67 results on '"E. Ferguson"'
Search Results
2. Mismatch-repair deficiency, microsatellite instability, and lynch syndrome in ovarian cancer: A systematic review and meta-analysis
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Cristina Mitric, Lina Salman, Lusine Abrahamyan, Soyoun Rachel Kim, Petros Pechlivanoglou, Kelvin K.W. Chan, Lilian T. Gien, and Sarah E. Ferguson
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Oncology ,Obstetrics and Gynecology - Published
- 2023
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3. Acceptability of bariatric surgery in people with endometrial cancer and atypical hyperplasia: A qualitative study
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Soyoun Rachel, Kim, Gabrielle E V, Ene, Andrea, Simpson, Dionne, Gesink, and Sarah E, Ferguson
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Oncology ,Obstetrics and Gynecology - Abstract
In young individuals with obesity, infertility, and endometrial cancer, significant, sustained weight loss through bariatric surgery may result in a durable oncologic and reproductive response. However, it is not known whether bariatric surgery is acceptable to this patient population. We performed a qualitative study to understand the acceptability of bariatric surgery in young individuals with obesity and endometrial cancer or atypical hyperplasia.All participants were of reproductive age with body mass index [BMI] ≥ 35 and grade 1 endometrial cancer or atypical hyperplasia. Semi-structured interviews were used to explore participant perception of their weight, fertility, and the possibility of bariatric surgery as part of the treatment strategy for their endometrial cancer/atypical hyperplasia. Thematic saturation was reached after 14 interviews.Fourteen participants with a median age of 34 years (range 27-38) and BMI of 42 (33-64) were interviewed. Participants were reluctant to accept bariatric surgery as a treatment option due to 1) lack of knowledge about the procedure, 2) stigma attached to bariatric surgery, and 3) fear of the risks associated with bariatric surgery. Their perception towards their weight, fertility, and cancer diagnosis was characterized by concepts of 'helplessness', 'isolation', 'frustration', and 'guilt'. We observed a significant gap in participant understanding of the complex interplay between their cancer, infertility, and obesity.More support and resources are required, with patient-oriented counseling focused on the implication of their weight on their cancer diagnosis and fertility, before presenting bariatric surgery as a treatment option. more...
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- 2023
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4. Impact of care by gynecologic oncologists on primary ovarian cancer survival: A population-based study
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Geneviève, Bouchard-Fortier, Lilian T, Gien, Rinku, Sutradhar, Wing C, Chan, Monika K, Krzyzanowska, Shiru Lucy, Liu, and Sarah E, Ferguson
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Oncologists ,Ovarian Neoplasms ,Oncology ,Multivariate Analysis ,Humans ,Obstetrics and Gynecology ,Female ,Carcinoma, Ovarian Epithelial ,Proportional Hazards Models - Abstract
Timely treatment of epithelial ovarian cancer (EOC) by gynecologic oncologists (GOs) with a combination of surgery and/or chemotherapy has been advocated. Nonetheless, some patients are not assessed by GOs prior to starting their treatment or have surgery by non-GOs. This study aims to determine trends over time in non-mucinous EOC care and to evaluate the impact of care on survival.Using province-wide administrative data, patients diagnosed with non-mucinous EOC between 2007 and 2018 were identified. Multivariate Cox proportional hazards regression models were used to evaluate the impact of GO assessment prior to initiating treatment or having surgery done by a non-GO on mortality.A total of 10,086 EOC patients were included between 2007 and 2018. During the study period, there was an 8% increase in GO assessment (79% in 2007 to 87% in 2018-19, p ≤ 0.001) and a 19% increase in surgeries performed by GOs (69% in 2007 to 88% in 2018-19, p ≤ 0.001). On multivariate analysis, there was an increased hazard of all-cause mortality for patients not assessed by GOs before first treatment (Hazard ratio (HR): 1.61; 95% CI 1.46-1.79). There was an increased hazard of all-cause mortality if ovarian cancer surgery was performed by non-GOs (HR 2.03; 95% CI 1.80-2.30).Assessment by GO before starting initial treatment is associated with improved survival in women with non-mucinous EOC as the type of surgeon performing primary ovarian cancer surgery. Assessment by GO for all patients with new or suspected ovarian cancer diagnosis before initiation of primary treatment should be advocated. more...
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- 2022
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5. Understanding the clinical implication of mismatch repair deficiency in endometrioid endometrial cancer through a prospective study
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Leslie Oldfield, Aaron Pollett, Alicia A. Tone, Alice Lytwyn, Matthew Cesari, Melyssa Aronson, Blaise A. Clarke, Emily Van de Laar, Soyoun Rachel Kim, Danielle Vicus, Trevor J. Pugh, Katherine Lajkosz, Tae L. Hart, Sarah E. Ferguson, Steven Gallinger, Marcus Q. Bernardini, Bojana Djordjevic, Amit M. Oza, Jordan Lerner-Ellis, Raymond H. Kim, Spring Holter, and Lua Eiriksson more...
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Adult ,0301 basic medicine ,Oncology ,medicine.medical_specialty ,Molecular phenotype ,MLH1 ,DNA Mismatch Repair ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Promoter Regions, Genetic ,Prospective cohort study ,Aged ,Neoplasm Staging ,business.industry ,Tumor biology ,Endometrial cancer ,Obstetrics and Gynecology ,Cancer ,DNA Methylation ,Middle Aged ,medicine.disease ,Endometrial Neoplasms ,stomatognathic diseases ,030104 developmental biology ,030220 oncology & carcinogenesis ,MISMATCH REPAIR DEFICIENCY ,Immunohistochemistry ,Female ,Lymph Nodes ,MutL Protein Homolog 1 ,business ,Carcinoma, Endometrioid - Abstract
Findings on impact of mismatch repair deficiency (MMRd) on patient outcomes in endometrial cancer (EC) have been inconsistent to date. The objective of this study was to compare the oncologic outcomes and recurrence patterns between MMRd and MMR-intact (MMRi) endometrioid EC (EEC).Between 2015 and 2018, we prospectively recruited 492 EEC cases from three cancer centers in Ontario, Canada. Tumors were reflexively assessed for MMR protein expression by immunohistochemistry (IHC). Clinicopathological, survival and recurrence patterns were compared between MMRd and MMRi cases.Of 492 EEC, 348 were MMRi (71%) and 144 were MMRd (29%) with median follow-up of 16.8 months (0-69.6). MMRd tumors tended to be grade 2 or 3 (56% vs. 29%, p 0.001), with propensity for lymphovascular space invasion (28% vs. 18%, p = 0.024), lymph node involvement (7% vs. 5%, p 0.001) and received more adjuvant treatment (46% vs. 33%, p = 0.027). This group also had significantly lower 3-year recurrence-free survival (78% vs. 90%, p = 0.014) although there was no difference in OS (p = 0.603). MMRd cases were more likely to recur in retroperitoneal lymph nodes (p = 0.045). Upon subgroup analysis, MLH1 methylated tumors had the worst prognostic features and survival outcomes.MLH1 methylated EECs exhibit more aggressive features compared to other MMRd and MMRi EECs. This may indicate an inherent difference in tumor biology, suggesting the importance of individualized management based on EC molecular phenotype. more...
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- 2021
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6. The MEMORY Study: MulticentEr study of Minimally invasive surgery versus Open Radical hYsterectomy in the management of early-stage cervical cancer: Survival outcomes
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Mario M. Leitao, Qin C. Zhou, Benny Brandt, Alexia Iasonos, Vasileios Sioulas, Katherine Lavigne Mager, Mark Shahin, Shaina Bruce, Destin R. Black, Carrie G. Kay, Meeli Gandhi, Maira Qayyum, Jennifer Scalici, Nathaniel L. Jones, Rajesh Paladugu, Jubilee Brown, R. Wendel Naumann, Monica D. Levine, Alberto Mendivil, Peter C. Lim, Elizabeth Kang, Leigh A. Cantrell, Mackenzie W. Sullivan, Martin A. Martino, Melissa K. Kratz, Valentin Kolev, Shannon Tomita, Charles A. Leath, Teresa K.L. Boitano, David W. Doo, Colleen Feltmate, Ronan Sugrue, Alexander B. Olawaiye, Ester Goldfeld, Sarah E. Ferguson, Jessa Suhner, and Nadeem R. Abu-Rustum more...
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Oncology ,Obstetrics and Gynecology ,Humans ,Minimally Invasive Surgical Procedures ,Uterine Cervical Neoplasms ,Female ,Laparoscopy ,Hysterectomy ,Disease-Free Survival ,Neoplasm Staging ,Retrospective Studies - Abstract
The Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive radical hysterectomy compared to open radical hysterectomy compromised oncologic outcomes and was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cervical carcinoma. We sought to assess oncologic outcomes at multiple centers between minimally invasive (MIS) radical hysterectomy and OPEN radical hysterectomy.This is a multi-institutional, retrospective cohort study of patients with 2009 FIGO stage IA1 (with lymphovascular space invasion) to IB1 cervical carcinoma from 1/2007-12/2016. Patients who underwent preoperative therapy were excluded. Squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinomas were included. Appropriate statistical tests were used.We identified 1093 cases for analysis-715 MIS (558 robotic [78%]) and 378. OPEN procedures. The OPEN cohort had more patients with tumors2 cm, residual disease in the hysterectomy specimen, and more likely to have had adjuvant therapy. Median follow-up for the MIS and OPEN cohorts were 38.5 months (range, 0.03-149.51) and 54.98 months (range, 0.03-145.20), respectively. Three-year PFS rates were 87.9% (95% CI: 84.9-90.4%) and 89% (95% CI: 84.9-92%), respectively (P = 0.6). On multivariate analysis, the adjusted HR for recurrence/death was 0.70 (95% CI: 0.47-1.03; P = 0.07). Three-year OS rates were 95.8% (95% CI: 93.6-97.2%) and 96.6% (95% CI: 93.8-98.2%), respectively (P = 0.8). On multivariate analysis, the adjusted HR for death was 0.81 (95% CI: 0.43-1.52; P = 0.5).This multi-institutional analysis showed that an MIS compared to OPEN radical hysterectomy for cervical cancer did not appear to compromise oncologic outcomes, with similar PFS and OS. more...
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- 2022
7. Perioperative outcomes of women with and without class III obesity undergoing hysterectomy for endometrioid endometrial cancer: A population-based study
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Rinku Sutradhar, Andrea N. Simpson, Stephanie Y. Cheng, Deborah Robertson, Qing Li, Sarah E. Ferguson, and Nancy N. Baxter
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0301 basic medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Hysterectomy ,Cohort Studies ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Obesity ,Perioperative Period ,education ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Class III obesity ,Endometrial cancer ,Obstetrics and Gynecology ,Perioperative ,Middle Aged ,medicine.disease ,Endometrial Neoplasms ,Treatment Outcome ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,Propensity score matching ,Female ,business ,Carcinoma, Endometrioid ,Cohort study - Abstract
Objective Population-based data on perioperative complications among women with endometrial cancer and severe obesity are lacking. We evaluated 30-day complication rates among women with and without class III obesity (body mass index ≥ 40 kg/m2) undergoing primary surgical management for endometrioid endometrial cancer (EEC), and how outcomes differed according to surgical approach (open vs. minimally invasive). Methods We performed a retrospective population-based cohort study of women with EEC undergoing hysterectomy in Ontario, Canada, between 2006 and 2015. We evaluated perioperative complications in the whole cohort, and in a 1:1 matched analysis using hard and propensity score matching to ensure similar distributions of patient, tumour, provider and institution-level factors between women with and without class III obesity (identified using a surgical billing code). The primary outcome of interest was the 30-day perioperative complication rate. Results 12,112 women met inclusion criteria; 2697 (22.3%) had class III obesity. We matched 2320 (86%) women with class III obesity to those without. The composite complication rate was significantly higher among women with class III obesity (23.2% vs. 18.4%, standardized mean difference [SMD] = 0.12), primarily due to wound infection/disruption (12.1% vs. 6.2%). There was no difference in outcomes for women with and without class III obesity when a minimally invasive approach was used. Conclusions Wound infection/disruption was increased for women with class III obesity compared to women without. Otherwise, perioperative complications were similar between the matched pairs. When minimally invasive approaches were used, women with class III obesity had a similar risk of complications as women without obesity. more...
