Georgia Zachou

Objectives: To determine the patient characteristics associated with a diagnosis of ovarian cancer following an emergency hospital admission, and to compare cancer characteristics between those diagnosed after emergency admission and those diagnosed by other routes. Methods and analysis: We conducted a national population-based study of women diagnosed with ovarian cancer in England between 2017 and 2021. Cancer registration data were linked to hospital data. Poisson regression was used to estimate adjusted risk ratios (adjRRs) that represent associations of patient characteristics with a cancer diagnosis 28 days after emergency admission. Results: Among 28 204 included women, 11 377 (40.3%) were diagnosed after emergency admission. Being diagnosed after emergency admission was more common in younger (18–29 years: 42.7%, adjRR 1.36, 95% CI 1.22 to 1.52) and older women (≥80 years: 54.9%, adjRR 1.25, 1.20 to 1.31), compared with women aged 60–69 years (36.2%). Women from the most deprived quintile of neighbourhoods had higher risks of being diagnosed after emergency admission (44.2%) than those from the least deprived quintile (37.8%, adjRR 1.11, 1.06 to 1.16). Women with severe frailty had substantially increased risks of being diagnosed after emergency admission (68.6%) than those who were fit (29.2%, adjRR 1.88, 1.78 to 1.99). Of the 8438 women diagnosed after emergency admission, 1155 (13.7%) had early stage (stages 1 or 2) cancer, compared with 5442 (39.2%) of the 13 865 not diagnosed after emergency admission. Conclusions: Two in five women were diagnosed after emergency admission, with even higher frequencies seen in younger and older women, frailer women, and those from deprived neighbourhoods. Women diagnosed after emergency admission were three times less likely to have early stage cancer. These UK based results are likely to be relevant for many other countries that aim to reduce the number of women diagnosed with symptoms so severe that emergency admission is necessary.

PURPOSE: As global cancer rates rise, the demand for effective, high-quality delivery of systemic anticancer therapy (SACT) is crucial. However, quality improvement (QI) research in medical oncology remains limited. This systematic review aims to identify and characterize QI interventions addressing quality deficits in medical oncology practice, focusing on intervention types, methodologies, and outcomes. METHODS: A systematic search of EMBASE and MEDLINE was conducted from January 2000 to November 2024, following PRISMA guidelines (PROSPERO: CRD42024579992). Studies were included if they evaluated a QI intervention in medical oncology using a baseline measurement and aiming to address a predefined quality deficit in patient-related outcomes. Data on study design, intervention types, quality deficits, and outcomes were extracted, and study quality was assessed using the QI Minimum Quality Criteria Set (QI-MQCS). RESULTS: Of the 11,655 studies identified, 28 met the inclusion criteria. Five key themes emerged: waiting times for SACT delivery at infusion visits, delays in commencement of initial SACT, optimal utilization of SACT, side effects of SACT, and safety. Most studies were conducted in the United States (n = 17), at a single center (n = 27) with only one national-level study. Funding was reported in three studies (two industry-sponsored, one philanthropic). All studies demonstrated a positive impact on at least one patient-related outcome measure. QI-MQCS scores ranged from 11 to 16 of 16. CONCLUSION: Although cancer treatment continues to evolve, QI strategies in medical oncology remain underexplored. While all identified interventions were beneficial, generalizability is limited by single-center settings and methodological constraints. Expansion of QI research beyond the United States, adoption of stronger study designs, and increased investment in QI training and infrastructure are needed. Multilevel support and sustainable funding are essential to scale up evidence-based QI efforts and improve oncology care globally.

Sentinel lymph node biopsy (SLNB) has been widely adopted in the management of early-stage gynaecological cancers such as endometrial, vulvar and cervical cancer. Comprehensive surgical staging is crucial for patients with early-stage ovarian cancer and currently, that includes bilateral pelvic and para-aortic lymph node assessment. SLNB allows the identification, excision and pathological assessment of the first draining lymph nodes, thus negating the need for a full lymphadenectomy. We systematically searched the MEDLINE, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases (from inception to 3 November 2022) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Our search identified 153 articles from which 11 were eligible for inclusion. Patients with clinical stage I–II ovarian cancer undergoing sentinel lymph node biopsy were included. Statistical analysis was performed in RStudio using the meta package, where meta-analysis was performed for the detection. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies C (QUADAS-C) tool. Overall, 11 observational studies met the predetermined criteria and these included 194 women. The meta-analysis showed that the detection rate of sentinel lymph nodes in early-stage ovarian cancer was 94% (95% CI of 86% to 1.00%). Significant heterogeneity was noted among the studies with Q = 47.6, p < 0.0001, I² = 79% and τ² = 0.02. Sentinel lymph nodes in early-stage ovarian cancer have a high detection rate and can potentially have applicability in clinical practice. However, considering the small number of participants in the studies, the heterogeneity among them and the low quality of evidence, the results should be interpreted with caution. Larger trials are needed before a change in clinical practice is recommended.

