Trajectories of sexual dysfunction and its risk factors in women with gynecologic cancer across radiation therapy and healthy controls.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24097-e24097
Author(s):  
Jinbing Bai ◽  
Despina Tsementzi ◽  
Pretesh R. Patel ◽  
Joseph W Shelton ◽  
Mary Dolan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Sexual Dysfunction ◽  
Gynecologic Cancer ◽  
Study Cohort ◽  
Healthy Controls ◽  
High Arousal ◽  
High Ph ◽  
Increased Risk ◽  
Patient Reported

e24097 Background: Women with gynecological cancer (GynCa) reported an increased risk for acute and long-term sexual dysfunction across cancer treatments, especially radiation therapy (RT). However, limited data exist on the course of sexual dysfunction across RT and its risk factors are unknown. This study sought to characterize women’s sexual dysfunction trajectories and identified risk factors of persistent sexual dysfunction. Methods: Using a longitudinal study design, patient-reported sexual dysfunction, demographic and clinical data were collected. Women receiving RT for GynCa older than 18 years or age, race, and BMI matched healthy controls were enrolled. Female Sexual Function Index (FSFI) was used to assess women’s sexual dysfunction. Patients completed all the questionnaires pre-RT, at the end of RT, 6- and 12-month post-RT. Group-based trajectory modeling was used to identify trajectories of sexual dysfunction and risk factors of persistent sexual dysfunction. Results: Eighty-two patients were analyzed, including 36 GynCa patients receiving RT and 46 healthy post-menopausal women, comprising of 33 Blacks, 44 Whites, and 5 others. Three trajectory groups of sexual dysfunction (total FSFI score) were identified: low risk (17.4%), moderate risk (12.3%), and high risk (70.4%). All three trajectory groups were significantly different from each other (p<0.01). Similarly, three trajectories were identified for each of six FSFI domains: desire (low [6.3%], moderate [62.5%], high [31.2%], p<0.01); arousal (low [38.1%], moderate [46.4%], high [15.4%], p<0.01); lubrication (low [49.7%], moderate [44.6%], high [5.7%], p<0.01); orgasm (low [43.8%], moderate [31.3%], high [24.9%], p<0.01); pain (low [25.5%], moderate [64.2%], high [10.3%], p<0.01); and satisfaction (low [8.3%], moderate [61.4%], high [30.3%], p<0.01). Risk factors of sexual dysfunction were high pH (p=0.007) and without chemotherapy (p=0.019). Young women had more arousal (p=0.011); high education level was associated with high arousal (p=0.039); low pH was associated with high arousal (p=0.018) and orgasm (p=0.036). No risk factors were found for desire and satisfaction domains. BMI, surgery, and study cohort (cancer vs healthy) were not predictors of sexual dysfunction trajectories. Conclusions: This study identified three trajectories of sexual dysfunction. Low education, high pH, no chemotherapy, and elder women were risk factors of severe sexual dysfunction. Sexual dysfunction interventions should address these risk factors.

scholarly journals Use of Cesarean Birth among Robson Groups 2 and 4 at Mizan-Tepi University Hospital, Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Margo S. Harrison ◽  
Tewodros Liyew ◽  
Ephrem Kirub ◽  
Biruk Teshome ◽  
Andrea Jimenez-Zambrano ◽  
...  
Keyword(s):  
Risk Factors ◽  
University Teaching ◽  
University Hospital ◽  
Study Cohort ◽  
Convenience Sample ◽  
Cesarean Birth ◽  
Group 4 ◽  
Increased Risk ◽  
Group 2 ◽  
Failed Induction

