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Gaillard DHK, Lof P, Sistermans EA, Mokveld T, Horlings HM, Mom CH, Reinders MJT, Amant F, van den Broek D, Wessels LFA, Lok CAR. Evaluating the effectiveness of pre-operative diagnosis of ovarian cancer using minimally invasive liquid biopsies by combining serum human epididymis protein 4 and cell-free DNA in patients with an ovarian mass. Int J Gynecol Cancer 2024; 34:713-721. [PMID: 38388177 DOI: 10.1136/ijgc-2023-005073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE To assess the feasibility of scalable, objective, and minimally invasive liquid biopsy-derived biomarkers such as cell-free DNA copy number profiles, human epididymis protein 4 (HE4), and cancer antigen 125 (CA125) for pre-operative risk assessment of early-stage ovarian cancer in a clinically representative and diagnostically challenging population and to compare the performance of these biomarkers with the Risk of Malignancy Index (RMI). METHODS In this case-control study, we included 100 patients with an ovarian mass clinically suspected to be early-stage ovarian cancer. Of these 100 patients, 50 were confirmed to have a malignant mass (cases) and 50 had a benign mass (controls). Using WisecondorX, an algorithm used extensively in non-invasive prenatal testing, we calculated the benign-calibrated copy number profile abnormality score. This score represents how different a sample is from benign controls based on copy number profiles. We combined this score with HE4 serum concentration to separate cases and controls. RESULTS Combining the benign-calibrated copy number profile abnormality score with HE4, we obtained a model with a significantly higher sensitivity (42% vs 0%; p<0.002) at 99% specificity as compared with the RMI that is currently employed in clinical practice. Investigating performance in subgroups, we observed especially large differences in the advanced stage and non-high-grade serous ovarian cancer groups. CONCLUSION This study demonstrates that cell-free DNA can be successfully employed to perform pre-operative risk of malignancy assessment for ovarian masses; however, results warrant validation in a more extensive clinical study.
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Affiliation(s)
- Duco H K Gaillard
- Division of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Delft Bioinformatics Lab, Delft University of Technology, Delft, Netherlands
| | - Pien Lof
- Department of Gynecological Oncology, Center for Gynecologic Oncology Amsterdam, Amsterdam, Netherlands
| | - Erik A Sistermans
- Department of Human Genetics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction & Development, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
| | - Tom Mokveld
- Delft Bioinformatics Lab, Delft University of Technology, Delft, Netherlands
| | - Hugo Mark Horlings
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Constantijne H Mom
- Department of Gynecological Oncology, Center for Gynecologic Oncology Amsterdam, Amsterdam, Netherlands
| | - Marcel J T Reinders
- Delft Bioinformatics Lab, Delft University of Technology, Delft, Netherlands
| | - Frédéric Amant
- Department of Gynecological Oncology, Center for Gynecologic Oncology Amsterdam, Amsterdam, Netherlands
- Division of Gynecologic Oncology, UZ Leuven, Leuven, Belgium
| | - Daan van den Broek
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Lodewyk F A Wessels
- Division of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christianne A R Lok
- Department of Gynecological Oncology, Center for Gynecologic Oncology Amsterdam, Amsterdam, Netherlands
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Hua Y, Cai D, Shirley CA, Mo S, Chen R, Gao F, Chen F. A prognostic model for ovarian neoplasms established by an integrated analysis of 1580 transcriptomic profiles. Sci Rep 2023; 13:19429. [PMID: 37940688 PMCID: PMC10632395 DOI: 10.1038/s41598-023-45410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
Even after debulking surgery combined with chemotherapy or new adjuvant chemotherapy paired with internal surgery, the average year of disease free survival in advanced ovarian cancer was approximately 1.7 years1. The development of a molecular predictor of early recurrence would allow for the identification of ovarian cancer (OC) patients with high risk of relapse. The Ovarian Cancer Disease Free Survival Predictor (ODFSP), a predictive model constructed from a special set of 1580 OC tumors in which gene expression was assessed using both microarray and sequencing platforms, was created by our team. To construct gene expression barcodes that were resistant to biases caused by disparate profiling platforms and batch effects, we employed a meta-analysis methodology that was based on the binary gene pair technique. We demonstrate that ODFSP is a reliable single-sample predictor of early recurrence (1 year or less) using the largest pool of OC transcriptome data sets available to date. The ODFSP model showed significantly high prognostic value for binary recurrence prediction unaffected by clinicopathologic factors, with a meta-estimate of the area under the receiver operating curve of 0.64 (P = 4.6E-05) and a D-index (robust hazard ratio) of 1.67 (P = 9.2E-06), respectively. GO analysis of ODFSP's 2040 gene pairs (collapsed to 886 distinct genes) revealed the involvement in small molecular catabolic process, sulfur compound metabolic process, organic acid catabolic process, sulfur compound biosynthetic process, glycosaminoglycan metabolic process and aminometabolic process. Kyoto encyclopedia of genes and genomes pathway analysis of ODFSP's signature genes identified prominent pathways that included cAMP signaling pathway and FoxO signaling pathway. By identifying individuals who might benefit from a more aggressive treatment plan or enrolment in a clinical trial but who will not benefit from standard surgery or chemotherapy, ODFSP could help with treatment decisions.
