The use of intraperitoneal chemotherapy for advanced ovarian cancer - The experience of a tertiary referral centre.

BACKGROUND: Platinum-based chemotherapy is the backbone of the medical management of ovarian cancer. The dose, route and timing of treatment are ongoing areas of debate. Intraperitoneal (IP) chemotherapy is an alternative delivery method treatment to the conventional intravenous (IV) route for patients with epithelial ovarian cancer, with efficacy supported by Level 1 evidence. AIMS: To compare the outcomes and feasibility of IP to IV delivery of platinum-based chemotherapy in patients with advanced epithelial ovarian cancer. MATERIALS AND METHODS: In a single institution, patients receiving adjuvant chemotherapy (IP and IV) for Stages III and IV epithelial ovarian cancer over the period January 2006-December 2018 were identified through a prospectively maintained database. All patients with an IP port inserted were included. A control group of patients treated with IV chemotherapy was created using criteria identified during the study and in the randomised trials that tested IP chemotherapy. Assessments were made for relapse-free survival (RFS) and overall survival (OS) for each cohort. RESULTS: A total of 639 patients received adjuvant chemotherapy (73 IP and 566 IV) during the study period. Both the IP group and matched IV control group (65 patients) had a median RFS of 26 months. The median OS in the IP group was 63.9 months, and in the IV group was 57.2 months. At ten years, a significantly higher proportion of patients were alive in the IP group cohort (16% vs 3%, relative risk 5.5, 95% CI 1.29-24, P = 0.012). IP chemotherapy was well tolerated by our cohort. In the IP group, 73% had four or more IP cycles and 99% received six or more cycles of chemotherapy. CONCLUSIONS: Our cohort had a high rate of completion of IP chemotherapy with excellent rates of completion of six cycles of any treatment. The RFS and OS in the IP chemotherapy group were comparable to each other and reflected those in the published literature. A significantly higher proportion of patients in the IP cohort were alive at ten years than in the IV cohort.

The socioeconomic gradient in mortality from ovarian, cervical, and endometrial cancer in Australian women, 2001-2018: A population-based study.

BACKGROUND: Socio-economic (SE) status is closely linked to health status and the mechanisms of this association are complex. One important adverse effect of SE disadvantage is vulnerability to cancer and cancer is a major cause of morbidity and mortality in Australia. AIMS: We aimed to estimate the effect of SE status on mortality rates from ovarian, cervical, and endometrial cancer. MATERIALS AND METHODS: National mortality data were obtained from the Australian Bureau of Statistics (ABS) for the calendar years from 2001 to 2018, inclusive. Individual deaths were grouped by the ABS Index of Relative Socio-economic Advantage and Disadvantage. Population data were obtained to provided denominators allowing calculation of mortality rates (deaths per 100 000 women aged 30-79 years). Statistical analyses performed included tabulating point-estimates of mortality rates and their changes over time and modelling the trends of rates using maximum likelihood method. RESULTS: Age-standardised mortality rates for ovarian and cervical cancer fell over the study period but increased for endometrial cancer. There was clear evidence of a SE gradient in the mortality rate for all three cancers. This SE gradient increased over the study period for ovarian and cervical cancer but remained unchanged for endometrial cancer. CONCLUSIONS: Women at greater SE disadvantage have higher rates of death from the commonest gynaecological cancers and this gradient has not reduced over the last two decades. After the COVID-19 pandemic efforts must be redoubled to ensure that Australians already at risk of ill health do not face even greater risks because of their circumstances.

The utilisation of sentinel lymph node biopsy for endometrial cancer in Australia and New Zealand.

AIMS: The aim of this study was to identify to what extent the sentinel lymph node (SLN) technique is utilised by gynaecological oncologists in Australia and New Zealand, identifying the techniques used, any barriers to uptake, and management of isolated tumour cells (ITCs) and micrometastases. MATERIALS AND METHODS: We conducted an online survey of all practising gynaecological oncologists in Australia and New Zealand. They were asked whether they utilised SLN biopsy and in what circumstances, how they managed non-mapping and how their multidisciplinary team managed small volume disease. Those who did not were asked to identify their concerns with the procedure, reasons for non-uptake and their alternate technique. RESULTS: We surveyed 63 gynaecological oncologists of whom 59 were practising, and 48 (81%) responded. Six members (11%) do not utilise SLN biopsy, and 42 (89%) do. Areas where clinicians differ in practice are those areas that are most controversial and include the use of SLN biopsy in complex atypical hyperplasia, the management of ITCs and micrometastases and procedures on unilateral or bilateral non-mapping. Those who do not utilise the technique cite concerns about the false-negative rate, equipment and training issues. CONCLUSIONS: The utilisation of SLN biopsy in endometrial cancer is well established in Australia and New Zealand, with similar practices and concerns to those of other international groups.

