Cross-cultural adaptation and validation of the Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia (FACIT-CD) questionnaire for Serbian women.

OBJECTIVES: The FACIT-CD (Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia) questionnaire is a disease-specific instrument for assessing the health-related quality of life (HRQoL) in women with cervical dysplasia. Our aim was to perform a cross-cultural adaptation and psychometric evaluation of the FACIT-CD scale in Serbian women with cervical squamous intraepithelial lesions (SIL). STUDY DESIGN: Our study included women of reproductive age diagnosed with SIL in a single university-affiliated hospital. A total of 160 participants with histologically confirmed low-grade (LSIL) or high-grade (HSIL) squamous intraepithelial lesions responded to the Serbian version of the FACIT-CD instrument, the Short Form-36v2 questionnaire (SF-36v2), the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI). Women also participated in an interview regarding their socio-demographic data. We evaluated the validity and reliability of the Serbian version of FACIT-CD. RESULTS: The Cronbach's alpha coefficient was 0.710 for the entire sample (0.702 for LSIL and 0.711 for HSIL). We found numerous correlations between the FACIT-CD scores and SF-36v2 scores, as well as between the BAI and BDI scores for both the total score and most of the domain scores. The mean FACIT-CD total score was high (114.47 ±â€¯13.25 out of 136.00 which is the maximum score). There were no significant differences in the mean scores between the LSIL and HSIL groups. CONCLUSIONS: Our study demonstrated that the Serbian FACIT-CD has overall good psychometric properties in women with both LSIL and HSIL. We propose the use of the FACIT-CD questionnaire as an indicator for HRQoL in women with cervical dysplasia.

Assessment of ovarian function after chemotherapy in women with early and locally advanced breast cancer from Serbia.

PURPOSE: Among harmful effects of chemotherapy is the reduction of ovarian function. The aim was to determine the serum levels of FSH, LH, estradiol and AMH after chemotherapy followed by endocrine therapy in breast cancer patients. METHODS: The study included 40 premenopausal hormone receptor-positive breast cancer patients aged 33-50 years. Anthracycline-based chemotherapy received 14/40 while anthracycline-taxane combination received 26/40 of patients, followed by tamoxifen (30/40) or tamoxifen plus goserelin (10/40). All of them experienced chemotherapy-induced secondary amenorrhea. Hormone levels were determined by ELISA. Statistics included Spearman's test, Mann-Whitney test and multiple linear regression analysis. RESULTS: Undetectable AMH levels were observed in 62.5 and 33.3% of patients with time period < 2 and ≥ 2 years from completion of chemotherapy to sample collection. Median levels of hormones for patients treated with anthracycline-based compared to anthracycline-taxane therapy were: 15.5 vs. 22.3 IU/L for FSH; 10.9 vs. 13.6 IU/L for LH; 55.5 vs. 39.5 pg/mL for estradiol; 0.11 vs. 0.11 ng/mL for AMH. The multiple linear regression showed that: women who received goserelin had significantly lower FSH; those with shorter time from completion of chemotherapy to sample collection had significantly higher LH and lower estradiol; younger women had higher AMH levels. CONCLUSIONS: The ovarian function was recovered from chemotherapy-induced secondary amenorrhea with time elapsed since the completion of adjuvant chemotherapy. It may be less disrupted in patients who received anthracycline-based chemotherapy and goserelin plus tamoxifen, as well.

Sister Society Meeting on Global Education Development and Collaboration: Meeting Report.

OBJECTIVES: To identify common barriers to teaching and training and to identify strategies that would be useful in developing future training programs in gynecologic oncology in low- and middle- income countries. METHODS: There is a lack of overall strategy to meet the needs of education and training in gynecologic oncology in low- and middle- income countries, the leaderships of sister societies and global health volunteers met at the European Society of Gynecologic Oncology in October 23, 2015. The challenges of the training programs supported by gynecologic oncology societies, major universities and individual efforts were presented and discussed. Strategies to improve education and training were identified. RESULTS: Major challenges include language barriers, limited surgical equipment, inadequate internet access, lack of local support for sustainability in training programs, inadequate pathology and radiation oncology, finance and a global deficiency in identifying sites and personnel in partnering or developing training programs. The leaderships identified various key components including consultation with the local Ministry of Health, local educational institutions; inclusion of the program into existing local programs, a needs assessment, and the development of curriculum and regional centers of excellence. CONCLUSIONS: Proper preparation of training sites and trainers, the development of global curriculum, the establishment of centers of excellence, and the ability to measure outcomes are important to improve education and training in gynecologic oncology in low- and middle- income countries.

Follow-up in Gynecological Malignancies: A State of Art.

OBJECTIVE: The main purpose of this article is to explore the current practice for follow-up of gynecological cancer, pointing out the different procedures, to determine the most clinically and cost-effective surveillance strategies after the primary treatment. MATERIALS AND METHODS: We analyzed the follow up strategies for ovarian, endometrial, and cervical cancer. All of the topics discussed below arose from the "ESGO State of Art Conference-Follow-up in gynaecological malignancies" in Turin, (September 11-13, 2014; http://torino2014.esgo.org/). RESULTS: Physical but these practices should be integrated with biomarkers or imaging strategies. Currently, most recommendations about follow-up are based on retrospective studies and expert opinion, and there is some disagreement on surveillance strategies due to lack of evidence-based knowledge. CONCLUSIONS: All surveillance procedures should be evidence-based with a clearly defined purpose: there is a need for prospective studies to compare the effectiveness of different follow-up regimens measuring overall survival, detection of recurrence, quality of life (QoL), and costs as outcomes.

The work place educational climate in gynecological oncology fellowships across Europe: the impact of accreditation.