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Affiliation(s)
- Yanjiao Hua
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Du Cai
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong Province, China
| | - Cole Andrea Shirley
- Sun Yat-Sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Sien Mo
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Ruyun Chen
- Sun Yat-Sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Feng Gao
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong Province, China
| | - Fangying Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.
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3
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British Gynaecological Cancer Society Recommendations for Evidence Based, Population Data Derived Quality Performance Indicators for Ovarian Cancer. Cancers (Basel) 2023; 15:cancers15020337. [PMID: 36672287 PMCID: PMC9856668 DOI: 10.3390/cancers15020337] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 01/06/2023] Open
Abstract
Ovarian cancer survival in the UK lags behind comparable countries. Results from the ongoing National Ovarian Cancer Audit feasibility pilot (OCAFP) show that approximately 1 in 4 women with advanced ovarian cancer (Stage 2, 3, 4 and unstaged cancer) do not receive any anticancer treatment and only 51% in England receive international standard of care treatment, i.e., the combination of surgery and chemotherapy. The audit has also demonstrated wide variation in the percentage of women receiving anticancer treatment for advanced ovarian cancer, be it surgery or chemotherapy across the 19 geographical regions for organisation of cancer delivery (Cancer Alliances). Receipt of treatment also correlates with survival: 5 year Cancer survival varies from 28.6% to 49.6% across England. Here, we take a systems wide approach encompassing both diagnostic pathways and cancer treatment, derived from the whole cohort of women with ovarian cancer to set out recommendations and quality performance indicators (QPI). A multidisciplinary panel established by the British Gynaecological Cancer Society carefully identified QPI against criteria: metrics selected were those easily evaluable nationally using routinely available data and where there was a clear evidence base to support interventions. These QPI will be valuable to other taxpayer funded systems with national data collection mechanisms and are to our knowledge the only population level data derived standards in ovarian cancer. We also identify interventions for Best practice and Research recommendations.
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Witjes VM, Braspenning JCC, Hoogerbrugge N, Smolders YHCM, Hermkens DMA, Mourits MJE, Ligtenberg MJL, Ausems MGEM, de Hullu JA. Healthcare professionals' perspectives on implementation of universal tumor DNA testing in ovarian cancer patients: multidisciplinary focus groups. Fam Cancer 2023; 22:1-11. [PMID: 35570228 PMCID: PMC9829642 DOI: 10.1007/s10689-022-00294-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/19/2022] [Indexed: 01/13/2023]
Abstract
Universal tumor DNA testing in epithelial ovarian cancer patients can function not only as an efficient prescreen for hereditary cancer testing, but may also guide treatment choices. This innovation, introduced as Tumor-First workflow, offers great opportunities, but ensuring optimal multidisciplinary collaboration is a challenge. We investigated factors that were relevant and important for large-scale implementation. In three multidisciplinary online focus groups, healthcare professionals (gynecologic oncologists, pathologists, clinical geneticists, and clinical laboratory specialists) were interviewed on factors critical for the implementation of the Tumor-First workflow. Recordings were transcribed for analysis in Atlas.ti according to the framework of Flottorp that categorizes seven implementation domains. Healthcare professionals from all disciplines endorse implementation of the Tumor-First workflow, but more detailed standardization and advice regarding the logistics of the workflow were needed. Healthcare professionals explored ways to stay informed about the different phases of the workflow and the results. They emphasized the importance of including all epithelial ovarian cancer patients in the workflow and monitoring this inclusion. Overall, healthcare professionals would appreciate supporting material for the implementation of the Tumor-First workflow in the daily work routine. Focus group discussions have revealed factors for developing a tailored implementation strategy for the Tumor-First workflow in order to optimize care for epithelial ovarian cancer patients. Future innovations affecting multidisciplinary oncology teams including clinical geneticists can benefit from the lessons learned.
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Affiliation(s)
- Vera M. Witjes
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jozé C. C. Braspenning
- grid.10417.330000 0004 0444 9382Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne H. C. M. Smolders
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorien M. A. Hermkens
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marian J. E. Mourits
- grid.4494.d0000 0000 9558 4598Department of Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolijn J. L. Ligtenberg
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Margreet G. E. M. Ausems
- grid.7692.a0000000090126352Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joanne A. de Hullu
- grid.10417.330000 0004 0444 9382Department of Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Manchon-Walsh P, Aliste L, Borràs JM, Coll-Ortega C, Casacuberta J, Casanovas-Guitart C, Clèries M, Cruz S, Guarga À, Mompart A, Planella A, Pozuelo A, Ticó I, Vela E, Prades J. Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148814. [PMID: 35886665 PMCID: PMC9322195 DOI: 10.3390/ijerph19148814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 12/10/2022]
Abstract
The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011–12) and pancreatic cancer (2012–15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients’ homes and their reference centers, clinical patient and treatment data, income category, and data from the patients’ district hospitals. A composite ‘textbook outcome’ was created from five subindicators of hospitalization. We included 646 cases of pancreatic cancer (12 centers) and 1416 of rectal cancer (26 centers). Distance had no impact on survival for pancreatic cancer patients and was not related to worse survival in rectal cancer. Compared to patients with medium–high income, the risk of death was higher in low-income patients with pancreatic cancer (hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.15–1.86) and very-low-income patients with rectal cancer (HR 5.14, 95% CI 3.51–7.52). Centralization was not associated with worse health outcomes in geographically dispersed patients, including for survival. However, income level remained a significant determinant of survival.
