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Lower limb lymphedema after systematic lymphadenectomy for ovarian cancer
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Abstracts / Gynecologic Oncology 125 (2012) S3–S167
tion, only 13 [1.93%] reported grade 3 or 4 peripheral neuropathy so this toxicity was not further investigated. Fatigue was not specifically collected as a part of GOG 179, thus from the 401 patients that were enrolled on GOG 204, a worse PS was significantly associated with reporting moderate to severe fatigue (OR 2.78 95% CI 1.66–4.68). Exposure to prior radiation (p= .0007), treatment regimen (p b .0001), and FACT-CX score (p= .0104) were significantly associated with the reporting of grade 3 or 4 leukopenia. Exposure to prior radiation (p= .0007), treatment regimen (p= .0008), and a lower FACT-CX score (pb .0001) were related to the reporting of grade 3 or 4 anemia. PS (p b .0001) and treatment regimen (p = .0275) were significantly associated with the reporting of grade 3 or 4 thrombocytopenia. Age (p = .0172) and treatment regimen (p b .0001) were significantly associated with the reporting of grade 3 or 4 neutropenia. The FACTCX score (p= .0016) was significantly associated with the reporting of grade 3 or 4 GI toxicity. Conclusions: The development of fatigue, hematologic and GI toxicity might be predictable based on factors other than treatment assignment such as age, PS, and patient-reported QOL measurement. Fatigue does not correlate with baseline overall QOL measurement in this cohort of patients. doi:10.1016/j.ygyno.2011.12.278
278 A prospective evaluation of quality of life, sexual function, and depression in women referred to a sexuality clinic for female cancer survivors E. Hill1, C. Raker1, S. Carson1, D. Wiggins1, C. Granai1, J. Gass1, E. Spriggs2, D. Dizon1. 1Women & Infants Hospital Brown University, Providence, RI, 2Brown University, Providence, RI. Objective: To characterize quality of life, sexual function, and depressive symptoms in female cancer survivors evaluated in a specialized program for sexual health. We also describe the effect of follow-up visits on these parameters. Methods: Female cancer survivors seen in the Women & Infants' Women's Oncology Center for Sexuality, Intimacy and Fertility clinic from February 2006 to August 2011 were prospectively assessed at new and follow-up visits with three questionnaires: the Female Sexual Function Index (FSFI; score range 2–36), the European Organization for Research and Treatment of Cancer Quality of Life (QOL) Core Questionnaire (QLQ-C30; range 0–100) and the Beck Depression Inventory (BDI; range 0–63). Higher scores on the FSFI and BDI reflect greater dysfunction while on the QLQ-C30 global QOL and functional scales reflect less dysfunction. These data were then analyzed in conjunction with demographic and medical history data. Statistics were generated using Stata v10. Results: There were 66 unique cancer patients seen in 114 clinic visits (66 new, 48 follow-up). Median age was 49.4 years (range 26–64). The majority comprised breast (39.4%), uterine (24.2%) or ovarian/ fallopian tube/peritoneal (15.2%) cancer survivors. Prior cancer treatment included surgery (92%), chemotherapy (63%), and/or radiation (56%). Significant sexual dysfunction was present at baseline (mean FSFI = 10.5, range 1.2–26.3), but this was not associated with poor quality of life (mean global QOL = 70.7, range 0–100). Women did have evidence of mild to moderate depression at baseline (mean BDI = 11.4, range 0–33). Women who were seen in follow-up showed improvement in FSFI domains for arousal (P = 0.05), satisfaction (P = 0.002) and total FSFI score (P = 0.03). The BDI scores also improved on follow-up though changes were not significant (P = 0.1). Global QOL scores remained stable. Conclusions: Female cancer survivors referred to a sexual health clinic demonstrate significant sexual dysfunction at baseline with
evidence for at least mild depressive symptoms. However, these findings do not appear to affect global quality of life. Our study is the first to prospectively assess these domains in women with cancer who refer to a sexual health program and demonstrates improvement in sexual function on follow-up visits, supporting the utility and relevance of a specialized clinic to address sexual concerns among women with gynecologic and breast cancer. doi:10.1016/j.ygyno.2011.12.279
