Saroj Rajan

Multimodal Prehabilitation in Indian Women with Advanced Ovarian Cancer: Enhancing Nutritional, Psychological, and Surgical Recovery

Malnutrition is common among women with gynecologic cancers, particularly advanced ovarian cancer, and adversely impacts treatment tolerance, surgical recovery, and quality of life. The neoadjuvant chemotherapy (NACT) phase provides a unique opportunity to introduce prehabilitation interventions to improve perioperative outcomes. To evaluate the feasibility and impact of a culturally tailored, home-based multimodal prehabilitation program on perioperative outcomes in Indian women with advanced ovarian cancer undergoing NACT.  Methods: Sixty women planned for NACT were enrolled and allocated to either a prehabilitation group (n = 30) or control group (n = 30). The intervention include yoga-based physiotherapy, individualized nutritional counseling, and psychological support. Outcomes assessed pre- and post-NACT included body mass index (BMI), hemoglobin, serum albumin, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), skeletal muscle index (SMI), Hospital Anxiety and Depression Scale (HADS) scores, in each group and between group comparisons of perioperative outcomes. Both groups showed significant within-group improvements in nutritional and inflammatory markers. Between-group comparisons revealed a smaller decline in BMI (-1.29 vs. -4.51; p < 0.001) and a greater reduction in HADS scores (-4.5 vs. -1.5; p =0.013) in the prehabilitation group. Hospital stay was significantly shorter in the prehabilitation group (median: 4 vs. 5.5 days;  p = 0.005), while reductions in intraoperative blood loss and postoperative complications did not reach statistical significance. Greater physiotherapy session attendance correlated with reduced BMI loss (ρ = -0.4187, p = 0.022). Multivariable analysis showed that prehabilitation and physiotherapy adherence were associated with smaller BMI declines, and prehabilitation reduced the odds of prolonged hospitalization. Implementing a culturally adapted multimodal prehabilitation program is feasible and improves short-term nutritional, psychological, and perioperative outcomes in women undergoing NACT for advanced ovarian cancer.

Cachexia in gynecologic cancers: The role of biomarkers and cachexia index

Abstract Background Cancer cachexia, a metabolic syndrome causing muscle loss, inflammation, and malnutrition, adversely affects prognosis and treatment in cancer patients. Despite extensive studies in other malignancies, cachexia remains underexplored in gynecologic cancers, particularly in India. This study evaluates the cachexia index (CXI) in gynecologic cancer patients and its association with Activin A and Myostatin. Methods In this prospective observational study, 160 women with gynecologic malignancies were assessed for cachexia using Fearon's criteria, the global leadership initiative on malnutrition (GLIM) definition, and CXI, which integrates skeletal muscle index (SMI), albumin, and neutrophil‐to‐lymphocyte ratio (NLR). Serum Activin A and Myostatin were measured via enzyme‐linked immunosorbent assay. A subgroup of 30 ovarian cancer patients received nutritional and physical prehabilitation, with biomarker reassessment post‐intervention. Results Cachexia prevalence was 22.50% (Fearon's) and 56.25% (GLIM). The median CXI was 56.74, with 33.75% having CXI &lt; 41, indicating severe cachexia. CXI &lt; 41 was correlated with advanced disease ( P  = 0.000), lower body mass index ( P  = 0.034), reduced SMI ( P  = 0.000), and elevated inflammatory markers. Activin A was significantly higher in severe cachexia ( P  = 0.024), while Myostatin showed no correlation. Prehabilitation significantly improved CXI ( P  = 0.0001) and reduced Activin A and Myostatin ( P  = 0.0003, P  &lt; 0.0001). In multivariable analysis, platelet‐to‐lymphocyte ratio emerged as the only independent predictor of low CXI (odds ratio 1.0145; 95% confidence interval 1.0081–1.0210; P  &lt; 0.001), while Activin A showed a trend toward significance ( P  = 0.088). Conclusion CXI provides a comprehensive cachexia assessment in gynecologic cancers. Elevated Activin A is linked to muscle degradation. Prehabilitation improves CXI and reduces cachexia biomarkers, emphasizing its therapeutic potential. Further validation of CXI and biomarkers may enhance cachexia diagnosis and management.

Reproductive outcomes following chemotherapy for gestational trophoblastic neoplasia: experience from a tertiary care center

Gestational trophoblastic neoplasia (GTN) affects reproductive-age women and is highly chemosensitive, with excellent survival outcomes. However, concerns remain regarding the impact of chemotherapy-particularly multiagent regimens-on reproductive and menstrual health. This retrospective, observational study included 78 women treated for GTN between 2011 and 2022. Data on demographics, disease characteristics, treatment history, menstrual changes, fertility outcomes, and pregnancy course were collected from medical records and patient interviews. Comparative analysis was performed between women who received single-agent (Group I) and multiagent chemotherapy (Group II). Logistic regression was used to identify independent predictors of live birth. The median age was 28 years (range: 17-71, IQR: 24-34). Of the 78 women, 30 (38.5 %) received single-agent and 48 (61.5 %) received multiagent chemotherapy. Menstrual abnormalities occurred in 14.1 % overall (13.3 % in Group I vs. 14.6 % in Group II; p = 0.99). Post-treatment, 35 women (44.8 %) conceived, and 30 (38.5 %) achieved at least one live birth. Cesarean delivery occurred in 46 % of live births. Among women desiring pregnancy, 20.5 % reported infertility. On logistic regression, age (OR 0.77; p = 0.009) and receipt of ≤7 cycles of combination chemotherapy (EMACO) (OR 6.03; p = 0.043) were significantly associated with live birth. Chemotherapy type was not an independent predictor. Most GTN survivors retain reproductive potential, regardless of chemotherapy type. Younger age and lower chemotherapy burden were associated with higher chances of live birth. These findings support fertility preservation counseling and tailored follow-up, particularly for high-risk patients undergoing multiagent chemotherapy.