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ObjectiveRace remains a significant predictor of poor outcomes in women with gynecologic cancer and minority patients consistently report worse quality of life during cancer treatment. Disparities between patients in strength of social and emotional supports may contribute to these outcomes. This study’s objective was to describe the racial differences in patient reported outcomes of women being evaluated or treated for a gynecologic malignancy at a large tertiary cancer hospital.MethodsIn this prospective cohort study, all patients presenting for care at a tertiary care gynecologic oncology clinic between January 2018 and September 2019 were evaluated for inclusion. All patients were administered validated patient reported outcome measure questionnaires at serial visits. Demographic data was gathered including self-reported race. Patients were characterized as White, Black, Asian, Hispanic/Latino, or Other. Patient reported outcomes were compared between respondents of different races using linear and logistic regression.ResultsBetween January 2018 to September 2019, 2022 patients with a known race completed questionnaires. Of these patients, 86.7% were White, 4.3% Black, and 4.9% Hispanic/Latino and 58.7% had a known cancer diagnosis. Non-White patients were significantly less likely to complete questionnaires (pConclusionsSignificant differences exist in patient reported outcomes between women of different racial backgrounds. Hispanic/Latino and Black women have less support during gynecologic cancer evaluation and treatment as compared with White women.

Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extreme suffering in this vulnerable population, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an essential package of palliative care for cervical cancer (EPPCCC). The EPPCCC consists of a set of interventions, medicines, simple equipment, social supports, and human resources, and is designed to be safe and effective for preventing and relieving all types of suffering associated with cervical cancer. It includes only inexpensive and readily available medicines and equipment, and its use requires only basic training. Thus, the EPPCCC can and should be made accessible everywhere, including for the rural poor. We provide guidance for integrating the EPPCCC into gynecologic and oncologic care at all levels of health care systems, and into primary care, in countries of all income levels.

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an augmented package of palliative care for cervical cancer with which even suffering refractory to the EPPCCC often can be relieved. The package consists of medicines, radiotherapy, surgical procedures, and psycho-oncologic therapies that require advanced or specialized training. Each item in this package should be made accessible whenever the necessary resources and expertise are available.

PURPOSE To enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration. METHODS We first reviewed the literature on the major types, severity, prevalence, and duration of suffering associated with cervical cancer. We then conducted a modified Delphi process with experts in cervical cancer care to supplement the literature. For each type of suffering, we distinguished between decedents (those who die from cervical cancer in a given year) and nondecedents (those who have cervical cancer in a given year but do not die). By applying the suffering prevalence and duration estimates to the number of decedents, nondecedents, and family caregivers in 2017, we were able to estimate their palliative care needs and the intensity of palliative care needed to respond adequately to this suffering. RESULTS There is a high prevalence among decedents of moderate or severe pain (84%), vaginal discharge (66%), vaginal bleeding (61%), and loss of faith (31%). Among both decedents and nondecedents, there is a high prevalence of clinically significant anxiety (63% and 50%, respectively), depressed mood (52% and 38%, respectively), and sexual dysfunction (87% and 83%, respectively). Moderate or severe financial distress is prevalent among decedents, nondecedents, and family caregivers (84%, 74%, and 66%, respectively). More than 40% of decedents and nondecedents are abandoned by their intimate partners. Most patients experience some combination of moderate or severe physical, psychological, social, and spiritual suffering. In total, 258,649 decedents and 2,558,857 nondecedents needed palliative care in 2017, approximately 85% of whom were in low- and middle-income countries where palliative care is rarely accessible. CONCLUSION Among women with advanced cervical cancer, suffering is highly prevalent and often severe and multifaceted.

To evaluate utilization of sentinel lymph node biopsy (SLNB) for early-stage vulvar cancer at minority-serving hospitals and low-volume facilities.Between 2012-2018, individuals with T1b vulvar squamous cell carcinoma were identified using the National Cancer Database. Patient, facility, and disease characteristics were compared between patients undergoing SLNB or inguinofemoral lymph node dissection (IFLD). Multivariable logistic regression, adjusted for patient, facility, and disease characteristics, was used to evaluate factors associated with SLNB. Kaplan-Meier survival analysis using log rank test and Cox regression was performed.Of the 3,532 patients, 2,406 (68.1%) underwent lymph node evaluation, with 1,704 (48.2%) undergoing IFLD and 702 (19.8%) SLNB. In a multivariable analysis, treatment at minority-serving hospitals (OR 0.39, 95% CI 0.19-0.78) and low-volume hospitals (OR 0.44, 95% CI 0.28-0.70) were associated with significantly lower odds of undergoing SLNB compared to receiving care at non-minority-serving and high-volume hospitals, respectively. While SLNB utilization increased over time for the entire cohort and stratified subgroups, use of the procedure did not increase at minority-serving hospitals. After controlling for patient and tumor characteristics, SLNB was not associated with worse OS compared to IFLD in patients with positive (HR 1.02, 95% CI 0.63-1.66) or negative (HR 0.92, 95% CI 0.70-1.21) nodal pathology.For patients with early-stage vulvar cancer, treatment at minority-serving or low-volume hospitals was associated with significantly decreased odds of undergoing SLNB. Future efforts should be concentrated toward ensuring that all patients have access to advanced surgical techniques regardless of where they receive their care.