279 Lower limb lymphedema after systematic lymphadenectomy for ovarian cancer G. Baiocchi, J. Timm, E. Fukazawa, C. Faloppa, L. Kumagai, R. Oliveira, L. Badiglian-Filho. AC Camargo Cancer Hospital, Sao Paulo, Brazil. Objective: Few studies have evaluated lymphedema after lymphadenectomy in ovarian cancer. The aims of our study were to evaluate the prevalence of lower limb lymphedema (LLL) in patients treated for ovarian cancer and correlate its presence to clinicopathological features. Methods: We reviewed a series of 36 patients with ovarian cancer who underwent systematic pelvic and retroperitoneal lymphadenectomy from June 2007 to June 2009. Medical records were reviewed for age, race, body mass index, FIGO stage, tumor histologic type and grade, number of resected lymph nodes and number of positive lymph nodes. Presence of lymphedema was identified through medical records. Results: All patients underwent optimal cytoreduction. Twenty-two (61.1%) patients were stage IIIC. Ten patients (27.8%) developed LLL. Mean time for lymphedema diagnosis was 4.59 months (range: 0.53– 8.7). Median resected lymph nodes were 48.5 (range: 13–140). Fourteen (38.9%) patients had lymph node involvement with median of 3.5 metastatic lymph nodes (range: 1–22). LLL development was not related to age (p = 0.11), obesity (p = 0.43), number of resected lymph nodes (p = 0.71), and number of metastatic lymph nodes. LLL prevalence was higher in patients with lymph node metastasis, but did not achieve statistical difference (p = 0.054). Conclusions: We found a prevalence of LLL in 27.8% of patients who underwent systematic lymphadenectomy for ovarian cancer. LLL prevalence was higher in patients with lymph node metastasis. doi:10.1016/j.ygyno.2011.12.280
280 Perception of risk, cancer worry, anxiety, and acceptability of screening among low-risk women undergoing ovarian cancer screening with the risk of ovarian cancer algorithm L. Holman1, K. Lu1, M. Hernandez1, R. Bast1, D. Bodurka1, S. Skates2, D. Gershenson1, C. Sun1. 1The University of Texas, MD Anderson Cancer Center, Houston, TX, 2Massachusetts General Hospital/Harvard University, Boston, MA. Objective: We evaluated baseline knowledge of ovarian cancer risk and perceptions toward ovarian cancer screening (OCS) in low-risk women initiating an OCS trial with the risk of ovarian cancer algorithm (ROCA). Methods: Low-risk, postmenopausal women were enrolled prospectively between 2001 and 2011, and concurrently enrolled in a large, multi-center, prospective OCS study utilizing the ROCA. A survey of risk perception, ovarian cancer worry (Cancer Worry Scale or CWS), anxiety (State-Trait Anxiety Inventory or STAI), health and well-being
Abstracts / Gynecologic Oncology 125 (2012) S3–S167
tion, only 13 [1.93%] reported grade 3 or 4 peripheral neuropathy so this toxicity was not further investigated. Fatigue was not specifically collected as a part of GOG 179, thus from the 401 patients that were enrolled on GOG 204, a worse PS was significantly associated with reporting moderate to severe fatigue (OR 2.78 95% CI 1.66–4.68). Exposure to prior radiation (p= .0007), treatment regimen (p b .0001), and FACT-CX score (p= .0104) were significantly associated with the reporting of grade 3 or 4 leukopenia. Exposure to prior radiation (p= .0007), treatment regimen (p= .0008), and a lower FACT-CX score (pb .0001) were related to the reporting of grade 3 or 4 anemia. PS (p b .0001) and treatment regimen (p = .0275) were significantly associated with the reporting of grade 3 or 4 thrombocytopenia. Age (p = .0172) and treatment regimen (p b .0001) were significantly associated with the reporting of grade 3 or 4 neutropenia. The FACTCX score (p= .0016) was significantly associated with the reporting of grade 3 or 4 GI toxicity. Conclusions: The development of fatigue, hematologic and GI toxicity might be predictable based on factors other than treatment assignment such as age, PS, and patient-reported QOL measurement. Fatigue does not correlate with baseline overall QOL measurement in this cohort of patients. doi:10.1016/j.ygyno.2011.12.278
278 A prospective evaluation of quality of life, sexual function, and depression in women referred to a sexuality clinic for female cancer survivors E. Hill1, C. Raker1, S. Carson1, D. Wiggins1, C. Granai1, J. Gass1, E. Spriggs2, D. Dizon1. 