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- 2020
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8. Year 1: Experiences of a tertiary cancer centre following implementation of reflex BRCA1 and BRCA2 tumor testing for all high-grade serous ovarian cancers in a universal healthcare system
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Jeanna McCuaig, Melanie Care, Kelly A. Metcalfe, Raymond H. Kim, Tracy Stockley, and Sarah E. Ferguson
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Adult ,0301 basic medicine ,medicine.medical_specialty ,Referral ,Genetic counseling ,Genetic Counseling ,Tertiary Care Centers ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Genetic Testing ,Family history ,Referral and Consultation ,Survival analysis ,Fisher's exact test ,Aged ,Neoplasm Staging ,Retrospective Studies ,Genetic testing ,Aged, 80 and over ,BRCA2 Protein ,Ontario ,Ovarian Neoplasms ,medicine.diagnostic_test ,BRCA1 Protein ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Cystadenocarcinoma, Serous ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,symbols ,Universal Health Care ,Female ,Ovarian cancer ,business - Abstract
Objective This study compares the rate and time to genetic referral, and patient uptake of germline genetic services, before and after implementation of reflex BRCA1/2 tumor testing for high-grade serous ovarian cancer (HGSOC) in a universal healthcare system. Methods A retrospective chart review of HSGOC patients diagnosed in the year before (PRE) and after (POST) implementation of reflex BRCA1/2 tumor testing was conducted. Clinical information (date/age at diagnosis, personal/family history of breast/ovarian cancer, cancer stage, primary treatment, tumor results) and dates of genetics referral, counseling, and germline testing were obtained. Incident rate ratios (IRR) and 95% CI were calculated using negative binomial regression. Time to referral was evaluated using Kaplan-Meier survival analysis. Fisher Exact tests were used to evaluate uptake of genetic services. Results 175 HGSOC patients were identified (81 PRE; 94 POST). Post-implementation of tumor testing, there was a higher rate of genetics referral (12.88 versus 7.10/1000 person-days; IRR = 1.60, 95% CI: 1.07–2.42) and a shorter median time from diagnosis to referral (59 days PRE, 33 days POST; p = .04). In the POST cohort, most patients were referred prior to receiving their tumor results (n = 63/77; 81.8%). Once referred, most patients attended genetic counseling (94.5% PRE, 97.6% POST; p = .418) and pursue germline testing (98.6% PRE; 100% POST; p = .455). Conclusions Following implementation of reflex BRCA1/2 tumor testing for HGSOC, significant improvements to the rate and time to genetics referral were identified. Additional studies are needed to evaluate physician referral practices and the long-term impact of reflex tumor testing. more...
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- 2020
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9. Supported self-management as a model for end-of-life care in the setting of malignant bowel obstruction: A qualitative study
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Maria C. Cusimano, Sarah E. Ferguson, Nazlin Jivraj, Katrina Sajewycz, Amit M. Oza, Michelle L A Nelson, Yeh Chen Lee, Valerie Bowering, and Stephanie Lheureux
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0301 basic medicine ,medicine.medical_specialty ,Palliative care ,Population ,Psychological intervention ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,education ,Qualitative Research ,Aged ,Aged, 80 and over ,Cervical cancer ,Chronic care ,Terminal Care ,education.field_of_study ,Self-management ,business.industry ,Self-Management ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Survival Analysis ,3. Good health ,Distress ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,Female ,business ,End-of-life care ,Intestinal Obstruction - Abstract
Objective Women with advanced gynecologic cancer and malignant bowel obstruction (MBO) undergo repeated hospitalizations, experience feelings of isolation and abandonment, and often die in acute settings. Innovative outpatient models of care are needed to address the unmet needs of this population at the end-of-life. We implemented a novel supported self-management (SMS) program focused on increasing patients' skill and confidence in managing MBO proactively in the ambulatory setting. Methods We performed a qualitative descriptive study embedded in a prospective single-arm evaluative trial ( Clinicaltrials.gov ID: NCT03260647 ) to understand the impact of this program on patients' sense of support, degree of distress, quality of care, and capacity to self-manage. Semi-structured interviews were completed and analysed using the Chronic Care Model as a theoretical framework. Data saturation was confirmed after 15 interviews. Results Fifteen patients (age range: 47–82) with diagnoses of advanced ovarian, endometrial, and cervical cancer were interviewed; 10 had died by end of follow-up, with a median interval from interview to death of 5 months. Patients were able to self-manage the: (i) medical aspects; (ii) psychological consequences, and (iii) changes in life roles and expectations resulting from their condition. Patients felt greatly supported, less isolated, and secure in their knowledge and ability to access care due to SMS. While patients understood their disease was not curative they did not fully appreciate that MBO signalled a significantly poorer prognosis. Conclusion Outpatient SMS interventions can be successfully implemented even for rapidly fatal conditions at the end-of-life and offer significant benefit to gynecologic cancer patients with MBO. Counselling should focus on the specific trajectory of MBO, and early palliative care referrals should be standard practice. more...
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- 2020
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10. Exploring variations in ovarian cancer survival by age and stage (ICBP SurvMark-2): A population-based study
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Charles H Norell, Isabelle Soerjomataram, Lorraine Shack, Freddie Bray, Jacques Ferlay, Paul A. Cohen, Prithwish De, Bjørn Møller, Richard Trevithick, Paul M. Walsh, Brian Rous, Hanna E. Tervonen, Alon D. Altman, Samantha Harrison, Peter Sykes, Eileen Morgan, Gerda Engholm, Geoff Porter, Dianne L. O'Connell, Michael Eden, Citadel J Cabasag, Andy Nordin, Serena Kozie, Mark J. Rutherford, Sarah E. Ferguson, Aude Bardot, Anna Gavin, Janice S. Kwon, Melina Arnold, John Butler, Louise Hanna, and Nathalie Saint-Jacques more...
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Adult ,0301 basic medicine ,Canada ,Adolescent ,Population ,Carcinoma, Ovarian Epithelial ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Advanced disease ,Humans ,Medicine ,Neoplasm Invasiveness ,Registries ,Stage (cooking) ,education ,Net Survival ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Ovarian Neoplasms ,education.field_of_study ,Norway ,business.industry ,Age Factors ,Australia ,Obstetrics and Gynecology ,Cancer ,Middle Aged ,medicine.disease ,United Kingdom ,Population based study ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Period Analysis ,Female ,business ,Ovarian cancer ,Ireland ,New Zealand ,Demography - Abstract
OBJECTIVE: The study aims to evaluate the differences in ovarian cancer survival by age and stage at diagnosis within and across seven high-income countries.METHODS: We analyzed data from 58,161 women diagnosed with ovarian cancer during 2010-2014, followed until 31 December 2015, from 21 population-based cancer registries in Australia, Canada, Denmark, Ireland, New Zealand, Norway, and United Kingdom. Comparisons of 1-year and 3-year age- and stage-specific net survival (NS) between countries were performed using the period analysis approach.RESULTS: Minor variation in the stage distribution was observed between countries, with most women being diagnosed with 'distant' stage (ranging between 64% in Canada and 71% in Norway). The 3-year all-ages NS ranged from 45 to 57% with Australia (56%) and Norway (57%) demonstrating the highest survival. The proportion of women with 'distant' stage was highest for those aged 65-74 and 75-99 years and varied markedly between countries (range:72-80% and 77-87%, respectively). The oldest age group had the lowest 3-year age-specific survival (20-34%), and women aged 65-74 exhibited the widest variation across countries (3-year NS range: 40-60%). Differences in survival between countries were particularly stark for the oldest age group with 'distant' stage (3-year NS range: 12% in Ireland to 24% in Norway).CONCLUSIONS: International variations in ovarian cancer survival by stage exist with the largest differences observed in the oldest age group with advanced disease. This finding endorses further research investigating international differences in access to and quality of treatment, and prevalence of comorbid conditions particularly in older women with advanced disease. more...
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- 2020
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11. Change in cancer-related fatigue over time predicts health-related quality of life in ovarian cancer patients
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Crystal J. Hare, Cassandra Crangle, Kaitlin McGarragle, Sarah E. Ferguson, and Tae L. Hart
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Ovarian Neoplasms ,Oncology ,Prevalence ,Quality of Life ,Obstetrics and Gynecology ,Humans ,Female ,Carcinoma, Ovarian Epithelial ,Fatigue - Abstract
There is limited research examining how change in cancer-related fatigue (CRF) over time predicts change in health-related quality of life (HRQOL), and no studies have examined this relationship in ovarian cancer patients, specifically. The purpose of this study was to explore the prevalence and trajectory of CRF over time and examine how change in CRF over time predicts change in HRQOL in ovarian cancer patients.Ovarian cancer patients (N = 202) were recruited from Princess Margaret Cancer Centre in Toronto, Canada. Consenting participants completed measures at baseline (beginning of study) and again three months later. Data were analyzed using a longitudinal multilevel mixed model design.Four groups of CRF trajectories emerged. Fifty-four percent reported CRF as always present, 16% reported CRF subsided, 21% reported CRF developed, and 9% reported CRF as never present. As CRF developed, functional and physical wellbeing decreased. As CRF subsided, functional, physical, and emotional wellbeing improved. CRF trajectory was not associated with change in social wellbeing over time.Our findings suggest CRF negatively impacts all domains of HRQOL except for social wellbeing in ovarian cancer patients. Among patients who reported that CRF improved over time, all HRQOL domains impacted by CRF showed recovery to normal endorsement rates. Among patients who reported development of CRF, impacted HRQOL domains significantly declined over time. Implications from this research indicate that fatigue management should be prioritized during and after cancer treatment to ensure optimal physical, functional, and emotional wellbeing. more...
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- 2022
12. Pre-operative wait times in high-grade non-endometrioid endometrial cancer: Do surgical delays impact patient survival?
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Andra Nica, Rinku Sutradhar, Rachel Kupets, Allan Covens, Danielle Vicus, Qing Li, Sarah E. Ferguson, and Lilian T. Gien
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Ontario ,Obstetrics and Gynecology ,Adenocarcinoma ,Middle Aged ,Hysterectomy ,Endometrial Neoplasms ,Time-to-Treatment ,Survival Rate ,Oncology ,Carcinosarcoma ,Multivariate Analysis ,Humans ,Female ,Neoplasm Grading ,Neoplasms, Cystic, Mucinous, and Serous ,Aged ,Neoplasm Staging ,Proportional Hazards Models - Abstract
Practice guidelines advocating for regionalization of endometrial cancer surgery to gynecologic oncologists practicing in designated gynecologic oncology centres were published in Ontario in June 2013. Our objectives were to determine whether this policy affected surgical wait times, and whether longer wait time to surgery is a predictor of survival in high grade endometrial cancer patients.This was a population-based retrospective cohort study, which included patients diagnosed with high-grade non-endometrioid endometrial cancer who had a hysterectomy between 2003 and 2017. Multivariable Cox proportional hazards regression with a spline function was used to model the relationship between surgical wait time and overall survival (OS).We identified 3518 patients who underwent hysterectomy for high-grade non-endometrioid endometrial cancer. Patients who had surgery with a gynecologic oncologist had a median surgical wait time from diagnosis to hysterectomy of 53 days compared to 57 days pre-regionalization (p = 0.0007), and from first gynecologic oncology consultation to hysterectomy of 29 days compared to 32 days pre-regionalization (p = 0.0006). Survival was inferior for patients who had surgery within 14 days of diagnosis (HR death 2.7 for 1-7 days, 95% CI 1.61-4.51, and HR death 1.96 for 8-14 days, 95% CI 1.50-2.57), reflective of disease severity. Decreased survival occurred with surgical wait times of more than 45 days from the patient's first gynecologic oncology appointment (HR death 1.19 for 46-60 days, 95% CI 1.04-1.36, and HR death 1.42 for 61-75 days, 95% CI 1.11-1.83).Regionalization of surgery for high-grade endometrial cancer has not had an impact on surgical wait times. Patients who have surgery more than 45 days after surgical consultation have reduced survival. more...
