Supportive Care in Cancer

The prognostic and predictive role of pain before systemic chemotherapy in recurrent ovarian cancer: an individual participant data meta-analysis of the North-Eastern German Society of Gynecological Oncology (NOGGO) of 1226 patients

Aim of this study was to analyze the impact of pain on quality of life and survival in recurrent OC patients. Raw data including the QLQ-C30 questionnaire from three phase II/III trials ("Topotecan phase III," "Hector," and "TRIAS") conducted by the North-Eastern German Society of Gynecological Oncology (NOGGO) were synthesized and analyzed using logistic and Cox regression analyses. Data on pain was available for 952 patients out of 1226. Moderate to severe pain, which was defined as pain ≥ 50 in the QLQ-C30 symptom scale, was experienced by more than one-third of patients (36.6%). A total of 31% were taking non-opioid pain medication and 16% opioids. Median age at randomization was 61 years (range 25-84). Most patients (84.7%) were diagnosed in FIGO III/IV. Pain was independent from age, FIGO stage, grading, amount of recurrences, and chemotherapy-free interval. ECOG was significantly worse in patients with pain (p < 0.001). Fatigue, nausea/vomiting, sleeping disorders, and abdominal symptoms such as loss of appetite, diarrhea, and constipation were more frequently found in patients with pain (all p < 0.001). Quality of life was significantly diminished (p < 0.001). Pain was also an independent marker for overall survival (OS). Median OS was 18.2 months in patients with pain compared with 22.0 months in patients without pain (p = 0.013, HR 1.25, 95% confidence interval 1.05-1.48). OS was shorter in patients with pain and without pain medication compared with those on sufficient pain medication, whereas OS was mostly decreased in patients having pain despite pain medication (18.5, 19.6, and 15.0 months respectively; p = 0.026). Progression-free survival and prior treatment discontinuation were not associated with pain. Best supportive care including sufficient pain medication should be delivered as early as possible because effective pain management is crucial for both quality of life and overall survival in patients with recurrent ovarian cancer.

Survivorship care plans and adherence to breast and cervical cancer screening guidelines among cancer survivors in a national sample

Abstract Purpose The impact of the components of survivorship care plans on adherence to cancer screening guidelines among cancer survivors is limited. We examined the association of receipt of treatment summaries, follow-up instructions, and type of doctor providing survivorship care with adherence to breast cancer screening (BCS) and cervical cancer screening (CCS) guidelines in female cancer survivors. Methods A cross-sectional analysis using Behavioral Risk Factor Surveillance System (BRFSS) data from 2014, 2016 and 2018 was conducted. BCS and CCS-eligible women were aged 40–74 and 30–64, respectively. BCS adherence was defined as a mammogram within 2 years and CCS adherence as a pap smear within 3 years or HPV test within 5 years. Univariate analysis with chi-square and multivariable logistic regression are reported. Results 5,001 BCS and 3,014 CCS-eligible survivors were identified. In the BCS group, recipients of treatment summaries and follow-up instructions were significantly more adherent with BCS (84.1% vs. 77.4%; 83.4% vs. 74%, respectively, p &lt; 0.001). In the CCS group, recipients of follow-up instructions were significantly more adherent with CCS (78.1% vs. 67.7%, p &lt; 0.001). In both groups, there was no significant difference in BCS or CCS based on type of physician providing care (p = 0.087). On multivariate analysis, receipt of follow-up instructions was the only factor significantly associated with BCS (OR:2.81; 95%CI:1.76–4.49) and CCS (OR:3.14; 95%CI:1.88–5.23). Conclusions Follow-up instructions, as part of survivorship care plans, have the strongest association with BCS and CCS among female cancer survivors. Additional research should focus on improving the distribution of survivorship care plans, particularly follow-up instructions, as a method to increase BCS and CCS among cancer survivors.

Experience of participating in national home-based medical care project for cancer patients with a temporary stoma: a qualitative study

This study aimed to explore the experiences of cancer patients with a temporary stoma who participated in a home-based healthcare service and to provide data to inform national health system policy development. This exploratory qualitative study involved 10 cancer patients with temporary stomas (five with rectal cancer, two with colorectal cancer, and three with ovarian cancer) recruited through purposive sampling in South Korea. In-depth, semi-structured online focus group interviews were conducted, and data were analyzed using thematic analysis. Four main themes were identified from the interview data: (1) adjusting with changes in daily life owing to the presence of a stoma, (2) skill building while participating in the project, (3) the need for a home-based medical care system during transitional care, and (4) the need for support in adapting to an ostomy. These themes included 12 subthemes. The findings highlight the need for ongoing health education and counseling services at a national level to support post-discharge self-care for cancer patients who had undergone ostomy. Patients with cancer discharged after colostomy surgery require continuous education and practical medical support, suggesting that home-based healthcare services may serve as a valuable alternative to conventional medical care.

Systematic nurse-led consultations based on electronic patient-reported outcomes for women with endometrial or ovarian cancer during chemotherapy—a feasibility study

Abstract Purpose This study aimed to investigate the feasibility of nurse-led consultations based on ePRO for women with endometrial or ovarian cancer receiving chemotherapy. Methods This was a prospective single-cohort feasibility study. The patients responded to weekly ePRO using the Elekta Kaiku platform, which was adapted to Danish. At selected time points during chemotherapy, nurses conducted nurse-led consultations replacing physicians. The primary outcome was the patient completion rate of ePRO reporting in the Elekta Kaiku platform. Secondary outcomes included assessing safety, acceptability, practicability, usability, patient satisfaction with ePRO, and patient symptom burden. Results Twenty patients were included, with a mean age of 59 years. A total of 320 ePRO reports were received, equivalent to an ePRO response of 18 times per patient during six cycles of chemotherapy. The results showed a high weekly completion rate (87%), high patient satisfaction with ePRO, and a continuous high symptom burden. Nurse-led consultations achieved a success rate of 55% in adhering to scheduled appointments. The primary contributing factors to this issue were the inadequate internal workflows and the complex symptom burden experienced by the patients. Conclusion This study indicates that weekly ePRO reporting in conjunction with nurse-led consultations may be feasible in this population. The use of ePRO revealed a high level of symptoms reported by patients throughout the treatment cycles. The results emphasize the importance of clinicians in proactively and systematically intervening at an early stage to prevent symptom escalation. However, the small sample size limits the generalizability of this study. Trial registration This study was registered at the Capital Region of Denmark (P-2021–179) and approved the 10/03/2021. ClinicalTtrials.gov ID: NTCC04945187.

The use of CAM products, practices, and practitioners by long-term endometrial cancer survivors in Australia

The use of complementary and alternative medicines (CAM) has been reported to be frequent and increasing in the general population and among cancer survivors. Very few studies have investigated the use of CAM among long-term endometrial cancer survivors. To address this gap in evidence, this qualitative study aimed to understand the use of CAM and factors motivating the use among long-term survivors of endometrial cancer. Semi-structured qualitative interviews were conducted with 17 women diagnosed with endometrial cancer 7-10 years previously, to understand their CAM use and its impact on their wellbeing. Thematic analysis was performed by two researchers to extract the most relevant quotes related to CAM products, practices, and practitioners. All 17 women interviewed used some type of CAM practices, practitioners, or products, specifically 94% concentrated on their diet, 88% focused on their exercise, 59% used a CAM product, 53% visited a CAM practitioner, and 18% used a CAM psychological approach. The main motivators for CAM use included to reduce physical and psychological symptoms, and to stop or reduce medications. Women reported a lack of lifestyle advice from their traditional medical healthcare team which they therefore tried to obtain from other sources. Our findings suggest CAM practices, practitioners, or products form an important part of women's healthcare options and are commonly used by long-term endometrial cancer survivors. Our data can be of importance to health care professionals and hospitals, as it reflects an unfulfilled need among cancer survivors that does not currently appear to be met by their traditional healthcare team.

Revealing relationships: The role of self-disclosure and marital intimacy in the post-traumatic growth of cervical cancer patients-A qualitative study

Positive psychological changes in cancer patients have been shown to positively influence disease progression and enhance quality of life. Based on this, the present study explores the psychological dynamics facilitating post-traumatic growth (PTG) in cervical cancer patients, specifically examining the roles of self-disclosure and marital intimacy in this process. This was a descriptive qualitative study.Twelve patients with cervical cancer were recruited from Nantong, China to participate in this study. Data were collected between October 2022 and August 2023 and analyzed using Colaizzi's seven-step analysis. In this study, six thematic keywords were extracted: "Traumatic reactions", "Psychological breakdown", "Need for self-disclosure", "Enhanced marital intimacy", "Cognitive restructuring and life changes", and "Current needs and future expectations". Both self-disclosure and marital intimacy played pivotal roles in facilitating PTG among cervical cancer patients. Nurses should focus on fostering positive psychological changes in cervical cancer patients-specifically, self-disclosure and marital intimacy play significant roles in facilitating post-traumatic growth. This suggests that fostering self-disclosure and marital intimacy could be important therapeutic goals to enhance psychosocial well-being and quality of life in cervical cancer patients.

The efficacy of complex decongestive therapy in the treatment of lymphedema associated with endometrial and cervical cancer: evaluation of sensation and balance

Abstract Purpose This study aimed to assess the impact of complex decongestive therapy (CDT) on proprioception, balance, light touch sensation, and two-point discrimination (2PD) in patients with lower extremity lymphedema (LLL) post-endometrial and cervical cancers. Methods The study included 72 patients diagnosed with LLL, who were randomly assigned using a block randomization method into two groups: a study group ( n  = 36) receiving CDT and a control group ( n  = 36) receiving no intervention. Patients were assessed before and after treatment using a digital goniometer for proprioception at 15°, 45°, and 60° knee flexion angles, a single-leg balance test with eyes open and closed, and a 30-s chair-stand test for balance assessment. Sensation was evaluated using Semmes Weinstein Monofilaments for light touch sensation and an aesthesiometer for 2PD. Results Significant improvements were observed in knee flexion at 15°, 45°, and 60° in the study group compared to the control group ( p  &lt; 0.001, p  &lt; 0.001, and p  &lt; 0.001, respectively). Although there was no difference between groups in single-leg balance with eyes open ( p  = 0.074) and closed ( p  = 0.919), improvements were noted within the study group before and after treatment ( p  &lt; 0.001). There was no significant difference between groups in light touch sensation, while the 2PD parameter improved in the study group ( p  = 0.012). Conclusions CDT may not fully address sensory deficits in patients with LLL. Balance issues appear to worsen with lymphedema progression regardless of treatment. However, CDT shows promise in improving kinesthesia. Clinical Trial Registration This is listed with study ID: NCT06204510.

Construction and implementation of a nursing intervention program based on supportive care theory for cervical cancer patients receiving postoperative concurrent chemoradiotherapy

To construct a nursing intervention program based on supportive care theory to address the diverse needs of cervical cancer patients undergoing postoperative concurrent chemoradiotherapy, and to evaluate its effectiveness. The intervention program was developed through a literature review, semi-structured interviews, and expert consultations. A total of 64 cervical cancer patients receiving postoperative concurrent chemoradiotherapy were recruited via convenience sampling from a tertiary hospital in Taiyuan, Shanxi Province, between June and November 2024. Participants were randomly assigned to either the intervention group (supportive care) or the control group (routine care). Outcome measures included the Supportive Care Needs Survey Short-Form 34 (SCNS-SF34), the Chinese version of the M.D. Anderson Symptom Inventory (MDASI-C), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Cervical Cancer Module (EORTC QLQ-CX24), which were assessed at three time points: baseline (pre-intervention), discharge, and 2 months post-discharge. At discharge and 2 months post-discharge, the intervention group reported significantly greater satisfaction with care needs (P < 0.001), reduced symptom severity and interference with daily life (P < 0.05), and improved quality of life (P < 0.05) compared to the control group. The supportive care theory-based nursing intervention effectively addressed the multifaceted needs of cervical cancer patients undergoing postoperative concurrent chemoradiotherapy, significantly improved their quality of life, and has important clinical application value.

A systematic review on the effects of logotherapy and meaning-centered therapy on psychological and existential symptoms in women with breast and gynecological cancer

Abstract Purpose Women diagnosed with breast cancer (BC) and gynecological cancer (GC) face psychological and existential challenges common to all cancers, such as anxiety and depression, along with specific issues related to body image and sexuality. Logotherapy and meaning-centered therapy (MCT) have shown positive effects on the psychological well-being of cancer patients. Methods A systematic review was conducted following PRISMA guidelines to assess the impact of logotherapy and meaning-centered therapy (MCT) on women diagnosed with BC and GC from January 2014 to December 2024. Empirical research articles published in English were included, while literature reviews, meta-analyses, doctoral theses, preprints, books, and studies involving other cancer types or metastatic/comorbid conditions were excluded. The search was conducted across Web of Science, Scopus, and PubMed databases using terms like uterine cancer, ovarian cancer, breast cancer, mastectomy, logotherapy, and MCT. The Boolean operators AND and OR were used in the Title and Abstract search fields across all three databases, as well as in the Topic search field for the WoS database. Results Out of the 36 articles initially obtained, 29 remained after eliminating duplicates and, finally, six papers were selected. The included studies examined various psychological and existential issues in patients with breast and gynecological cancer, including anxiety, distress, depression, hopelessness, death anxiety, post-traumatic stress, perception of physical symptoms, quality of life, post-traumatic growth, spiritual well-being, and meaning in life. Conclusion Findings suggest that logotherapy decreases depressive symptoms, anxiety, and post-traumatic stress, whereas improves meaning in life, quality of life, physical symptom perception, and post-traumatic growth in women with BC and GC. Implementing logotherapy in cancer care units through a multidisciplinary approach could be valuable, considering biopsychosocial factors, and incorporating aspects of self-image and sexuality in treatment would also be beneficial.

Symptom clusters and self-management experiences of cervical cancer patients undergoing concurrent chemoradiotherapy: a qualitative study

To explore symptom clusters, symptom experiences, and self-management strategies in patients with cervical cancer undergoing concurrent chemoradiotherapy. A qualitative descriptive approach was used. Semi-structured interviews were conducted with patients with cervical cancer using an interview guide. The audio recording of the interviews was transcribed. Thematic analysis was conducted using Colaizzi's seven-step framework. Thirteen participants were interviewed. The mean age of the participants was 47 years. Three themes were identified: (a) Struggle for survival among patients reintegrating into society; (b) Overcoming self-management challenges; and (c) Resilience and adaptation in the face of adversity. Individuals diagnosed with cervical cancer who undergo concurrent chemoradiotherapy often experience various clusters of symptoms. Despite facing challenges in self-management, these patients maintain a positive attitude and persistently strive to coexist harmoniously with their health conditions.

Predicting psychological distress in advanced ovarian cancer patients during the COVID-19 pandemic

Abstract Purpose This longitudinal study investigated distress rates in patients with advanced ovarian cancer during the COVID-19 pandemic and examined whether time, illness representations, and coping strategies predicted distress levels. Methods UK patients with stage 3 or 4 ovarian cancer were recruited between September 2020 and March 2021. Data were collected at baseline (T0), 2 months (T1), and 4 months (T2) post-enrolment. Validated questionnaires assessed distress (anxiety, depression, PTSD, fear of progression) and predictors (coping strategies and illness perceptions), analysed via multilevel modelling. Results Seventy-two participants returned a questionnaire at T0, decreasing to 49 by T2. High distress was observed, with over 50% of participants experiencing anxiety and depression consistently. Nearly 60% reported clinical levels of fear of progression at some point. PTSD rates resembled the general population. Although distress levels remained stable over time, some individual variability was observed. Time had minimal effect on distress. Coping strategies and illness perceptions remained stable. Threatening illness perceptions consistently predicted distress, while specific coping strategies such as active coping, acceptance, self-blame, and humour predicted various aspects of distress. Together, these factors explained up to half of the distress variance. Conclusion The findings have implications for routine screening for distress and the inclusion of psychological treatment pathways in advanced ovarian cancer care. Addressing illness representations is crucial, with attention to informational support. Future research should explore the long-term effects of heightened distress and the effectiveness of interventions targeting illness perceptions. This study informs current clinical practice and future pandemic preparedness in cancer care.

“It doesn’t really apply to what I’m going through”: a mixed-methods study of barriers to palliative care among patients with advanced ovarian cancer

Palliative care aims to provide symptom relief and general support for patients with serious illness. Despite experiencing significant treatment side effects, specialty palliative care is under-utilized by patients with advanced ovarian cancer. We explored barriers to palliative care in this population. We conducted a sequential mixed-methods study. Qualitative: we interviewed patients with advanced ovarian cancer (N = 7). Guided by the Social Ecological Model (SEM), interviews assessed intrapersonal, interpersonal, organizational, and policy-level barriers to receipt of specialty palliative care. Interviews were audio-recorded, transcribed, and analyzed with directed content analysis. Quantitative: patients with advanced ovarian cancer (N = 38) completed self-report surveys assessing knowledge about, attitudes towards, and prior experiences with specialty palliative care. Descriptive statistics were used to characterize survey responses. Qualitative analysis identified barriers to specialty palliative care at each SEM level. Intrapersonal factors (e.g., knowledge, attitudes) were most frequently discussed. Other common barriers included insurance coverage and distance/travel time. Survey responses indicated most participants were aware of palliative care (74%) but had mixed attitudes towards palliative care and did not feel they needed for palliative care. No survey respondents had received a physician recommendation for palliative care, and a sizable minority (29%) thought palliative care referral should only take place when patients have no remaining treatment options. Among patients with advanced ovarian cancer, barriers to specialty palliative care exist at multiple levels. Our results underscore the potential value of a multilevel intervention to support receipt of palliative care in this population.

Association of prognostic nutritional index with muscle loss and survival in patients with ovarian cancer treated with primary debulking surgery and chemotherapy

Sarcopenia is prevalent in ovarian cancer and contributes to poor survival. This study is aimed at investigating the association of prognostic nutritional index (PNI) with muscle loss and survival outcomes in patients with ovarian cancer. This retrospective study analyzed 650 patients with ovarian cancer treated with primary debulking surgery and adjuvant platinum-based chemotherapy at a tertiary center from 2010 to 2019. PNI-low was defined as a pretreatment PNI of < 47.2. Skeletal muscle index (SMI) was measured on pre- and posttreatment computed tomography (CT) at L3. The cut-off for the SMI loss associated with all-cause mortality was calculated using maximally selected rank statistics. The median follow-up was 4.2 years, and 226 deaths (34.8%) were observed. With a median duration of 176 days (interquartile range: 166-187) between CT scans, patients experienced an average decrease in SMI of 1.7% (P < 0.001). The cut-off for SMI loss as a predictor of mortality was - 4.2%. PNI-low was independently associated with SMI loss (odds ratio: 1.97, P = 0.001). On multivariable analysis of all-cause mortality, PNI-low and SMI loss were independently associated with all-cause mortality (hazard ratio: 1.43, P = 0.017; hazard ratio: 2.27, P < 0.001, respectively). Patients with both SMI loss and PNI-low (vs. neither) had triple the risk of all-cause mortality (hazard ratio: 3.10, P < 0.001). PNI is a predictor of muscle loss during treatment for ovarian cancer. PNI and muscle loss are additively associated with poor survival. PNI can help clinicians guide multimodal interventions to preserve muscle and optimize survival outcomes.

Predictors of the 6-min walk test in patients with ovarian cancer

To identify the predictors of the 6-min walk test (6MWT) and investigate the relationship between 6MWT, performance status, functional mobility, fatigue, quality of life, neuropathy, physical activity level, and peripheral muscle strength in patients with ovarian cancer (OC). Twenty-four patients diagnosed with stage II-III ovarian cancer were included in the study. Patients were assessed using the following measurement methods: 6MWT for walking capacity, Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) for performance status, an armband physical activity monitor for physical activity level, Checklist Individual Strength (CIS) for fatigue, Functional Cancer Treatment Evaluation with Quality of Life-Extreme (FACT-O) for quality of life, Functional Evaluation of Cancer Treatment/Gynecological Oncology-Neurotoxicity (FACT/GOG-NTX) for neuropathy, a hand-held dynamometer for peripheral muscle strength, and 30-s chair-stand test for functional mobility. The mean 6MWT distance was 578.48 ± 115.33 meters. 6MWT distance correlated with ECOG-PS score (r = -0.438, p = 0.032), handgrip strength (r = 0.452, p= 0030), METs (r = 0.414, p = 0.044) 30s-CST (r= 0.417, p= 0.043), and neuropathy score (r = 0.417, p = 0.043) significantly. There was no relationship between 6MWT distance and other parameters (p> 0.05). Multiple linear regression analysis demonstrated that performance status was the sole predictor of 6MWT. The walking capacity seems to be associated with performance status, peripheral muscle strength, level of physical activity, functional mobility, and severity of neuropathy in patients with ovarian cancer. Evaluating these may help clinicians to understand factors behind the decreased walking capacity.

Impact of alexithymia on suicidal ideation among patients with ovarian cancer: a moderated mediation model of self-perceived burden and general self-efficacy

Suicidal ideation (SI) and alexithymia are common psychological problems among patients with cancer. Studying how alexithymia predicts SI is helpful for its intervention and prevention strategies. The present study aimed to investigate whether self-perceived burden (SPB) mediates the impact of alexithymia on SI and if general self-efficacy moderates the associations of alexithymia with SPB and SI. To measure SI, alexithymia, SPB, and general self-efficacy, 200 patients with ovarian cancer at all stages regardless of the type of treatment completed the Chinese version of the Self-Rating Idea of Suicide Scale, Toronto Alexithymia Scale, Self-Perceived Burden Scale, and General Self-Efficacy Scale in a cross-sectional study. The PROCESS macro for SPSS v4.0 procedure was applied to perform moderated mediation analysis. SPB significantly mediated the positive impact of alexithymia on SI (a×b = 0.082, 95% confidence interval [CI]: 0.026, 0.157). General self-efficacy significantly moderated the positive association between alexithymia and SPB (β = -0.227, P < 0.001). The mediating role of SPB was gradually reduced as general self-efficacy grew (low: 0.087, 95% CI: 0.010, 0.190; medium: 0.049, 95% CI: 0.006, 0.108; high: 0.010, 95% CI: -0.014, 0.046). Thus, a moderated mediation model involving SPB and general self-efficacy for explaining how alexithymia causes SI was supported. Alexithymia could cause SI by inducing SPB among patients with ovarian cancer. General self-efficacy could attenuate the association between alexithymia and SPB. Interventions aimed at reducing SPB and enhancing general self-efficacy could reduce SI by partially preventing and attenuating the impact of alexithymia.