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Affiliation(s)
- Paula Manchon-Walsh
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
- Correspondence:
| | - Luisa Aliste
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
| | - Josep M. Borràs
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
| | - Cristina Coll-Ortega
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
| | - Joan Casacuberta
- Cartographic and Geological Institute of Catalonia, Parc de Montjuïc, 08038 Barcelona, Spain; (J.C.); (I.T.)
| | - Cristina Casanovas-Guitart
- Health Service Procurement and Assessment, Catalonian Health Service (CatSalut), Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (C.C.-G.); (À.G.); (A.P.)
| | - Montse Clèries
- Healthcare Information and Knowledge Unit, Department of Health, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain; (M.C.); (E.V.)
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain
| | - Sergi Cruz
- Subdirectorate-General for the Service Portfolio and Health Map, Directorate-General for Health Planning, Department of Health, Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (S.C.); (A.M.); (A.P.)
| | - Àlex Guarga
- Health Service Procurement and Assessment, Catalonian Health Service (CatSalut), Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (C.C.-G.); (À.G.); (A.P.)
| | - Anna Mompart
- Subdirectorate-General for the Service Portfolio and Health Map, Directorate-General for Health Planning, Department of Health, Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (S.C.); (A.M.); (A.P.)
| | - Antoni Planella
- Subdirectorate-General for the Service Portfolio and Health Map, Directorate-General for Health Planning, Department of Health, Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (S.C.); (A.M.); (A.P.)
| | - Alfonso Pozuelo
- Health Service Procurement and Assessment, Catalonian Health Service (CatSalut), Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (C.C.-G.); (À.G.); (A.P.)
| | - Isabel Ticó
- Cartographic and Geological Institute of Catalonia, Parc de Montjuïc, 08038 Barcelona, Spain; (J.C.); (I.T.)
| | - Emili Vela
- Healthcare Information and Knowledge Unit, Department of Health, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain; (M.C.); (E.V.)
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain
| | - Joan Prades
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
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Classe JM, Joly F, Lécuru F, Morice P, Pomel C, Selle F, You B. Prise en charge chirurgicale du cancer épithélial de l'ovaire - première ligne et première rechute: Surgical management of epithelial ovarian cancer - first line and first relapse. Bull Cancer 2021; 108:S13-S21. [PMID: 34955158 DOI: 10.1016/s0007-4551(21)00583-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Based on recently published data, these recommendations present some evolutions in the surgical management of high grade epithelial ovarian cancers. In apparently early stages (FIGO I and II), surgical staging must be undertaken to confirm the absence of both peritoneal lesions and lymph node involvement (that might change stage and management). Neoadjuvant chemotherapy is not indicated, surgical exploration should be performed upfront, by laparotomy, to reduce the risk of rupture of the primary tumor. In advanced stages, the first step is to evaluate the feasibility of primary surgery with complete tumor cytoreduction. If it appears unfeasible, 3 or 4 cycles of neoadjuvant chemotherapy are administered before interval surgey. Whether it is implemented in the primary or interval setting, surgery must be performed by experimented teams, in an approved facility, having developed a rehabilitation program. Lymph node dissection is not mandatory if no adenopathies have been identified by imaging and by peroperative palpation. At first relapse, the surgical decision must be made by a multidisciplinary team, using scores predictive of complete cytoreduction (AGO or iMODEL criteria). Similarly as in first line, the objective is to achieve resection without any residual disease. Surveillance after first-line treatment must be adapted, according to the probability of another complete cytoreduction in case of late relapse, especially in patients who benefited from primary complete surgery and maintained good performance status.
