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Query: UMLS:C1140680 (ovarian cancer)
 28,141 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

While there has not been a dramatic improvement in the cure rate of ovarian cancer, >40% of women survive longer than 5 years, with what is commonly considered a "chronic" cancer. In each phase of the illness (diagnosis, surgery and chemotherapy with curative intent, remission and survivorship, relapse and sequential chemotherapy, bowel obstruction and end of life), quality of life (QOL) is one of the most important considerations. There has recently been a large increase in studies reporting the assessment of QOL; that has changed the field from descriptive reporting to quantitative science. There are well-validated, standardized scales, and approximately 10% of randomized cancer trials include health-related QOL as one of the main end points. This article reviews the history and development of QOL evaluation and the 2 main approaches to QOL assessment (psychometric based and utility based) and describes strategies for meaningful interpretation of QOL profiles. While the humanities perhaps teach us much about the value of QOL, the science of the study of QOL will be the foundation and confirmation of many of the anticipated advances for patients.
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PMID:Quality of life in ovarian cancer. 1605 May 65

Bowel obstruction is the most common complication in patients with ovarian cancer. Management of this situation is controversial. The aim of our retrospective study was to determine the best approach for managing bowel obstruction in recurrent ovarian cancer. A retrospective analysis of data on 47 patients with intestinal obstruction by ovarian cancer was performed. Twenty-seven patients were submitted to surgery, with 21 intestinal procedures performed, 2 gastrostomy tubes placed, and 4 patients deemed inoperable. Twenty patients were managed medically with Octreotide (mean dosage of 0.48 mg/day), of which 1 patient required a nasogastric tube. Age, performance status, diagnosis of tumor to occlusion time, obstruction site, previous chemotherapy or radiotherapy, presence of ascites, or palpable masses were the variables analyzed. Student's t-test and Pearson chi-square test were used to compare the two different groups of treatment (surgical vs medical therapy). Disease-free-survival curves were plotted according to the Kaplan-Meier method and analyzed by the log-rank test. Cox's proportional hazards model was used for multivariate analysis. Values less than or equal to 0.05 were considered significant. The mean age of the patients was 58.7 years. Perioperative mortality and morbidity were both 22%. All patients died with minimal distress. Performance status results were significantly different between the patients submitted to surgery and patients treated with Octreotide (P= 0.03). No significant differences were found in the other variables analyzed. In multivariate analysis, only type of treatment emerges as a strong predictor of poor outcome (P < 0.001). Both surgery and Octreotide therapy are able to control distressing symptoms in end-stage ovarian cancer. Survival was significantly longer in the surgical group, and surgical palliation should be considered first in patients with good performance status.
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PMID:Palliative care for intestinal obstruction in recurrent ovarian cancer: a multivariate analysis. 1617 32

Symptoms of malignant bowel obstruction in patients with recurrent ovarian cancer lead to a poor quality of life. Sandostatin LAR Depot (LAR) is an intramuscular, monthly administered, long-acting form of octreotide. LAR's safety and utility were evaluated in a pilot study enrolling 15 advanced ovarian cancer patients with bowel dysfunction. Once safety with subcutaneous (SQ) octreotide was assessed, patients were given 30 mg LAR on Day 1 and octreotide SQ for 2 weeks. Of 13 evaluable patients, three patients had a major response to LAR treatment with reduction in bowel obstruction symptoms, two had a minor response, four had no response, and four had progressive symptoms. Three patients remained on LAR for more than 9 months. No significant toxicities were attributable to octreotide or LAR. Because three patients received nine or more monthly injections of LAR, possible direct antitumor effects of LAR or synergy with chemotherapy needs to be explored.
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PMID:Long-acting octreotide for the treatment and symptomatic relief of bowel obstruction in advanced ovarian cancer. 1637 43

The objective of this study was to compare the treatment outcomes of surgical versus chemotherapeutic interventions for the management of intestinal obstruction secondary to metastatic epithelial ovarian cancer. A retrospective analysis of 39 patients with epithelial ovarian cancer who had 98 events of intestinal obstruction was performed. A medical records review of patients treated for advanced ovarian cancer from 1973 to 2003 was conducted. Time from treatment to obstruction, complications, and predictors of outcome were analyzed. Mean time from diagnosis of cancer to first obstruction was 38 months (range, 7-234 months). Of 39 patients with obstruction, 5% were stage I, 2% stage II, 85% stage III, and 8% stage IV. Prior to first obstruction, the median number of prior surgeries was 2 and chemotherapy regimens 3. Sites of the 98 events of obstruction were small intestine, 79 (81%); large intestine, 8 (8%); and combined small and large intestines, 11 (11%). The mean time to re-obstruction was 6.4 months (0-24) for chemotherapy, 5.1 months (0-40) for surgery, and 1.9 months (0-15) for supportive care. The mean hospital stays were 7 days (2-10) for chemotherapy, 18 days (3-50) for surgery, and 7 days (0-20) for supportive care. There were 4 major complications in the chemotherapy patients, 11 in the surgical patients, and 2 in the supportive only patients. The only significant factor predictive of > or =6 month obstruction-free period was prior response to platinum-based chemotherapy. Of the 13 patients with a response to chemotherapeutic or surgical treatment, 46% had an initial response to platinum-based chemotherapy, while 27% of 22 patients who re-obstructed in <6 months were platinum sensitive. In this retrospective analysis of selected patients, surgery and chemotherapy were found to have similar outcomes. The surgical approach had higher morbidity. The best predictor of either treatment's effectiveness is tumor sensitivity to platinum-based chemotherapeutic agents (P= 0.168).
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PMID:An analysis of surgical versus chemotherapeutic intervention for the management of intestinal obstruction in advanced ovarian cancer. 1644 22

