Fragilità, qualità della vita e inversione precoce della stomia temporanea defunzionante nel cancro ovarico (FOLERO)
Fragilità, qualità della vita e inversione precoce della stomia temporanea defunzionante nel cancro ovarico (FOLERO): uno studio prospettico di coorte per determinare l'effetto della fragilità sulla sopravvivenza e valutare l'inversione precoce della stomia intestinale temporanea
Complete macroscopic surgical resection (CMR) requires extensive surgery and combined with chemotherapy confers best chance of survival in advanced ovarian cancer. During cytoreductive surgery 11% of women require a temporary diverting intestinal stoma.
Unexpectedly, our results from a unique fully accounted for population demonstrate that survival was not improved when increasing the proportion of women in whom CMR was achieved and in a yet unidentified subgroup of women extensive surgery was detrimental. In these women surgical treatment should be omitted in favor of chemotherapy only. Accordingly, there is an imperative need to improve patient selection to surgical treatment.
In Sweden, we treat an unselected population of women in a public healthcare system, where 30% of women with are >75 years. Despite these circumstances guidelines on patient-selection are lacking.
Age is an imprecise variable to base clinical decisions on but must be considered with an aging population. The dynamics between physiological changes of aging, comorbidity and medical condition are included in the concept of frailty, that has gained little attention in oncology, despite their potential to stratify risk and mortality.
The FOLERO study is a prospective adequately powered national cohort study with aim to determine if frailty instruments may be used to select patient to surgical treatment. In addition, we test the feasibility of early stoma reversal after index cytoreductive surgery in a small phase I trial and follow our patients Health Related Quality of Life after state of the art surgical treatment.
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
Hypothesis: Frailty is a predictor of poor survival Primary objective: To assess three different frailty instruments as predictors of survival Exposure: Frailty according to the three different frailty instruments evaluated Control: No frailty according to the three different frailty instruments evaluated Primary outcome measure: Overall survival
Secondary objectives (selection):
- To evaluate the effect of sarcopenia on postoperative outcome and survival
- To evaluate the effect of surgical extent on postoperative outcome and survival
- To describe the HRQoL and symptoms of the" Low anterior resection syndrome" after surgery
Phase I sub-study on the feasibility and safety of early stoma reversal (Karolinska University Hospital only)
Hypothesis: Early stoma reversal in select patients with advanced ovarian cancer is feasible and safe.
Primary objective: To assess the feasibility and safety of early closure of defunctioning stoma after upfront cytoreductive surgery in ovarian cancer Primary outcome measure : Feasibility and safety of early stoma reversal as measured by rate of anastomotic leakage, urgent re- operations and time-interval to adjuvant chemotherapy (defined cut-offs based on historic comparison in the study protocol)
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Fase
Fase
- Non applicabile
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: Fihima M Yusuf, MSc
- Numero di telefono: +46725815883
- Email: fihima.mohamed-yusuf@regionstockholm.se
Luoghi di studio
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Gothenburg, Svezia, 41685
- Reclutamento
- Sahlgrenska University Hospital and Sahlgrenska Academy
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Contatto:
- Pernilla Dahm-Kähler, MD, Prof.
- Numero di telefono: 0313434216
- Email: pernilla.dahm-kahler@gu.se
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Investigatore principale:
- Pernilla Dahm-Kähler, MD, Prof.
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Investigatore principale:
- Charlotte Palmqvist, MD, PhD
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Linköping, Svezia, 581 85
- Reclutamento
- Linköping University Hospital
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Contatto:
- Madelene Wedin, MD, PhD
- Email: madelene.wedin@regionostergotland.se
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Investigatore principale:
- Madelene Wedin, MD, PhD
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Lund, Svezia, 22185
- Reclutamento
- Skåne University Hospital
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Contatto:
- Mihaela Asp, MD, PhD
- Email: Mihaela.Asp@skane.se
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Investigatore principale:
- Mihaela Asp, MD, PhD
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Sub-investigatore:
- Päivi Kannisto, MD, Ass Prof
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Solna
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Stockholm, Solna, Svezia, 171 76
- Reclutamento
- Karolinska University Hospital
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Contatto:
- Sahar Salehi, MD, Ass Prof
- Email: sahar.salehi@regionstockholm.se
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Contatto:
- Daniel Hunde, MD
- Email: daniel.hunde@regionstockholm.se
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Sub-investigatore:
- Daniel Hunde, MD
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Investigatore principale:
- Sahar Salehi, MD, Ass Prof
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Women with epithelial ovarian cancer scheduled for cytoreductive surgery with curative intent
- Age ≥18 years
- Signed written informed consent
Exclusion Criteria:
- Not able to understand the Swedish or English language
- Other diagnosis than ovarian cancer on final pathology
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Altro
- Assegnazione: N / A
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
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Sperimentale: Frailty
Single arm study evaluating frailty by assessment of questionnaires and three different frailty tools |
Frailty and Quality of Life evaluation after surgery |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Overall Survival
Lasso di tempo: 24 months after index surgery
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Overall survival time is calculated from the date of index surgery to the date of death (due to any cause), or for patients still alive to the date of last follow-up. |
24 months after index surgery
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Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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1-year mortality
