METHODS: A cross-sectional study was conducted among 95 breast and gynaecology cancer survivor subjects. The Malay International Physical Activity Questionnaire (IPAQ) was used to assess physical activity and sitting time. Quality of life was assessed using the Malay EORTC QLQ-C30 questionnaire. Sociodemographic, clinical characteristics and anthropometric measurements were also obtained in this study.
RESULTS: The mean age of the subject was 51.8 ± 7.7 years old and the duration of survivorship was 4.3 ± 3.4 years. A total of 76.8% of subjects were categorized as having low physical activity level with a mean MET 403.5 ± 332.7 minutes/week and sitting time of 416.9 ± 151.0 minutes/day. Overall, subjects aged 50 years and above (p=0.006), widowed (p=0.032), retired (p=0.029) and had other non-communicable diseases (p=0.005) showed lower levels of physical activity. Increased physical activity had a positive effect on physical function (r=0.2, p=0.038), reduced insomnia (r=-0.3, p <0.001) and constipation symptoms (r=-0.3, p=0.012) domains of quality of life. The longer the sitting period showed more severe insomnia symptoms (r=0.2, p=0.03) but improved social function (r=0.2, p=0.012).
CONCLUSIONS: Increasing physical activity and reducing sitting time have a positive effect on the quality of life of cancer survivors. The focus of health education should be prioritized to older adults (50 years and above), widows, retirees, and those with other comorbidities as they are at risk of being not physically active.
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OBJECTIVES: To assess the effectiveness of centralisation of care for patients with gynaecological cancer.
SEARCH METHODS: We searched the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL (The Cochrane Library, Issue 4, 2010), MEDLINE, and EMBASE up to November 2010. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies.
SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, interrupted time series studies, and observational studies that examined centralisation of services for gynaecological cancer, and used multivariable analysis to adjust for baseline case mix.
DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data, and two assessed risk of bias. Where possible, we synthesised the data on survival in a meta-analysis.
MAIN RESULTS: Five studies met our inclusion criteria; all were retrospective observational studies and therefore at high risk of bias.Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent. Adverse event data were not reported in any of the studies.
AUTHORS' CONCLUSIONS: We found low quality, but consistent evidence to suggest that women with gynaecological cancer who received treatment in specialised centres had longer survival than those managed elsewhere. The evidence was stronger for ovarian cancer than for other gynaecological cancers.Further studies of survival are needed, with more robust designs than retrospective observational studies. Research should also assess the quality of life associated with centralisation of gynaecological cancer care. Most of the available evidence addresses ovarian cancer in developed countries; future studies should be extended to other gynaecological cancers within different healthcare systems.