Endometrial carcinosarcoma.

Endometrial carcinosarcoma is a rare and aggressive high-grade endometrial carcinoma with secondary sarcomatous trans-differentiation (conversion theory). The clinical presentation and diagnostic work-up roughly align with those of the more common endometrioid counterpart, although endometrial carcinosarcoma is more frequently diagnosed at an advanced stage. Endometrial carcinosarcoma is not a single entity but encompasses different histological subtypes, depending on the type of carcinomatous and sarcomatous elements. The majority of endometrial carcinosarcomas are characterized by p53 abnormalities. The proportion of POLE and microsatellite instablity-high (MSI-H) is directly related to the epithelial component, being approximately 25% and 3% in endometrioid and non-endometrioid components.The management of non-metastatic disease is based on a multimodal approach with optimal surgery followed by (concomitant or sequential) chemotherapy and radiotherapy, even for early stages. Palliative chemotherapy is recommended in the metastatic or recurrent setting, with carboplatin/paclitaxel doublet being the first-line regimen. Although the introduction of immunotherapy plus/minus a tyrosine kinase inhibitor shifted the paradigm of treatment of patients with recurrent endometrial cancer, patients with endometrial carcinosarcoma were excluded from most studies evaluating single-agent immunotherapy or the combination. However, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) approved the use of pembrolizumab and lenvatinib in endometrial cancer (all histotypes) after progression on chemotherapy and single-agent immunotherapy in MSI-H cancers. In the era of precision medicine, emerging knowledge on molecular endometrial carcinosarcoma is opening new promising therapeutic options for more personalized treatment. The present review outlines state-of-the-art knowledge and future directions for patients with endometrial carcinosarcoma.

Clear cell carcinoma of the endometrium.

Clear cell endometrial carcinoma represents an uncommon and poorly understood entity. Data from molecular/genomic profiling highlighted the importance of various signatures in assessing the prognosis of endometrial cancer according to four classes of risk (POLE mutated, MMRd, NSMP, and p53 abnormal). Unfortunately, data specific to clear cell histological subtype endometrial cancer are lacking. More recently, data has emerged to suggest that most of the patients (more than 80%) with clear cell endometrial carcinoma are characterized by p53 abnormality or NSMP type. This classification has important therapeutic implications. Although it is an uncommon entity, clear cell endometrial cancer patients with POLE mutation seem characterized by a good prognosis. Chemotherapy is effective in patients with NSMP (especially in stage III and IV) and patients with p53 abnormal disease (all stages). While, preliminary data suggested that patients with MMRd are less likely to benefit from chemotherapy. The latter group appears to benefit much more from immune checkpoint inhibitors: recent data from clinical trials on pembrolizumab plus lenvatinib and nivolumab plus cabozantinib supported that immunotherapy plus tyrosine kinase inhibitors (TKI) would be the most appropriate treatment for recurrent non-endometrioid endometrial cancer (including clear cell carcinoma) after the failure of platinum-based chemotherapy. Moreover, ongoing clinical trials testing the anti-tumor activity of innovative products will clarify the better strategies for advanced/recurrent clear cell endometrial carcinoma. Further prospective evidence is urgently needed to better characterize clear cell endometrial carcinoma.

Factors that Facilitate and Hinder the Experience of Compersion Among Individuals in Consensually Non-Monogamous Relationships.

Compersion refers to the positive feelings, such as joy, excitement and contentment, that one may experience in response to one's partner's other consensually non-monogamous (CNM) intimate relationship(s). In the study, we recruited 44 CNM participants who had experienced compersion to complete an open-ended online survey regarding the factors that facilitated and hindered their experiences of compersion. A thematic analysis identified three main themes: intrapersonal/individual factors, experiences in and characteristics of the relationship with one's partner(s), and feelings/judgments about one's metamour (one's partner's partner). The factors most commonly named by participants as facilitating compersion included: feelings of self-worth, feeling secure and that one's needs were being met in the relationship with the partner, communication with one's partner, and positive regard for one's metamour. Participants shared conflicting experiences regarding the nature of the relationship between jealousy and compersion and whether the ability to feel compersion was innate or learned. Findings were generally consistent with the small body of literature on this phenomenon. Several theories, including Broaden-and-Build, Self-Expansion, and Crossover, may help us understand the underpinnings of compersion and the pathways through which the experience might strengthen and deepen relationships. The study's results suggest multiple hypotheses ripe for future testing. Increasing our knowledge of this little known phenomenon carries the potential to help us identify strategies to manage jealousy and increase positive feelings across all relationship types.

