digoxin and Ovarian-Neoplasms

Both in vitro and clinical trial data suggest that cardiac glycosides demonstrate a synergistic anti-tumor effect when administered with platinum chemotherapy. Epidemiologic studies have also demonstrated improved cancer survival in colorectal, breast, head and neck and hepatocellular carcinoma patients on digoxin therapy at the time of cancer treatment. We sought to determine whether digoxin improves survival in epithelial ovarian cancer patients treated with platinum.. Surveillance, Epidemiology and End-Results (SEER) tumor registries program data on ovarian cancer patients diagnosed in 2007-2009 were linked to Medicare claims data to capture platinum administration, digoxin use and cardiac comorbidities. We analyzed 762 patients who underwent cancer-directed surgery and received platinum chemotherapy. Patients were considered digoxin users during platinum administration if a prescription was filled within 6months of cancer diagnosis. Cox proportional hazards regression models were used to determine the impact of digoxin use on overall survival (OS).. Among 762 epithelial ovarian cancer patients treated with surgery and platinum chemotherapy, 53 (7%) used digoxin ever and 38 (5%) used digoxin specifically during platinum administration. Adjusting for age, heart disease and Charlson comorbidity score, digoxin use was not associated with OS (HR=1.29, 95% CI 0.81, 2.06).. In this SEER-Medicare database analysis, digoxin use during chemotherapy was not associated with improved OS outcomes in patients with epithelial ovarian cancer treated with surgery and platinum chemotherapy. These conclusions are limited, however, by a small sample size and bias intrinsic to claims-based data and should be further evaluated in a larger cohort.

Topics: Aged; Aged, 80 and over; Carcinoma, Ovarian Epithelial; Cohort Studies; Digoxin; Female; Humans; Medicare; Neoplasms, Glandular and Epithelial; Organoplatinum Compounds; Ovarian Neoplasms; Registries; SEER Program; United States

Digoxin is a phyto-estrogen capable of inducing hormonal effects. Use has been associated with increased risk of breast cancer, an estrogen-sensitive malignancy. The incidence of corpus uteri (uterus) cancer is also strongly increased with exposure to estrogens. Therefore, we evaluated whether digoxin use might also increase its incidence. In all women in Denmark, we identified digoxin users from 1995 through 2008 using a nationwide pharmacy registry system. Cancer occurrence was obtained from Danish Cancer Registry. Relative risk was determined using incidence risk ratios (RR) and 95% confidence intervals (CIs) relative to non-users after adjustment for age- and calendar-time. For ovarian and cervical cancers, RRs in users and non-users were similarly evaluated, these cancers representing gynecological cancers with weak or no associations to estrogen exposure. Of 2.1 million women, 104,648 (4.9%) had digoxin exposure and 137,493 6.5% had exposure to angina drugs but not digoxin during the study period. For uterus cancer, the RR was increased in current digoxin users (1.48, 95% CI: 1.32-1.65; N = 350). Incidence was marginally increased in former users. For ovary and cervix cancers, RRs in current digoxin users were 1.06 (95% CI: 0.92-1.22; N = 207) and 1.00 (95% CI: 0.79-1.25; N = 81), respectively. We examined risks in women using angina drugs but not digoxin to determine whether being under cardiac care affected risk. Among women using angina drugs only, RRs for uterus, ovary or cervix cancers were not statistically significant. We conclude that women currently using digoxin, a phyto-estrogen, have an increased risk of developing uterus cancers.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Denmark; Digoxin; Female; Humans; Middle Aged; Ovarian Neoplasms; Phytoestrogens; Risk Factors; Uterine Cervical Neoplasms; Young Adult

A case of a 62-year-old woman presenting with a 20-year history of vulvodynia previously unresponsive to medical treatment is described. The epidemiology, phenomenology and medical management of vulvodynia is reviewed. The case presentation illustrates the role of pregabalin in successful medical management of this chronic pain disorder, as well as the management of common psychiatric morbidities associated with this condition.

Topics: Amitriptyline; Analgesics; Anti-Ulcer Agents; Anticoagulants; Antidepressive Agents; Anxiety; Cardiotonic Agents; Cataract; Cataract Extraction; Cholecystectomy; Chronic Disease; Citalopram; Digoxin; Female; gamma-Aminobutyric Acid; Heart Failure; Humans; Hypertension; Hysterectomy; Lorazepam; Middle Aged; Mitral Valve Insufficiency; Omeprazole; Ovarian Neoplasms; Pain; Pregabalin; Sterilization, Tubal; Stomach Diseases; Vulvar Diseases

The clinicopathologic features of a patient with primary carcinoid tumor of the ovary who presented with the signs of cardiac failure are described. The patient underwent total abdominal hysterectomy + bilateral salpingo-oophorectomy + omentectomy + bilateral pelvic lymphadenectomy + appendectomy; and she is alive with no evidence of recurrent disease one year after surgery.

Topics: Appendectomy; Carcinoid Tumor; Cardiac Output, Low; Dermoid Cyst; Digoxin; Fallopian Tubes; Female; Furosemide; Humans; Hysterectomy; Lymph Node Excision; Middle Aged; Neoplasms, Multiple Primary; Ovarian Neoplasms; Ovariectomy