Objective: Disrespectful and abusive (D&A) maternity care is a deterrent to facility childbirth and can thus contribute to child and maternal mortality. This study will review existing literature on D&A in Tanzania to better understand and contextualize the issue. Methods: A comprehensive literature search was conducted to find relevant publications on D&A during childbirth in Tanzania. The search was conducted on the National Center for Biotechnology Information (NCBI) and PubMed (U.S. National Library of Medicine at the National Institutes of Health). The inclusion criteria were as follows: qualitative, quantitative, and ethnographic studies conducted in Tanzania on obstetrical violence; published in English; focused on prevalence, incidence, root causes, historical trends, interventions, and policy recommendations for obstetrical violence in Tanzania. Results: Twenty-one studies were selected for this literature review. Up to 73.1% of women reported experiencing at least one form of D&A during labor. Commonly reported D&A events include non-dignified care, non-confidential care, and physical abuse. Other forms of D&A, including detention in facilities and asking for unofficial payments, are also reported. Ninety-six percent of nurses, midwives, and nursing assistants in Tanzania self-reported engaging in at least one form of D&A. Lack of training and provider support, long work hours, fear of blame, and limited infrastructure were reported as factors leading to D&A by providers. Conclusions: In Tanzania, D&A during childbirth is prevalent in healthcare systems. The direct relationship between D&A and poor maternal and fetal health is well-documented. Individual and systemic factors influence both provider and patient perspectives of D&A, providing a window into a complex and sensitive phenomenon. It is important that D&A in Tanzania be viewed holistically, and that interventions target the multifaceted nature of the issue.

Objective Our goal was to pragmatically describe patient reported outcomes (PROs) in a typical clinic population of vulvar cancer patients, as prior studies of vulvar cancer PROs have examined clinical trial participants. Methods A prospective PRO program was implemented in the Gynecologic Oncology clinic of a tertiary academic institution in January 2018. Vulvar cancer patients through September 2019 were administered the European Organization for the Research and Treatment of Cancer Quality of life Questionnaire, the Patient Reported Outcome Measurement Information System Instrumental and Emotional Support Scales, and the Functional Assessment of Cancer Therapy-Vulvar questionnaire. Binary logistic regressions were performed to determine adjusted odds ratios for adverse responses to individual questions by insurance, stage, age, time since diagnosis, recurrence, radiation, and surgical radicality. Results Seventy vulvar cancer patients responded to PROs (85.4% response rate). Seventy-one percent were > 1 year since diagnosis, 61.4% had stage I disease, and 28.6% recurred. Publicly insured women had less support and worse quality of life (QOL, aOR 4.15, 95% CI 1.00–17.32, p = 0.05). Women who recurred noted more interference with social activities (aOR 4.45, 95% CI 1.28–15.41, p = 0.019) and poorer QOL (aOR 5.22 95% CI 1.51–18.10, p = 0.009). There were no major differences by surgical radicality. Those >1 year since diagnosis experienced less worry (aOR 0.17, 95% CI 0.04–0.63, p = 0.008). Conclusions Surgical radicality does not affect symptoms or QOL in vulvar cancer patients, whereas insurance, recurrence, and time since diagnosis do. This data can improve counseling and awareness of patient characteristics that would benefit from social services referral.

The unintended consequences of appropriate public health interventions during an infectious disease outbreak such as isolation and quarantine of exposed individual include depression, anxiety, exacerbation of pre-existing mental illness, cardiovascular illness, and dementia. Populations that may be especially at risk for mental health consequences of isolation include children and adolescents, the elderly, people with cognitive disorders such as dementia, and those with preexisting psychiatric illness. Awareness of these dangers of necessary public health responses and allocation of resources for interventions when populations are under a lockdown should be a mandatory part of emergency planning.