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Affiliation(s)
- Jean-Marc Classe
- Service de chirurgie oncologique, institut de cancérologie de l'Ouest, boulevard Professeur-Jacques-Monod, 44800 Saint-Herblain ; Université de médecine, 1, rue Gaston-Veil, 44000 Nantes, France.
| | - Florence Joly
- Service d'oncologie, centre François-Baclesse, 3, avenue du Général-Harris ; CHU avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Fabrice Lécuru
- Service de gynécologie sénologie, institut Curie, 26, rue d'Ulm, 75015 Paris, France
| | - Philippe Morice
- Service de chirurgie gynécologique, Gustave-Roussy, 14, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Christophe Pomel
- Service de chirurgie générale et oncologique, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - Frédéric Selle
- Service de cancérologie, Centre hospitalier Diaconesses-Croix-Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Benoît You
- Service d'oncologie médicale, hôpital Lyon Sud, 165, chemin du Grand-Revoyet, Lyon, France
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Implementation of National Guidelines increased survival in advanced ovarian cancer - A population-based nationwide SweGCG study. Gynecol Oncol 2021; 161:244-250. [PMID: 33581846 DOI: 10.1016/j.ygyno.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/13/2021] [Indexed: 01/31/2023]
Abstract
AIM The first Swedish National Guidelines for Ovarian Cancer (NGOC) were published in 2012. We aimed to evaluate surgical outcomes and survival in patients with stage IIIC-IV disease, before and after the NGOC implementation. METHOD Women with primary epithelial ovarian cancer, FIGO stage IIIC-IV, registered in the Swedish Quality Registry for Gynecologic Cancer 2008-2011 and 2013-2016 were included. Surgical outcomes were analyzed, including frequency of complete cytoreduction (R0). Relative survival (RS) and excess mortality rate ratios (EMRRs) were computed as measures of survival. Univariable and multivariable regression (Poisson) were calculated. RESULTS In total, 3728 women were identified, 1746 before and 1982 after NGOC. After adjusting for age and stage, survival was improved 2013-2016 vs. 2008-2011 (EMRR 0.89; 95%CI:0.82-0.96, p < 0.05). For women undergoing primary debulking surgery (PDS), R0 frequency (28.9% vs. 53.3%; p < 0.001) and 5-year RS (29.6% (95%CI:26.8-32.8) vs. 37.4% (95%CI:33.6-41.7)) were increased, but fewer patients (58% vs. 44%, p < 0.001) underwent PDS after NGOC implementation. Median survival for the PDS cohort increased from 35 months (95%CI,32.8-39.2) to 43 months (95%CI,40.9-46.4). In the neoadjuvant chemotherapy (NACT) + interval debulking surgery (IDS) cohort, R0 increased (36.8% to 50.1%, p < 0.001), but not 5-year RS (17.5% vs. 20.7%, ns). Compared to PDS, the EMRR was 1.32 (95%CI,1.19-1.47, p < 0.001) for NACT+IDS and 3.00 (95%CI,2.66-3.38, p < 0.001) for chemotherapy alone. In multivariable analyses, PDS, R0, age ≤ 70 years, and stage IIIC were found to be independent factors for improved RS. CONCLUSION Implementation of the first National Guidelines for Ovarian Cancer improved relative survival in advanced ovarian cancer.
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8
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Luijten JCHBM, Vissers PAJ, Lingsma H, van Leeuwen N, Rozema T, Siersema PD, Rosman C, van Laarhoven HWM, Lemmens VEP, Nieuwenhuijzen GAP, Verhoeven RHA. Changes in hospital variation in the probability of receiving treatment with curative intent for esophageal and gastric cancer. Cancer Epidemiol 2021; 71:101897. [PMID: 33484974 DOI: 10.1016/j.canep.2021.101897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies describe a large variation in the proportion of patients undergoing treatment with curative intent for esophageal (EC) and gastric cancer (GC). Since centralization of surgical care was initiated and more awareness regarding hospital practice variation was potentially present, we hypothesized that hospital practice variation for potentially curable EC and GC patients changed over time. METHODS Patients with potentially curable EC (n = 10,115) or GC (n = 3988) diagnosed between 2012-2017 were selected from the Netherlands Cancer Registry. Multilevel multivariable logistic regression was used to analyze the differences in the probability of treatment with curative intent between hospitals of diagnosis over time, comparing 2012-2014 with 2015-2017. Relative survival (RS) between hospitals with different probabilities of treatment with curative intent were compared. RESULTS The range of proportions of patients undergoing treatment with curative intent per hospital of diagnosis for EC was 45-95 % in 2012-2014 and 54-89 % in 2015-2017, and for GC 52-100 % and 45-100 %. The adjusted variation declined for EC with Odds Ratios ranging from 0.50 to 1.72 between centers in the first period to 0.70-1.44 in the second period (p < 0.001) and did not change for GC (Odds Ratios ranging from 0.78 to 1.23 to 0.82-1.23, (p = 1.00)). A higher probability of treatment with curative intent was associated with a better survival for both malignancies. CONCLUSION Although substantial variation between hospitals of diagnosis in the probability in receiving treatment with curative intent still exists for both malignancies, it has decreased for EC. A low probability of receiving curative treatment remained associated with worse survival.