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- 2021
13. Gynecologic oncology treatment modifications or delays in response to the COVID-19 pandemic in a publicly funded versus privately funded North American tertiary cancer center
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Liat Hogen, Sue Li, Michael J. Worley, Paulina Cybulska, Sabrina Piedimonte, Stephane Laframboise, Sarah E. Ferguson, Taymaa May, Geneviève Bouchard-Fortier, and Marcus Q. Bernardini
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0301 basic medicine ,Time Factors ,COVID19 ,Logistic regression ,Medical Oncology ,Tertiary Care Centers ,0302 clinical medicine ,Gynecologic Surgical Procedures ,Volume reductions ,Young adult ,Aged, 80 and over ,Obstetrics and Gynecology ,Cancer Care Facilities ,Middle Aged ,Oncology ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,Female ,Elective Surgical Procedure ,Adult ,medicine.medical_specialty ,Canada ,Genital Neoplasms, Female ,Treatment delays cancer surgery ,Gynecologic oncology ,Article ,Hospitals, Private ,Time-to-Treatment ,03 medical and health sciences ,Young Adult ,medicine ,Humans ,Pandemics ,Aged ,Retrospective Studies ,Pandemic ,business.industry ,Hospitals, Public ,Cancer ,COVID-19 ,Retrospective cohort study ,medicine.disease ,Triage ,United States ,030104 developmental biology ,Gynecology ,Emergency medicine ,Communicable Disease Control ,business - Abstract
OBJECTIVE: To compare gynecologic oncology surgical treatment modifications and delays during the first wave of the COVID-19 pandemic between a publicly funded Canadian versus a privately funded American cancer center. METHODS: This is a retrospective cohort study of all planned gynecologic oncology surgeries at University Health Network (UHN) in Toronto, Canada and Brigham and Women's Hospital (BWH) in Boston, USA, between March 22,020 and July 302,020. Surgical treatment delays and modifications at both centers were compared to standard recommendations. Multivariable logistic regression was performed to adjust for confounders. RESULTS: A total of 450 surgical gynecologic oncology patients were included; 215 at UHN and 235 at BWH. There was a significant difference in median time from decision-to-treat to treatment (23 vs 15 days, p < 0.01) between UHN and BWH and a significant difference in treatment delays (32.56% vs 18.29%; p < 0.01) and modifications (8.37% vs 0.85%; p < 0.01), respectively. On multivariable analysis adjusting for age, race, treatment site and surgical priority status, treatment at UHN was an independent predictor of treatment modification (OR = 9.43,95% CI 1.81-49.05, p < 0.01). Treatment delays were higher at UHN (OR = 1.96,95% CI 1.14-3.36 p = 0.03) and for uterine disease (OR = 2.43, 95% CI 1.11-5.33, p = 0.03). CONCLUSION: During the first wave of COVID-19 pandemic, gynecologic oncology patients treated at a publicly funded Canadian center were 9.43 times more likely to have a surgical treatment modification and 1.96 times more likely to have a surgical delay compared to an equal volume privately funded center in the United States. more...
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- 2021
14. Diagnostic accuracy of frozen section and patterns of nodal spread in high grade endometrial cancer: a secondary analysis of the SENTOR prospective cohort study
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Danielle Vicus, Zibi Marchocki, Aysha Zia, Manjula Maganti, Katherine Pulman, Marjan Rouzbahman, Gabrielle Ene, Matthew Cesari, Jelena Mirkovic, Maria C. Cusimano, and Sarah E. Ferguson
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Frozen section procedure ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Endometrial cancer ,Sentinel lymph node ,Obstetrics and Gynecology ,medicine.disease ,Metastasis ,Serous fluid ,medicine.anatomical_structure ,Oncology ,Biopsy ,medicine ,Lymphadenectomy ,Radiology ,business ,Lymph node - Abstract
Objectives: Recent studies have shown that sentinel lymph node (SLN) biopsy accurately detects nodal metastases in patients with high-grade endometrial cancer (EC). SLN biopsy has the potential to replace complete lymphadenectomy for surgical staging in patients with high-grade EC, provided that an SLN algorithm is followed (side-specific pelvic and para-aortic lymphadenectomy for non-mapped hemipelves). The aim of this study was to define the accuracy of intraoperative frozen section for the detection of metastases in SLN biopsy and describe the pattern of lymph node (LN) spread in patients with high-grade EC. Methods: We performed a secondary analysis of clinicopathologic data from the SENTOR prospective cohort study evaluating SLN node biopsy at 3 designated cancer centres in Toronto, Canada (ClinicalTrials.gov ID: NCT01886066). Patients with clinical stage I high-grade EC (grade 3 endometrioid, serous, clear cell, carcinosarcoma, undifferentiated, or mixed tumors) undergoing laparoscopic or robotic primary hysterectomy were enrolled. The primary outcome was sensitivity of frozen section of the SLN specimen, compared to a standardized ultrastaging protocol. Secondary outcomes included the pattern and characteristics of LN spread. Results: There were 126 patients with high-grade EC with median age 66 years (range: 44-86) and median BMI 26.9 kg/m2 (range: 17.6-49.3). Frozen section was performed on surgical specimens from 212 hemipelves; SLNs were identified in 202 specimens (95.7%) and fatty tissue alone was identified in 10 specimens (4.7%). Of the 202 hemipelves in which SLNs were identified, 24 were positive for metastatic disease. Frozen section correctly identified only 12, yielding a sensitivity of 50% (12/24, 95% CI 29.6-70.4) and negative predictive value of 94% (178/202, 95% CI 89-96.5). A total of 24 patients had LN metastases: 16 (13%) had isolated pelvic metastases, 7 (6%) had both pelvic and para-aortic metastases and 1 (0.8%) had an isolated para-aortic metastasis. All para-aortic metastases (n=8) occurred in non-sentinel LNs, among patients with serous (n=5), carcinosarcoma (n=2), and dedifferentiated (n=1) histology. One patient with isolated para-aortic metastases (carcinosarcoma, p53 abnormal) did not have a mapped SLN, but was identified by the SLN algorithm. Nodal metastases occurred in 10% of patients (3/30) with grade 3 endometrioid histology (all pelvic), compared to 33% of patients (15/46) with serous histology (10 pelvic alone, 5 pelvic and para-aortic). Conclusions: Intraoperative frozen section of SLNs in high-grade EC patients has poor sensitivity. However, frozen section may still be beneficial to confirm the presence of nodal tissue and ensure adherence to an SLN algorithm, including complete pelvic and para-aortic lymphadenectomy for non-mapped hemipelves. Because isolated para-aortic metastases are rare, para-aortic lymphadenectomy may be omitted in patients in which SLNs were successfully mapped to the pelvis. more...
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- 2021
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15. The levonorgestrel intrauterine system (LNG-IUS) for prevention of endometrial cancer in women with obesity is cost effective
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Janice S. Kwon, Sarah E. Ferguson, Annick Pina, Andrea N. Simpson, Laurence Bernard, Clare J. Reade, and Sarah Sinasac
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endocrine system ,medicine.medical_specialty ,education.field_of_study ,Obstetrics ,business.industry ,Incidence (epidemiology) ,Endometrial cancer ,Population ,Obstetrics and Gynecology ,Cancer ,medicine.disease ,Oncology ,Relative risk ,medicine ,Levonorgestrel ,Prospective cohort study ,education ,business ,Body mass index ,medicine.drug - Abstract
Objectives: To estimate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) as an endometrial cancer prevention strategy in women with obesity. Methods: A Markov decision-analytic model was used to compare 5 strategies in women with a body mass index of 30 or greater: 1) Usual care 2) LNG-IUS for 5 years 3) LNG-IUS for 7 years 4) LNG-IUS for 5 years, replaced once for a total of 10 years 5) LNG-IUS for 7 years, replaced once for a total of 14 years. Obesity was presumed to be associated with a 3-fold relative risk of endometrial cancer incidence and a 2.65-fold disease-specific mortality. The LNG-IUS was assumed to confer a 50% reduction in cancer incidence over the period of the LNG-IUS insertion. Costs of LNG-IUS and cancer care were included. Outcomes were incremental cost-effectiveness ratios, calculated in 2019 Canadian dollars per year of life saved. One-way and two-way sensitivity analyses were performed. Results: The LNG-IUS strategy was considered cost-effective if the cost of the intervention is less than 66 400 CAD (50 000 USD) per year of life saved. The strategy becomes cost-effective if 1 LNG-IUS is inserted in 57-year-old women for 5 years, 1 LNG-IUS is inserted in 52-year-old women for 7 years, 2 subsequent LNG-IUS for a total of 10 years are inserted in 51-year-old women or 2 subsequent LNG-IUS for a total of 14 years are inserted in 45-year-old women, when compared to usual care. The results are stable to variations in cost but sensitive to the estimated risk reduction of the LNG-IUS and the impact of obesity on endometrial cancer incidence and disease-specific mortality. Conclusions: The LNG-IUS is a cost-effective method of endometrial cancer prevention in women with obesity. This intervention warrants investigation in a prospective study in this high-risk population. more...
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- 2021
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16. Perioperative outcomes and survival in elderly women with ovarian cancer
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Susan Dong, Marcus Q. Bernardini, Stephane Laframboise, Liat Hogen, Lindy Romanovsky, Paulina Cybulska, Shabbir M.H. Alibhai, Sarah E. Ferguson, Taymaa May, Xuan Li, and Genevieve Bouchard-Fortier
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Polypharmacy ,medicine.medical_specialty ,business.industry ,Medical record ,Obstetrics and Gynecology ,Perioperative ,Debulking ,medicine.disease ,Oncology ,Geriatric oncology ,Internal medicine ,medicine ,Stage (cooking) ,Adverse effect ,Ovarian cancer ,business - Abstract
Objectives: The rate of perioperative adverse events, postoperative outcomes and survival between patients aged 60-69 yo versus those ≥70 yo undergoing surgery for the primary treatment of advanced ovarian cancer (OC). Methods: We retrospectively identified all patients ≥60 years old treated surgically for primary advanced high-grade OC at our institution between January 2016 and December 2018. Institutional National Surgical Quality Improvement Program data were obtained for post-operative complications. Additional data were abstracted from medical records. Results are stratified based on the treatment approach: primary debulking surgery (PDS) or neo-adjuvant chemotherapy followed by interval debulking surgery (NACT/IDS). Appropriate statistical tests were performed. Results: A total of 77 patients were analyzed; 45 were between 60-69 years and 32 were ≥70 years. There were no differences in preoperative BMI, ECOG, ASA, CCI, polypharmacy, baseline bloodwork and stage (Table 1). Only 2 patients ≥70 years (0.6%) saw a geriatric oncology specialist prior to treatment. A total of 32 patients underwent PDS (60-69yo: n=18, ≥70yo: n=14), and 45 patients had NACT/IDS (60-69yo: n=27, ≥70yo: n=18). In both PDS and NACT/IDS groups, there were no differences in the post-operative adverse events between the two age groups. Older patients in the NACT/IDS group received less total platinum and taxane chemotherapy before and after surgery compared to NACT/IDS patients aged 60-69 years (p Download : Download high-res image (144KB) Download : Download full-size image Download : Download high-res image (263KB) Download : Download full-size image Conclusions: Although baseline characteristics were comparable between younger and older OC patients, reasons for PDS versus NACT/IDS were difficult to extrapolate from the medical record. Age was not a factor influencing perioperative outcomes of advanced ovarian cancer patients and the main predictor of outcomes was treatment approach. Since PDS is the main predictor of survival, a standardized, multi-disciplinary approach to optimize the management of older patients with ovarian cancer is necessary. Use of a formal assessment tool and consultation with a geriatric specialist may facilitate more patients undergoing PDS. more...
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- 2021
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17. Acceptability of bariatric surgery in young women with endometrial cancer and atypical endometrial hyperplasia: a qualitative study
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Sarah E. Ferguson, Rachel Soyoun Kim, Andrea N. Simpson, Gabrielle Ene, and Dionne Gesink
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medicine.medical_specialty ,business.industry ,Endometrial cancer ,media_common.quotation_subject ,Obstetrics and Gynecology ,Fertility ,medicine.disease ,Comorbidity ,Obesity ,Surgery ,Oncology ,Weight loss ,medicine ,medicine.symptom ,business ,Body mass index ,Atypical Endometrial Hyperplasia ,Patient education ,media_common - Abstract
Objectives: Development of endometrial cancer (EC) or atypical hyperplasia (AH) in young women with obesity is often the first significant obesity-related comorbidity they experience. The current approach to fertility-preserving endometrial cancer treatment is with progestin; however, this does not address the underlying cause - obesity - and its associated metabolic abnormalities. Significant, sustained weight loss through bariatric surgery may result in a more durable response by addressing obesity directly, and subsequently improve both oncologic and reproductive outcomes. However, it is not known whether bariatric surgery is acceptable to this patient population. Methods: We performed a qualitative study to understand the acceptability of bariatric surgery among women of reproductive age (≥ 18 and ≤41 years) with obesity (body mass index [BMI] ≥ 35) and grade 1 endometrioid EC or AH. Participants were recruited from Princess Margaret Hospital, in Toronto, after referral for fertility-sparing management. Semi-structured interviews were used to explore participant perceptions towards their weight, fertility, and the possibility of bariatric surgery as part of the treatment strategy for their EC/AH. Interviews were transcribed, coded and analyzed inductively and deductively using Transtheoretical Model as theoretical framework and thematic analysis. Thematic sufficiency was reached after 11 interviews. Results: Eleven participants with median age of 33 years (range 27-38) and BMI of 42.1 (35.1-56.9) were interviewed. Two (18%) participants had grade 1 endometrioid EC, and 9 (82%) had AH. Patients were reluctant to accept bariatric surgery as a treatment option due to 1) lack of knowledge about the procedure, 2) stigma attached to bariatric surgery, and 3) fear of the unknown. The desire to conceive was highlighted as the strongest motivator for patients to consider bariatric surgery. Their perception towards their weight, fertility and diagnosis of EC/AH were characterized by concepts of ‘helplessness’, ‘isolation’, ‘frustration’ and ‘guilt’. We observed a significant gap in participant understanding of the complex interplay between their cancer, fertility and obesity. Patients highlighted the need for compassionate care from their health providers, as well as more resources or education about their diagnoses and treatment options. Conclusions: There is an urgent unmet need for patient education regarding EC/AH diagnosis, and the interplay of their EC/AH with fertility and weight. More supports and resources are required, with patient-oriented counseling focused on implication of their weight on their cancer diagnosis and fertility, before presenting bariatric surgery as a treatment option. more...