Lasso di tempo: 12 months from index surgery
|
Mortality within 1-year after index surgery |
12 months from index surgery
|
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Health related quality of life (HRQoL) (QLQ-C30)
Lasso di tempo: At baseline, 12-15 weeks after index surgery and 12 months after index surgery
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Assessed by validated questionnaire and comprise the European Organisation for Research and Treatment of Cancer (EORTC), Core Questionnaire (QLQ-C30) |
At baseline, 12-15 weeks after index surgery and 12 months after index surgery
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Health related quality of life (HRQoL) (QLQ-OV28)
Lasso di tempo: At baseline, 12-15 weeks after index surgery and 12 months after index surgery
|
Assessed by validated questionnaire and comprise the European Organisation for Research and Treatment of Cancer (EORTC), EORTC Quality of life Questionnaire Ovarian Cancer Module (QLQ)-OV28 |
At baseline, 12-15 weeks after index surgery and 12 months after index surgery
|
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Health related quality of life (HRQoL) (QLQ-ELD14)
Lasso di tempo: At baseline, 12-15 weeks after index surgery and 12 months after index surgery
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Assessed by validated questionnaire and comprise the European Organisation for Research and Treatment of Cancer (EORTC), EORTC Quality of life Questionnaire Elderly Module (EORTC-QLQ-ELD14) |
At baseline, 12-15 weeks after index surgery and 12 months after index surgery
|
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Health related quality of life (HRQoL) (EQ-5D-5L)
Lasso di tempo: At baseline, 12-15 weeks after index surgery and 12 months after index surgery
|
Assessed by validated questionnaire and comprise the European Organisation for Research and Treatment of Cancer (EORTC), EQ-5D-5L |
At baseline, 12-15 weeks after index surgery and 12 months after index surgery
|
|
Low anterior resection syndrome (LARS)
Lasso di tempo: At baseline, 12-15 weeks after index surgery and 12 months after index surgery
|
Assessed by the validated LARS questionnaire |
At baseline, 12-15 weeks after index surgery and 12 months after index surgery
|
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Postoperative complications
Lasso di tempo: 30 days after index surgery
|
Assessed by validated instruments, Clavien-Dindo Classification |
30 days after index surgery
|
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Readmissions
Lasso di tempo: 30 days after index surgery
|
Assessed by review of hospital records from the day of discharge after index surgery |
30 days after index surgery
|
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Length of hospital stay
Lasso di tempo: From date of index surgery to the date of discharge or at latest 90 days after index surgery
|
Assessed by review of hospital records |
From date of index surgery to the date of discharge or at latest 90 days after index surgery
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Extent of surgery vs survival
Lasso di tempo: Up to 60 months after index surgery
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Measured by surgical complexity score (as defined by the Mayo and Karolinska Surgical Complexity scores) and Peritoneal Cancer Index (PCI) both by assessment at the preoperative multidisciplinary conference The agreement between preoperative and peroperative assessment of surgical extent needed to achive complete macroscopic resection. |
Up to 60 months after index surgery
|
|
Sarcopenia vs post-operative outcome
Lasso di tempo: Up to 60 months after index surgery
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Sarcopenia is measured by computed tomography and different muscle groups by different software programs (e.g. Coreslicer, Slice-o-matic etc.). |
Up to 60 months after index surgery
|
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Standard regimen of adjuvant chemotherapy
Lasso di tempo: At 1 year after index surgery
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Standard regimen of adjuvant chemotherapy is defined as Carboplatin (AUC 5) and Paclitaxel (175 mg/m2) every 21 days for 6 cycles. Dose and frequency will be assessed by review of hospital records |
At 1 year after index surgery
|
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Time interval to adjuvant chemotherapy
Lasso di tempo: From index surgery to first infusion of adjuvant chemotherapy
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Assessed by review of hospital records. |
From index surgery to first infusion of adjuvant chemotherapy
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Total number of hospital days and readmissions within90 days after index surgery
Lasso di tempo: 90 days after index surgery
|
Total number of hospital days within 90 days after index surgery by review of hospital records |
90 days after index surgery
|
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Health economics
Lasso di tempo: At baseline, 12-15 weeks after index surgery and 1 year after index surgery
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Health economics will be assessed by the Eq5D-5L validated instrument |
At baseline, 12-15 weeks after index surgery and 1 year after index surgery
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Recurrence or progression free survival
Lasso di tempo: Up to 60 months after index surgery
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Defined as the time interval between index surgery and the date of recurrence or death, whichever comes first. For event-free patients recurrence free survival is the time between index surgery and the date for the last follow-up visit by review of medical records. |
Up to 60 months after index surgery
|
Collaboratori e investigatori
Sponsor
Sponsor
Investigatori
Investigatori
- Direttore dello studio: Sahar Salehi, MD, PhD, Karolinska University Hospital
Pubblicazioni e link utili
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Inizio studio (Effettivo)
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
- Malattie urogenitali
- Malattie genitali
- Malattie del sistema endocrino
- Neoplasie urogenitali
- Neoplasie per sede
- Neoplasie
- Malattie urogenitali femminili
- Malattie urogenitali femminili e complicanze della gravidanza
- Malattie genitali, femmina
- Neoplasie delle ghiandole endocrine
- Malattie ovariche
- Malattie annessiali
- Neoplasie genitali, femmina
- Disturbi gonadici
- Neoplasie ovariche
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- 2023-04696-01
- 2023 (Sovvenzione/contratto NIH degli Stati Uniti)
Informazioni su farmaci e dispositivi, documenti di studio
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