|
1
|
Armbrust R, Davies-Oliveira J, Sehouli J. Health-related quality of life metrics as endpoints in surgical trials: hype or hope? Int J Gynecol Cancer 2024; 34:447-450. [PMID: 38438183 DOI: 10.1136/ijgc-2023-005127] [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: 03/06/2024] Open
Abstract
The management of gynecological cancer has evolved considerably over the past decades in almost every field of treatment. Surgery plays a major role in the treatment algorithm. However, these invasive interventions can have profound implications for the quality of life (QoL) of affected individuals. The routine implementation of QoL measurements in clinical trials has become common, reflecting a new research 'standard', despite the fact that all available QoL instruments were not designed nor validated prospectively for surgical trials. This review seeks to address whether patient reported outcomes and QoL measurements rightfully take center stage in current surgical trials, leading to direct implementation for the benefit of patient care, or are they simply more of a researcher's hope. We will also provide an 'action plan' to better implement QoL measurements in future surgical trials.
Collapse
Affiliation(s)
- Robert Armbrust
- Gynecology with Center of Oncological Surgery, Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Jalid Sehouli
- Gynecology with Center of Oncological Surgery, Charite Universitatsmedizin Berlin, Berlin, Germany
| |
Collapse
|
|
2
|
Balint N, Woopen H, Richter R, Pirmorady-Sehouli A, Pietzner K, Sehouli J. Sexuality as a Prognostic Factor-Results of an Individual Patient Data NOGGO (North-Eastern German Society of Gynecological Oncology)-Meta-Analysis of 644 Recurrent Ovarian Cancer Patients Prior to Chemotherapy. Cancers (Basel) 2024; 16:811. [PMID: 38398202 PMCID: PMC10886503 DOI: 10.3390/cancers16040811] [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: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The aim of this study was to analyze the associations between sexuality, quality of life, treatment discontinuation, and survival in recurrent ovarian cancer (OC). METHODS Raw data from various phase II/III studies, including the questionnaires EORTC-QLQ-C30 and QLQ-OV28, were included. Data from the meta-analysis were calculated using logistic and Cox regression. RESULTS Data on sexuality were available for 644 patients. A total of 162 patients had an interest in sex and were sexually active (Group A). A total of 45 patients had an interest in sex and were sexually not active (Group I) and 437 patients had no interest in sex and were not sexually active (Group N). Group A was younger in median age (age at randomization), at 57 years, than Group I, at 60 years, and Group N, at 65 years (p < 0.001). Group A had a better ECOG performance status and fewer recurrences (all p < 0.001). FIGO stage, grading, and BMI were not associated with interest in sex and sexual activity. Group A showed higher scores in role, body, and social function (all p < 0.001), emotional functionality (p < 0.002), and body image (p = 0.012). In addition, Group A reported less pain, less peripheral neuropathy, and less fatigue (all p < 0.001). There was no association with the premature discontinuation of chemotherapy. Group A showed better survival rates compared to group N (22.3 months vs. 17.4 months, p < 0.001). CONCLUSIONS Physicians should routinely address the topic of sexuality with ovarian cancer patients. Sexuality appears to be a marker for quality of life as well as overall survival.
Collapse
Affiliation(s)
- Nicole Balint
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany (R.R.); (K.P.); (J.S.)
| | - Hannah Woopen
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany (R.R.); (K.P.); (J.S.)
| | - Rolf Richter
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany (R.R.); (K.P.); (J.S.)
| | - Adak Pirmorady-Sehouli
- Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany;
| | - Klaus Pietzner
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany (R.R.); (K.P.); (J.S.)
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany (R.R.); (K.P.); (J.S.)
