Importance of guidelines and networking for the management of rare gynecological cancers

Benchmarking vulvar cancer wound care practice in Australia and New Zealand: A cross-sectional study

PURPOSE

This study aimed to investigate current vulvar cancer wound care practices in Australia and New Zealand, identify knowledge of evidence supporting practice, explore enablers and barriers and determine areas for future improvement and research.

METHODS

An online cross-sectional survey collected quantitative and qualitative data from 64 nurses and doctors between May and July 2023. Descriptive statistics and content analysis were conducted. A consumer advisory group contextualised findings within lived experiences.

RESULTS

Common vulvar wound care practices included wound irrigation (n = 48, 83 %) and perineal drying (n = 40, 69 %), along with urinary catheters (n = 50, 86 %) and drains (n = 33, 57 %). Not using a wound dressing was common (n = 41, 71 %). Using silver (n = 25, 39 %), topical (n = 11, 17 %) or prophylactic (n = 2, 3 %) antibacterial agents were less common. Only 23 % (n = 15) of respondents reported knowledge of organisational guidance and care was commonly determined by practitioner preference, clinical assessment, and specialist wound nurse review. Reported enablers included guidance documents, clear instructions, clinician expertise, effective communication, and a well-informed patient. Reported barriers included infection, comorbidities, clinician variability, lack of evidence, systematic barriers, poor communication, and wound access challenges. The most common suggestion for improvement was the development of evidence based guidance. Four priority areas for future research were identified as; building an evidence base, evaluating the patient experience, investigating the impact of reducing risk factors and evaluating education interventions.

CONCLUSIONS

By benchmarking current wound care practices following surgery for vulvar cancer in Australia and New Zealand, priorities to direct future research and practice change efforts are supported.

Consore: A Powerful Federated Data Mining Tool Driving a French Research Network to Accelerate Cancer Research

BACKGROUND

Real-world data (RWD) related to the health status and care of cancer patients reflect the ongoing medical practice, and their analysis yields essential real-world evidence. Advanced information technologies are vital for their collection, qualification, and reuse in research projects.

METHODS

UNICANCER, the French federation of comprehensive cancer centres, has innovated a unique research network: Consore. This potent federated tool enables the analysis of data from millions of cancer patients across eleven French hospitals.

RESULTS

Currently operational within eleven French cancer centres, Consore employs natural language processing to structure the therapeutic management data of approximately 1.3 million cancer patients. These data originate from their electronic medical records, encompassing about 65 million medical records. Thanks to the structured data, which are harmonized within a common data model, and its federated search tool, Consore can create patient cohorts based on patient or tumor characteristics, and treatment modalities. This ability to derive larger cohorts is particularly attractive when studying rare cancers.

CONCLUSIONS

Consore serves as a tremendous data mining instrument that propels French cancer centres into the big data era. With its federated technical architecture and unique shared data model, Consore facilitates compliance with regulations and acceleration of cancer research projects.

European multidisciplinary tumor boards support cross-border networking and increase treatment options for patients with rare gynecological tumors

OBJECTIVE

To evaluate outcomes of European cross-border multidisciplinary tumor boards in terms of participation, adherence to treatment recommendations, and access to novel treatment strategies.

METHODS

The European reference network for rare gynecological tumors (EURACAN G2 domain) aims to improve the diagnosis, management, and treatment of patients with these cancers. Cross-border multidisciplinary tumor boards were initiated to facilitate intercollegiate clinical discussions across Europe and increase patients' access to specialist treatment recommendations and clinical trials. All G2 healthcare providers were invited to participate in monthly multidisciplinary meetings. Patient data were collected using a standardized form and case summaries were distributed before each meeting. After each tumor board, a meeting summary with treatment recommendations was sent to all participants and the project manager at the coordinating center. The multidisciplinary tumor board format and outcomes were regularly discussed at G2 domain meetings. Anonymized clinical data and treatment recommendations were registered in a prospective database. For this report, clinical data were collected between November 2017 and December 2020 and follow-up data retrieved until May 2021.

RESULTS

During the 3-year period, 31 multidisciplinary tumor boards were held with participants from 10 countries and 20 centers. 91 individual patients were discussed between one and six times for a total of 109 case discussions. Follow-up data were retrieved from 64 patients and 80 case discussions. Adherence to treatment recommendations was 99%. Multidisciplinary tumor board recommendations resulted in 11 patients getting access to off-label treatment and one patient being enrolled in a clinical trial in another European country. 14/91 patients were recommended for surveillance only when additional treatment had been considered locally.

CONCLUSION

Cross-border multidisciplinary tumor boards enable networking and clinical collaboration between healthcare professionals in different countries. Surveillance strategies, off-label drug use, and increased participation in clinical trials are possible benefits to patients with rare gynecological tumors.

[Treatments for rare ovarian tumors: What's new?]

Even if each rare ovarian tumor (ROT) has a low incidence, the sum of all these entities represents almost the half of all ovarian neoplasms. Thus, development of dedicated clinical trial emerged as a prerequisite to improve their managements. Owing to the spreading of dedicated institutional networks and (supra)national collaborations, the number of clinical trials has increased the past few years, with different types of trials; while some focused on specific molecular features, others assessed innovative molecules. Furthermore, relevant randomized clinical trials were designed as a mean to position new treatment options. Currently, innovative molecular-driven trials, based on master protocol trials are emerging and may shed light towards the improvement of personalized medicine regarding ROT.

Update on new treatments for rare ovarian tumours

PURPOSE OF REVIEW

In spite of their rarity when considered individually, the sum of all rare ovarian tumours (ROT) represent almost half of all ovarian malignancies. As such, their appropriate inclusion within dedicated clinical trials is essential for enhanced management.

RECENT FINDINGS

Supported by institutional expert national (e.g. TMRG) and international (e.g. ESGO) networks and owing to national (e.g. ARCAGY-GINECO) and international (e.g. ENGOT) collaborations dedicated to clinical research, the last few years have shown increased number of clinical trials dedicated to ROT. These either were based on specific molecular features of ROT (e.g. expression of oestrogen receptors for low-grade serous ovarian carcinomas and anastrazole evaluation in the PARAGON trial) or on the evaluation of innovative therapies (e.g. pembrolizumab within the ROT cohort from the AcSé Pembrolizumab multicentric basket trial). Furthermore, recent years have also shown the advent of randomized clinical trials. For instance, the ALIENOR trial positioned weekly paclitaxel as a new option for relapsed sex cord-stromal tumours, while the GOG281/LOGS trial raised trametinib as a new standard-of-care option for recurrent low-grade serous carcinomas.

SUMMARY

The last few years have exhibited a paradigm shift towards the possibility to develop dedicated trials for ROT, owing to international collaborations supported by institutional networks. Current trials, molecular-driven and based on innovative designs, are highly promising, as they may bring ROT management towards more personalized medicine.