Seema Singhal

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.

Patterns of care for vulvar cancer and insights from revised FIGO staging: a retrospective study

The objective of this study was to evaluate the clinicopathological characteristics and patterns of care among women diagnosed with vulvar malignancy at a tertiary care teaching institute. Additionally, the study aimed to analyse the implications of revised FIGO staging system on stage shift and patient outcomes. A retrospective observational study was conducted, wherein hospital records of biopsy-proven cases of vulvar cancers managed over a period of 10 years were comprehensively reviewed. The assignment of FIGO staging was performed utilizing both 2009 and 2021 FIGO staging systems for comparative analysis. Statistical analysis was performed using STATA version 17. Survival curves were constructed using the Kaplan-Meier method, with differences assessed using the log-rank test. Additionally, multivariable analysis was conducted using the Cox proportional hazard model. A total of 82 cases meeting the inclusion criteria were enrolled in the study. Management patterns varied widely, with the majority undergoing surgery (73.2%), followed by definitive radiotherapy with or without chemotherapy (10.9%), neoadjuvant radiotherapy and subsequent surgery (4.9%), and palliative care (10.9%). Post-operative radiotherapy was administered in 31.7% of cases. The disease-specific recurrence rate was found to be 32.9%, and the mortality rate was 30.5%. The median Disease-Free Survival (DFS) was 17 months (interquartile range [IQR]: 1-36 months), while the Overall Survival (OS) was 27 months (IQR: 9-52 months). Upon application of the 2021 staging system, a stage shift was observed in 18% of cases of advanced vulvar cancer. The 3-year DFS and OS were reduced for stage IIIA and stage IVA, while showing improvement for stage IIIB. The revised FIGO 2021 staging system offers enhanced simplicity in its application within clinical practice and demonstrates improved correlation with prognosis. Approximately 18% cases experienced restaging under the updated system. Not applicable.

Evaluating The Feasibility and Acceptability of Cervical Cancer Screening in an Urban Slum Community by HPV Self-Sampling With the Aid of Telecounselling: Lessons Learnt

HPV testing is the most sensitive method of secondary cervical cancer prevention and the preferred method recommended by the World Health Organization. To increase cervical cancer screening, self-sampling has been introduced, which has shown significant results in improving access and simplifying screening for large and remote populations in low- and middle-income countries. This study aims to evaluate the feasibility and acceptability of HPV self-sampling in an urban slum community using tele-counselling, which is a niche population for HPV positivity and HPV-related diseases. This study is a community-based, prospective, single-arm design. Women were counselled telephonically about the methods of self-sampling, and HPV self-sampling kits were couriered to them. The collected kits were returned via courier and tested at the study site. In the case of a positive test result, the individual was linked to treatment at the study center. Test positives were offered either a 'see and treat' approach or colposcopy triage. In the community, 982 women were enrolled in the study, but only 600 (61%) women consented to screening by HPV self-sampling. Ninety-six (15.6%) out of 600 women tested positive for Hr-HPV. Age, educational status, locality, occupation, menopausal status, and smoking status were similar in both screen-negative and screen-positive groups. Among the 600 women, 570 (95%) found it easy to take a self-sample, and 588 (98%) were satisfied with the overall experience. CIN I was found in 6 (6.4%), and CIN II was found in 4 (4.3%) cases. LEEP was performed in patients diagnosed with CIN II. HPV self-sampling is an acceptable method of cervical cancer screening, with an acceptance rate of 61% among urban slum women. It demonstrates that HPV self-sampling is feasible when supported by tele-counselling.