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Kwong FL, Kristunas C, Davenport C, Aggarwal R, Deeks J, Mallett S, Kehoe S, Timmerman D, Bourne T, Stobart H, Neal R, Menon U, Gentry-Maharaj A, Sturdy L, Ottridge R, Sundar S. Investigating harms of testing for ovarian cancer - psychological outcomes and cancer conversion rates in women with symptoms of ovarian cancer: A cohort study embedded in the multicentre ROCkeTS prospective diagnostic study. BJOG 2024. [PMID: 38556698 DOI: 10.1111/1471-0528.17813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To investigate psychological correlates in women referred with suspected ovarian cancer via the fast-track pathway, explore how anxiety and distress levels change at 12 months post-testing, and report cancer conversion rates by age and referral pathway. DESIGN Single-arm prospective cohort study. SETTING Multicentre. Secondary care including outpatient clinics and emergency admissions. POPULATION A cohort of 2596 newly presenting symptomatic women with a raised CA125 level, abnormal imaging or both. METHODS Women completed anxiety and distress questionnaires at recruitment and at 12 months for those who had not undergone surgery or a biopsy within 3 months of recruitment. MAIN OUTCOME MEASURES Anxiety and distress levels measured using a six-item short form of the State-Trait Anxiety Inventory (STAI-6) and the Impact of Event Scale - Revised (IES-r) questionnaire. Ovarian cancer (OC) conversion rates by age, menopausal status and referral pathway. RESULTS Overall, 1355/2596 (52.1%) and 1781/2596 (68.6%) experienced moderate-to-severe distress and anxiety, respectively, at recruitment. Younger age and emergency presentations had higher distress levels. The clinical category for anxiety and distress remained unchanged/worsened in 76% of respondents at 12 months, despite a non-cancer diagnosis. The OC rates by age were 1.6% (95% CI 0.5%-5.9%) for age <40 years and 10.9% (95% CI 8.7%-13.6%) for age ≥40 years. In women referred through fast-track pathways, 3.3% (95% CI 1.9%-5.7%) of pre- and 18.5% (95% CI 16.1%-21.0%) of postmenopausal women were diagnosed with OC. CONCLUSIONS Women undergoing diagnostic testing display severe anxiety and distress. Younger women are especially vulnerable and should be targeted for support. Women under the age of 40 years have low conversion rates and we advocate reducing testing in this group to reduce the harms of testing.
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Affiliation(s)
- Fong Lien Kwong
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - Caroline Kristunas
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Clare Davenport
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ridhi Aggarwal
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London, UK
| | - Sean Kehoe
- St Peter's College, University of Oxford, Oxford, UK
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Tom Bourne
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | | | - Richard Neal
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Usha Menon
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Alex Gentry-Maharaj
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Lauren Sturdy
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ryan Ottridge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sudha Sundar
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Kwong FL, Scerif M, Yap JK. Sentinel lymph node biopsy based on anatomical landmarks and locoregional mapping of inguinofemoral sentinel lymph nodes in women with vulval cancer: an operative technique. J OBSTET GYNAECOL 2023; 43:2207205. [PMID: 37170959 DOI: 10.1080/01443615.2023.2207205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Inguinal lymph node involvement is the most robust predictor of mortality in vulval cancer and sentinel lymph node (SLN) biopsy is a safe diagnostic modality. We describe a technique based on anatomical landmarks. Our aims are (1) to describe the territorial mapping of SLNs, (2) to evaluate the associated complication rate vis-à-vis those reported in the literature, and (3) to assess its accuracy in detecting SLNs. Data from women who underwent groin SLN biopsies for vulval cancer at a single cancer centre were prospectively collected. All subjects met the GROINSS-V eligibility criteria. The location of the SLN relative to the saphenous vein was recorded. All women were followed up and early and late complications were recorded. The recurrence rate at the time of the census was calculated. A total of 71 groins in 44 women were included. The SLN was primarily located over Cloquet's node (85.2%). The incidence of early wound cellulitis and dehiscence were 2.8% and 11.3% while lymphocysts were present in 11.3% of groins. The negative nodal recurrence rate was 1.7%. Results showed that this reproducible technique allows access to 96.7% of SLNs, including both deep and superficial SLNs whilst minimising the need for extensive dissection and complications associated with overharvesting of lymph nodes.
