Tertiary prevention strategies for micrometastatic lymph node cervical cancer: A systematic review and a prototype of an adapted model of care

PURPOSE

We found a need for balancing the application of clinical guidelines and tailored approaches to follow-up of cervical cancer (CC) patients in the lymph node micrometastatic (MICs) setting. This review aimed to determine the current knowledge of management of MIC-positive CC cases.

METHODOLOGY

We addressed prognostic and risk of recurrence monitoring impacts associated with MIC+ cases. The electronic databases for literature and relevant articles were analysed.

RESULTS

Fifteen studies, (4882 patients), were included in our systematic review. While the results show that MICs significantly worsen prognosis in early CC. A tertiary prevention algorithm for low volume lymph node disease may stratify follow-up according to the burden of nodal disease and provide data that helps improve follow-up performance.

CONCLUSION

MICs worsen prognosis and should be managed as suggested by the algorithm. However, this algorithm must be externally validated. The clinical impact of isolated tumor cells (ITC) remains unclear.

Relationship, social support, and personality as psychosocial determinants of the risk for postpartum blues

OBJECTIVES

The purpose of the study was to identify factors increasing or decreasing the risk for postpartum blues.

MATERIAL AND METHODS

A total of 101 women in their first week postpartum were included in the study. The Edinburgh Postnatal Depression Scale, questions concerning their medical and social status, and psychological tests (the Personality Inventory NEO-FFI, The Mieczysław Plopa and Jan Rostowski Marriage Questionnaire, and the Berlin Social Support Scales) were used.

RESULTS

The probability of postpartum blues was detected in 16.8% of the respondents. The risk decreased with higher satisfaction with intimacy (OR = 0.81), partner similarity (OR = 0.78), and the overall satisfaction with the relationship (OR = 0.94), while higher disappointment elevated that risk (OR = 1.12). As far as social support is concerned, further inde-pendent factors included perceived available social support (OR = 0.31), perceived instrumental social support (OR = 0.24), need for support (OR = 2.74), and protective buffering support (OR = 3.41). High level of neuroticism as well as fear of childbirth increased the risk for postpartum blues (OR = 2.17 and OR = 1.30, respectively). High level of extraversion and better quality of sleep constituted protective factors (OR = 0.74 and OR = 0.60, respectively).

CONCLUSIONS

Maternal disappointment with marriage/relationship, neuroticism and introversion, poor quality of sleep, fear of childbirth, and seeking social support are among the factors signaling the need for careful observation for signs of possible postpartum mood disorders both, during hospitalization and the follow-up visits.

Personality type, social support and other correlates of risk for affective disorders in early puerperium

OBJECTIVES

The purpose of this study was to assess the prevalence of risk for postpartum mood disorders in mothers during the early postnatal period and to search for coexisting conditions.

MATERIAL AND METHODS

We studied 546 women in the first week after delivery. The subjects filled out a questionnaire concerning their health, social and demographic status, the Edinburgh Postnatal Depression Scale, the Patient Health Questionnaire, the NEO-FFI Personality Inventory and the Berlin Social Support Scales.

RESULTS

Probable mood disorders affected 15.85% of these patients. The risk increased with a current cesarean section (ORa = 2.54), a higher level of neuroticism (ORa = 1.65), greater fear of childbirth (ORa = 1.18), a lower level of extraversion (ORa = 0.77) and greater need for social support (ORa = 2.68).

CONCLUSIONS

High level of neuroticism and introversion, as well as higher fear of delivery and the need of social support are among factors increasing the probability of mood disturbances in early postpartum period. A cesarean section might elevate the risk similarly. The mental health of such patients should be carefully examined.

Screening for maternal postpartum depression and associationswith personality traits and social support. A Polish follow-upstudy 4 weeks and 3 months after delivery

OBJECTIVES

To investigate the likelihood of postpartum depression and to explore maternal characteristics in terms of personality, social support and other medical and psychological data.

METHODS

A sample of 548 patients was investigated 4 weeks and 3 months after delivery. They responded to questionnaires containing sociodemographic questions: the EPDS (Edinburgh Postnatal Depression Scale), the PHQ-9 (Patient Health Questionnaire-9), theNEO-FFI (Personality Inventory), and the BSSS (Berlin Social Support Scales).

RESULTS

Probable depression any time during first 3 months postpartum was prevalent among 6.38% of women, based on the following criteria: EPDS > 12 points and PHQ-9 > 9 points. A score of EPDS > 9 in the first week after delivery (ORa = 4.16; CI 1.59-10.86), a history of hospitalisation during pregnancy (ORa = 3.51; CI 1.32-9.20), a high level of neuroticism (ORa = 1.37; CI 1.05-1.77), and high buffering-protective social support (ORa =2.56; 1.25-5.23) were significantly associated with depressive symptoms. Potential protective factors were initial breastfeeding (ORa = 0.31; CI 0.11-0.90) and high satisfaction with currently received social support (ORa=0.41;CI 0.22-0.79). The total dropout rate was 23%.

CONCLUSIONS

New mothers who are neurotic and who suffered from physical or mental problems during pregnancy and puerperium might experience depressive symptoms more easily. They would also protect those close to them from negative information about themselves. A lack of initial breastfeeding and unsatisfactory social support played a similar role.