Accuracy of Opportunistic Bone Mineral Density Assessment on Staging Computed Tomography for Gynaecological Cancers.

Background and Objectives: Women with gynecological cancers constitute a high-risk cohort for loss of bone density. International guidance stipulates women undergoing cancer treatments associated with bone loss should have a quantitative assessment of bone density. Access to Dual-energy X-ray Absorptiometry (DXA) is limited. This study aimed to assess the accuracy of opportunistic bone density measurement on staging computed tomography (CT) scans for gynaecological malignancies, in comparison to the gold standard DXA. Materials and Methods: Women with a staging CT scan of the abdomen and pelvis for a new diagnosis of gynecological cancer were recruited. DXA was performed within 6 weeks of treatment for gynaecological cancer. Lumbar bone density was measured by CT attenuation values, in Hounsfield units (HU), of the anterior trabecular region. Correlations between CT and DXA parameters were analysed. Receiver Operating Characteristic(ROC) curves for diagnosis of low bone density and osteoporosis were analysed. Results: Final cohort included 48 of 50 women recruited. There was good diagnostic accuracy for abnormal bone density and osteoporosis, with areas under the ROC curve at L1 of 0.77 (p = 0.002) and 0.80 (p = 0.020) respectively. CT-HU of 170-190 yielded sensitivities of 87-90%, positive predictive values of 75-84% and negative predictive values of 71-75% for the diagnosis of low bone mineral density. CT-HU of 90-110 yielded specificities of 85-93% for the diagnosis of osteoporosis. Moderate correlations were found between CT-HU and both DXA T-scores and diagnostic categories. Conclusions: This is the first study to assess the opportunistic application of CT in the assessment of bone health in women with gynaecological cancer, a cohort at high-risk of osteoporosis. The correlation between bone density assessment in CT-HU and DXA, and strong AUC values for the diagnosis of low bone density (0.77) and osteoporosis (0.80) support this pragmatic solution in resolving the care-gap in cancer treatment-induced bone loss, often associated with poor access to DXA.

Incidence, management, and sequelae of ureteric obstruction in women with cervical cancer.

PURPOSE: Hydronephrosis due to ureteric obstruction (UO) is stage-defining at cervical cancer presentation but may occur after primary staging. We aimed to determine the incidence and review the presentation and management of UO in women with cervical cancer attending our center. Particular attention was paid to the evolving role of interventional radiology (IR) in management. METHODS: Women with a new diagnosis of cervical cancer between January 2012 and December 2016 formed the cohort that was retrospectively reviewed from the oncology database and patient records. RESULTS: There were 310 women diagnosed with cervical cancer; 240 were stages I/II and 70 were stages III/IV. Primary treatments were chemoradiotherapy (n = 168; 54.2%), surgery (n = 121; 39.0%), and palliative care alone (n = 21; 6.8%). UO occurred in 74 (23.9%); present at primary staging in 53 (71.6%) and arising after staging in 21 (28.4%). Primary interventions for hydronephrosis were IR (n = 50; 67.6%), cystoscopic stenting (n = 19; 25.7%), bowel urinary conduit construction (n = 2; 2.7%), and none (n = 3; 4.1%). For those who attended IR, the mean number of IR procedures was 2.2, range 1-7. Maximum serum creatinine was 303 µmol/L for women with UO at primary staging compared with 252 µmol/L for UO after staging (P = 0.267). Thirty-eight women experienced substantial morbidity related to UO. Stage-adjusted mortality risk was 2.3 times higher for UO cases compared with those without UO. CONCLUSIONS: UO is associated with substantial morbidity and survival disadvantage in cervical cancer and may present after primary cancer staging. We recommend renal biochemistry during routine follow-up. A majority of cervical cancer-associated UO cases are managed with IR in our center.

Determinants of fertility issues experienced by young women diagnosed with breast or gynaecological cancer - a quantitative, cross-cultural study.

BACKGROUND: Although there is a recognition of the importance of fertility to young women with cancer, we do not know who is at risk of distress related to fertility issues following diagnosis. We investigated the determinants of fertility-related distress adopting a cross-cultural perspective and using the Common Sense Model (CSM). We chose the CSM as a theoretical framework as it allows to explore how individuals conceptualise illness within the socio-cultural context. METHODS: British and Polish women with breast or gynaecological cancer were recruited through outpatient clinics or online outlets and completed a questionnaire. Linear regression, mediation and moderated mediation methods were performed. RESULTS: One hundred sixty-four women participated (mean age 34.55 (SD = 6.66); 78.7% had gynaecological cancer). The determinants of fertility-related distress were: country of origin, recruitment site, negative affect, desire to have children, treatment regret, and total illness perception score. The impact of the desire to have children on fertility-related distress was mediated by psychological value of children, perceived consequences of cancer on one's life, emotional representation, and treatment-related regret. Country of origin moderated the relationship between the desire to have children and fertility-related distress when mediated by treatment-related regret. CONCLUSIONS: The CSM proved useful in investigating predictors of fertility-related distress, with emotional, rather than cognitive representation of illness determining its levels. Socio-cultural background played a role in determining one's fertility-related distress and contributed to the explanation of the relationship between one's desire to have children, treatment-related regret, and fertility-related distress.