Surgery for ovarian cancer carries a risk of bowel resection to either achieve optimal debulking or relieve obstruction. This prospective study assessed the likelihood of bowel resection in 842 women undergoing surgery for ovarian cancer and identified factors associated with increased risk. Bowel resection was performed in 8.6% of women. The likelihood of bowel resection increased significantly (p < 0.0001, chi2 test) with: Secondary surgery (22% vs 5.8% at primary surgery). Symptoms of bowel disturbance (21.9% vs 6.3% if no symptoms). FIGO stage III/IV disease (12.8% vs 2% in stage I/II). CA125 levels >or=2500 (12.9% vs 4.8% if CA125<2500). These women should be selectively offered pre-operative computerised tomography, stoma marking and counselling by stoma nurses. The 5-year survival was 14% in patients following bowel resection compared with 44% in patients not having bowel resection. Bowel resection should be performed only if it will result in optimal debulking or it relieves imminent bowel obstruction.
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PMID:Can we identify the patients who are likely to undergo bowel resection at the time of surgery for ovarian cancer? 1675 91

A patient with a stutter caused by the trauma of the death of a loved one was able to recover normal speech 1 week before her death, which resulted from intestinal obstruction caused by ovarian cancer. The stutter appeared to have been overcome using a combination therapy of sophrology, self-regulation, and drug therapy. During a genuine resilience process, the patient was able to overcome an earlier existential fracture. In this final phase of life, health professionals and the family fully respected the patient's independence to remain in control of events. She repeatedly refused to have a nasogastric tube inserted to extract fecal matter from the stomach. This patient consequently repossessed her own language of expression in a body that was shattered by cancerous illness and the consequences of treatments. She thus managed to find a successful balance between the body, the spirit, and the brain.
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PMID:Disappearance of a stutter shortly before death. 1750 40

Women dying of ovarian cancer vary considerably in their complications and in the types of health care they receive. The objective of this study was to describe the complications of ovarian cancer, other than pain, and their treatment at the end of life. This study used a cohort of 421 enrollees in three nonprofit managed-care organizations who died with ovarian cancer during 1995-2000. Data were collected from abstraction of paper and electronic medical records. Proportions of women experiencing complications and undergoing treatments were calculated. Logistic regression was used to evaluate the association of patient characteristics with the probability of receiving an intervention for complications. The most common complications recorded in the medical record were fatigue or weakness (75%), nausea or vomiting (71%), constipation (49%), edema of the extremities (44%), and anemia (34%). The prevalence of major complications was as follows: ascites, 28%; bowel obstruction, 12%; pleural effusion, 10%; bladder obstruction, 3%; and disordered nutrition that required support with parenteral nutrition, 9%. Patients may not always have received interventions for major complications; for example, pleural effusion apparently was left untreated in almost half of the women with this problem. After adjustment, women who died at younger ages were more likely to receive an intervention, compared to older women (odds ratio for each decade of age, 0.71, 95% confidence interval=0.53, 0.94, P for trend=0.02). The study, which preceded the establishment of palliative care programs, suggests that care given to ovarian cancer patients at the end of life may be inadequate.
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PMID:Complications at the end of life in ovarian cancer. 1760 60

Bowel obstruction is a common complication in patients with far advanced abdominal or pelvic cancer. In patients with recurrent or advanced disease, where options for curative treatment have been exhausted, palliation of symptoms with minimal additional morbidity is the aim of therapy. Owing to the difficulties inherent in conducting perspective randomized trials, clinicians face a significant challenge in managing terminally ill obstructed patients. We evaluated the case of a woman with ovarian cancer. Clinically, the objective of the study was to focus attention on the most up-to-date evidence concerning the treatment of malignant bowel obstruction.
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PMID:Symptom management in a patient with end-stage ovarian cancer: case report. 1771 6

Displacement of an intrauterine device (IUD) through the perforation site is a rare but one of the major complications. Theoretically, an extrauterine IUD can be located anywhere in the abdominopelvic cavity. It may be asymptomatic or may cause serious complications, including infection, fistula, organ perforation, or bowel obstruction. However, there is no report of IUD located within an ovarian carcinoma to our knowledge, and our report is the first case of an IUD found in the center of an ovarian cancer.
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PMID:Intrauterine device found in an ovarian carcinoma. 1830 91

The purpose of this study is to describe patient-related variables in a cohort of advanced cancer patients (ACPs) enrolled in a home parenteral nutrition (HPN) program. This study reviewed the cohort of ACPs enrolled in the Northern Alberta Home Total Parenteral Nutrition Program (NAHTPNP). Thirty-eight ACPs received HPN during the study period, 24% of all patients admitted for PN. Of these, 27 (71%) were female. Mean age was 48.76 y (SD 13.8 y). Bowel obstruction was the most common indication for initiating HPN (84%, 32) and ovarian cancer was the most common malignancy (34%, 13). Patients who began HPN with a Karnofsky performance status (KPS) of greater than 50 (median of 70) were found to have a longer duration of life (median: 6 months) compared with patients who began HPN with a KPS of 50 or below (median=50; median 3 months; p=0.01; two-tailed). There was no difference in survival between malignancy type (p=NS). Advanced cancer is the fastest growing indication for enrollment in the HPN program. ACP demonstrated a 3% average annual increase proportionate to all indications for HPN starts, accounting for 7%-48% of HPN starts from 1999-2006. HPN is an increasingly used therapy for patients with advanced cancer, most commonly for intestinal failure in the setting of bowel obstruction. Initiation of HPN at a higher KPS was associated with a longer duration of life. Further studies are needed to validate the use of TPN in end-stage cancer patients.
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PMID:Use of parenteral nutrition in patients with advanced cancer. 1834 59


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