GCIG-Consensus guideline for Long-term survivorship in gynecologic Cancer: A position paper from the gynecologic cancer Intergroup (GCIG) symptom benefit committee

Effects of Cancer Rehabilitation Interventions for Women Treated for Gynaecological Cancers: A Meta-Analysis of Randomised Controlled Trials

AIM

To analyse and synthesise current evidence on the effectiveness of cancer rehabilitation interventions in increasing physical activity, increasing healthy dietary habits, alleviating psychological distress, and increasing health-related quality of life (HRQoL) in women treated for gynaecological cancers (GCs).

DESIGN

A meta-analysis of randomised controlled trials (RCTs).

DATA SOURCES

A systematic search was conducted in 12 databases from inception to 31 May 2024.

REVIEW METHODS

The quantitative results from comparable RCTs were pooled and meta-analysed using Review Manager 5.4 software. The results from non-comparable (i.e., clinically heterogeneous) RCTs were narratively summarised. The methodological quality of all RCTs was assessed using Version 2 of the Cochrane risk of bias tool for randomised trials.

RESULTS

Nine RCTs reported in a total of 12 articles met the inclusion criteria and comprised a total of 418 patients. The interventions had significant effects on total physical activity levels at post-intervention, 6-month follow-up, and 12-month follow-up, and on self-efficacy in physical activity at post-intervention and 3-month follow-up. However, the interventions did not significantly improve overall HRQoL or healthy dietary habits and did not significantly alleviate anxiety and depression. The key intervention components were information provision on health-promoting behaviours; adoption of behavioural change techniques (goal setting, action planning, relapse prevention, problem-solving, self-monitoring, and social support); and stress and emotion management.

CONCLUSION

Rehabilitation interventions effectively increase physical activity in women treated for GCs, leading to sustainable effects. However, there is limited evidence on the effectiveness of such interventions in improving overall HRQoL, encouraging healthy eating, and alleviating psychological distress in women treated for GCs.

RELEVANCE TO CLINICAL PRACTICE

This review found that rehabilitation interventions can increase physical activity levels among women treated for GCs. It also identified the key effective components of such interventions.

REPORTING METHOD

This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.

PATIENT OR PUBLIC CONTRIBUTION

None.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews registration number: CRD42023442877.

Illness Perception and Risk Management Behaviors Among Patients With Gynecologic Cancer at Risk of Lower Extremity Lymphedema

BACKGROUND

Patients with gynecologic cancer who undergo lymphadenectomy are at increased risk of lower extremity lymphedema (LEL). They are encouraged to be alert to the possibility of LEL and take risk-management measures throughout life. However, we know little about the perception for LEL and adherence to risk-management measures of Chinese patients with gynecologic cancer.

OBJECTIVE

To assess the illness perception and risk management behaviors of Chinese gynecologic cancer patients and further examine the effect of illness perception on risk management behaviors.

METHODS

This was a cross-sectional study. From June to December 2023, gynecologic cancer patients at risk of LEL were surveyed (n = 223). Questionnaires on illness perception and risk management behaviors specifically for LEL were utilized. Descriptive statistics, Pearson correlation analysis, univariate analysis, and multiple linear regression analysis were used for data analysis.

RESULTS

The participants exhibited suboptimal LEL risk management behaviors, with the physical activity dimension receiving the lowest score (3.24 ± 1.02). Patients' self-perceived understanding of LEL was relatively low (2.88 ± 0.83). Multiple linear regression analysis revealed that the identity, cause, and control dimensions of illness perception, as well as several demographic and disease variables, were significant predictors of patients' LEL risk management behaviors.

CONCLUSIONS

The LEL risk management behaviors of patients with gynecologic cancer need to be improved. Consideration of perceptions of identity, cause, and control is crucial for enhancing LEL risk management behaviors.

IMPLICATIONS FOR PRACTICE

Health professionals can implement targeted health education based on an assessment of patients' perceptions of LEL, thereby promoting lymphedema risk management.

British Gynaecological Cancer Society and British Menopause Society guidelines: Management of menopausal symptoms following treatment of gynaecological cancer

These guidelines have been developed jointly by the British Gynaecological Cancer Society and British Menopause Society to provide information for all healthcare professionals managing women treated for gynaecological cancer. Menopausal symptoms can have a significant impact on quality of life for women. Cancer therapies, including surgery, pelvic radiotherapy, chemotherapy and endocrine therapy, can all affect ovarian function. The benefits and risks of using hormone replacement therapy are considered by cancer type with guidance on the type of HRT and optimal time of commencement after cancer treatment. Vaginal estrogens can be very effective for improving urogenital symptoms and are safe for the majority of women, including those for whom systemic HRT is contraindicated with rare exceptions. Alternative options to HRT are reviewed including pharmacological and non-pharmacological approaches.

