2,701 results on '"GYNECOLOGY"'
Search Results
2. Internal fellowship candidate match rates in obstetrics and gynecology before and after the widespread adoption of virtual interviews post-COVID.
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McLaughlin, Hannah, Janke, Monica, Roberts, Celeste, Spencer, Ryan, Siedel, Jean, and Uppal, Shitanshu
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COVID-19 pandemic , *COVID-19 , *GYNECOLOGY , *OBSTETRICS - Published
- 2024
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3. The role of gynecologic oncology providers in intraoperative consultations in obstetrics and gynecology department.
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Grubbs, Allison, Foley, Olivia, Hinchcliff, Emily, Marcus, Jenna, Roque, Dario, Tanner, Edward, and Barber, Emma
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GYNECOLOGIC oncology , *GYNECOLOGY , *OBSTETRICS - Published
- 2024
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4. Race, ethnicity, and gender in academic gynecology oncology leadership.
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Velasquez, Jessica, Gellman, Caroline, Saleh, Mona, Prasad-Hayes, Monica, and Blank, Stephanie
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RACE , *ETHNICITY , *GENDER , *GYNECOLOGY , *ONCOLOGY - Published
- 2024
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5. Implementation of an interactive, digital cancer risk assessment tool in a Medicaid-predominant, racially-diverse gynecology clinic in Brooklyn, New York.
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Kim, Michael, Chandler, Isabelle, Webster, Emily, Grant, Benjamin, Brewer, Jesse, Soussana, Tamar, Hayek, Judy, Veca, Josine, Howard, Denise, Sharaf, Ravi, and Frey, Melissa
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DISEASE risk factors , *RISK assessment , *GYNECOLOGY - Published
- 2024
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6. Multi-disciplinary summit on genetics services for women with gynecologic cancers: A Society of Gynecologic Oncology White Paper.
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Randall, Leslie M, Pothuri, Bhavana, Swisher, Elizabeth M, Diaz, John P, Buchanan, Adam, Witkop, Catherine T, Bethan Powell, C, Smith, Ellen Blair, Robson, Mark E, Boyd, Jeff, Coleman, Robert L, and Lu, Karen
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Humans ,Genital Neoplasms ,Female ,Genetic Services ,Genetic Counseling ,Gynecology ,Patient Selection ,Societies ,Medical ,Female ,Congresses as Topic ,Consensus Development Conferences as Topic ,Practice Guidelines as Topic ,Lynch Syndrome II ,Genetic Testing ,Hereditary Breast and Ovarian Cancer Syndrome ,Surgical Oncology ,Clinical Research ,Prevention ,Genetics ,Ovarian Cancer ,Cancer ,Health Services ,Rare Diseases ,Oncology and Carcinogenesis ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis - Abstract
ObjectiveTo assess current practice, advise minimum standards, and identify educational gaps relevant to genetic screening, counseling, and testing of women affected by gynecologic cancers.MethodsThe Society of Gynecologic Oncology (SGO) organized a multidisciplinary summit that included representatives from the American College of Obstetricians and Gynecologists (ACOG), the American Society Clinical Oncology (ASCO), the National Society of Genetic Counselors (NSGC), and patient advocacy groups, BrightPink and Facing our Risk of Cancer Empowered (FORCE). Three subject areas were discussed: care delivery models for genetic testing, barriers to genetic testing, and educational opportunities for providers of genetic testing.ResultsThe group endorsed current SGO, National Comprehensive Cancer Network (NCCN), and NSGC genetic testing guidelines for women affected with ovarian, tubal, peritoneal cancers, or DNA mismatch repair deficient endometrial cancer. Three main areas of unmet need were identified: timely and universal genetic testing for women with ovarian, fallopian tube, and peritoneal cancers; education regarding minimum standards for genetic counseling and testing; and barriers to implementation of testing of both affected individuals as well as cascade testing of family members. Consensus building among all stakeholders resulted in an action plan to address gaps in education of gynecologic oncology providers and delivery of cancer genetics care.