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- 2021
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18. Evaluating the effect of a group pre-treatment chemotherapy psycho-education session for chemotherapy-naive gynecologic cancer patients and their caregivers
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Nazek Abdelmutti, Lisa Ould Gallagher, Diana Samoil, Nazlin Jivraj, Naa Kwarley Quartey, Sarah E. Ferguson, Meredith Giuliani, Aileen Trang, Lisa Tinker, and Janet Papadakos
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0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Canada ,Genital Neoplasms, Female ,Disease ,Anxiety ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Survivorship curve ,Antineoplastic Combined Chemotherapy Protocols ,Medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Aged ,business.industry ,Obstetrics and Gynecology ,Cancer ,Middle Aged ,medicine.disease ,Chemotherapy regimen ,Self Efficacy ,Psychotherapy ,030104 developmental biology ,Oncology ,Caregivers ,030220 oncology & carcinogenesis ,Family medicine ,Preparedness ,Female ,medicine.symptom ,business ,Patient education - Abstract
The objective was to evaluate the effects of a pre-chemotherapy education class on chemotherapy-naïve patients diagnosed with gynecologic cancer and their informal caregivers.A prospective cohort study was conducted at a cancer centre in Toronto, Canada. All women diagnosed with gynecologic cancer, who were scheduled to receive chemotherapy treatment, and their caregivers were invited to attend the GyneChemo class, newly introduced as the centre's standard of care. Consenting attendees were asked to complete pre-and post-class survey measures assessing anxiety, self-efficacy, information needs, preparedness to begin chemotherapy treatment, and satisfaction with the class.Between September 2014 to September 2016, 642 individuals attended the GyneChemo class. 75 patients and 64 caregivers completed both pre- and post-class measures. Over 80% of participants agreed that the class was beneficial, specific to their needs, and administered in an appropriate setting. Significant increases in patient and caregiver self-efficacy (p 0.001) and preparedness to begin chemotherapy treatment (p 0.001) were found following class completion. Significant differences in patient's anxiety scores were found, with patients who reported an annual household income of$25,000 experiencing increased anxiety (MD = +5.33) and patients reporting an income of $25,000-$75,000 reporting decreased anxiety (MD = -4.75) following class completion (p = 0.034). No significant difference in the average pre-post caregiver anxiety score (p = 0.207) was found.This educational model provides patients and informal caregivers with information specific to their chemotherapy regimen and disease site. Integrating pre-treatment education into cancer care has the potential to improve the survivorship experience by increasing self-efficacy, treatment preparedness, and psychological well-being. more...
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- 2020
19. The use of indocyanine green fluorescence angiography to assess anastomotic perfusion following bowel resection in surgery for gynecologic malignancies - A report of 100 consecutive anastomoses
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Liat Hogen, Julie M.V. Nguyen, Marcus Q. Bernardini, Stephane Laframboise, Sarah E. Ferguson, Taymaa May, and Geneviève Bouchard-Fortier
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0301 basic medicine ,Adult ,Indocyanine Green ,medicine.medical_specialty ,Colectomies ,genetic structures ,Adolescent ,Genital Neoplasms, Female ,medicine.medical_treatment ,Gynecologic oncology ,Anastomosis ,03 medical and health sciences ,chemistry.chemical_compound ,Young Adult ,0302 clinical medicine ,Medicine ,Humans ,Fluorescein Angiography ,Digestive System Surgical Procedures ,Aged ,Retrospective Studies ,Aged, 80 and over ,Intraoperative Care ,medicine.diagnostic_test ,business.industry ,Anastomosis, Surgical ,Obstetrics and Gynecology ,Retrospective cohort study ,Bowel resection ,Middle Aged ,Surgery ,030104 developmental biology ,Oncology ,chemistry ,030220 oncology & carcinogenesis ,Angiography ,Female ,business ,Perfusion ,Indocyanine green - Abstract
Objective Real-time intraoperative assessment of anastomotic perfusion with indocyanine green fluorescence angiography (ICG-FA) is a recent technique that is found to assist intraoperative decision-making and decrease risk of anastomotic leak in the General Surgery literature. No studies to date evaluate its use in Gynecologic Oncology. Our objectives were to assess the safety and feasibility of ICG-FA use and to describe the intraoperative assessment of anastomotic perfusion with ICG-FA. Methods A retrospective study of a prospectively-collected database of patients with a gynecologic malignancy who underwent a bowel resection at Princess Margaret Cancer Centre in Toronto, Canada, between November 1, 2017 and December 15, 2019 was conducted. ICG-FA was administered intravenously, and a near infrared imaging system (Pinpoint, Novadaq, Canada; SPY-PHI, Stryker, USA) was used to objectively assess bowel perfusion. Results ICG-FA was used to assess a total of 100 bowel anastomoses in 82 consecutive surgeries: 56 low anterior resections, 19 small bowel resections, 15 right hemi-colectomies, 6 left hemi-colectomies, 3 transverse colectomies, and 1 total colectomy. Fifty-five end-to end, 44 side-to-side and 1 end-to-side anastomoses were assessed. ICG angiography was successful in all patients, allowing complete visualization of anastomotic perfusion in all cases. Hypoperfusion detected by ICG-FA resulted in change in operative plan for three patients (two anastomotic revisions and one diverting ileostomy). There were no adverse reactions to ICG. In this cohort, there was one postoperative anastomotic leak. Conclusions ICG-FA enables objective and accurate intraoperative evaluation of anastomotic perfusion in surgeries for gynecologic malignancies. Its implementation and routine use were found to be safe and well-tolerated without side effects in our study cohort. ICG-FA can be used with other risk-assessment strategies to guide operative decision-making in Gynecologic Oncology. more...
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- 2020
20. Oncologic outcomes and morbidity following heated intraperitoneal chemotherapy at cytoreductive surgery for primary epithelial ovarian cancer: A systematic review and meta-analysis
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Maria C. Cusimano, Osvaldo Espin-Garcia, Antoine Bouchard-Fortier, Rouhi Fazelzad, Katrina Sajewycz, Geneviève Bouchard-Fortier, Sarah E. Ferguson, Taymaa May, and Lin Lu
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0301 basic medicine ,medicine.medical_specialty ,MEDLINE ,Carcinoma, Ovarian Epithelial ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Medicine ,Humans ,Infusions, Parenteral ,Randomized Controlled Trials as Topic ,Retrospective Studies ,Ovarian Neoplasms ,business.industry ,Obstetrics and Gynecology ,Perioperative ,Cytoreduction Surgical Procedures ,Hyperthermia, Induced ,Regimen ,Observational Studies as Topic ,030104 developmental biology ,Systematic review ,Oncology ,030220 oncology & carcinogenesis ,Meta-analysis ,Chemotherapy, Cancer, Regional Perfusion ,Observational study ,Female ,business ,Cohort study - Abstract
Objectives Heated intraperitoneal chemotherapy (HIPEC) has not been universally adopted at the time of interval cytoreductive surgery for primary epithelial ovarian cancer (EOC) despite evidence of a 12-month overall survival (OS) benefit in a recent landmark randomized trial. We performed a systematic review and meta-analysis to assess oncologic outcomes and perioperative morbidity following HIPEC among primary EOC patients. Methods We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, from inception to August 2019, for observational and randomized studies of primary EOC patients undergoing HIPEC. We assessed risk of bias using the Institute of Health Economics Quality Appraisal Checklist for single-arm cohort studies, Newcastle-Ottawa Scale for comparative cohort studies, and Cochrane Collaboration's Tool for randomized trials. We qualitatively summarized survival outcomes and calculated the pooled proportion of 30-day grade III-IV morbidity and postoperative death. Results: We identified 35 articles including 2252 primary EOC patients; one study was a randomized trial, and only six studies included a comparator group of surgery alone. The timing, temperature, and chemotherapeutic agents used for HIPEC differed across studies. Reported OS was highly variable (3-year OS range: 46–77%); three comparative cohort studies and the sole randomized trial reported statistically significant survival benefits for HIPEC over surgery alone, while two comparative cohort studies did not. The pooled proportions for grade III-IV morbidity and postoperative death at 30 days were 34% (95% CI 20–52) and 0% (95% CI 0–5) respectively. Conclusion One randomized trial suggests that HIPEC at time of interval cytoreductive surgery should be considered in patients with primary EOC. However, there is significant heterogeneity in literature with respect to an appropriate HIPEC regimen, short- and long-term outcomes. High-quality prospective randomized trials are urgently needed to clarify the role of HIPEC in the first-line treatment of primary EOC. more...
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- 2020
21. Implementation of a standardized voiding protocol after minimally invasive surgery in gynecologic oncology: a quality improvement initiative
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Stuart A. McCluskey, Nastasia Kujbid, Taymaa May, Stephane Laframboise, Rosemary Oheneba-Adom, Marcus Q. Bernardini, Genevieve Bouchard-Fortier, Liat Hogen, Aysha Zia, Gregg Nelson, Paulina Cybulska, Sarah E. Ferguson, and Rachel Soyoun Kim more...
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Protocol (science) ,medicine.medical_specialty ,Quality management ,Hysterectomy ,Urinary retention ,business.industry ,Urinary system ,medicine.medical_treatment ,Obstetrics and Gynecology ,Gynecologic oncology ,urologic and male genital diseases ,female genital diseases and pregnancy complications ,Surgery ,Catheter ,Oncology ,Cohort ,medicine ,medicine.symptom ,business - Abstract
Objectives: Urinary retention after pelvic surgery is common and contributes to postoperative catheter-associated urinary tract infection (UTI). The aim of our quality improvement study was to reduce the rate of UTI by 50% during the study period. Methods: A standardized voiding protocol was designed and implemented in patients undergoing minimally invasive hysterectomy for gynecologic malignancy between January to September 2020. The protocol included: 1) aseptic indwelling catheter insertion technique, 2) use of a new catheter for every insertion attempt, 3) proper positioning of the catheter bag below the patient's bladder on the side of the table during surgery, 4) catheter removal immediately after surgery prior to transfer to recovery room, 5) bladder scan after void, 6) and limiting repeat catheterizations for retention (Figure 1). We compared the demographics, time to first void, rate of urinary retention, and UTI rates between the pre- and post-protocol cohorts. Data for the historical cohort was obtained using the National Surgical Quality Improvement Program (NSQIP) database. Chi-square and Fisher's exact tests were used for comparison of categorical variables and Wilcoxon Rank-Sum tests for continuous variables. Results: A total of 79 post-protocol patients were compared to 124 patients in a historical cohort. The post-implementation cohort was younger (59 vs 65; p=0.04) but clinical and surgical characteristics were not statistically different between the two cohorts. The voiding protocol led to a significant decrease in the interval to first void (289 vs 526 minutes; p Conclusions: Implementation of a standardized voiding protocol was associated with a significant reduction in time to first void, and 50% decreased catheter-associated UTI. more...
