrees of exposure to risks. This revision has reviewed the bibliography gathered in Medline related to breast cancer, cervix cancer, uterus cancer, and ovarian cancer, along with their relationship with different work-related risks and types of working roles. The results have shown enough scientific evidence to suspect that work related exposition could be a plausible cause of these gynaecological cancers. Therefore, we want to stress the need of enhancing the coordinated investigation between all the medical specialties involved, and to encourage the spread of the necessary knowledge to manage and prevent them.

Effectiveness of Relaxation Breathing Exercise on fatigue in gynecological cancer patients undergoing chemotherapy

Purpose:This study aimed to determine the effectiveness of Relaxation Breathing Exercise(RBE)on fatigue in patients with gynaecological cancer undergoing chemotherapy.Methods:We used a quasi-experiment with pre-and post-test design.Forty-two patients were consecutively sampled,21 of whom were assigned to the group receiving RBE four times a day and 21 to the group receiving RBE twice a day.Fatigue scores were measured every day for 7 days for both groups using the Piper Fatigue Scale.Data obtained were analysed using repeated-ANOVA and independent ttest with a significant level of a<0.01.Results:We found a significant decrease(P<0.01)in the mean fatigue scores of both groups(four times RBE in a day group=3.29±0.59 and twice RBE in a day group=4.19±0.61)after the completion of the intervention.However,the four times RBE a day group showed larger decrease on fatigue scores than the twice RBE a day group did(Mean Difference=0.91;99%CI=0.41 to 1.41;P=0.001).Conclusion:Conducting RBE four times a day effectively alleviated fatigue better than RBE twice a day on gynaecological cancer patients undergoing chemotherapy.

Spontaneous Regression of Clear Cell Carcinoma of the Endometrium

This report documents a rare case of complete spontaneous regression of clear cell carcinoma of the endometrium. An elderly woman with paranoid schizophrenia was admitted to the hospital because of vaginal bleeding. Diagnostic curetting and biopsy were performed and she was diagnosed with clear cell carcinoma of endometrium. Anti-tumour therapy was not possible because of her poor psychiatric status. 13 months later the woman died of a natural cause and at autopsy the endometrial tumour could no longer be identified. Myocardial infarction, aggravated by poor functional status of organism due to sepsis, was concluded to be the cause of death.