Uterine serous carcinoma.

Serous endometrial cancer represents a relative rare entity accounting for about 10% of all diagnosed endometrial cancer, but it is responsible for 40% of endometrial cancer-related deaths. Patients with serous endometrial cancer are often diagnosed at earlier disease stage, but remain at higher risk of recurrence and poorer prognosis when compared stage-for-stage with endometrioid subtype endometrial cancer. Serous endometrial cancers are characterized by marked nuclear atypia and abnormal p53 staining in immunohistochemistry. The mainstay of treatment for newly diagnosed serous endometrial cancer includes a multi-modal therapy with surgery, chemotherapy and/or radiotherapy. Unfortunately, despite these efforts, survival outcomes still remain poor. Recently, The Cancer Genome Atlas (TCGA) Research Network classified all endometrial cancer types into four categories, of which, serous endometrial cancer mostly is found within the "copy number high" group. This group is characterized by the increased cell cycle deregulation (e.g., CCNE1, MYC, PPP2R1A, PIKCA, ERBB2 and CDKN2A) and TP53 mutations (90%). To date, the combination of pembrolizumab and lenvatinib is an effective treatment modality in second-line therapy, with a response rate of 50% in advanced/recurrent serous endometrial cancer. Owing to the unfavorable outcomes of serous endometrial cancer, clinical trials are a priority. At present, ongoing studies are testing novel combinations of various targeted and immunotherapeutic agents in newly diagnosed and advanced/recurrent endometrial cancer - an important strategy for serous endometrial cancer, whereby tumors are usually p53+ and pMMR, making response to PD-1 inhibitor monotherapy unlikely. Here, the rare tumor working group (including members from the European Society of Gynecologic Oncology (ESGO), Gynecologic Cancer Intergroup (GCIG), and Japanese Gynecologic Oncology Group (JGOG)), performed a narrative review reporting on the current landscape of serous endometrial cancer and focusing on standard and emerging therapeutic options for patients affected by this difficult disease.

Feeling Good About Your Partners' Relationships: Compersion in Consensually Non-Monogamous Relationships.

Compersion is a well-known term in polyamorous communities that connotes the positive emotion an individual may experience in relation to their partner's relationship with another partner. We know little about this emotion or about the factors that facilitate or inhibit its expression. The lack of a standardized measure for compersion has likely contributed to its neglect in the empirical literature. We sought to remedy this gap by creating a reliable and valid quantitative scale, The COMPERSe (Classifying Our Metamour/Partner Emotional Response Scale), through a multi-stage, bottom-up process grounded in a qualitative understanding of consensually non-monogamous (CNM) individuals' lived experience of compersion. This paper describes the thematic analysis of qualitative data (n = 44) which underpinned item generation, revision of the item pool based on researcher, practitioner, and community member feedback, exploratory (n = 310) and confirmatory factor analyses (n = 320) to ascertain the factor structure of the data, and examination of convergent and divergent validity. Results supported the use of a three-factor scale (Happiness about Partner/Metamour Relationship, Excitement for New Connections, and Sexual Arousal), which demonstrated excellent internal consistency as well as strong divergent and convergent validity.

Healthcare Experiences and Needs of Consensually Non-Monogamous People: Results From a Focus Group Study.

