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  1. Article: Evaluating the Harms of Cancer Testing-A Systematic Review of the Adverse Psychological Correlates of Testing for Cancer and the Effectiveness of Interventions to Mitigate These.

    Kwong, Fong Lien / Davenport, Clare / Sundar, Sudha

    Cancers

    2023  Volume 15, Issue 13

    Abstract: 1) Background: Several studies have described the psychological harms of testing for cancer. However, most were conducted in asymptomatic subjects and in cancers with a well-established screening programme. We sought to establish cancers in which the ... ...

    Abstract (1) Background: Several studies have described the psychological harms of testing for cancer. However, most were conducted in asymptomatic subjects and in cancers with a well-established screening programme. We sought to establish cancers in which the literature is deficient, and identify variables associated with psychological morbidity and interventions to mitigate their effect. (2) Methods: Electronic bibliographic databases were searched up to December 2020. We included quantitative studies reporting on variables associated with psychological morbidity associated with cancer testing and primary studies describing interventions to mitigate these. (3) Results: Twenty-six studies described individual, testing-related, and organisational variables. Thirteen randomised controlled trials on interventions were included, and these were categorised into five groups, namely the use of information aids, music therapy, the use of real-time videos, patient navigators and one-stop clinics, and pharmacological or homeopathic therapies. (4) Conclusions: The contribution of some factors to anxiety in cancer testing and their specificity of effect remains inconclusive and warrants further research in homogenous populations and testing contexts. Targeting young, unemployed patients with low levels of educational attainment may offer a means to mitigate anxiety. A limited body of research suggests that one-stop clinics and patient navigators may be beneficial in patients attending for diagnostic cancer testing.
    Language English
    Publishing date 2023-06-25
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers15133335
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Sentinel lymph node biopsy based on anatomical landmarks and locoregional mapping of inguinofemoral sentinel lymph nodes in women with vulval cancer: an operative technique.

    Kwong, Fong Lien / Scerif, Miski / Yap, Jason Kw

    Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology

    2023  Volume 43, Issue 1, Page(s) 2207205

    Abstract: Inguinal lymph node involvement is the most robust predictor of mortality in vulval cancer and sentinel lymph node (SLN) biopsy is a safe diagnostic modality. We describe a technique based on anatomical landmarks. Our aims are (1) to describe the ... ...

    Abstract Inguinal lymph node involvement is the most robust predictor of mortality in vulval cancer and sentinel lymph node (SLN) biopsy is a safe diagnostic modality. We describe a technique based on anatomical landmarks. Our aims are (1) to describe the territorial mapping of SLNs, (2) to evaluate the associated complication rate vis-à-vis those reported in the literature, and (3) to assess its accuracy in detecting SLNs. Data from women who underwent groin SLN biopsies for vulval cancer at a single cancer centre were prospectively collected. All subjects met the GROINSS-V eligibility criteria. The location of the SLN relative to the saphenous vein was recorded. All women were followed up and early and late complications were recorded. The recurrence rate at the time of the census was calculated. A total of 71 groins in 44 women were included. The SLN was primarily located over Cloquet's node (85.2%). The incidence of early wound cellulitis and dehiscence were 2.8% and 11.3% while lymphocysts were present in 11.3% of groins. The negative nodal recurrence rate was 1.7%. Results showed that this reproducible technique allows access to 96.7% of SLNs, including both deep and superficial SLNs whilst minimising the need for extensive dissection and complications associated with overharvesting of lymph nodes.
    MeSH term(s) Female ; Humans ; Sentinel Lymph Node Biopsy/methods ; Sentinel Lymph Node ; Lymph Node Excision/adverse effects ; Lymph Node Excision/methods ; Lymphatic Metastasis/pathology ; Lymph Nodes/surgery ; Lymph Nodes/pathology ; Vulvar Neoplasms/surgery ; Vulvar Neoplasms/pathology ; Neoplasm Staging
    Language English
    Publishing date 2023-05-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 604639-3
    ISSN 1364-6893 ; 0144-3615
    ISSN (online) 1364-6893
    ISSN 0144-3615
    DOI 10.1080/01443615.2023.2207205
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Postnatal diagnosis of an occult uterine scar dehiscence after three uncomplicated vaginal births after Caesarean section: A case report.

