[Health professionals' perspective about women's experiences during the diagnostic process of ovarian cancer in Catalonia: Qualitative study]

OBJECTIVE

To identify missed opportunities in the diagnosis of ovarian cancer (OC) in the public health system of Catalonia, through the analysis of the perceptions of health professionals on the stories's experiences of OC patients.

DESIGN

Qualitative exploratory-descriptive study, with two focus groups.

SETTING

Primary Care, November 2017.

PARTICIPANTS

Thirty-four professionals based on theoretical sampling: 21 family doctors, 8 professionals from sexual and reproductive health centres and 5 hospital gynaecologists.

METHODS

Participants discussed the different diagnostic pathways for women with OC through the presentation of flowcharts which were developed with three storie's and experiences of OC patients.

RESULTS

Three themes with various sub-themes were identified as follow: a)lack of cancer diagnostic suspicion (lack of knowledge of symptoms of OC, anamnesis and physical examination overlooked, fragmentation of patient's care and bias and prejudice); b)difficulties in activating the diagnostic process (limited access to tests, unequal accessibility to gynaecology and lack of follow-up); and c)absence of fast-track referral system.

CONCLUSIONS

The results offer insight into the difficulties of early diagnosis of OC in our setting. We believe that their identification will allow the development of strategies to improve diagnostic accuracy and quality of care for women with OC in our setting.

[Quality of healthcare in oncological patients from health personnel's perspective]

INTRODUCTION

The quality of care in health institutions is a constant challenge, mainly in oncology. The literature shows it has partially evaluated in contrast to it proposed by Donabedian; in addition, health personnel's perspective, who has direct contact with the patient, knows and executes the care process, has not been considered. The objective of the present study was to establish a framework to evaluate the quality of healthcare provided to patients with colorectal or ovarian cancer from health personnel's perspective.

MATERIAL AND METHODS

Cross-sectional study that included health personnel belonging to nine services of a cancer hospital. A questionnaire was applied to evaluate the quality of healthcare through amenities, the interpersonal and scientific-technical dimension (Donabedian's model). The variables were standardized, compliance with them among services was compared using non-parametric tests (Kruskal-Wallis test and Mann-Whitney U test), and 40 indicators were evaluated.

RESULTS

Health personnel's 181 members participated, the evaluated oncology hospital presented regular compliance to the quality of healthcare (bad ≤82, regular 83-109, good ≥110). When comparing this in the nine services, differences were detected between surgery and radiotherapy (higher compliance scores, 132 and 126 respectively) versus the other services P<.05. Both services had more than 25 indicators with compliance ≥80%.

CONCLUSIONS

It is shown that the established framework is useful for evaluating the quality of healthcare from health personnel's perspective (an approach not used so far for this type of evaluation), by detecting differences in its compliance, specific problems and its causes by service.

Fiber burden and asbestos-related diseases: an umbrella review

Objective:

What are the levels of asbestos exposure that cause each type of health effect? The objective of this study was to review the available scientific evidence on exposure levels for asbestos and their relationship to health effects.

Method:

An umbrella review of English-language reviews and meta-analyses, from 1980 to March 2021 was conducted. We included reviews involving quantified asbestos exposures and health outcomes. The review has been adapted to the indications of the PRISMA declaration. Methodological quality of the selected studies was assessed using the AMSTAR instrument.

Results:

We retrieved 196 references. After applying the search strategy and quality analysis, 10 reviews were selected for in-depth analysis. For lung cancer, the highest risk was observed with exposure to amphiboles. Longer, thinner fibers had the greatest capacity to cause lung cancer, especially those > 10 μm in length. For mesothelioma, longer and thinner fibers were also more pathogenic; amphiboles ≥ 5 μm are especially associated with increased mesothelioma risk. No studies observed an increased risk for lung cancer or mesothelioma at asbestos exposure levels < 0.1 f/ml. No reviews provided information on exposure concentrations for pulmonary fibrosis. Currently, there is limited evidence in humans to establish the causal relationship between gastrointestinal cancer and asbestos exposure.