A comparison of three preoperative nutritional assessment methods for predicting ovarian cancer patient prognosis: which is better?

The study aimed to compare the predictive values of three widely used nutritional assessment methods, body mass index (BMI), Nutritional Risk Screening 2002 (NRS 2002), and the prognostic nutritional index (PNI), for different clinical prognostic indicators of ovarian cancer patients. Patients diagnosed with ovarian cancer treated in our hospital between January 2017 and March 2019 were retrospectively included. The three nutritional assessment methods were assessed, and multivariable analysis was conducted to explore predictive factors for clinical prognoses. Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUROC) were generated to evaluate the discriminative abilities of the three nutritional assessment tools. A total of 442 patients were recruited. Multivariable analysis revealed that the PNI value predicted 1-year death and 1-year recurrence and that both the NRS 2002 score and the PNI value predicted 30-day readmission (P < 0.05). For PNI, AUROCs were 0.834 for predicting 1-year death and 0.719 for 1-year recurrence prediction; for NRS, the AUROC was 0.820 2002 for predicting 30-day readmission. The optimal cutoff values that maximized the prognostic prediction ability were PNI values of 47.75 g/L and 50.40 g/L for 1-year death and 1-year recurrence, respectively, and an NRS 2002 score of 3 points for 30-day readmission following discharge. For ovarian cancer patients, the PNI is better at predicting 1-year death and 30-day readmission after discharge, and the NRS 2002 is superior for predicting 1-year recurrence.

Resistance exercise dose effects on muscle morphology, muscle function and quality of life in advanced-stage ovarian cancer survivors

Abstract Aim Advanced-stage ovarian cancer survivors often have compromised muscle morphology (muscle mass and density), muscle function (muscle strength and physical function), and health-related quality of life (HRQoL). We recently reported improvements in these outcomes following resistance training. Information on the resistance exercise dose required to improve health-related outcomes is still lacking in this cancer group. Here we examined the exercise dose delivered and the effect of the delivered dose on changes in outcomes of interest. Methods Twelve women with stage III or IV ovarian cancer completed a 12-week supervised resistance exercise intervention. Exercise metrics included compliance (exercise dose completed), dose modifications (sessions modified) and tolerance (rating of perceived exertion; RPE). Participants were allocated to lower (&lt; 63%) or higher (&gt; 63%) exercise compliance based on median split. Differences in change to muscle morphology, muscle function and HRQoL between compliance groups were investigated. Results Median compliance and session RPE were 63.0% and 13 (somewhat hard), respectively. Dose reductions occurred in 92.7% of sessions. Both groups experienced improvements in muscle morphology and function. Higher compliance was associated with greater improvements in whole body lean mass (+ 1.3 kg vs. + 0.5 kg) and lower body strength (+ 50 kg vs. + 13 kg). Only the lower compliance group experienced a clinically significant improvement in 400-m walk time (-48.4 s vs. -9.4 s). Both groups experienced clinically meaningful improvements in social and cognitive functioning. Conclusion Relatively lower doses of resistance exercise may benefit advanced-stage ovarian cancer survivors. Exercise programs may need to be flexible and individualized to fit the needs of this cancer group.

Efficacy of fosaprepitant combined with tropisetron plus dexamethasone in preventing nausea and emesis during fractionated radiotherapy with weekly cisplatin chemotherapy: interim analysis of a randomized, prospective, clinical trial using competing risk analysis

There are no well-recognized guidelines for antiemesis during concurrent chemoradiotherapy (CCRT) for cervical cancer (CC) and nasopharyngeal cancer (NPC) until now. The study was designed to assess the efficacy and safety of fosaprepitant combined with tropisetron and dexamethasone in preventing nausea and vomiting during 5 weeks of fractionated radiotherapy and concomitant weekly low-dose cisplatin chemotherapy in patients with CC or NPC. Patients with CC or NPC were scheduled to receive fractionated radiotherapy and weekly cisplatin (25-40 mg/m Between July 2020 and July 2022, 116 patients consented to the study of whom 103 were included in this interim analysis (fosaprepitant group [N = 52] vs control group [N = 51]). The cumulative incidence of emesis at 5 weeks (competing risk analysis) was 25% (95% CI 14.2-37.4) for the fosaprepitant group compared with 59% (95% CI 43.9-71.0) for the control group. There was a significantly lower cumulative risk of emesis in the fosaprepitant group (HR 0.35 [95% CI 0.19-0.64]; p < 0.001). Fosaprepitant was well tolerated as the incidences of adverse events in the two groups were comparable. The addition of fosaprepitant to tropisetron plus dexamethasone significantly reduced the risk of nausea and vomiting during 5 weeks of CCRT in patients with CC or NPC, and fosaprepitant was well tolerated. The trial was registered with ClinicalTrials.gov on October 3, 2022, number NCT05564286.

Cost-utility analysis of a supervised exercise intervention for women with early-stage endometrial cancer

Abstract Purpose Cardiovascular disease (CVD) is the leading cause of death after treatment for endometrial cancer (EC). There is clinical evidence that exercise significantly reduces the risks of CVD and cancer recurrence in this population; however, it is unclear whether there is value for money in integrating exercise into cancer recovery care for women treated for EC. This paper assesses the long-term cost-effectiveness of a 12-week supervised exercise intervention, as compared with standard care, for women diagnosed with early-stage EC. Method A cost-utility analysis was conducted from the Australian health system perspective for a time horizon of 5 years. A Markov cohort model was designed with six mutually exclusive health states: (i) no CVD, (ii) post-stroke, (iii) post-coronary heart disease (CHD), (iv) post-heart failure, (v) post-cancer recurrence, and (vi) death. The model was populated using the best available evidence. Costs and quality-adjusted life years (QALYs) were discounted at 5% annual rate. Uncertainty in the results was explored using one-way and probabilistic sensitivity analyses (PSA). Result The incremental cost of supervised exercise versus standard care was AUD $358, and the incremental QALY was 0.0789, resulting in an incremental cost-effectiveness ratio (ICER) of AUD $5184 per QALY gained. The likelihood that the supervised exercise intervention was cost-effective at a willingness-to-pay threshold of AUD $50,000 per QALY was 99.5%. Conclusion This is the first economic evaluation of exercise after treatment for EC. The results suggest that exercise is cost-effective for Australian EC survivors. Given the compelling evidence, efforts could now focus on the implementation of exercise as part of cancer recovery care in Australia.

Sharing real-world experiences to optimize the management of olaparib toxicities: a practical guidance from an Italian expert panel

Olaparib is the first poly(ADP-ribose) polymerase inhibitor approved as maintenance therapy of recurrent ovarian cancer (OC) patients with a BRCA mutation. To achieve the maximum clinical benefit, adherence to olaparib must be persistent. However, in clinical practice, this is challenged by the frequent suboptimal management of toxicities. In view of the expanding use of olaparib also in Italy, physicians must learn how to adequately and promptly manage drug toxicities not to unnecessarily interrupt or reduce the dose. The experts agreed that nausea,vomiting, anemia, and fatigue are the most frequent events experienced by OC patients on olaparib, and that these toxicities usually develop early during treatment, are mainly of grade 1-2 and transient and can be managed with simple non-pharmacological interventions. By sharing their real-world experiences, the panel prepared, for each toxicity, an algorithm organized by grade and besides the procedures indicated in the local label, included supportive care interventions based also on nutritional and lifestyle modifications and psycho-oncology consultation. Moreover, in view of the tablet entry into the Italian market, the full and reduced dosages of capsules and tablets were compared. This practical guidance is intended to be a tool to support especially less-experienced physicians in the management of these complex patients, with the aim to help preventing the worsening of patients' conditions and the unnecessary interruption/reduction of olaparib dosage, which may jeopardize treatment efficacy.

Climacteric symptoms in postoperative patients among endometrial cancer, cervical cancer, and ovarian cancer: a cross-sectional study

Abstract Purpose To date, no studies have assessed climacteric symptoms after hystero-adnexectomy for endometrial, cervical, or ovarian cancer. Thus, this study aimed to compare climacteric symptoms among patients who underwent surgery for these three cancer types. Methods In this cross-sectional study, we interviewed patients who were registered at a menopausal outpatient clinic between January 1999 and July 2016 after undergoing total hysterectomy, intrapelvic only or intrapelvic plus para-aortic lymph node dissection, and bilateral adnexectomy performed via laparotomy as a cancer treatment. Climacteric symptoms were assessed using a patient-reported questionnaire covering core domains with five symptoms only at the initial consultation. Each symptom was graded from 0 (no symptoms) to 3 (severe symptoms). We evaluated the frequency of symptom severity according to the time elapsed since surgery and the cancer type. Results The numbers of patients with endometrial, ovarian, and cervical cancer were 328, 90, and 107, respectively. Overall, climacteric symptoms were more severe in patients with cervical cancer than in those with endometrial or ovarian cancer; symptom severity decreased with increasing time since surgery. However, symptom severity did not decrease significantly over time in patients with cervical cancer even after &gt; 5 years had elapsed since surgery. Conclusion The climacteric symptoms were less severe in patients with endometrial or ovarian cancer with longer time elapsed since surgery but not in those with cervical cancer. Patients with cervical cancer may require more prompt interventions, including symptomatic treatment and longer follow-up period, than those with endometrial or ovarian cancer.

Perioperative immunonutrition intervention on postoperative outcomes among gynaecological cancer patients under enhanced recovery after surgery setting

Enhanced Recovery After Surgery (ERAS) and immunonutrition (IMN) are established strategies for enhancing postoperative outcomes and modulating immune response. However, current research often overlooks the influence of patients' nutritional status and acceptability in the effectiveness of these combined therapies. The study was aimed at evaluating the effectiveness of perioperative IMN in gynaecological cancer (GC) patients. This was an open-label randomised controlled trial. The primary outcomes were postoperative hospitalisation, nutritional status, and functional status. A total of 110 participants were randomised into the perioperative IMN intervention (I-ERAS) or control (CO) group under an ERAS protocol. Mean age was 50.15 ± 13.07 years in I-ERAS and 49.27 ± 13.80 years in CO. Compared with CO, I-ERAS had a significantly shorter hospital stay (81.5 ± 40.9 h vs. 102.7 ± 58.7 h, p < 0.05) and faster gastrointestinal recovery, including earlier transition to a solid diet and return of bowel sounds. Importantly, none of the I-ERAS patients were readmitted within 30 days, compared with a 7.4% readmission rate in the CO group (p < 0.05). In addition, I-ERAS patients had improved wound healing (p < 0.05); better preservation of nutritional status (p < 0.05), a more favourable inflammatory profile (p < 0.01), and faster recovery of functional status (p < 0.05) and physical performance (p < 0.01). Perioperative IMN within an ERAS protocol for GC surgery is a valuable intervention that reduces hospitalisation, enhances wound healing, improves inflammatory profiles, and lowers readmissions, making it suitable for routine ERAS practice. NCT06039306, dated 14 September 2024 PROTOCOL VERSION: POIMNERAS2023, version 2, September 2023.

Physical exercise set as part of multimodal prehabilitation plan in patients with gynecological cancer undergoing abdominal cytoreductive surgery

Physical prehabilitation is a key element of multimodal preoperative care, but there is a lack of standardized, home-based exercise protocols, particularly in gynecological oncology. This gap, together with organizational barriers to supervised programs, may limit the feasibility and implementation of prehabilitation in many centers. The aim of this study was to present an original set of home-based physical exercises developed for patients with gynecological cancer undergoing cytoreductive surgery and to compare it with existing recommendations from the literature. A structured literature search was conducted in PubMed, Medline, EMBASE, and PsycINFO using predefined terms related to prehabilitation, cancer, and physical exercise. Eligible studies were reviewed by two independent investigators. Based on this review and clinical experience, we developed a set of aerobic and resistance exercises tailored to the needs of gynecological oncology patients, designed to be safe, feasible, and performed at home without specialized equipment. Eight studies describing prehabilitation exercise interventions were identified, of which only one addressed gynecological oncology specifically. Most existing programs relied on supervised or hybrid interventions and rarely provided detailed descriptions of exercises. In contrast, our proposed set includes structured aerobic activity and five resistance exercises focusing on abdominal, core, and paraspinal muscles, illustrated with infographics and supplemented with educational materials to ensure patient adherence at home. Evidence regarding home-based prehabilitation exercise programs in gynecological oncology remains scarce. Our proposed exercise set is, to our knowledge, the first detailed, practical, and reproducible home-based protocol for this patient population and may facilitate broader implementation of prehabilitation across oncological centers.

Impact of practising an adapted and collective physical activity, such as five-a-side touch rugby, on the physical self-esteem of patients treated or followed up for breast or gynaecological cancer

The benefits of an adapted physical activity have been demonstrated on disease-free survival, tolerance to treatment and quality of life for patients with cancer. Self-esteem in the physical area is a specific type of self-esteem that contributes significantly to global self-esteem. Few studies have focused on physical self-esteem, although it is a marker of good health in this population. The participants were being followed up or treated for breast or gynaecological cancer and were practising healthy sports such as five-a-side touch rugby. We assessed anthropometric data, physical parameters and physical self-esteem of the participants. Physical self-esteem was assessed using the 25-item Physical Self Inventory (ISP-25) questionnaire completed by patients at the start and end of the season. The level of physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ). Among the 40 patients included, physical self-esteem did not show a statistically significant variation over a time span of 8 to 55 months. However, general physical self-esteem increased when participants practised intense or moderate physical activity compared with those whose physical activity was limited (p = 0.012 and p = 0.032). Our study suggests that physical self-esteem tends to remain stable over time among patients practising five-a-side rugby for health type adapted physical activity for 8 to 55 months. Furthermore, it has been demonstrated that levels of physical self-esteem are significantly higher in patients who engage in more intensive physical activity. These findings underscore the importance of incorporating the prescription of adapted physical activity into the follow-up and management of patients treated for breast or gynaecological cancer.

The impact of nutritional intervention on postoperative prognosis in gynecological cancer patients: a systematic review and meta-analysis

Gynecological cancers present a major global health challenge, with malnutrition recognized as a significant factor worsening prognosis. Extensive surgical procedures and chemotherapy often compromise nutritional status, leading to delayed recovery and poor outcomes. This review aimed to assess the role of nutritional interventions in improving postoperative prognosis among gynecological cancer patients. Following PRISMA guidelines, PubMed, ScienceDirect, and Google Scholar were searched up to August 2025. Eligible randomized trials, cohort, and feasibility studies evaluated nutritional interventions, including early oral feeding, oral supplements, parenteral nutrition, prehabilitation, coffee, and gum chewing. Risk of bias was assessed using Cochrane RoB 2.0 and ROBINS-I. Data were narratively synthesized, with random-effects meta-analysis performed where appropriate. This study has been registered with PROSPERO (CRD420251071481). A total of 13 studies (randomized and observational) were included. Pooled analyses showed no overall difference in hospital stay between nutritional interventions and standard care (MD -0.56 days; 95% CI -1.34 to 0.22), though subgroup analysis revealed that early oral feeding (EOF), coffee, and gum chewing significantly shortened hospitalization, while total parenteral nutrition (TPN) prolonged it. Nutritional interventions did not significantly reduce postoperative complications overall (OR 0.85; 95% CI 0.55-1.32), but EOF and gum chewing lowered infective and ileus-related morbidity in some studies. Gastrointestinal recovery was consistently accelerated with EOF, coffee, and gum chewing, whereas TPN delayed recovery. Oral nutritional supplements (ONS) improved nutritional indices, and prehabilitation shortened the time to chemotherapy. Survival outcomes were rarely reported, with malnutrition predicting poor prognosis. Overall, interventions were safe and well-tolerated. Nutritional interventions, particularly EOF, coffee, gum chewing, and ONS, enhance recovery and nutritional status in gynecologic oncology, whereas TPN should be reserved for selected malnourished patients.

The role of nursing interventions in the management and outcomes of gynecological tumors: a systematic review and meta-analysis

This meta-analysis evaluates the effectiveness of nurse-led interventions in improving quality of life (QoL), mental health, sexual function, marital satisfaction, postoperative recovery, and symptom distress in gynecological cancer patients. A systematic search of PubMed, Embase, Web of Science, Cochrane Library, and PsycINFO identified randomized controlled trials (RCTs) and quasi-experimental studies. A random-effects meta-analysis was conducted, assessing heterogeneity (I Ten RCTs (1,574 participants) showed nurse-led interventions significantly reduced anxiety (d = 0.85-1.29), depression (d = 1.29), and improved QoL (d = 0.42-1.29). Sexual rehabilitation programs enhanced sexual function (d = 0.95) and marital satisfaction (d = 0.65-0.80). Postoperative nursing interventions lowered infection rates (OR = 7.82) and improved recovery. cognitive-behavioral therapy (CBT)-based interventions, when adapted for delivery by trained nurses, had the strongest psychological benefits, while structured postoperative care optimized recovery. Heterogeneity was moderate to high (I Nurse-led interventions effectively improve mental health, QoL, sexual function, and recovery in gynecological cancer patients, offering a cost-effective, accessible alternative to physician-led care. Future research should standardize protocols, conduct multicenter trials, and assess long-term impacts.

Association between sleep quality and life satisfaction and self-efficacy among women with gynecological cancer in West China: A cross-sectional study

To estimate the sleep quality in patients with gynecological cancer and to determine the association between sleep quality and life satisfaction, self-efficacy, and clinical and demographic factors. A cross-sectional online survey was conducted at a tertiary hospital in Chengdu, China, involving a sample of 663 patients with gynecological cancer. Data were collected using a general demographic questionnaire, the Satisfaction with Life Scale, the Self-Efficacy Scale, and the Pittsburgh Sleep Quality Index. The statistical methods included correlation analysis, and multiple linear regression. Of the 663 participants, 78.7% had poor sleep quality. The mean quality score was 8.21 ± 3.51. Employment status was positively correlated with sleep quality, whereas treatment of sleep problems, low life satisfaction, and low self-efficacy were negatively correlated with sleep quality. Poor sleep quality is common in patients with gynecological cancer. Clinicians should pay more attention to sleep quality in patients with gynecological cancer and adopt targeted strategies based on the relevant influencing factors to ensure optimal sleep quality.

A nurse-led theory-based psycho-educational intervention programme for women with gynaecological cancer: a multicentre randomised controlled trial

To explore the effects of a nurse-led psycho-educational interventions (PEI) on uncertainty in illness, anxiety and sexual functioning among women with gynaecological cancer (GC). An assessor-blinded multicentre randomised controlled trial was conducted in Hong Kong and Hunan, China. The intervention group received a 4-session, 12-week-long nurse-led PEI while the control group received attention on four occasions. The outcomes were measured at baseline and upon completion of the programme. Of the 402 participants recruited, 202 were randomly assigned to the intervention group and 200 to the control group. The intervention demonstrated significant effects on ambiguity (Group*Time regression coefficient, B =  - 2.13, 95% CI: - 3.87 to - 0.38, p = 0.017), inconsistency (Group*Time, B =  - 1.27, 95% CI: - 2.19 to - 0.34, p = 0.007) and overall uncertainty in illness (Group*Time, B =  - 3.27, 95% CI: - 6.34 to - 0.20, p = 0.037). At post-intervention, women in the intervention group were more likely to perceive a greater level of intimacy (p < 0.001), a greater level of sexual interest (p = 0.023) and their partners to have a greater interest in sexual relations (p = 0.005); and less likely to report a reduction in close physical contact with family and close friends (p = 0.034), when compared with their control counterparts. We demonstrated the potential benefits of a nurse-led PEI on improving uncertainty in illness and sexual function among women with GC in China, in comparison to usual care. In view of the potential benefits of the PEI on uncertainty in illness and sexual functioning, the intervention could be incorporated into routine clinical practice. ISRCTN Registry (registration number: ISRCTN18351717, registered on 22 April 2023).

Developing and assessing a vomiting-free ward workflow for gynecological patients receiving chemotherapy

Chemotherapy-induced nausea and vomiting (CINV) significantly diminishes the quality of life (QoL) for patients undergoing early and late-stage cancer treatments. Despite preventive antiemetic measures, CINV remains a challenge, with limited response rates. CINV adversely affects not only patients' physical health but also their psychological well-being, social interactions, and treatment adherence. This study aimed to evaluate the impact of a vomiting-free ward initiative on managing CINV and its effects on the psychological well-being and QoL of gynecological cancer patients receiving chemotherapy. In this study, 960 gynecological oncology patients receiving inpatient chemotherapy at a premier obstetrics and gynecology hospital in Sichuan Province were enrolled from January to December 2023. They were evenly divided into intervention and control groups based on their admission dates. Both groups underwent standard care, and the intervention group followed a vomiting-free ward protocol. The effectiveness of this specialized ward was evaluated using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool, the Functional Living Index-Emesis (FLIE), and the Hospital Anxiety and Depression Scale (HADS). The intervention group showed significant improvements in the frequency and severity of both acute and delayed CINV compared to the control group. Furthermore, there was a 9.7% and 7.2% decrease in the impact of severe nausea and vomiting on leisure activities and a 6.9% and 8.6% reduction in how moderate to severe nausea and vomiting affected daily living, respectively. The introduction of the vomiting-free ward significantly reduced levels of patient anxiety (t = - 3.148, P < 0.001) and depression (t = - 3.223, P < 0.001) compared to standard care. The implementation of a vomiting-free ward effectively mitigates nausea and vomiting, enhances QoL, and decreases anxiety and depression among gynecological oncology patients. This innovative approach can be integrated into clinical practice, providing valuable insights and guidelines for healthcare professionals.