    Kwong, Fong Lien / Hamoodi, Ibraheem

    Case reports in women's health

    2020  Volume 27, Page(s) e00203

    Abstract: Introduction: The incidence of Caesarean sections has been increasing in the United Kingdom. Obstetricians have become more inclined to offer a trial of a vaginal birth to women following a single uncomplicated Caesarean section due to growing ... ...

    Abstract Introduction: The incidence of Caesarean sections has been increasing in the United Kingdom. Obstetricians have become more inclined to offer a trial of a vaginal birth to women following a single uncomplicated Caesarean section due to growing recognition of the high morbidity associated with repeat abdominal surgeries, and the relative rarity of a Caesarean scar defect causing complications at subsequent vaginal deliveries. The diagnosis of a Caesarean scar defect such as a uterine scar dehiscence in the postnatal period still remains elusive due to its vague presentation. An incorrect diagnosis or a delay in diagnosis can lead to unnecessary interventions or delay the management of patient symptoms.
    Case presentation: A 35-year-old woman with a single Caesarean section and three subsequent uncomplicated vaginal deliveries was diagnosed with an occult scar dehiscence two weeks postnatally. She initially complained of persistent vaginal bleeding and underwent a suction evacuation for suspected retained placental tissue. Her symptoms did not improve, and a CT scan was requested to rule out a uterine perforation following the surgical procedure. The CT scan suggested a uterine dehiscence at the level of the previous scar. As the patient remained clinically well, her symptoms were managed conservatively. She underwent a laparoscopic sterilisation six months later and was discharged as the scar defect had fully resolved.
    Conclusion: Clinicians should remain vigilant about the possibility of an occult scar defect in women with a previous Caesarean section who present with persistent vaginal bleeding and pain in the postnatal period.
    Language English
    Publishing date 2020-04-14
    Publishing country Netherlands
    Document type Case Reports
    ZDB-ID 2800286-6
    ISSN 2214-9112 ; 2214-9112
    ISSN (online) 2214-9112
    ISSN 2214-9112
    DOI 10.1016/j.crwh.2020.e00203
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Prevalence of computed tomography-based sarcopenia and the prognostic value of skeletal muscle index and muscle attenuation amongst women with epithelial ovarian malignancy: A systematic review and meta-analysis.

    Tranoulis, Anastasios / Kwong, Fong Lien Audrey / Lakhiani, Aarti / Georgiou, Dimitra / Yap, Jason / Balega, Janos

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2022  Volume 48, Issue 7, Page(s) 1441–1454

    Abstract: Background: Sarcopenia represents an index of frailty amongst cancer patients and it is associated with poor oncological outcomes and a higher risk of surgical complications in several types of malignancy.: Aim: To further delineate the impact of ... ...

    Abstract Background: Sarcopenia represents an index of frailty amongst cancer patients and it is associated with poor oncological outcomes and a higher risk of surgical complications in several types of malignancy.
    Aim: To further delineate the impact of sarcopenia assessed via computed tomography scan (CT) on oncological outcomes and post-operative complications amongst women with epithelial ovarian carcinoma (EOC). Our secondary objective was to quantify and understand the prevalence of sarcopenia in EOC.
    Design: We systematically searched MEDLINE, SCOPUS, ClinicalTrials.gov, and Cochrane Database, from inception up to August 2021. Quality assessment was performed using the Newcastle-Ottawa scale (NOS). Outcomes consisted of prevalence, overall survival (OS), progression-free survival (PFS) and post-operative complications. Pooled analyses of proportion estimates, hazard ratios (HRs) and odds ratios (ORs) were performed with STATA and Review Manager 5.3.
    Results: 21 studies were included in this meta-analysis. NOS scores ranged from six to nine. Pooled analysis yielded an overall sarcopenia prevalence of 41%. Pooled analysis of adjusted HRs demonstrated significant association between low muscle attenuation (MA) [aHR = 1.23, (95% CI 1.02-1.47), p-value = 0.03] and OS, whilst low skeletal muscle index (SMI) trended towards shorter OS [aHR = 1.37, (95% CI 0.99-1.90), p-value = 0.05. Low-SMI was also associated with higher risk of total post-operative complications [uOR = 1.56, (95% CI 1.16-2.11), p-value = 0.004].
    Conclusion: Our findings suggest that CT-assessed skeletal mass and radiodensity represent rather accurate indices of nutritional status and could prospectively be incorporated into the decision-making process in women with EOC.
    MeSH term(s) Carcinoma, Ovarian Epithelial/pathology ; Female ; Humans ; Muscle, Skeletal/diagnostic imaging ; Muscle, Skeletal/pathology ; Ovarian Neoplasms/complications ; Ovarian Neoplasms/diagnostic imaging ; Ovarian Neoplasms/surgery ; Postoperative Complications/pathology ; Prevalence ; Prognosis ; Sarcopenia/diagnostic imaging ; Sarcopenia/epidemiology ; Sarcopenia/etiology ; Tomography, X-Ray Computed
    Language English
    Publishing date 2022-02-24
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2022.02.024
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Investigating harms of testing for ovarian cancer - psychological outcomes and cancer conversion rates in women with symptoms of ovarian cancer: A cohort study embedded in the multicentre ROCkeTS prospective diagnostic study.

