Southern African Journal of Gynaecological Oncology - latest Issue
Volume 8, Issue 2, 2016
Author Greta DreyerSource: Southern African Journal of Gynaecological Oncology 8, pp 3 –4 (2016)More LessPatient-centred guidelines for brachytherapy for cervical cancer : This multi-disciplinary and multi-institutional South African group developed a document that is additional to existing more technical guidelines and which is based on their research into patient experiences and comments. It is hoped that all South African facilities will take note of and implement these guidelines. In an invited editorial, Kotzen congratulates the group and points out that local research from our service-overloaded radiation facilities is scarce and that we fail to utilise our unique position in the world to help improve techniques and outcomes in cost-effective ways. He points out correctly that the use of affordable ultrasound in gynaecologic oncology deserves much more attention.
Author Jeffrey KotzenSource: Southern African Journal of Gynaecological Oncology 8, pp 4 –5 (2016)More LessBrachytherapy is an essential component of the curative radiation treatment for cervical cancer. No additional treatment, including sophisticated EBRT techniques, such as IMRT and SBRT, can make up for the survival decrement from lack of brachytherapy as a component of definitive care. Overall survival was superior in patients who received brachytherapy (HR 0.554).1 The procedure is invasive and uncomfortable at best. Intracavitary brachytherapy is associated with anxiety. Women need to be given detailed information before the brachytherapy application to reduce anxiety. Sexual malfunction from ovarian failure and vaginal stenosis is common following treatment of cervical cancer, and sufficient counselling to enable the patients to manage sexual dysfunction is often neglected.
Brachytherapy for cervical cancer : guidelines to facilitate patient-centred care in a multidisciplinary environmentSource: Southern African Journal of Gynaecological Oncology 8, pp 7 –12 (2016) http://dx.doi.org/10.1080/20742835.2016.1More Less
Objective: To establish patient-centred guidelines to assist multidisciplinary members in providing quality care for cervical cancer patients receiving brachytherapy.Design: A qualitative research design.
Main measures: This prospective research study was conducted from July 2012 to March 2014 and constituted five stages. Stage 1: 28 one-to-one semi-structured patient interviews were conducted, stage 2: development of the proposed guidelines, stage 3: two focus group reviews of the proposed guidelines, stage 4: refinement of these guidelines by review by national heads of brachytherapy units and stage 5: presentation of the final guidelines.
Results: Four main themes with sub-themes were identified from the patient interviews. Patients’ perspectives of care were integrated into the development process of the proposed guidelines. Guidelines were developed to address the practice setting and define the collective and exclusive roles and responsibilities of the radiation oncologists, radiation therapists and oncology nurses. Content validity, clarity and applicability of the guidelines were confirmed.
Conclusion: Guidelines were established integrating the patient experience into the development process. They provide a framework that clearly defines the roles and responsibilities of each member of the multidisciplinary team. Members are encouraged to implement the guidelines to ensure that quality patient-centred care is delivered, rendering patient satisfaction.
Source: Southern African Journal of Gynaecological Oncology 8, pp 13 –18 (2016)More Less
Aim: To investigate the diagnostic value of the R-way colposcopic evaluation system (R-way system) in cervical cancer screening.
Materials and Methods: Between August 2013 and August 2014, a total of 1059 cases referred for colposcopy at Peking University First Hospital were studied using both the R-way system and the conventional colposcopic method. Our study evaluated and compared the diagnostic ability of the two methods in detecting high-grade lesions and cervical cancer (hereinafter called CIN2+). Evaluating indicators including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Youden index and the area under the curve (AUC) of the receiver operating characteristic (ROC) were calculated.
Results: The R-way system had a slightly lower specificity (94.52%) than conventional colposcopic method (95.99%) for CIN2+ detection (p = 0.181). However, the sensitivity (77.81%) was significantly higher than conventional colposcopic method (46.62%) (χ2 = 64.351, p < 0.001). Meanwhile, the AUC of the ROC for CIN2+ detection using R-way system (0.839) is larger than that with conventional colposcopic method (0.731) (Z = 4.348, p < 0.001). If preliminary results had been drawn from cervical exfoliated cytology before colposcopy referral, the combination of the R-way system with cytology could increase the sensitivity to 93.89% for CIN2+ detection (excluding ASCUS\LSIL), which is confirmed by multiple punch biopsy or ECC.
