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CONTEXT: Vulvar cancer is one of the uncommon gynecological malignancies. Multimodality treatment with surgery, radiotherapy, and chemotherapy are required for treatment of the disease. AIMS: The aim of the study was to evaluate clinical outcome in patients of carcinoma vulva, treated at our institution. SUBJECTS AND METHODS: This was a retrospective-cohort study done in 50 patients with squamous cell carcinoma of the vulva, treated at our institution from January 2008 to December 2014. Data were analyzed on the basis of age, stage, type of treatment received, and treatment-related toxicity. Disease-free survival and overall survival were estimated. STATISTICAL ANALYSIS USED: Kaplan-Meier survival analysis and Chi-square test were used for statistical analysis. RESULTS: Majority of the patients (52%) had presented with Stage III disease. Thirty-six of 50 patients underwent surgery: simple vulvectomy - 2, radical vulvectomy - 34, bilateral inguinal lymph node dissection was done in 32 patients, and 1 patient underwent ipsilateral-inguinal lymph node dissection. Among 40 patients who received radiotherapy and eight patients received palliative radiotherapy. Seventeen patients underwent intensity-modulated radiotherapy (IMRT) and 15 patients received conventional radiotherapy. Significantly less Grade 2 or more skin toxicity (P = 0.003) observed in patients who underwent IMRT. Among non-IMRT group, eight patients required treatment break during radiation. At a median follow-up time of 25.5 months, median overall survival was 31 months and median disease-free survival was 25 months. About 42% patients were alive and free of disease at last follow-up. CONCLUSIONS: Modified radical vulvectomy with inguinal lymph node dissection followed by radiotherapy is the mainstay of management of locally advanced carcinoma vulva. Using IMRT, we could minimize the treatment related radiation toxicity and treatment breaks.
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CONTEXT: Deterioration in mental health and poor quality of life (QOL) among women suffering from breast and ovarian cancer is not a direct result of the illness but mediated by many other psychosocial variables. AIMS: The study intended to examine if there was any effect of educational level, residential status, family type, duration of treatment, and income level of family on anxiety, depression, and QOL among the breast and ovarian cancer patients, undergoing second- or subsequent-line chemotherapy. SUBJECTS AND METHODS: Forty married female cancer patients with breast and ovarian cancer, aging between 40 and 60 years, education level ranges from no formal education to postgraduate degree, income level ranges from Rs. 1000 per month to Rs. 20000 per month, and undergoing second- or subsequent-line chemotherapy for the past 1-10 years were studied. Levels of anxiety and depression were determined by Hospital Anxiety and Depression Scale. The QOL was measured by using WHO QOLBREF scale. STATISTICAL ANALYSIS USED: Mean and standard deviation and Levene's F values were calculated. If Levene's F value was significant, then Mann-Whitney U-test was done or else independent samples t-test was used. RESULTS: Among all the variables, education, residential status, and income affect significantly on anxiety, depression, and QOL. CONCLUSIONS: Early detection of psychosocial variables is essential for better screening of the cancer patients undergoing chemotherapy, and therefore, further psychological intervention can be planned accordingly.
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CONTEXT: Cancer patients receiving chemotherapy for their recurrent disease often report the presence of anxiety and depression. AIMS: In the study, we intended to find out the mental health status and overall quality of life (QOL) of such patients and to identify the effect of supportive psychotherapy. SUBJECTS AND METHODS: Forty cancer patients undergoing second or subsequent line chemotherapy(CCT) were selected for psychotherapy session. Pre- and post-psychotherapy evaluation of anxiety and depression was determined by hospital anxiety depression scale. The QOL was measured before and after psychotherapy sessions by using WHO QOL-BREF scale. STATISTICAL ANALYSIS USED: Statistical analysis was done by paired t-test, using SPSS V.20. RESULTS: Among 40 patients, 17 patients had breast cancer, and the remaining had ovarian cancer. All breast cancer and 19 ovarian cancer patients were receiving 2nd line CCT. Four ovarian cancer patients were undergoing 3rd line CCT. Results indicated that mean scores (± standard deviation) of anxiety 13.95 (±4) and depression 15.5 (±4.4) both exceeded the cut-off score of 11 and mean score of QOL physical health 29.77 (±10.1), psychological health 31.3 (±10.1), social relationship 35.1 (±9.6), and environmental condition 25.9 (±9.9) was below cut-off score of 60. After psychotherapy, there was significant reduction in anxiety (P < 0.01), depression (P < 0.01) and improvement on QOL physical heath (P = 0.02), psychological health (P < 0.01), environmental condition (P < 0.01), and social relationship (P < 0.01). CONCLUSIONS: Supportive psychotherapy helps to reduce the level of anxiety, depression, and increase the QOL. Therefore, psychotherapeutic intervention should be encouraged along with chemotherapy to promote positive mental health and to obtain full benefit of their physical treatment.
