Ingvild Vistad

Advanced endometrial cancer: New medical treatment options on the horizon

Preferences for follow up in long‐term survivors after cervical cancer

AbstractIntroductionAn increasing number of cervical cancer survivors combined with lack of data on the efficacy of long‐term surveillance, challenges existing follow‐up models. However, before introducing new follow‐up models, cervical cancer survivors’ own views on follow up are important. We aimed to explore preferences for follow up in long‐term cervical cancer survivors and their associations with self‐reported late‐effects.Material and methodsIn 2013, we mailed 974 Norwegian long‐term cervical cancer survivors treated during 2000‐2007 a questionnaire with items covering preferences for follow up after treatment, clinical variables and validated questionnaires covering anxiety, neuroticism and depression.ResultsWe included 471 cervical cancer survivors (response rate 57%) with a median follow up of 11 years. In all, 77% had FIGO stage I disease, and 35% were attending a follow‐up program at the time of survey. Of the patients, 55% preferred more than 5 years of follow up. This was also preferred by 57% of cervical cancer survivors who were treated with conization only. In multivariable analyses, chemo‐radiotherapy or surgery with radiation and/or chemotherapy (heavy treatment) and younger age were significantly associated with a preference for more than 5 years’ follow up. Late effects were reported by more than 70% of the cervical cancer survivors who had undergone heavy treatment.ConclusionsOur study reveals the need for targeted patient education about the benefits and limitations of follow up. To meet increasing costs of cancer care, individualized follow‐up procedures adjusted to risk of recurrence and late‐effects in cervical cancer survivors are warranted.

Long‐term quality of life, vulvar symptoms, and sexual functioning: A cross‐sectional study of Norwegian vulvar cancer survivors

AbstractIntroductionVulvar cancer survivors are at risk of experiencing impaired health‐related quality of life and sexual functioning after treatment. However, studies on survivorship challenges, particularly several years after treatment, are scarce. Our aim was to assess health‐related quality of life in Norwegian vulvar cancer survivors more than 5 years after treatment and to compare reported vulvar symptoms and sexual functioning with women from a normative sample of the general Norwegian female population.Material and MethodsPatients treated primarily for early‐stage vulvar squamous cell carcinoma at the Norwegian Radium Hospital between 2006 and 2016 were invited to participate. Health‐related quality of life, vulvar symptoms, and sexual functioning were assessed using the EORTC QLQ‐C30 and EORTC QLQ‐VU34. To recruit a normative sample, the EORTC QLQ‐VU34 was also distributed to a sample of Norwegian women with no prior history of cancer. EORTC QLQ‐C30 scores among vulvar cancer survivors were compared to “thresholds for clinical importance.” EORTC QLQ‐VU34 scores among cancer survivors were compared to those of the normative sample.ResultsA total of 44 (57%) of 77 vulvar cancer survivors completed the questionnaires, and 334 women from the general population were included for the normative sample. A considerable proportion of cancer survivors reported clinically relevant problems: 43% reported impaired physical functioning, while 30% experienced impaired emotional, cognitive, and social functioning. Genital and groin symptoms were significantly more common among cancer survivors than among women in the normative sample. Fewer vulvar cancer survivors were sexually active (9/44 (20%) versus 232/334 (69%)) and they reported a higher degree of sexual dysfunction compared to the normative sample.ConclusionsVulvar cancer survivors reported impaired health‐related quality of life even several years after treatment. Vulvar complaints and impaired sexual functioning were more common among vulvar cancer survivors than among women from the normative sample.

