maj
Anna Norbeck- Institutionen för kliniska vetenskaper, Lund
Title: Impact of perioperative factors in patients with advanced ovarian cancer
Main supervisor: Päivi Kannisto, docent, Lunds universitet
Reviewers: Andrea Stuart, docent, Lunds universitet
Niklas Nielsen, professor, Lunds universitet
Abstract
Background
Ovarian cancer is often diagnosed at an advanced stage. Many patients have anemia preoperatively, with iron deficiency anemia being the most common cause. The surgery is often extensive and with an increased risk of excessive intraoperative blood loss, and as a consequence postoperative anemia. Red blood cell transfusions have an immunosuppressive effect and perioperative transfusions have been shown to be associated with an increased risk of cancer recurrence, morbidity and mortality
Research questions
1. Evaluate the timeline from the first presentation of symptoms to a physician until there is a reasonable suspicion of cancer among women diagnosed with advanced stage ovarian cancer.
2. Evaluate the clinical significance after gradual implementation of new patient blood management clinical routines to the postoperative recovery of patients with advanced ovarian cancer.
3. Investigate if administration of intravenous iron, in patients with iron deficiency, close to surgery could reduce anemia and if there is a difference between patients undergoing primary debulking surgery and interval debulking surgery.
4. Investigate the effect of intravenous iron, administered pre and perioperatively, on muscle strength in patients with iron deficiency undergoing surgery for advanced ovarian cancer.
Preliminary results
1. The time interval from first presentation with symptoms to reasonable suspicion of ovarian cancer was associated with whether the consultation was in primary care or specialized care, emergency or planned visit and the patient’s age.
2. The percentage of transfused patients decreased from 83% to 52%. Severe complications (Clavien Dindo ³ 3a) remained stable during the study period, despite a slight increase of anemia. Length of hospital stay was reduced.
Significance
Ovarian cancer is often diagnosed at a late stage even though most patients have symptoms before diagnosis. Earlier diagnosis could improve the chances of optimal treatment. It’s important to optimize the patient before major surgery and correcting anemia perioperatively can facilitate and improve patient recovery.
Published studies
Norbeck A, Asp M, Carlsson T, Kannisto P, Malander S. Age and Referral Route Impact the Access to Diagnosis for Women with Advanced Ovarian Cancer. J Multidiscip Healthc. 2023 May 3;16:1239-1248.
Submitted manuscript
Norbeck A, Bengtsson J, Malander S, Asp M, Kannisto P. Safe to save blood in ovarian cancer surgery - time to change transfusion habits.
Om evenemanget
Plats:
Föreläsningssalen KK vån 3, SUS Klinikgatan 12 Lund
Kontakt:
anna [dot] norbeck [at] med [dot] lu [dot] se