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Affiliation(s)
- Josianne C H B M Luijten
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Pauline A J Vissers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Tom Rozema
- Department of Radiotherapy, Institute Verbeeten, Tilburg, the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Valery E P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Rob H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
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9
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Increased disease-free and relative survival in advanced ovarian cancer after centralized primary treatment. Gynecol Oncol 2020; 159:409-417. [PMID: 32943206 DOI: 10.1016/j.ygyno.2020.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/04/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze 5-year disease-free survival (DFS) and relative survival (RS) before and after the 2011 implementation of centralized primary treatment of patients with advanced ovarian cancer. METHODS A population-based cohort study using the Swedish Quality Registry for Gynecological Cancer (SQRGC). Women with FIGO stage III and IV epithelial ovarian and Fallopian tube cancers were divided into two cohorts: before and after centralization. We estimated RS using the Ederer II method, analyzed the difference in the excess mortality rate ratio (EMRR) and estimated 5-year DFS in a Cox proportional hazard regression model with centralization, age, primary treatment and complete cytoreduction as variables. RESULTS A total of 495 women were identified with 244 women before (2008-2010) and 251 after (2011-2013) centralization. An increased 5-year RS from 24% (95%CI:19-31) to 37% (95%CI:31-44) and an increased median RS from 27 months (95%CI:23-34) to 44 months (95%CI:40-52), p < 0.001 (log-rank), were observed in the total cohort regardless of primary treatment. EMRR was found to be 0.62 (95%CI:0.51-0.76) in 2011-2013 compared to 2008-2010 for all patients. After centralization, 5-year DFS was significantly longer, hazard ratio of 0.77 (95%CI:0.64-0.93) and centralization was found to be an independent significant factor for both survival and DFS. Complete cytoreduction was found to be a significant independent factor associated with increased RS and DFS. CONCLUSION Centralization of primary treatment of advanced ovarian cancer was associated with significantly increased complete cytoreduction, 5-year RS and DFS, and was found to be a significant independent factor for both RS and DFS.
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10
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Ripping TM, Witjes JA, Meijer RP, van Rhijn BWG, Oddens JR, Goossens-Laan CA, Mulder SF, van Moorselaar RJA, Kiemeney LA, Aben KKH. Hospital-specific probability of cystectomy affects survival from muscle-invasive bladder cancer. Urol Oncol 2020; 38:935.e9-935.e16. [PMID: 32917503 DOI: 10.1016/j.urolonc.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/15/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Radical cystectomies (RCs) are increasingly centralized, but bladder cancer can be diagnosed in every hospital The aim of this study is to assess the variation between hospitals of diagnosis in a patient's chance to undergo a RC before and after the volume criteria for RCs, to identify factors associated with this variation and to assess its effect on survival. METHODS AND MATERIALS Patients diagnosed with muscle-invasive bladder cancer (cT2-4a,N0/X,M0/X) without nodal or distant metastases between 2008 and 2016 were identified through the Netherlands Cancer Registry. Multilevel logistic regression analysis was used to investigate the hospital specific probability of undergoing a cystectomy. Cox proportional hazard regression analysis was used to assess the case-mix adjusted effect of hospital-specific probabilities on survival. RESULTS Of the 9,215 included patients, 4,513 (49%) underwent a RC. The percentage of RCs varied between 7% and 83% by hospital of diagnosis before the introduction of the first volume criteria (i.e., 2008-2009; minimum of 10 RCs). This variation decreased slightly to 17%-77% after establishment of the second volume criteria (i.e., 2015-2016; minimum of 20 RCs). Age, cT-stage and comorbidity were inversely and socioeconomic status was positively associated with RC. Both being diagnosed in a community hospital and/or being diagnosed in a hospital fulfilling the RC volume criteria were associated with increased use of RC compared to academic hospitals and hospitals not fulfilling the volume criteria. For each 10% increase in the percentage of RC in the hospital of diagnosis, 2-year case-mix adjusted survival increased 4% (hazard ratio 0.96, 95% confidence interval 0.94-0.98). CONCLUSION Probability of RC varied between hospitals of diagnosis and affected 2-year overall survival. Undergoing a RC was associated with age, cT-stage, socioeconomic status, type of hospital, and whether the hospital of diagnosis fulfilled the RC volume criteria. Future research is needed to identify patient, tumor, and hospital characteristics affecting utilization of curative treatment as this may benefit overall survival.