OBJECTIVE 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) increases the sensitivity for preoperative detection of lymph nodes and distant metastases in endometrial cancer. The objective of this investigation was to determine the prognostic value of preoperative PET-CT compared with computed tomography (CT) alone for high-risk endometrial carcinoma. MATERIALS AND METHODS We performed a retrospective review of high-risk histology endometrial cancer from 2008 to 2015. Clinical variables including surgical procedure, preoperative imaging modality, and outcome were collected. Survival analysis was performed utilizing the Kaplan-Meier and Cox proportional hazards methodologies. RESULTS Of the 555 women treated for high-risk histology endometrial cancer, 88 (16%) had preoperative PET-CT, and 97 (17%) CT without PET available. PET-CT demonstrated positive findings in 37 women (42%) compared with 33 (30%) with preoperative CT alone. PET-CT had a positive predictive value of 96% for nodal metastasis compared with 60% for CT alone. The median follow-up time for the entire cohort was 59 months (range, 12 to 96 mo). Patients with a negative preoperative PET-CT (n=54) had a median progression-free survival (PFS) that was not reached, whereas the median PFS in the PET-CT positive group was 13 months (n=34). Women with a negative PET-CT had a longer median overall survival (OS) not yet reached compared with 34 months in the PET-CT positive cohort (hazard ratio, 2.4; P

ObjectiveThe National Comprehensive Cancer Network recommends that all women diagnosed with epithelial ovarian cancer undergo genetic testing, as the diagnosis of pathogenic variants may inform cancer survival and impact treatment options. The objective of this study was to assess factors associated with referral to genetic counseling in women with epithelial ovarian cancer.MethodsA retrospective cohort study identified women with epithelial ovarian cancer from 2012 to 2017 at Massachusetts General Hospital and North Shore Medical Center, a community hospital affiliated with Massachusetts General Hospital. Multivariate logistic regression evaluated how race, age, stage, year of diagnosis, insurance status, family history of breast or ovarian cancer, and language relates to the receipt of genetic counseling.ResultsOf the total 276 women included, 73.9% were referred for genetic screening, of which 90.7% attended a genetic counseling visit. Older women were less likely to undergo genetic counseling (age ≥70 years: OR 0.26, 95% CI 0.07–0.94, p=0.04). Women who died within 365 days of initial oncology consult rarely reached a genetic counselor (OR 0.05, 95% CI 0.01–0.24, pConclusionOlder women with epithelial ovarian cancer and those who died within 1 year of initiation of care were less likely to undergo recommended genetic counseling. Race, insurance status, and language were not identified as predictive factors, although we were limited in this assessment by small sample size.

Background: Large numbers of Forcibly Displaced Myanmar Nationals (FDMN), also called the Rohingya community, in Bangladesh face chronic life-threatening illnesses. Symptoms concerning for a cancer diagnosis are not easily evaluated and treated by healthcare systems available to this population. We conducted a rapid needs assessment of cancer screening and pain and palliative care with the goal of identifying the prevalence of cancer risk factors among the Rohingya who attended local health facilities. Methods: A cross-sectional study was conducted in the Kutupalong camp of Ukhiya, Cox’s Bazar among the Rohingya community. Data were collected through purposive sampling. Face-to-face interviews were done using a structured questionnaire. Statistics were analyzed by using IBM SPSS 23. Results: Out of 85 participants, 75 were female and 10 were male. 70 (82.4%) were uneducated (defined as lacking any formal institutional education), 10 (11.8%) people completed the primary level education and only 5 (5.9%) people received secondary level education. There were many participants with pulmonary disease with 35 (41.2%) people endorsing a history of asthma, bronchitis, and/or tuberculosis. There was a lack of female menstrual sanitation and hygiene with only 25 (29.4%) patients using sanitary napkins, that were donated by Non Government Organizations. Only 5.9% of the women had received any form of cervical cancer screening. Conclusion: This study identifies risk factors associated with cancers and life-limiting diseases among the FDMN Rohingya refugees in Bangladesh. It is necessary to develop targeted education, cancer screening and cancer awareness programs for this population.

Obstetric violence or disrespect and abuse in childbirth is a worldwide phenomenon that takes on various forms, from absence of informed consent to physical harm. The objective of this review is to assess prevalence and root causes of obstetric violence in different countries, and potential solutions to address disrespect and abuse in childbirth. The review finds that obstetric violence is rooted in a patriarchal understanding of gender stereotypes and is exacerbated by power dynamics between health professionals and patients, especially for minorities. Obstetric violence has a long-lasting impact on women’s lives and can jeopardize subsequent decisions to access healthcare services.