Background. Primary cesarean birth rates were high among women who were either nulliparous (Group 2) or multiparous (Group 4) with a single, cephalic, term fetus who were induced, augmented, or underwent cesarean birth before labor in our study cohort. Objectives. The objective of this analysis was to determine what risk factors were associated with cesarean birth among Robson Groups 2 and 4. Methods. This study was a prospective hospital-based cross-sectional analysis of a convenience sample of 1,000 women who delivered at Mizan-Tepi University Teaching Hospital in the summer and fall of 2019. Results. Women in Robson Groups 2 and 4 comprised 11.4% (n = 113) of the total population (n = 993). The cesarean birth rate in Robson Group 2 (n = 56) was 37.5% and in Robson Group 4 (n = 57) was 24.6%. In Robson Group 2, of all prelabor cesareans (n = 5), one birth was elective cesarean by maternal request; the intrapartum cesarean births (n = 16) mostly had a maternal or fetal indication (93.8%), with one birth (6.2%) indicated by “failed induction or augmentation,” which was a combined indication. In Robson Group 4, all 4 women delivered by prelabor cesarean had a maternal indication (one was missing data), and 3 of the intrapartum cesareans were indicated by “failed induction or augmentation.” In multivariable modeling of Robson Group 2, having a labor duration of “not applicable” increased the risk of cesarean delivery (RR 2.9, CI (1.5, 5.4)). The odds of requiring maternal antibiotics was the only notable outcome with increased risk (RR 11.1, CI (1.9, 64.9)). In multivariable modeling of Robson Group 4, having a labor longer than 24 hours trended towards a significant association with cesarean (RR 3.6, CI (0.9, 14.3)), and women had a more dilated cervix on admission trended toward having a lower odds of cesarean (RR 0.8, CI (0.6, 1.0)). Conclusion. Though rates of primary cesarean birth among women who have a term, single, cephalic fetus and are induced, augmented, or undergone prelabor cesarean birth are high, those that occur intrapartum seem to be associated with appropriate risk factors and indications, though we cannot say this definitely as we did not perform an audit. More research is needed on the prelabor subgroup as a separate entity.

Sexual health inquiry preferences among gynecologic cancer patients after radiation therapy.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 87-87
Author(s):  
Gerard Edward Heath ◽  
Pamela Fairchild ◽  
Mitchell Berger ◽  
Anagha Tolpadi ◽  
Christina Chapman ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Sexual Dysfunction ◽  
Sexual Health ◽  
Sexual Function ◽  
Cancer Patients ◽  
Gynecologic Cancer ◽  
Healthcare Providers ◽  
Sexual History ◽  
Categorical Variables ◽  
Gynecologic Cancers

87 Background: Following radiation therapy (RT), gynecologic oncology patients report high rates of sexual dysfunction. However, little is known regarding communication of sexual health among these patients and their healthcare providers. The aim of this study was to assess the beliefs/attitudes of patients regarding sexual history taking. Methods: Survey results were obtained from 75 women who presented for follow up care for gynecologic cancers in the radiation oncology department. The surveys assessed patient beliefs about sexual health and its impact on overall quality of life, the role practitioners should play in obtaining an accurate sexual history, and preferences and level of embarrassment regarding sexual history collection. Overall level of sexual functioning was assessed using the Female Sexual Function Index (FSFI). Chi-squared tests were used to analyze categorical variables and logistic regression modeling was used to predict agreement with survey statements. Results: Most subjects were white and married with a mean FSFI score of 9.9 [(SD = 10.3) sexual dysfunction is defined as < 26.5]. 78.7% agreed that sexual function is an important component of overall health, and only 12.0% reported embarrassment about discussing their sexual health with healthcare providers. 62.79% agreed that medical providers should take a sexual history on a regular basis. However, 58.7% and 22.7% of women report never or almost never being asked about their sexual health by their primary care physician or Ob/Gyn, respectively. Approximately two-thirds of women expressed a preference to have a female provider obtain their sexual health history. Conclusions: Gynecologic cancer patients s/p RT report low sexual function scores. A majority agree that sexual function is essential to overall health. They report little embarrassment regarding discussions of sexual health, yet, note limited discussion about the topic with their healthcare providers. This work highlights the need for improvements in communication about sexual health. We suggest that healthcare providers caring for women with gynecologic cancers should more regularly inquire about their patients’ sexual health and function.

