Natacha Phoolcharoen

Examining the impact of age on chemotherapy completion in epithelial ovarian, fallopian tube and primary peritoneal cancer: a retrospective cohort study in Thailand

ObjectiveTo explore the difference in chemotherapy completion and reasons for discontinuation between older (≥70 years) and younger (<70 years) patients.DesignRetrospective cohort study.SettingSingle tertiary centre in Thailand.ParticipantsThe patients who received chemotherapy from 1 January 2009 to 30 June 2021 were included and followed up until 30 June 2022. Of the 757 patients with epithelial ovarian, fallopian tube and primary peritoneal cancer (EOC), 108 were in the older group and 649 were in the younger group.Primary and secondary outcome measuresThe difference in chemotherapy completion, the association between younger and older patients and early discontinuation of chemotherapy.ResultsThe proportion of chemotherapy completion was significantly lower in older versus younger patients (84.3% versus 92.6%, p=0.007). Excluding discontinuation due to disease progression, the chemotherapy completion was comparable (93.5 versus 95.7%, p=0.456). Dose reduction and grade 3–4 hematotoxicity occurred more often in the older group. The univariable logistic regression model showed that older age (≥70 years) was significantly associated with early chemotherapy discontinuation (OR 2.39; 95% CI 1.29–4.24). However, after adjusting for potential confounders, age was not significantly associated with early discontinuation (OR 1.20; 95% CI 0.54–2.66). Multiple comorbidities and types of surgery were identified as independent risk factors for chemotherapy discontinuation.ConclusionThe completion of chemotherapy was observed in a majority of older adults with EOC. Age is not the only determinant of chemotherapy completion. Comorbidity and disease status are crucial for determining chemotherapy discontinuation.

Knowledge, attitudes and practices regarding cervical cancer screening among women in the Dindaeng community, Bangkok, Thailand: a cross-sectional community-based study

Objectives To assess knowledge, attitudes and practices regarding cervical cancer screening among women in Bangkok’s Dindaeng community and identify factors influencing screening uptake. Design Cross-sectional, community-based survey. Setting Primary care level; conducted in a high-density, low-income urban community in Bangkok, Thailand. Participants A total of 450 women aged 25–65 years were recruited using convenience sampling. After excluding ineligible participants (eg, prior hysterectomy), 428 women completed the questionnaire. All participants were literate in Thai and resided in the study area. Primary and secondary outcome measures The primary outcome was a history of cervical cancer screening (ever screened vs never screened). Secondary outcomes included frequency of screening, barriers to screening and level of knowledge regarding cervical cancer and human papillomavirus (HPV). Results Among 428 participants (mean age 47.9±11.2 years), 65.4% reported ever having been screened, but only 19.1% adhered to regular screening intervals. The most common barriers to screening were the absence of symptoms (54.7%) and fear of the procedure (42.1%). Only 31.8% correctly identified HPV as the cause of cervical cancer, and 23.8% were aware of the HPV vaccine. Higher knowledge scores were associated with having fewer children (adjusted OR (AOR) = 10.71; 95% CI: 1.29 to 89.12), while oral contraceptive use was negatively associated with high knowledge scores (AOR=0.14; 95% CI: 0.03 to 0.74). Conclusions Despite a moderate rate of screening uptake, consistent adherence and knowledge regarding cervical cancer and its prevention remain suboptimal. Targeted community health education and structural interventions are needed to improve awareness and promote regular screening in low-income urban settings.

Disparities in Human Papillomavirus Vaccination and Cervical Cancer Prevention and Screening Strategies: A Meta-Analysis

Sociodemographic disparities continue to impact access to cervical cancer screening and treatment outcomes. Although advancements in preventive and therapeutic strategies have contributed to reductions in cervical cancer incidence and mortality, inequities in healthcare access remain largely influenced by social gradients and limited health literacy. This study aimed to investigate the influence of factors such as age, race, socioeconomic status, educational attainment, and insurance coverage on cervical cancer mortality and participation in preventive measures, including HPV vaccination and cervical cancer screening. A systematic search of the MEDLINE, EMBASE, and Cochrane databases was conducted through January 2024. Eligible studies examined associations between disparities, defined as differences in race, social determinants of health, treatment modalities, and cervical cancer prevention or mortality. Data were synthesized using a random-effects meta-analysis, supplemented by subgroup analyses and multiple meta-regression models. A total of 69 studies met the inclusion criteria. Screening participation was higher among individuals who were non-Black, had attained higher education levels, were publicly insured, were married, and had a higher income. In contrast, higher cervical cancer mortality rates were observed among individuals who were Black, uninsured, less educated, unmarried, or those who either did not receive treatment or underwent surgery alone. Significant disparities persist in access to cervical cancer prevention services and in mortality outcomes. These findings highlight the urgent need for policy interventions aimed at addressing economic, social, and racial barriers to equitable healthcare access.