The 2015 outbreak of Zika virus in Brazil led to a significant increase of neonatal microcephaly. While Zika virus was identified in Africa in the 1940s and was noted to be present in Asia, it was not until 2007 that there was a significant shift in the behavior of the virus. Reasons for this change in Zika virus behavior and pathogenesis could be due to a change in the virulence of the virus, and a new ability to infect the human host. Additionally, the changing habitat of mosquitoes along with increasing urbanization and changes of human habitats has increased the risk of Zika virus exposure. This review summarizes the response to the Zika pandemic and recommendations for interventions through the lens of the Sendai Framework for disaster risk reduction. Emergency preparedness focuses on lessening the likelihood and the impact of disasters. Preparedness encompasses the actions of mitigation, prevention, response, and recovery.

Introduction: Morbidity and Mortality (M&M) rounds can identify adverse events and improve patient safety however adoption in cancer centers is not routine. Herein we report the results of a chemotherapy-specific gynecologic oncology M&M rounds and identify reasons for hospital admission Methods: Between July 2014 and April 2016, all admissions Results: 585 patients were admitted, 78% of whom had ovarian cancer and 43% of whom had recurrent disease. Overall, 47% of admissions were unplanned and these were significantly longer than planned admissions (5.6 vs. 2.4 days, p = 0.0003). Of unplanned admissions, 43% were due to chemotherapy, and 57% were due to disease burden. 74% of patients had received >1 prior line of chemotherapy, and 22% were on clinical trial. The most common causes of unplanned admission were nausea, vomiting or failure to thrive (28.9%), fever (17.9%) and small bowel obstruction (19.9%). Conclusions: There is a high rate of unplanned admission

Background: Ovarian cancer accounts for 4% of cancers occurring in women and ranks first in gynecological cancer mortality. Maintaining and improving quality of life is an important goal of cancer treatment. The toxicities of cancer treatment particularly chemotherapy can impact an individual’s wellbeing. Objective: Assessment of quality of life among ovarian cancer patients receiving chemotherapy. Method: A descriptive study was conducted among 202 patients with ovarian cancer treated at the National Institute of Cancer Research and Hospital in Bangladesh. Ethical approval was received from the ethics committee of NICRH. Data was collected using the EORTC QLQC30 questionnaire and the ovarian cancer specific EORTC QOL OV-28 module. Functional, symptomatic and global variables were scored and analyzed by SPSS. Multiple linear regressions determined the effects of predictor variables and correlation of the global health status with other variables. Results: 48.6% of patients were ages 41 to 50 years. The mean score of global health status was 55.77. Deteriorating emotional function, distressing physical and psychological symptoms, sexual dysfunction and financial difficulties adversely affect the quality of life. Their correlation with global health status was strongly significant (P value < 0.05). Fatigue (r value -0.604; p < 0.05) loss of appetite (r value -0.442; p < 0.05), insomnia (r value -0.339; p < 0.05), dyspnea (r value -0.377; p < 0.05), heartburn (r value -0.369; p < 0.05), and alopecia (r value -0.262; p < 0.05) were negatively associated with QOL. Conclusion: The overall quality of life among the ovarian cancer patients receiving chemotherapy is low. Increasing knowledge in this area will help clinicians to optimize patient management. Interventions should focus on both physical and psychological and sexual health issues that adversely affect the quality of life.

ObjectiveChemotherapy has multiple adverse effects, including chemotherapy-related cognitive impairment, the phenomenon colloquially referred to as ‘chemobrain’. The objective of this study was to understand patient-reported experiences of this phenomenon in relation to chemotherapy administration among gynecologic oncology patients.MethodsA prospective patient-reported outcomes program was implemented in the Gynecologic Oncology clinic of a tertiary academic institution in January 2018. Patients with endometrial or ovarian cancer who received chemotherapy were included through September 2019 in this cohort study. Patients completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire. Serial responses were compared before, during, and after chemotherapy using a mixed effects linear regression with random effects for repeated measures within patients and a fixed effect for endometrial versus ovarian cancer.ResultsFifty patients were included who completed a total of 152 patient-reported outcome measures. Thirty-five questionnaires were administered before chemotherapy, 59 during treatment, and 58 at a median of 161 days after the final cycle of chemotherapy. Seventy-one percent of patients reported no difficulties with concentration before chemotherapy, which remained stable after chemotherapy (72%). Sixty-six percent reported no difficulty with memory before chemotherapy versus 52% after chemotherapy. There were significant differences in feeling tension (pConclusionsWhile no overt memory issues were discovered with serial administration of patient-reported outcome measures, rates of adverse emotional symptoms such as depression, tension, and worry diminished after chemotherapy administration. Further study is needed about the phenomenon of chemotherapy-related cognitive impairment using a larger cohort.

