A Manifesto on the Preservation of Sexual Function in Women & Girls with Cancer

Malignancies that affect females who survive cancer commonly originate in, invade, and/or metastasize to the sexual organs, including the ovaries, uterine corpus, uterine cervix, vagina, vulva, fallopian tubes, anus, rectum, breast(s), and brain. Females comprise most of the population (in number and proportion) with cancers that directly affect the sexual organs. Most females in the age groups most commonly affected by cancer are sexually active in the year before diagnosis, which includes most menopausal women who have a partner. 

Among female cancer survivors, the vast majority have cancers that are treated with local or systemic therapies that result in removal, compromise, or destruction of the sexual organs. Additionally, female cancer survivors often experience abrupt or premature onset of menopause, either directly with surgery, radiation, or other treatments or indirectly through disruption of female sex hormone or other neuroendocrine physiology. 

For many female patients, cancer treatment has short-term and long-lasting effects on other aspects of physical, psychological, and social functioning that can interfere with normal sexual function; these effects include pain, depression, and anxiety; fatigue and sleep disruption; changes in weight and body image; scars, loss of normal skin sensation, and other skin changes; changes in bodily odors; ostomies and loss of normal bowel and bladder function; lymphedema, and strained intimate partnerships and other changes in social roles. 

In spite of these facts, female patients who are treated for cancer receive insufficient counseling, support, or treatment to preserve or regain sexual function after cancer treatment.

Below:  Interactive biopsychosocial model of sexuality

Interactive Biopsychosocial Model of sexuality in the context of cancer, with examples in each domain that influence sexuality.

Full article at:   http://goo.gl/bL4EDW

By:    Stacy Tessler Lindau, MD, MAPP, Emily M. Abramsohn, MPH, and Amber C. Matthews, BA

Departments of Obstetrics and Gynecology (Dr Lindau, Ms Abramsohn, and Ms Matthews, https://obgyn.uchicago.edu/) and Medicine-Geriatrics (Dr Lindau), University of Chicago, Chicago, IL.

Corresponding author: Stacy Tessler Lindau, MD, MAPP. Email: ude.ogacihcu@uadnils

Am J Obstet Gynecol. 2015 Aug; 213(2): 166–174.

Published online 2015 Mar 25. doi:  10.1016/j.ajog.2015.03.039

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The Spectrum of Malignancies among Adult HIV Cohort in Poland between 1995 and 2012: A Retrospective Analysis of 288 Cases

The aim of the study was to evaluate the spectrum of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs) in HIV-infected patients in Poland.

A retrospective observational study was conducted among HIV-infected adult patients who developed a malignancy between 1995 and 2012 in a Polish cohort. Malignancies were divided into ADMs and NADMs. Non-AIDS-defining malignancies were further categorised as virus-related (NADMs-VR) and unrelated (NADMs-VUR). Epidemiological data was analysed according to demographic data, medical history, and HIV-related information. Results were analysed by OR, EPITools package parameters and Fisher's exact test.

Results: In this study 288 malignancies were discovered. The mean age at diagnosis was 41.25 years (IQR20-81); for ADMs 38.05 years, and for NADMs-VURs 46.42 years; 72.22% were male, 40.28% were co-infected with HCV. The risk behaviours were: 37.85% IDU, 33.33% MSM, and 24.31% heterosexual. Mean CD4+ at the diagnosis was 282 cells/mm³ (for ADMs 232 and for NADMs-VUR 395). Average duration of HIV infection at diagnosis was 5.69 years. There were 159 (55.2%) ADMs and 129 (44.8%) NADMs, among whom 58 (44.96%) NADMs-VR and 71 (55.04%) NADMs-VUR. 

The most frequent malignancies were: NHL (26.39%), KS (17.01%), ICC (11.81%), HD (7.99%), lung cancer (6.25%) and HCC (4.86%). The amount of NADMs, NADMs-VURs in particular, is increasing at present. Male gender, advanced age: 50–60 years and ≥ 60 years, longer duration of HIV-infection and successful HAART were independent predictors of NADMs overall, respectively.

Conclusions

In a Polish cohort NHL was the most frequent malignancy among ADMs, whereas HD was the most frequent among NADMs. Increased incidence of NADMs appearing in elderly men with longer duration of HIV-infection and with better virological and immunological control was confirmed. As HIV-infected individuals live longer, better screening strategies, especially for NADMs-VUR, are needed. The spectrum of cancer diagnoses in Poland currently does not appear dissimilar to that observed in other European populations.

Below:  Estimated prevalence of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs). The latter are divided into virus related (NADMs-VR) and virus unrelated (NADMs-VUR) over the presented periods of time

Full article at: http://goo.gl/unAlxb

By:  Jacek Kowalski,1 Grażyna Cholewińska,1 Karolina Pyziak-Kowalska,1 Elżbieta Jabłonowska,2 Grażyna Barałkiewicz,3Anna Grzeszczuk,4 Magdalena Leszczyszyn-Pynka,5 Anita Olczak,6 Maria Jankowska,7 Tomasz Mikuła,8 Monika Bociąga-Jasik,9 Ewa Firląg-Burkacka,8 and Andrzej Horban8

¹Hospital for Infectious Diseases in Warsaw, Warsaw, Poland

²University of Lodz, Lodz, Poland

³Poznan University of Medical Sciences, Poznan, Poland

⁴Medical University of Bialystok, Bialystok, Poland

⁵Pomeranian Medical University, Szczecin, Poland

⁶Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland

⁷Medical University of Gdansk, Gdansk, Poland

⁸Medical University of Warsaw, Warsaw, Poland

⁹Jagiellonian University Medical College, Krakow, Poland

Corresponding author.

Address for correspondence: Jacek Kowalski, Hospital for Infectious Diseases in Warsaw, Wolska 37, 01-201 Warsaw, Poland. e-mail:moc.liamg@2891ikslawokkecaj

 

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Malignancies in HIV/AIDS: From Epidemiology to Therapeutic Challenges

Via: ht.ly/PV5hP  HT @RushMedical

The incidence of AIDS-defining cancers (ADCs) -- Kaposi sarcoma, primary central nervous system lymphoma, non-Hodgkin lymphoma, and cervical cancer -- although on the decline since shortly after the introduction of highly active antiretroviral therapy (HAART), has continued to be greater even in treated HIV-infected persons than in the general population. While the survival of newly infected people living with HIV/AIDS now rivals that of the general population, morbidity and mortality associated with non-AIDS-defining cancers (NADCs) such as lung, liver, anal and melanoma are significant and also continue to rise. Increasing age (i.e., longevity) is the greatest risk factor for NADCs, but longevity alone is not sufficient to fully explain these trends in cancer epidemiology. In this review, we briefly review the epidemiology and etiology of cancers seen in HIV/AIDS, and in this context, discuss preclinical research and broad treatment considerations. Investigation of these considerations provides insight into why malignancies continue to be a major problem in the current era of HIV/AIDS care.

Below:  Summary of AIDS-defining cancers (ADC) and non-AIDS-defining cancer (NADC) etiology in the context of HIV and HAART