BACKGROUND: A good educational climate/environment in the workplace is essential for developing high-quality medical (sub)specialists. These data are lacking for gynecological oncology training. OBJECTIVE: This study aims to evaluate the educational climate in gynecological oncology training throughout Europe and the factors affecting it. METHODS: A Web-based anonymous survey sent to ENYGO (European Network of Young Gynecological Oncologists) members/trainees to assess gynecological oncology training. This included sociodemographic information, details regarding training posts, and a 50-item validated Dutch Residency Educational Climate Test (D-RECT) questionnaire with 11 subscales (1-5 Likert scale) to assess the educational climate. The χ test was used for evaluating categorical variables, and the Mann-Whitney U (nonparametric) test was used for continuous variables between 2 independent groups. Cronbach α assessed the questionnaire reliability. Multivariable linear regression assessed the effect of variables on D-RECT outcome subscales. RESULTS: One hundred nineteen gynecological oncological fellows responded. The D-RECT questionnaire was extremely reliable for assessing the educational environment in gynecological oncology (subscales' Cronbach α, 0.82-0.96). Overall, trainees do not seem to receive adequate/effective constructive feedback during training. The overall educational climate (supervision, coaching/assessment, feedback, teamwork, interconsultant relationships, formal education, role of the tutor, patient handover, and overall consultant's attitude) was significantly better (P = 0.001) in centers providing accredited training in comparison with centers without such accreditation. Multivariable regression indicated the main factors independently associated with a better educational climate were presence of an accredited training post and total years of training. CONCLUSIONS: This study emphasizes the need for better feedback mechanisms and the importance of accreditation of centers for training in gynecological oncology to ensure training within higher quality clinical learning climates.

[Assessment of the natural course and treatment of premalignant uterine cervical lesions in pregnancy].

INTRODUCTION: Premalignant changes of the uterine cervix occur with similar frequency during pregnancy and in non-pregnant women. Due to the fact that any surgery on the cervix can jeopardize pregnancy, it is important to define the protocol of procedures for the treatment of these changes during pregnancy. OBJECTIVE: The aim of the study was to investigate the natural course of premalignant cervical changes during pregnancy and the impact of their treatment on the pregnancy course. METHODS: Study involved all patients with colposcopically, cytologically and hystopathologically diagnosed premalignant cervical changes during pregnancy from 2002 to 2008. Patients were divided into two groups according to the applied treatment during pregnancy: surgery or monitoring by regular colposcopic and cytological examinations. The two groups were compared concerning treatment outcome, persistence or regression of changes and pregnancy duration. RESULTS: Study involved 58 patients. Spontaneous remission of lesions occurred after pregnancy in 63.79% of cases. High-grade squamous intraepithelial lesion (H-SIL) demonstrated a higher rate of persistency in comparison with low-grade squamous intraepithelial lesion (L-SIL) (X2=25.115; p<0.05). Only one finding of L-SIL progressed into H-SIL in the monitored group. Patients who underwent conization during pregnancy had a significantly more frequent preterm deliveries (X2=14.369; p<0.05). CONCLUSION: The obtained high rate of spontaneous regression of cervical changes after pregnancy as well as the lower incidence of preterm births in patients who were not treated by conization during pregnancy, confirm that patients with premalignant cervical changes should be, if invasion is excluded, under follow-up throughout pregnancy by regular colposcopic and cytological examinations. Therapeutic conization, due to numerous complications, should be performed only when there is a suspected presence of a more severe form of the disease (micro invasive and invasive carcinoma).

Cervical cancer burden and prevention activities in Europe.

Cervical cancer is an important public health care problem in Europe. The overall incidence rate of cervical cancer in Europe is 10.6 per 100,000. However, within Europe, the incidence rates significantly differ, being lower in Western Europe where prevention programs are better developed. Significantly higher are the incidence and mortality rates in Central and Eastern Europe, being in close correlation to the intensity of organized screening. Human papillomavirus (HPV) vaccines are being delivered to the low-incidence populations that already have extensive screening programs, whereas the high-incidence countries have not implemented the vaccination programs yet. The resolution of the problem of cervical cancer control in Europe will be a matter of the implementation of public health care programs across the whole continent.

Fertility preserving management in gynecologic cancer patients: the need for centralization.

Preservation of fertility has became a very important issue in gynecologic oncology. It is a result of both the increasing incidence of gynecologic cancer in young patients and the increasing age at first pregnancy. Today, in a young patient with a gynecologic cancer, preservation of fertility is possible and depends primarily on the extent and type of cancer. The clinical importance of an appropriate management of young patients with gynecologic cancer has lead the ESGO Task Force for Fertility Preservation in Gynecologic Cancer to conduct a survey with the aim of exploring the numbers and eligibility of gynecologic cancer patients for fertility-sparing treatment in selected gynecologic oncology centers across Europe. A questionnaire designed to allow adequate insight into the number of patient eligible for fertility-sparing treatment and the resulting treatment was sent to 20 ESGO-accredited centers. The data were collected retrospectively for the year 2007. The reply was received from 14 gynecologic oncology centers, and those surveys were included for analysis. The small numbers of patients eligible for conservative management (14-15 per year/median number in ESGO-accredited centers) and even the smaller number of those who actually receive fertility-sparing treatment (<10) raise the question of quality of care for these patients. These low numbers support the concept of centralization for fertility-sparing management to improve the quality of patients care. Since carrying out the survey on fertility-sparing management in ESGO-accredited gynecologic oncology centers in Europe, the ESGO Task Force for Fertility Preservation in Gynecologic Cancer has proposed a protocol for referrals to centralized units that have developed specific expertise. Optimal management for young patients with gynecologic cancer should include a clear decision-making process, an adequate counseling about the future oncological and obstetrical risks, the appropriate management, and a careful follow-up within a multidisciplinary setting.