BackgroundIntimate partner violence (IPV) is well recognized as a human rights violation and a serious global health issue that has affected about a third of worldwide women at any given time. It is defined as physical, sexual, or psychological harm caused by a spouse or an intimate partner. Its short and long-term detrimental effects on women’s physical, mental, sexual, and reproductive health are well-documented. However, its effect on nutritional status is not well-studied, and previous studies have led to contradictory findings. This study aimed to explore the association between intimate partner violence and undernutrition among married Nepalese women of reproductive age.MethodThe 2016 Nepal Demographic Health Survey data was used in this study. This study used a modified version of the Conflict Tactics Scale to determine women’s exposure to IPV, and anemia and low body mass index as the proxies of undernutrition. Prevalence of IPV, anemia, and underweight were calculated across sociodemographic characteristics, and multivariate logistic regression was used to analyze the association between IPV and undernutrition.ResultsAmong 3476 women included in this study, the prevalence of physical, sexual, and emotional IPVs were 21.75%, 7.42%, and 12.31% respectively. 13.78% of women were underweight and 38.95% were anemic. The adjusted odds ratio of physical, sexual, and emotional IPV survivors of being underweight were 1.06 (95% CI: 0.95–1.17), 0.96 (95% CI: 0.73–1.25), and 1.14 (95% CI: 0.89–1.43) respectively. The adjusted odds ratio of being anemic for physical, sexual, and emotional IPV survivors was 1.01 (95% CI: 0.93–1.09), 1.24 (95% CI: 1.02–1.52), and 0.92 (95% CI: 0.76–1.11) respectively.ConclusionNone of the three IPV types was significantly associated with being underweight. Among the three IPV types, only sexual IPV (SIPV) was significantly associated with anemia, meaning the increase in SIPV score by 1, which is experiencing an additional form of SIPV, increased SIPV survivors' odds of being anemic by 24%. Therefore, IPV screening should be a part of regular healthcare assessment for undernourished married women, especially for those who are anemic, and appropriate support should be offered to IPV survivors.

Purpose Over the past several decades, research has suggested reactive oxygen species act as cofactors for cervical cancer development. The aim of this study is to evaluate the antioxidant and lipid peroxidation status in cervical cancer patients in Bangladesh. Methods From December 2017 to 2018, a cross-sectional observational study was conducted on 50 cervical cancer patients and 50 controls. Plasma levels of lipid peroxidation and total antioxidant capacity were measured. The Student’s t test was used for statistical analysis. P values less than 0.05 were taken as a level of significance. Results There was a significant reduction in total antioxidant levels in patients with cervical cancer, 972.77 ± 244.22 SD µmol equivalent to ascorbic acid/L, compared to normal controls, 1720.13 ± 150.81 SD µmol equivalent to ascorbic acid/L (P P P Conclusion There was an increased oxidative stress index due to imbalance between lipid peroxidation generation and total antioxidant capacity in cervical cancer patients. Further studies are needed to explore the role of oxidative stress as a cofactor for cervical carcinogenesis.

The current Rohingya refugee situation in Bangladesh has become one of the most protracted in the world. A significant number of Rohingya women fleeing Myanmar experienced sexual violence. Gender-Based Violence is a significant problem facing displaced vulnerable refugee populations especially women and children. Rohingya women continue to be vulnerable to Gender- Based Violence within the Bangladesh refugee camps. There has been an enormous humanitarian response by the Bangladesh government, local Bangladeshi groups, and the international sector. This commentary summarizes what is known of the Rohingya experience and the humanitarian response.

Background: Post caesarean section (CS) wound infection or surgical site infection is a leading cause of prolonged hospital stay or readmission. An understanding of its risk factors is important. Methods: A case control study was conducted in the Department of Obstetrics and Gynecology of Sir Salimullah Medical College & Mitford Hospital, in Dhaka, Bangladesh from January to June 2014 to evaluate the risk factors of postoperative surgical site infection following CS. One hundred patients were studied. Results: Fifty patients of post CS wound infection (surgical site infection: SSI) were selected as cases. Body mass index > 25 (kg/m2), anemia (p = 0.001), prolonged rupture of membrane (p = 0.005), prolonged operation time (p = 0.019), and junior surgeons performing the operation (p = 0.011) were the risk factors for CS-SSI. Conclusions: Pre- and postoperative care and surgical training of junior doctors should be directed to these risk factors.