Changes in the incidence and uptake of reproductive surgery versus in vitro fertilisation in Australia between 2001 and 2015: A population-based study.

OBJECTIVE: Improvements in success rates of assisted reproduction led to predictions that infertility surgery in both women and men would become extinct in developed countries. We sought to identify the changes in reproductive surgery that occurred between 2001 and 2015 to determine whether these predictions have been accurate. DESIGN: The Australian Institute of Health and Welfare (AIHW) national procedural dataset and the Australian Medicare Benefits Scheme (MBS) claims database were searched for procedure data for male and female reproductive surgery and assisted reproduction from January 2001 to December 2015. The denominators were based on annual point estimates of the total population aged 25-44 years (female) and 25-55 years (male) from the Australian Bureau of Statistics (ABS). This dataset provides procedures undertaken but not their indications. RESULTS: Over the study period the incidence of tubal surgery fell by 66%, vasectomy reversal by 33%, and surgical varicocoelectomy by 50%. In contrast, the rate of hysteroscopic myomectomy increased by 48%, hysteroscopic septoplasty by 125%, and laparoscopy for severe endometriosis increased by 84%. In vitro fertilisation oocyte retrievals increased by 90%. The rate of abdominal myomectomy was unchanged. CONCLUSION: Fertility surgery is not dead but has evolved.

Association between a national quality improvement program and excisional treatment of cervical dysplasia in Australia.

AIM: In Australia, the National Cervical Screening and HPV Vaccination Programs aim to reduce the incidence of cervical cancer. Identification and treatment of preinvasive disease is important, but excisional treatment has been associated with adverse pregnancy outcomes. A national quality improvement program (Cervical Quality Improvement Program [c-QuIP]) aimed to reduce the rate of excisional treatment in young human papilloma virus (HPV)-vaccinated women. This study examined national trends in the rate of excisional treatment in young women. METHODS: Comprehensive national data were obtained from Medicare Australia regarding incidence rates of excisional treatment for the 10-year period 2007 to 2016 inclusive. These data were used to calculate age-stratified incidence rates of excisional treatment in young (20-24 years), intermediate (25-34 years) and older (35-60 years) women. RESULTS: The rate of excisional treatment (procedures per 10 000 women) fell in young women (from 25 to 6/7, P < 0.005) and women of intermediate age (from 23 to 13, P < 0.005), but there was no significant change in the rate in women aged 35 to 60 years (from 7 to 6.5). CONCLUSION: In the decade since introduction of the National HPV Vaccination Program the rate of excisional treatment of the cervix in Australia has fallen in women aged less than 35 years but has not changed for older women. The introduction of a national program aiming to reduce the rate appeared to have little impact.

An improvement index to quantify the evolution of performance in field events.

The mean of the top 25 performances in 8 men's and 5 women's field events since the 1890s showed that performances increased dramatically after the Second World War II and subsequently plateaued during the late twentieth century. A performance improvement index, developed on the basis of work done, was set to 100% in 1948. The underlying rise found in all events was modelled using an exponential function with a superposition of steps and linear changes to account for the introduction of rule changes, drugs testing and the introduction of new technologies. The performance improvement index in throwing events increased to 140.9% compared with 125.8% in jumping events, and women's performance improvement always exceeded that of men's. Around half of all events were shown to have reached 99.9% of their predicted limit with a majority reaching it within the next 25 years. It was concluded that performance will only change in the future if an intervention takes place: this could be the emergence of a new technology, a rule change or a new athlete population.

An improvement index to quantify the evolution of performance in running.

Improvements in track and field sports have been attributed to factors such as population increase, drugs and new technologies, but previous research has found it difficult to distinguish the contributions from specific influences. Here it is shown how this is possible by means of a performance improvement index based on useful work done combined with modelling of the annual top 25 performances. The index was set to 100 in 1948 and showed that, by 2012, it had increased in running events to between 110.5 and 146.7 (men's 100 m and marathon). Underlying global effects accounted for the majority of all improvements (16.2 to 46.7) with smaller influences attributable to an influx of African runners (3.6 to 9.3), and a 4-year oscillation that arose from staging of the Olympic Games (±0.2 to ±0.6). Performance decreased with the introduction of compulsory random drug testing (-0.9 to -3.9) the World Anti-Doping Agency (WADA; -0.5 to -2.5) and fully automated timing (-0.6 to -2.5). Changes in elite sporting performance since the 1890s are attributable to societal changes caused by the industrial revolution and globalisation superimposed on millennia of human evolution.