Dyadic effects of locus of control and coping style on posttraumatic growth in patients with gynecological cancer and their spouses: an actor‒partner interdependence modeling approach

This study aimed to examine the dyadic effects of locus of control and coping style on the posttraumatic growth(PTG) of gynecological cancer patients and their spouses via the actor-partner interdependence model (APIM). This was a prospective cross-sectional survey study. A convenience sampling method was used to select participants. The Demographic and Cancer-related Information Questionnaire, Internality, Powerful others and Chance Scale, Simplified Coping Style Questionnaire and Chinese-Posttraumatic Growth Inventory Scale were utilized for the survey. An actor‒partner interdependence model was constructed to examine the impact of locus of control and coping style on PTG for both patients and their spouses. The date of 400 individuals(200 couples) were analyzed. The PTG scores for patients and their husbands were 61.66 ± 12.82 and 57.77 ± 12.03, respectively. Both partners' PTG was influenced by internal locus of control and positive coping style (P < 0.01). Each partner's internal locus of control and positive coping style could predict their own PTG, with a significant actor effect (P < 0.05). The spouse's internal locus of control could predict the patient's PTG, whereas the patient's positive coping style could predict the spouse's PTG, indicating significant partner effects (P < 0.05). The PTG of gynecological cancer patients and their spouses is moderate. The locus of control and coping style of both partners have an interactive effect on their own PTG. To promote PTG for both partners, healthcare professionals should intervene simultaneously with patients and their spouses, incorporating positive psychological intervention methods.

A quality control circle to improve preventive care for lower limb lymphedema in gynecologic oncology surgery

This study aims to enhance compliance with lower limb lymphedema (LLL) prevention care measures post-gynecologic oncology surgery (GOS) through quality control circle (QCC) activity, aiming to improve patient recovery outcomes and reduce postoperative complications. A 6-month QCC activity was conducted within the hospital, employing the ten-step plan-do-check-act model for QCC activity. The root causes of inadequate implementation of LLL prevention care measures were analyzed, leading to the development of relevant strategies and protocols. Compliance rates of preventive care measures pre- and post-QCC activity were compared. The focus of this improvement initiative was on "inadequate postoperative preventive measures" and "lack of standardized discharge preventive measures." Strategies included ensuring nurses proficiently assess LLL following gynecologic malignancy surgeries, enhancing standardized preventive measures for LLL post-GOS, and establishing personalized and diversified education models. Following the implementation of QCC activity, there was a significant improvement in the compliance rate of LLL prevention care measures. The compliance rate increased from 74.00% before the activity to 92.80%, surpassing the target rate by 119.00%, with an improvement rate of 25.40%. Comprehensive evaluations of circle members' abilities showed significant improvement, with notable increases in problem-solving abilities, initiative, and confidence. Implementation of QCC activity resulted in a substantial improvement in compliance with LLL prevention care measures following GOS, ensuring safer and more effective patient care services.

Prognostic role of chemotherapy-induced nausea and vomiting in recurrent ovarian cancer patients: results of an individual participant data meta-analysis in 1213

The aim of this study was to analyze the potential impact of chemotherapy-induced nausea and vomiting (CINV) on dose reductions, discontinuation of chemotherapy, and survival. This study was designed as individual participant data meta-analysis with the original study data of three phase II/III trials that were conducted by the North-Eastern German Society of Gynecological Oncology (NOGGO) including 1213 patients with recurrent ovarian cancer. Logistic and Cox regression analyses were used to estimate odds and hazard ratios after adjusting for age, ECOG, amount of delivered cycles, amount of recurrences, and amount of comedications and study. The majority of patients developed nausea (58.1%) and almost one third experienced vomiting (31.0%). CINV was not associated with FIGO stage, grading, histology, and number of recurrences. The necessity of dose reduction and discontinuation of chemotherapy did not correlate to nausea and vomiting (p = 0.88, p = 0.39 and p = 0.25, p = 0.54 respectively). Progression-free survival was shorter in patients with grade III/IV nausea and vomiting (p = 0.02; hazard ratio (HR) for grade III/IV nausea 1.58, 95% CI 1.14-2.20, and p = 0.02; HR for grade III/IV vomiting 1.67, 95% CI 1.15-2.42 respectively). CINV grade III/IV was also associated with poorer overall survival (p < 0.001; HR for grade III/IV nausea 2.35, 95% CI 1.64-3.37, and p < 0.001; HR for grade III/IV vomiting 1.67, 95% CI 1.15-2.42 respectively). CINV is significantly associated with poorer prognosis in recurrent ovarian cancer patients while there was no correlation found with the necessity of dose reduction and prior discontinuation of treatment. This study underlines the importance of prevention and treatment of CINV as part of early best supportive care.

Fear, worry and sadness: an exploratory study of psychological wellbeing in men caring for their partner with ovarian cancer

Ovarian cancer is the leading cause of death from female cancers in Australia with the majority of women presenting with advanced disease. The burden of caregiving is largely borne by male carers; however, little research has examined the challenges male ovarian cancer caregivers (MOCC) experience. This study aimed to explore the psychosocial wellbeing and cancer-related challenges experienced by MOCC. A cross-sectional small-scale exploratory online survey study recruited 36 MOCC. The study questionnaire was comprised of the Generalised Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire Depression Module (PHQ-9), Functional Assessment of Cancer Therapy Scale (FACT-G) Family Member, Fear of Cancer Recurrence Scale, Insomnia Severity Index (ISI), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACTIT-F) and Cancer-Related Challenges Scale (CRCS). The most common challenges ever experienced were worry about the future (91%), fear of metastasis (90%) and feeling worried or uncertain (88%). The most common current challenges were fear of cancer recurrence (75%), fear of metastasis (68%) and changes in sexual relationships (64%). Depression and anxiety were significantly correlated with all psychosocial variables highlighting the relationships between elements of wellbeing for MOCC. Clinical levels of fear of cancer recurrence were reported by 89% of MOCC. The challenges faced by MOCC are psychosocial in nature. There is a high correlation between anxiety and depression, and this coupled with the fear of disease recurrence indicates a greater need for screening of these issues, appropriate referral and development of support resources for this high-risk group of cancer carers.

Efficacy of dexamethasone in the management of malignant small bowel obstruction in advanced epithelial ovarian cancer

Malignant small bowel obstruction (MSBO) occurs in up to 50% of women with advanced epithelial ovarian cancer (EOC) causing symptom burden and distress to women and their families, particularly in the terminal stages of the disease. Corticosteroids are used to promote symptom resolution in malignant small bowel obstruction (MSBO) related to EOC, with little published data on their efficacy, optimal dosing and duration of treatment. To evaluate the efficacy of dexamethasone in achieving symptom control in women with advanced EOC presenting with MSBO, assess dexamethasone dosing and efficacy over subsequent presentations, and examine differences in dexamethasone responsiveness between platinum-resistant and platinum-sensitive patient. This is a retrospective cohort study of women presenting with MSBO due to advanced EOC over a 12-year period from January 2005 to December 2016 in a single tertiary hospital. Ninety-one women with MSBO were administered dexamethasone over 154 admissions with 89% of women initially achieving partial or complete symptom control. Dexamethasone responsiveness did not change with recurrent admissions, and platinum responsive patients were more likely to respond to dexamethasone than platinum-resistant patients (OR 3.6 [95%CI 1.1 to 12.2, p = 0.04]). A total of 15.6% of patients required additional measures to control symptoms of MSBO, and 44.8% had adequate symptom resolution to allow them to remain on or commence further treatment for EOC. Dexamethasone therapy is a useful adjunctive therapy in the management of symptoms associated with MSBO in women with EOC.

Re: “The intrapersonal and interpersonal processes of fear of recurrence among cervical cancer survivors: a qualitative study”

Recent advances in non-pharmacological interventions for symptom burden management in breast cancer patients treated with ovarian function suppression

The effects of aerobic and resistance training across eight cancer types: a systematic review

Bridging gaps in oncofertility: evaluation of reproductive dysfunction and fertility assessment in pediatric cancer survivors

Development and refinement of patient care recommendations in brachytherapy for locally advanced cervical cancer using nominal group technique workshops

Abstract Purpose Patient experiences of brachytherapy for locally advanced cervical cancer (LACC) are widely variable, with reports of difficult and traumatic experiences and aspects of care requiring improvement. The aim of this study was to develop patient care recommendations and consult with key stakeholders to review, refine and prioritise recommendations. Methods Phase 1: Patient care recommendations were developed from qualitative exploratory study data. Phase 2: Service users and providers with recent experience of brachytherapy for LACC were recruited to online nominal group technique (NGT) workshops. Four NGT stages were followed: (1) initial voting and silent generation; (2) round robin; (3) clarification; and (4) prioritisation. Voting data were summed across the workshops, deriving inter-group scores. Qualitative data were analysed through content analysis. Results Phase 1: Fifty-one patient care recommendations were developed. Phase 2: Thirteen participants took part in three online NGT workshops, with a combination of service users and providers. Initial recommendations were voted on; four new recommendations were added; minor changes were made and second voting was undertaken. Recommendations were positively received with 25 recommendations scoring maximum points from all participants. An importance score above 90% was given to 46 recommendations. The remaining recommendations received scores between 74 and 90%. Conclusions NGT workshops facilitated collaboration between key stakeholders, discussing, refining and prioritising patient care recommendations, leading to verification of achievable and relevant recommendations. These provide a foundation for future development of guidelines and subsequent implementation into clinical practice, aiming to improve consistency of care and patient experiences of brachytherapy for LACC.

Comparative analysis of treatment decision-making in patients with localized prostate and cervical cancer: what influences receiving surgery or radiotherapy?

Abstract Purpose This study focused on identifying the factors influencing the decision-making process in patients with localized prostate and cervical cancer in Japan and specifically examining the choice between surgery and radiotherapy. Methods Patients with specific cancer stages registered with a healthcare research company for whom radical surgery or radiotherapy was equally effective and recommended participated in this cross-sectional online survey. Results The responses of 206 and 231 patients with prostate and cervical cancer, respectively, revealed that both groups relied heavily on the physicians’ recommendations (prostate: odds ratio (OR) = 40.3, p &lt; 0.001; cervical: OR = 5.59, p &lt; 0.001) and their impression of radiotherapy (prostate: OR = 9.22, p &lt; 0.001; cervical: OR = 2.31, p &lt; 0.001). Factors such as hypertension (OR = 6.48, p &lt; 0.05), diabetes mellitus (OR = 9.68, p &lt; 0.05), employment status (OR = 0.08, p &lt; 0.01), and impressions of surgery (OR = 0.14, p &lt; 0.01) also played a significant role in patients with prostate cancer. In contrast, the specialty of the physician (OR = 4.55, p &lt; 0.05) proposing the treatment influenced the decision-making process of patients with cervical cancer. Information sources varied between the two groups: patients with prostate cancer were more inclined towards printed materials, whereas patients with cervical cancer were more inclined towards interpersonal relationships. Conclusion Although several limitations, such as the sample and recall bias, were noted, this study emphasizes the role of psychosocial factors in the decision-making process and the requirement for tailored information sources.

AI-driven patient support: Evaluating the effectiveness of ChatGPT-4 in addressing queries about ovarian cancer compared with healthcare professionals in gynecologic oncology

Artificial intelligence (AI) chatbots, such as ChatGPT-4, allow a user to ask questions on an interactive level. This study evaluated the correctness and completeness of responses to questions about ovarian cancer from a GPT-4 chatbot, LilyBot, compared with responses from healthcare professionals in gynecologic cancer care. Fifteen categories of questions about ovarian cancer were collected from an online patient Chatgroup forum. Ten healthcare professionals in gynecologic oncology generated 150 questions and responses relative to these topics. Responses from LilyBot and the healthcare professionals were scored for correctness and completeness by eight independent healthcare professionals with similar backgrounds blinded to the identity of the responders. Differences between groups were analyzed with Mann-Whitney U and Kruskal-Wallis tests, followed by Tukey's post hoc comparisons. Mean scores for overall performance for all 150 questions were significantly higher for LilyBot compared with the healthcare professionals for correctness (5.31 ± 0.98 vs. 5.07 ± 1.00, p = 0.017; range = 1-6) and completeness (2.66 ± 0.55 vs. 2.36 ± 0.55, p < 0.001; range = 1-3). LilyBot had significantly higher scores for immunotherapy compared with the healthcare professionals for correctness (6.00 ± 0.00 vs. 4.70 ± 0.48, p = 0.020) and completeness (3.00 ± 0.00 vs. 2.00 ± 0.00, p < 0.010); and gene therapy for completeness (3.00 ± 0.00 vs. 2.20 ± 0.42, p = 0.023). The significantly better performance by LilyBot compared with healthcare professionals highlights the potential of ChatGPT-4-based dialogue systems to provide patients with clinical information about ovarian cancer.

Preventing chemotherapy-induced ovarian damage through PI3K/AKT and Hippo pathway regulation

Post-traumatic reactions and quality of life after pelvic exenteration for gynecologic cancer: a retrospective cohort study

“It really takes a village”: perspectives on multi-level barriers to endometrial cancer care for rural patients

While it is established that rural cancer patients face multi-level barriers to high-quality treatment, the interconnections between these barriers and how they drive rural cancer disparities is not well-understood. Therefore, our objective was to better understand the interconnections between barriers to high-quality treatment faced by rural endometrial cancer (EC) patients. We conducted semi-structured interviews with 32 clinicians and healthcare personnel from three large, geographically diverse, rural-serving, integrated healthcare systems in North Carolina. A semi-structured interview guide was developed to examine barriers to high-quality treatment for rural EC patients. Initial codes were derived from a multi-level conceptual framework of rural cancer control, and transcribed interviews were analyzed using thematic analysis. We identified three domains of interconnected barriers. First, travel distance, the most frequently noted barrier, amplified financial barriers and caregiver burden. While gynecologic oncologists could reduce travel burden by referring patients to nearby treatment facilities, provider participants expressed mixed opinions regarding the quality of care received at local facilities. Second, limited health literacy among rural patients often led to challenges in patient-provider communication, including challenges with care-related decision making and comprehension of diagnosis and treatment goals. Finally, supportive care and financial resources were often concentrated at large, urban facilities and not accessible to rural patients. However, even these large facilities lack established systems or standardized processes for supporting the most vulnerable patients. To achieve equitable access to care and outcomes among EC patients, those living in rural areas may require more targeted, intensive outreach, support, and resources.

Interpretable machine learning model based on clinical factors for predicting muscle radiodensity loss after treatment in ovarian cancer

Muscle radiodensity loss after surgery and adjuvant chemotherapy is associated with poor outcomes in ovarian cancer. Assessing muscle radiodensity is a real-world clinical challenge owing to the requirement for computed tomography (CT) with consistent protocols and labor-intensive processes. This study aimed to use interpretable machine learning (ML) to predict muscle radiodensity loss. This study included 723 patients with ovarian cancer who underwent primary debulking surgery and platinum-based chemotherapy between 2010 and 2019 at two tertiary centers (579 in cohort 1 and 144 in cohort 2). Muscle radiodensity was assessed from pre- and post-treatment CT acquired with consistent protocols, and a decrease in radiodensity ≥ 5% was defined as loss. Six ML models were trained, and their performances were evaluated using the area under the curve (AUC) and F1-score. The SHapley Additive exPlanations (SHAP) method was applied to interpret the ML models. The CatBoost model achieved the highest AUC of 0.871 (95% confidence interval, 0.870-0.874) and F1-score of 0.688 (95% confidence interval, 0.685-0.691) among the models in the training set and outperformed in the external validation set, with an AUC of 0.839 and F1-score of 0.673. Albumin change, ascites, and residual disease were the most important features associated with a higher likelihood of muscle radiodensity loss. The SHAP force plot provided an individualized interpretation of model predictions. An interpretable ML model can assist clinicians in identifying ovarian cancer patients at risk of muscle radiodensity loss after treatment and understanding the contributors of muscle radiodensity loss.

“I think that a brief conversation from their provider can go a very long way”: Patient and provider perspectives on barriers and facilitators of genetic testing after ovarian cancer

Identify predisposing, enabling, and reinforcing factors impacting genetic counseling/testing among ovarian cancer patients guided by Green and Kreuter's PRECEDE-PROCEED model. Gynecologic oncology providers (N = 4), genetic counselors (N = 4), and ovarian cancer patients (N = 9) completed semi-structured qualitative interviews exploring participants' knowledge of and experiences with genetic counseling/testing. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive content analysis by two independent raters. Thematic analysis identified predisposing, enabling, and reinforcing factors impacting referral for and uptake of genetic counseling/testing. Predisposing factors included participant's knowledge, beliefs, and attitudes related to genetic counseling/testing. Both patients and providers also cited that insurance coverage and out-of-pocket cost are major concerns for ovarian cancer patients considering genetic testing. Finally, both patients and providers emphasized that genetic counseling/testing would provide additional information to an ovarian cancer patient. While providers emphasized that genetic testing results were useful for informing a patient's personal treatment plan, patients emphasized that this knowledge would be beneficial for their family members. Barriers to genetic testing for ovarian cancer patients exist at multiple levels, including the patient (e.g., knowledge, attitudes), the provider (e.g., workload, availability of services), the institution (e.g., difficulty with referrals/scheduling), and the healthcare system (e.g., insurance/cost). Interventions aiming to increase genetic testing among ovarian cancer patients will likely need to target multiple levels of influence. Future quantitative studies are needed to replicate these results. This line of work will inform specific multilevel intervention strategies that are adaptable to different practice settings, ultimately improving guideline concordant care.

Physical and functional well-being and symptoms of ovarian cancer in women undergoing first-line of chemotherapy: a one-year follow-up

Clinicopathological features and chemotherapy can influence the quality of life (QOL), women with ovarian cancer. This study aimed to evaluate the physical and functional well-being, and ovarian cancer-specific effects scores reported from QOL questionnaire among women with ovarian cancer at the time of in their initial diagnosis and access the scores trajectory of women receiving neoadjuvant and adjuvant chemotherapy. This prospective study used cross-sectional analysis at baseline and longitudinal analysis from baseline to 12-month post-chemotherapy. QOL was evaluated at the baseline, at sixth cycle and 12-month post-chemotherapy using FACT-O questionnaire. Clinicopathological features and chemotherapy regime were evaluated and tested for associations with QOL measures. Of the 38 women enrolled in this study, 27 (80.1%) completed the questionnaire for 12 months. The multivariate linear regression results suggest, at the baseline, women with advance stage and presence of post-surgery residual disease showed lower scores in physical and functional well-being, ovarian cancer-specific effects, and FACT-O TOI domains (p < 0.05). Longitudinal analysis spanning over 12 months showed an improvement in mean physical well-being, functional well-being, and ovarian cancer-specific effects scores, independent of chemotherapy received (p < 0.05). At the baseline, the clinicopathological features such as stage, presence of post-surgery residual disease, and type of chemotherapy correlated with on QOL scores. At one-year follow-up, women who underwent chemotherapy showed improvement in QOL regardless of the type of chemotherapy they received. Future prospective study with a larger group is recommended.

Quality of life of ovarian cancer patients treated with combined platinum taxane chemotherapy: a systematic review of the literature

Chemotherapy is the cornerstone of adjuvant therapy in ovarian cancer. Its impact on the quality of life (QoL) has been addressed in several studies; however, several misperceptions concerning this affect patient counseling and physicians' ability to overcome patient fears. In the present systematic review, we sought to accumulate current evidence in the field in order to help establish robust information that will help physicians answer patients' questions. The present systematic review is based on the PRISMA guidelines. Studies that evaluated patient QoL pre-, during, and post-chemotherapy with the use of the QLQC-30 were selected for inclusion. Their methodological quality was assessed with the before-after studies tool that is proposed by the National Institute of Health (NIH). Ten studies that involved 5181 patients were included in the present systematic review. The risk of bias and methodological quality of included studies was of good and fair overall quality. Retrieved data suggest there is substantial evidence that points toward improved global QoL among ovarian cancer patients treated with taxanes-platinum combination therapy. Individual outcomes evaluated with the QLQ-C30 also provide positive results, although underreporting was noted. Despite the significant heterogeneity in outcome reporting, the findings of this study reveal the significant benefit of combined platinum taxane chemotherapy on the QoL of ovarian cancer patients and can be used for patients counseling in order to reduce refusals that arise from fear of adverse effects that may negatively affect QoL. Graphical abstract.

Olaparib for ovarian cancer: a single-institution, multi-site qualitative study

This qualitative study sought to learn patients' perspectives on olaparib - including maintenance olaparib - in their own words. Olaparib-treated patients were interviewed by phone. A semi-structured interview guide that focused on symptoms and quality of life was formulated in alignment with the study objective. Interviews were transcribed and analyzed with content analysis. Twenty olaparib-treated patients were interviewed. Four themes emerged: (1) The Long Cancer Journey. Patients prescribed olaparib appear to have had a long cancer journey, sometimes with prior cancer ("I had breast cancer in 1996") and sometimes with a long interval from an ovarian cancer diagnosis; (2) Adherence. Despite this journey, patients were adherent to olaparib ("I set it for an alarm 15 min before I have to take [olaparib] and then exactly when I'm supposed to take it"); (3) Adherence Despite Challenges. Adherence continued despite side effects (although olaparib was "pretty tolerable"). This adherence also continued despite cost ("…for a month's supply, mine was $15,837… and my insurance covered some of it but not near enough"), and (4) Modifications in Perceptions of BRCA Status. Olaparib as cancer therapy influenced perceptions of BRCA mutations ("But I… I have to tell you, I'm grateful that I qualified to be on Lynparza®"). Although oral maintenance therapy for ovarian cancer is relatively new, patients appear willing to take olaparib long term; and they seem to take great lengths to remain adherent, despite having sometimes had a long cancer journey.