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Affiliation(s)
- Fong Lien Kwong
- PanBirmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Miski Scerif
- PanBirmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - Jason Kw Yap
- PanBirmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
- University of Birmingham, Birmingham, UK
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Kwong FL, Davenport C, Sundar S. Evaluating the Harms of Cancer Testing-A Systematic Review of the Adverse Psychological Correlates of Testing for Cancer and the Effectiveness of Interventions to Mitigate These. Cancers (Basel) 2023; 15:3335. [PMID: 37444445 DOI: 10.3390/cancers15133335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Several studies have described the psychological harms of testing for cancer. However, most were conducted in asymptomatic subjects and in cancers with a well-established screening programme. We sought to establish cancers in which the literature is deficient, and identify variables associated with psychological morbidity and interventions to mitigate their effect. (2) Methods: Electronic bibliographic databases were searched up to December 2020. We included quantitative studies reporting on variables associated with psychological morbidity associated with cancer testing and primary studies describing interventions to mitigate these. (3) Results: Twenty-six studies described individual, testing-related, and organisational variables. Thirteen randomised controlled trials on interventions were included, and these were categorised into five groups, namely the use of information aids, music therapy, the use of real-time videos, patient navigators and one-stop clinics, and pharmacological or homeopathic therapies. (4) Conclusions: The contribution of some factors to anxiety in cancer testing and their specificity of effect remains inconclusive and warrants further research in homogenous populations and testing contexts. Targeting young, unemployed patients with low levels of educational attainment may offer a means to mitigate anxiety. A limited body of research suggests that one-stop clinics and patient navigators may be beneficial in patients attending for diagnostic cancer testing.
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Affiliation(s)
- Fong Lien Kwong
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Clare Davenport
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Kwong FL, Hamoodi I. Postnatal diagnosis of an occult uterine scar dehiscence after three uncomplicated vaginal births after Caesarean section: A case report. Case Rep Womens Health 2020; 27:e00203. [PMID: 32346520 PMCID: PMC7178318 DOI: 10.1016/j.crwh.2020.e00203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/13/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction The incidence of Caesarean sections has been increasing in the United Kingdom. Obstetricians have become more inclined to offer a trial of a vaginal birth to women following a single uncomplicated Caesarean section due to growing recognition of the high morbidity associated with repeat abdominal surgeries, and the relative rarity of a Caesarean scar defect causing complications at subsequent vaginal deliveries. The diagnosis of a Caesarean scar defect such as a uterine scar dehiscence in the postnatal period still remains elusive due to its vague presentation. An incorrect diagnosis or a delay in diagnosis can lead to unnecessary interventions or delay the management of patient symptoms. Case Presentation A 35-year-old woman with a single Caesarean section and three subsequent uncomplicated vaginal deliveries was diagnosed with an occult scar dehiscence two weeks postnatally. She initially complained of persistent vaginal bleeding and underwent a suction evacuation for suspected retained placental tissue. Her symptoms did not improve, and a CT scan was requested to rule out a uterine perforation following the surgical procedure. The CT scan suggested a uterine dehiscence at the level of the previous scar. As the patient remained clinically well, her symptoms were managed conservatively. She underwent a laparoscopic sterilisation six months later and was discharged as the scar defect had fully resolved. Conclusion Clinicians should remain vigilant about the possibility of an occult scar defect in women with a previous Caesarean section who present with persistent vaginal bleeding and pain in the postnatal period. Bladder flap haematomas over 5 cm raise the possibility of a Caesarean scar defect. Niche formation causes a spectrum of menstrual disorders. Contraception should be offered to all women with a Caesarean scar defect.
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Affiliation(s)
- Fong Lien Kwong
- Northumbria Specialist Emergency Care Hospital, Northumbria Way, Cramlington, Newcastle NE23 6NZ, United Kingdom
| | - Ibraheem Hamoodi
- Northumbria Specialist Emergency Care Hospital, Northumbria Way, Cramlington, Newcastle NE23 6NZ, United Kingdom
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Huang Q, Wu R, Cong S, Yang Q, Kwong FL, Ng DHL. Synthesis and characterization of tetrapod-like Cu-ZnO nanowhiskers prepared by photo-reduction technique. J Nanosci Nanotechnol 2010; 10:5427-5430. [PMID: 21125912 DOI: 10.1166/jnn.2010.1929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Tetrapod-like Cu-ZnO nanowhiskers were synthesized by a photo-reduction technique in an aqueous solution containing Cu2+ ions. The XRD and TEM analyses revealed that the as-prepared ZnO nanowhiskers were covered by Cu coating or surrounded by Cu nanoparticles. Pure Cu nanoparticles were also produced in the solution by increasing the duration of xenon irradiation. These nanoparticles were amorphous and could be converted to crystalline structure by further electron beam irradiation. The photoluminescence measurement showed that the visible emission from the Cu-coated ZnO nanowhiskers had a blue shift when compared with that of the pure ZnO.
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Affiliation(s)
- Qingwu Huang
- Key Laboratory of Hubei Province for Ceramics and Refractories, Wuhan University of Science and Technology, Wuhan 430081, China
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