BACKGROUND: Individuals engaged in consensual non-monogamy (CNM) face broad and potentially harmful experiences of sexual stigma in society, yet no published empirical literature has examined the experiences of this population within the healthcare system. AIM: The present investigation sought to explore positive and negative experiences of CNM individuals within the healthcare system, as well as specific needs of these patients regarding inclusive healthcare practices. METHODS: 20 CNM-identified adults from a non-profit organization serving CNM individuals completed a brief survey and participated in 1 of 3 focus groups of 70 minutes duration centered on their healthcare needs and experiences. OUTCOMES: CNM patients report challenges in addressing their healthcare needs related to lack of provider knowledge, inadequate preventative screenings, and stigmatizing behaviors that impact their health and trust in the healthcare system. CLINICAL IMPLICATIONS: Healthcare providers must monitor and work to avoid assumptions and pathologization of individuals who engage in CNM, creating an open, accepting environment to work collaboratively with CNM individuals to meet their unique sexual health needs. STRENGTH & LIMITATIONS: Although the present sample is diverse with respect to sexual and gender identity and socioeconomic status, it may not represent the experiences of CNM individuals outside of the midwestern United States and those who do not identify as polyamorous. CONCLUSION: CNM individuals frequently experience sexual stigma in interactions with the healthcare system that interferes with receipt of sensitive, medically accurate care relevant to their unique needs and experiences. Vaughan MD, Jones P, Taylor BA, et al. Healthcare Experiences and Needs of Consensually Non-Monogamous People: Results From a Focus Group Study. J Sex Med 2019;16:42-51.

Cediranib in patients with relapsed platinum-sensitive ovarian cancer (ICON6): a randomised, double-blind, placebo-controlled phase 3 trial.

BACKGROUND: Angiogenesis is a validated clinical target in advanced epithelial ovarian cancer. Cediranib is an oral antiangiogenic vascular endothelial growth factor receptor 1-3 inhibitor that has shown antitumour activity in recurrent ovarian cancer. We assessed efficacy and safety of cediranib in combination with platinum-based chemotherapy and as continued maintenance treatment in patients with first relapse of platinum-sensitive ovarian cancer. METHODS: In this randomised, three-arm, double-blind, placebo-controlled phase 3 trial, we randomly assigned patients aged 18 years or older with relapsed platinum-sensitive ovarian cancer at 63 centres in Australia, Canada, New Zealand, Spain, and the UK. Participants received up to six cycles of platinum-based chemotherapy (once every 3 weeks) then entered a maintenance phase. Participants were randomly allocated (2:3:3), with five stratification factors and in alternating blocks, to receive placebo alongside chemotherapy and then placebo only maintenance (arm A; reference), cediranib 20 mg once-daily alongside chemotherapy then placebo only maintenance (arm B; concurrent), or cediranib 20 mg once-daily alongside chemotherapy then cediranib 20 mg once-daily maintenance (arm C; maintenance). Patients continued treatment to progression or excessive toxic effects. The primary efficacy endpoint was progression-free survival between arms A and C. Efficacy analysis was by intention to treat. Safety was assessed in all patients who received the allocated study drug. This trial is registered with ClinicalTrials.gov, number NCT00532194; the ISRCTN registry, number ISRCTN68510403; and ANZ Clinical Trials Registry, number ACTRN1261000016003. FINDINGS: We randomly assigned 486 [corrected] women between Nov 13, 2007, and Dec 23, 2011; results presented are for 456 patients randomly assigned subsequent to the 30mg safety phase. During a median of 19·5 months (IQR 14-26) follow-up, 113 (96%) of 118 women assigned to arm A and 141 (86%) of 164 assigned to arm C had disease progression. Median progression-free survival was 11·0 months (95% CI 10·4-11·7) in arm C and 8·7 months (7·7-9·4) in arm A (hazard ratio 0·56, 0·44-0·72, p<0·0001). 156 (90%) of 174 patients in arm B had disease progression, and median progression-free survival was 9·9 months (95% CI 9·4-10·5). Diarrhoea, neutropenia, hypertension, and voice changes were significantly more common, during chemotherapy with cediranib, and diarrhoea, hypothyroidism and voice changes were more common during maintenance. Poor compliance with cediranib was noted during maintenance treatment with toxic effects being the most common cause for discontinuation. INTERPRETATION: Cediranib, when given orally with chemotherapy and continued as maintenance, yielded a meaningful improvement [corrected] in progression-free survival in women with recurrent platinum-sensitive ovarian cancer, albeit with added toxic effects. The positive results in ICON6 could provide women with a new therapeutic option for recurrent ovarian cancer. Assessment of the secondary endpoint of overall survival will need longer follow-up. FUNDING: Medical Research Council, Cancer Research UK, Canadian Cancer Society Research Institute, Cancer Australia, National Gynecological Cancer Centre, and AstraZeneca.

Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup.

OBJECTIVE: The objective of this study was to provide a consensus review on gestational trophoblastic disease diagnosis and management from the combined International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. METHODS: A joint committee representing various groups reviewed the literature obtained from PubMed searches. RESULTS AND CONCLUSIONS: Guidelines were constructed on the basis of literature review. After initial diagnosis in local centers, centralization of pathology review and ongoing care is recommended to achieve the best outcomes.

Gynecologic Cancer InterGroup (GCIG) consensus review for uterine serous carcinoma.

OBJECTIVES: Uterine serous carcinoma (USC) represents a rare and aggressive histologic subtype of endometrial cancer, associated with a poor prognosis. This article critically reviews the literature pertinent to the epidemiology, pathology, molecular biology, diagnosis, management, and perspectives of patients with USC. METHODS: As one of a series of The Gynecologic Cancer InterGroup (GCIG) Rare Tumor Working Group in London, November 2013, we discussed about USC many times with various experts among international GCIG groups. RESULTS: Both USC and approximately 25% of high-grade endometrioid tumors represent extensive copy number alterations, few DNA methylation changes, low estrogen and progesterone levels, and frequent P53 mutations. Uterine serous carcinoma shares molecular characteristics with ovarian serous and basal-like breast carcinomas. In addition to optimal surgery, platinum- and taxane-based chemotherapy should be considered in the treatment of both early- and advanced-stage disease. The combination of radiation and chemotherapy appears to be associated with the highest survival rates. The role of radiation therapy in the management of this disease, with a high propensity for distant failures, remains elusive. CONCLUSIONS: Uterine serous carcinoma is a unique and biologically aggressive subtype of endometrial cancer and should be studied as a distinct entity. Futures studies should identify the optimized chemotherapy and radiation regimens, sequence of therapy and schedule, and the role of targeted biologic therapy.

Exploring the Intersectionality of Bisexual, Religious/Spiritual, and Political Identities from a Feminist Perspective.

While there is a small but growing body of work that examines the religious and spiritual lives of bisexuals, there is a strong need for additional research that further explores the intersectionality of these distinct identities. Motivated by the feminist notions that the personal is political and that individuals are the experts of their own experiences (Unger, 2001), the specific aim of this study is to better understand the intersection of multiple identities experienced by bisexual individuals. Relying upon data collected by Herek, Glunt, and colleagues during their Northern California Health Study, in this exploratory study we examine the intersection of bisexual, religious/spiritual, and political identities by conducting an archival secondary analysis of 120 self-identified bisexual individuals. Among the significant findings, results suggest that higher LGB self-esteem scores and openness about sexual orientation correlated with higher levels of spirituality. Further, attraction to same sex partners was associated with perceiving sexual orientation as a choice, identifying as bisexual at a younger age, more likely to disclose one's sexual orientation, less likely to view religion as being socially important, and a higher score on the belief statement. We discuss the implications of these results and make suggestions for future research on the role of religion and spirituality in bisexual lives.

Corrigendum to: The cost savings of the rural accelerated chest pain pathway for low-risk chest pain in rural general practice: a cost minimisation analysis.

Introduction The rural accelerated chest pain pathway (RACPP) has been shown to safely reduce the number of transfers to hospital for patients who present with chest pain to rural general practice. Aim This study aimed to estimate the costs associated with assessing patients with low-risk chest pain using the RACPP in rural general practice compared with transporting such patients to a distant emergency department (ED). Methods This was a retrospective cost minimisation analysis. All patients with low-risk chest pain that were assessed in New Zealand (NZ) rural general practice using the RACPP between 1 June 2018 and 31 December 2019 were asked to participate. The costs incurred by patients were determined by an online survey. Patients were also asked to estimate the costs if they would have been transferred to ED. System costs were obtained from the relevant healthcare organisations. The main outcome measure was the total cost for patients who present with low-risk chest pain. Results In total, 15 patients (22.7% response rate) responded to the survey. Using the RACPP in general practice resulted in a median cost saving of NZ$1184 (95% CI: $1111 to $1468) compared with transferring the same patient to ED. Discussion Although limited by low enrolment, this study suggests that there are significant savings if the RACPP is used to assess patients with low-risk chest pain in rural NZ general practice.