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- 2017
7. Gynecologic Oncology 2017 Update: New Features and Expanded Scope
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Karlan, Beth Y
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Cooperative Behavior ,Editorial Policies ,Gynecology ,Humans ,Journal Impact Factor ,Periodicals as Topic ,Societies ,Medical ,Surgical Oncology ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Reproductive medicine - Published
- 2017
8. Gynecologic Oncology: An update on our progress
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Beth Y, Karlan
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Female ,Genital Neoplasms ,Female ,Gynecology ,Humans ,Journal Impact Factor ,Medical Oncology ,Periodicals as Topic ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Reproductive medicine - Published
- 2014
9. Palliative care utilization of gynecology oncology patients with advanced cancer (057).
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Reyes, Maria De Fatima, Chen, Lee-may, Patel, Kanan, and Sudore, Rebecca
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CANCER patients , *PALLIATIVE treatment , *GYNECOLOGY - Published
- 2023
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10. The importance of family-focused care in the setting of advanced gynecological cancers.
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Applebaum AJ
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- Humans, Female, Gynecology, Genital Neoplasms, Female therapy
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Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2024
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11. The impact of depressive symptoms on health value in patients with gynecologic cancer: A comparison with physical symptoms and performance status.
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Yu, Ye Lee, Yeo, Hyemin, and Kang, Sokbom
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GYNECOLOGIC cancer , *CANCER patients , *VISUAL analog scale - Abstract
The importance of managing depressive symptoms is frequently underestimated in the clinic. In this study, the effects of depressive symptoms on health utility value (HUV) in gynecologic cancer patients are evaluated. In addition, the effects were compared with those of performance status and physical symptoms. Patient-reported outcome data from 274 gynecologic cancer patients were prospectively collected. HUV was measured using the 3-level version of the EuroQoL 5-dimension descriptive system (EQ-5D-3L) and the EuroQoL visual analog scale (EQ-VAS). The Patient Health Questionnaire-9 (PHQ-9) was used to measure the severity of depressive symptoms. The impact of depressive symptoms on HUV was analyzed using the generalized linear model. Moderate–severe depressive symptoms were significantly associated with a decrease in HUV in gynecologic cancer patients (p < 0.0001 for the EQ-5D-3L and EQ-VAS). Severe fatigue and severe pain were also associated with a decrease in HUV (p = 0.018 and p < 0.0001 for the EQ-5D-3L and EQ-VAS; p < 0.0001 for the EQ-5D-3L, respectively), and the effect sizes were comparable to that of moderate-severe depressive symptoms. In addition to the patients with moderate–severe depressive symptoms, the patients with mild depressive symptoms also experienced a significant decrease in HUV (p < 0.0001 for the EQ-5D-3L and EQ-VAS). The effect size for mild depressive symptoms was comparable to those for mild fatigue or mild pain. Even mild depressive symptoms may significantly compromise HUV in gynecologic cancer patients, and the effect is comparable to that of performance status or physical symptoms. Gynecologic oncologists should put more effort into properly preventing, detecting, and managing depressive symptoms. • Depressive symptoms were associated with a significant decrease in health utility value in gynecologic cancer patients. • Even patients with mild depressive symptoms were significantly associated with a decrease in health utility value. • The magnitudes of these associations on health utility value were comparable to the impacts of physical symptoms. [ABSTRACT FROM AUTHOR]
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- 2020
