Impact of risk factors, early rehabilitation and management of lymphedema associated with breast cancer: a retrospective study of breast Cancer survivors over 5 years.

BACKGROUND: Breast cancer-related lymphedema (BCRL) is a potentially disabling and often irreversible consequence of breast cancer treatment, caused by the mechanical incompetence of the lymphatic system, resulting in reduced drainage capacity and functional overload due to an excessive volume of interstitial fluid surpassing the system's transport capacity in the arm. We wanted to determine the impact and explore the differences in independent risk factors for the occurrence of BCRL; incidence of BCRL over a five-year period at the Institute of Oncology Vojvodina in Sremska Kamenica and to answer the research question regarding the influence of the prehabilitation program on the overall incidence of BCRL during the observed five-year period. METHODS: From 2014 to 2018, a retrospective study was conducted at the Institute of Oncology of Vojvodina in Sremska Kamenica, analyzing female patients who had undergone breast cancer surgery. RESULTS: The study included 150 breast cancer patients who developed secondary lymphedema following surgery with the mean age of 59.2 ± 11.3 years. Fluctuations in hospitalization rates were observed over the five-year period, with the highest number of admissions in 2014 (24.0%) and a decline in 2018 (14.0%). The most common surgical procedure performed was left quadrantectomy (24.0%), followed by right quadrantectomy (20.0%) and left amputation (15.3%). The mean number of removed lymph nodes was 15.2 ± 6.1, with no statistically significant association between the number of removed lymph nodes and the manifestation of secondary lymphedema. The severity of secondary lymphedema varied based on patient age, with a higher incidence of moderate and severe lymphedema observed in patients aged 61 years and older. Patients who underwent radical surgery were more likely to experience severe lymphedema compared to those who had conservative surgery, although this difference was not statistically significant. CONCLUSION: In our study, the type of surgery, elapsed time since surgery, and the number of removed lymph nodes were not influencing factors for the occurrence of BCRL. However, concerning its severity, a greater number of systemic therapy modalities combined with radiotherapy were associated with a more frequent occurrence of mild and moderate BCRL. Also, the severity of BCRL varied among different age groups, with a higher incidence of moderate and severe lymphedema observed in patients aged 61 years and older. Ultimately, improving the quality of life for individuals affected by secondary lymphedema remains a crucial goal in the field of oncology.

The Role of Resilience in the Relationship between Sociodemographic, Clinical Characteristics, and Social Support among Breast Cancer Patients in Serbia.

BACKGROUND: The management of breast cancer treatments within the limitations of family, social, and professional life is emotionally burdening and negatively affects physical, psychological, and social well-being, reducing the overall quality of life of patients and their families. METHODS: This cross-sectional descriptive-analytical study was conducted from March to August 2023 at the "Dr. Radivoj Simonovic" General Hospital in Sombor. A total of 236 breast cancer patients participated in this study. The research was conducted using the following instruments: a questionnaire on sociodemographic and clinical characteristics of patients, the Berlin Social-Support Scales-for assessing social support-and the Connor-Davidson Resilience Scale-for assessing resilience. This study aimed to determine the predictors and levels of social support and resilience of breast cancer patients. We also wanted to examine whether resilience is a mediator between patients' sociodemographic and clinical characteristics and levels of social support. RESULTS: The total average value of social support was 3.51 ± 0.63, while on the resilience scale, the respondents achieved a total average score of 52.2 ± 9.63. Perceived and actually received social support of breast cancer patients were positively correlated with resilience [p < 0.01], while no statistically significant correlations were found for the need for support and satisfaction. The sets of predictors can significantly predict their effects on all types of perceived social support (emotional social support: 9%; perceived instrumental social support: 9%) and all types of received social support (actually received emotional social support: 8%; actually received instrumental social support: 7%; actually received informational social support: 8%). There is a potential mediating role of resilience in relation to sociodemographic factors, clinical characteristics, and the need for support. CONCLUSION: This study confirms that a strong connection exists between social support and resilience. However, the analysis did not confirm the mediating role of resilience between the sociodemographic and clinical characteristics on the one hand and social support on the other.

Direct antiglobulin test positivity in Serbian blood donors in the era of gel card technology.

BACKGROUND AND OBJECTIVES: In the era of gel cards, we aimed to determine the incidence of a positive direct antiglobulin test (DAT) in a population of blood donors in Serbia and to compare results with the period when a conventional tube technique was used. MATERIALS AND METHODS: A retrospective study was conducted on 184,171 blood donors over 10 years (2012-2021). Positive DAT results initially were detected after positive result of the compatibility test. After a DAT had been initially performed on fresh blood samples, a control DAT was performed 6 months later. RESULTS: Using gel cards, we found a low incidence (0.09%) of DAT positivity among 55,254 female and 128,917 male blood donors, with no difference found in the occurrence of a positive DAT between them. Positive DAT moderately positively correlated with increasing age of blood donors, but without statistical significance. The vast majority of blood donors (98.86%) were IgG positive. All donors were in good health, did not take medication or had anaemia or haemolysis. During the period 1980-1989, when the test tube technique was used, we found 0.05% DAT-positive blood donors. CONCLUSION: The incidence of positive DAT results in Serbian blood donors is higher compared with that found using the previous test tube technique, but the incidence is consistent with the findings of other studies.

