Fertility preservation in patients with gynecologic cancer

In this editorial we comment on the article by Gu et al.We focus and debate the necessity of fertility sparing surgery in young women’s with gynecologic cancers,specifically on those patients with the desire to conceive.This type of individu-alized treatment options is often very difficult,due to the risk of disease evolution and multiple disparities in fertility preservation services among women in di-fferent countries and societies.For this reason national policy interventions are mandatory in order to ensure equitable access this procedures,in women with cancer.

Supportive care needs of women with gynecologic cancer and factors affecting in Turkiye: a cross sectional study

Background:Identifying and managing patients'supportive care needs is an essential component of health care.The cancer patients'needs are multidimensional and it is important to identify these needs.This study was conducted to assess supportive care needs of women with gynecologic cancer and affecting factors.Methods:This cross-sectional study consisted of 98 women with gynecologic cancer.The data of the study was gathered using“Personal Information Form”and the“James Supportive Care Screening”.Results:The most frequently reported unmet needs of gynecologic cancer patients were emotional issues,including uncertainty(87.6%),fears(85.7%),feeling down(86.7%),worry(87.6%),loss of interest in usual activities(73.3%)and physical symptoms including fatigue/lack of energy(81.9%),weakness(81.9%),lack of appetite(76.2%).The most frequently reported social/practical problems was transportation problems(50%).The mean scores for JSCS was 29.72±15.57.There were a statistically significant difference was found only between family type,stage of the disease,and time of diagnosis,and the total mean scores of the JSCS(p<0.05).Conclusion:It has been determined that patients with gynecological cancer mostly experience emotional and physical problems.Health professionals working in the oncology unit should be aware of unmet needs.Certain programs and services to address the identified unmet needs should be provided.

EVALUATION ON QUALITY OF LIFE FOR GYNECOLOGIC CANCER PATIENTS

Objective: To compare the quality of life (QOL) for gynecologic cancer patients with different cancer sites and to assess the impact of patients’ characteristics, disease parameters, and treatments on the subscale and overall QOL. Methods: A prospective study was conducted including 146 gynecologic cancer patients. QOL data were collected using the general Functional Assessment of Cancer Therapy (FACT- G) QOL questionnaire. Results: Advanced stage patients showed significantly poor physical well-being, emotional well-being, and functional well-being, as compared with early stage patients. QOL was reported higher in older patients (P=0.03), patients above high school education (P=0.004), and patients with help at home (P=0.009). Conclusion: Patients with later stage, multi- modality therapy, poor education, and little social support have the most significant impairments and need more support.

Care of survivors of gynecologic cancers

The number of cancer survivors is increasing and most healthcare providers will manage patients who have completed therapy for malignancy at some point. The care of survivors of gynecologic malignancies may seem daunting in a busy general gynecology practice. This paper intends to review the literature and suggest management of these women for the general gynecologist.

Impact of gynecological cancers on women’s mental health

Gynecological cancers and their treatments are associated with both specific and non-specific long-term physiological effects.Cancer patients face transformations in their lifestyle,body image,role,and social interactions and suffer from physical,psychological,and economic problems.The mental health of cancer patients is of great importance and requires special attention,as growing evidence demonstrates its influence not only on quality of life but also on treatment com-pliance.Gynecological cancers have peculiar psychological consequences,which are linked to the specificity of the site of the neoplasia.Clinicians should be aware of the importance of protecting the psychophysical health of these patients and the fact that their physical health and quality of life also depend on the quality of their mental health.It is possible to structure targeted and effective prevention interventions and treatments to reduce psychological distress and improve the quality of life of subjects living with gynecological cancers.

