Anders Tolver

Assessing ovarian cancer via laparoscopic video: inter-rater and intra-rater reliability

Ovarian Cancer is often diagnosed at an advanced stage. Central to treatment is a correct initial assessment and the probability of complete resection of visible cancer. The predictive index value (PIV) is a validated tool for laparoscopic procedures, assessing the chance of complete resection by evaluating 7 intra-abdominal areas. The final PIV determines the type of treatment to which women with ovarian cancer are referred. Gynecologic oncologists perform the procedure and assessment, and agreement and correct staging are essential. This study examines the agreement among gynecologists when assessing videos using the PIV. Laparoscopic videos were collected from October 2021 to January 2024, comprising 20 videos, of which 5 were duplicated. Each video was edited by a gynecologic oncologist, representing the seven intra-abdominal areas according to the PIV model. Eight gynecologic oncologists, eight gynecologists specialized in benign conditions, and eight residents in gynecology were invited to assess the videos using the PIV. The ratings from the participants were examined according to laparoscopic real-time scores. Inter-rater and intra-rater agreement were quantified using kappa statistics. Twenty-one individuals participated in the study. Correct assessment of intra-abdominal areas, that is, agreement with laparoscopic real-time scores, ranged from 58.4% to 81.7%. The probability of correct scores among groups of gynecologists ranged from 34% (95% CI 14.9 to 60.2) to 98.9% (95% CI 95.9 to 99.7), with the highest scores among gynecologic oncologists. The inter-rater agreement of all participants ranged from moderate to substantial agreement (Light κ = 0.436-0.624). For specific intra-abdominal sites, it ranged from fair to perfect agreement (Light κ = 0.181-0.829). Assessing ovarian cancer based on videoclips was challenging, even for specialists in gynecologic oncology, indicating that edited videos reduce accuracy in evaluating disease burden. Gynecologic oncologists achieved the highest scores among all groups, suggesting that specialized training and knowledge improve consistency and that the assessment should remain an expert task.

Systematic nurse-led consultations based on electronic patient-reported outcomes for women with endometrial or ovarian cancer during chemotherapy—a feasibility study

Abstract Purpose This study aimed to investigate the feasibility of nurse-led consultations based on ePRO for women with endometrial or ovarian cancer receiving chemotherapy. Methods This was a prospective single-cohort feasibility study. The patients responded to weekly ePRO using the Elekta Kaiku platform, which was adapted to Danish. At selected time points during chemotherapy, nurses conducted nurse-led consultations replacing physicians. The primary outcome was the patient completion rate of ePRO reporting in the Elekta Kaiku platform. Secondary outcomes included assessing safety, acceptability, practicability, usability, patient satisfaction with ePRO, and patient symptom burden. Results Twenty patients were included, with a mean age of 59 years. A total of 320 ePRO reports were received, equivalent to an ePRO response of 18 times per patient during six cycles of chemotherapy. The results showed a high weekly completion rate (87%), high patient satisfaction with ePRO, and a continuous high symptom burden. Nurse-led consultations achieved a success rate of 55% in adhering to scheduled appointments. The primary contributing factors to this issue were the inadequate internal workflows and the complex symptom burden experienced by the patients. Conclusion This study indicates that weekly ePRO reporting in conjunction with nurse-led consultations may be feasible in this population. The use of ePRO revealed a high level of symptoms reported by patients throughout the treatment cycles. The results emphasize the importance of clinicians in proactively and systematically intervening at an early stage to prevent symptom escalation. However, the small sample size limits the generalizability of this study. Trial registration This study was registered at the Capital Region of Denmark (P-2021–179) and approved the 10/03/2021. ClinicalTtrials.gov ID: NTCC04945187.