Cervical Cancer Prevention Knowledge (Cckp-64) among Female Students in Novi Sad, Serbia during COVID-19 Pandemic.

Cervical cancer is a significant global health concern affecting young women, with over 500,000 new cases reported annually. This questionnaire-based study aimed to evaluate the knowledge of cervical cancer prevention among female students at the University of Novi Sad during the COVID-19 pandemic using the Cervical Cancer Knowledge Prevention-64 (CCKP-64) tool. The study sample consisted of 402 predominantly 20-22-year-old female students from either social or technical science faculties in urban environments. Results revealed that out of the 402 female students involved in the study, most had a good general knowledge of primary prevention of cervical cancer, with a correct answer rate ranging from 29.9 to 80.6%. On the contrary, only 63.4% of female students have heard about the vaccine against cervical cancer; 52.0% know that the vaccine exists in Serbia; and 31.8% know where to get vaccinated. Only a small proportion of students (9.7%) have encountered cervical cancer among their relatives/friends and think that the disease could affect them in the future (25.4%). Older students (>26 years) generally (p < 0.05) had better knowledge regarding distressing symptoms of cervical cancer, cytological examination and secondary prevention; however, it was also noted that a significant percentage of this age group reported not having received vaccinations (53.0%, p = 0.001). This study underscores the need for increased awareness and education about the HPV vaccine and secondary prevention among young women in Serbia. Future research should investigate knowledge and attitudes toward cervical cancer prevention in diverse populations to develop effective interventions and strategies. These findings have implications for public health policies in Serbia to promote cervical cancer prevention among young women.

COVID-19-Related Stress, Fear and Online Teaching Satisfaction among Nursing Students during the COVID-19 Pandemic.

The COVID-19 pandemic has had a significant impact on mental health, particularly among students, due to COVID-19-related fear and also the transition from traditional to online lectures. In this questionnaire-based study, the COVID-19 Stress Scales (CSS), the Fear of COVID-19 Scale (FCV-19S), and the Online Teaching Satisfaction Scale were used to assess COVID-19-related fear, stress, and overall satisfaction with online teaching during the COVID-19 pandemic among nursing students in Serbia. A total of 167 students participated in the study, whose mean age was 21.3 ± 5.3, and the majority of whom were female and first-year students. Overall, most students experienced moderate to extremely high COVID-19-related stress levels. Overall, first-year and fourth-year students scored significantly lower regarding the Xenophobia and Traumatic stress subscales than second-year and third-year students, whereas first-year students also scored significantly lower on the Danger and Contamination subscales. First-year students experienced less COVID-19-related fear compared to senior students. Students were reasonably satisfied with online teaching. A stratified program is needed to prevent further decline of students' mental health and to improve their adaptation through public, health, and educational changes.

Neoadjuvant chemotherapy in locally advanced cervical cancer in pregnancy-Review of the literature.

Cervical cancer is the third most common malignancy in pregnancy. Pregnancy does not have a detrimental effect on the survival of patients with cervical carcinoma. Management of cervical carcinoma in pregnancy depends on the stage of the disease, tumor size, nodal status, pathohistological characteristics of the tumor, the gestation of pregnancy, age and parity of patient and her motivation to preserve the pregnancy. In pregnant patients with the locally advanced cervical carcinoma (LACC) and strong desire to continue the pregnancy, the neoadjuvant chemotherapy (NACT) could be the option to preserve pregnancy while having cancer under the control. The goal of NACT in treatment of LACC in pregnancy is: 1. To treat, stabilize and prevent further dissemination of the disease until the term 2. To decrease the volume and extent of the tumor, making it more operable or radiosensitive after delivery 3. To effect on lymph node metastasis and distant micrometastasis during pregnancy Chemotherapy should not be applied during the organogenesis, before 10th, preferably 14th week of gestation. Administration of chemotherapy after the first trimester is not related tothe increased number of congenital malformations. If applied in the second or third trimester, chemotherapy is connected withfetal growth restriction, low birth weight, and preterm labor. Since data on safety and efficacy of NACT in LACC in pregnancy are still limited and based on a low level of evidence from 37 cases known so far, this treatment modality should remain experimental and reserved to highly motivated patients wishing to preserve the pregnancy.

Clinical and genetic landscape of treatment naive cervical cancer: Alterations in PIK3CA and in epigenetic modulators associated with sub-optimal outcome.