New Approach for Evaluation of Quantitative Risk Factors of Venous Thromboembolism Using Individualized Reference Values.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4022-4022
Author(s):  
Rainer B. Zotz ◽  
Andrea Gerhardt ◽  
Rudiger E. Scharf
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Reference Values ◽  
Protein S ◽  
Healthy Controls ◽  
New Approach ◽  
Increased Risk ◽  
Risk Determinants ◽  
Protein S Activity

Abstract The evaluation of quantitative risk factors of venous thromboembolism is characterized by several unsolved problems. The majority of quantitative components of hemostasis are dependent on age, sex, and hormone intake. The cut-off values determined in case-control studies depend on the specific patient/control group and can not be generalized on individuals with other characteristics. Furthermore, the approach does not give reference values dependent on age, sex, and hormone intake which are necessary for risk estimations in clinical practice. To overcome these disadvantages, we used a multiple regression analysis to create a system of reference values which change continuously depending on age, sex, and hormone intake according to the parameter distribution in healthy controls and calculated the relative risk of hemostatic components (729 patients with first VTE and 675 healthy controls). A significantly increased risk for venous thrombosis was associated with deficiency of protein S activity (odds ratio (OR) 2.8 to 6.1, p=0.0007), free protein S concentration (OR 2.7 to 20.4, p=0.0001), protein C activity (OR 3.2 to 9.4, p=0.0001), antithrombin activity (OR up to 75, p=0.0001), and increased levels of fibrinogen (OR 3.8, p=0.0001), factor VIII:C (OR 3.3, p=0.0001), factor IX (OR 2.3, p=0.0001), factor XI (OR 2.9, p=0.0001), vWF activity (OR 2.4, p=0.0001), and vWF antigen (OR 3.5, p=0.0001). In contrast to previously published studies, this new approach gives clinically important cut-off values dependent on age, sex, and hormone intake and allows to identify patients at increased risk for venous thrombosis on an individualized basis. Particularly parameters which are highly dependent on age and sex, like protein S activity, can be characterized more precisely using the described procedure. This comprehensive analysis demonstrates that, apart from well-known risk determinants, deficiency of protein S and increased values of FI, FVIII:C, FIX, FXI, vWF, and vWF-Ag are risk determinants predicting venous thrombosis.

Risk factors of sudden death in young adult patients with myelomeningocele

2012 ◽  
Vol 9 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Sarah C. Jernigan ◽  
Jay G. Berry ◽  
Dionne A. Graham ◽  
Stuart B. Bauer ◽  
Lawrence I. Karlin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sleep Apnea ◽  
Young Adult ◽  
Sudden Death ◽  
Adult Patients ◽  
Csf Shunt ◽  
Study Cohort ◽  
Fisher Exact Test ◽  
Adult Women ◽  
Increased Risk

Object Although survival for patients with myelomeningocele has dramatically improved in recent decades, the occasional occurrence of sudden, unexplained death in young adult patients with myelomeningocele has been noted by the authors. This study was undertaken to determine risk factors for sudden death in this population. Methods The authors performed a retrospective chart review of patients born between 1978 and 1990 who received care at Children's Hospital Boston. The relationship between sudden death and patient demographics, presence of CSF shunt and history of shunt revisions, midbrain length as a marker for severity of hindbrain malformation, seizures, pulmonary and ventilatory dysfunction, body mass index, scoliosis, renal dysfunction, and cardiac disease was evaluated using the t-test, Fisher exact test, and logistic regression analysis. Results The age range for 106 patients in the study cohort was 19–30 years, with 58 (54.7%) women and 48 (45.3%) men. Six patients, all of whom were young women, experienced sudden death. In multivariate analysis, female sex, sleep apnea, and midbrain elongation ≥ 15 mm on MR imaging remained significantly associated with a higher risk of sudden death. These risk factors were cumulative, and female patients with sleep apnea and midbrain length ≥ 15 mm had the greatest risk (adjusted risk ratio 24.0, 95% CI 7.3–79.0; p < 0.05). No other comorbidities were found to significantly increase the risk of sudden death. Conclusions Young adult women with myelomeningocele are at significantly increased risk of sudden death in the setting of midbrain elongation and sleep apnea. Further investigation is needed to determine the benefit of routine screening to identify at-risk patients for closer cardiopulmonary monitoring and treatment.