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Affiliation(s)
- Theodora M Ripping
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bas W G van Rhijn
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jorg R Oddens
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Sasja F Mulder
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Lambertus A Kiemeney
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Katja K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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11
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Hermens M, van Altena AM, Nieboer TE, Schoot BC, van Vliet HAAM, Siebers AG, Bekkers RLM. Incidence of endometrioid and clear-cell ovarian cancer in histological proven endometriosis: the ENOCA population-based cohort study. Am J Obstet Gynecol 2020; 223:107.e1-107.e11. [PMID: 31981507 DOI: 10.1016/j.ajog.2020.01.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Several studies have suggested that endometriosis is associated with an increased risk of ovarian cancer, especially for the clear-cell and endometrioid subtypes. However, previous studies lack sufficient power or diagnostic certainty. OBJECTIVE The objective of the study was to assess the association between histologically proven endometriosis and ovarian cancer in a large population-based cohort study. STUDY DESIGN We identified 131,450 women with a histological diagnosis of endometriosis between 1990 and 2015 from the Dutch nationwide registry of histopathology and cytopathology (PALGA). For the control cohort 132,654 women with a benign dermal nevus were matched on age and inclusion year with the endometriosis cases. Histological diagnoses of ovarian, fallopian tubes, and peritoneal cancers between January 1990 and July 2017 were retrieved. Incidence rate ratios were estimated for ovarian cancer and its subtypes for the whole follow-up period as well as for women with more than 1 person-year at risk. RESULTS We found a crude incidence rate ratio of 4.79 (95% confidence interval, 4.33-5.31) and an age-adjusted incidence rate ratio of 7.18 (95% confidence interval, 6.17-8.36) for ovarian cancer overall. Endometrioid and clear-cell ovarian cancer had the highest age-adjusted incidence rate ratio of 29.06 (95% confidence interval, 20.66-40.87) and 21.34 (95% confidence interval, 14.01-32.51), respectively. Median age at ovarian cancer diagnosis was 56 years (interquartile range, 49-63) for the endometriosis cohort and 60 years (interquartile range, 53-67) for the nevus cohort, (P < .05). After excluding women with less than 1 person-year at risk following an endometriosis diagnosis, we found a crude incidence rate ratio of 1.04 (95% confidence interval, 0.91-1.19) and an age-adjusted incidence rate ratio of 1.08 (95% confidence interval, 0.87-1.35) for ovarian cancer overall. However, statistically significant age-adjusted incidence rate ratios of 2.29 (95% confidence interval, 1.24-4.20) for clear-cell ovarian cancer and 2.56 (95% confidence interval, 1.47-4.47) for endometrioid ovarian cancer were found. CONCLUSION A significantly higher incidence of clear-cell and endometrioid ovarian cancer was found in women with histologically proven endometriosis. Additionally, we found an increased incidence of all ovarian cancer subtypes in histologically proven endometriosis; however, in many of these women, endometriosis and ovarian cancer were diagnosed synchronously after the average menopausal age, which may suggest that the risk of ovarian cancer in endometriosis patients remains, even when clinical endometriosis symptoms are no longer present.
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Affiliation(s)
- Marjolein Hermens
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Anne M van Altena
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Theodoor E Nieboer
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benedictus C Schoot
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands; Department of Obstetrics and Gynecology, University Hospital Ghent, Ghent, Belgium
| | - Huib A A M van Vliet
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Albert G Siebers
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands; PALGA (the nationwide network and registry of histo- and cytopathology in The Netherlands), Houten, The Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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12
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Koole SN, van Driel WJ, Sonke GS. Hyperthermic intraperitoneal chemotherapy for ovarian cancer: The heat is on. Cancer 2020; 125 Suppl 24:4587-4593. [PMID: 31967678 DOI: 10.1002/cncr.32505] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 11/12/2022]
Abstract
Patients with advanced epithelial ovarian cancer have a high incidence of peritoneal disease recurrence despite maximal efforts to surgically remove all visible tumor plus intravenous chemotherapy. The administration of intraperitoneal chemotherapy that specifically targets the peritoneal surface has been investigated in previous trials, but questions about the design of these studies has prevented this treatment from being widely adopted in clinical practice. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a single intraoperative approach that also targets the peritoneal surface. A randomized phase 3 trial showed significant benefit in recurrence-free and overall survival when HIPEC was added to interval cytoreductive surgery (CRS) in patients who were not eligible for primary surgery because of the extent of their disease (OVHIPEC trial; NCT00426257). The trial showed no important differences in toxicity or patient-reported outcomes between the study groups. The extent of surgery and the number of bowel resections were also similar between the 2 study groups, and the effect of HIPEC was homogeneous across the levels of predefined and post hoc subgroups. Nevertheless, the design and the results of the OVHIPEC trial were critically assessed, and this resembles the reluctance to adopt the positive results of the earlier intraperitoneal chemotherapy studies. This overview discusses the design and results of the OVHIPEC trial. The evidence that is currently available points to a clinically relevant and cost-effective benefit of HIPEC added to interval CRS for patients with stage III ovarian cancer who are not eligible for primary surgery. Ongoing collaborative research will provide further evidence regarding the role of HIPEC in ovarian cancer.