The quality and readability of online consumer information about gynecologic cancer.

OBJECTIVE: The Internet has become an important source of health-related information for consumers, among whom younger women constitute a notable group. The aims of this study were (1) to evaluate the quality and readability of online information about gynecologic cancer using validated instruments and (2) to relate the quality of information to its readability. METHODS: Using the Alexa Rank, we obtained a list of 35 Web pages providing information about 7 gynecologic malignancies. These were assessed using the Health on the Net (HON) seal of approval, the Journal of the American Medical Association (JAMA) benchmarks, and the DISCERN instrument. Flesch readability score was calculated for sections related to symptoms and signs and treatment. RESULTS: Less than 30% of the Web pages displayed the HON seal or achieved all JAMA benchmarks. The majority of the treatment sections were of moderate to high quality according to the DISCERN. There was no significant relationship between the presence of the HON seal and readability. Web pages achieving all JAMA benchmarks were significantly more difficult to read and understand than Web pages that missed any of the JAMA benchmarks. Treatment-related content of moderate to high quality as assessed by the DISCERN had a significantly better readability score than the low-quality content. CONCLUSIONS: The online information about gynecologic cancer provided by the most frequently visited Web pages is of variable quality and in general difficult to read and understand. The relationship between the quality and readability remains unclear. Health care providers should direct their patients to reliable material online because patients consider the Internet as an important source of information.

"Will It Affect Our Chances of Having Children?" and Feeling "Like a Ticking Bomb" -The Fertility Concerns and Fears of Cancer Progression and Recurrence in Cancer Treatment Decision-Making Among Young Women Diagnosed With Gynaecological or Breast Cancer.

Objective: Cancer treatment decision making process is particularly fraught with challenges for young women because the treatment can affect their reproductive potential. Among many factors affecting the process, fears of cancer progression and recurrence can also be important psychological factors. Our aim is to apply Common-Sense Model and shared decision-making model to explore experiences of treatment decision-making women of reproductive age who were diagnosed with gynaecological or breast cancer and the influence of fertility issues and fears of cancer progression and recurrence. Method: We conducted telephone interviews with 24 women who were diagnosed with gynaecological or breast cancer aged 18-45, who finished active treatment within 5 years prior to study enrolment and had no known evidence of cancer recurrence at the time of participation. They were recruited from three NHS oncology clinics in Scotland and online outlets of cancer charities and support organisations. We analysed the data using Braun and Clarke's thematic analysis method as it allows for both inductive and deductive analyses. Results: We identified five main themes pertaining to treatment-related decision-making experiences and fertility issues and fear of progression and recurrence: Becoming aware of infertility as a potential consequence of cancer treatment; Balancing-prioritising cancer and fertility; Decisions about treatments; Evaluation of treatment decisions; and The consequences of treatments. Sub-themes have also been reported. Different factors such as whether the cancer is breast or gynaecological, physicians' willingness of discussing fertility, influence of others in decision-making, childbearing and relationship status as well as fear of cancer recurrence emerged as important. Conclusion: The importance of physicians directly addressing fertility preservation in the process of treatment decision-making and not treating it as an "add-on" was evident. Satisfaction with treatment decisions depended on both the quality of the process of decision making and its outcome. Fear of recurrence was present in different parts of the adaptation process from illness perceptions to post-treatment evaluation of decisions. Both Common-Sense Model and shared decision-making model were helpful in understanding and explaining young women's experience of treatment decision-making and fertility concerns.

Copolymerization of Phthalic Anhydride with Epoxides Catalyzed by Amine-Bis(Phenolate) Chromium(III) Complexes.