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- 2021
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22. Gynecologic oncology and surgical oncology treatment modifications, cancellations or delays in response to the COVID-19 pandemic in public versus private cancer centers in North America
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Sue Li, Genevieve Bouchard-Fortier, Sabrina Piedimonte, Taymaa May, Liat Hogen, Michael Worley, Sarah E. Ferguson, Marcus Q. Bernardini, Stephane Laframboise, and Paulina Cybulska
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medicine.medical_specialty ,Featured Posters ,Referral ,business.industry ,General surgery ,Obstetrics and Gynecology ,Cancer ,Retrospective cohort study ,Gynecologic oncology ,medicine.disease ,Oncology ,Surgical oncology ,308 - Poster Session ,Cohort ,Ambulatory ,Health care ,Medicine ,business - Abstract
Objectives: The major shift in health-care resource utilization during the COVID-19 pandemic to support patients requiring mechanical ventilation and intensive care monitoring has led to unprecedented cancellations of elective surgeries and reductions of ambulatory clinic visits worldwide. The primary objective of this study is to determine whether the response to the pandemic resulted in modifications, cancellations or delays to the standard therapeutic algorithms for patients with gynecologic malignancies at tertiary, large-volume publicly funded Canadian cancer centers as compared to a privately funded American cancer center. Methods: This is a retrospective cohort study of all surgical oncology and gynecologic oncology cases performed in the province of Ontario and at the University Health Network/Princess Margaret Cancer Center (UHN/PMH) as a surrogate for treatment delays, compared to all gynecologic oncology patients treated at the Dana Farber Cancer Institute, Boston, MA, USA, between March 3, 2020-June 30, 2020. Descriptive statistics and treatment times were analysed using SPSS 25.0 Results: In the province of Ontario, between March 15, 2020-October 25, 2020, there was a 19% overall decrease in surgical oncology volumes compared to the same time period the previous year (March 17, 2019-Oct 17, 2019). There was an increase of 96% in high priority surgical oncology cases and a 43% decrease in low priority cancer cases. Surgeries for gynecologic malignancies decreased by 8% in the province of Ontario as compared to the previous year. At UHN/PMH, a publicly funded tertiary cancer center in Ontario, there was a 59.8% reduction in surgical oncology volumes between March 09, 2020-May 04 2020, as compared to the previous year (March 04, 2019-April 29 2019). In comparison, at the Dana Farber Cancer Institute, a privately funded tertiary cancer center, there were 202 new gynecologic oncology patient referrals and 66 returning patients between March 3, 2020-June 30, 2020. The median time from referral to first consultation for new patients was 11 days (range 1-21) and the time to primary treatment was 31 days (range 5-157). New patients with ovarian malignancies had the shortest time to treatment of 22 days (range 5-157). There were no modifications made to the standard of care treatment plans for any patients and 5.7% of the patients had treatment delays. Conclusions: During the COVID-19 pandemic, the public Canadian healthcare system in the province of Ontario was subjected to a 19% reduction in surgical oncology volumes and 8% specifically for gynecologic oncology surgeries, while there was a 5.7% treatment delay for gynecologic oncology surgeries for a similar patient cohort treated at a tertiary cancer center in a privately funded health care system in the United States. more...
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- 2021
23. Preoperative wait times in high-grade endometrial cancer: do surgical delays impact patient survival?
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Rinku Sutradhar, Rachel Kupets, Qing Li, Allan Covens, Danielle Vicus, Andra Nica, Sarah E. Ferguson, and Lilian T. Gien
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education.field_of_study ,medicine.medical_specialty ,Hysterectomy ,business.industry ,Endometrial cancer ,medicine.medical_treatment ,General surgery ,Population ,Obstetrics and Gynecology ,Context (language use) ,Retrospective cohort study ,Gynecologic oncology ,medicine.disease ,Oncology ,Cohort ,medicine ,education ,business ,Gynecologic Oncologist - Abstract
Objectives: Practice guidelines advocating for the regionalization of endometrial cancer surgery to gynecologic oncologists practicing in designated gynecologic oncology centres were released by Cancer Care Ontario in June 2013. We sought to determine the impact this policy had on contemporary surgical wait times. Moreover, a discussion about the impact of delays in treatment has never been more timely than in the context of the current COVID19 pandemic, which has burdened health care systems around the world. Our primary objective was to establish whether longer wait time to surgery is a predictor of survival in patients with high grade endometrial cancer. Methods: This was a retrospective cohort study, which included patients diagnosed with non-endometrioid high-grade endometrial cancer (serous, carcinosarcoma, clear cell, and undifferentiated) between 2003 and 2017. A total of 2 regionalization periods were defined, before and after January 2014 to allow 6 months for knowledge translation after guideline publication. Patients were identified in population-based administrative provincial data sources. Multivariable Cox proportional hazards regression with a spline function was used to model the relationship between wait time and overall survival, as measured from time of surgery. Results: We identified 3518 patients with high grade endometrial cancer. Median wait time between diagnosis and surgery for the entire cohort did not significantly change with regionalization of care (50 vs 52 days, p=0.14). Patients who had surgery with a gynecologic oncologist had a median surgical wait time from diagnosis to hysterectomy of 55 days compared to 59 days pre-regionalization (p=0.0002), and from first gynecologic oncology consultation to hysterectomy of 29 days compared to 32 days pre-regionalization (p=0.0006). Survival was worst for patients who had surgery within 14 days of diagnosis (HR death 2.7, 95% CI 1.61-4.51 for 1-7 days and HR death 1.96, 95% CI 1.5-2.57 for 8-14 days), indicating disease severity. Decreased survival occurred with surgical wait times of more than 45 days from the patient's first gynecologic-oncology appointment (HR death 1.19, 95% CI 1.04-1.36 for 46-60 days and HR death 1.42, 95% CI 1.11-1.82). Download : Download high-res image (109KB) Download : Download full-size image Conclusions: Regionalization of surgery for high grade endometrial cancer has not had a negative impact on surgical wait times. Impact on survival is seen with patients who have surgery more than 45 days after surgical consultation. more...
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- 2021
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24. The impact of care by gynecologic oncologists on the survival of primary epithelial ovarian cancer: a population-based study
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Sarah E. Ferguson, Rinku Sutradhar, Lucy Liu, Wing Chan, Monika K. Krzyzanowska, Lilian T. Gien, and Genevieve Bouchard-Fortier
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Chemotherapy ,medicine.medical_specialty ,education.field_of_study ,Taxane ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Population ,Obstetrics and Gynecology ,Retrospective cohort study ,medicine.disease ,Oncology ,Internal medicine ,Cohort ,Medicine ,Stage (cooking) ,business ,Ovarian cancer ,education - Abstract
Objectives: Timely treatment of primary epithelial ovarian cancer (EOC) by gynecologic oncologists (GOs) with a combination of surgery and/or platinum/taxane-based chemotherapy at expert centers has been advocated. Nonetheless, some patients have their oncologic surgery by non-GOs or are not assessed by GOs prior to starting their initial cancer treatment. The aim of the study was to evaluate the impact of care by gynecologic oncologists on the survival of primary non-mucinous EOC in Ontario. Methods: In this population-based retrospective cohort study, patients diagnosed with non-mucinous EOC between 2007-2018 were identified using province-wide administrative databases. Assessment by GOs was defined as any consultation 6 months prior to diagnosis date and up to first treatment (surgery or chemotherapy). Type of surgeon performing surgeries related to ovarian cancer were identified (general gynecologists, general surgeons, or GOs). Multivariate cox proportional hazards regression models were used to evaluate the impact of GO consultations prior to initiating treatment or having surgery done by a GO on the survival of ovarian cancer. Age, socioeconomic status (SES), year of diagnosis, comorbidity score and days from diagnosis to surgery were covariates in the models. FIGO stage was available in 70% of our cohort. Sensitivity analysis was performed adjusting for stage and the other covariates. Results: A total of 10,086 EOC patients were included between 2007-2018 with a median age of 63 years (range 53-72). Primary treatment included surgery alone in 26% of patients (2,593/10,086), while 63% (6,397/10,086) had neoadjuvant chemotherapy and/or adjuvant chemotherapy and 11% (1,096/10,086) had chemotherapy alone. A total of 8,990 ovarian cancer patients underwent surgery as part of their primary treatment. During the study period, there was an increase in GO consultations (79% in 2007 to 87% in 2018-19) and surgeries performed by GOs (69% in 2007 to 88% in 2018-19). On multivariate analysis, there was an increase in all-cause mortality for patients not assessed by GOs before first treatment (Hazard ratio (HR): 2.18; 95% CI 1.98-2.41). There was also an increase in all-cause mortality if ovarian cancer surgery was performed by non-GOs (HR 2.37; 95% CI 2.11- 2.67) after adjusting for age, SES, year of diagnosis, comorbidity score and days from diagnosis to surgery. In a sensitivity analysis where FIGO stage was added to the models, there remained a significant increase in all-cause mortality for patients not assessed by GOs before first treatment (HR 1.44; 95% CI 1.26-1.66) and an increase in all-cause mortality if ovarian cancer surgery was performed by non-GOs (HR 2.23; 95% CI 1.88-2.65). Conclusions: Assessment by GO before starting initial treatment (chemotherapy or surgery) was associated with improved survival in women with non-mucinous EOC. Type of surgeons performing primary ovarian cancer surgery had a significant impact on survival. more...
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- 2021
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25. Comprehensive perioperative care program to improve same-day discharge after minimally invasive gynecologic oncology surgery (MIGOS)
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Marcus Q. Bernardini, Stuart A. McCluskey, Rosemary Oheneba-Adom, Liat Hogen, Aysha Zia, Paulina Cybulska, Nastasia Kujbid, Stephane Laframboise, Taymaa May, Gregg Nelson, Sarah E. Ferguson, Genevieve Bouchard-Fortier, and Rachel Soyoun Kim more...
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medicine.medical_specialty ,Hysterectomy ,Quality management ,business.industry ,medicine.medical_treatment ,Psychological intervention ,Obstetrics and Gynecology ,Run chart ,Perioperative ,Gynecologic oncology ,Surgery ,symbols.namesake ,Oncology ,Patient experience ,medicine ,symbols ,business ,Fisher's exact test - Abstract
Objectives: Same-day discharge (SDD) after minimally invasive hysterectomy for benign or malignant gynecologic conditions has been shown to be safe and feasible, but remains challenging to implement. We designed and implemented a quality improvement perioperative program for minimally invasive gynecologic oncology surgery (MIGOS). Our aim was to improve SDD rate from 30% to 75% over the study period, while maintaining acceptable 30-day perioperative outcomes and patient experience. Methods: Consecutive patients undergoing minimally invasive hysterectomy at a single cancer centre were included during the 9-month project period and a historical cohort of 100 consecutive patients was identified for comparison. A team of gynecologic oncologists, anesthesiologists, and nurses developed a comprehensive perioperative care program and met bi-weekly to revise interventions through plan-do-study-act (PDSA) cycles. Patients were followed for 30 days after discharge. We conducted a descriptive analysis of the characteristics of pre-MIGOS and MIGOS patient cohorts using Wilcoxon rank-sum or Fisher exact tests. We used a run chart to monitor effects of interventions on outcomes and a pre-post analysis to evaluate for statistical significance of change in SDD and perioperative outcomes. Results: We assessed 100 consecutive pre-MIGOS and 79 consecutive MIGOS patients. Overall SDD rates increased from 31% (31/100) to 71% (56/79) after implementation (p Download : Download high-res image (130KB) Download : Download full-size image Conclusions: Following implementation of a perioperative quality improvement program targeted towards minimally invasive gynecologic oncology surgery, a multidisciplinary team significantly improved SDD rates while maintaining low 30-day perioperative complications and excellent patient experience. more...
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- 2021
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26. Ovarian cancer incidence and death in average-risk women undergoing bilateral oophorectomy at benign hysterectomy
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Sarah E. Ferguson, Rahim Moineddin, Maria C. Cusimano, Ning Liu, Maria Chiu, Suriya Aktar, and Nancy N. Baxter
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medicine.medical_specialty ,education.field_of_study ,Hysterectomy ,business.industry ,Obstetrics ,Incidence (epidemiology) ,medicine.medical_treatment ,Population ,Obstetrics and Gynecology ,medicine.disease ,Malignancy ,Cancer registry ,Oncology ,Interquartile range ,medicine ,Ovarian cancer ,business ,education ,Cohort study - Abstract
Objectives: Opportunistic bilateral oophorectomy (BO) is often considered in patients undergoing benign hysterectomy, but the degree to which BO reduces the incidence of ovarian cancer in this population remains unclear and is important for patient decision-making. Methods: We performed a population-based cohort study of all women (≥20 years) undergoing hysterectomy for benign indications from 1996-2015 in Ontario, Canada, followed to December 2019. Patients with ovarian pathology at hysterectomy, previous breast or gynecologic cancer, or evidence of genetic susceptibility to malignancy were excluded. Ovarian cancers and deaths were ascertained from the Ontario Cancer Registry. Inverse probability of treatment weighted Fine & Gray subdistribution hazard models were used to examine the effect of BO on ovarian cancer incidence and death, while accounting for competing risks and adjusting for demographic factors, gynecologic conditions, and comorbidities. Results: We identified 249,924 patients (BO 61,203 [25%]; ovarian conservation 188,721 [75%]) with median age 45 years (interquartile range [IQR] 40-52). Over median follow-up of 14 years (IQR 9-19), 584 women developed ovarian cancer (0.2%) and 17,052 died (6.8%) from any cause. Baseline characteristics were balanced after IPT weighting (standardized differences Conclusions: BO results in a small absolute reduction in incident ovarian cancer among women undergoing benign hysterectomy. Population-average risk estimates derived in this study are generalizable, directly address the limitations of previous work, and should be used to counsel patients preoperatively. more...