Decrements in Morning and Evening Energy Are Associated With a Higher Symptom Burden in Patients With Gynecologic Cancers Receiving Chemotherapy

BACKGROUND

Decrements in energy are a significant problem associated with chemotherapy. To date, no study examined the variability of energy in patients with gynecologic cancers.

OBJECTIVE

To identify distinct morning and evening energy profiles in patients with gynecologic cancers and evaluate for differences in demographic and clinical characteristics, other common symptoms, and quality-of-life (QOL) outcomes.

METHODS

A sample of 232 patients with gynecologic cancers completed questionnaires 6 times over 2 cycles of chemotherapy. Latent profile analysis was used to identify distinct morning and evening energy profiles. Differences in demographic and clinical characteristics, other common symptoms, and QOL outcomes were evaluated using parametric and nonparametric tests.

RESULTS

Three distinct morning (ie, high [9.2%], low [63.1%], very low [27.1%]) and 2 distinct evening (moderate [30.6%], very low [69.4%]) energy classes were identified. Clinical risk factors associated with the worst morning energy profiles included lower functional status and a higher comorbidity burden. Less likely to exercise on a regular basis was the only characteristic associated with the worst evening energy profile. For both symptoms, the worst profiles were associated with higher levels of depression and sleep disturbance, lower levels of cognitive function, and poorer QOL.

CONCLUSIONS

Approximately 70% of patients with gynecologic cancers experienced decrements in morning and evening energy. The study identified modifiable risk factors associated with more decrements in morning and evening energy.

IMPLICATIONS FOR PRACTICE

Clinicians can use these findings to identify higher-risk patients and develop individualized energy conservation interventions for these vulnerable patients.

Potential antitumor activity of triptolide and its derivatives: Focused on gynecological and breast cancers

Cancer remains one of the greatest global health concerns. This is especially true for gynecological cancers, which include cervical, ovarian, and endometrial cancers, and breast cancer. Natural products used for cancer treatment offer some unique advantages. Triptolide (TPL) is a biologically active terpenoid extracted from Tripterygium wilfordii, which exhibits anti-inflammatory, immunosuppressive, antitumor, and other pharmacological activities. However, clinical applications of TPL are restricted because of poor water solubility and severe cytotoxicity; to overcome these limitations, various TPL derivatives and drug delivery systems, especially nanocarriers, have been used. Furthermore, various preclinical and clinical studies have demonstrated that TPL and its derivatives exhibit excellent antitumor effects by targeting proteins involved in multiple signaling pathways. Here, we review the progress regarding novel drug delivery systems, antitumor activities, and molecular mechanisms of action of TPL and its derivatives against gynecological and breast cancers. TPL and its derivatives inhibit tumor growth, suppress tumor metastasis, and enhance the drug sensitization of resistant cancers. In addition, TPL and its derivatives exert synergistic antitumor effects against gynecological and breast cancers when combined with existing antitumor drugs, such as carboplatin, cisplatin, and PI3K inhibitors. Moreover, we highlight the clinical potential of TPL analogs against cancer from bench to bedside and their prospects for future applications in gynecologic and breast cancers.

Side Effects from Cancer Therapies and Perspective of 1044 Long-Term Ovarian Cancer Survivors-Results of Expression VI-Carolin Meets HANNA-Holistic Analysis of Long-Term Survival with Ovarian Cancer: The International NOGGO, ENGOT, and GCIG Survey

The aim of this survey was to increase the knowledge on the characteristics and health concerns of long-term survivors (LTS; survival > 5 years) after ovarian cancer in order to tailor follow-up care. This international survey was initiated by the NOGGO and was made available to members of ENGOT and GCIG. The survey is anonymous and consists of 68 questions regarding sociodemographic, medical (cancer) history, health concerns including distress, long-term side effects, and lifestyle. For this analysis, 1044 LTS from 14 countries were recruited. In total, 58% were diagnosed with FIGO stage III/IV ovarian cancer and 43.4% developed recurrent disease, while 26.0% were receiving cancer treatment at the time of filling in the survey. LTS who survived 5-10 years self-estimated their health status as being significantly worse than LTS who survived more than 10 years (p = 0.034), whereas distress also remained high 10 years after cancer diagnosis. Almost half of the cohort (46.1%) reported still having symptoms, which were mainly lymphedema (37.7%), fatigue (23.9%), pain (21.6%), polyneuropathy (16.9%), gastrointestinal problems (16.6%), and memory problems (15.5%). Almost all patients (94.2%) regularly received follow-up care. Specialized survivorship care with a focus on long-term side effects, lifestyle, and prevention should be offered beyond the typical five years of follow-up care.