Accuracy of Smartphone Images of the Cervix After Acetic Acid Application for Diagnosing Cervical Intraepithelial Neoplasia Grade 2 or Greater in Women With Positive Cervical Screening: A Systematic Review and Meta-Analysis

PURPOSE Smartphones are used in cervical screening for visual inspection after acetic acid or Lugol's iodine (VIA/VILI) application to capture and share images to improve the sensitivity and interobserver variability of VIA/VILI. We undertook a systematic review and meta-analysis assessing the diagnostic accuracy of smartphone images of the cervix at the time of VIA/VILI (termed S-VIA) in the detection of precancerous lesions in women undergoing cervical screening. METHODS This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies from January 1, 2010, to June 30, 2020, were assessed. MEDLINE/PubMed, Embase, CINAHL, Cochrane, and LILACS were searched. Cohort and cross-sectional studies were considered. S-VIA was compared with the reference standard of histopathology. We excluded studies where additional technology was added to the smartphone including artificial intelligence, enhanced visual assessment, and other algorithms to automatically diagnose precancerous lesions. The primary outcome was the accuracy of S-VIA for the diagnosis of cervical intraepithelial neoplasia grade 2 or greater (CIN 2+). Data were extracted, and we plotted the sensitivity, specificity, negative predictive value, and positive predictive value of S-VIA using forest plots. This study was prospectively registered with The International Prospective Register of Systematic Reviews:CRD42020204024. RESULTS Six thousand three studies were screened, 71 full texts assessed, and eight studies met criteria for inclusion, with six included in the final meta-analysis. The sensitivity of S-VIA for the diagnosis of CIN 2+ was 74.56% (95% CI, 70.16 to 78.95; I2 61.30%), specificity was 61.75% (95% CI, 56.35 to 67.15; I2 95.00%), negative predictive value was 93.71% (95% CI, 92.81 to 94.61; I2 0%), and positive predictive value was 26.97% (95% CI, 24.13 to 29.81; I2 61.3%). CONCLUSION Our results suggest that S-VIA has accuracy in the detection of CIN 2+ and may provide additional support to health care providers delivering care in low-resource settings.

Hands-On Training Courses for Cervical Cancer Screening, Diagnosis, and Treatment Procedures in Low- and Middle-Income Countries

In 2018, there were approximately 570,000 new cases of cervical cancer worldwide. More than 85% of cases occurred in low- and middle-income countries (LMICs), primarily because of poor access to screening and a limited number of medical providers trained to diagnose and treat cervical precancerous lesions. Our objective was to provide locally arranged, hands-on training courses for medical providers in LMICs to learn to perform cervical cancer screening, diagnosis, and treatment procedures. The courses included didactic lectures and hands-on training stations using low-cost simulation models developed by bioengineers and students at Rice University in Houston, TX, United States, and the Malawi Polytechnic in Blantyre, Malawi. The hands-on training stations included visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, endocervical curettage, loop electrosurgical excision procedure (LEEP), and thermal ablation. Provider pre- and postcourse confidence levels in performing the procedures were evaluated. From February 2017 to January 2020, we arranged 15 hands-on training courses in seven cities across six countries (El Salvador, Mozambique, Trinidad and Tobago, Lesotho, Malawi, and Nepal). Overall, there were 506 participants. The average number of participants per course was 38 (range 19-92). The participants included doctors, nurses, and midwives. The course duration varied from 1 to 3 days. Increased confidence in performing VIA, colposcopy and cervical biopsy, ablation, and LEEP was reported by 69%, 71%, 61%, and 76% of participants, respectively. Our findings suggest that locally arranged, hands-on cervical cancer prevention training courses in LMICs can improve provider confidence in performing cervical cancer screening, diagnosis, and treatment procedures. These courses are part of a larger strategy to build local capacity for delivering and improving cervical cancer prevention services in LMICs.

Reported adverse events following COVID-19 vaccination in gynecologic cancer patients in Thailand: A descriptive study

Objective Data on the safety of coronavirus disease 19 (COVID-19) vaccines in gynecologic cancer patients are scarce. The type of vaccine used in Thailand differs from what has been studied in other countries. This study evaluated the prevalence and characteristics of reported adverse events following COVID-19 vaccines in patients with gynecologic cancer patients. Method A retrospective, single-center descriptive study was performed in patients with gynecologic cancer who received at least one dose of the COVID-19 vaccine at King Chulalongkorn Memorial Hospital, Thailand, from January 2020 to August 2021. Adverse events were collected through structured telephone interviews using a standardized questionnaire. Descriptive statistics summarized patient characteristics and adverse events. Associations with any-grade adverse events were assessed using logistic regression and Fisher’s exact test for categorical variables. Results Of the 294 patients interviewed, 72.8% were in remission, under surveillance, or in palliative treatment at the time of vaccination, and 17.7% were undergoing treatment. The most common adverse effects were grade 1–2 injection site reactions. One patient developed grade 3 fever and seizures 10 days after the first dose of the AstraZeneca vaccine. Between the second and fourth doses of the vaccination, the most common adverse events were grade 1–2 injection site reactions. No severe allergic reactions or grade 4 adverse events were reported. The study concluded that patients under 60 years of age had more adverse events than older patients (adjusted odds ratio 1.99, 95% confidence interval 1.08–3.71 p = 0.029). The treatment status did not affect adverse events. Of 283 patients who received two doses, 27.6% were infected with COVID-19. Conclusion COVID-19 vaccination was generally well tolerated among gynecological cancer patients who received active anticancer therapy and those under surveillance. Younger patients frequently reported more adverse effects than older patients.