scholarly journals Lower Extremity Lymphedema in Gynecologic Cancer Patients: Propensity Score Matching Analysis of External Beam Radiation versus Brachytherapy

Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1471 ◽  
Author(s):  
Won Ick Chang ◽  
Hyun-Cheol Kang ◽  
Hong-Gyun Wu ◽  
Hak Jae Kim ◽  
Seung Hyuck Jeon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Laparoscopic Surgery ◽  
Propensity Score ◽  
Lower Extremity ◽  
Cancer Patients ◽  
Gynecologic Cancer ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

The goal of this study is to compare the risk of lower extremity lymphedema (LEL) between pelvic external beam radiation therapy (EBRT) and vaginal brachytherapy, and to identify risk factors for LEL in gynecologic cancer patients treated with adjuvant radiation therapy (RT) after radical surgery. A total of 263 stage I–III gynecologic cancer patients who underwent adjuvant RT were retrospectively reviewed. One-to-one case-matched analysis was conducted with propensity scores generated from patient, tumor, and treatment characteristics. Using the risk factors found in this study, high- and low-risk groups were identified. With a median follow-up of 36.0 months, 35 of 263 (13.3%) patients developed LEL. In multivariate analysis, laparoscopic surgery (HR 2.548; p = 0.024), harvesting more than 30 pelvic lymph nodes (HR 2.246; p = 0.028), and para-aortic lymph node dissection (PALND, HR 2.305; p = 0.014) were identified as independent risk factors for LEL. After propensity score matching, the LEL incidence of the brachytherapy group was significantly lower than the EBRT group (p = 0.025). In conclusion, high-risk patients with risk factors such as laparoscopic surgery, harvesting more than 30 pelvic lymph nodes, PALND, and adjuvant pelvic EBRT require closer observation for LEL.

Variation in the Association between Antineoplastic Therapies and Venous Thromboembolism in Patients with Active Cancer

2020 ◽  
Vol 120 (05) ◽  
pp. 847-856 ◽  
Author(s):  
Michela Giustozzi ◽  
Antonio Curcio ◽  
Bob Weijs ◽  
Thalia S. Field ◽  
Saulius Sudikas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Venous Thromboembolism ◽  
Cause Of Death ◽  
Cancer Diagnosis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Cancer Type ◽  
Increased Risk ◽  
Active Cancer

Abstract Background Venous thromboembolism (VTE) is a major cause of death in cancer patients. Although patients with cancer have numerous risk factors for VTE, the relative contribution of cancer treatments is unclear. Objective The objective of this study is to evaluate the association between cancer therapies and the risk of VTE. Methods From UK Clinical Practice Research Datalink, data on patients with first cancer diagnosis between 2008 and 2016 were extracted along with information on hospitalization, treatments, and cause of death. Primary outcome was active cancer-associated VTE. To establish the independent effects of risk factors, adjusted subhazard ratios (adj-SHR) were calculated using Fine and Gray regression analysis accounting for death as competing risk. Results Among 67,801 patients with a first cancer diagnosis, active cancer-associated VTE occurred in 1,473 (2.2%). During a median observation time of 1.2 years, chemotherapy, surgery, hormonal therapy, radiation therapy, and immunotherapy were given to 71.1, 37.2, 17.2, 17.5, and 1.4% of patients with VTE, respectively. The active cancers associated with the highest risk of VTE—as assessed by incidence rates—included pancreatic cancer, brain cancer, and metastatic cancer. Chemotherapy was associated with an increased risk of VTE (adj-SHR: 3.17, 95% confidence interval [CI]: 2.76–3.65) while immunotherapy with a not significant reduced risk (adj-SHR: 0.67, 95% CI: 0.30–1.52). There was no association between VTE and radiation therapy (adj-SHR: 0.91, 95% CI: 0.65–1.27) and hormonal therapies. Conclusion VTE risk varies with cancer type. Chemotherapy was associated with an increased VTE risk, whereas with radiation and immunotherapy therapy, an association was not confirmed.