Attitude towards hereditary cancer risk management among women with cancer in Taiwan

Risk management intentions prior to genetic counseling predict risk management uptake following genetic testing. Limited studies examined the attitude and understanding towards genetic counseling/testing in underserved countries. The purposes of this study were to explore knowledge and attitude towards genetic counseling, testing, and risk management for breast and ovarian cancer, and to understand the factors influencing risk management intentions in women with cancer in Taiwan. Cross-sectional with correlational design was used in this study. Participants were enrolled for genetic testing based on clinical criteria suspected of having hereditary cancer. Survey was conducted using a standardized questionnaire including (1) demographics and personal/family history of cancer; (2) prior experience or consideration of genetic testing and reasons for not considering; (3) perception and attitude towards genetic counseling; and (4) intentions for risk management with a hypothetical BRCA1 mutation status. Multinomial logistic regression was used to analyze the predictors of participants' intentions for cancer risk management strategies. A total of 430 women with cancer were analyzed in which 51.6% had family history of cancer in first-degree relatives. Only 30.7% had considered genetic testing and 28.4% had known about genetic counseling prior to the study. When prompted with the services of genetic counseling, the attitude towards genetic counseling was fairly positive (score of 19.8 ± 2.9 out of 25). Given hypothetical BRCA1 mutation status, enhanced breast cancer screening with annual breast MRI was much more accepted than cancer risk reducing interventions. More positive attitude towards genetic counseling (each score point increase) was associated with higher odds of intention for breast MRI (OR 1.20, 95% CI 1.09-1.32) and preventive tamoxifen (OR 1.11, 95% CI 1.02-1.22). Having considered genetic testing prior to the study was associated with higher odds of intention for all four risk management strategies: breast MRI (OR 2.99, 95% CI 1.46-6.11), preventive tamoxifen (OR 1.79, 95% CI 1.00-3.17), risk-reducing mastectomy (OR 2.24, 95% CI 1.13-4.42), and risk-reducing salpingo-oophorectomy (OR 2.69, 95% CI 1.27-6.93). Knowledge of genetic testing and positive attitude towards genetic counseling were associated with increased willingness to consider cancer risk management strategies for hereditary breast and ovarian cancer syndrome. Given the limited knowledge on genetic testing and counseling in the studied population, increasing public awareness of these services may increase adoption of the risk management strategies.

Sexual functioning after ovarian cancer: are women receiving the information and support they need?

Ovarian cancer (OC) can significantly impact sexual functioning beyond initial treatment and into survivorship. However, research suggests that the information and advice women want on this topic may not be readily provided by health professionals (HPs). We explored the psychological and sexual wellbeing of a sample of Australian women diagnosed with OC, to inform the development of effective, targeted sexuality resources. This paper presents a subset of our findings. Participants were recruited nationwide via social media, print advertisement and the database of a support organisation, Ovarian Cancer Australia. Self-reported demographic and clinical survey data were collected including perceptions of the availability and adequacy of sexuality support post-OC. Participants (n = 98) were on average 52.8 years old and 5.5 years post-diagnosis. A minority (22%) reported that the impact of OC on their sexuality was discussed by HPs; and 46% were satisfied with that discussion. Approximately half (52%) had wanted to discuss sexuality concerns with a HP during treatment and 43% still felt the need for this discussion. Open-ended responses revealed the need for more information that was detailed and specified what to expect post-diagnosis. Shortcomings of HPs in addressing sexuality were also revealed. This research provides further evidence that sexual health remains inadequately addressed in OC care across the trajectory for the majority of women, and is an area of unmet need.

Assessment of quality of life among advanced ovarian cancer patients in a tertiary care hospital in India

The study aims to record the quality of life (Qol) and its changes while ovarian cancer (OC) patients undergo debulking surgeries and chemotherapy in a tertiary care hospital of Eastern India. Patients with advanced epithelial OC (FIGO stages III-IV) were recruited. They underwent primary/interval debulking surgeries with classical chemotherapy (adjuvant/neoadjuvant) of intravenous tri-weekly doses of paclitaxel + carboplatin. QoL was assessed using Fact- O + FACIT-Sp-12 questionnaire with a set of 51 questions in different domains (spiritual, physical, social, emotional, and functional factors) and a special set for OC patients under the heading "Additional concerns." The responses from patients were recorded at baseline (diagnosis/study entry), 2, 4, and 6 months during the treatment visits. Overall survival (OS) was assessed using Kaplan Meier curve. A majority of patients were 49.15±10.8 years of age, school-educated (54%), unemployed/homemakers (73.5%), belonging from rural setup (64.6%) with a monthly income of Rs. 2000/- to Rs. 5000/-. There was no statistically significant (p>0.05) improvement found in Qol from the baseline till the end of the study, neither overall nor in subsets (responders (Rs)/partial responders (PRs)/non-responder (NRs) groups or the adjuvant and neoadjuvant chemotherapy groups). The common toxicities like anemia, constipation, and weight loss were significantly (p<0.05) correlated with the patients' physical, functional, emotional, and social well-being. Ovarian cancer patients represent a poor functional, social, and disease-specific quality of life that needs to be addressed, identified, and improved by the growing nexus of healthcare providers and researchers.

Feasibility of implementing a cervix cancer–specific patient-reported outcome measure in routine ambulatory clinics

To evaluate the implementation of a cervix cancer-specific patient-reported outcome measure, the European Organization for Research and Treatment of Cancer Quality of Life Cervical Cancer module (EORTC QLQ-CX24), into gynecologic oncology clinics. This was a prospective, multi-institutional, cross-sectional study involving cervix cancer patients previously treated with curative intent radiotherapy who were attending routine follow-up appointments. Between January 2017 and August 2018, eligible patients were approached to complete the EORTC QLQ-CX24 prior to their clinical encounter and then review it with their oncologist. Patient and oncologist experience was evaluated using Feedback Questionnaires following the encounter. Descriptive statistics were used to summarize the results of the EORTC QLQ-CX24 and Feedback Questionnaires. Open-ended questions within the Feedback Questionnaires were analyzed to identify themes. Eighty-four patients consented to participate in the study. Of these, 80 (95.2%) completed the EORTC QLQ-CX24 and 76 (90.4%) completed both the EORTC QLQ-CX24 and the Feedback Questionnaires. There were high rates of completion for most items within the EORTC QLQ-CX24 (93-98%), except for items pertaining to vaginal symptoms and sexual health (34-35%). All eligible oncologists participated (n = 9). Overall, patients and oncologists positively endorsed use of the questionnaire during clinical encounters. The majority of patients (80%) and oncologists (89%) reported use of the questionnaire improved communication, including discussion of sensitive topics. Interestingly, only a minority of patients and oncologists stated a perceived preference for electronic completion (18% and 44%, respectively). Implementation of the EORTC QLQ-CX24 in gynecologic oncology clinics was feasible and acceptable according to patients and oncologists.

Cancer-related fatigue among long-term survivors of breast, cervical, and colorectal cancer: a French registry–based controlled study

While several studies have documented fatigue during and after cancer treatment, long-term cancer survivor fatigue is underreported. In this study, we compare fatigue, quality of life (QoL), and anxiety between relapse-free cancer survivors 15 years after diagnosis and healthy controls. Cancer survivors (CS) were randomly selected from three large population-based cancer registries (Bas-Rhin, Calvados, and Doubs, France). Cancer-free controls were randomly selected from electoral lists with stratification on age group, residence area, and gender. All participants completed self-reported fatigue (MFI), QoL (EORTC QLQ-C30), and anxiety (STAI) questionnaires. Univariable and multivariable logistic regression were used to study the association between fatigue and cancer status, in three cancer subgroups: breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC). Two hundred sixty-three CS and 688 controls (125/275, 45/153, 93/260 CS/controls for BC, CC, and CRC respectively) were included. The mean age was 66 years. In multivariable analyses, CS had higher general and mental fatigue than controls p = 0.04 and p = 0.02, respectively. No difference in QoL was observed between CS and controls. CS were more anxious than controls (p < 0.01). Anxiety was associated with general fatigue (p < 0.0001) and mental fatigue (p < 0.0001). Fifteen years after diagnosis, cancer survivors reported more general and mental fatigue compared with controls. Our results reinforce guidelines, identifying fatigue as a persistent symptom.

Knowledge matters and empowers: HPV vaccine advocacy among HPV-related cancer survivors

To describe knowledge about human papillomavirus (HPV), HPV-related care behavior, and advocacy intent (e.g., vaccine recommendation and willingness to become an advocate for vaccination) and to investigate associations between knowledge, HPV-related care behavior, and advocacy intent among HPV-related cancer survivors. A cross-sectional online survey was offered through Qualtrics to HPV-related cancer survivors who were either volunteers at a cancer center or patients of survivorship clinics. A total of 200 survivors responded. Only 33.2% of respondents reported knowing their cancer was HPV-related and 56.8% reported HPV vaccine is safe. Participants who knew that their cancer was caused by HPV were more likely to have vaccinated their children (p < .001). Also, participants who knew that the vaccine is safe were more willing to recommend the vaccine (p < .001), to be a peer mentor for others with HPV-related cancers (43.2% vs. 14.0%, p < .001), and to act as an advocate for increasing vaccination rates (44.1% vs. 24.4%, p = 0.01). Finally, survivors who were aware of the vaccine's effectiveness in decreasing precancerous lesions were more likely to recommend the vaccine (45.7% vs. 12.0%, p = .002). Raising survivor awareness of the link between HPV and cancer and HPV vaccine safety may increase their willingness to serve as powerful opinion leaders and peer mentors to promote HPV vaccination. Providers may take the simple step of informing patients that their cancer is HPV-related and HPV vaccine is safe to increase the number of informed and empowered survivors.

The intrapersonal and interpersonal processes of fear of recurrence among cervical cancer survivors: a qualitative study

Cervical cancer's emotional and mental toll often extends beyond the disease's duration. Fear of cancer recurrence has been identified as prominent in patients and survivors, yet there is a paucity of studies regarding this population. The present study sought to explore and expand the understanding of the meaning of fear of cancer recurrence among cervical cancer survivors. In this qualitative study, semi-structured interviews were conducted with 15 cervical cancer survivors. The interviewees' mean age was 41.33 years (range 34-47 years), and the mean time since diagnosis was 3.1 years (ranged from 0.5 to 7 years). Three central themes emerged that represent intrapersonal and interpersonal processes: The first, "No longer resilient" refers to feelings of uncertainty in the face of the illness experienced on the intrapersonal level, where the interviewee mostly engaged with efforts to return to the "normal" state that existed before the cancer diagnosis. The second, "To be afraid in a dyad," relates to the interpersonal level that included mutual fears shared by the interviewee and her partner. The third "And what if the disease comes back and I die?" represents a combination of intrapersonal and interpersonal processes manifested by the greatest fear - death - expressed by both the interviewee and her partner. The present findings revealed that the fear of cancer recurrence represents intrapersonal and interpersonal processes encompassing three factors - uncertainty, social-cognitive processing, and death anxiety. Accordingly, potential psycho-social treatment options could be tailored to specifically address the prominence of these factors for cervical cancer survivors.

Association of bowel radiation dose-volume with skeletal muscle loss during pelvic intensity-modulated radiotherapy in cervical cancer

Radiation-induced bowel damage may compromise nutrient absorption and digestion and affect body composition during pelvic radiotherapy in patients with locally advanced cervical cancer (LACC). This study aimed to evaluate the relationship between bowel radiation dose-volume and body composition changes during pelvic radiotherapy. Data of 301 LACC patients treated with chemoradiotherapy were analyzed. Changes in skeletal muscle index (SMI) and density (SMD), and total adipose tissue index (TATI) were measured from computed tomography images at the L3 vertebral level. A reduction in SMI, SMD, or TATI of ≥10% was classified as "loss." Bowel V45 indicates the bowel volume (mL) receiving a radiation dose of ≥45 Gy. The relationship between body composition and bowel V45 was analyzed using logistic regression models. After treatment, 61 (20.3%), 81 (26.9%), and 97 (32.2%) patients experienced SMI, SMD, and TATI loss, respectively. Increased bowel V45 was independently associated with increased odds of SMI loss (odds ratio [OR]: 1.012; 95% confidence interval [CI]: 1.007-1.018; p<0.001) and TATI loss (OR: 1.006; 95% CI: 1.001-1.010; p=0.01), but not with SMD loss (OR: 1.005; 95% CI: 1.000-1.009; p=0.054). The cut-off value with the highest accuracy for predicting SMI loss was V45 ≥222 mL; a higher rate of SMI loss was noted in 40.0% of patients with V45 ≥222 mL than in 13.7% of patients with V45 <222 mL (p<0.001). Higher bowel dose-volume was significantly associated with muscle loss during pelvic radiotherapy. Bowel dose-volume consideration is required in individualized nutritional counseling and supportive care in clinical practice.

Dyadic coping in young and middle-aged women with gynecological cancer: a latent class analysis

Cancer is a shared stress that can cause psychosocial and emotional burdens for both patients and their partners. This study aimed to identify patterns of dyadic coping (DC) among young and middle-aged women with gynecological cancer and to assess between-group differences. Between June 2021 and November 2021, patients with gynecological cancer who received therapy in a tertiary-grade hospital in Shandong, China, completed questionnaires including a demographic questionnaire, the Dyadic Coping Inventory, the PROMIS-Anxiety Short Form, the PROMIS-Depression Short Form, and the revised Conflict Tactics Scale and were classified into subtypes by latent class analysis. The sample consisted of 339 patients. Approximately one-third of the patients, especially cervical cancer patients, were exposed to varying degrees of DC issues. Three patterns were identified: class 1, middle-DC group (33.6%); class 2, low-DC group (32.2%); and class 3, high-DC group (34.2%). Postmenopausal patients were more likely to be included in class 1, while patients with cervical cancer were more likely to be included in class 2 (p < 0.05). Additionally, patients in class 2 were more likely to report insufficient emotional support (p < 0.05). A positive correlation was found for social relationship domains, and a negative correlation was found for anxiety and depression (p < 0.05). The findings indicated a high prevalence of DC in young and middle-aged women with gynecological cancer. Overall, participants scored in the low-to-middle range in terms of DC levels, and patients with cervical cancer and those with insufficient emotional support were more likely to report DC issues and require additional attention.

Caregivers’ satisfaction with cervical cancer care in Ethiopia

Cervical cancer is the second most common cancer among African women, following breast cancer. Palliative care is among the standards of care in cancer management. While caregivers play key roles in palliative care, their satisfaction with the care influences treatment outcomes and patients' quality of life. This study evaluated caregivers' satisfaction with the care provided to patients with advanced cervical cancer. A cross-sectional evaluation of caregivers' satisfaction with patient care was conducted at a tertiary hospital in Ethiopia. The study tool included the 20-item family satisfaction with advanced cancer care (FAMCARE) and caregiver stress index (CSI). Using binary logistic regression, we identified factors associated with caregivers' satisfaction. A total of 360 caregivers were interviewed. Most of the caregivers were male (58.1%), below the age of 35 years (60.8%), and educated to the high school level or less (64.4%). The average FAMCARE score was 77.7 out of the maximum 100. High satisfaction was observed among subscales "availability of treatment and care" and "psychosocial care," while low satisfaction was observed with "physical patient care" and "provision of information." Caregivers' stress and time dedicated to the caregiving were associated with caregivers' satisfaction. Overall, high satisfaction with advanced care at the tertiary hospital was documented. However, the caregivers also bore high burden of strain. Management of caregivers' strain, prompt treatment of patients' symptoms, and provision of adequate information to the caregivers could further improve caregivers' satisfaction.

Evaluating the role of perceived injustice in mental health outcomes in cervical cancer care

Perceived injustice is a novel psychosocial construct which reflects negative cognitive appraisals of blame, unfairness, and the severity and irreparability of one's loss. Experiences of injustice are increasingly recognised as a key determinant of recovery outcomes in healthcare. The aim of this study was to explore the impact of perceived injustice on psychological outcomes amongst a group of cancer patients and survivors who received false-negative smear results under a National Cervical Cancer Screening Programme (CervicalCheck). Women who received false-negative smear results who were involved in the CervicalCheck controversy in Ireland completed online measures of perceived injustice (IEQ), psychological distress (depression and anxiety as measured by the HADS), and satisfaction with care (PSCC) (n = 144). Rates of psychological distress in this sample were high, with 76% scoring in the clinical range for anxiety, 51% in the clinical range for depression, and 88% in the clinical range for perceived injustice. Hierarchical regression analyses revealed that perceived injustice contributed unique variance to the prediction of depression and anxiety. Satisfaction with care significantly moderated the association between perceived injustice and depression. Cancer patients who report high levels of perceived injustice are at greater risk for experiencing psychological distress. The relationship between perceived injustice and depression may vary as a function of satisfaction with care. Addressing issues of perceived injustice in the psychosocial and rehabilitative care of cancer patients may support the early identification of those at risk of significant psychological distress and enhance intervention success. Implications for policy and practice in healthcare are discussed.

Exploring exercise behavior, barriers, and facilitators among gynecologic cancer survivors: a cross-sectional study

Perceived food literacy in women with gynecologic cancer receiving chemotherapy

Listening to Australians with ovarian cancer: a cross-sectional survey investigating clinical trials awareness, information access and participation

Abstract Purpose To inform development of centralised, evidence-based clinical trials resources for Australians with ovarian cancer, a structured understanding of knowledge gaps and resource needs was essential. The study aimed to assist resource development by assessing awareness, information access, and participation in clinical trials of ovarian cancer patients. Methods A national, cross-sectional online survey among Australians with ovarian cancer was conducted between October and November 2024. Descriptive and inferential statistics along with qualitative content analyses were conducted. Associations were examined using Chi-Square and Fisher Exact tests. Results Surveys from 272 respondents indicated moderate knowledge ( $$\overline{x }$$ x ¯ = 4.46/10, SD = 2.34) and a high perception of importance of clinical trials ( $$\overline{x }$$ x ¯ = 9.27/10, SD = 1.17). 56% of respondents reported not receiving clinical trials information and 44% had sought information themselves. Respondents preferred information by email newsletter (34%), through health professional discussions (20%) and accessing an online information hub (17%). Information access enablers included clinicians being knowledgeable about clinical trials, personalised discussions, and access to a centralised information source. Barriers included fragmented information across websites, use of complex medical language and competing responsibilities as caregivers. A qualitative analysis of open-ended responses ( n  = 96) revealed three core themes: ‘we need better solutions to help find information and participate in clinical trials’, ‘weighing up options’ in their decision to participate, and ‘we want to help improve outcomes for women in the future’. Conclusions Results from this study of Australians with ovarian cancer inform actionable change through development of evidence-based, tailored resources. Further solutions and evaluation of intervention effectiveness will continue through sector collaboration.

Symptom burden, palliative care knowledge, and palliative care needs in advanced gynecological cancer patients in Korea

Pain management and analgesic strategies in patients with carcinoma uterine cervix undergoing intracavitary or interstitial brachytherapy

Pain management is a critical aspect of brachytherapy (BT) for carcinoma of the uterine cervix. Pain intensity can vary based on technique, patient characteristics, and analgesic strategies. This study aims to evaluate pain severity and associated factors to guide optimal pain control. This retrospective observational study included 85 patients of carcinoma uterine cervix who received external beam radiotherapy (EBRT) followed by BT between October 2022 and May 2025. The BT schedule was 7 Gy × 4 fractions, using ICBT or ISBT. Pain was assessed during treatment using a numeric rating scale and categorized as mild (1-3), moderate (4-6), or severe (7-10). Analgesia was stratified into four regimens: paracetamol (PCT) alone, PCT and non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and fentanyl patient-controlled analgesia (PCA). Mode of anaesthesia and the drugs used were also analyzed. Of the 85 patients, 33 experienced mild pain, 33 moderate, and 19 severe pain. The median age was 53.2 years, with the severe pain group being significantly older (p = 0.009). Pain severity was significantly associated with brachytherapy technique (p = 0.013), with ISBT correlating with higher pain levels. Whilst use of analgesics (p = 0.078) showed trends towards significance, anaesthesia type did not (p = 0.21). Severe pain group were more likely to be administered fentanyl and opioids. Multimodal analgesic strategies, including fentanyl infusions and opioids, are crucial in managing severe pain. Tailored pain management should be considered to reduce complications and improve patient comfort and compliance during cervical cancer treatment.