Background: The Ministry of Health and Family Welfare of the Government of Bangladesh developed a midwifery education strategy in 2011 and starting in 2013, BRAC University developed a three-year Diploma in Midwifery. A survey was developed to understand the challenges of the newly graduated midwives and to identify resource and educational needs. The survey feedback will help develop and strengthen curriculum for primary and postgraduate midwifery training. Methods: A 30-question survey was given to midwives at the Hope Hospital in Cox’s Bazar and at the birth centers in the surrounding rural communities. Questions explored the midwives’ clinical experience, patient problems in the prenatal, intrapartum, and postnatal period, and asked about what education; training and clinical resources were needed. Results: Thirty-two midwives answered the surveys. The midwives’ average time from graduation from the midwifery diploma program was sixteen months. All the respondents felt comfortable managing most maternal issues but felt further training was important. They also identified the lack of many clinical resources including blood products, medicines, vaccines, and ultrasound. They identified significant maternal health issues among their patients including adolescent pregnancy, malnutrition, anemia, sexual violence, pregnancy-induced hypertension, hemorrhage, low birth weight infants, prolonged and obstructed labors. Conclusion: Training and increasing the number of midwives are crucial strategies for reducing maternal and neonatal mortality. There is a significant need for long-term placement and commitment of midwives to rural areas in Bangladesh. Health systems and organizations employing midwives must be accountable for the continuing education, mentorship, and supportive needs of midwives.

There is a worldwide increase in the rate of caesarean sections. With recent migration patterns and the influx of refugees into high-income countries, migrants and refugees are also subjected to the increase in caesarean section rates. This article explores known information about the obstetrical experiences of refugee and displaced women. Pregnancy care varies depending on the location of the displaced women. Obstetrical care in refugee centers in Greece is examined as an example of the overall challenges facing European countries as they juggle the influx of refugees. Challenges to obstetrical care include physician shortage and the ongoing economic crisis in Greece. Refugees are some of the world’s most vulnerable populations and overall their obstetrical outcomes are worse than women of the host communities. Providers in refugee centers must be supported and educated in best obstetrical practices including labor management and a judicious use of caesarean deliveries. Increased outreach and training of maternal health worker can improve reproductive healthcare for refugees in non-camp environments.

Patients receiving chemotherapy have reported cognitive challenges including short-term memory loss and reduced executive functioning. While cognitive decline can be multifactorial and related to aging, depression, surgery, and other medications, there has been a steadily increasing body of knowledge showing a significant association between cognitive decline and chemotherapy administration. This clinical review summarizes patient-reported cognitive changes, support from neuroimaging and neuropsychological testing. The mechanism of action of and patient susceptibilities to cognitive decline are reviewed. Current behavioral and pharmacologic interventions are discussed. There is a need to identify patients at risk for developing chemotherapy induced cognitive decline and to screen for early signs of cognitive deterioration. The risk of cognitive dysfunction and possible interventions should be included in the informed consent discussion with patients who are undergoing cytotoxic treatments.

Objective: Art as a therapy helps in reparation and recovery. The aim of this study was to see the response of the cancer patients and their carers residing in Bangladesh towards art therapy and the perceived effect of art therapy on their physical and psychological condition. Method: The study was a record review study conducted through a cross-sectional descriptive method from July to November 2018. Along with the cancer patients, their immediate carers were enrolled in this study since patients and their carers both suffer from the distress that comes with the diagnosis of cancer. In-depth interviews and focused group discussions of art therapy were conducted with our study population at BPSCF and BSMMU. Findings: After art therapy, there was an improvement in sensory perception and self-perception, physical and psychological condition, communication and social skills and helped in more personal integration and built stronger insight among the patients and carers. Majority of the participants of art therapy felt good and wanted to continue art therapy. Significance of results: The results of this study will help to create awareness among the community about the importance of psychotherapies like art therapy in the life of the cancer patients and their carers. Introducing the concept of art therapy will also help the public health practitioners to improvise palliative care services in Bangladesh in a very cost-effective approach.