Conclusions:

Banning all asbestos exposure remains the best measure to preventing its negative health effects. The highest quality reviews and meta-analyses support that there is little risk of lung cancer or mesothelioma at daily exposure levels below 0.1 f/ml.

Evaluación del desempeño diagnóstico del Índice de Riesgo de Malignidad II en mujeres con diagnóstico de masa anexial en un hospital de tercer nivel

OBJETIVO

Evaluar la exactitud diagnóstica del Índice de Riesgo de Malignidad II (IRM II) en 100 pacientes con diagnóstico de masa anexial.

MÉTODO

En una muestra de 100 pacientes con diagnóstico de masa anexial se cuantificaron variables demográficas y se aplicó el IRM II. Mediante una tabla 2 × 2 se obtuvieron la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y la exactitud diagnóstica, y se compararon con el resultado histopatológico.

RESULTADOS

El IRM II con resultado positivo se presentó en el 73.1% (52 pacientes) de los casos con resultado histopatológico maligno y en el 26.9% de aquellos con resultado histopatológico benigno. Presenta una sensibilidad en la prueba del 73.1%, una especificidad del 70.8%, un valor predictivo positivo del 73.2% y un valor predictivo negativo del 70.8%. La exactitud diagnóstica es del 72%.

CONCLUSIONES

El IRM II es una herramienta de cribaje con aceptable desempeño diagnóstico para normar la conducta, como referir a un centro especializado o solicitar estudios más específicos en pacientes con diagnóstico de masa anexial por sospecha de malignidad.

OBJECTIVE

Evaluate the usefulness of the Malignancy Risk Index II (MRI II) using diagnostic accuracy variables in 100 patients diagnosed with adnexal mass.

METHOD

In a sample of 100 patients with a diagnosis of adnexal mass, demographic variables were quantified and MRI II was applied. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were obtained using a 2 × 2 table and compared with the histopathological result.

RESULTS

MRI II with positive result was presented in 73.1% (52 patients) with malignant histopathological result and in 26.9% of patients with benign histopathological result. It presents a sensitivity in the test of 73.1%, a specificity of 70.8%, positive and negative predictive value of 73.2 and 70.8%, respectively. Diagnostic accuracy of 72%.

CONCLUSIONS

MRI II is a screening tool with acceptable diagnostic performance to regulate behavior, such as referring to a specialized center or requesting more specific studies in patients diagnosed with adnexal mass due to suspected malignancy.

Experiencia con el uso de olaparib en pacientes con cáncer de ovario

Introduction

More than the twenty percent of ovarian cancers are hereditary, and most have BRCA mutations. The 30% of Mexican patients with the BRCA1 mutation have the BRCA1 gene exon 9-12del deletion founder mutation (BRCA1 ex9-12del). BRCA-mutated tumors are more sensitive to PARP inhibitors such as olaparib.

Objective

To show the clinical experience on the use of olaparib at Instituto Nacional de Cancerología in Mexico.

Method

Ovarian cancer patients treated with olaparib from November 2016 to December 2018 were studied, and their characteristics, clinical response, progression-free survival (PFS) and toxicities were described.

Results

Nineteen patients were assessed, with BRCA1 mutation being found in 78.9%, out of which 21.1% were carriers of the ex9-12del founder mutation. The median of PFS was 12 months; for patients treated on second and third line it was > 15 months, and for those treated with a fourth and subsequent line it was 8.3 months. Patients with the founder mutation had better results. Toxicities were like those reported in previous studies.

Conclusions

Olaparib offers greater PFS benefit as maintenance therapy after a first and second relapse. Patients with founder mutation have had sustained PFS.