Effects of relaxation breathing exercise on fatigue and cortisol level among Indonesian gynecological cancer patients undergoing chemotherapy:a pilot study

Objective:This study aimed to determine the effect of the relaxation breathing exercise(RBE)on fatigue and cortisol levels among Indonesian women with gynecological cancer undergoing chemotherapy.Methods:This pilot study consecutively recruited 44 gynecological cancer patients to receive RBE(22)or usual care(22).Cortisol level was measured before and after completion of the intervention(day 8).Fatigue was measured using the Piper Fatigue Scale(PFS).Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale(HADS)at the baseline days of the study for days 1,4,and 8.The obtained data were analyzed using Fisher’s exact test,the independent t-test,and the Mann-Whitney U test.Results:There were significant increases in cortisol levels within the groups,either the intervention or control groups,respectively(P-value=0.0003 and 0.001).Despite there being no statistical significance between the intervention and control groups,there were noticeable differences in the cortisol levels,indicating the extreme increase in cortisol levels in the control group(Median[IQR1-IQR3]:2.30[0.99-9.09];Min-Max:0.43-23.38)compared with the intervention group(Median[IQR1-IQR3]=2.97[1.26-5.18];Min-Max=0.39-6.91).Conclusions:RBE helps prevent a significant increase in cortisol levels that can alleviate fatigue for women with gynecological cancer.Further research was recommended to compare several intervention modalities for fatigue and cancer-related symptom management based on cortisol level changes.

Nurses’ Role and Experiences as Group-Leaders in a Group Intervention for Women after Gynecological Cancer

Aim: The aim of this study is to provide insight into nurses’ role and their experiences of leading an education and counselling group intervention for women after gynecological cancer. Methods: A qualitative study, based on focus group interview and logs from nurses who led the intervention, was conducted. Findings: The group leaders were touched by the women’s community and were given a deeper understanding of lived experiences after cancer. These insights raised the group-leaders’ understanding of nursing and influenced them to sharpen focus on patient care and priorities in cancer care and follow-up. Being a group-leader meant creating a trusting and secure atmosphere in which the individual woman’s own coping resources was strengthened and empowered. Equally important, the nurses worked continuously and substantially on themselves to build strength and endurance related to situations that called for competent leadership. Conclusion: Being competent in group leadership and having knowledge in the field of cancer are important qualifications for group leaders. Practice Implications: The study shows that nurses gain valuable insight and knowledge about women’s lived experiences of going through gynecological cancer, cancer treatment and rehabilitation. As such, this intervention seems to be educational for nurses, as well as for participants.

Gynecological malignancies and hormonal therapies: Clinical management and recommendations

Every year in the world a large number of women receive a diagnosis of gynecological cancer and undergo a therapy such as surgery, chemotherapy and radiotherapy to the pelvic region. A large portion of these patients are already in menopause, but for younger patients therapies are responsible of early menopause. The physical and psychological symptoms due to iatrogenic menopause significantly reduce the quality of life; however hormone replacement therapy(HRT) has a high efficacy in reducing menopausal symptoms. The prescription of HRT in patients with story of gynecological cancer is debated because its safety has not been completely proven. The main criticism is based on the theory that the hormone replacement could stimulate growth of residual cancer cells increasing the risk of recurrence.

Effects of COVID-19 fear and anxiety on attitudes towards complementary and alternative medicine use in women with gynecological cancer during the COVID-19 pandemic