Changes in Affect and Drinking Outcomes in a Pharmacobehavioral Trial for Alcohol Dependence.

OBJECTIVE: Despite extensive research exploring affect in alcohol dependent individuals in recovery, empirical research on affective changes over the course of psychosocial treatment and their role on drinking outcomes has been minimal. The present study examined the relationship between changes in positive affect (PA), negative affect (NA), and drinking outcomes during a pharmacobehavioral trial. METHOD: Data for these post-hoc exploratory analyses were derived from a clinical trial of 321 alcohol dependent male and female individuals. The study design had four treatment arms for medication: three levels of dose of ondansetron as well as a control condition (placebo). All participants received weekly cognitive behavioral therapy for twelve weeks. We conducted an exploratory evaluation of changes in negative and positive affect and drinking behavior over time during the treatment phase of the trial using multilevel modeling. RESULTS: Participants experienced substantial reductions in drinking, decreases in NA, and increases in PA over the course of treatment. Individuals who experienced increases in PA over the course of treatment significantly reduced their drinking in subsequent weeks, while those who had reductions in NA only experienced reductions in drinking later in treatment if they also reported increases in PA. These results support the role of affect regulation in treatment. CONCLUSIONS: These results suggest that affective change during the course of treatment may serve as one potential mechanism of action for changes in drinking behavior. The interaction between reductions in NA and increases in PA may be particularly important in promoting new coping skills and reducing drinking.

Decreased hypersensitivity reactions with carboplatin-pegylated liposomal doxorubicin compared to carboplatin-paclitaxel combination: analysis from the GCIG CALYPSO relapsing ovarian cancer trial.

OBJECTIVE: To describe and analyze observed hypersensitivity reactions (HSR) from the randomized, multicenter phase III CALYPSO trial that evaluated the efficacy and safety of the combination of carboplatin and pegylated liposomal doxorubicin (CD) compared with standard carboplatin-paclitaxel (CP) in patients with platinum-sensitive relapsed ovarian cancer (ROC). METHODS: HSR documented within case report forms and SAE reports were specifically analyzed. Analyses were based on the population with allergy of any grade and for grade >2 allergy. RESULTS: Overall 976 patients were recruited to this phase III trial, with toxicity data available for 466 and 502 on the CD and CP arms, respectively. There was a 15.5% HSR rate associated with CD (2.4% grade >2) versus 33.1% with CP (8.8% grade >2), p<0.001. HSRs occurred more often during first cycle in the CD (46%) arm than in the CP arm (16%). Multivariate predictors of allergy were chemotherapy regimen and age; patients randomized to CD and patients ≥ 70 years old on CP had less allergy. Few patients (<6%) stopped treatment due to allergy. Allergy rates were higher in patients who did not receive prior supportive treatment; however there was no relationship between allergy and the type of carboplatin product received, or response rate. CONCLUSIONS: Use of PLD with carboplatin instead of paclitaxel and older age were the only 2 factors predicting a low rate of HSRs in patients with ROC. CD has previously demonstrated superior progression-free survival and therapeutic index than CP. Taken together these data support the use of CD as a safe and effective therapeutic option for platinum-sensitive ROC.

Impact of motivational changes on drinking outcomes in pharmacobehavioral treatment for alcohol dependence.

