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A Multicenter Randomised Controlled Study

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A Multicenter Randomised Controlled Study

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Introduction
The main aim of this article is to reflect on ovarian cancer, its prevalence or incidence in Australia and USA. It also provides the treatment and prevention of ovarian cancer. Webb, management, and Jordan (2017) suggested that ovarian cancer was listed seventh most common cancer in women globally with 240,000 new cases in 2012.
Definition
Ovarian cancer is a life-threating disease, with only 30%of cure rate (Lengyel, 2010). Ovarian Cancer arises when atypical cells in a fallopian tube, an ovary in an uncontrolled way. These ovaries are in pair found in the uterus of the female reproductive system (Cancer Australia, 2018). There are three possible sites of ovarian cancer originations: the fallopian tube, the surfaces of the ovary, or the mesothelium-lined peritoneal cavity (Lengyel, 2010). Older age, family background of ovarian cancer, use of oral contraceptive pills and smoking are some important risk factors for ovarian cancer (Jones et al., 2010. Morch, Lokkegard, Andreasen, Kruger-Kjearr, and Lidegaard (2009) concluded that combined hormone therapy (types of regimes, routes of administration, progestin types, doses amount, and length of use) and estrogen therapy have increased the risk of ovarian cancer. Abdominal bloating, mysterious weight gain or weight loss, changes in bowel system, changes in the monthly cycle, tiredness, backache are the main symptoms of ovarian cancer (Jones et al., 2010).

Prevalence of Ovarian Cancer in United States of America (USA)
The research conducted by American Cancer Society stated that 21,550 new cases of epithelial ovarian cancer and 14,600 deaths related to ovarian cancer in 2009 (Lengyel, 2010). The overall rate was 16.2 per 100,000 and the medium age of ovarian cancer was 60 in USA (Arab et al., 2010). Arab et al. (2010) concluded that life expectancy is higher in USA so the medium age for ovarian cancer in USA is higher than other parts of world. “The 5-year survival rate for patients with ovarian cancer is only 35%” (Su et al., 2012, p. 1).
Prevalence of Ovarian Cancer in Australia
In 2006, ovarian cancer is the ninth most common type of cancer in Australia, 1226 cases were detected (Jones et al., 2010). Most ovarian cancer is developed at the age of 50 whereas 64 is the median age of ovarian cancer among Australian women. Almost 15% of deadly ovarian carcinoma developed with the inheritance of a muted gene (Jones et al., 2010). Cancer Australia (2018) stated that the chances of survival among Australian women with ovarian (2009-13) were 44.4%. The prevalence of ovarian cancer was 3,980 at the end of 2012. The number of deaths had reached 460 to 960 (1968-2015) from ovarian cancer in Australia (Cancer Australia, 2018).

Factors

Number of percentage

Ovarian cancer diagnosed in 2018

1613 females

Estimated number of death from ovarian cancer

1069 females

Chances of surviving with ovarian cancer for at least 5 years

44.4%

People living with ovarian cancer in 2012

3,980 females

Table: Ovarian cancer statistics in Australia
Source: Australian Government – Cancer Australia (2018)