Objective:Patients with gynecological cancer commonly use complementary and alternative medicine(CAM)methods to cope with the disease.However,despite the existence of treatment strategies,the effect of fear and anxiety caused by coronavirus disease 2019(COVID-19)pandemic on attitudes about CAM use is unclear.This study was carried out to investigate the effect of fear and anxiety experienced by patients with gynecological cancer during the COVID-19 pandemic on their attitudes towards the use of CAM.Methods:This is a cross-sectional and descriptive study that included 177 women with gynecological cancer;participants were recruited from a social networking site for cancer patients in Turkey between June and December 2021.Data were collected using an online survey that included the Personal Information Form,the Fear of COVID-19 Scale,the Coronavirus Anxiety Scale,and the Attitude Towards Holistic Complementary and Alternative Medicine Scale.Descriptive statistics,t-test,Pearson’s correlation test,and simple linear and multiple regression analyses were performed to analyze the data.Results:During the pandemic,55.4%of the participants reported using CAM methods,but only 22.6%were using CAM before the pandemic.The participants who used CAM during the pandemic also scored higher on the fear of COVID-19 and coronavirus anxiety scales(20.69±5.37 and 13.09±6.29,respectively)compared to the participants who did not use CAM(9.29±2.72 and 6.35±2.06,respectively).Fear of COVID-19 accounted for 52%of the CAM attitude score,while coronavirus anxiety accounted for 15%of the CAM attitude score.Fear of COVID-19 and coronavirus anxiety together accounted for 53%of CAM attitude.Conclusion:Gynecological cancer patients with high levels of COVID-19-related anxiety and fear during the pandemic used CAM more.Given that the psychological effects of the pandemic will continue in the coming years,CAM use should be evaluated as a coping strategy,especially due to the COVID-19-related anxiety and fear experienced by patients with gynecological cancer.While the rational and effective CAM methods should be supported,strategies should be developed to prevent misuse of CAM and its interference in prescribed medical treatments.

Ribavirin in Acute Hepatitis E Infection in Patients with Gynecological Cancer:A Case Series

Hepatitis E virus infection is usually a self-limited disease.However,during the last years there has been growing evidence for prolonged and chronic infection occurring in patients with immunosuppression.Also patients with malig-nant and rheumatic diseases have been identified to be at risk for chronic hepatitis E.However,their course and prognosis are not well characterized and there have been no reports of hepatitis E virus infection in patients with gynecological cancer.Here,we report three Caucasian females with breast and ovarian cancers presenting with elevation of amino-transferase levels during anticancer treatment.Although only few or no clinical hints suggested hepatitis E virus infection,the diagnosis of hepatitis E virus infection was confirmed by seroconversion,which might occur with some delay,and/or by polymerase chain reaction.While two patients had a self-limited course,the third patient with a high-risk oncological constellation required ribavirin in order to resume chemo-therapy.These cases highlight the need for hepatitis E virus testing in patients with gynecological cancer and elevated aminotransferase levels.Further,these cases show that in selected high-risk patients,ribavirin treatment may be nec-essary based on the decision of a multidisciplinary team.

The microbiome and ovarian cancer: insights, implications, and therapeutic opportunities

Ovarian cancer is the leading cause of gynecologic cancer death in the United States.Most ovarian cancer patients are diagnosed with advanced-stage disease,which poses a challenge for early detection and effective treatment.At present,cytoreductive surgery and platinum-based chemotherapy are foundational for patients with newly diagnosed ovarian cancer,but unfortunately,most patients will recur and die of their disease.Therefore,there is a significant need to seek innovative,novel approaches for early detection and to overcome chemoresistance for ovarian cancer patients.The microbiome,comprising diverse microbial communities inhabiting various body sites,is vital in maintaining human health.Changes to the diversity and composition of the microbial communities impact the microbiota-host relationship and are linked to diseases,including cancer.The microbiome contributes to carcinogenesis through various mechanisms,including altered host immune response,modulation of DNA repair,upregulation of pro-inflammatory pathways,altered gene expression,and dysregulated estrogen metabolism.Translational and clinical studies have demonstrated that specific microbes contribute to ovarian cancer development and impact chemotherapy’s efficacy.The microbiome is malleable and can be altered through different approaches,including diet,exercise,medications,and fecal microbiota transplantation.This review provides an overview of the current literature regarding ovarian cancer and the microbiome of female reproductive and gastrointestinal tracts,focusing on mechanisms of carcinogenesis and options for modulating the microbiota for cancer prevention and treatment.Advancing our understanding of the complex relationship between the microbiome and ovarian cancer may provide a novel approach for prevention and therapeutic modulation in the future.