[Protocol for the examination of surgical specimens from patients with peritoneal carcinomatosis originating in ovary, fallopian tube and peritoneum]

Peritoneal carcinomatosis (PC) is a malignant entity with a high rate of morbimortality. It is considered an end-stage common to several abdominal and pelvic malignant tumours, such as epithelial ovarian, fallopian tubal and peritoneal cancer. Although many of these tumors have a good response to chemotherapy, prognosis is poor due to the high rate of recurrence. Surgeons, gynecologists and oncologists are increasingly concerned with improving the survival. The surgical technique described by Sugarbaker in the eighties is a plausible option. It aims for a complete resection of macroscopic carcinomatosis (cytoreductive surgery) followed by intraoperative or perioperative intraperitoneal chemotherapy. This therapeutic option necessarily involves specific multidisciplinary units; histopathology of specimens from this surgical technique is now more frequent in our department. We describe our initial experience with PC originating from epithelial ovarian, tubal and peritoneal cancer treated with the modified Sugarbaker surgery employed in our hospital. We outline our protocol designed to achieve uniformity in procedure, and summarize the initial results.

[Triple synchronous primary gynaecological tumours. A case report]

BACKGROUND

Synchronous multiple primary malignancies in the female genital tract are infrequent. From 50 to 70% of them corresponds to synchronous cancers of the endometrium and ovary. To our knowledge, this is only the third case report in the international literature of three concurrent gynaecological cancers of epithelial origin. A case is presented, as well as a literature review due to the infrequency of its diagnosis and the lack of information on the subject.

CLINICAL CASE

A 49-year-old woman, with previous gynaecological history of ovarian endometriosis. She underwent a hysterectomy and bilateral oophorectomy, as she had been diagnosed with endometrial hyperplasia with atypia. The final histopathology reported synchronous ovarian, Fallopian tube, and endometrial cancer. An extension study and complete surgical staging was performed, both being negative. She received adjuvant treatment of chemotherapy and radiotherapy. She is currently free of disease.

CONCLUSIONS

The aetiology is uncertain. There is controversy relating to increased susceptibility of synchronous neoplasms to pelvic endometriosis and inherited genetic syndromes. Its diagnosis needs to differentiate them from metastatic disease. Additionally, they are problematical from a clinical, diagnostic, therapeutic, and prognostic point of view. The presentation of more cases of triple synchronous cancers is necessary for a complete adjuvant and surgical treatment.

Role of 18F-FDG PET/CT in diagnosing peritoneal carcinomatosis in the restaging of patient with ovarian cancer as compared to contrast enhanced CT and tumor marker Ca-125

OBJECTIVES

To investigate the role of whole-body fluorine-18-2-deoxy-2-fluoro-d-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the identification of peritoneal carcinomatosis in patients with ovarian cancer (OC).

MATERIAL AND METHODS

Seventy-nine patients with histologically proven stages III-IV OC who underwent (18)F-FDG PET/CT were studied retrospectively. We considered group A as 51 patients who also underwent computed-tomography with contrast-enhancement (CECT), and group B as 35 patients who had also been tested for biomarker Ca-125. Sensitivity, specificity, accuracy, positive predictive values (PPV) and negative predictive values (NPV) of (18)F-FDG PET/CT as compared to CECT and to Ca-125 were evaluated.

RESULTS

(18)F-FDG PET/CT' sensitivity, specificity, accuracy, PPV and NPV for all 79 patients were: 85%, 92.31%, 88.61%, 91.89% and 85.71%, respectively. (18)F-FDG PET/CT sensitivity in group A was 78.6%, while it was 53.6% for CECT. (18)F-FDG PET/CT specificity, calculated in the same group, was 91.3%, while that of CECT was 60.9% (statistically significant difference, McNemar 4, P=0.039). Accuracy was 84.3% and 56.9%, respectively. (18)F-FDG PET/CT' sensitivity in group B was 86.4%, while that of Ca-125 was 81.8% (no statistical difference, McNemar 0, P=1). (18)F-FDG PET/CT specificity in group B was 84.6% while that of Ca-125 was 38.5% (clear but not statistically significant difference, McNemar 3.12, P=0.070). Accuracy calculated in the same group was 85.7% for (18)F-FDG PET/CT and 65.7% for Ca-125.

CONCLUSION

(18)F-FDG PET/CT is a useful diagnostic tool when peritoneal biopsy cannot be performed and it can better select those who are candidates for adjuvant chemotherapy.