The effect of ligand structure on the catalytic activity of amine-bis(phenolate) chromium(III) complexes in the ring-opening copolymerization of phthalic anhydride and a series epoxides was studied. Eight complexes differing in the donor-pendant group (R1) and substituents (R2) in phenolate units were examined as catalysts of the model reaction between phthalic anhydride and cyclohexane oxide in toluene. They were used individually or as a part of the binary catalytic systems with nucleophilic co-catalysts. The co-catalyst was selected from the following organic bases: PPh3, DMAP, 1-butylimidazole, or DBU. The binary catalytic systems turned out to be more active than the complexes used individually, and DMAP proved to be the best choice as a co-catalyst. When the molar ratio of [PA]:[epoxide]:[Cr]:[DMAP] = 250:250:1:1 was applied, the most active complex (R1-X = CH2NMe2, R2 = F) allowed to copolymerize phthalic anhydride with differently substituted epoxides (cyclohexene oxide, 4-vinylcyclohexene oxide, styrene oxide, phenyl glycidyl ether, propylene oxide, butylene oxide, and epichlorohydrin) within 240 min at 110 °C. The resulting polyesters were characterized by Mn up to 20.6 kg mol-1 and narrow dispersity, and they did not contain polyether units.

Sister Mary Joseph nodule: an unusual site for endometrioid cancer metastasis.

Sister Mary Joseph (SMJ) nodules are rare malignant metastatic umbilical nodules, indicating disseminated disease and associated with a poor prognosis. This is the case of an 80-year-old woman who presented with umbilical discomfort and an ulcerated umbilical nodule. She was noted to have a bulky uterus and vaginal bleeding. CT abdomen-pelvis showed an enlarged uterus and right-sided lymphadenopathy, extending from the groin to the para-aortic area. Upper and lower endoscopies were normal. Biopsy of the umbilical nodule revealed metastatic endometrioid adenocarcinoma grade 1-2 with the endometrium and the ovary suggested as potential primary sites. The patient had cytoreductive surgery including en bloc resection of the umbilical tumour. Final histology confirmed Stage IVb endometrioid adenocarcinoma of the uterus. This unusual case highlights the diagnostic challenges faced with the presentation of an umbilical nodule. Gynaecological malignancy should always be considered within the initial differential diagnosis of an SMJ nodule.

Fertility and parenthood issues in young female cancer patients--a systematic review.

PURPOSE: For young women who were diagnosed with cancer prior to having children, reproductive potential might affect the quality of life (QoL). This systematic review looks at fertility issues in young female cancer patients, focusing on their influence on psychological well-being, specific fertility-related interventions and reproductive decisions. METHODS: Thirteen medical and social science databases were searched for relevant articles up to December 2012, according to PRISMA guidelines. Twenty-six articles meeting the eligibility criteria were included in the review, along with 5 additional papers that missed the inclusion criteria narrowly. Narrative synthesis was used to analyse the studies. RESULTS: Depression, anxiety and quality of life (QoL) seemed to be related to the perceptions of reproductive issues rather than to the fertility status based on the type of treatment received. Fertility-related interventions improved patients' QoL, decisional regret, and decisional conflict. Finally, cancer influenced women's reproductive decisions. Pursuing pregnancy was affected mainly by worries about child's and mother's health. Decisions about treatment were influenced by the wish to preserve fertility. The generalisability of these results might be undermined by small sample sizes and homogeneity of participants within and across the studies. Inferences about causality of associations are problematic due to predominantly cross-sectional design. IMPLICATIONS FOR CANCER SURVIVORS: The existing literature gives preliminary insight into the importance of fertility for young women diagnosed with cancer. However, more research is needed in order to offer patients comprehensive care.

Program running versus problem solving: two patterns of cardiac response.

Our previous research showed that mental tasks that involve program running (RUN tasks), e.g. performing arithmetic operations, cause greater tonic increase in cardiovascular activity than tasks that require a search for problem solutions (EDIT tasks), e.g. logical completion of a series of digits. However, it was not clear what physiological mechanism was responsible for this difference. The aim of the experiment was to compare cardiac response patterns while solving three mental tasks matched for their duration and level of difficulty: a simple RT task (control task) and two numerical tasks: RUN and EDIT. Forty-eight males, university students, divided randomly into three groups (n=16), participated in the experiment. Each group performed a different task. Task-evoked changes in heart rate (HR), strong volume (SV), cardiac output (CO), pre-ejection period (PEP), and power of HF component of heart rate variability were subject of the analysis. The results showed a higher tonic HR increase during the RUN task than the two other tasks and larger shortening of PEP during the RUN than the EDIT task. The HF power was larger during the RT task than the RUN task. No significant between-task difference was found in SV and CO changes. The results seem to support the hypothesis that higher cardiac responsiveness to RUN than EDIT tasks is mainly due to the difference in sympathetic activation.