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- 2021
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27. Treatment outcomes and predictive factors in patients 70 years and older with advanced ovarian cancer
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Sarah E. Ferguson, Taymaa May, Liat Hogen, Sabrina Piedimonte, Stephane Laframboise, Paulina Cybulska, Geneviève Bouchard-Fortier, and Marcus Q. Bernardini
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Oncology ,medicine.medical_specialty ,Advanced ovarian cancer ,business.industry ,Internal medicine ,Treatment outcome ,medicine ,Obstetrics and Gynecology ,In patient ,business - Published
- 2021
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28. Sentinel lymph node biopsy versus complete lymphadenectomy in high grade endometrial cancer: a systematic review and meta-analysis of performance characteristics
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Osvaldo Espin-Garcia, Rachel Soyoun Kim, Genevieve Bouchard-Fortier, Maria C. Cusimano, Emma C. Rossi, Lauren Clarfield, Silvia Cabrera, Zibi Marchocki, Katherine Stewart, Walter H. Gotlieb, Pamela T. Soliman, Robert G. Holloway, Manuel Maria Ianieri, Sarah E. Ferguson, and Jeffrey How more...
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Endometrial cancer ,medicine.medical_treatment ,Not Otherwise Specified ,Sentinel lymph node ,Obstetrics and Gynecology ,medicine.disease ,medicine.anatomical_structure ,Breast cancer ,Oncology ,Meta-analysis ,Biopsy ,medicine ,Lymphadenectomy ,Radiology ,business ,Lymph node - Abstract
Objectives: Sentinel lymph node (SLN) biopsy is widely accepted as the standard of care for surgical staging in low grade endometrial cancer, but its value in high grade endometrial cancer remains unclear. The aim of this systematic review and meta-analysis was to evaluate the performance characteristics of SLN biopsy compared with pelvic lymphadenectomy in endometrial cancer patients with high-grade histology (PROSPERO ID: CRD42020160280). Methods: We systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, ClinicalTrials.gov, Ovid MEDLINE Epub Ahead of Print and In-Process & Other Non-Indexed Citations (January 1, 2000 to February 4, 2020) for prospective observational studies evaluating SLN biopsy in clinical stage I high grade endometrial cancer patients (grade 3 endometrioid, serous, clear cell, carcinosarcoma, mixed, undifferentiated/dedifferentiated, high grade not otherwise specified). Studies in which patients underwent cervical injection of indocyanine green for SLN detection, and at least a bilateral pelvic lymphadenectomy as a reference standard, were eligible for inclusion. If data was not reported specifically for patients with high grade histology, authors were contacted for aggregate data. We pooled detection rates and measures of diagnostic accuracy using a generalized linear mixed-effects model with a logit link, and assessed risk of bias using the QUADAS-II tool. Results: We identified 20 eligible studies, of which the authors for 8 provided data on 427 high grade patients specifically. The study-level median age was 66.9 years (range 44-82.8) and the study-level median BMI was 28.8 kg/m2 (range 18.9-45.2). The pooled detection rates were 91% per patient (95% CI 85-95; I2=62%) and 64% bilaterally (95% CI 53-73, I 2=72%). The overall node-positivity rate was 26% (95% CI 20-34; I 2=47%). Of 87 node positive patients, SLN biopsy correctly identified 80, yielding a pooled sensitivity of 92% per patient (95% CI 84-96; I2=0%) (Figure 1), false negative rate of 8% (95% CI 4-16; I2=0%), and negative predictive value of 97% (95% CI 95-99; I 2=0%). Download : Download high-res image (94KB) Download : Download full-size image Conclusions: SLN biopsy accurately detects lymph node metastases in high grade endometrial cancer, with a false negative rate comparable to that observed in melanoma and breast cancer. Diagnostic accuracy would be even higher if a strict SLN algorithm was followed in all included studies. SLN biopsy can replace complete lymphadenectomy in patients with high grade endometrial cancer. more...
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- 2021
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29. Progesterone receptor expression is associated with longer overall survival within high-grade histotypes of endometrial carcinoma: A Canadian high risk endometrial cancer consortium (CHREC) study
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Martin Köbel, Tony Panzarella, Eshetu G. Atenafu, Marcus Q. Bernardini, Sarah E. Ferguson, C. Blake Gilks, T.C. Ho, Peter F Rambau, Gregg Nelson, Blaise A. Clarke, and Jessica N. McAlpine
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0301 basic medicine ,Oncology ,Canada ,medicine.medical_specialty ,Serous carcinoma ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Progesterone receptor ,medicine ,Carcinoma ,Humans ,Survival rate ,Neoplasm Staging ,Gynecology ,Tissue microarray ,business.industry ,Endometrial cancer ,Hazard ratio ,Obstetrics and Gynecology ,Middle Aged ,Prognosis ,medicine.disease ,Immunohistochemistry ,Endometrial Neoplasms ,Survival Rate ,Serous fluid ,030104 developmental biology ,Receptors, Estrogen ,Tissue Array Analysis ,030220 oncology & carcinogenesis ,Female ,Neoplasm Grading ,Receptors, Progesterone ,business ,Carcinoma, Endometrioid - Abstract
Objective To assess the association of hormone receptor expression with outcome in high-grade endometrial carcinomas. Methods This study included three sites participating in the Canadian High Risk Endometrial Cancer (CHREC) consortium. Sections from tissue microarrays containing cases with a diagnosis of endometrioid grade 3 (EC3) and endometrial serous carcinoma (ESC) were assessed for estrogen (ER) and progesterone receptor (PR) expression by immunohistochemistry. Expression was considered present if >1% of tumor cell nuclei were labeled. Associations with overall survival were assessed. Results ER expression was present in 168/216 (78%) of EC3 and 124/192 (65%) of ESC. PR expression was present in 148/212 (70%) of EC3 and 83/196 (42%) of ESC. PR expression was significantly associated with favorable overall survival in EC3 and ESC (log rank, p =0.018 and p =0.0024) but ER expression was not. PR expression was significantly associated with favorable overall survival in EC3 independent of age, stage, center and lymph-vascular invasion (hazard ratio=0.457, 95% CI 0.257–0.811, p =0.0075) as well as in stage I and II ESC (hazard ratio=0.266, 95% CI 0.094–0.750, p =0.0123). Conclusion Our data provide support for the assessment of the PR expression status in EC3 and ESC. Future work will be required to determine how PR expression may be incorporated into management of patients with EC3 and ESC. more...
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- 2016
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30. Use of a genetic navigator to maximize Lynch syndrome detection in women with endometrial and non-serous/mucinous ovarian cancer
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Aaron Pollett, Raymond H. Kim, Jordan Lerner-Ellis, D Vicus, Alicia A. Tone, A. Lytwyn, Matthew Cesari, E. Van de Laar, Melyssa Aronson, Spring Holter, Lua Eiriksson, Tae L. Hart, Blaise A. Clarke, and Sarah E. Ferguson more...
- Subjects
Gynecology ,medicine.medical_specialty ,Serous fluid ,Oncology ,business.industry ,medicine ,Obstetrics and Gynecology ,Ovarian cancer ,medicine.disease ,business ,Lynch syndrome - Published
- 2020
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31. Sentinel lymph node biopsy versus lymphadenectomy for high-grade endometrial cancer staging (SENTOR trial): A prospective multicenter cohort study
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Jelena Mirkovic, Gabrielle E. V. Ene, Gulisa Turashvili, Stephane Laframboise, Danielle Vicus, Katherine Pulman, Sarah E. Ferguson, Marcus Q. Bernardini, Genevieve Bouchard-Fortier, Taymaa May, Maria C. Cusimano, Liat Hogen, Matthew Cesari, Marjan Rouzbahman, Aysha Zia, Lilian T. Gien, Blaise A. Clarke, Manjula Maganti, Allan Covens, and Rachel Kupets more...
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Endometrial cancer ,Sentinel lymph node ,Obstetrics and Gynecology ,medicine.disease ,Oncology ,Biopsy ,medicine ,Lymphadenectomy ,Radiology ,business ,Cohort study - Published
- 2020
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32. Performance characteristics of screening strategies to identify Lynch syndrome in women with non-serous and non-mucinous ovarian cancer
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Matthew Cesari, Alicia A. Tone, Spring Holter, Melyssa Aronson, A. Lytwyn, Soyoun Rachel Kim, Aaron Pollett, D Vicus, Sarah E. Ferguson, Leslie E. Oldfield, Tae L. Hart, Trevor J. Pugh, Lua Eiriksson, Blaise A. Clarke, Raymond H. Kim, Manjula Maganti, and E. Van de Laar more...
- Subjects
Oncology ,Serous fluid ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Obstetrics and Gynecology ,medicine.disease ,business ,Ovarian cancer ,Lynch syndrome - Published
- 2020
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33. Association of treatment modality with sexual dysfunction in gynecologic cancer survivors: A secondary analysis of the gyne-GALS randomized controlled trial
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Sarah E. Ferguson, Meredith L. Chivers, Jeanne Carter, Maria C. Cusimano, Catherine C. Classen, John W. Robinson, Lori A. Brotto, J.J. Koval, and Lisa Barbera
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medicine.medical_specialty ,business.industry ,Obstetrics and Gynecology ,Gyne ,law.invention ,Sexual dysfunction ,Oncology ,Randomized controlled trial ,law ,Treatment modality ,Internal medicine ,Secondary analysis ,Gynecologic cancer ,medicine ,medicine.symptom ,business - Published
- 2020
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34. The use of indocyanine green fluorescence angiography for colorectal anastomoses in cytoreductive surgery for ovarian carcinoma
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Taymaa May, Liat Hogen, Julie My Van Nguyen, S. Laframboise, Sarah E. Ferguson, Genevieve Bouchard-Fortier, and Marcus Q. Bernardini
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medicine.medical_specialty ,Oncology ,medicine.diagnostic_test ,business.industry ,Ovarian carcinoma ,Angiography ,medicine ,Obstetrics and Gynecology ,Radiology ,Anastomosis ,business ,Cytoreductive surgery ,Indocyanine green fluorescence - Published
- 2019
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35. A multi-centre prospective study comparing costs between robotics, laparoscopy and laparotomy in management of endometrial cancer
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Susie Lau, Lilian T. Gien, B. Renkosinski, Tony Panzarella, Helen Steed, Marcus Q. Bernardini, S. Kosa, Sarah E. Ferguson, and Vanessa Samouëlian
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,General surgery ,medicine.medical_treatment ,Endometrial cancer ,Obstetrics and Gynecology ,Robotics ,medicine.disease ,Oncology ,Laparotomy ,medicine ,Artificial intelligence ,Multi centre ,Laparoscopy ,Prospective cohort study ,business - Published
- 2019
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36. The sooner the better: Genetic testing following ovarian cancer diagnosis
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S. Randall Armel, E. Fox, Joan Murphy, David Chitayat, R. Demsky, Bruce R. Rosen, Manjula Maganti, Jeanna McCuaig, Cheryl Shuman, and Sarah E. Ferguson
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Adult ,Oncology ,medicine.medical_specialty ,endocrine system diseases ,Genetic counseling ,Genes, BRCA2 ,Genes, BRCA1 ,Genetic Counseling ,Internal medicine ,medicine ,Serous ovarian cancer ,Humans ,Genetic Testing ,Family history ,Germ-Line Mutation ,Aged ,Genetic testing ,Aged, 80 and over ,Family Health ,Ovarian Neoplasms ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Cancer ,Middle Aged ,medicine.disease ,Cystadenocarcinoma, Serous ,Test (assessment) ,Cohort ,Female ,Neoplasm Grading ,Ovarian cancer ,business - Abstract
Objective As treatment based genetic testing becomes a reality, it is important to assess the attitudes and preferences of women newly diagnosed with ovarian cancer regarding genetic testing. The objective of this study was to determine when women with a diagnosis of high grade serous ovarian cancer would prefer to undergo genetic testing and factors that influence this preference. Methods Women over 18years of age with a known diagnosis of high grade serous ovarian cancer diagnosed between October 2010–2013 were identified via the Princess Margaret Cancer Center Registry. Participants completed a questionnaire, which obtained preferences and attitudes towards genetic testing, cancer history, and demographic information. Results 120 of the 355 women identified (33.8%) completed the questionnaires. The median age at time of ovarian cancer diagnosis was 57years (range 35–84). The majority of participants in this study were offered (94.6%) and pursued (84.8%) genetic testing. In this cohort, testing was most frequently offered at diagnosis (41.8%) or during treatment (19.1%). In this study, women with high grade serous ovarian cancer felt that genetic testing should be offered before or at the time of diagnosis (67.8%). Having a family history of breast or ovarian cancer was significantly (p=0.012) associated with preferring genetic testing at an earlier time point in the disease course. Conclusions Our results demonstrate that women with high grade serous ovarian cancer acknowledge the personal and clinical utility of genetic testing and support test implementation at the time of cancer diagnosis. more...