BACKGROUND: Psychological factors such as motivation to change and self-efficacy influence drinking outcomes in alcohol-dependent individuals who are enrolled in pharmacobehavioral studies. Previous results from our research clinic indicated that initial stage of change of heavy drinkers enrolled in a pharmacobehavioral trial was significantly associated with alcohol consumption. However, overall empirical findings regarding the consistency and extent of the connection between motivational factors and behavior are mixed. This may be in part because of the impact of changes in motivation over the course of treatment and/or characteristics of the individuals receiving the intervention. Our goal in the present study was to examine the extent to which levels of motivation and self-efficacy changed during the treatment phase of a pharmacobehavioral treatment trial, and the extent to which these variables affected drinking behavior in subsets of alcohol-dependent individuals. METHODS: We conducted an exploratory evaluation of changes in motivation, temptation to drink, confidence to abstain, and drinking behavior over time during the treatment phase of a pharmacobehavioral study involving 321 alcohol-dependent individuals. We also examined the extent to which individual variables such as initial drinking severity, onset of alcohol dependence, and medication status influenced changes in motivation, self-efficacy, and drinking behavior. RESULTS: Participants reported improvements in motivation to change, self-efficacy for change, and drinking behaviors over the course of treatment. As hypothesized, motivation to change and self-efficacy for change were related to specific dimensions of posttreatment drinking. Heavy drinkers reported more improvement in drinking behaviors than did nonheavy drinkers. Early-onset drinkers who were on medication reduced their drinking more than those on placebo, and these drinking changes appear to be partially mediated by reductions in temptation. CONCLUSIONS: Reductions in drinking occur and are predicted by increased motivation to change, reduced temptation to drink, and increased confidence to abstain in this population of alcoholic-dependent individuals. Early and late onset and heavy drinkers and those taking medications displayed differential changes in drinking behavior, some of which were explained by the mediating effects of self-efficacy. This is a first step in understanding more about which alcoholic individuals respond best to treatment and what mechanisms may be involved in the changes in drinking and drinking-specific changes in frequency and intensity of drinking.

This Being is a Guest House: Embracing Humility, Liberation & Strengths in Therapy with Sexual and Gender Diverse Muslims.

The complexity of the lives of sexual and gender diverse Muslims within the United States calls for mental health providers to own our power and privilege. Embracing cultural humility in service of aligning ourselves with liberation psychology, we call for an intersectionally informed, strengths-based approach to empowering/affirming clients whose diverse religious experiences intersect with their experiences of marginalization as sexual and gender diverse (SGD) Muslims. Drawing on extant personal narratives around mental health and therapy of this population, the authors offer critical reflections, processes and opportunities for clinicians to take responsibility in honoring the diverse journeys and experiences of SGD Muslims in serving them in journeys of healing.

A Quantitative Examination of Identity Integration in Gay, Lesbian, and Bisexual People of Faith.

Much of the religious/spiritual development of gays, lesbians, and bisexuals (GLBs) has focused on experiences of conflict and distress, providing little insight into how these identities can be integrated. The present study explored the religious and spiritual lives of GLBs with a specific focus on the integration of these identities. We conducted a retrospective secondary data analysis of 750 GLB individuals from the Northern California Health Study to quantitatively assess sexual orientation and religion/spirituality integration using hierarchical cluster analysis. Resulting MANCOVA analyses of the five revealed groupings (integrated, gay identity struggle, anti-religious/spiritual, secular, and low gay salience) present numerous statistically significant differences between these integration clusters and a variety of dependent variables including measures of demographics, religiosity/spirituality, gay identity, and multiple mental health outcomes. We discuss the implications of these findings while also making suggestions for future research.

Phase I study of BNC105P, carboplatin and gemcitabine in partially platinum-sensitive ovarian cancer patients in first or second relapse (ANZGOG-1103).

PURPOSE: The primary objective of this study was to determine the recommended dose of the vascular disrupting agent, BNC105P, in combination with gemcitabine and carboplatin in patients with ovarian cancer in first or second relapse with a minimum 4 month progression-free interval after last platinum. METHODS: Patients received carboplatin AUC4 on day 1 in combination with escalating doses of 800 or 1000 mg/m2 gemcitabine on days 1 and 8 and escalating doses of 12 or 16 mg/m2 BNC105P on days 2 and 9 every 21 days for a maximum for six cycles. Maintenance treatment with 16 mg/m2 BNC105P treatment continued for a maximum of six additional cycles. Patients were followed for safety and anti-tumor activity. RESULTS: Fifteen patients were enrolled in the study. Adverse events were most commonly of hematological origin. Dose-limiting toxicities (thrombocytopenia and neutropenia) occurred in two patients at the dose level of 800 mg/m2 gemcitabine, carboplatin AUC4 and 16 mg/m2 BNC105P. No dose-limiting toxicities were observed at a dose level of gemcitabine 1000 mg/m2, carboplatin AUC4 and BNC105P 12 mg/m2. BNC105P as a single agent was well tolerated at a dose of 16 mg/m2 in maintenance treatment. Ten patients (67%) achieved a complete or partial response according to CA125 and/or RECIST response criteria, four of 13 (31%) responded by RECIST alone. The median progression-free survival was 5.9 months. CONCLUSIONS: We have established that BNC105P 12 mg/m2 with gemcitabine 1000 mg/m2 and carboplatin AUC4 is the recommended dose level and has an acceptable toxicity profile. Further exploration of BNC105P in the ovarian cancer setting is planned.