Time trends in human papillomavirus prevalence and genotype distribution in vulvar carcinoma in Norway

AbstractIntroductionApproximately 25%–43% of all vulvar carcinomas are associated with human papillomavirus (HPV). In many countries, vulvar carcinoma incidence rates are increasing, possibly due to greater HPV exposure. However, studies exploring changes in HPV prevalence and genotype distribution in vulvar carcinoma over time are scarce. Our aim was to evaluate time trends in HPV prevalence and genotype distribution in vulvar squamous cell carcinoma in an unselected, nationwide sample of Norwegian women. Further, we explored clinical and histopathological aspects in relation to HPV status and investigated whether HPV status was associated with survival.Material and methodsAll vulvar squamous cell carcinoma cases from 1970–1975 and 2000–2005 were extracted from the Cancer Registry of Norway and corresponding tissue blocks were retrieved. After detailed histology review, HPV testing was conducted using real‐time TaqMan PCR. Overall survival rates were calculated using the Kaplan–Meier method. Multivariable Cox regression analysis was performed to estimate hazard ratios adjusted for age at diagnosis, stage and diagnostic period.ResultsHistological review was performed on 352 vulvar squamous cell carcinoma cases. We were able to obtain valid HPV analysis results for 282 cases, Overall, 29.8% (95% CI 24.5%–35.5%) of cases were high‐risk HPV (hrHPV)‐positive. When comparing the two periods, we found that the percentage of hrHPV‐positive tumors increased significantly from 23% (95% CI 16.0%–31.4%) in 1970–1975 to 35.3% (95% CI 27.8%–43.3%) in 2000–2005 (P = 0.025). The predominant genotypes were HPV 16 (73%), HPV 33 (21%), and HPV 18 (6%), with similar distributions in both periods. In the more recent cohort, several additional genotypes were detected: HPV 6, 11, 39, 45, 52, 58 and 66 were found in smaller percentages, ranging from 1.8% to 3.6%. In univariate analysis, patients with HPV‐positive tumors showed improved overall survival compared with patients with HPV‐negative tumors (hazard ratio [HR] 0.65, 95% CI 0.48–0.86).ConclusionsThe prevalence of HPV in vulvar squamous cell carcinomas in Norway was significantly higher in 2000–2005 than in 1970–1975. The three predominant genotypes were HPV 16, 33 and 18 in both time periods. However, several other HPV genotypes have emerged over the last decades. HPV‐positivity was associated with better overall survival.

Empowerment and quality of life in gynecological cancer survivors: Outcomes from a multicenter quasi‐experimental cohort study from Norway (the LETSGO trial)

AbstractBackgroundIncreasing outpatient demands and unmet patient needs necessitate personalized follow‐up care for cancer survivors. This study investigated whether a self‐management–focused follow‐up model improves empowerment and quality of life (QoL) in gynecological cancer survivors compared to standard follow‐up.MethodsTwelve Norwegian hospitals participated in this cohort study. Patients initiating routine follow‐up after primary treatment were eligible and allocated to either intervention or standard care follow‐up groups based on their treatment hospital. The intervention included nurse‐led consultations using coaching techniques for education on symptom monitoring and healthy lifestyle, alternated with physician‐led consultations and access to a mobile app. Standard follow‐up consisted of physician‐led consultations only. The primary outcome was change in patient empowerment over 12 months, measured with the self‐monitoring and insight domain of the Health Education Impact Questionnaire (heiQ). Secondary outcomes included changes in remaining heiQ domains and QoL. Data were analyzed according to intention‐to‐treat principles using linear mixed effects models.ResultsAmong 741 participants (intervention: 378, standard: 363), baseline characteristics were comparable. At 12 months, no significant differences were observed in self‐monitoring and insight (Δ = 0.02 [95% confidence interval (CI), –0.04 to 0.08]; effect sizes [ES] = 0.29). However, health‐directed activity (Δ = 0.15 [95% CI, 0.04–0.25]; ES = 0.15), emotional well‐being (Δ = 0.12 [95% CI, 0.02–0.20]; ES = 0.15), social functioning (Δ = 5.2 [95% CI, 1.1–9.3]; ES = 0.41), and physical functioning (Δ = 2.5 [95% CI, 0.0–5.0]; ES = 0.20) were significantly more improved in the intervention group.ConclusionLifestyle and Empowerment Techniques in Survivorship of Gynaecologic Oncology follow‐up did not significantly impact self‐monitoring and insight, but positively influenced other survivorship domains, indicating its potential for enhancing self‐management and QoL in gynecological cancer survivors.