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- 2015
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37. Performance characteristics of a brief Family History Questionnaire to screen for Lynch syndrome in women with newly diagnosed endometrial cancer
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Christine Massey, Steven Gallinger, Melyssa Aronson, Amit M. Oza, Sarah E. Ferguson, Marcus Q. Bernardini, Helen Mackay, Lua Eiriksson, Blaise A. Clarke, Aaron Pollett, and Golnessa Mojtahedi
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Adult ,medicine.medical_specialty ,Cohort Studies ,Germline mutation ,Surveys and Questionnaires ,Internal medicine ,Positive predicative value ,medicine ,Humans ,Genetic Predisposition to Disease ,Genetic Testing ,Prospective Studies ,Family history ,Medical History Taking ,Prospective cohort study ,Early Detection of Cancer ,Germ-Line Mutation ,Aged ,Genetic testing ,Aged, 80 and over ,Family Health ,Gynecology ,medicine.diagnostic_test ,business.industry ,Medical record ,Endometrial cancer ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Colorectal Neoplasms, Hereditary Nonpolyposis ,Lynch syndrome ,Endometrial Neoplasms ,Oncology ,Female ,business - Abstract
Objective The brief Family History Questionnaire (bFHQ) was developed to identify endometrial cancer patients whose family histories suggest Lynch syndrome (LS). We compared the bFHQ, extended Family History Questionnaire (eFHQ) and dictated medical records (DMRs) to determine which family history screening strategy is superior in identifying LS in unselected women with newly diagnosed endometrial cancer that have undergone universal germline testing. Methods Prospective cohort study recruited women with newly diagnosed endometrial cancer to evaluate screening strategies to identify LS. Participants completed bFHQ and eFHQ, had tumor assessed with immunohistochemistry (IHC) for mismatch repair proteins (MMR) and micro-satellite instability testing and underwent universal germline testing for LS. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) were compared between the family history screening strategies as well as IHC. Results 118 of 182 eligible patients (65%) consented; 87 patients (74%) were evaluable with both family history and germline mutation status. Median age was 61 years (range 26–91). All 7 patients with confirmed LS were correctly identified by bFHQ, compared to 5 and 4 by eFHQ and DMR, respectively. The sensitivity, specificity, PPV and NPV values of bFHQ were 100%, 76.5%, 25.9% and 100%, respectively, performing similar to IHC testing. While eFHQ was more specific than bFHQ (86.7% vs. 76.5%, P = 0.007), 2 cases of LS were missed. Conclusions The patient-administered bFHQ effectively identified women with confirmed LS and is a good screening tool to triage women with endometrial cancer for further genetic assessment. more...
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- 2015
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38. Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer
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Vanessa Samouëlian, Tony Panzarella, Ben Renkosinski, Sarah E. Ferguson, Lilian T. Gien, Susie Lau, Christopher Giede, Tien Le, Marcus Q. Bernardini, and Helen Steed
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Adult ,medicine.medical_specialty ,Visual analogue scale ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Gynecologic Surgical Procedures ,Quality of life ,Robotic Surgical Procedures ,Internal medicine ,Surveys and Questionnaires ,Medicine ,Humans ,Patient Reported Outcome Measures ,Prospective Studies ,Brief Pain Inventory ,Prospective cohort study ,Aged ,Aged, 80 and over ,030219 obstetrics & reproductive medicine ,business.industry ,Endometrial cancer ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Endometrial Neoplasms ,Sexual dysfunction ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,Quality of Life ,Female ,Laparoscopy ,medicine.symptom ,Sexual Health ,business ,Cohort study - Abstract
Objective To evaluate patient-reported outcomes (PROs) between women treated by laparoscopic, robotic and open approaches for endometrial cancer. Methods Prospective cohort study comparing PRO at baseline, short- (1 and 3 weeks) and long-term (12 and 24 weeks) follow-up postoperatively. Quality of life (QOL) measures were the Functional Assessment of Cancer Therapy (FACT-G), EuroQol Five Dimensions (EQ-5D), and Brief Pain Inventory (BPI). Sexual health measures were the Female Sexual Function Index (FSFI) and the Sexual Adjustment and Body Image Scale for Gynecologic Cancer (SABIS-G). Results 468 eligible patients (laparotomy = 92, laparoscopy = 152, robotic = 224) were recruited. There were no significant differences between the laparoscopy and robotic groups for any PRO ( P > 0.05). At short-term follow-up, patients who underwent minimally invasive surgery (robotic or laparoscopy) had significantly higher FACT-G ( P P P = 0.02) and improved pain interference ( P = 0.0008), than patients undergoing laparotomy. At long-term follow-up, there were sustained improvements in the FACT-G ( P = 0.035) and the health state EQ-5D visual analogue scale ( P = 0.022). Surgical approach had no impact on sexual health ( P > 0.05); however the mean FSFI score for the entire cohort met clinical cut-offs for sexual dysfunction. Conclusion Minimally invasive approaches result in improved QOL beyond the short-term postoperative period, with benefits noted up to 12 weeks after surgery. This prolonged QOL advantage provides further evidence that MIS should be the standard surgical approach for women with early stage endometrial cancer. more...
- Published
- 2018
39. Is adjuvant chemotherapy beneficial for surgical stage I ovarian clear cell carcinoma?
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Dina Bassiouny, Allan Covens, Danielle Vicus, Liat Hogen, Harry Brar, Lilian T. Gien, Sarah E. Ferguson, and Marcus Q. Bernardini
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Oncology ,Adult ,medicine.medical_specialty ,Paclitaxel ,Adjuvant chemotherapy ,medicine.medical_treatment ,Carboplatin ,03 medical and health sciences ,0302 clinical medicine ,Cytology ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Stage (cooking) ,Aged ,Aged, 80 and over ,Ovarian Neoplasms ,Chemotherapy ,Univariate analysis ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Cancer ,Middle Aged ,medicine.disease ,Survival Analysis ,Surgery ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Clear cell carcinoma ,Cohort ,Female ,business ,Adenocarcinoma, Clear Cell - Abstract
Objective To assess the impact of adjuvant chemotherapy on survival in patients with surgical stage I ovarian clear cell carcinoma (OCCC). Methods Data collection and analysis of surgical stage I OCCC patients treated at two tertiary cancer centers was performed. Descriptive statistics, univariate and multivariable analyses and Kaplan-Meier survival probability estimates were completed. Results Sixty stage I OCCC patients who underwent comprehensive surgical staging were identified. 29 patients received adjuvant chemotherapy and 31 did not. Median follow-up was 4.96 (0.4–16.4) years. The 5-year disease specific survival (DSS) was 84.2%: 95% for stage IA and 76% for stage IB+IC (p=0.16). There were 11 disease specific deaths: 7 in the no adjuvant chemotherapy group (NACG) and 4 in the adjuvant chemotherapy group (ACG). 5-year DSS was 84.2%: 74% in NACG and 93% in ACG, (p=0.13). Seventeen patients recurred: 11 in NACG and 6 in ACG (p=0.2). None of the 21 patients with stage I known negative cytology recurred. 5-year PFS was 74%: 58% in NACG and 86% in ACG (p=0.035). On univariate analysis, no-adjuvant chemotherapy and positive cytology were poor prognostic factors for PFS: HR=2.36, p=0.04 and HR=3.1, p=0.027, respectively. After adjusting for positive cytology, no-adjuvant chemotherapy was still found to significantly correlate with a worse PFS (HR=4, p=0.01). Conclusion Our data supports the use of adjuvant chemotherapy for surgical stage I OCCC. As no patients in our cohort with surgical stage I known negative cytology recurred, more research on the benefit of adjuvant chemotherapy in this group is warranted. more...
- Published
- 2017
40. Corrigendum to 'The sooner the better: Genetic testing following ovarian cancer diagnosis' [Gynecol. Oncol. 137 (2015) 423-429]
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Bruce R. Rosen, Manjula Maganti, R. Demsky, Joan Murphy, David Chitayat, S. Randall Armel, Jeanna McCuaig, E. Fox, Cheryl Shuman, and Sarah E. Ferguson
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Oncology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Internal medicine ,medicine ,Obstetrics and Gynecology ,business ,Ovarian cancer ,medicine.disease ,Genetic testing - Published
- 2017
41. Fertility sparing treatment of complex atypical hyperplasia and low grade endometrial cancer using oral progestin
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Tomer Feigenberg, Nadia Ismiil, S. Laframboise, Christine Massey, Andrea N. Simpson, Blaise A. Clarke, Lilian T. Gien, and Sarah E. Ferguson
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Adult ,medicine.medical_specialty ,Antineoplastic Agents, Hormonal ,Pregnancy Rate ,Reproductive Techniques, Assisted ,medicine.medical_treatment ,media_common.quotation_subject ,Population ,Fertility ,Medroxyprogesterone Acetate ,Hysterectomy ,Pregnancy ,medicine ,Humans ,Medroxyprogesterone acetate ,Fertility preservation ,education ,Retrospective Studies ,media_common ,Gynecology ,education.field_of_study ,business.industry ,Megestrol Acetate ,Endometrial cancer ,Pregnancy Outcome ,Fertility Preservation ,Obstetrics and Gynecology ,medicine.disease ,Endometrial Neoplasms ,Endometrial hyperplasia ,Treatment Outcome ,Oncology ,Endometrial Hyperplasia ,Female ,Neoplasm Grading ,business ,Live birth ,Carcinoma, Endometrioid ,Organ Sparing Treatments ,medicine.drug - Abstract
Oral progestin is an alternative to hysterectomy for women with complex atypical hyperplasia (CAH) or grade one endometrial cancer (G1EC) who wish fertility preservation. We evaluated treatment efficacy and fertility outcomes in this population.Women45 y treated with oral progestin for CAH or G1EC were identified from two cancer centers. Data were obtained from medical records and telephone questionnaires. Time until complete response (CR), and from CR until recurrence was censored for patients without events and analyzed for associations with patient and treatment characteristics; cumulative incidence functions were used to estimate event probability over time.44 patients were identified, 19 (43%) with CAH and 25 (57%) with G1EC. Median age was 36.5 y (26-44). 24 (55%) achieved CR (median time: 5.7 months). Older age was associated with a lower likelihood of CR (HR 0.84, p=0.0003, 95% CI, 0.8-0.9). CR probability appeared to plateau after 12 months of therapy. Among those with CR, 13 (54%) recurred (median time 3.5 y). 24 patients (55%) underwent hysterectomy; 3 (13%) were upstaged. 11 (25%) underwent fertility treatment with the following outcomes: 6 (55%) no pregnancy, 2 (18%) at least one live infant, and 3 (27%) spontaneous abortion. One achieved a live birth without intervention.Oral progestin is an effective temporizing fertility-sparing treatment for women with CAH/G1EC. Fertility specialist involvement is recommended due to the low live birth rate without intervention. Progestin therapy should be re-evaluated at 1 year in non-responders due to a low probability of success. Hysterectomy is recommended after childbearing due to a high recurrence rate. more...