scholarly journals A220 A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS OF THE RISK OF ADVERSE NEONATAL OUTCOME IN INFLAMMATORY BOWEL DISEASE AND PREGNANCY

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 94-95
Author(s):  
K Leung ◽  
P Tandon ◽  
V Govardhanam ◽  
C Maxwell ◽  
V Huang
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Preterm Birth ◽  
Bowel Disease ◽  
Neonatal Outcomes ◽  
Healthy Controls ◽  
Increased Risk ◽  
Adverse Neonatal Outcomes ◽  
Inflammatory Bowel ◽  
Active Disease

Abstract Background Inflammatory bowel disease (IBD) often affects women in their child-bearing years. These women may be at an increased risk of adverse neonatal outcomes. Aims The aim of this study was to evaluate the risk of these outcomes in this population of patients, with an emphasis of determining risk factors for development of these conditions. Methods Medline, Embase, and Cochrane library were searched through to May 2019 for studies reporting adverse neonatal outcomes in IBD patients. Weighted odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the risk of these outcomes in patients with IBD compared to healthy controls, with risk factors such as disease activity and medication exposure also being assessed. Results Sixty studies were included (8194 pregnancies with inflammatory bowel disease and 3253 healthy pregnancies). Compared to healthy controls, patients with inflammatory bowel disease were more likely to deliver infants with low birth weight (LBW) (OR 2.78, 95% CI 1.16–6.66) and infants who were admitted to the neonatal intensive care unit (NICU) (OR 3.33, 95% CI 1.83–6.05). Patients with Crohn’s disease had an increased risk of infants born with congenital anomalies (OR 3.03, 95% CI, 1.43–6.42), whereas patients with ulcerative colitis had an increased risk of preterm delivery (OR 2.68, 95% CI, 1.12–6.43). Active disease increased the risk of preterm birth (OR 2.06, 95% CI 1.21–3.51), LBW (OR 2.96, 95% CI 1.54–5.70), and small for gestation age (OR 2.62, 95% CI 1.18–5.83) compared to disease in remission. Tumor necrosis factor antagonists was associated with increased risk of NICU admission (OR 2.42, 95% CI 1.31–4.45) and LBW (OR 1.54, 95% CI, 1.01–2.35). Conclusions Patients with inflammatory bowel disease are at an increased risk of developing adverse neonatal outcomes such as preterm birth, LBW, congenital anomalies, and NICU admissions. Patients with clinically active disease and those exposed to anti-TNF therapy may be at higher risk of developing these adverse outcomes. The findings of this study are important to communicate to patients and healthcare providers alike. Furthermore, this information may help to mitigate these risks through collaborative specialized care during pregnancy in order to reduce the overall morbidity and mortality for both mother and baby. Funding Agencies None

scholarly journals ARE THERE SIDE-TO-SIDE DIFFERENCES IN KNEE MORPHOLOGY IN PATIENTS WITH BILATERAL PATELLAR INSTABILITY

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0011
Author(s):  
Shital Parikh ◽  
Neil Rajdev
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patellar Height ◽  
Intraobserver Reliability ◽  
Study Cohort ◽  
Similar Treatment ◽  
Increased Risk ◽  
Symptomatic Knee