    Kwong, Fong Lien / Kristunas, Caroline / Davenport, Clare / Aggarwal, Ridhi / Deeks, Jon / Mallett, Sue / Kehoe, Sean / Timmerman, Dirk / Bourne, Tom / Stobart, Hilary / Neal, Richard / Menon, Usha / Gentry-Maharaj, Alex / Sturdy, Lauren / Ottridge, Ryan / Sundar, Sudha

    BJOG : an international journal of obstetrics and gynaecology

    2024  

    Abstract: Objective: To investigate psychological correlates in women referred with suspected ovarian cancer via the fast-track pathway, explore how anxiety and distress levels change at 12 months post-testing, and report cancer conversion rates by age and ... ...

    Abstract Objective: To investigate psychological correlates in women referred with suspected ovarian cancer via the fast-track pathway, explore how anxiety and distress levels change at 12 months post-testing, and report cancer conversion rates by age and referral pathway.
    Design: Single-arm prospective cohort study.
    Setting: Multicentre. Secondary care including outpatient clinics and emergency admissions.
    Population: A cohort of 2596 newly presenting symptomatic women with a raised CA125 level, abnormal imaging or both.
    Methods: Women completed anxiety and distress questionnaires at recruitment and at 12 months for those who had not undergone surgery or a biopsy within 3 months of recruitment.
    Main outcome measures: Anxiety and distress levels measured using a six-item short form of the State-Trait Anxiety Inventory (STAI-6) and the Impact of Event Scale - Revised (IES-r) questionnaire. Ovarian cancer (OC) conversion rates by age, menopausal status and referral pathway.
    Results: Overall, 1355/2596 (52.1%) and 1781/2596 (68.6%) experienced moderate-to-severe distress and anxiety, respectively, at recruitment. Younger age and emergency presentations had higher distress levels. The clinical category for anxiety and distress remained unchanged/worsened in 76% of respondents at 12 months, despite a non-cancer diagnosis. The OC rates by age were 1.6% (95% CI 0.5%-5.9%) for age <40 years and 10.9% (95% CI 8.7%-13.6%) for age ≥40 years. In women referred through fast-track pathways, 3.3% (95% CI 1.9%-5.7%) of pre- and 18.5% (95% CI 16.1%-21.0%) of postmenopausal women were diagnosed with OC.
    Conclusions: Women undergoing diagnostic testing display severe anxiety and distress. Younger women are especially vulnerable and should be targeted for support. Women under the age of 40 years have low conversion rates and we advocate reducing testing in this group to reduce the harms of testing.
    Language English
    Publishing date 2024-03-31
    Publishing country England
    Document type Journal Article
    ZDB-ID 2000931-8
    ISSN 1471-0528 ; 0306-5456 ; 1470-0328
    ISSN (online) 1471-0528
    ISSN 0306-5456 ; 1470-0328
    DOI 10.1111/1471-0528.17813
    Database MEDical Literature Analysis and Retrieval System OnLINE

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