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Affiliation(s)
- Simone N Koole
- Department of Gynecology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Center for Gynecologic Oncology Amsterdam, Amsterdam, the Netherlands
| | - Willemien J van Driel
- Department of Gynecology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Center for Gynecologic Oncology Amsterdam, Amsterdam, the Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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13
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White KM, Walton RJ, Zhao GW, Creighton N, Farrell R, Saidi S, Herbst U, Hogg R, Currow DC. Patterns of surgical care for women with ovarian cancer in New South Wales. Aust N Z J Obstet Gynaecol 2020; 60:592-597. [PMID: 32458415 DOI: 10.1111/ajo.13180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/22/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the delivery of surgical services and outcomes for women with ovarian cancer across New South Wales (NSW). AIM The study objective was to provide a descriptive analysis of the proportion of women who had surgery for ovarian cancer in NSW in specialist gynaecological oncology hospitals and compare outcomes for women attending specialist and non-specialist services in NSW. MATERIALS AND METHODS This study is a retrospective analysis of women with primary ovarian, fallopian tube or peritoneal cancer from 2009 to 2012. Data were analysed from the NSW Cancer Registry, NSW Admitted Patient Data Collection and Register of Births Deaths and Marriages. Treating hospitals were characterised as public specialist, public non-specialist and private. Morbidity and mortality outcomes are reported. RESULTS The study included 1106 women. Fifty-seven hospitals performed surgery: seven public specialist, 27 private and 23 public non-specialist hospitals. The highest proportion of surgery was performed in public specialist hospitals (61%). There was considerable variation in the utilisation of public specialist hospitals between local health districts. There was no significant difference in outcomes related to the type of hospital where surgery was performed. CONCLUSIONS Although the majority of women are having surgery in a specialist gynaecological oncology public hospital across NSW, many are not. Women living in regional and remote NSW were less likely to have their surgery in a specialist hospital. This is the first step in understanding where women in NSW are currently receiving their surgical care, as well as the outcomes related to this.
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Affiliation(s)
- Kahren M White
- The Cancer Institute NSW, Sydney, New South Wales, Australia
| | | | - George W Zhao
- The Cancer Institute NSW, Sydney, New South Wales, Australia
| | | | - Rhonda Farrell
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Samir Saidi
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Unine Herbst
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Russell Hogg
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - David C Currow
- The Cancer Institute NSW, Sydney, New South Wales, Australia
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14
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den Ouden JE, The R, Myren BJ, Boll D, Driel WJV, Lalisang RI, Kruitwagen RF, van Altena AM. Development of a decision aid for primary treatment of patients with advanced-stage ovarian cancer. Int J Gynecol Cancer 2020; 30:837-844. [PMID: 32276940 DOI: 10.1136/ijgc-2019-001095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/03/2020] [Accepted: 02/18/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Despite renewed treatment options for advanced epithelial ovarian cancer, survival remains poor. The Patient Association and the Gynecological Oncology Working Party in the Netherlands have identified a need for a tool to improve shared decision-making. The aim of this study was to develop an evidence-based online decision aid for patients with advanced epithelial ovarian cancer and their medical team. METHODS First, we identified the patients' and clinicians' needs using surveys and in-depth interviews. Second, we conducted multidisciplinary face-to-face meetings with representatives from all stakeholders (clinicians and patient representatives) to determine the content of the decision aid. Third, we developed the decision aid using standardized criteria and national guidelines. Finally, we tested the usability of the tool with patients and clinicians who participated in the needs assessment. RESULTS Patients and clinicians indicated the need for more sources of reliable information that include all treatment options available in the Netherlands. Although most interviewees were satisfied with the level of information available at the time of their own treatment, the majority (90%) of the patients stated that no choice of treatment was offered. We developed a consultation sheet and an online decision aid based on patient interviews and team discussions. The sheet contains a summary of all treatment options and login codes for the decision aid; it will be offered to patients at their first consultation. The decision aid can be used at home and includes information about epithelial ovarian cancer and all available treatment options and questions about quality of life and treatment preferences, delivering a personalized summary for discussion during the following consultation about the primary treatment choices. DISCUSSION In cooperation with patients and clinicians, we developed a decision aid for advanced-stage epithelial ovarian cancer patients and their medical team to support shared decision-making, based on a confirmed need for more extensive information sources. The decision aid is currently under assessment in a multicenter implementation trial.