1Women & Infants Hospital Brown University, Providence, RI, 2Brown University, Providence, RI. Objective: To characterize quality of life, sexual function, and depressive symptoms in female cancer survivors evaluated in a specialized program for sexual health. We also describe the effect of follow-up visits on these parameters. Methods: Female cancer survivors seen in the Women & Infants' Women's Oncology Center for Sexuality, Intimacy and Fertility clinic from February 2006 to August 2011 were prospectively assessed at new and follow-up visits with three questionnaires: the Female Sexual Function Index (FSFI; score range 2–36), the European Organization for Research and Treatment of Cancer Quality of Life (QOL) Core Questionnaire (QLQ-C30; range 0–100) and the Beck Depression Inventory (BDI; range 0–63). Higher scores on the FSFI and BDI reflect greater dysfunction while on the QLQ-C30 global QOL and functional scales reflect less dysfunction. These data were then analyzed in conjunction with demographic and medical history data. Statistics were generated using Stata v10. Results: There were 66 unique cancer patients seen in 114 clinic visits (66 new, 48 follow-up). Median age was 49.4 years (range 26–64). The majority comprised breast (39.4%), uterine (24.2%) or ovarian/ fallopian tube/peritoneal (15.2%) cancer survivors. Prior cancer treatment included surgery (92%), chemotherapy (63%), and/or radiation (56%). Significant sexual dysfunction was present at baseline (mean FSFI = 10.5, range 1.2–26.3), but this was not associated with poor quality of life (mean global QOL = 70.7, range 0–100). Women did have evidence of mild to moderate depression at baseline (mean BDI = 11.4, range 0–33). Women who were seen in follow-up showed improvement in FSFI domains for arousal (P = 0.05), satisfaction (P = 0.002) and total FSFI score (P = 0.03). The BDI scores also improved on follow-up though changes were not significant (P = 0.1). Global QOL scores remained stable. Conclusions: Female cancer survivors referred to a sexual health clinic demonstrate significant sexual dysfunction at baseline with
evidence for at least mild depressive symptoms. However, these findings do not appear to affect global quality of life. Our study is the first to prospectively assess these domains in women with cancer who refer to a sexual health program and demonstrates improvement in sexual function on follow-up visits, supporting the utility and relevance of a specialized clinic to address sexual concerns among women with gynecologic and breast cancer. doi:10.1016/j.ygyno.2011.12.279
279 Lower limb lymphedema after systematic lymphadenectomy for ovarian cancer G. Baiocchi, J. Timm, E. Fukazawa, C. Faloppa, L. Kumagai, R. Oliveira, L. Badiglian-Filho. AC Camargo Cancer Hospital, Sao Paulo, Brazil. Objective: Few studies have evaluated lymphedema after lymphadenectomy in ovarian cancer. The aims of our study were to evaluate the prevalence of lower limb lymphedema (LLL) in patients treated for ovarian cancer and correlate its presence to clinicopathological features. Methods: We reviewed a series of 36 patients with ovarian cancer who underwent systematic pelvic and retroperitoneal lymphadenectomy from June 2007 to June 2009. Medical records were reviewed for age, race, body mass index, FIGO stage, tumor histologic type and grade, number of resected lymph nodes and number of positive lymph nodes. Presence of lymphedema was identified through medical records. Results: All patients underwent optimal cytoreduction. Twenty-two (61.1%) patients were stage IIIC. Ten patients (27.8%) developed LLL. Mean time for lymphedema diagnosis was 4.59 months (range: 0.53– 8.7). Median resected lymph nodes were 48.5 (range: 13–140). Fourteen (38.9%) patients had lymph node involvement with median of 3.5 metastatic lymph nodes (range: 1–22). LLL development was not related to age (p = 0.11), obesity (p = 0.43), number of resected lymph nodes (p = 0.71), and number of metastatic lymph nodes. LLL prevalence was higher in patients with lymph node metastasis, but did not achieve statistical difference (p = 0.054). Conclusions: We found a prevalence of LLL in 27.8% of patients who underwent systematic lymphadenectomy for ovarian cancer. LLL prevalence was higher in patients with lymph node metastasis. doi:10.1016/j.ygyno.2011.12.280
280 Perception of risk, cancer worry, anxiety, and acceptability of screening among low-risk women undergoing ovarian cancer screening with the risk of ovarian cancer algorithm L. Holman1, K. Lu1, M. Hernandez1, R. Bast1, D. Bodurka1, S. Skates2, D. Gershenson1, C. Sun1. 1The University of Texas, MD Anderson Cancer Center, Houston, TX, 2Massachusetts General Hospital/Harvard University, Boston, MA. Objective: We evaluated baseline knowledge of ovarian cancer risk and perceptions toward ovarian cancer screening (OCS) in low-risk women initiating an OCS trial with the risk of ovarian cancer algorithm (ROCA). Methods: Low-risk, postmenopausal women were enrolled prospectively between 2001 and 2011, and concurrently enrolled in a large, multi-center, prospective OCS study utilizing the ROCA. A survey of risk perception, ovarian cancer worry (Cancer Worry Scale or CWS), anxiety (State-Trait Anxiety Inventory or STAI), health and well-being