Prevention and treatment of Ovarian Cancer
Ovarian cancer can be treated by surgery, chemotherapy, radiotherapy, hormone therapy, follow-up with Dr (Cancer Australia, 2018). The role of surgery and chemotherapy are highlighted below.
Surgery
The treatment of ovarian cancer relies on the stage of diseases, the severity of disease, and location of cancer (Cancer Australia, 2018). Surgery is an initial treatment of ovarian cancer when most of the cancer cell, tissues, and organs are removed as much as possible, followed by chemotherapy. Finch et al. (2009) found that surgery has a significant impact on the treatment of ovarian cancer. 127 women who carry mutation BCRA1 or BCRA2 genes in their ovaries and fallopian tubes were surveyed (Finch et al., 2009). It was found that the risk of ovarian cancer was 55% prior to surgery and it dropped down to 11% after surgery (Finch et al., 2009). The early stage of ovarian cancer is generally removed laparoscopy, it involves small cuts in the abdominal wall (Cancer Australia 2018). Cytoreductive surgery is largely practised in the initial phase of ovarian cancer (Van et al., 2014).
Chemotherapy
The majority of women with ovarian cancer undergo both surgery and adjuvant chemotherapy to eliminate remaining cancer cells after surgery (Cancer Australia, 2018). Women with stage III and IV undergo chemotherapy to shrink the cancer cell prior to surgery (Cancer Australia, 2018). Almost 90% of women with ovarian cancer experience nausea, pain, and difficulty sleeping receiving chemotherapy (Newton et al., 2011).
Early screening of ovarian Cancer
According to Ali (2018), ovarian cancer is one of the leading causes of death among other gynaecological cancers. Till date there is no specific or reliable screening technique for detecting ovarian cancer. The risk factors of ovarian cancer include non-modifiable and modifiable factors. The main goal of ovarian cancer prevention strategy management is to significantly decrease the risk of developing ovarian cancer. Quinn et al. (2013) stated that one of the important approaches towards treating ovarian cancer is its early detection and simultaneous prevention. According to Professor Jacobs, “Today, for the first time, results have shown that this screening strategy can save lives”. Here the screening strategy means early detection of ovarian cancer (Ovarian Cancer Australia, 2015). The use of non-surgical preventive approaches like parity, contraceptives and breastfeeding has been shown to be highly preventive against the development of ovarian cancer. Targeting inflammation is also reported to one of the effective preventive approaches against ovarian cancer and can be achieved either via the use of non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or via lifestyle modifications and/or amalgamation of both. Lifestyle modification mainly includes healthy diet supplemented with anti-oxidants and regular exercise. Surgical protective approaches include hysterectomy, prophylactic bilaterial salpingo-oophorectomy and tube ligation. Another drug which is frequently used for treating and simultaneous prevention of ovarian cancer is metformin. Metformin, which is mainly used to treat type 2 diabetes mellitus, works via adenosine mono-phosphate dependent kinase (AMPK) pathway which helps to decrease the incidence of ovarian cancer (Quinn et al., 2013). Ali (2018) is of the opinion that a better understanding of the risk factors associated with the development of ovarian cancer along with the current preventive approaches may increase the disease awareness and at the same time will help to decrease the rate of occurrence of ovarian cancer. These preventive strategies will also help to increase the survival rate by 5 years along with significant decrease in mortality rate among the general group of population especially those who are highly susceptible towards the development of ovarian cancer.

Health Care Professionals in Ovarian Cancer
Surgical oncologists are surgeons who dedicate their significant among of time towards studying and subsequent treatment of malignant neoplastic disease. An ideal surgical oncologist must possess required skills, knowledge and clinical experience to perform both extra-ordinary as well as standard surgical procedures important for the ovarian cancer patients or other patients with malignant tumour. Surgical oncologists must be capable of diagnosing malignant tumours accurately while differentiating aggressive neoplastic lesions from benign reactive processes (Vinotha et al., 2016). Moreover, surgical oncologists must have a detailed understanding about the oncology, radiation oncology, haematology and medical oncology (Are et al., 2013). They are also required to organize interdisciplinary studies in the domain of cancer. An ideal surgical oncologist must also have clear knowledge about pathology which is crucial to take decision in the domain of adequacy of surgical margins (Raphael et al., 2003). According to DiSaia et al. (2017), a surgical oncologists share role with medical oncologist as primary care physicians for successful cancer treatment.
Rehabilitation therapists in ovarian cancer treatment
Ovarian cancer and its treatment have major impact on the ability of patient to carryout daily living activities like moving, eating, speaking, drinking and engaging in sexual activities. The role of rehabilitation therapists is to maximize the physical function of an ailing person surviving from cancer and thereby promoting independence and assistance to successfully adopt with the condition. One of the important allied health professional in ovarian cancer is rehabilitation professional (Faithfull et al., 2016). A rehabilitation professionals support a patient during the treatment of ovarian cancer via conducting therapeutic exercises along with neuromuscular training. It helps to build strength along with energy so that the patient can continue to participate in daily living activities. Rehabilitation therapist provides non-invasive electronic stimulation of the nervous stimulation that help to increase tactile sensory functions along neuronal awareness and thereby causing reduction on the neuropathy caused via the side-effects of chemotherapy. Throughout the treatment of the ovarian cancer, the rehabilitation therapists consult regularly with other members of multidisciplinary team and thereby helping to improve patient’s physical and mental well-being (Cancer Treatment Centres of America, 2018).
Impact of ovarian cancer on community
Ovarian cancer is particularly challenging for women in both physical and on psychological grounds. Moreover, the nature of the disease, cost of treatment, fatal outcomes aggressive therapy along with perceived loss of femineity also known to cats a huge impact on the family members and this again cast a negative impact over the society. The detection of ovarian cancer and its aggressive therapy can cast a huge financial burden over the entire family which hampers their steady social life and thereby hampering the equilibrium of the community participation (Northouse et al., 2012). Moreover, the experience of the uncertainty in life or the possibility in dying creates massive depression not only over the patient, but also over her family members which further hampers the overall community participation and while developing an overall hopeless about the disease and the therapy plan (Kumar & Schapira, 2013).