Health-related hardiness and influencing factors among cervical cancer radiotherapy patients: A cross-sectional study

Health-Related Hardiness (HRH) is a key psychological resource for adaptive recovery in cancer patients, but evidence remains limited among cervical cancer (CC) patients undergoing radiotherapy. Based on the hardiness model, this study assesses HRH levels in this population and examines its associations with coping styles, perceived social support, and health literacy, aiming to identify key influencing factors and inform targeted psychological support. This cross-sectional study enrolled 230 eligible CC patients via convenience sampling from the radiotherapy department of a tertiary hospital in Northeast China between December 2024 and August 2025. Research instruments included the General Demographic Information questionnaire, Health-Related Hardiness Scale, Medical Coping Modes Questionnaire, Perceived Social Support Scale, and Health Literacy Management Scale. The total HRH score for CC radiotherapy patients was (128 ± 20.04), indicating a moderately low level. Among the HRH dimensions, control had the lowest mean score (3.44 ± 0.77), followed by commitment (3.88 ± 0.79) and challenge (4.05 ± 0.72). Confronting coping styles, perceived social support, and health literacy were positively correlated with HRH, while avoiding and yielding coping styles were negatively correlated. Multiple linear regression analysis identified education level (β = 0.157, p = 0.004), number of children (β =  - 0.134, p = 0.013), number of radiotherapy sessions (β =  - 0.171, p = 0.002), and coping dimensions of confrontation, avoidance, and submission (β = 0.351, p < 0.01; β =  - 0.235, p < 0.01; β =  - 0.145, p = 0.015), perceived social support (β = 0.136, p = 0.021), and health literacy (β = 0.125, p = 0.045) as significant factors influencing HRH, jointly accounting for 41.3% of the total variance. The overall HRH among CC radiotherapy patients remains suboptimal. Healthcare institutions should prioritize fostering patients' positive psychological states and guiding them toward adaptive coping strategies. By improving health literacy and strengthening social support, healthcare providers can enhance patients' HRH, thereby promoting treatment adherence and health outcomes.

Falls, walking or balance problems, and limitations in activities of daily living (ADLs) among older endometrial cancer survivors

Functional status deficits are important quality of life concerns for older cancer survivors. We examined the prevalence of falls, walking/balance problems, and limitations in activities of daily living (ADLs) among older women with a history of endometrial cancer. Cancer registry records from the Surveillance, Epidemiology, and End Results (SEER) program linked with Medicare Health Outcomes Survey (MHOS) data were used to identify endometrial cancer survivors aged ≥ 65 years who completed a survey ≥ 1 year after their cancer diagnosis (N = 3766), as well as an age- and race-matched group of women without a cancer history (N = 3766). We estimated prevalence ratios (PRs) to compare the prevalence of falls, walking or balance problems, and limitations in ADLs (bathing, dressing, eating, getting in/out of chairs, walking, using the toilet) between groups. Difficulty with walking or balance was more common among survivors than the noncancer group (43% vs 36%; PR = 1.19; 95% CI: 1.10-1.27). Fall prevalence was similar between groups (endometrial cancer: 25%; noncancer: 26%; PR = 0.98; 95% CI: 0.89-1.08). Nearly half of endometrial cancer survivors (47%) reported at least one ADL limitation, with several activities (getting in/out of a chair, walking, bathing, using the toilet) more often limited among survivors than among women without cancer. Functional impairments, especially problems with walking and/or balance, are common among older endometrial cancer survivors. Our results highlight the importance of addressing functional problems during the ongoing survivorship care of women with a history of endometrial cancer, with referral to rehabilitation or other relevant services when indicated.

Correlation between an integrative oncology treatment program and survival in patients with advanced gynecological cancer

Integrative oncology (IO) is increasingly becoming part of palliative cancer care. This study examined the correlation between an IO treatment program and rates of survival among patients with advanced gynecological cancer. Patients were referred by their oncology healthcare professionals to an integrative physician (IP) for consultation and IO treatments. Those undergoing at least 4 treatments during the 6 weeks following the consultation were considered adherence to the integrative care program (AIC), versus non-adherent (non-AIC). Survival was monitored for a period of 3 years, comparing the AIC vs. non-AIC groups, as well as controls who did not attend the IP consultation. A total of 189 patients were included: 71 in the AIC group, 44 non-AIC, and 74 controls. Overall 3-year survival was greater in the AIC group (vs. non-AIC, p = 0.012; vs. controls, p = 0.003), with no difference found between non-AIC and controls (p = 0.954). Multimodal IO programs (≥ 3 modalities) were correlated in the AIC group with greater overall 3-year survival (p = 0.027). Greater rates of survival were also found in the AIC group at 12 (p = 0.004) and 18 months (p = 0.001). When compared with the AIC group, a multivariate analysis found higher crude and adjusted hazard ratios for 3-year mortality in the non-AIC group (HR 95% CI 2.18 (1.2-3.9), p = 0.010) and controls (2.23 (1.35-3.7), p = 0.002). Adherence to an IO treatment program was associated with higher survival rates among patients with advanced gynecological cancer. Larger prospective trials are needed to explore whether the IO setting enhances patients' resilience, coping, and adherence to oncology treatment.

A single-arm, prospective trial investigating the effectiveness of a non-hormonal vaginal moisturizer containing hyaluronic acid in postmenopausal cancer survivors

To assess the feasibility and efficacy of a non-hormonal hyaluronic acid (HLA) vaginal gel in improving vulvovaginal estrogen-deprivation symptoms in postmenopausal women with a history of hormone receptor-positive (HR+) cancer. For this single-arm, prospective longitudinal trial, we identified disease-free patients with a history of HR+ breast cancer treated with aromatase inhibitors or HR+ endometrial cancer treated with surgery and postoperative radiation. Participants used HLA daily for the first 2 weeks, and then 3×/week until weeks 12-14; dosage was then increased to 5×/week for non-responders. Vulvovaginal symptoms and pH were assessed at 4 time points (baseline [T1], 4-6 weeks [T2], 12-14 weeks [T3], 22-24 weeks [T4]) with clinical evaluation, the Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), Female Sexual Function Index (FSFI), and Menopausal Symptom Checklist (MSCL). Of 101 patients, mean age was 55 years (range, 31-78), 68% (n = 69) were partnered, and 60% (n = 61) were sexually active. In linear mixed models, VAS/VuAS scores significantly improved at all assessment points (all p  6.5) decreased from 26% at T1 to 19% at T4 (p = 0.18). HLA moisturization improved vulvovaginal health/sexual function of cancer survivors. While HLA administration 1-2×/week is recommended for women in natural menopause, a 3-5×/week schedule appears to be more effective for symptom relief in cancer survivors.

Sleep, quality of life, and depression in endometrial cancer survivors with obesity seeking weight loss

Incidence and mortality rates of uterine cancer are increasing and, obesity, which is also rising, has been associated with uterine cancer development and mortality. A recent study found that poor sleep quality is common among endometrial cancer survivors and those with obesity had more sleep disturbances than those having normal weight. However, it is unclear if higher levels of obesity (Class III, BMI ≥ 40 kg/m We evaluated sleep, depression, and quality of life in 100 Stage I endometrial cancer survivors with obesity seeking weight loss enrolled in a lifestyle intervention (NCT01870947) at baseline. The average age was 60 years and mean BMI was 42.1 kg/m Our results reveal that endometrial cancer survivors with class III compared with class I obesity have poorer sleep quality, higher depression, and lower quality of life. Given the rising rates of obesity and uterine cancer mortality, interventions to combat both obesity and poor sleep are needed.

Reproductive concerns in young women with cervical cancer: latent profiles and key influencing factors

Cervical cancer incidence in China has risen to 13.83/100,000, particularly affecting younger women. Following recent family policy changes, reproductive concerns among cervical cancer patients have intensified. While fertility-sparing treatments show good survival rates, many patients still experience significant anxiety about future fertility. This study aims to examine distinct reproductive concern profiles and their influencing factors in cervical cancer patients of childbearing age. We studied 247 patients from a Nanjing tertiary hospital between October 2023 and October 2024. Participants completed surveys including a demographic questionnaire, Reproductive Concerns After Cancer Scale, Patient Health Questionnaire-9, Benefit Finding Scale, and Fear of Cancer Recurrence Scale. Latent profile analysis (LPA) was conducted to identify reproductive concerns. Latent profile analysis revealed three distinct reproductive concern profiles: (1) a low-concern group with reproductive expectations (27.94%), (2) a moderate-concern group with self and child health preoccupations (49.39%), and (3) a high-concern group with impaired reproductive adaptation (22.67%). Significant influencing factors included age, number of children, residential location, depressive symptoms, and fear of cancer recurrence. These cross-sectional findings emphasize the need for careful consideration of individualized, multiple-disciplinary care for young women with cervical cancer. Benefit finding was associated with lower reproductive concerns.

Unveiling delays: understanding the diagnostic pathways of women with advanced cervical cancer

This qualitative inquiry delves into the diagnostic odyssey experienced by women diagnosed with locally advanced cervical cancer, seeking to elucidate the multifaceted factors influencing symptom recognition and access to healthcare services. Semi structured interviews were conducted with 17 women diagnosed with locally advanced cervical cancer at a tertiary care hospital. The study employs Braun and Clarke thematic analysis, a structured approach to identifying, interpreting, and displaying themes that reflect participants' experiences. Two overarching themes of significance emerged: (1) "Personal Attitude: from symptom recognition to seeking healthcare" encapsulating individual symptom perception and healthcare-seeking behavior, and (2)"Weaknesses of the health system: from access to referral," uncovering systemic obstacles impeding timely diagnosis and treatment. These findings underscore the urgent need for comprehensive strategies including patient education, healthcare provider training, improved referral systems, and empathetic healthcare interactions, to mitigate diagnostic delays and improve outcomes. By applying a rigorous qualitative approach, our study contributes to a deeper understanding of diagnostic delays in cervical cancer and provides a framework for future research in similar contexts.

Illness perception and intimate relationships in patients with cervical cancer: the mediating role of dyadic coping

A good intimate relationship (IR) can relieve the psychological distress of patients with cervical cancer and promote a sense of well-being during stressful times. Researchers have found that IR is related to illness perception (IP) and dyadic coping (DC). Therefore, this study aimed to (1) describe the IR of patients with cervical cancer, (2) identify the relationships and pathways among IP, DC and IR in patients with cervical cancer and (3) explore the mediating role of DC between IP and IR in cervical cancer patients. A total of 175 patients with cervical cancer were recruited at a tertiary hospital in China from September 2021 to January 2023. The data were collected through a general demographic and disease-related information questionnaire, the Locke-Wallace Marriage Adjustment Test, the Revised Illness Perception Questionnaire of Cervical Cancer and the Dyadic Coping Inventory. The mean score for intimate relationships was 107.78 (SD = 23.99, range 30-154). Pearson's correlation analysis revealed that intimate relationships were positively correlated with IP (personal control) and DC (stress communication, supportive DC, delegated DC and common DC) and were negatively correlated with IP (consequence, timeline acute/chronic, timeline cyclical and emotional representation) and negative DC. As for the results of the structural equation model, DC fully mediated the influencing effects of both positive and negative IP on IR. The level of IR of patients with cervical cancer in China should be improved. DC has a significant mediating effect on the link between the IP and IR.

Supervised resistance exercise for women with ovarian cancer who have completed first-line treatment: a pragmatic study

Abstract Objectives In ovarian cancer (OC), suboptimal muscle morphology (i.e., low muscle mass and density) is associated with poor clinical outcomes, yet little is known about the effect of interventions aimed at improving these measures. We investigated the effect of resistance exercise after first-line treatment on muscle mass and density, muscle strength and physical function, health-related quality of life (QoL), and pelvic-floor function in advanced-stage OC survivors. Methods Fifteen OC survivors participated in supervised resistance exercise twice weekly for 12 weeks (in-clinic or by telehealth). Assessments included muscle mass and density (dual-energy X-ray absorptiometry, peripheral quantitative computed tomography), muscle strength (1-repetition maximum [1RM] chest press, 5RM leg press, handgrip strength), physical function (400-m walk, timed up-and-go [TUG]), QoL (QLQ-C30 questionnaire), and self-reported pelvic floor function (Australian Pelvic Floor Questionnaire). Results The median age was 64 (range 33–72) years, 10 women underwent neoadjuvant chemotherapy and five underwent adjuvant chemotherapy. All participants completed the intervention (median attendance = 92%; range 79–100%). Post-intervention improvements were observed for whole-body lean mass (1.0 ± 1.4 kg, p = 0.015), appendicular lean mass (0.6 ± 0.9 kg, p = 0.013), muscle density (p = 0.011), upper and lower body strength (p ≤ 0.001), 400-m walk (p = 0.001), TUG (p = 0.005), and social and cognitive QoL domains (p = 0.002 and 0.007), with no change to pelvic floor symptoms (p &gt; 0.05). Conclusion In this study, supervised resistance exercise effectively improved muscle mass and density, muscle strength, and physical functioning without deleterious effects on the pelvic floor. Considering the prognostic value of these outcomes, larger studies are needed to confirm the benefits of resistance exercise in OC supportive care.

Mediating effects of sense of coherence and psychological resilience on stigma and quality of life among postoperative middle-aged and older patients with malignant gynecological tumors: a cross-sectional, structural equation model

Abstract Purpose Middle-aged and older individuals are at a crucial stage of aging, marked by increased vulnerability to psychological and physiological challenges. Cancer has a negative impact on the quality of life of patients. Stigma is closely related to the quality of life (QoL) of middle-aged and older patients with malignant gynecological tumors, but the mechanism behind this relationship is still unclear. Sense of coherence (SOC) and psychological resilience (PR) are positive mental health factors that can alleviate psychological stress and improve the quality of life. Therefore, this study aimed to explore the mediating role of sense of coherence and psychological resilience between stigma and quality of life. Methods A cross-sectional survey was conducted from May 2023 to January 2024, involving a total of 428 postoperative patients from the gynecological oncology departments of four tertiary grade A hospitals in Fujian Province. Assessment tools included the Functional Assessment of Cancer Therapy-General scale, the Social Impact Scale, the Connor–Davidson Resilience Scale, and the Sense of Coherence Scale-13. Data analysis was performed using IBM SPSS 26.0 and AMOS 24.0 software. Results Descriptive analyses showed generally low quality of life levels. Stigma negatively affected psychological resilience and quality of life, while psychological resilience positively affected quality of life. Stigma also negatively influenced the sense of coherence, whereas the sense of coherence positively affected quality of life. Furthermore, the sense of coherence had a positive effect on psychological resilience. The sense of coherence and psychological resilience partially mediated the relationship between stigma and quality of life. Conclusions Stigma has a direct impact on the quality of life and also exerts an indirect effect through the mediation of sense of coherence and psychological resilience. Clinical healthcare providers can improve patients’ quality of life by reducing stigma and promoting sense of coherence and psychological resilience.

Psychological distress, body image, and nutritional status during hospitalization for gynecological cancer surgery: a prospective observational study

Abstract Background Hospitalization for gynecological cancer surgery represents a critical window for assessing and addressing psychological and nutritional vulnerabilities. This prospective observational study investigated changes in emotional distress, anxiety, depression, body-image dissatisfaction, orthorexic tendencies, and nutritional status from admission to discharge, and explored associations between psychological and nutritional variables. Methods A total of 220 women hospitalized for surgical treatment of gynecological cancer were enrolled, with 181 (82.3%) completing both baseline (T0) and discharge (T1) assessments. Psychological outcomes were evaluated using the Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), Body-Image Scale (BIS), and Teruel Orthorexia Scale (TOS). Nutritional status was assessed through the Mini Nutritional Assessment (MNA). Changes between T0 and T1 were analyzed using paired t-tests. Pearson’s correlations examined associations between psychological and nutritional variables. A multivariable logistic regression identified predictors of clinically relevant distress (DT ≥ 4) at discharge. Results Significant improvements were observed in anxiety (p &lt; 0.001), depression (p &lt; 0.001), emotional distress (p &lt; 0.001), and orthorexic tendencies (p &lt; 0.001) between admission and discharge. Conversely, body-image dissatisfaction increased significantly (p &lt; 0.001). Nutritional risk remained high throughout hospitalization, with no statistically significant change (p = 0.221). Higher body-image dissatisfaction at admission predicted a greater likelihood of clinically relevant distress at discharge (p = 0.003). Conclusions Hospitalization offers a pivotal opportunity to identify and address emotional and nutritional needs in women with gynecological cancers. Integrated, multidisciplinary supportive care models targeting both psychological and nutritional vulnerabilities are crucial to promote holistic recovery during and beyond the surgical course.

Perceived social support, fatigue, and sleep quality in women treated for gynecological cancer: a cross-sectional study

Abstract Aim The study aims to determine the levels of perceived social support, fatigue, and sleep quality among women undergoing treatment for gynecological cancer. Methods This cross-sectional and descriptive study included 217 women. Participants completed the personal information form, the multidimensional perceived social support scale, the Pittsburgh Sleep Quality Index, and the brief fatigue questionnaire. This study was conducted with patients who received treatment at the Gynaecological Oncology Clinic of a Training and Research Hospital and met the inclusion criteria. Data were collected between April and September 2023 after obtaining approval from the ethics committee and the relevant institution. Results The mean total score for perceived social support was 59.85 ± 17.04, the median total score on the fatigue scale was 63.00 (IQR = 16.50), and the mean total score on the PSQI was 6.91 ± 2.60. Most of the participants (67.4%) had poor sleep quality. There was a weak negative correlation between the daytime dysfunction subdimension and the total PSQI score and both the subdimensions and total score of the social support scale, as well as a weak positive correlation with the fatigue scale (p &lt; 0.05). Conclusion In our study, perceived social support and fatigue scores among patients with gynecological cancer were found to be above the moderate level, while their sleep quality was poor.

Randomised controlled trial of music listening combined with progressive muscle relaxation for mood management in women receiving chemotherapy for cancer

Abstract Aims To evaluate the effects of passive music listening combined with progressive muscle relaxation on anxiety, depression, stress, coping, and quality-of-life in women with breast and gynaecological cancers receiving chemotherapy. Methods This was an assessor-blinded, randomised wait-list controlled trial. A total of 120 participants were randomly allocated into an intervention group or a wait-list control group. The intervention group received an intervention comprising training on passive music listening and progressive muscle relaxation, with once-daily self-practice at home for 3 weeks. The wait-list control group received the same intervention after the outcome assessment at week 6. All outcome data were collected before (T0) and 3 weeks (T1), 6 weeks (T2), and 12 months (T3) after randomisation. A generalised estimating equations model was used to compare the changes in each outcome at different time points. Process evaluation was conducted using data from the patient’s self-report forms and interviews. Results The findings indicated that at T1 and T2, the intervention group’s reductions in anxiety were significantly larger than those of the control group. Additionally, the intervention group exhibited significantly better decreases in depression at T2, stress at T1, and dysfunctional coping at T2, and a greater improvement in quality-of-life score at T1 and T2 when compared to the control group. Most of the interviewed participants provided positive feedback on the intervention. Conclusions The intervention was beneficial for lowering anxiety, depression, and stress and increasing the quality-of-life of women receiving chemotherapy for breast and gynaecological cancers. Trial registration. The trial was prospectively registered with ClinicalTrials.gov on 9 February 2022 (registration number: NCT05262621).

Oocyte collection and outcome following oncologic treatment: a retrospective multicentre study

Abstract Purpose This study assesses fertility treatment outcomes in female patients who had undergone successful oocyte retrieval following cancer therapy. Methods Between January 2020 and December 2022, we collected fertility treatment data from six participating centres in Spain and Germany. All patients associated with this data had undergone successful oocyte retrieval following cancer treatment. Results Women had most frequently been diagnosed with a haematological (41.9%), breast (22.6%) or gynaecological malignancy (12.9%); two thirds (67.7%) had previously received a chemotherapy, half a radiotherapy (53.3%) and 45.2% had undergone surgery. On average, 7 years (range 0–28) had passed between cancer treatment and first ovarian stimulation cycle. Forty-nine ovarian stimulation cycles had been conducted on these 31 women between 2004 and 2021 (mean age at first oocyte collection following treatment: 34.8 ± 5.7 years). On average, 7 oocytes were collected per cycle (range 0–26) and 11 were collected per patient (range 0–51). Out of the 190 oocytes collected for immediate use of artificial reproductive technique, 139 were fertilised at a rate of 73%. Live birth rate per fresh transfer was 45% (9/20); no births were reported following cryotransfer (0/10). Mean values of anti-Mullerian hormone (AMH) before stimulation declined with time since treatment; however, oocytes were successfully collected from four women with an AMH of &lt;0.5 ng/ml, although no pregnancies were reported. Ten pregnancies were documented; 3 ended in miscarriage. Two twin and 5 single pregnancies resulted in nine live births. On average, children were carried to term. Conclusion In this small cohort, oocytes were successfully collected after chemotherapy and radiotherapy, despite—in individual cases—low AMH values. Further studies are needed to enrich the database and ultimately provide appropriate counselling to female cancer patients regarding expectations and ART outcome following cancer therapy.

Can we improve the management of inoperable malignant bowel obstruction? Results of a feasibility study of elemental diet as an alternative to parenteral nutrition in patients with advanced gynaecological cancer

Abstract Purpose Nutrition support in inoperable bowel obstruction (IBO) remains challenging. Parenteral nutrition (PN) is recommended if the prognosis is &gt; 2 months. An elemental diet (ED) is licensed for strictures in Crohn’s disease but has not been used in malignant bowel obstruction. The aim of this study was to evaluate the use of ED in patients with IBO and provide a proof of concept of ED as an acceptable feeding option. Methods This was a mixed-methods single-arm feasibility study. The primary endpoint was to provide a ‘proof of concept’ of ED as an acceptable feeding option for patients with IBO. Secondary endpoints included taste acceptability, incidences of vomiting and pain, the proportion of women who tolerated ED, the number of cartons drunk, quality of life (QOL) and the number of women treated with chemotherapy. Patients (&gt; 18 years) with CT-confirmed IBO who could tolerate 500 ml of liquid in 24 h remained on the trial for 2 weeks. Results A total of 29 patients were recruited; of those, 19 contributed to the analysis for the primary endpoint; 13 (68.4%) participants tolerated the ED; 26 patients contributed to MSAS and EORTC QLQ questionnaires at baseline to allow for the assessment of symptoms. At the start of the study, 18 (69%) of patients experienced vomiting, reducing to 4 (25%) by the end of day 15 of the study; 24 (92%) of patients reported pain at consent, reducing to 12 (75%) by the end of day 15. QOL scores improved from 36.2 (95% CI 27.7–44.7) at baseline to 53.1 (95% CI 40.3–66) at the end of day 15; 16 (84%) participants commenced chemotherapy within the first week of starting ED. The number of cartons across all participants showed a median of 1.3 cartons per day (range 0.8 to 2.5). Conclusion ED is well tolerated by patients with IBO caused by gynaecological malignancies and may have a positive effect on symptom burden and QOL.

