Nicha Assavapokee

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.

Practice guideline for management of endometrial cancer in Thailand: a Thai Gynecologic Cancer Society consensus statement

The Thai Gynecologic Cancer Society (TGCS) continues its efforts to elevate the standard of practice of gynecologic oncologists across all regions of Thailand. A key initiative involves collaborating with the Royal Thai College of Obstetricians and Gynaecologists and the National Cancer Institute, Thailand to regularly update and release clinical practice guidelines (CPGs) for gynecologic cancer. The TGCS released the first CPG for endometrial cancer (EMC) in 2011. Following significant advancements in disease understanding and the major revision of EMC staging by the International Federation of Gynecology and Obstetrics in 2023, national experts collaborated to update the guideline for EMC. The key components of the CPG for EMC covered screening, diagnostic indications and methods, primary treatment including surgical approaches and procedures, pathological processes, adjuvant therapies, and the management of recurrent and advanced diseases through medical or surgical means. The guideline was based on scientific evidence, recommendations from international organizations, and the unique healthcare context of Thailand. The final version reflects a consensus reached through extensive discussions among TGCS members. To share our work with international organizations and healthcare professionals, an English version of the CPG was developed. While it mirrors the content of the Thai version, it differs in length and level of detail. The English version additionally included the level of evidence and a recommendation summary for each section, reflecting common domestic practices, available resources, and coverage under health reimbursement systems.

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.