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12. Cervical cancer treatment in Rwanda: Resource-driven adaptations, quality indicators, and patient outcomes
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Rebecca J. DeBoer, Victoria Umutoni, Lisa Bazzett-Matabele, Ethan Katznelson, Cam Nguyen, Aline Umwizerwa, Jean Bosco Bigirimana, Alan Paciorek, Nicaise Nsabimana, Deogratias Ruhangaza, Diomede Ntasumbumuyange, Lawrence N. Shulman, Scott A. Triedman, and Cyprien Shyirambere
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Adult ,Time Factors ,Paclitaxel ,Uterine Cervical Neoplasms ,Kaplan-Meier Estimate ,Adenocarcinoma ,Hysterectomy ,Disease-Free Survival ,Health Services Accessibility ,Carboplatin ,Time-to-Treatment ,Carcinoma, Adenosquamous ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Quality Indicators, Health Care ,Retrospective Studies ,Aged, 80 and over ,Rwanda ,Obstetrics and Gynecology ,Chemoradiotherapy, Adjuvant ,Middle Aged ,Surgical Oncology ,Oncology ,Gynecology ,Carcinoma, Squamous Cell ,Health Resources ,Female - Abstract
Most cervical cancer cases and deaths occur in low- and middle-income countries, yet clinical research from these contexts is significantly underrepresented. We aimed to describe the treatment quality, resource-driven adaptations, and outcomes of cervical cancer patients in Rwanda.A retrospective cohort study was conducted of all patients with newly diagnosed cervical cancer enrolled between April 2016 and June 2018. Data were abstracted from medical records and analyzed using descriptive statistics, Kaplan Meier methods, and Cox proportional hazards regression.A total of 379 patients were included; median age 54 years, 21% HIV-infected. A majority (55%) had stage III or IV disease. Thirty-four early-stage patients underwent radical hysterectomy. Of 254 patients added to a waiting list for chemoradiation, 114 ultimately received chemoradiation. Of these, 30 (26%) received upfront chemoradiation after median 126 days from diagnosis, and 83 (73%) received carboplatin/paclitaxel while waiting, with a median 56 days from diagnosis to chemotherapy and 207 days to chemoradiation. There was no survival difference between the upfront chemoradiation and prior chemotherapy subgroups. Most chemotherapy recipients (77%) reported improvement in symptoms. Three-year event-free survival was 90% with radical hysterectomy (95% CI 72-97%), 66% with chemoradiation (95% CI 55-75%), and 12% with chemotherapy only (95% CI 6-20%).Multi-modality treatment of cervical cancer is effective in low resource settings through coordinated care and pragmatic approaches. Our data support a role for temporizing chemotherapy if delays to chemoradiation are anticipated. Sustainable access to gynecologic oncology surgery and expanded access to radiotherapy are urgently needed.
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- 2022
13. CATCH: Blueprint for a cancer genetic risk assessment tool for use in a diverse, underserved gynecology clinic population (163).
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Webster, Emily, Ahsan, Muhammad Danyal, Li, Xuan, Kulkarni, Amita, Dioun, Shayan, Levi, Sarah, Cantillo, Evelyn, Holcomb, Kevin, Chapman-Davis, Eloise, Sharaf, Ravi, and Frey, Melissa
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DISEASE risk factors , *RISK assessment , *GYNECOLOGY - Published
- 2023
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14. Endometriosis and menopausal hormone therapy impact the hysterectomy-ovarian cancer association
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Marc T. Goodman, Argyrios Ziogas, Jenny Chang-Claude, Anna H. Wu, Susan J. Jordan, Joellen M. Schildkraut, Minh Tung Phung, Francesmary Modugno, Penelope M. Webb, Daniel W. Cramer, Rachel Palmieri Weber, Andrew Berchuck, Bhramar Mukherjee, Holly R. Harris, Kathleen R. Cho, Hoda Anton-Culver, Harvey A. Risch, Kirsten B. Moysich, Renée T. Fortner, Celeste Leigh Pearce, Gillian E. Hanley, Kathryn L. Terry, Susanne K. Kjaer, Lilah Khoja, Alice W. Lee, Malcolm C. Pike, Allan Jensen, Karen McLean, Aruna Muthukumar, and Jennifer A. Doherty
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medicine.medical_specialty ,Inverse Association ,medicine.drug_class ,medicine.medical_treatment ,Endometriosis ,Hysterectomy ,Article ,medicine ,Humans ,Ovarian Neoplasms ,Gynecology ,business.industry ,Estrogen Replacement Therapy ,Obstetrics and Gynecology ,Cancer ,Odds ratio ,medicine.disease ,Oncology ,Estrogen ,Case-Control Studies ,Female ,Hormone therapy ,Menopause ,business ,Ovarian cancer - Abstract