Rates of paclitaxel hypersensitivity reactions using a modified Markman’s infusion protocol as primary prophylaxis

Abstract Purpose Markman’s desensitisation protocol allows successful retreatment of patients who have had significant paclitaxel hypersensitivity reactions. We aimed to reduce the risk and severity of paclitaxel hypersensitivity reactions by introducing this protocol as primary prophylaxis. Methods We evaluated all patients with a gynaecological malignancy receiving paclitaxel before (December 2018 to September 2019) and after (October 2019 to July 2020) the implementation of a modified Markman’s desensitisation protocol. The pre-implementation group received paclitaxel over a gradually up-titrated rate from 60 to 180 ml/h. The post-implementation group received paclitaxel via 3 fixed-dose infusion bags in the first 2 cycles. Rates and severity of paclitaxel hypersensitivity reactions were compared. Results A total of 426 paclitaxel infusions were administered to 78 patients. The median age was 64 years (range 34–81), and the most common diagnosis was ovarian, fallopian tube and primary peritoneal cancer (67%, n = 52/78). Paclitaxel hypersensitivity reaction rates were similar in the pre-implementation (8%, n = 16/195) and post-implementation groups (9%, n = 20/231; p = 0.87). Most paclitaxel hypersensitivity reactions occurred within 30 min (pre- vs. post-implementation, 88% [n = 14/16] vs. 75% [n = 15/20]; p = 0.45) and were grade 2 in severity (pre- vs. post-implementation, 81% [n = 13/16] vs. 75% [n = 15/20]; p = 0.37). There was one grade 3 paclitaxel hypersensitivity reaction in the pre-implementation group. All patients were successfully rechallenged in the post-implementation group compared to 81% (n = 13/16) in the pre-implementation group (p = 0.43). Conclusion The modified Markman’s desensitisation protocol as primary prophylaxis did not reduce the rate or severity of paclitaxel hypersensitivity reactions, although all patients could be successfully rechallenged.

Patient-reported outcome measures (PROMs) to personalise follow-up care of ovarian cancer: what do patients think? A qualitative interview study

Abstract Purpose The purpose of this study was to explore ovarian cancer patients’ preferences regarding follow-up care and, in particular, the use of patient-reported outcome measures (PROMs) as an approach to personalise follow-up care. Methods Between May and June 2021, semi-structured interviews were conducted with ovarian cancer patients, who had finished their primary treatment at least 6 months prior and were receiving follow-up care at our centre. Interviews were transcribed verbatim and analysed using an inductive thematic approach. A thematic flow chart was created describing interacting themes. Results Seventeen patients were interviewed, of which 11 were familiar with PROMs. Two key themes emerged from the data: the need for reassurance and the wish for personalised care. A follow-up scheme using PROMs was identified as a separate theme with the potential to personalise care. Several barriers and facilitators of PROMs were mentioned. Conclusions Ovarian cancer patients have a desire for personalised follow-up care and seek reassurance. PROMs may be able to support both of these needs. Future research is needed to determine the most effective, patient-centred way to implement them. Implications for cancer survivors By understanding what patients’ preferences are regarding follow-up care, more initiatives can be set up to personalise follow-up care, through which patient anxiety and dissatisfaction can be reduced.

Trends in nutritional status and factors affecting prognostic nutritional index in ovarian cancer patients during chemotherapy: a prospective longitudinal study based on generalized estimating equations

Abstract Purpose Numerous studies have investigated the relationships between nutritional status and the prognosis of ovarian cancer (OC). However, the majority of these studies have focused on pre-chemotherapy malnutrition, with limited attention given to dynamic changes in nutritional status during chemotherapy and the associated risk factors affecting the prognostic nutritional index (PNI) in OC women. This study aims to explore the variation trend in the nutritional status of OC women over time during chemotherapy and assess its predictive factors. Methods A prospective longitudinal study was conducted from January 2021 to August 2023. Body mass index (BMI), PNI, Nutritional Risk Screening (NRS) 2002, serum albumin, and prealbumin measurements were utilized to assess the nutritional status of OC women. Data were collected through face-to-face interviews before initial chemotherapy (T0) and during the first (T1), third (T2), and fifth (T3) cycles of chemotherapy. Generalized Estimating Equations (GEE) were employed for the analysis of potential predictive factors. Results A total of 525 OC women undergoing chemotherapy completed the study. Significantly varied levels of BMI, PNI, and serum concentrations of hemoglobin, albumin, prealbumin, potassium, sodium, magnesium, and calcium were observed in these patients ( p  &lt; 0.05). The prevalence of nutritional risk decreased over time during chemotherapy ( p  &lt; 0.05). Nutritional parameters, including BMI, PNI, and the serum concentrations of albumin and prealbumin, exhibited an upward trend in nutritional status throughout the chemotherapy cycles ( p  &lt; 0.05). Multivariate analysis indicated that higher levels of BMI, serum albumin, prealbumin, absolute lymphocyte count, and hemoglobin ≥ 110 g/L at admission were associated with elevated PNI after chemotherapy ( β  = 0.077, p  = 0.028; β  = 0.315, p  &lt; 0.001; β  = 0.009, p  &lt; 0.001; β  = 1.359, p  &lt; 0.001; β  =  − 0.637, p  = 0.005). Conclusion Patients consistently demonstrated improvements in nutritional risk and status from the initiation to the completion of chemotherapy cycles. Nutritional monitoring of OC women, particularly those exhibiting abnormalities at the commencement of chemotherapy, is crucial. Targeted nutritional support programs should be developed to enhance the prognosis of OC women.

Investigating psychological mechanisms linking pain severity to depression symptoms in women cancer survivors at a cancer center with a rural catchment area

Abstract Purpose Women cancer survivors, especially those in rural areas, with high levels of depression may be acutely susceptible to pain due to the ways they think, feel, and behave. The current study seeks to elucidate the relationship between symptoms of depression and pain severity in women cancer survivors, by examining the putative mediators involved in this relationship, specifically their self-efficacy for managing their health, how overwhelmed they were from life’s responsibilities, and relational burden. Methods Self-report data were collected from 183 cancer survivors of breast, cervical, ovarian, or endometrial/uterine cancer, who were between 6 months and 3 years post-active therapy. Results Women cancer survivors with higher (vs. lower) symptoms of depression had more severe pain. Individual mediation analyses revealed that survivors with higher levels of depression felt more overwhelmed by life’s responsibilities and had lower self-efficacy about managing their health, which was associated with greater pain severity. When all mediators were simultaneously entered into the same model, feeling overwhelmed by life’s responsibilities significantly mediated the link between survivors’ symptoms of depression and their pain severity. Conclusions The relationship between symptoms of depression and pain severity in women cancer survivors may be attributed in part to their self-efficacy and feeling overwhelmed by life’s responsibilities. Early and frequent assessment of psychosocial factors involved in pain severity for women cancer survivors may be important for managing their pain throughout the phases of cancer survivorship.

The comparison of functional status and health-related parameters in ovarian cancer survivors with healthy controls

Abstract Purpose The primary purpose of this study was to evaluate functional status and health-related parameters in ovarian cancer (OC) survivors and to compare these parameters with healthy controls. The secondary purpose of this study was to compare these parameters in early and advanced OC survivors. Methods Thirty-two OC survivors (n = 15 early stage; n = 17 advanced stage) with no evidence/suspicion of cancer recurrence after completing adjuvant local and systemic treatments for at least 12 months and 32 healthy controls were recruited for functional- and health-related assessments. Participants were assessed using the following methods of measuring the following: 6-min walk test (6MWT) for functional exercise capacity, 30-s chair stand test (30 s-CST) for functional fitness and muscle endurance, a handheld dynamometer for peripheral muscle strength, and a handheld dynamometer for lower extremity strength, Medical Micro RPM for respiratory muscle strength, International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity level, and Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) for performance status, Checklist Individual Strength (CIS) for fatigue, Treatment/Gynecological Oncology-Neurotoxicity (FACT/GOG-NTX) for neuropathy, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression level, and the World Health Organization-Five Well-Being Index (WHO-5) for generic quality of life. Results All OC survivors underwent surgery and chemotherapy, and only 9.4% received radiotherapy in addition to chemotherapy. The median recurrence-free period post-completion of adjuvant treatments was 24.00 (12.00–75.00) months. OC survivors had lower 6MWT (m) (p &lt; 0.001, r = 1.50), peripheral muscle strength (p = 0.005, r = 0.72), knee extension (p &lt; 0.001, r = 1.54), and respiratory muscle strength (maximal inspiratory pressure) (p &lt; 0.001, r = 1.90) (maximal expiratory pressure) (p &lt; 0.001, r = 1.68) compared to healthy controls. HADS-A (p = 0.005, r = 0.75) and CIS scores (p = 0.025, r = 0.59) were also higher in the OC survivors. Early-stage OC survivors had better 6MWT (m) than advanced-stage OC survivors (p = 0.005, r = 1.83). Peripheral muscle strength was lower in advanced-stage OC survivors (p = 0.013, r = 0.92). FACT/GOG-NTX scores were higher in early-stage OC survivors (p &lt; 0.001, r = 1.42). No significant differences were observed between early- and advanced-stage OC survivors in other measures (p &lt; 0.05). Conclusion The findings suggest functional status, and health-related parameters are negatively affected in OC survivors. Additionally, higher levels of fatigue, neuropathy anxiety, and depression were reported in advanced OC survivors.

Experiences and facilitators of physical activity engagement amongst colorectal and endometrial cancer survivors: the Wearable Activity Technology and Action-Planning (WATAAP) trial

Abstract Purpose This study explored colorectal and endometrial cancer survivors’ experiences of participation in a wearable intervention and the dimensions that influenced intervention engagement and physical activity behaviour change. Methods Semi-structured interviews ( n = 23) were conducted with intervention participants (mean age 65.8 (SD ±7.1) and analysed using thematic analysis. Results Four main themes were identified: (i) commitment, (ii) accountability and monitoring, (iii) routine, (iv) Fitbit as health coach. Those that assigned a higher priority to PA were more likely to schedule PA and be successful in PA change. Those less successful presented more barriers to change and engaged in more incidental PA. The Fitbit acting as health coach was the active ingredient of the intervention. Conclusions Commitment evidenced through prioritising PA was the foundational dimension that influenced PA engagement. Interventions that foster commitment to PA through increasing the value and importance of PA would be worthwhile. Wearables holds great promise in PA promotion and harnessing the technique of discrepancy between behaviour and goals is likely a valuable behaviour change technique.

Type of treatment, operated organ and sexual functioning of patients with cervical cancer

Abstract Cancer treatment affects every area of a patient's life. Currently available cancer treatment methods not only increase the chances of survival, but also challenge patients to return to their pre-disease lifestyle. This means that a patient's functioning both during and after the disease consists not only of satisfaction in the spheres of family life and work life, but also sexual functioning. The primary objective of the presented study was to assess the sexual functioning of female patients, taking the type of treatment, quality of life domains and sociodemographic factors into account. The study was conducted on 70 women between the ages of 32 and 84 at the Department of Oncology and Radiotherapy of the University Clinical Center, and the Department of Obstetrics and Gynecology, Gynecologic Oncology and Gynecologic Endocrinology in Gdansk, Poland in 2021. The results indicate that patients who experience less discomfort and have better ratings of their overall functioning also report better ratings of their sexual functioning, and are less likely to report irritating complaints. Women treated with radiation therapy report more difficulties in functioning than patients who did not receive this treatment.

Safety and antiemetic efficacy of weekly administration of netupitant/palonosetron plus dexamethasone during 5 weeks of concomitant chemo-radiotherapy—the DANGER-emesis study

Abstract Purpose Netupitant 300 mg/palonosetron 0.5 mg (NEPA) would be ideal as antiemetic prophylaxis for patients receiving weekly cisplatin, as it would reduce concurrent medication intake compared to the 3-day aprepitant regimen. However, due to the longer half-life of netupitant (~ 88 h), weekly administration could potentially lead to accumulation and toxicity. This study aims to investigate the safety and antiemetic efficacy of weekly administration of NEPA plus dexamethasone (DEX) in patients treated for cervical cancer with radiotherapy and weekly cisplatin 40 mg/m2. Methods This single-arm, open-label, phase II study evaluated patients with cervical cancer receiving NEPA and DEX before weekly cisplatin and concomitant radiotherapy for up to 5 weeks. Safety was assessed during weekly adverse event (AE) assessments. Efficacy was evaluated using Patient Diaries reporting daily nausea, vomiting, and use of rescue medication during the study period. Results Between October 8, 2018, and January 2, 2024, 73 patients were recruited from two Danish departments of oncology; 37 completed all five weekly cycles. The majority of AEs were of mild or moderate intensity, with fatigue being the most frequently observed (95% of patients). Seven (10%) patients encountered ≥ 1 grade 3 treatment-related AEs (TRAEs). No grade 4 TRAEs or deaths were observed. In terms of efficacy, no vomiting and no nausea days 1–35 were 86% and 18%, respectively. Mean time to first emetic episode was 9 days. Conclusion Weekly NEPA administration was safe, well-tolerated, and highly effective during concomitant radiotherapy and weekly cisplatin. Trial registration This trial is registered at ClinicalTrials.gov (NCT03668639-2018–09-10).

Breaking the silence: the role of sexual communication on quality of life in women with cervical cancer

Abstract Introduction Cervical cancer (CC) and its treatments impact various dimensions of quality of life (QoL), including physical, psychological, and sexual functioning. Sexual health, a crucial QoL aspect, is often compromised, highlighting the necessity for open sexual communication. Materials and methods This study involved 60 women diagnosed with stage IIb-IIIa CC. The 36-Item Short Form Survey (SF-36) was used to measure physical and psychological components of QoL, the Female Sexual Function Index-6 (FSFI-6) to assess its sexual component, and the Sexual Communication Self-Efficacy Scale (SCSES) to diagnose communication confidence. Self-administered questions gauged patient-provider sexual communication. The results include quotes from participants, providing additional insight. Results Sexual communication self-efficacy and patient-provider communication correlated significantly with QoL components. Only 23.33% discussed sexual issues with their doctors. Participants’ experiences highlighted the impact of cancer on sexuality and the need for tailored support. Discussion Post-diagnosis psychosexual changes emphasize the importance of communication in renegotiating sexual identity and needs. Effective communication is associated with improved QoL, highlighting the role of healthcare professionals in addressing psychosexual issues. Integrating PLISSIT and BETTER models provides a comprehensive approach to sexual communication in the cancer context. Conclusion The study demonstrates the importance of sexual communication self-efficacy in QoL of CC patients and highlights the need for healthcare professionals to include sexual communication education in cancer care.

Efficacy of regional cooling + oral dexamethasone for primary prevention of hand-foot syndrome associated with pegylated liposomal doxorubicin

Abstract Purpose Pegylated liposomal doxorubicin (PLD)-induced hand-foot syndrome (HFS) frequently lowers the quality of life of ovarian cancer patients. Wrist and ankle cooling, having a limited preventive effect, has been the commonest supportive HFS care. In this study, we retrospectively assessed the primary preventive effect of a combination of regional cooling and oral dexamethasone therapy (cooling + oral Dex) on HFS. Methods This study is a single-arm retrospective, observational study. Recurrent ovarian cancer patients were administered PLD ± bevacizumab. We retrospectively examined the efficacy of hands and feet cooling (from the start of PLD to the end) + oral Dex (day 1–5: 8 mg/day, day 6, 7: 4 mg/day) for primary HFS prevention. Results This study included 74 patients. The initial dose of PLD was 50 mg/m 2 and 40 mg/m 2 for 32 (43.2%) and 42 (56.8%) patients, respectively. HFS of Grade ≥ 2 and Grade ≥ 3 developed in five (6.8%) and one (1.4%) patient(s), respectively. The incidence of ≥ Grade 2 and ≥ Grade 3 HFS was much lower than those reported in previous studies. Dose reduction was required in 13 patients (17.6%) mainly because of neutropenia or mucositis; there was no HFS-induced dose reduction. Meanwhile, PLD therapy was discontinued mainly because of interstitial pneumonia (4 patients) and HFS (one patient). Conclusions We demonstrated the efficacy of regional cooling and oral Dex for primary prevention of PLD-induced HFS. Although future prospective studies are needed to confirm its efficacy, this combination therapy can be considered for primary prevention of HFS in ovarian cancer patients on PLD.

Symptom burden survey and symptom clusters in patients with cervical cancer: a cross-sectional survey

Abstract Purpose The purpose of this study is to determine the incidence and severity of symptoms of patients with cervical cancer within 6 months after radiotherapy and chemotherapy, form a symptom burden report, evaluate the distribution characteristics of symptoms, identify symptom clusters, and provide a basis for clinical doctors and nurses to improve the symptom management of patients with cervical cancer after radiotherapy and chemotherapy. Methods The patients with cervical cancer within 6 months after radiotherapy and chemotherapy were recruited to investigate their symptom burden. Exploratory factor analysis was used to identify symptom clusters. Results A total of 250 patients participated in the study. The study found that the most common symptom among the 40 symptoms was fatigue, and the most serious symptom was nocturia. Based on the occurrence rate and severity of symptoms, nine symptom clusters were identified, including psycho–emotion-related symptom cluster, pain–disturbed sleep-related symptom cluster, menopausal symptom cluster, tinnitus–dizziness-related symptom cluster, urinary-related symptom cluster, dry mouth–bitter taste-related symptom cluster, intestinal-related symptom cluster, memory loss–numbness-related symptom cluster, and emaciation-related symptom cluster. The three most serious symptom clusters are pain–disturbed sleep-related symptom cluster, urinary-related symptom cluster, and memory loss–numbness-related symptom cluster. Conclusion The symptoms of patients with cervical cancer within 6 months after radiotherapy and chemotherapy are complex, and nine symptom clusters can be identified according to the incidence and severity of symptoms. We can find the potential biological mechanism of each symptom cluster through the discussion of previous mechanism research and clinical research. The number of symptom clusters and the number of symptoms within the symptom cluster are closely related to the symptom evaluation scale selected for the study. Therefore, the symptom cluster study urgently needs a targeted symptom evaluation scale that can comprehensively reflect the patient’s condition.

Exploring clinical trials awareness, information access and participation amongst Australians with ovarian cancer: a qualitative study

Abstract Purpose Ovarian cancer is associated with advanced stage diagnosis and poor survival rates. Clinical trials are critical for improving both clinical and quality of life outcomes. Challenges exist to clinical trials awareness, information access and participation, but perspectives of Australians with ovarian cancer have not been previously investigated. We aimed to explore clinical trials awareness, information access and participation amongst Australians with ovarian cancer. Methods Utilising an exploratory qualitative approach, women with ovarian cancer participated in online focus groups and interviews between December 2023 and February 2024. Transcripts underwent inductive content analysis. Results Five themes and five subthemes emerged. In theme 1, participants identified “Barriers exist that affect clinical trial awareness and participation” and were explored through their experience of ovarian cancer. In theme 2, participants shared that “Instigating the conversation and doing my own research” was necessary to access clinical trials. Theme 3 describes ideas on “Finding solutions to improve clinical trial awareness and information access” through subthemes: “we need a centralised, credible source”; “communicate clinical trials in various ways from trusted contacts”; and “I want tailored, relevant information”. Theme 4 explained that “Altruism is a motivator” in willingness to participate in trials. Finally, in theme 5, participants explained that “Emotions regarding clinical trials are varied” illustrated in subthemes: “feeling left behind” and “feeling fortunate”. Conclusions These qualitative insights will inform development of a cross-sectional survey for national distribution amongst Australians with ovarian cancer. Results will assist in developing solutions to improve clinical trials awareness and information access.

Characteristics and associated factors of insomnia in gynecological cancer patients: A cross-sectional study

To investigate the characteristics and associated factors of insomnia in patients with gynecological cancer. A cross-sectional study was conducted on 195 gynecological cancer patients with insomnia. In addition to sleep quality, general information, gynecological cancer information, concomitant symptoms and biological indicators were investigated. ① 77.43% of patients were rated as "poor" or "very poor" in terms of sleep quality, with difficulty falling asleep being the main type of insomnia. ② The sleep quality of gynecological cancer patients was related to cancer type, cancer stage, number of chemotherapy cycles, Karnofsky Performance Status score, depression, anxiety, fatigue, pain, and follicle-stimulating hormone. ③Fatigue (OR = 9.228, CI = 2.198-38.750) and pain (OR = 5.077, CI = 1.321-19.515) were significant associated factors for the aggravation of insomnia. Gynecological cancer patients exhibit high levels of insomnia. Particular attention should be paid to patients with fatigue and pain, with interventions targeting reduction in sleep latency. Clarifying insomnia characteristics and associated factors is helpful to improve sleep quality and provide evidence-based insights for clinical management of gynecological cancer.

