Acceptability and Feasibility of Early Palliative Care Among Women with Advanced Epithelial Ovarian Cancer: A Randomized Controlled Pilot Study.

OBJECTIVE: To evaluate the acceptability of early palliative care (EPC) among patients with advanced ovarian cancer and to determine the feasibility of larger-scale phase III trials. METHODS: We performed a randomized controlled pilot study of adult women (>18 years) with pathologically confirmed epithelial ovarian cancer that had recurred or progressed on first-line therapy and had no immediate need for palliative care. We randomly assigned patients to either EPC or standard oncologic care (SOC), and collected patient-reported outcomes (PRO) at baseline, 3 months, and 6 months; end-of-life care quality indicators were collected at study completion. Study endpoints were rates of enrollment, EPC adherence, and PRO completion. RESULTS: Of 32 eligible patients approached, 23 enrolled (72%; 95% CI 53-86) and were randomly assigned to either EPC (n = 12) or SOC (n = 11). At baseline, participants had poor physical and emotional wellbeing, high rates of depression (65%), and understood that their disease was not curable (87%). Eleven patients (92%; 95% CI 62-100) attended their EPC consultation, and all visits took place within 4 weeks of enrollment. However, PRO completion was low due to deaths by 3 (5/23) and 6 months (9/23). CONCLUSION: Patients had accurate perceptions of their disease status, were willing to be randomly assigned to EPC, and attended scheduled appointments. However, a definitive trial in this group is not feasible without major adjustments to eligibility criteria and a multicentre, international effort. We propose that EPC be considered routinely at progression or recurrence given patients' symptom burden and clear acceptance of the intervention, as well as evidence of benefit from adequately powered trials in other malignancies.

Calcified Sister Mary Joseph nodule as the presenting complaint of advanced low-grade serous ovarian cancer.

A healthy 38-year-old woman presented with a hard umbilical mass that has been growing for a few months in duration with no other significant symptoms and signs. Computed tomography images identified a lobulated densely calcified umbilical mass, left ovarian cysts, a subcentimeter calcified omental nodule, and nonspecific punctate pelvic calcifications. Histopathology of the mass revealed low-grade serous carcinoma with postsurgical diagnosis of International Federation of Gynecology and Obstetrics (FIGO) stage IV ovarian cancer. This case presentation emphasizes the importance of increased awareness of interpreting radiologists of a seemingly benign appearing imaging finding such as umbilical calcification on CT as a sign of intra-abdominal/pelvic malignancies.