Working with LGBT Individuals: Incorporating Positive Psychology into Training and Practice.

This paper examines how positive psychology principles can be incorporated into clinical training and practice to work with lesbian, gay, bisexual and transgender (LGBT) clients. LGBT psychology literature has all too often relied on heterosexual and cisgender reference groups as the norm with respect to psychological health, primarily framing the experiences of LGBT individuals through the lens of psychopathology. As a result, strengths that could be ascribed to the LGBT experience have been overlooked within training and practice. While positive psychology is actively being incorporated into clinical and counseling psychology curricula, broadening the paradigm to include LGBT individuals has generally not been included in the discussion. Specific recommendations for training psychologists to incorporate and foster positive social institutions, positive subjective experiences and character strengths when working with LGBT clients and celebrating their unique experiences are provided.

Feasibility, acceptability and preferences for intraperitoneal chemotherapy with paclitaxel and cisplatin after optimal debulking surgery for ovarian and related cancers: an ANZGOG study.

OBJECTIVE: Intraperitoneal (IP) chemotherapy in women with optimally debulked stage III ovarian cancer has been reported to prolong overall survival, but has not been widely adopted due to concerns about its toxicity, inconvenience and acceptability to patients. The purposes of this study were to determine the regimen's feasibility, adverse events, catheter-related complications, progression-free survival, health-related quality of life (HRQL), and patients' preferences for IP versus intravenous (IV) chemotherapy. METHODS: We conducted a single arm, multi-center study of IP chemotherapy with IV paclitaxel 135 mg/m(2) (D1) over 3 hours, IP cisplatin 75 mg/m(2) (D2), and IP paclitaxel 60 mg/m(2) (D8) for 6 cycles in women with optimally debulked stage III ovarian or related cancers. RESULTS: Thirty-eight eligible patients were recruited from 12 sites between July 2007 and December 2009. Seventy-one percent (n=27) completed at least 4 cycles and 63% (n=24) completed all 6 cycles. Grade 3 or 4 adverse events included nausea (n=2), vomiting (n=2), abdominal pain (n=2), and diarrhea (n=1), but not febrile neutropenia, neurotoxicity, or nephropathy. There were no treatment-related deaths. Catheter-related complications were the most frequent cause of early discontinuation of treatment (16 patients, 21%). Apart from neurotoxicity HRQL which worsened over time, HRQL was stable or improved with time. Most patients (≥50%) judged moderate benefits (e.g., an extra 6 months survival time or a 5% improvement in survival rates) necessary to make IP chemotherapy worthwhile. CONCLUSION: IP chemotherapy was feasible, tolerable, and most participants considered moderate survival benefits sufficient to warrant the adverse effects and inconvenience.

Providing care for women with gynaecological malignancy: the need for a coordinated national approach.

Gynaecological cancer services in New Zealand have followed an evolutionary process rather than being centrally organised according to evidence on best practice. A report was recently commissioned by the Ministry of Health to review gynaecological cancer services and to provide guidance on the most efficient and effective way to delivery high quality, equitable care for women diagnosed with gynaecological cancers. It is apparent the sustainability of current services is compromised by disparities in access to evidence-based multidisciplinary care, significant workforce shortages and a lack of standardised formal referral protocols. Key recommendations of the report include the establishment of an overarching national gynaecological cancer steering group and ultimately a four centre hub and spoke model of care provision.