Factors associated with period of sick leave after gynecologic cancer treatment: a prospective cohort study

Abstract Purpose Gynecologic cancer is one of the most common malignancies in working-age women. This study aimed to investigate factors associated with period of sick leave after gynecologic cancer treatment in Japan. Methods A prospective cohort study on period of sick leave was conducted among 207 cancer survivors who returned to work at the same workplace. Questionnaires were randomly distributed to patients aged under 65 years and more than one-year post-treatment. Clinical information was extracted from medical records, and the factors influencing the period of sick leave were analyzed using the Mann–Whitney U test and logistic regression analysis. Results Surgery plus more than six courses of chemotherapy (number ( n ) = 41, 166.02 ± 146.84 days) led to a significantly longer period of sick leave than surgery without lymph node dissection ( n  = 64, 31.15 ± 30.47 days), surgery with lymph node dissection ( n  = 41, 55.56 ± 85.90 days), surgery plus less than six courses of chemotherapy ( n  = 21, 72.42 ± 56.07 days), and radiotherapy alone ( n  = 21, 58.85 ± 84.24 days) (OR: 2.63, 2.95, 2.67, and 2.08; 95% CI: 7.71–54.59, 18.17–92.94, 18.22–126.63, and 2.38–115.33; p  = 0.009, p  = 0.004, p  = 0.009, and p  = 0.041). gynecologic cancer survivors who experienced adverse effects after treatment had a significantly longer period of sick leave (OR: 8.50; CI: 52.98–84.98; p  &lt; 0.001). In univariate and multivariate analyses, patients who received surgery plus more than six courses of chemotherapy were most involved in long period of sick leave than other factors (OR: 11.20, and 16.997; CI: 4.86–25.08, and 5.51–52.35; p  &lt; 0.001, and p  &lt; 0.001). Conclusion Patients with gynecologic cancer requiring long-term treatment required the most time to return to work.

How do patients interpret and respond to a single-item global indicator of cancer treatment tolerability?

Abstract Background There is increasing interest in patient-reported measures of cancer treatment tolerability. A global measure of bother, the FACT GP5 item (“I am bothered by side effects of treatment”) is potentially useful for regulatory, research, and clinical use. To understand this item’s appropriateness for capturing treatment tolerability, we conducted cognitive interviews on this item with 3 samples of cancer patients. Methods Patients with ovarian cancer (Study 1: N = 21; on treatment), lymphoma (Study 2: N = 14; on treatment), and colorectal or lung cancer (Study 3: N = 16; treatment naïve) were interviewed about GP5’s understandability and relevance to their treatment side effects. What patients think about when answering GP5 was also assessed. In all studies, the interview included both structured and open-ended questions. Qualitative data were coded to extract themes and responses to structured questions were tallied. Results Most patients on treatment (Studies 1 and 2) reported that the GP5 item wording is appropriate (88%) and its meaning is clear (97%). They were very confident or confident in their response (97%) and stated that GP5 was relevant to their cancer experience (97%). When answering GP5, patients considered their treatment and specific side effects. A large proportion (40%) of the treatment-naïve (Study 3) patients reported that GP5 was not relevant to their cancer treatment, and the largest proportion responded to GP5 thinking of negative side effect expectancies. Conclusion This study provides assurance that GP5 is a useful indicator of treatment tolerability, and is meaningful to people with cancer, especially once they have started treatment.

Evaluating perioperative self-reported sleep quality in patients with a gynecologic malignancy

Abstract Purpose This study aims to evaluate patient-reported peri-operative sleep quality and identify demographic, clinical, and psychosocial factors associated with poor sleep perioperatively among individuals with gynecologic malignancies. Methods This prospective study included patients with confirmed gynecologic malignancies who underwent surgery between September 2020 and October 2023 and were admitted to the hospital for at least one overnight stay. Preoperative sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while postoperative sleep quality was measured with the Richards-Campbell Sleep Questionnaire (RCSQ). “Good” sleep was defined as a PSQI score &lt; 5 or an RCSQ score &gt; 50. Statistical analyses were conducted using t-tests, Pearson’s χ 2 , or Fisher’s exact tests, as appropriate. Results The mean age of participants was 58.6 years (SD 13.2); 68.9% identified as white, 50% had ovarian cancer, and 54.6% had advanced-stage disease. Pre-operatively, 56.1% of patients reported poor sleep, most commonly due to overnight awakenings from nocturia (67.4%) and vasomotor symptoms (28%). Poor sleep was more common among patients with cervical or vulvar cancer (p = 0.02), those using sleep medications preoperatively (p = 0.002), and those with co-morbid anxiety and depression (p = 0.06). Good post-operative sleep on post-operative day 1 and on day of discharge was associated with increased use of opioid medications (p = 0.007 and 0.02, respectively). Overall, sleep quality significantly declined during hospitalization (p &lt; 0.001). Conclusion Poor perioperative sleep in patients with gynecologic cancers was linked to cancer type, mental health, pain management, and the hospital environment with sleep deteriorating during hospitalizations. Addressing these factors may offer meaningful opportunities to improve sleep.

The experience and supportive care needs in people affected by ovarian cancer and their informal caregivers: a qualitative systematic review

Abstract Purpose To critically synthesise qualitative research to understand the experiences of supportive care needs in people affected by ovarian cancer and their informal caregivers. Method A qualitative systematic review has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The Joanna Briggs meta-aggregation methodology was utilised. Electronic databases were searched for all qualitative studies irrespective of research design by an expert systematic review librarian. Data extraction and methodological quality assessment were performed. Results A total of 26 studies were included which represented a total sample of 962 participants inclusive of 842 patients and 120 informal caregivers. There were a total of 133 individual findings included in this review, which were synthesised into four main findings that emerged: (1) awareness around ovarian cancer, (2) communication in the healthcare sector, (3) everything that comes with the disease, (4) what the future holds. Conclusion This review identified that while some women living with ovarian cancer experienced suffering and distress, others reported emotional wellbeing and comfort needs met. There were gaps in service from both the informal caregiver and women ranging from before diagnosis even to post-treatment and beyond. Service redesign needs to occur with a focus on (1) improved awareness around ovarian cancer signs and symptoms, (2) effective communication strategies within and across healthcare providers, (3) increased information and support for both women and their informal caregiver throughout the cancer trajectory, and (4) developing survivorship care plans to promote wellness.

Understanding nutrition challenges and information needs of women undergoing cytoreductive surgery for ovarian cancer: a study protocol for an experience-based co-design methodology

Abstract Purpose Cytoreductive surgery (CRS) with or without intraperitoneal hyperthermic chemotherapy (HIPEC) is a complex surgery aimed at removing peritoneal surface malignancy (PSM). PSM is prevalent in ovarian cancer, with up to 85% of patients experiencing non-specific symptoms leading to malnutrition. Studies have shown oncology patients display confusion about nutrition recommendations, although understudied in ovarian cancer. Experience-based co-design is a method of participatory research with key principles including empowerment and collaboration. This project aims to utilise experience-based co-design to understand nutrition challenges and develop nutrition resources for women undergoing CRS ± HIPEC for ovarian cancer. The secondary aim is to evaluate the experience-based co-design process to ensure it aligns with key principles of co-design. Methods This multi-centre study utilises experience-based co-design. Using maximum variation sampling, women with lived experience of CRS ± HIPEC for ovarian cancer, along with experienced oncology healthcare professionals will be invited to participate. Participants will be interviewed to identify key nutrition issues and information needs. Using thematic analysis, a patient journey map will be developed and key themes identified. A feedback session will be held for participants to identify priorities for service improvement and patient resource development based on key issues identified by patient journey mapping. These priorities will be addressed in co-design workshops with participants with lived experience and clinicians to develop patient information resources. Resources and experience-based co-design processes will be evaluated at the completion of the workshops. Conclusions This study will deliver new insights into the nutrition challenges and information needs identified by people undergoing CRS ± HIPEC for ovarian cancer within a co-design approach.

Surgery in ovarian cancer patients older than 70 years of age and frailty assessment

Chronological age does not correlate precisely with physiological age, nor is age alone a predictor for the risk of poor recovery from surgery. Instead, it is necessary to determine patient frailty, defined as an ability to maintain homeostasis after stressors linked to the applied therapy, including extensive surgery. The clinical usefulness of the frailty assessment prior to surgery has been correlated with long-term outcomes in ovarian cancer patients and with the proposed modification of the Frailty Index as the Memorial Sloan Kettering-Frailty Index (MSK-FI) that includes both functional assessment and comorbidity. The aim of this study was the assessment of the frailty status of 114 patients based on the MSK-FI relative to the rates of 5-year overall survival in a group of older patients more than 70 years old treated surgically due to ovarian cancer. In our group of older patients operated on due to ovarian cancer, we have observed statistically significantly longer OS when the frailty status index as measured by the MSK-FI was less than 3. Notably, the patients from the high-risk group (MSK-FI ≥ 3) had statistically significant lower rates of complete resections. As the frailty status of the patient is a useful predictor of perioperative morbidity, it should be precisely determined prior to beginning treatment. The MSK-FI helps to support this process.

Exploring awareness, perceptions, and practices relating to nutritional status and low muscle mass in patients with ovarian cancer

Abstract Purpose Women with ovarian cancer are at high risk of malnutrition and muscle loss due to advanced-stage diagnosis and treatment toxicities. Evidence-based guidelines recommend screening for malnutrition and sarcopenia to prevent associated adverse consequences, including reduced survival. This study aimed to describe awareness and perceptions of nutrition-related issues and practices in ovarian cancer among Australian healthcare professionals. Methods A national survey was completed between November 2023 and March 2024. The 24-item survey evaluated awareness and perceptions of nutrition-related issues, screening and referral practices for malnutrition and sarcopenia at specific timepoints (from diagnosis, during, and/or post-treatment) and barriers to nutrition care in ovarian cancer. Results Professionals (n = 57) were predominantly nurses (39%), dietitians (23%), or surgeons (19%). The most reported nutrition-related issues at diagnosis were weight loss (67%), overweight/obesity (54%), and sarcopenia (44%). During treatment, weight loss (70%) and sarcopenia (65%) were prominent, while post-treatment, weight gain (46%) and sarcopenia (39%) were most reported. The perceived clinical importance of malnutrition and sarcopenia varied according to professional discipline. Professionals identified chemotherapy as the treatment with the highest nutrition risk (97%), and 75% reported observing self-initiated dietary changes during treatment, yet 18% indicated their health services did not screen for nutrition risk, and 58% did not screen for sarcopenia. Key barriers were lack of established processes for sarcopenia screening (75%), limited dietetic services (60%), and lack of specific referral pathways (58%). Conclusion The perceived importance of malnutrition and sarcopenia in ovarian cancer varies according to professional discipline despite robust evidence of the importance to clinical outcomes.

A qualitative study on rumination in young and middle-aged ovarian cancer survivors

Ovarian cancer can have a significant psychological impact on young and middle-aged patients who are often prone to recurring changes in mood that can lead to rumination. This phenomenological qualitative study aimed to explore rumination in young and middle-aged ovarian cancer survivors. From August to November 2023, 21 young and middle-aged ovarian cancer survivors who were treated at a tertiary general hospital in Changsha, Hunan Province, China were selected using purposive sampling. In-depth semi-structured interviews were conducted using phenomenological research methods; interview data were analyzed according to the Colaizzi 7-step analysis method. Rumination among young and middle-aged ovarian cancer survivors was summarized into four themes and 12 subthemes: uncontrollable response (unstoppable depression, sustained concerns, psychosomatic symptoms), persistent frustration (stigma, consciousness of self-guilt, social avoidance), recurring anxiety (anxiety about death, cancer recurrence, loss of function), and adaptive adjustment (distancing from emotional black holes, clarifying the value of life, and engaging in meaningful action). Rumination is common among young and middle-aged ovarian cancer survivors. They experience uncontrollable responses, persistent frustration, recurring anxiety, and adaptive adjustment. These results can provide a reference for healthcare professionals to develop targeted intervention strategies. This study revealed the content and experiences of rumination among young and middle-aged ovarian cancer survivors, providing theoretical support for intervention development. Mindfulness-based therapies may be useful in helping patients strengthen their psychological coping, and combining social resources to provide patients with comprehensive support may help reduce their negative emotions and improve quality of life.

Associations between dyadic communication and dyadic coping of patients with cervical cancer and their spouses: a study utilizing the actor-partner interdependence model

There is a growing focus on exploring dyadic interactions and outcomes between couples undergoing cervical cancer (CC). The purpose of this cross-sectional study was to figure out how dyadic communication influences both CC patients' and spouses' coping abilities. A sample of 286 CC dyads completed questionnaires assessing dyadic communication and dyadic coping. The actor-partner interdependence model was used to analyze the interaction effect between the dyads. Dyadic communication among cervical cancer (CC) patients has a predictive effect on their own negative dyadic coping (β =  - 0.141, P = 0.034) and on their spouses' delegated dyadic coping (β = 0.133, P = 0.044). In contrast, dyadic communication among CC spouses is negatively associated with their own supportive dyadic coping (β =  - 0.237, P < 0.001), delegated dyadic coping (β =  - 0.156, P = 0.018), common dyadic coping (β =  - 0.148, P = 0.026) and also with CC patients' supportive dyadic coping (β =  - 0.153, P = 0.022). Dyadic communication between CC patients and their spouses affect their own and each other's dyadic coping. Exploring interventions focused on the CC couples' communication strategies to enhance their positive dyadic coping should be considered.

Vaginal morbidity, sexual functioning, and health-related quality of life in cervical cancer survivors: a cross-sectional multicenter study (VAMOS)

To compare sexual/vaginal functioning between early cervical cancer (ECC) and locally advanced cervical cancer (LACC) survivors. VAMOS was a multicenter, cross-sectional, questionnaire, noninferiority study including ECC patients treated with surgery and, if clinically indicated, adjuvant (chemo)radiotherapy and LACC patients treated with neoadjuvant (chemo)radiotherapy followed by surgery. Patient-reported outcomes (PROs) were assessed using the EORTC QLQ-C30, EORTC QLQ-CX24, and Female Sexual Functioning Index (FSFI) questionnaires. Clinical reported outcomes (ClinROs) consisted of vaginal morbidity scored according to the CTCAE v4.0 scoring system. One hundred forty-three patients were included. Compared to ECC patients (n = 97), LACC patients (n = 46) were significantly less sexually active in the 4 weeks prior to completion of the questionnaires (65% vs. 41%; p = .005). The primary endpoint was not met: LACC patients reported a higher mean score (more problems) for sexual/vaginal functioning than ECC patients, with a non-clinically relevant mean difference of 6.38 ([95% CI: - 6.41, 19.17]; p = .570 for noninferiority). Regarding the secondary endpoints, the prevalence of sexual dysfunction between the two groups did not differ significantly (p = 0.124). Compared to ECC patients, LACC patients did not have significantly more vaginal morbidity (adjusted odds ratio [OR] 1.51 [95% CI: 0.22, 10.29]; p = .674). Moreover, there was poor agreement between any vaginal morbidity and sexual dysfunction (Cohen's kappa of 0.17). Compared to ECC survivors, LACC survivors were significantly less sexually active and reported equivalent or worse sexual/vaginal functioning, although the proportion of patients with sexual dysfunction was similar. Clinical assessment of vaginal morbidity was poorly correlated with sexual dysfunction.

The effect of Benson relaxation technique on cancer patients: a systematic review

Although many studies have investigated the effect of this method on cancer patients, no review of the available literature has been done. So, a literature review is conducted to evaluate all published literature on the Benson relaxation technique in cancer patients. A systematic literature search was conducted. A systematic search of online electronic databases including PubMed/MEDLINE, Scopus Web of Science, PsycINFO, and EMBASE was performed using keywords extracted from Medical Subject Headings such as "Benson Relaxation Technique," "Cancer Patients," "Malignancy," and "Neoplasia" from the beginning to April 27, 2023. A total of 810 publications were assessed for relevance by title and abstract. The remaining 31 articles were examined using inclusion criteria for all Persian and English-language publications that evaluate the effectiveness of the Benson relaxation technique on cancer patients. We did not have gray literature in our review. The methodological quality of the included studies was appraised using specific checklists. Finally, nine studies were included in this systematic review. Studies on breast cancer patients showed improvement in fatigue, nausea, vomiting, pain, shortness of breath, insomnia, anorexia, constipation, diarrhea, treatment side effects, breast symptoms, arm symptoms, worry about hair loss, and scores of hope. Two studies were conducted among cervical cancer patients that showed a decrease in anxiety scores and an improvement in the quality of sleep. Another study on gastric cancer patients showed decreased Chemotherapy-Induced Nausea, Vomiting, and Retching scores. Overall, this systematic review showed that the Benson relaxation method could improve sleep quality, appetite, anxiety, and quality of life. Therefore, using the Benson relaxation technique is suggested to improve health-related outcomes in cancer patients.

Recently urodynamic and quality of life assessment in the non-menopausal women with cervical cancer after radical hysterectomy

The aim of this study was to evaluate the pre- and postoperative changes in the recently urodynamic and quality of life (QoL) in nonmenopausal women diagnosed with cervical cancer and treated with radical hysterectomy (RH). Twenty-eight nonmenopausal women (28-49 years) with cervical carcinoma (FIGO stage Ia2-IIa) underwent a radical hysterectomy. Urodynamic studies were performed 1 week before (U0) and 3-6 months (U1) after surgery. A self-administered condition-specific QoL questionnaire (PFDI-20, PFIQ-7) was applied at U0 and U1. Data from the urodynamics analysis performed at U1 showed that the average first sensation volume (119.39 ± 12.28 ml vs 150.43 ± 31.45 ml, P < 0.001), the residual urine volume (6.39 ± 10.44 ml vs. 42.32 ± 33.72 ml, P < 0.001), and the time of urination (46.10 ± 16.65 s vs. 74.31 ± 23.94 s, P < 0.001) were increased, while the bladder volume at a strong desire to void (448.89 ± 86.62 ml vs. 322.82 ± 50.89 ml, P < 0.001), the bladder compliance (82.63 ± 58.06 ml/cmH Radical hysterectomy results in urodynamic changes, and 3-6 months postoperation may be an important period for changes in bladder dysfunction after RH. Urodynamic and QoL analyses may provide methods for assessing symptoms.

How does genetic testing influence anxiety, depression, and quality of life? A hereditary breast and ovarian cancer syndrome suspects trial

Emotional distress associated with genetic testing for hereditary breast and ovarian cancer syndrome (HBOC) is reported to interfere with adherence to treatment and prophylactic measures and compromise quality of life. To determine levels of anxiety, depression, and quality of life in patients tested for pathogenic BRCA1/2 mutations and identify risk factors for the development of adverse psycho-emotional effects. Cross-sectional observational trial involving 178 breast or ovarian cancer patients from a referral cancer hospital in Northeastern Brazil. Information was collected with the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization (WHO) Quality of Life (QoL) questionnaire (WHOQOL-BREF). Patients suspected of HBOC had higher levels of anxiety than depression. The presence of (probably) pathogenic BRCA1/2 mutations did not affect levels of anxiety and depression. High schooling, history of psychiatric disease, and use of psychotropic drugs were directly associated with high anxiety. High schooling was too inversely associated with QoL as such a breast tumor. Anxiety and depression were directly correlated and both reduced significantly QoL. Our results highlight the importance of psychological support and screening of risk factors for anxiety and depression and low QoL in HBOC patients at the time of testing.

“From chemo to chemo”—the temporal paradox of chemotherapy

Abstract Purpose To uncover the experience of time in women undergoing chemotherapy for ovarian cancer. Methods A combination of consensual qualitative research and Giorgi’s descriptive phenomenology. Results The key phenomenon found and pre-reflectively organizing the patients’ experience was the temporal paradox of chemotherapy—a sense of both acceleration and deceleration in between chemotherapy sessions that desynchronizes patients with the time of others. Conclusion The experienced paradoxes concentrating around the timings of the chemotherapy treatments are of particular relevance for supportive care. It is particularly important to acknowledge the disturbing effect of the cyclical nature of chemotherapy.

Factors influencing posttraumatic growth in ovarian cancer survivors

The purpose of this study was to examine posttraumatic growth (PTG), cancer coping, posttraumatic stress, and genetics knowledge among ovarian cancer survivors and to identify factors affecting PTG. This cross-sectional study included 148 outpatient ovarian cancer survivors at a cancer center. Data were collected between February 25 and April 11, 2019, and were analyzed using t tests, ANOVA, Pearson-correlations, and multiple regression. On average, the ovarian cancer survivors scored 68.09 ± 20.17 in PTG, 59.75 ± 13.37 in cancer coping, 29.30 ± 17.25 in posttraumatic stress, and 9.42 ± 3.33 in genetics knowledge. There were significant differences in PTG according to religion (t = - 2.92, p = .004), marital status (F = 3.06, p = .050), and family history of cancer (t = 2.00, p = .047). In the final analysis, the statistically significant factors influencing PTG were religion (β = .170, p = .004) and cancer coping (β = .691, p < .001), and posttraumatic stress had borderline statistical significance (β = - .107, p < .068). These factors explained 52.2% of the variance in PTG. Ovarian cancer survivors showed a moderate level of genetics knowledge while having a high risk for posttraumatic stress. Overall, this study showed that cancer coping was a powerful factor that influenced PTG in ovarian cancer survivors. Religion was found to positively affect PTG, and posttraumatic stress had a small negative effect. Spiritual nursing interventions and improving cancer coping while reducing posttraumatic stress are necessary to increase the PTG of ovarian cancer survivors.

‘It made me feel part of the team, having my homework to do’ — women and specialist nurse experiences of remote follow-up after ovarian cancer treatment: a qualitative interview study

Abstract Purpose Ovarian cancer patients require monitoring for relapse post-treatment, and alternative follow-up pathways are increasing, which require in-depth exploration to ensure acceptability and inform implementation. This study aimed to explore women and specialist nurses’ experiences of participating in a feasibility study of an electronic patient-reported outcome (ePRO) follow-up pathway after ovarian cancer treatment. Methods The feasibility study incorporated an ePRO questionnaire, blood test and telephone consultation with a specialist nurse, instead of face-to-face hospital visits. All women and the nurses involved were invited to take part in nested semi-structured interviews. Interviews were recorded and transcripts analysed using framework analysis. Results Twenty interviews were conducted (16 out of 24 women who took part in the feasibility study and all 4 nurses). Four themes were identified: (1) readiness and motivators, (2) practicalities and logistics, (3) personal impact and (4) future role. An overarching theme highlighted how women strived to seek reassurance and gain confidence. Most women and nurses were positive about the ePRO pathway and would happily continue using it. Conclusion This work provides invaluable insight into the experiences of women on remote ePRO follow-up post-treatment. Important logistic and implementation issues were identified, which should inform future large-scale work to introduce and evaluate remote ePRO methods in cancer follow-up. This work highlights the key factors influencing women’s readiness and acceptability of an ePRO pathway, and how services should be carefully designed to ensure patients feel reassured and confident post-treatment. Furthermore, it highlights that flexibility and patient preference should be considered in remote service delivery. Trial registration ClinicalTrials.gov ID: NCT02847715 (first registered 19 May 2016).