Highlights • Neoadjuvant chemotherapy is a feasible treatment option in advanced endometrial cancer not amenable to primary surgery. • High rates of subsequent interval cytoreductive surgery are achievable. • Cytoreductive surgery after chemotherapy results in improved progression-free and overall survival., The objective of this retrospective cohort study was to review the use of neoadjuvant chemotherapy followed by interval cytoreductive surgery in patients presenting with advanced, unresectable endometrial cancer at two large cancer centers. Patients with advanced endometrial cancer treated with neoadjuvant chemotherapy between 2008 and 2015 were identified from an institutional database. Clinical and surgical variables were analyzed and time to recurrence and death was calculated and compared between surgical groups. Thirty-three patients were identified (mean age 64.8 (range 42–86 years)). Overall, 28% of patients had endometrioid histology, 48% serous, 4% clear cell, 4% carcinosarcoma, 12% mixed and 4% other. Ineligibility for primary surgery was due to unresectable disease (85%), comorbidities (6%) and unknown reasons (9%). All patients received neoadjuvant chemotherapy with 91% of patients receiving carboplatin and paclitaxel. On reimaging, 12% of patients had progressed, 76% had a partial response and 3% had a complete response to chemotherapy. 76% of patients underwent interval surgery, with cytoreduction to no visible residual disease achieved in 52%. Overall, 91% of patients recurred and 85% died during follow-up. Patients undergoing surgery after chemotherapy had significantly longer progression-free survival (11.53 vs. 4.99 months, p = 0.0096) and overall survival (24.13 vs. 7.04 months, p = 0.0042) when compared to patients who did not have surgery. Neoadjuvant chemotherapy is a feasible treatment option to allow for interval cytoreductive surgery in patients with advanced endometrial cancer not amenable to primary debulking. Patients who undergo surgery after chemotherapy have significantly improved progression free and overall survival.

Objective The objective of this study was to determine the proportion of patients with a pre-invasive endometrial lesion who meet Mayo criteria for lymph node dissection on final pathology to determine if the use of sentinel lymph node biopsy in patients with pre-invasive lesions would be warranted. Methods All women who underwent hysterectomy for a pre-invasive endometrial lesion (atypical hyperplasia or endometrial intra-epithelial neoplasia) between 2009 and 2019 were included for analysis. Relevant statistical tests were utilized to test the associations between patient, operative, and pathologic characteristics. Results 141 patients met inclusion criteria. 51 patients (36%) had a final diagnosis of cancer, the majority (96%) of which were Stage IA grade 1 endometrioid carcinomas. Seven patients (5%) met Mayo criteria on final pathology (one grade 3, seven size >2 cm, one >50% myoinvasive). Three of these seven patients had lymph nodes assessed of which 0% had metastases. Six of these patients had frozen section performed, and 2 met (33%) Mayo criteria intraoperatively. Of the seven patients in the overall cohort that had lymph node sampling, six had a final diagnosis of cancer and none had positive lymph nodes. Of the 51 patients with cancer, only 10 had cancer diagnosed using frozen section, and only two met intra-operative Mayo criteria. Age > 55 was predictive of meeting Mayo criteria on final pathology (p = 0.007). No patients experienced a cancer recurrence across a median follow up of 24.3 months. Conclusions Atypical hyperplasia and endometrial intra-epithelial neoplasia portend low risk disease and universal nodal assessment is of limited value.

Objective To review the use of neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery in patients presenting with advanced, unresectable endometrial cancer at two large cancer centers. Methods In this retrospective cohort study, patients with advanced endometrial cancer treated with neoadjuvant chemotherapy between 2008 – 2015 were identified from an institutional database. Clinical and surgical variables were analyzed and time to recurrence and death was calculated and compared between surgical groups. Results Thirty-three patients were identified (mean age 64.8 (range 42–86 years)). Overall, 28% of patients had endometrioid histology, 48% serous, 4% clear cell, 4% carcinosarcoma, 12% mixed and 4% other. Ineligibility for primary surgery was due to unresectable disease (85%), comorbidities (6%) and unknown reasons (9%). All patients received NACT with 91% of patients receiving carboplatin and paclitaxel. On reimaging, 12% of patients had progressed, 76% had a partial response and 3% had a complete response to chemotherapy. 76% of patients underwent interval surgery, with cytoreduction to no visible residual disease achieved in 52%. Overall, 91% of patients recurred and 85% died during follow-up. Patients undergoing surgery after chemotherapy had significantly longer progression-free survival (11.53 vs. 4.99 months, p=0.0096) and overall survival (24.13 vs. 7.04 months, p=0.0042) when compared to patients who did not have surgery. Conclusions Neoadjuvant chemotherapy is a feasible treatment option to allow for interval cytoreductive surgery in patients with advanced endometrial cancer not amenable to primary debulking. Patients who undergo surgery after chemotherapy have significantly improved progression free and overall survival.

