ABSTRACT
Background@#The COVID-19 pandemic has immobilized and impaired the operation of hospitals, clinics, and other health-care facilities leaving a plethora of patients and persons-at-risk in a more precarious position. Cancer patients were vulnerable to infections and complications due to the nature of the malignancy. Their caregivers were likewise predisposed to infection while taking care of them. This paper focused on determining the concerns of both gestational trophoblastic neoplasia (GTN) patients and their caregivers and identified possible factors of improvement in the delivery of essential cancer care.@*Objective@#The objective of the study was to describe the different concerns of GTN patients and their caregivers during chemotherapy and other adjunctive treatments during the COVID-19 pandemic in a Tertiary Government Hospital.@*Materials and methods@#A qualitative type of research was employed in this research, for which an in-depth interview was used. A total of 12 respondents, 6 patients and 6 caregivers, were interviewed using a semi-structured pretested questionnaire.@*Results@#Findings showed that infection with COVID-19, financial and logistical constraints exacerbated by the pandemic were the main concerns of both patients and caregivers. Other concerns recorded include change in their attending physician, survivability of the patient, and the availability of caregivers.@*Conclusions@#Despite the recorded apprehensions from the patients and caregivers, there was a general satisfaction in the delivery of health care at the Division of Trophoblastic Diseases due to the clarity in the follow-up and treatment schedules which have been optimized through the revised guidelines and protocols set by the division to adapt to the COVID-19 pandemic.
Subject(s)
COVID-19ABSTRACT
Background@#Gestational trophoblastic neoplasia (GTN) is considered one of the most curable malignancies, especially when diagnosis and treatment are commenced early. Identifying predictors for the development of GTN will enable prompt management equating to an excellent prognosis.@*Objectives@#The objectives of this study were to determine the validity of uterine artery Doppler parameters (UADPs) as predictors for postmolar GTN, compare UADP values before and after evacuation, determine cutoff values and relationship with beta‑human chorionic gonadotropin (hCG) levels.@*Materials and methods@#This was a prospective cohort study, which included histopathologically confirmed hydatidiform mole (HM) patients who underwent suction curettage. UADPs (pulsatility index (PI), resistive index, and systolic/diastolic [S/D] ratio) were measured preevacuation, 4 weeks postevacuation, and 6 weeks postevacuation. Patients were followed up to determine whether they will develop postmolar GTN or not.@*Results@#A total of 31 HM patients were admitted during the study period, 84% (26/31) of whom underwent suction curettage. Of these, 92% (24/26) had histopathology of complete HM and were recruited. However, only 17 patients followed up and completed the study. Results showed that there was an increasing trend of the UADP from preevacuation to 6 weeks postevacuation and the trend between those with and without postmolar GTN was statistically significant. There was also an inverse relationship between the UADP and baseline β‑hCG values. UADP showed lower values among patients who developed postmolar GTN compared to those who did not. The cutoff values recommended by the area under curve (AUC) that can be a possible predictor were 4th‑week right PI of 2.14 (AUC = 0.71) and right S/D ratio of 2.60 (AUC = 0.73) and 6th‑week left PI of 2.80 (AUC = 0.70) and right PI of 2.53 (AUC = 0.74).@*Conclusion@#Neoangiogenesis, a hallmark of malignancy, is correlated with invasive disease and will show increased myometrial vascularization with lower uterine artery indices. Doppler ultrasound may be a useful tool for postmolar follow‑up and GTN diagnosis. However, the small sample size in this study is a limitation and a larger multicenter study is recommended.