Kam Singh

The Impact of Gestational Trophoblastic Neoplasia Following the Completion of Treatment: A Descriptive Exploratory Qualitative Study

ABSTRACT Aims To explore women's experience of the period after completion of cancer treatment for gestational trophoblastic neoplasia (GTN): a descriptive exploratory study. Design A descriptive exploratory qualitative study. Methods Women diagnosed with the rare pregnancy‐related cancer GTN who had completed their treatment participated in semi‐structured telephone interviews. Twenty‐two interviews were conducted in June 2024 and digitally recorded and transcribed verbatim. The analysis used reflective thematic analysis. Results Complex responses to treatment completion were revealed, described by some as a ‘double‐edged sword’. The end of treatment routine, coupled with recovery from physical effects, left space for the impact of all they had experienced to ‘hit home’. Multiple concerns and losses were described, including issues relating to pregnancy, self‐identity, confidence, fear of recurrence, work and relationships. Gaps in immediate post‐treatment support services created challenges for recovery. Conclusion The study provides valuable insight into the physical, emotional and social impact of GTN experienced by patients following treatment. The findings highlight the importance of continuing support in the immediate post‐treatment period. This study has identified ways in which services can be improved, recognising the need for an individual‐tailored approach to reflect the complex responses of patients to treatment completion. Impact The findings reveal that many women begin to process the implications of their diagnosis and treatment following the completion of their treatment. The end of treatment can be a time when support from healthcare staff is reduced due to fewer routine contacts with healthcare staff. However, these findings suggest the need for nurses to ensure services continue to provide support during the post‐treatment recovery phase. Patient or Public Contribution The interview schedule was reviewed by women previously treated for GTN.

Atypical placental site nodules: A retrospective case series

Abstract Introduction Atypical placental site nodule (APSN) is a rare diagnosis, representing remnants of a previous pregnancy and extravillous trophoblast tissue. These lesions are potential precursor lesions to rare forms of Gestational trophoblastic neoplasia (GTN). Recent data suggest up to a 15% risk of malignancy occurring either concurrently or manifesting within a few months of diagnosis. These patients are often young with future fertility considerations. Prognosis, treatment, and clinical follow‐up of APSN cases currently remain a matter of debate. This study aimed to address and explore some of these issues. Material and Methods Retrospective case series analysis was performed between 1st January 2000 and 31st December 2023 at the Sheffield Trophoblastic Disease Centre, Sheffield, UK. Patients on conservative management were asked at routine follow‐up telephone consultations if they would consider a completion hysterectomy in light of the risk of progression to GTN. Results Twenty‐two cases of APSN were registered, of which 10 (45%) received surgical management. Two (20%) cases were incidentally diagnosed following total abdominal hysterectomy (TAH) for other indications and eight (80%) had a TAH within twelve months of their initial diagnosis as part of primary management. None had histological evidence of GTN. Of the twelve (55%) patients initially opting primarily for conservative management, three (25%) decided to have a TAH performed based on the current evidence for risk of malignant transformation, eight (67%) indicated they would have a TAH based on advice from the center, and one (8%) was uncertain. No patients were diagnosed with GTN. Conclusions In this study, we found no evidence of malignant transformation in our patients, which conflicts with other published data conferring an 11%–14% risk of malignant transformation. An international consensus opinion needs to be reached within the Gestational trophoblastic community regarding the optimal advice, management, and follow‐up regimens for patients diagnosed with APSN.