What do partners of patients with ovarian cancer need from the healthcare system? An examination of caregiving experiences in the healthcare setting and reported distress

Ovarian cancer is typically characterized by late-stage diagnoses, frequent recurrences, and treatment changes. Ovarian cancer caregivers (OCC) are thus heavily involved with cancer care and often are highly distressed. We explored the relationship with OCC distress and caregiving experiences within the healthcare system and with the healthcare providers (HCP), using a cross-sectional questionnaire study. OCC provided sociodemographic and patient medical information, and completed measures of consequences of caregiving and needs from HCP, and of depression and anxiety. We recruited participants through advertisements and two cancer centers. N = 82 OCC provided complete questionnaires. Participants on average were 57.2 years old, English-speaking white men, and were partnered for 28.5 years. On average, patients were diagnosed at stage III, and treated with surgery and chemotherapy. Eight percent met clinical cut-offs for depression (23.2% in sub-clinical range), and 23.2% met clinical cut-offs for anxiety (20.7% in sub-clinical range). Depression and anxiety were significantly correlated with lacking time for social relationships, higher workload, lacking information, and needing more help from HCP. Only depression was correlated with problematic quality of information from HCP. OCC distress is related to their caregiving roles within the cancer care system, and how HCP support them in their responsibilities, which may contribute to a lack of time to access their supports. Perceived involvement by the HCP has an important influence on OCC distress. Higher demands of caregiving and insufficient support from the cancer care system may relate to increased distress. Our study supports the need for better integration of caregiver supports from within the healthcare system.

Perception of side effects associated with anticancer treatment in women with breast or ovarian cancer (KEM-GO-1): a prospective trial

Due to advances in anticancer treatment and supportive care, patients increasingly complained about nonphysical side effects of chemotherapy and targeted therapy in recent years. Therefore, continuous assessment of side effects and patients' perceptions is important. The aim of this study was to evaluate the identification and severity of side effects perceived by ovarian cancer (OC) and breast cancer (BC) patients undergoing contemporary anticancer therapy. Between 2015 and 2017, consecutive chemo-naïve OC and BC patients were enrolled in this prospective cohort study. Interviews were performed 12 ± 3 weeks after start of anticancer therapy, and patients were asked to select and rank, according to severity, 72 physical or nonphysical symptoms potentially related to their treatment. Data were analyzed with descriptive statistics. Forty-five OC patients and 98 BC patients completed the interview. Sleeping difficulties were ranked as the most troublesome symptom, followed by concerns about family or partner, and loss of hair. Alopecia was the most predominant side effect for BC patients, whereas OC patients were highly afflicted by numbness in limbs. Chemotherapy alone or in combination with targeted therapy caused pronounced sleep disturbances. Prolonged taxane treatment led to shortness of breath and numbness in limbs. Vomiting was ranked by one and nausea by eight women among the five most bothersome symptoms. Sleep disturbances have lately emerged as the most severe problem in women with OC or BC receiving anticancer therapy. Concerns about family and partner were ranked second in the current study and first in previous investigations.

The impact of a co-created yoga program for women diagnosed with gynecologic cancer on patient-reported outcomes: a series N-of-1 trial

Psychosocial oncology supportive care research has focused on adults diagnosed with breast cancer and used conventional group-based analyses that can mask meaningful individual differences. This study aimed to evaluate the effects of a co-created 12-week Hatha yoga program on patient-reported outcomes among women diagnosed with gynecologic cancer, using group- and individual-level analyses to emphasize person-centered processes. A multiple baseline series N-of-1 trial design was used. Participants self-selected to enroll in a morning or evening program, attending bi-modal 60-min classes twice weekly, complemented by optional group discussions, journaling, and pre-recorded videos for at-home practice. Self-report data were collected online at 9-11 timepoints, spanning baseline (3-5 weeks), program (12 weeks), and follow-up (8 weeks) phases. Data from 20 participants (M Visual analysis of individual profiles and piecewise models that represent the average rate of change for the sample demonstrated similar results across most outcomes. Collectively, the analyses showed that during the program, quality of life, perceived cognitive abilities, sexual distress, and perceived stress improved (ps < .05), while follow-up fatigue and perceived stress worsened (ps < .05). However, the results of the analyses diverged for negative body image. The overall slope (fixed effect) showed improvement during the program (p < .05); yet, visual analysis of individual profiles suggested variability across participants. Individual-level analyses also revealed divergent responses for 3 participants across outcomes. This study demonstrates the potential of a co-created Hatha yoga program to improve psychosocial outcomes for women with gynecologic cancer, an often underrepresented population in the literature. Findings also highlight the added value of using individual-level analytic approaches, supporting the need for personalized approaches in supportive care. The co-created program represents a promising line of inquiry to meet a pressing need for programs that address the sequelae of gynecologic cancer. ClinicalTrials.gov, no.: NCT05610982; November 3, 2022.

Cancer worry among BRCA1/2 pathogenic variant carriers choosing surgery to prevent tubal/ovarian cancer: course over time and associated factors

Abstract Objective High cancer risks, as applicable to BRCA1 and BRCA2 pathogenic variant (PV) carriers, can induce significant cancer concerns. We examined the degree of cancer worry and the course of this worry among BRCA1/2-PV carriers undergoing surgery to prevent ovarian cancer, and identified factors associated with high cancer worry. Methods Cancer worry was evaluated as part of the multicentre, prospective TUBA-study (NCT02321228) in which BRCA1/2-PV carriers choose either novel risk-reducing salpingectomy with delayed oophorectomy or standard risk-reducing salpingo-oophorectomy. The Cancer Worry Scale was obtained before and 3 and 12 months after surgery. Cancer worry patterns were analysed using latent class growth analysis and associated factors were identified with regression analysis. Results Of all 577 BRCA1/2-PV carriers, 320 (57%) had high (≥ 14) cancer worry pre-surgery, and 54% had lower worry 12 months post-surgery than pre-surgery. Based on patterns over time, BRCA1/2-PV carriers could be classified into three groups: persistently low cancer worry (56%), persistently high cancer worry (6%), and fluctuating, mostly declining, cancer worry (37%). Factors associated with persistently high cancer concerns were age below 35 (BRCA1) or 40 (BRCA2), unemployment, previous breast cancer, lower education and a more recent BRCA1/2-PV diagnosis. Conclusions Some degree of cancer worry is considered normal, and most BRCA1/2-PV carriers have declining cancer worry after gynaecological risk-reducing surgery. However, a subset of these BRCA1/2-PV carriers has persisting major cancer concerns up to 1 year after surgery. They should be identified and potentially offered additional support. Clinical trial registration The TUBA-study is registered at ClinicalTrials.gov since December 11th, 2014. Registration number: NCT02321228.

The relationship between sexual activity during chemotherapy and sexual functioning after treatment among females with breast and gynecologic cancer

Abstract Purpose Sexual inactivity has been shown to be a predictor of future sexual problems and related distress in female cancer survivors; however, very little is known about the sexual lives of women in active treatment. The aims of present study are to estimate rates of sexual activity during adjuvant chemotherapy and their relationship to sexual outcomes 12 months after therapy initiation. Methods Self-report questionnaires were completed by gynecologic and breast cancer patients (n = 58) prior to their first chemotherapy infusion, at three timepoints during treatment, and at follow-up 1 year later. Questionnaires assessed sexual activity, sexual desire, sexual arousal, sexual satisfaction, depressive symptoms, and treatment toxicities. Results Engagement in sexual activity during chemotherapy was significantly associated with reports of experiencing sexual desire (B = 1.94, p = .03), arousal (B = 3.31, p = .01), and higher satisfaction ratings (β = .33, p = .02) 12 months after the initiation of chemotherapy. Conclusions The results indicate that remaining sexually active during treatment is associated with better sexual function and higher sexual satisfaction in the year following chemotherapy initiation.

The effect of acupressure on anxiety, depression, pain, and vital signs in gynecological cancer patients receiving brachytherapy: A randomized controlled study

This study aimed to evaluate the effects of acupressure on pain, anxiety, depression, and physiological parameters in women undergoing brachytherapy for gynecological cancer. The research was conducted between December 2023 and September 2024 using a randomized controlled design. All patients receiving brachytherapy were randomly assigned to the acupressure group (n = 40) or the control group (n = 40). In addition to standard clinical care, the acupressure group received manual acupressure for 30 min before each brachytherapy session at specific acupressure points (SP6, PC6, LI4, HT7, LV4). The data were collected using the Personal Information Form, Visual Analog Scale (VAS), State-Trait Anxiety Inventory (STAI-I), Hospital Anxiety and Depression Scale (HADS), and Vital Signs Form. The groups were comparable in terms of sociodemographic and clinical characteristics (p > 0.05). Significant reductions were observed in anxiety, depression, and pain levels in the acupressure group at post-test compared to baseline and the control group (p  0.05). The results obtained from this study suggest that acupressure may be a beneficial complementary method for reducing anxiety, depression, and pain, as well as contributing to the regulation of certain physiological parameters in patients undergoing brachytherapy. These findings indicate that acupressure could be considered an intervention that may be integrated into clinical practice to support psychological and physiological well-being. NCT06531551. Date of Registration: 1 August 2024.

A single institution retrospective study of pelvic insufficiency fractures following curative-intent pelvic intensity-modulated radiation therapy for gynecologic, gastrointestinal, and genitourinary cancers

We aimed to determine the incidence of and explore risk factors for pelvic insufficiency fractures (PIFs) among patients that received curative-intent pelvic intensity-modulated radiation therapy (IMRT) for gynecologic (GYN), gastrointestinal (GI), and genitourinary (GU) cancers. We audited records of adult patients with GYN, GI, and GU cancers who received neoadjuvant, definitive, or adjuvant pelvic IMRT from 2011 to 2015 with a treatment volume that included the primary tumor or post-operative bed and at least one pelvic lymph node region, and a prescription dose of at least 40 Gy (if conventionally fractionated at 1.8-2 Gy per fraction) or a prescription dose of 25 Gy in 5 fractions for patients with rectal cancer treated with hypo-fractionated neoadjuvant short course IMRT. All baseline and follow-up pelvic imaging reports were reviewed to identify PIF diagnoses. Demographic and relevant clinical, treatment, and dosimetric factors were analyzed to explore risk factors for PIFs. Among 658 audited patients, 46 (7%) developed 86 PIFs. The incidence for GYN, GI, and GU patients was 8% (13/159), 11% (30/276), and 1% (3/223), respectively, with anal and endometrial subsites having the highest incidence at 14% each. IMRT was delivered as neoadjuvant therapy for 16/46 (35%), definitive therapy for 22/46 (48%), and adjuvant therapy for 8/46 (17%). The median time to PIF diagnosis was 14 months (range 3-53 months), and 26/46 (57%) were symptomatic at diagnosis. The most common PIF location was the sacrum (67/86 [78%]). Multivariable logistic regression analysis found female gender (odds ratio [OR] 2.74, 95% CI 1.36-5.80; p = 0.006), osteoporosis (OR 6.91, 95% CI 2.43-18.8; p = 0.0002), and a dose fractionation of 25 Gy in 5 fractions (compared to schedules of > 25 to < 50 Gy (OR 5.34, 95% CI 1.87-15.6; p = 0.0019) or ≥ 50 Gy (OR 9.53, 95% CI 1.82-50.1; p = 0.0077)) to be significant PIF risk factors. In our cohort, PIFs were a common complication for patients with GYN and GI cancers, but not GU cancers, in the IMRT era. Most PIFs occurred within 2 years of treatment, and most occurred in the sacrum. Female patients and patients with osteoporosis appeared to be at higher risk. Prospective studies using validated PIF diagnostic criteria should further examine the relationships between PIFs and dosimetric variables, including hypo-fractionated regimens such as 25 Gy in 5 fractions.

Effects of aerobic cycling training in patients with gynaecologic cancer-related lower extremity lymphedema: A randomised comparative study

Lower extremity lymphedema (LEL) after gynaecological cancer is a chronic disease that affects quality of life and functionality negatively. Exercise therapies help to volume reduction and improved lower extremity functionality and quality of life in patients with lymphedema. However, studies on this subject were mostly focused on upper extremity lymphedema. In this study, we aimed to compare complete decongestive therapy (CDT) and CDT + cycle ergometry in terms of quality of life, lower extremity functionality and volume measurement in patients with gynaecological cancer-related lower extremity lymphedema. This study included 63 patients who gave written and verbal informed consent. The participants were randomly divided into two groups as cycling (32 patients) and non-cycling group (31 patients). Demographic and clinical data of patients were recorded. While patients in non-cycling group were treated with only CDT for 3 weeks, patients in cycling group were treated with CDT + cycle ergometry for 3 weeks. Cycle ergometry treatment was performed with Voit AT-200 Black Collection horizontal bike for 20 min. Exercise intensity was adjusted to 40-59% of heart rate reserve (HRR). Volume measurement was evaluated by circumference measurement method, quality of life was evaluated by Lymphedema Quality of Life Questionnaire (LYMQOL) and lower extremity functionality was evaluated by Lower Extremity Functional Scale (LEFS) in all participants. Both cycling group and non-cycling group benefited from treatments in terms of volume reduction, LEFS and LYMQOL (function, appearance, symptom, mood and overall quality of life) values (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). In comparison of cycling and non-cycling groups, significant differences were found in favor of cycling group in terms of delta (Δ) extremity volume values (ml), Δ LEFS, Δ LYMQOL (function, appearance, symptom, mood and overall quality of life) (p = 0.04, p = 0.03, p < 0.001, p = 0.04, p = 0.002, p = 0.002, p < 0.001, p < 0.001 and p = 0.003, respectively). In other words; both groups benefited from treatments in terms of volume reduction, functionality and quality of life. However, benefit of cycling group is greater than benefit of non-cycling group. Aerobic exercise added to CDT in gynaecological cancer-related lower extremity lymphedema is effective in terms of volume reduction, improved lower extremity functionality and quality of life. ClinicalTrials.gov Identifier: NCT06200948 .

Attachment style and body image as mediators between marital adjustment and sexual satisfaction in women with cervical cancer

The majority of cervical cancer survivors face persisting sexual debilitating problems over time. The impairment in sexual function and satisfaction are not limited to physical dimensions. The goals of this study were to assess if marital adjustment and body image mediated the relationship between attachment style, sexual functioning, and sexual satisfaction. This study used a cross-sectional design. The sample included 113 sexually active women that completed the EORTC QLQ C30 and EORTC QLQ CX24, the Index of Sexual Satisfaction, the Experiences in Close Relationships Scale, and the Revised Dyadic Adjustment Scale. Using structural equation modeling to describe the relationship between variables, an excellent fitted model was found: X The results showed that vaginal/sexual functioning, attachment style, marital adjustment, and body image were important predictors of sexual satisfaction. Psychoeducational programs to help patients deal with the impairment of sexual/vaginal functioning, as well as emotional support programs for couples to strengthen their marital relationship, need to be implemented, i.e., the couple's intimacy and women's body image, that have a clear impact on sexual satisfaction.

Incidence, management, and sequelae of ureteric obstruction in women with cervical cancer

Hydronephrosis due to ureteric obstruction (UO) is stage-defining at cervical cancer presentation but may occur after primary staging. We aimed to determine the incidence and review the presentation and management of UO in women with cervical cancer attending our center. Particular attention was paid to the evolving role of interventional radiology (IR) in management. Women with a new diagnosis of cervical cancer between January 2012 and December 2016 formed the cohort that was retrospectively reviewed from the oncology database and patient records. There were 310 women diagnosed with cervical cancer; 240 were stages I/II and 70 were stages III/IV. Primary treatments were chemoradiotherapy (n = 168; 54.2%), surgery (n = 121; 39.0%), and palliative care alone (n = 21; 6.8%). UO occurred in 74 (23.9%); present at primary staging in 53 (71.6%) and arising after staging in 21 (28.4%). Primary interventions for hydronephrosis were IR (n = 50; 67.6%), cystoscopic stenting (n = 19; 25.7%), bowel urinary conduit construction (n = 2; 2.7%), and none (n = 3; 4.1%). For those who attended IR, the mean number of IR procedures was 2.2, range 1-7. Maximum serum creatinine was 303 μmol/L for women with UO at primary staging compared with 252 μmol/L for UO after staging (P = 0.267). Thirty-eight women experienced substantial morbidity related to UO. Stage-adjusted mortality risk was 2.3 times higher for UO cases compared with those without UO. UO is associated with substantial morbidity and survival disadvantage in cervical cancer and may present after primary cancer staging. We recommend renal biochemistry during routine follow-up. A majority of cervical cancer-associated UO cases are managed with IR in our center.

Impact of Saccharomyces boulardii on acute gastrointestinal toxicities in patients undergoing pelvic radiotherapy for gynecologic cancers: a randomized controlled trial

Acute gastrointestinal (GI) toxicities are common side effects of pelvic radiotherapy in gynecologic cancers. Although bacterial probiotics show promise, there is limited evidence for yeast-based probiotics such as Saccharomyces boulardii. This study aimed to evaluate the efficacy of S. boulardii in preventing acute radiation-induced GI toxicities in patients undergoing pelvic radiotherapy for cervical and endometrial cancers. A prospective, randomized, double-blind, controlled trial was conducted with 60 patients receiving definitive or postoperative pelvic radiotherapy. Patients were randomized to receive either S. boulardii (250 mg/day) or a placebo, starting one week before radiotherapy and continuing throughout treatment. Acute GI toxicities were assessed weekly using the Common Terminology Criteria for Adverse Events (CTCAE) version 5. Stool consistency and inflammatory markers were also monitored. The primary outcome was the reduction in the severity of diarrhea and other GI symptoms. S. boulardii significantly reduced the incidence of type 6 and 7 stool consistency at week 3 (p = 0.01). However, despite this transient improvement, the treatment group experienced a significantly higher incidence of diarrhea at week 4 compared to the control group (p = 0.03). Overall, no significant differences were found between the groups in terms of cumulative GI toxicities or anti-diarrheal medication use, with diarrhea remaining the most common acute GI toxicity in both groups. No consistent effect of S. boulardii was observed across the measured outcomes, and its overall efficacy in preventing acute radiation-induced enteritis remains inconclusive. Further studies with larger sample sizes are warranted. The study was registered with the Thai Clinical Trials Registry (TCTR20210204013) on 04 February 2021.

Associations of the gut microbiome with psychoneurological symptom cluster in women with gynecologic cancers: a longitudinal study

The present study aimed to evaluate the associations between the gut microbiome and psychoneurological symptoms (PNS) cluster in women with gynecologic cancers over time. In this secondary data analysis, 19 women with cervical and endometrial cancers treated with radiotherapy were followed at pre-treatment, 6-8 weeks, and 6 months post-treatment. To measure symptoms, Functional Assessment of Cancer Therapy-General (FACT-G) and Patient Health Questionnaire-9 (PHQ-9) were used. An average Z score of at least three out of five symptoms was computed as the PNS cluster total score. Rectal swabs were also collected at the same time points and sequenced using 16S rRNA V4 regions. The Kruskal-Wallis and permutational multivariable analysis of variance tests were used to compare α- and β-diversity between patients with high and low PNS cluster. The linear discriminant analysis effect size (LEfSe) tested taxa differences between study groups. Also, the linear mixed-effect model was used to evaluate the association of the gut microbiome and the PNS cluster over cancer treatment. The patients' mean age was 58 years, 47% Black, 52% single/divorced, and 66% had college or above education. Among the participants, 63% had endometrial cancer with stage I disease. There was a different taxonomy profile between patients with high and low PNS. Patients with high PNS had a lower α-diversity than those with low PNS (Shannon, p = 0.03, evenness, p = 0.03). The mixed effects model results showed that low α-diversity and abundance of Fusicatenibacter and Ruminococcus were associated with high PNS cluster over cancer treatment. The association between the gut microbiome and PNS cluster suggest that the gut microbiota plays a role in developing the PNS cluster. Future larger studies are required to shed light on the gut microbiota role in symptom development in gynecologic cancer patients.

Improvements in strength and agility measures of functional fitness following a telehealth-delivered home-based exercise intervention in endometrial cancer survivors

Endometrial cancer is strongly linked to obesity and inactivity; however, increased physical activity has important benefits even in the absence of weight loss. Resistance (strength) training can deliver these benefits; yet few women participate in resistance exercise. The purpose of this study was to describe both physiological and functional changes following a home-based strength training intervention. Forty post-treatment endometrial cancer survivors within 5 years of diagnosis were enrolled in a pilot randomized trial, comparing twice-weekly home-based strength exercise to wait list control. Participants conducted the exercises twice per week for 10 supervised weeks with 5 weeks of follow-up. Measures included DXA-measured lean mass, functional fitness assessments, blood biomarkers, and quality of life outcomes. On average, participants were 60.9 years old (SD = 8.7) with BMI of 39.9 kg/m Home-based muscle-strengthening exercise led to favorable and clinically relevant improvements in 3 of 7 physical function assessments. Physical function, body composition, blood biomarkers, and patient-reported outcomes were feasible to measure. These fitness improvements were observed over a relatively short time frame of 10 weeks.