Conclusion
In conclusion, ovarian cancer is one of the most prevalent cancer among women globally. Ovarian cancer may affect women in their weight gain/loss, menstruation cycle, abdominal bloating, and so on. The prevalent rate in Australia is also higher but the rate is declining in recent years. Surgery and chemotherapy are mainly two treatment methods of ovarian cancer.

References
Ali, A. T. (2018). Towards prevention of ovarian cancer. Current cancer drug targets. operations: 10.2174/1568009618666180102103008
Arab, M., Khayamzadeh, M., Tehranian, A., Tabatabaeefar, M., Hosseini, M., Anbiaee, R., . . . Akbari, M. (2010). Incidence rate of ovarian cancer in Iran in comparison with developed countries. Indian Journal of Cancer, 47(3), 322-7. https://dx.doi.org.dbgw.lis.curtin.edu.au/10.4103/0019-509X.64721 Retrieved from https://search-proquest-com.dbgw.lis.curtin.edu.au/docview/850421359?accountid=10382
Are, C., Rajaram, S., Are, M., Raj, H., Anderson, B. O., Chaluvarya Swamy, R., … & Cazap, E. L. (2013). A review of global cancer burden: trends, challenges, strategies, and a role for surgeons. Journal of surgical oncology, 107(2), 221-226. https://doi.org/10.1002/jso.23248
Australian Government – Cancer Australia (2018). Ovarian Cancer statistics. Access date: 1st May 2018. Retrieved from: https://ovarian-cancer.canceraustralia.gov.au/statistics
Cancer Australia. (2018). Ovarian Cancer. Retrieved from https://ovarian-cancer.canceraustralia.gov.au/home
Cancer Treatment Centres of America (2018). Oncology rehabilitation for ovarian cancer. Access date: 1st May 2018. Retrieved from: https://www.cancercenter.com/ovarian-cancer/oncology-rehabilitation/
DiSaia, P. J., Creasman, W. T., Mannel, R. S., McMeekin, D. S., & Mutch, D. G. (2017). Clinical Gynecologic Oncology E-Book. Elsevier Health Sciences. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=MkoQDgAAQBAJ&oi=fnd&pg=PP1&dq=DiSaia,+P.+J.,+Creasman,+W.+T.,+Mannel,+R.+S.,+McMeekin,+D.+S.,+%26+Mutch,+D.+G.+(2017).+Clinical+Gynecologic+Oncology+E-Book.+Elsevier+Health+Sciences.&ots=WBLgD4LT4B&sig=UKNiRP54PiSqsI7jpV2eIRLB5Jg#v=onepage&q&f=false
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van, d. L., Zusterzeel, P. L. M., Van Gorp, T., Buist, M. R., van Driel, W.,J., Gaarenstroom, K. N., . . . Massuger, L. F. A. G. (2014). Cytoreductive surgery followed by chemotherapy versus chemotherapy alone for recurrent platinum-sensitive epithelial ovarian cancer (SOCceR trial): A multicenter randomised controlled study. BMC Cancer, 14, 22. https://dx.doi.org.dbgw.lis.curtin.edu.au/10.1186/1471-2407-14-22 Retrieved from https://search-proquest-com.dbgw.lis.curtin.edu.au/docview/1482035139?accountid=10382
Vinotha, T., Anitha, T., Ajit, S., Rachel, C., & Abraham, P. (2016). The Role of Completion Surgery in Ovarian Cancer. The Journal of Obstetrics and Gynecology of India, 66(1), 435-440. doi: 10.1007/s13224-015-0796-4
Webb, P. M., Green, A. C., & Jordan, S. J. (2017). Trends in hormone use and ovarian cancer incidence in US white and Australian women: Implications for the future. Cancer Causes & Control, 28(5), 365-370. https://dx.doi.org.dbgw.lis.curtin.edu.au/10.1007/s10552-017-0868-0 Retrieved from https://search-proquest-com.dbgw.lis.curtin.edu.au/docview/1885694488?accountid=10382

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