ObjectiveTriaging patients with presumptive ovarian cancer to the appropriate specialist may improve survival. Therefore, there is increasing interest in complementary diagnostic markers to the standard serum CA125. In patients with pelvic masses, we examined the ability of epidemiologic variables and preoperative differential blood counts to improve detection of ovarian cancer over CA125 alone.MethodsFrom pathology reports, patients were classified as having: epithelial ovarian cancer (n=743), including fallopian tube and primary peritoneal cancer, non-epithelial ovarian cancers (n=46), non-ovarian cancers (n=122), or benign disease (1,129). From women with epithelial ovarian cancer, we excluded those who received prior neoadjuvant chemotherapy (n=19). Women were also excluded if they did not have a serum CA125 or complete blood count measured within 180 days prior to surgery (n=1099) or did not have both tests within 90 days of each other (n=13). Categorizing patients by menopausal status, we calculated Pearson correlations between differential counts or ratios and CA125, and used t tests to identity univariate predictors of malignancy and stepwise logistic regression and likelihood ratio tests to create models best distinguishing epithelial ovarian cancer from benign disease.Results337 women with epithelial ovarian cancer and 365 with benign disease were included in the analysis. Compared with cancers, women with benign disease had lower average: age, 52.5 versus 58.4 years (p2 (p=0.004), and lymphocyte-to-monocyte ratio, 5.6 versus 3.9 (pConclusionsEpidemiologic variables and differential counts or ratios better distinguished between benign and malignant disease when compared with serum CA125 alone using separate models for pre- and postmenopausal women.

The Onco E6™ Cervical Test, based on detection of the E6 oncoprotein of HPV 16 and 18 genotypes is evaluated as a screen for the early detection cervical neoplasia in resource-limited countries.This prospective study from June 2018 to June 2019 evaluated 235 women aged 21-65 years, who came to Gynaecological Oncology Outpatient Department by VIA, cytology, E6 oncoprotein test and by colposcopy. Screen-positive women by any of the tests or women with suspicious findings were further evaluated by biopsy at colposcopy. The McNemar test was used to compare the performance of E6 oncoprotein test with other screening tests.The E6 oncoprotein positivity rate was 6.8% (n = 16) with 81.25% HPV 16 positive and 18.75% HPV 18 positive. Among VIA positive cases (n = 100), E6 oncoprotein was positive in 9% (p .001). In histopathology confirmed chronic cervicitis, CIN I, CIN II, CIN III and invasive cervical cancer, E6 test was positive for 2.8%, 4.7%, 25%, 50% and 100% respectively. E6 oncoprotein test had the highest specificity and Positive Predictive Value (PPV; 97% and 75%) compared to VIA (42% and 18%), cytology (95% and 46%) and colposcopy (94% and 59%). Sensitivity of the E6 oncoprotein test for detection of CIN3+ was significantly higher than that of cytology (52% VS 25%) but lower than that of VIA (52% VS 74%).The HPV E6 oncoprotein test is highly specific and is an effective triage test to reduce colposcopy referrals for the large number of false positive test outcomes seen with VIA.

Highlights • Twin pregnancy with complete hydatidiform mole and co-existing normal live fetus is rare. • Antenatal and postpartum complications such as gestational trophoblastic neoplasia are common. • Patients require close clinical monitoring and urgent delivery in the setting of complications. • Follow-up with serum β-HCG is important for the diagnosis of persistent trophoblastic disease., Hydatidiform mole coexisting with a normal live fetus in a twin pregnancy is extremely rare. Management of these cases is challenging due to the risk of severe antepartum and post-partum complications. Herein, we report the case of a 24-year-old gravida 2 para 1 who presented at 28 weeks gestation with severe preeclampsia, vulvar edema and a serum β-HCG of 285,000 IU/mL. Ultrasonography demonstrated a single live intra-uterine pregnancy with concurrent hydatidiform mole. Conservative management with magnesium sulfate and anti-hypertensive medications was initiated however the patient developed HELLP syndrome and required urgent delivery at 33 weeks. Copious molar tissue was removed from the uterus during delivery. Four weeks post-partum, her β-HCG had dropped to 14,000 IU/ml and continued to decline at 6 weeks (2900 IU/ml). However, at eight weeks, it increased to 3500 IU/ml and the patient was treated with nine cycles of intramuscular methotrexate. Current guidelines for management of a twin pregnancy with coexistent mole recommend close clinical monitoring if the mother and fetus are stable and urgent delivery in the setting of complications. During the postpartum period, careful follow up with clinical evaluation and serial serum β-HCG is important for the diagnosis and treatment of persistent trophoblastic disease.