Background This is an update of a previous Cochrane Review, last updated in 2014. Ovarian cancer is the eighth most common cancer and seventh most common cause of death due to cancer in women worldwide. Traditionally, most women who have been treated for cancer undergo long‐term follow‐up in secondary care. However, it has been suggested that the use of routine review may not be effective in improving survival, or health‐related quality of life (HRQOL), or relieving anxiety. In addition, traditional follow‐up may not be cost‐effective. Objectives To compare the potential effects of different strategies of follow‐up in women with epithelial ovarian cancer, following completion of primary treatment. Search methods For this update, we searched the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL 2022, Issue 11, MEDLINE, and Embase from August 2013 to November 2022. We also searched review articles and contacted experts in the field. Selection criteria All randomised controlled trials (RCTs) that evaluated follow‐up strategies for women with epithelial ovarian cancer following completion of primary treatment. Data collection and analysis We followed standard Cochrane methodology. Two review authors independently selected potentially relevant trials, extracted data, and assessed risk of bias. They compared results, and resolved disagreements by discussion. We assessed the certainty of evidence, using the GRADE approach, for the outcomes of interest: overall survival (OS), health‐related quality of life (HRQOL), psychological effects, and cost analysis. Main results For this update, we included one new RCT, including 112 women with ovarian, fallopian tube, or peritoneal cancer, who had completed primary treatment by surgery, with or without chemotherapy. This study reported the effect of individualised, i.e. individually tailored, nurse‐led follow‐up versus conventional medical follow‐up on HRQOL, psychological outcomes, and cost‐analysis. Individualised follow‐up improved HRQOL in one of the two scales, with a decrease in mean difference (MD) in the QLQ‐C30 discomfort scale following 12 months of individualised treatment compared to 12 months of conventional treatment (MD ‐5.76 points, 95% confidence interval (CI) ‐10.92 to ‐0.60; 1 study, 112 participants; low‐certainty evidence; minimal important difference 4 to 10 points). There may be little or no difference in the other HRQOL scale (QLQ‐Ov28, MD ‐0.97 points, 95% CI ‐2.57 to 0.63; 1 study, 112 participants: low‐certainty evidence); psychological outcome, measured with the hospital anxiety and depression scale (HADS; MD 0.10 point, 95% CI ‐0.81 to 1.02; 1 study, 112 participants: low‐certainty evidence), or cost analysis (MD ‐GBP 695.00, 95% CI ‐1467.23 to 77.23; 1 study, 112 participants: moderate‐certainty evidence). Our previous review included one RCT, with 529 women in a confirmed remission, with normal CA125 concentration and no radiological evidence of disease, after surgery and first‐line chemotherapy for ovarian cancer. This study evaluated immediate treatment of ovarian cancer relapse following a rise of serum CA125 levels versus delaying treatment until symptoms developed for OS, and HRQOL. There was little or no difference in OS between the immediate and delayed arms after a median follow‐up of 56.9 months (unadjusted hazard ratio (HR) 0.98, 95% CI 0.80 to 1.20; 1 study, 529 participants; moderate‐certainty evidence). Time from randomisation to first deterioration in global health score or death was shorter in the immediate treatment group than in the delayed treatment group (HR 0.71, 95% CI 0.58 to 0.88). Authors' conclusions Limited evidence from one trial suggests that routine surveillance with CA125 in asymptomatic women and treatment at CA125‐defined relapse does not seem to offer survival advantage when compared to treatment at symptomatic relapse. However, this study pre‐dates the use of PARPi maintenance treatment and the increased use of secondary cytoreductive surgery, so the results may be limited in their applicability to current practice. Limited evidence from one trial suggests that individualised nurse‐led follow‐up may improve HRQOL in women with ovarian cancer following completion of primary treatment. Large RCTs are needed to compare different types of follow‐up, looking at survival, HRQOL, psychological effects, and cost as outcomes.

Subcutaneous metastases at presentation in cervical cancer are rare and they are associated with ominous prognosis. In this literature review, we present a case of skin metastasis and systematically review the current literature with the aim to discuss trends, treatment and survival of the reported cases.

Salem A, et al. J Cardiovasc Imaging. 2019 Sep;28:e2. https://doi.org/10.4250/jcvi.2019.0077