Category Archives: Endometrial Cancer

GOC2: A PRO study on open vs. minimally invasive endometrial cancer surgeries

MDedge and MDLinx separately alerted me to a very interesting study based on GOC 2 (Gynecological Oncology), a Canadian research program. In this particular study (cost comparisons  apparently will be reported separately – MDedge has a video of an interview of the study lead), open surgery for Endometrial Cancer was compared to laparoscopic and robotic surgery techniques. The study was reported at the Society of Gynecologic Oncology 2017 Meeting.

This study is another example where women were recruited across multiple sites, and they answered survey questions, and thus, is a Patient Reported Outcomes (PRO) study on Quality of Life (QOL) following procedures of varying invasiveness.

As a reference, Endometrial Cancer represents about 3.6% of all new cancer cases in the US, occurring as new cases in an estimated 61,380 women in 2017, with a projected mortality for about 10, 920 women. The 5 year survival rate is approximately 81.3%, making Quality of Life an important concern for survivors. An NCI link is available below if you wish to explore more.

The Current Study

Patients with confirmed stage I or stage II endometrial cancer  were recruited across 8 centers in Canada. 106 patients from the open surgery arm, and 414 from the minimally invasive surgery arm participated, with the breakdown amounting to 168 laparoscopic and 246 robotic surgery patients.

Approximately 80% of patients completed the QOL questionnaires. Only about 25 – 50% of the patients responded to the sexual-function questionnaires. Those responding were found to be young, pre-menopausal and sexually active.

The study itself was not randomized, but adjustments were made to accommodate this.

Also, quoting Dr. Ferguson from MDedge below, about sexual function:

Both of the surgical groups “met the clinical cutoff for sexual dysfunction” on the Female Sexual Function Index questionnaire, she said.

Results

The results can be viewed as three distinct sets:

  1. There was no statistical significance in QOL or sexual function, between laparoscopic and robotic procedures.
  2. At 3 weeks, patients in all groups fared better in terms of pain, but Quality of Life was worse for Open Surgery Patients. Novel to this study, this extended to the 3 month period as well, both clinically and statistically. (Please watch video on the MDedge link)
  3. While fewer patients responded to the questionnaires on sexual function, there was no significant difference between the open and minimally invasive surgery groups for up to 26 weeks. I am puzzled by this honestly. If you have reduced Quality of Life, your sexual function ought to be reduced. If it is not, then how would you have a significant difference in one case and not the other? The lower number of responses might be the confounding factor here, and honestly as the paper sits behind a paywall, there is only so much I can glean from reading articles and the abstract.

References:

  1. The MDedge Article (along with the video): http://www.mdedge.com/oncologypractice/article/134206/gynecologic-cancer/video-pain-and-impaired-qol-persist-after-open
  2. Abstract 51 from SGO: https://www.sgo.org/wp-content/uploads/2016/12/SGO-AM17-abstract_titles.pdf
  3. Some Endometrial Cancer Statistics: https://seer.cancer.gov/statfacts/html/corp.html
  4. Image Courtesy of Pexels: https://www.pexels.com/photo/woman-sitting-by-the-seashore-during-day-89820/

A seemingly surprising increase in incidence of Endometrial Cancer

The ACOG 2017 saw several interesting results come out. One surprising result, presented at an oral presentation, appears to be a presentation about the increase in the incidence of Endometrial Cancer.

It appears that Endometrial Cancer rates were stable from 1999 to 2002, but then, since 2006 to 2014, the rates appear to have increased by 10%.

The authors were curious, as you and I might be, so they examined EC incidence through the Surveillance, Epidemiology, and End Result Program database from 1975 through 2014.

Factors affecting Endometrial Cancer

It appears that FDA approved hormonal therapies have dropped in number, and therefore the use of non FDA approved combinations of estrogen and estrogen+progesterone, which may not be enough to stop endometrial cancer.

Obesity, which has been increasing consistently, already a known risk factor, might be aggravated.

Study Limitations

The study, as stated by the authors themselves, is clearly not a randomized clinical trial, but an ecological study. Therefore, it is not sufficient to draw conclusions and yet, the findings, especially the coincidence of the use of non-approved hormonal therapy and the increase in endometrial cancer as well as factors such as obesity is quite interesting, and this should be flushed out further, perhaps with targeted studies. Women, in particular should be aware of risk factors and seek medical help in advance.

References

  1. A report on the study: http://www.mdedge.com/clinicalendocrinologynews/article/137805/gynecologic-cancer/endometrial-cancer-rates-increased?channel=247&utm_source=News_CEN_eNL_051317_F&utm_medium=email&utm_content=Are%20some%20obese%20women%20having%20issues%20with%20IUDs?
  2. The ACOG summary of the study: http://journals.lww.com/greenjournal/Abstract/2017/05001/Increased_Incidence_of_Endometrial_Cancer.19.aspx
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/beach-woman-sunrise-silhouette-40192/