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- 2014
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42. Streamlined next-generation sequencing panel provides comprehensive molecular assessment of mismatch repair deficiency in endometrial and non-serous ovarian cancer
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Leslie E. Oldfield, Tiantian Li, Sarah E. Ferguson, Trevor J. Pugh, E. Van de Laar, D Vicus, I. Cirlan, Alicia A. Tone, and Blaise A. Clarke
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Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,MISMATCH REPAIR DEFICIENCY ,medicine ,Serous ovarian cancer ,Obstetrics and Gynecology ,business ,DNA sequencing - Published
- 2019
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43. Clinical outcomes of surgically unresectable endometrial cancers
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J. Lukovic, Jessica L. Conway, J. Zhang, Alexandra Rink, Kathy Han, Wei Xu, Sarah E. Ferguson, and Neesha C. Dhani
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medicine.medical_specialty ,Oncology ,business.industry ,Obstetrics and Gynecology ,Medicine ,Radiology ,business - Published
- 2019
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44. Creating a scoring system using pre-operative factors to predict the extent of surgery at the time of interval cytoreduction in advanced ovarian cancer
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Sarah E. Ferguson, A. Gemmill, Marcus Q. Bernardini, V. Gupta, S. Laframboise, Taymaa May, and Wei Xu
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Advanced ovarian cancer ,medicine.medical_specialty ,Scoring system ,Oncology ,business.industry ,Obstetrics and Gynecology ,Medicine ,Interval (graph theory) ,business ,Pre operative ,Surgery - Published
- 2019
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45. Impact of surgical approach on survival outcomes in women undergoing radical hysterectomy for cervical cancer: A population-based cohort study
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Karla Willows, Lilian T. Gien, H. Raziee, Sarah E. Ferguson, Rahim Moineddin, Fahima Dossa, Ning Liu, Nancy N. Baxter, and Maria C. Cusimano
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Cervical cancer ,medicine.medical_specialty ,Population based cohort ,Surgical approach ,Oncology ,business.industry ,General surgery ,medicine ,Obstetrics and Gynecology ,Radical Hysterectomy ,medicine.disease ,business - Published
- 2019
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46. Informational needs of gynecologic cancer survivors
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Sara Urowitz, Pamela Catton, Sarah E. Ferguson, Audrey Jusko Friedman, Christine Massey, Janet Papadakos, Sophie Bussière-Côté, and Nazek Abdelmutti
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Gynecology ,Health Services Needs and Demand ,medicine.medical_specialty ,Consumer Health Information ,Genital Neoplasms, Female ,business.industry ,MEDLINE ,Obstetrics and Gynecology ,Gynecologic oncology ,Middle Aged ,Patient Education as Topic ,Oncology ,Surveys and Questionnaires ,Family medicine ,Survivorship curve ,Needs assessment ,Gynecologic cancer ,Ambulatory ,medicine ,Recurrent disease ,Humans ,Female ,Survivors ,business ,Patient education - Abstract
In preparation for the launch of a gynecologic oncology survivorship program, this study looked at the informational needs of women with gynecologic cancers. Although studies have touched on some of these needs, no published literature has investigated the comprehensive informational needs of gynecologic oncology patients within all sites of gynecologic cancers.A needs assessment, consisting of a self-administered questionnaire, was conducted at an ambulatory gynecologic oncology clinic from August 2010 to March 2011. This study investigated the informational needs of patients, including the importance of information, the amount desired, and the preferred mode of delivery. Informational needs were grouped into six domains: medical, practical, physical, emotional, social, and spiritual.185 surveys were analyzed and the majority of the respondents were Caucasian (77%) and over the age of 50 (66%). Forty-nine percent of respondents were diagnosed with ovarian cancer, and there was an even distribution between newly diagnosed patients (38%), those in long-term follow-up (27%), and those with recurrent disease (37%). Overall, respondents placed more importance on receiving medical information (P0.01). The three preferred education modalities were; pamphlets, one-on-one discussions with health care professionals and websites. Age, education, and disease site were associated with differing informational needs.This study has highlighted the most important informational needs of patients with gynecologic malignancies in our patient population. This information may guide the development of clinical survivorship programs and educational resources for patients in the future. more...
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- 2012
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47. Prospective validation of sentinel lymph node (SLN) biopsy with indocyanine green (ICG) fluorescence imaging in high-risk endometrial cancer
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Allan Covens, Sarah E. Ferguson, Maria C. Cusimano, Gabrielle E. V. Ene, Geneviève Bouchard-Fortier, D Vicus, Matthew Cesari, Stephane Laframboise, Lilian T. Gien, Patricia Shaw, Marcus Q. Bernardini, Taymaa May, Rachel Kupets, and Aysha Zia more...
- Subjects
Fluorescence-lifetime imaging microscopy ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Endometrial cancer ,Sentinel lymph node ,Obstetrics and Gynecology ,medicine.disease ,chemistry.chemical_compound ,Oncology ,chemistry ,Biopsy ,medicine ,Radiology ,business ,Indocyanine green - Published
- 2018
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48. A prospective randomized trial comparing patient-controlled epidural analgesia to patient-controlled intravenous analgesia on postoperative pain control and recovery after major open gynecologic cancer surgery
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Richard Barakat, Yukio Sonoda, Dennis S. Chi, Venkatraman E. Seshan, Douglas A. Levine, Nadeem R. Abu-Rustum, Tim Malhotra, and Sarah E. Ferguson
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medicine.medical_specialty ,Genital Neoplasms, Female ,medicine.drug_class ,Visual analogue scale ,medicine.medical_treatment ,Uterine Cervical Neoplasms ,law.invention ,Randomized controlled trial ,law ,Laparotomy ,Gynecologic cancer ,medicine ,Clinical endpoint ,Humans ,Infusions, Intravenous ,Adverse effect ,Pain Measurement ,Ovarian Neoplasms ,Pain, Postoperative ,Morphine ,Local anesthetic ,business.industry ,Obstetrics and Gynecology ,Analgesia, Patient-Controlled ,General Medicine ,Perioperative ,Surgery ,Analgesia, Epidural ,Analgesics, Opioid ,Clinical trial ,Opioid ,Oncology ,Anesthesia ,Uterine Neoplasms ,Female ,business ,Abdominal surgery ,medicine.drug - Abstract
A previous prospective comparative study reported no difference in resting or dynamic pain scores among women with gynecologic cancer undergoing laparotomy and radical hysterectomy who were treated with either local anesthetic/opioid patient-controlled epidural analgesia (PCEA) or conventional intravenous (IV) opioid patient-controlled analgesia (PCA). However, there was a shorter hospital stay, earlier return of bowel function, and use of less morphine in the PCEA group. No prospective randomized trials have compared IV PCA to PCEA for postoperative control of pain in women treated for benign or malignant gynecologic diseases. This prospective randomized study compared the effect of PCEA and IV morphine PCA on pain scores and other postoperative recovery parameters in women undergoing major open abdominal surgery. Between 2004 and 2007, 67 patients were randomized to PCEA (treatment group) and 68 to the IV PCA (control group). The majority of study women (75%) had gynecologic cancer. Pain and other postoperative outcomes were compared with an intention-to-treat analysis. A 10-point visual analog scale (VAS) was used to measure postoperative pain, at rest and when coughing. There was significantly less pain at rest among patients in the PCEA group postoperatively on day 1 compared to the PCA group (mean VAS: 3.3 vs. 4.3, P = 0.01). Superior pain control during coughing was found in the PCEA group for first 3 postoperative days; the mean VAS scores on days 1, 2, and 3 were 5.5, 5.0, and 4.7 in the PCEA group, and 6.7, 6.5, and 5.7 in the PEA group (P < 0.05). During the first 6 days, overall postoperative pain in the PCEA group was significantly lower during both rest and coughing compared to the PCA group (P < 0.003). No significant major adverse events were associated with placement or use of the thoracic epidural, and an extremely low rate of epidural malfunctioning was noted. These data show superior pain control by PCEA in comparison to conventional IV PEA among women undergoing major open abdominal surgery, and are consistent with the findings of other randomized controlled trials in different patient populations. more...
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- 2009
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49. Low risk of complications associated with the fenestrated peritoneal catheter used for intraperitoneal chemotherapy in ovarian cancer
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Linda M. Nicoll, Carol L. Brown, Nadeem R. Abu-Rustum, Yukio Sonoda, Joanne F. Chou, Destin Black, Alexia Iasonos, Mario M. Leitao, Douglas A. Levine, Sarah E. Ferguson, Dennis S. Chi, and Richard R. Barakat more...
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Adult ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Antineoplastic Agents ,Catheterization ,Catheters, Indwelling ,Port (medical) ,medicine ,Humans ,Infusions, Parenteral ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,Ovarian Neoplasms ,Chemotherapy ,Catheter insertion ,business.industry ,Obstetrics and Gynecology ,Bowel resection ,Middle Aged ,medicine.disease ,Chemotherapy regimen ,Surgery ,Discontinuation ,Catheter ,Oncology ,Female ,Ovarian cancer ,business - Abstract
Objectives We previously reported a 10% rate of catheter complications, including inflow obstruction and infection, using a fenestrated catheter to administer intraperitoneal (IP) chemotherapy for ovarian cancer. Because of recent reports of higher rates of catheter complications, we performed this study to update our experience with the fenestrated catheter. Methods We reviewed the medical records of all patients who had a fenestrated catheter placed at our institution from 5/97–5/06. Data were collected regarding patient demographics, surgical procedure, timing of catheter insertion, and reasons for discontinuing IP chemotherapy. Results We identified 342 patients who had fenestrated catheters placed and for whom follow-up data were available. Nine patients (3%) required discontinuation of chemotherapy due to catheter complications. Three patients experienced catheter infection, 5 patients had inflow obstruction, and 1 patient's port could not be accessed. Seventy-one patients (21%) discontinued IP chemotherapy for reasons unrelated to the catheter. The percentage of patients who completed the intended chemotherapy regimen was similar for patients who underwent a bowel resection (22/30 [73%]) compared to those who had not (226/312 [72%]) ( P =1.0). Conclusions The fenestrated catheter for IP chemotherapy continues to be associated with a low risk of catheter-related complications. The low rate of complications, even in the setting of bowel resection and increase in utilization during upfront chemotherapy, suggest that the fenestrated catheter is still a feasible method for the administration of IP chemotherapy. more...
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- 2008
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50. Treatment related outcomes in high-risk endometrial carcinoma: Canadian high risk endometrial cancer consortium (CHREC)
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Mina Wesa, Marcus Q. Bernardini, Eshetu G. Atenafu, Gregg Nelson, Guangming Han, Blaise A. Clarke, T.C. Ho, Tony Panzarella, Vanessa Samouëlian, Sarah E. Ferguson, Martin Köbel, Susie Lau, Lilian T. Gien, Jessica N. McAlpine, Blake Gilks, Alon D. Altman, and Anna Cameron more...
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0301 basic medicine ,Oncology ,medicine.medical_specialty ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Carcinosarcoma ,Carcinoma ,Adjuvant therapy ,Medicine ,Humans ,Prospective cohort study ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,business.industry ,Proportional hazards model ,Endometrial cancer ,Obstetrics and Gynecology ,Cancer ,Middle Aged ,medicine.disease ,Endometrial Neoplasms ,Serous fluid ,030104 developmental biology ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,business - Abstract
The lack of randomized clinical data pertaining to optimal surgery and adjuvant treatment in women with high-risk histotypes of endometrial cancer has resulted in selective management based on institutional policies. The objective of this study was to assess differences in treatment strategies and their outcomes among various institutions.High-risk endometrial cancer cases (2000-2012) with corresponding clinicopathologic data were collected from 7 academic cancer centers. Histotypes included grade 3 endometrioid (EC3), serous (ESC), clear cell (CCC) and carcinosarcoma (CS). Associations with overall survival were performed using Cox proportional hazard regression.1260 patients treated between 2000 and 2012 were included in the study: 398 EC3, 449 ESC, 91 CCC, 236 CS and 83 'other'. The use of adjuvant chemotherapy, adjuvant radiation, and extent of surgical staging were statistically different among the 7 centers (P0.001). Histotype was independently associated with overall survival (OS) in patients with stage 1 and 2 disease who underwent surgical staging (P=0.0324). Adjuvant radiation was associated with improved OS for EC3 and CCC and adjuvant chemotherapy was associated with improved OS for ESC and CS. There was a high rate of recurrence (17.8% and 21.4%) in completely staged, stage 1A patients with ESC and CS respectively.There exists a wide variation in practice and outcomes for high-risk histotypes of endometrial cancer. The relative impact of adjuvant therapy appears to be histotype dependent and prospective studies examining adjuvant treatment in high-risk histotypes should use caution combining them together. more...
- Published
- 2015
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