| |
Collapse
|
|
4
|
Hasenburg A, Plett H, Krämer B, Braicu E, Czogalla B, Bossart M, Singer S, Mayr D, Staebler A, du Bois A, Kommoss S, Link T, Burges A, Heitz F, Keul J, Trillsch F, Harter P, Wimberger P, Buderath P, Klar M. The effect of fertility-sparing surgery on sexuality and global quality of life in women with malignant ovarian germ cell and sex cord stromal tumors: an analysis of the CORSETT database of the AGO study group. Arch Gynecol Obstet 2021; 304:1541-1549. [PMID: 34287678 PMCID: PMC8553700 DOI: 10.1007/s00404-021-06019-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/23/2021] [Indexed: 12/22/2022]
Abstract
Purpose Malignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) are ovarian neoplasms that affect disproportionally young women. Little is known about the impact of surgical and adjuvant management of these patient’s sexual life. This study investigated the effect of fertility-sparing surgery on sexual activity and global quality of life (gQoL) in women with MOGCT and SCST. Methods CORSETT was an observational, multicenter, mixed retrospective/prospective cohort study of the AGO study group. Women of any age who had been diagnosed with MOGCTs and SCSTs between 2001 and 2011 were asked to complete the Sexual Activity Questionnaire (SAQ) and the EORTC QLQ-C30. Results In total, 355 patients were included. Of these, 152 patients with confirmed histological diagnosis had completed the questionnaires. A total of 106 patients were diagnosed with SCST and 46 with MOGCT. Totally, 83 women (55%) were sexually active. After fertility-sparing surgery, patients had a 2.6 fold higher probability for being sexually active than after non-fertility-conserving treatment (unadjusted odds ratio (OR) 2.6, p = 0.01). After adjustment for age, time since diagnosis, FIGO stage, histology and phase of disease, the OR dropped to 1.8 (p = 0.22). Of the sexually active patients, 35 (42%) reported high levels of discomfort during intercourse; 38% after fertility-sparing; and 58% after non-fertility-sparing surgery (adjusted OR 2.8, p = 0.18). Women with fertility-conserving treatment reported a significantly better global QoL (Fadj 2.1, 6.2 points difference, p = 0.03) but not more pleasure during intercourse than women without fertility-sparing surgery (Fadj 0.4, p = 0.52). Conclusion Fertility preserving approaches should be offered to every patient, when oncologically acceptable.
Collapse
Affiliation(s)
- Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany.
| | - Hellmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Bernhard Krämer
- Department for Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Elena Braicu
- Department of Gynecology, Campus Virchow Clinic, Charité Berlin, Berlin, Germany
| | - Bastian Czogalla
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Michaela Bossart
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg, Germany
| | - Susanne Singer
- Division of Epidemiology and Health Care Research, University Medical Center Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics, Mainz, Germany.,University Cancer Centre Mainz, Mainz, Germany
| | - Doris Mayr
- Institute of Pathology, University Hospital, LMU Munich, Munich, Germany
| | - Annette Staebler
- Division of Gynecologic Pathology, Institute of Pathology and Neuropathology, University of Tübingen, Tuebingen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Stefan Kommoss
- Department for Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Theresa Link
- Department of Gynecology and Obstetrics, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alexander Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Jacqueline Keul
- Department for Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Fabian Trillsch
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Paul Buderath
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | - Maximilian Klar
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg, Germany
| |
Collapse
|
|
5
|
Muallem MZ, Diab Y, Jöns T, Sehouli J, Muallem J. Nerve-Sparing Systematic Lymph Node Dissection in Gynaecological Oncology: An Innovative Neuro-Anatomical and Surgical Protocol for Enhanced Functional Outcomes. Cancers (Basel) 2020; 12:E3473. [PMID: 33266391 PMCID: PMC7700575 DOI: 10.3390/cancers12113473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
Whilst systematic lymph node dissection has been less prevalent in gynaecological cancer cases in the last few years, there is still a good number of cases that mandate a systematic lymph node dissection for diagnostic and therapeutic purposes. In all of these cases, it is crucial to perform the procedure as a nerve-sparing technique with utmost exactitude, which can be achieved optimally only by isolating and sparing all components of the aortic plexus and superior hypogastric plexus. To meet this purpose, it is essential to provide a comprehensive characterization of the specific anatomy of the human female aortic plexus and its variations. The anatomic dissections of two fresh and 17 formalin-fixed female cadavers were utilized to study, understand, and decipher the hitherto ambiguously annotated anatomy of the autonomic nervous system in the retroperitoneal para-aortic region. This study describes the precise anatomy of aortic and superior hypogastric plexus and provides the surgical maneuvers to dissect, highlight, and spare them during systematic lymph node dissection for gynaecological malignancies. The study also confirms the utility and feasibility of this surgery in gynaecological oncology.
Collapse
Affiliation(s)
- Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (J.S.); (J.M.)
| | - Yasser Diab
- Department of Gynecology, Portland Hospital, Portland, 3305 VIC, Australia;
| | - Thomas Jöns
- Department of Anatomy, Mitte Campus Clinic, Charité Medical University, 10117 Berlin, Germany;
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (J.S.); (J.M.)
| | - Jumana Muallem
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (J.S.); (J.M.)
| |
Collapse
|