Conclusion: The diagnostic value of the R-way evaluation system is higher than that of the conventional colposcopic evaluation system in cervical cancer screening. Moreover, taking the ease of use and standardized quality control management into account, the R-way system is highly preferable.
Experiences of women receiving high dose rate brachytherapy for cervical cancer at an academic hospitalSource: Southern African Journal of Gynaecological Oncology 8, pp 20 –23 (2016) http://dx.doi.org/10.1080/20742835.2016.1257174More LessThe objective of this study was to present a descriptive summary of the experiences of women treated with high dose rate brachytherapy for cervical cancer. A qualitative descriptive design was used and 16 women treated at an academic hospital in Gauteng were purposively selected. Qualitative interviews were conducted and thematic analysis was used to analyse the data, from which two themes arose: the treatment experience and experiencing emotional distress. Being treated with brachytherapy was a negative experience causing fear, pain and humiliation. The participants feared the procedure, before receiving the first treatment and even after having had one. Pain was a major problem, as the preventative medication participants received did not protect them from experiencing pain. Having to open and hang their legs was a humiliating experience aggravated by the presence of observers and the rotation of doctors. Their belief in God comforted them and gave them courage to endure the treatment, whilst caring staff comforted and supported them. In addition to individualised patient education, nurses should assess the level of pain women experience before, during and after receiving brachytherapy and advocate for the revision of pain management protocols.
Acute Toxicity in HIV-positive vs. HIV-negative cervical cancer patients treated by radical chemo-radiation in ZambiaSource: Southern African Journal of Gynaecological Oncology 8, pp 24 –28 (2016) http://dx.doi.org/10.1080/20742835.2016.12393More Less
Background: The current standard of radical treatment for patients with cancer of the cervix is combination therapy in the form of radiotherapy with chemotherapy. Generally the same treatment protocol is applied to HIV-positive and HIV-negative patients. However, HIV-positive patients with invasive cervical cancer have not been evaluated in detail regarding treatment response, its toxicities and compliance.
Methods: This prospective, quantitative comparative study was conducted to evaluate acute toxicity in radical combination therapy, in HIV-positive (on HAART) and HIV-negative patients for cervical cancer at the Cancer Diseases Hospital, Lusaka, Zambia. In total, 120 stage IB2–IIIB cervical cancer patients were serially recruited to have an equal number of participants in each arm. Participants received cisplatin-based radical chemo-radiation for five to six weeks and were assessed for acute reactions in four systems: genitourinary, haematopoietic, skin, and gastrointestinal. Toxicity was scored using the NCI CTC v2.0.
Results: The results revealed that there was no significant difference with regard to major acute reactions between the two groups. Radical chemo-radiation is therefore well tolerated by HIV-positive patients.
Conclusion: Radical chemo-radiation in conventional doses was safely tolerated by a well-selected cervical cancer HIV-positive group on HAART and could be considered suitable for similar patients.
Immunohistochemistry markers in diagnosing high-grade serous carcinoma of ovary with breast metastasis : a rare case reportSource: Southern African Journal of Gynaecological Oncology 8, pp 29 –31 (2016) http://dx.doi.org/10.1080/20742835.2016.1239355More LessOvarian cancer patients presenting with breast metastasis are a rare phenomenon. Very few cases have been documented so far in the literature and have shown that long-term prognosis of these patients is poor despite intense chemotherapy schedules. This report discusses a case of high-grade serous carcinoma of the ovary with metastases to the right breast and axilla in a 49-yearold female as the first case in the authors’ centre in South India. Additional immunohistochemistry markers were checked to confirm the diagnosis. The patient was on the third line of chemotherapy in December 2015. It is strongly emphasised that breast examination should be routine in all cases of ovary malignant tumours. IHC markers may differentiate between second primary versus metastatic secondaries in the breast. Further clinical trials using novel chemotherapy and systematic review of all case reports may help to form uniform consensus guidelines for these rare entities.