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Affiliation(s)
- Judith E den Ouden
- Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
| | - Regina The
- Development and Implementation of Decision Aids, ZorgKeuzeLab, Delft, Netherlands
| | - Britt J Myren
- Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
| | - Dorry Boll
- Obstetrics and Gynecology, Catharina Hospital, Eindhoven, Netherlands
| | - Willemien J van Driel
- Center for Gynecological Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Roy I Lalisang
- Internal Medicine, Division Medical Oncology, Maastricht University Medical Center, Maastricht, Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht, Netherlands
| | - Roy Fpm Kruitwagen
- GROW, School for Oncology and Developmental Biology, Maastricht, Netherlands.,Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Anne M van Altena
- Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
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15
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Zijlstra M, Timmermans M, Fransen H, van der Aa M, Reyners A, Raijmakers N, van de Poll-Franse L. Treatment patterns and associated factors in patients with advanced epithelial ovarian cancer: a population-based study. Int J Gynecol Cancer 2020; 29:1032-1037. [PMID: 31263022 DOI: 10.1136/ijgc-2019-000489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/02/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES A significant proportion of women with advanced-stage ovarian cancer receive no cancer-directed treatment and limited research has been devoted to this group. This population-based study aimed to gain insight into treatment patterns and trends in patients with advanced epithelial ovarian cancer in the Netherlands and the main reasons for deciding for no cancer-directed treatment. METHODS All patients diagnosed with advanced epithelial ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) classification IIB-IV, between 2008 and 2016 were identified from the Netherlands Cancer Registry. Trends in the number of patients receiving cancer-directed treatment were analyzed. Multivariable logistic regression analysis was used to identify factors associated with no cancer-directed treatment. The main reasons for no cancer-directed treatment were analyzed. RESULTS A total of 9303 patients were included, of whom 14% (n=1270) received no cancer-directed treatment while 67% (n=6218) received a combination of cytoreductive surgery and chemotherapy. Some 15% (n=1399) received chemotherapy only, and 4.5% (n=416) surgical resection or hormonal therapy only. The proportion of patients receiving no cancer-directed treatment was higher in 2014-2016 (16%, n=496/3175) compared with 2008-2010 (11%, n=349/3057, p<0.001). Associated factors with no cancer-directed treatment were higher age, FIGO stage IV, lower socioeconomic status, co-morbidity, and more recent years of diagnosis (p<0.001). Main reasons for no cancer-directed treatment were patient's choice (40%) and poor condition of the patient (29%). CONCLUSIONS The proportion of patients with advanced epithelial ovarian cancer not receiving cancer-directed treatment has increased in the last decade in the Netherlands. Patient's choice was the main reason for the decision to undergo no cancer-directed treatment, which indicates patient involvement in the decision-making process. The second most common reason for no cancer-directed treatment was poor condition of the patient, which might indicate careful selection of patients for treatment. Decision-making regarding treatment is well-considered, but more insight is needed, especially from the patient's perspective.
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Affiliation(s)
- Myrte Zijlstra
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Medical Oncology, Maxima Medical Centre, Eindhoven, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Maite Timmermans
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Gynaecology, Haga Hospital, The Hague, The Netherlands
| | - Heidi Fransen
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Maaike van der Aa
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - An Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Natasja Raijmakers
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Lonneke van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,CoRPS- Center of Research on Psychology in Somatic diseases, Department of Medicaland Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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16
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Timmermans M, Sonke GS, Slangen BFM, Baalbergen A, Bekkers RLM, Fons G, Gerestein CG, Kruse AJ, Roes EM, Zusterzeel PLM, Van de Vijver KK, Kruitwagen RFPM, van der Aa MA. Outcome of surgery in advanced ovarian cancer varies between geographical regions; opportunities for improvement in The Netherlands. Eur J Surg Oncol 2019; 45:1425-1431. [PMID: 31027945 DOI: 10.1016/j.ejso.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/29/2019] [Accepted: 04/09/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The care for patients with epithelial ovarian cancer(EOC) is organised in eight different geographical regions in the Netherlands. This situation allows us to study differences in practice patterns and outcomes between geographical regions for patients with FIGO stage IIIC and IV. METHODS We identified all EOC patients who were diagnosed with FIGO stage IIIC or IV between 01.01.2008 and 31.12.2015 from the Netherlands Cancer Registry. Descriptive statistics were used to summarize treatment and treatment sequence(primary cytoreductive surgery(PCS) or neoadjuvant chemotherapy and interval cytoreductive surgery(NACT-ICS)). Moreover, outcome of surgery was compared between geographical regions. Multilevel logistic regression was used to assess whether existing variation is explained by geographical region and case-mix factors. RESULTS Overall, 6,741 patients were diagnosed with FIGO IIIC or IV disease. There were no differences in the percentage of patients that received any form of treatment between the geographical regions(range 80-86%, P = 0.162). In patients that received cytoreductive surgery and chemotherapy, a significant variation between the geographical regions was observed in the use of PCS and NACT-ICS(PCS: 24-48%, P < 0.001). The percentage of complete cytoreductive surgeries after PCS ranged from 10 to 59%(P < 0.001) and after NACT-ICS from 37 to 70%(P < 0.001). Moreover, geographical region was independently associated with the outcome of surgery, also when adjusted for treatment sequence(P < 0.001). CONCLUSION We observed a significant variation in treatment approach for advanced EOC between geographical regions in the Netherlands. Furthermore, the probability to achieve no residual disease differed significantly between regions, regardless of treatment sequence. This may suggest that surgical outcomes can be improved across geographical regions.
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Affiliation(s)
- M Timmermans
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht, the Netherlands.
| | - G S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - A Baalbergen
- Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - R L M Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - G Fons
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - C G Gerestein
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands
| | - A J Kruse
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Isala Hospital, Zwolle, the Netherlands
| | - E M Roes
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - P L M Zusterzeel
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - K K Van de Vijver
- Department of Pathology, Ghent University Hospital, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - R F P M Kruitwagen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - M A van der Aa
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
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17
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Masic S, Smaldone MC. Treatment delays for muscle-invasive bladder cancer. Cancer 2019; 125:1973-1975. [PMID: 30840318 DOI: 10.1002/cncr.32047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/11/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Selma Masic
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Marc C Smaldone
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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