Introduction It is not known if there are side-to-side differences in knee morphology in patients with bilateral patellar instability (BPI). Such knowledge would help to answer the question whether similar treatment and prognosis could be expected for both knees in patients with BPI. The purpose of our study was to evaluate and compare anatomic / morphologic risk factors between knees in patients with BPI. Materials and Methods Of 294 patients who underwent surgical stabilization for patellar instability (2008-2017), 32 patients were identified who underwent staged or simultaneous bilateral surgery. This formed the study cohort. Demographic data, mechanism of initial injury and first knee side to be symptomatic were recorded. Radiographs and MRI of these 64 knees were evaluated for trochlear dysplasia (trochlear depth), patellar height (Caton-Deschamps index, Insall-Salvati ratio), patellar tilt, TT-TG distance, sulcus angle (cartilaginous and bony) and trochlear bump (cartilaginous and bony). The number and percentage of knees with pathologic values for measured risk factors were analyzed. For each risk factor, 15% side-to-side differences were considered significant. Statistical correlation was calculated between the time of presentation (first symptomatic knee) and magnitude of risk factors. All measurements were repeated after a 3-week interval and ICC was calculated to determine intraobserver reliability. Results The mean age of 32 patients was 14.6 years. 17/32 patients were females. 29 patients had staged surgery with mean interval of 21 months between surgeries; 3 patients had simultaneous surgery on each knee. Patients with BPI had multiple risk factors. 22/32 patients (69%) had the same Dejour type of trochlear dysplasia. For each measured risk factor, the number and percentage of patients with 15% or more side-to-side differences is shown (Table 1). There were significant side-to-side differences in patellar height ratios, TT-TG distance, and trochlear bump. The timing of presentation did not correlate with increased risk factors, i.e, the knee that presented earlier did not have increased risk factors compared to contralateral knee. ICC showed excellent intraobserver reliability. Conclusion There were significant side-to-side differences between knees in patients with BPI. Treatment and prognosis should be based on anatomic risk factors for each knee in patients with BPI. [Table: see text]

Stroke Rates and Risk Factors in Patients Treated With Radiation Therapy for Early-Stage Breast Cancer

2006 ◽  
Vol 24 (18) ◽  
pp. 2779-2785 ◽  
Author(s):  
Reshma Jagsi ◽  
Kent A. Griffith ◽  
Todd Koelling ◽  
Rachel Roberts ◽  
Lori J. Pierce
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Radiation Therapy ◽  
Early Stage ◽  
Breast Cancer Patients ◽  
Increased Risk ◽  
Absolute Excess Risk ◽  
Artery Disease

Purpose To examine whether stroke risk is elevated in American breast cancer patients treated with modern techniques, as well as whether supraclavicular radiation therapy (RT) is associated with increased risk. Methods Observed rates of stroke in 820 eligible early-stage breast cancer patients treated at the University of Michigan Hospital (Ann Arbor, MI) were compared with expected rates. Relationships between potential risk factors and actuarial rate of first stroke were analyzed. Results Median follow-up was 6.8 years. Twenty patients had at least one cerebrovascular accident (CVA) in follow-up; 35 patients had at least one CVA or transient ischemic attack (CVA/TIA). The standardized incidence ratios were 1.74 (0.94 to 2.37) for CVA and 1.68 (1.003 to 2.06) for CVA/TIA. The absolute excess risk per 1,000 patients per year was 1.67 for CVA and 2.76 for CVA/TIA. On bivariate analysis, factors significantly associated with actuarial rate of first CVA included hypertension (P = .002), age (P < .0001), coronary artery disease (P = .001), atrial fibrillation (P = .009), and supraclavicular RT (P = .021). Factors associated with CVA/TIA were hypertension (P < .001), coronary artery disease (P = .002), and age (P < .0001). Tamoxifen use alone was not significant (P = .19), but tamoxifen combined with baseline hypertension led to increased risk of CVA/TIA (log-rank P < .0001). On multivariate analysis, only age (P < .001) and hypertension (P = .003) remained significant predictors of CVA/TIA. Age was the only significant predictor of CVA alone (P < .001). Conclusion American breast cancer survivors may have an elevated risk of stroke compared with the general population, but the absolute excess risk is low. This study found no significant association between supraclavicular RT and stroke after controlling for other factors.

Sign in / Sign up

Export Citation Format

Share Document