Nomograms constructed for predicting diagnosis and prognosis in cervical cancer patients with second primary malignancies: a SEER database analysis

PURPOSE

Cervical cancer (CC) patients are more likely to develop second primary malignancies (SPMs) than general population. With the advancement in cancer therapy, CC patients are achieving long-term survival, leading SPMs to our attention. Our study aims to establish diagnostic and prognostic nomograms for CC patients with second primary malignancies (CCSPMs) to help make personalized follow-up plans and treatments.

METHODS

Data of CCSPMs between 2000 and 2019 was extracted from SEER. The proportions and the median interval time of CCSPM onset were calculated. 11 related clinical characteristics, including age, race, marital status, grade, FIGO stage, radiotherapy, chemotherapy, and surgery, were further explore. Logistic and Cox regressions were employed to predict risk factors for CCSPMs diagnosis. Finally, two nomograms were developed to predict the probability occurrence and prognosis of CCSPMs, respectively.

RESULTS

For diagnostic nomogram construction, 59,178 CC patients were randomly divided into training (n = 41,426) and validation cohorts (n = 17,752). For prognostic nomogram construction, 3527 CCSPMs patients were randomly divided into training (n = 2469) and validation cohorts (n = 1058). The diagnostic nomogram consisting of above 11 independent risk factors (all P < 0.05), had high accuracy (AUCtraining = 0.851 and AUCvalidating = 0.845). The prognostic nomogram integrated with eight independent prognostic factors such as treatments, FIGO stage and TNM stage performed well in predicting 5-year OS (AUCtraining = 0.835 and AUCvalidating = 0.837).

CONCLUSION

Our diagnostic and prognostic nomograms could facilitate clinicians to quantify individual SPMs risk and survival probabilities and optimize the surveillance recommendations and personalized clinical decision-making.

Barriers to and facilitators of a healthy lifestyle for patients with gynecological cancer: a systematic review of qualitative and quantitative research with healthcare providers and patients

The prevalence of an unhealthy lifestyle among patients with gynecological cancer is high and associated with increased risk of all-cause mortality. Although lifestyle changes have the potential to improve outcomes, lifestyle counseling is not routinely integrated into standard care. This review explores research on the barriers to and facilitators of both the promotion of healthy lifestyles by healthcare providers (HCPs) and healthy lifestyle changes by patients with gynecological cancer. The Theoretical Domains Framework (TDF) was used to deductively code the identified factors for a comprehensive understanding of the barriers and facilitators. A search across five databases yielded a total of 12,687 unique studies, of which 43 were included in the review. Of these 43, 39 included gynecological cancer patients and only 6 included HCPs. Among the barriers identified for HCPs, most studies evaluated barriers regarding weight loss counseling. Limited knowledge, reluctance to address weight loss, skepticism about the benefits, and workload concerns were commonly reported barriers for HCPs. HCPs will benefit from education and training in lifestyle counseling, including effective communication skills like motivational interviewing. Gynecological cancer patients lacked tools, support, knowledge, and faced mental health issues, environmental constraints, and physical limitations. The review emphasizes the importance of addressing these barriers and utilizing identified facilitators, such as social support, to promote and support healthy lifestyle behaviors on the part of patients and their promotion by HCPs. Future research should focus not only on patients but also on supporting HCPs and implementing necessary changes in current practices.

Quantification of Women Who Could Benefit from Hormone Therapy after Endometrial Cancer Treatment: An Analysis of SEER Data

Our primary aim was to estimate the magnitude of stage I endometrial cancer (EC) survivors that could benefit from hormonal therapy (HT). Our secondary aims were to assess EC incidence in women below 50 and below 60 over the years, and analyze the overall survival and any influencing factors. We analyzed the endometrioid EC data from the Surveillance, Epidemiology, and End Results (SEER) program according to women's age, tumor stage, and grade. We analyzed the proportions of EC survivors below 50 and below 60 years of age and stratified those age groups by race. For age distribution and survival analysis SEER, 18 registries' research data (2000-2018) were analyzed. We analyzed the SEER 12 registries' research data (1992-2019) for incidence time trends. Our investigation found a 14% and 40% cumulative prevalence of stage I EC that occurs in women below 50 or 60 years, respectively. EC's prevalence has progressively risen in recent decades, but cancer-specific mortality remains low. The increasing number of women affected by EC in premenopause or early postmenopause face an 18 years-survival rate of 96.86% and 95.73%, respectively. A significant proportion of low-grade EC survivors can potentially benefit from HT treatment, and this requires awareness of other aspects of their health or quality of life, in addition to cancer treatments.