BACKGROUND: There is a lack of information as to which molecular processes, present at diagnosis, favor tumour escape from standard-of-care treatments in cervical cancer (CC). RAIDs consortium (www.raids-fp7.eu), conducted a prospectively monitored trial, [BioRAIDs (NCT02428842)] with the objectives to generate high quality samples and molecular assessments to stratify patient populations and to identify molecular patterns associated with poor outcome. METHODS: Between 2013 and 2017, RAIDs collected a prospective CC sample and clinical dataset involving 419 participant patients from 18 centers in seven EU countries. Next Generation Sequencing has so far been carried out on a total of 182 samples from 377 evaluable (48%) patients, allowing to define dominant genetic alterations. Reverse phase protein expression arrays (RPPA) was applied to group patients into clusters. Activation of key genetic pathways and protein expression signatures were tested for associations with outcome. FINDINGS: At a median follow up (FU) of 22 months, progression-free survival rates of this FIGO stage IB1-IV population, treated predominantly (87%) by chemoradiation, were65•4% [CI95%: 60•2-71.1]. Dominant oncogenic alterations were seen in PIK3CA (40%), while dominant suppressor gene alterations were seen in KMT2D (15%) and KMT2C (16%). Cumulative frequency of loss-of-function (LOF) mutations in any epigenetic modulator gene alteration was 47% and it was associated with PIK3CA gene alterations in 32%. Patients with tumours harboring alterations in both pathways had a significantly poorer PFS. A new finding was the detection of a high frequency of gains of TLR4 gene amplifications (10%), as well as amplifications, mutations, and non-frame-shift deletions of Androgen receptor (AR) gene in 7% of patients. Finally, RPPA protein expression analysis defined three expression clusters. INTERPRETATION: Our data suggests that patient population may be stratified into four different treatment strategies based on molecular markers at the outset. FUND: European Union's Seventh Program grant agreement No 304810.

Cyclooxygenase-2 expression in cervical cancer.

BACKGROUND/AIM: Cyclooxygenase (COX) or prostaglandin H2 synthase is the first enzyme that catalyzes the first two steps in the biosynthesis of prostaglandins from arachidonic acid. The aim of the study was to determine the expression level of COX-2 in patients with cervical cancer and compare it with that in the control group with no cervical pathology. METHODS: The study included 76 patients divided into two groups: the control group--30 patients without histopathological changes and the group A--46 patients with cervical cancer, FIGO stage IB-IIA. Histopathological and immunohistochemical analyses were performed in these two groups of patients. RESULTS: In the control group, the expression of COX-2 was not confirmed compared to the group A of 26 (56.52%) patients. The expression of COX-2 showed a statistically significant difference in the presence oflymphocytic stromal infiltration (p = 0.0053). The expression of COX-2 was more pronounced in the stromal tissue without lymphocytic infiltration (80% vs. 20%). CONCLUSION: A higher expression of COX-2 in cervical carcinoma without stromal lymphocytic infiltration suggests a possible paradoxical effect of COX-2 in immunosuppression. Frequent COX-2 expression in the subgroup with poor prognostic histological parameters in the group A indicates the importance of COX-2 expression in the carcinogenesis of cervical cancer.

Information sources for Serbian women on cervical carcinoma risk factors.

BACKGROUND: The epidemiological situation regarding cervical carcinoma in Serbia is rather unfavorable and one of contributing factors is the insufficient interest of women concerning the risk factors responsible for occurrence of this disease. The aim of this study was to determine the sources of relevant information for women METHODS: An anonymous questionnaire was used for questioning of patients, students and women undergoing systematic examinations. There were 600 women in total in 2006, 2009 and 2010, and the data were statistically processed by the χ 2 test with Yates correction and the Fisher test. RESULTS: When observed for certain groups of tested women, and summed up for all three periods, there was a statistically significant difference for the answer "without any knowledge" (p=0.0001). When observed for certain years and summed up for all three tested groups, there was a statistically significant difference in answers regarding the source of information, the "doctor" (p=0.0011), "media" (p=0.0349) and "encyclopedia-internet" (p=0.0136). CONCLUSION: The media are a dominant source of information for women on risk factors for cervical cancer. The significance of the Internet increased during the three observed periods, while the students considered themselves least informed of all concerning risk factors.

[Linear trend in patients with ovarian cancer in period 2001-2008 at Oncology Institute of Vojvodina].

INTRODUCTION: Ovarian cancer is one of the leading health problems, as it is the underlying cause of disease and deaths of a large number of women around the world. Postmenopausal female population, in whom ovarian carcinoma is most often diagnosed in advanced stages of the disease, is primarily affected. MATERIAL AND METHODS: We used data from Hospital Registry for Malignant Neoplasms at Oncology Institute of Voijvodina for the period from 2001 to 2008, according to which 422 cases of ovarian carcinoma were reported. The obtained data were classified into three groups according to FIGO classification of ovarian malignant neoplasms. The statistical assessment of data employed the method of linear trend and tests of statistical significance (t-test). RESULTS: The results of our study showed that most cases of diagnosed disease were advanced forms of ovarian cancer, FIGO stages II and IV. The linear trend of the reported cases in stage 1 for the period 2001/2008 showed a descending trend. According to the processed data, in the same period of time, stage II showed an ascending trend, while stages III and IV described together showed a moderate ascending linear trend. CONCLUSION: A vast majority of cases of ovarian cancer are detected in advanced stages of the disease, which is at the same time the group with the worst prognosis. Special attention should be paid to the group of patients with positive family history, as well as the presence of BRCA 1 and BRCA 2 genetic mutations. Currently existing diagnostic procedures have not given good results individually in terms of high sensitivity for diagnosis of early stages.