Advanced ovarian cancer as a risks of primary multiple malignant tumors after the treatment of extra genital cancer


MANAGAMENT OF GYNECOLOGICL CANCER PATIENTS OLDER THAN 70 YEARS OF AGE



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MANAGAMENT OF GYNECOLOGICL CANCER PATIENTS OLDER THAN 70 YEARS OF AGE


GALINA CHAKALOVA, MD, PhD

Int J Gerent 7, 2013 (in press)

Department of Gynecological Oncology, National Oncological Center, Sofia, Bulgaria

Abstract

Background: The incidence of geriatric oncology patients has not been studied very well. A prospective study of the incidence of geriatric patients with malignant gynecological disease was presented.

Patients and methods: From 1982 till 2006 in our clinic 8377 patients were treated, 834 (10%) of them were 70 years of age or more.

Results: In 63,3% 528 patients were between 70 and 74 years of age, 215 patients (25,8%) were between 75 and 79 years of age and 91 patients (10,9%) were 80 years of age and older. Endometrial cancer was detected in 240 cases, ovarian cancer in 192 cases, vulva cancer in 180 cases, cervical cancer in 169 cases, uterine sarcoma in 37 cases and vaginal cancer in 16 cases. The comorbidities included were hypertension, diabetes, cardiovascular disease, pulmonary disease and cerebrovascular disease. Operation was performed in 655 cases (78%), radiation therapy only in 152 cases (18%) and chemotherapy only in 27 cases (3%). In the present study, the in-hospital complication rate was 9.3%. No case of death related with surgery was obtained.

Conclusion: The key in choosing the treatment therapy is the localization and the stage, while the age is not relevant to the tactics. The cases of geriatric gynecological malignancies were treated following the same guidelines like younger patients. An increase in elderly surgical cancer workload is inevitable in the coming years. The special needs of elderly cancer patient should be taken into consideration prior to treatment planning.

Kay words: geriatric patients, gynecological cancer, treatment


ORGANIZATION OF GYNECOLOGICAL CANCER CARE AND THE ECONOMICS IN BULGARIA


GALAINA CHAKALOVA

Int. J. Gynecol. Cancer
, vol. 21, Suppl 3, October 2011, p.1281.

National Oncology Hospital, Sofia, Bulgaria

Background and aims. Cancer care can be complex, and given the wide range and numbers of health-care professionals involved, an enormous potential for poor coordination and miscommunication exists. Multidisciplinary teams should improve coordination, communication, decision making between health-care team members and patients, and produce more positive outcomes. The final treatment result is in strong relation with the economics.

Methods. We reviewed the cancer incidence in Bulgaria for the last 20 years according to Cancer Registry data, and regulations and laws in relations of the health reform.

Results. The Bulgarian health system underwent a great deal of reorganization in the last two decades; a general tendency being to facilitate expanding involvement of the private sector in health care. Our findings clearly suggest that cancer survival is related to macro-economic variables such as the gross domestic product (GDP), the total national (public and private) expenditure on health (TNEH) and the total public expenditure on health (TPEH). Survival is related to wealth (GDP), but only up to a certain level, after which survival continues to be related to the level of health investment.

Conclusion. Cancer survival depends on the of effective diagnosis and treatment modalities, but our enquiry suggests that the availability of these depends on macro-economic determinants, including health and public health investment. Analysis of the relationship between health system organization and cancer outcome is complicated and requires more information than is at present available.

OVARIAN CANCER-AGE AND STAGE DETERMINATION AND TREATMENT RESULTS

K. ANGELOV, G. CHAKALOVA

Int.J. Gynecol Cancer, vol. 19, 2009, Supl. 2, 129.

Clinic of gynecological Oncology, National Oncologic Hospital, Sofia, Bulgaria
Background: Ovarian cancer is the disease with worst prognosis in oncogynecology. Early detection is difficult and late diagnosis is the most common.

Patients and methods: For a 25-year period (1982-2006) 2016 patients with ovarian cancer were treated in our clinic.

Results: 85 patients were 29 years of age or younger, 510 – from 30 to 49, 1229 patients – from 50 to 69 and 192 patients were older than 70 years of age. Most patients were in the 55-59 years of age group – 519 patients. In 369 cases (18,3 %) stage I was found, in 98 cases (4,9%) – stage II, in 1441 cases (71,5%) – stage III, and in 108 cases (5,4%) – stage IV. Serous and mucinous adenocarcinoma were found in 85% of the cases. In 1188 cases a radical operation – hysterectomy with adnexectomy and omentectomy was performed. In 562 cases a tumor reduction operation was used, and in 265 cases – only biopsy was performed. Postoperative chemotherapy was used in all cases (between 6 and 18 couses). A second operation was performed in 1124 cases. Intestinal and bladder resection were performed in 482 cases. 3-year survival for all cases is 55%.

Conclusion: Most cases are in stage III and patients between 50 and 69 years of age. In 59% of the cases a radical operation was possible. A screening program will be useful for reduction of advanced stages of ovarian cancer.

PSHYCHOLOGICAL ASPECTS AND QUALITY OF LIFE IN WOMEN WITH GYNECOLOGIC CANCER

G. Chakalova (1), B. Chakalov (2)

Int. J. Gynecol. Cancer, vol. 21, Suppl 3, October 2011, p.1297.

National Oncology Hospital (1), Medical Center, Gineka (2), Sofia, Bulgaria

Background and aims. Psychological interventions are important for reducing emotional distress, enhancing coping, improving “adjustment” and quality of live. The aim of this study was the psychological reactions of gynecologic cancer patients.

Methods. . The psychological status of 216 women were study. One hundred ten (61 individual intervention, 20 group, 29 no- intervention) was assessed before the treatment, 6, 12, 18, and 24 months later. The problems of anxiety, depression, psychosexual and communications issues are examined. The scores from the patients were compared to those 106 no cancer controls.

Results. The women who counseling were significantly less depressed and anxious and had more knowledge of their illness, better relationships with care givers, and fewer sexual difficulties. Patients continue to think about their illness and treatment, but find it increasingly hard to share their worries. Their score on overall quality of life never reaches that of the controls. All groups improved with time, interviewer rated anxiety was significantly lower for the individual therapy subjects only.

Conclusion. Patients treated for gynecologic cancer have psychological reactions and should be informed about the risk. The patients change their personal frame of reference over the course of time, and needs to talk about their disease long after treatment. The more information about possible symptoms they receive the better their ability to cope with them should they arise.




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