Objective To evaluate the association between hysterectomy and ovarian cancer, and to understand how hormone therapy (HT) use and endometriosis affect this association. Methods We conducted a pooled analysis of self-reported data from 11 case-control studies in the Ovarian Cancer Association Consortium (OCAC). Women with (n = 5350) and without ovarian cancer (n = 7544) who never used HT or exclusively used either estrogen-only therapy (ET) or estrogen+progestin therapy (EPT) were included. Risk of invasive epithelial ovarian cancer adjusted for duration of ET and EPT use and stratified on history of endometriosis was determined using odds ratios (ORs) with 95% confidence intervals (CIs). Results Overall and among women without endometriosis, there was a positive association between ovarian cancer risk and hysterectomy (OR = 1.19, 95% CI 1.09-1.31 and OR = 1.20, 95% CI 1.09-1.32, respectively), but no association upon adjusting for duration of ET and EPT use (OR = 1.04, 95% CI 0.94-1.16 and OR = 1.06, 95% CI 0.95-1.18, respectively). Among women with a history of endometriosis, there was a slight inverse association between hysterectomy and ovarian cancer risk (OR = 0.93, 95% CI 0.69-1.26), but this association became stronger and statistically significant after adjusting for duration of ET and EPT use (OR = 0.69, 95% CI 0.48-0.99). Conclusions The hysterectomy-ovarian cancer association is complex and cannot be understood without considering duration of ET and EPT use and history of endometriosis. Failure to take these exposures into account in prior studies casts doubt on their conclusions. Overall, hysterectomy is not risk-reducing for ovarian cancer, however the inverse association among women with endometriosis warrants further investigation.
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- 2022
15. A novel proteomic-based screening method for ovarian cancer using cervicovaginal fluids: A window into the abdomen
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Lewis K. Pannell, Michael A. Finan, Annelise M. Wilhite, Jennifer Scalici, Rodney P. Rocconi, and Lindsay Schambeau
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Adult ,Proteomics ,Oncology ,medicine.medical_specialty ,Cervix Uteri ,Sensitivity and Specificity ,Cohort Studies ,Young Adult ,Internal medicine ,Statistical significance ,Biomarkers, Tumor ,medicine ,Humans ,Prospective Studies ,Cervix ,Periplakin ,Early Detection of Cancer ,Aged ,Aged, 80 and over ,Ovarian Neoplasms ,Gynecology ,biology ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Vagina ,Cohort ,biology.protein ,Female ,Apolipoprotein A1 ,Ovarian cancer ,business ,Kappa - Abstract
Objective Our objective is to develop a site-specific proteomic-based screening test for ovarian cancer(OC) using the mucus of the cervix and vagina and evaluate a potential means for home testing. Methods Cervicovaginal fluid samples were obtained from ovarian cancer and normal control patients for LC-mass spectrometry(MS) proteomic evaluation. Statistical modeling determined the protein panel with the highest penetrance across ovarian cancer samples. A subcohort of patients consented to provide self-collected vaginal samples at home with questionnaire on feasibility. Cohen's kappa methodology was utilized to determine agreement between physician-collected and patient-collected samples. Results A total of 83 consecutive patient samples were collected prospectively (33 ovarian cancer & 50 controls). Thirty patients consented for self-collection. Using LC-MS, 30 peptides demonstrated independent statistical significance for detecting ovarian cancer. Using statistical modeling, the protein panel that determined the best predictor for detecting OC formed a “fingerprint” consisting of 5 proteins: s erine proteinase inhibitor A1; periplakin; profilin1; apolipoprotein A1; and thymosin beta4-like protein. These peptides demonstrated a significant increase probability of detecting ovarian cancer with the ROC curve having an AUC of 0.86 (p = 0.00001). Physician-collected and patient-collected specimens demonstrated moderate agreement with kappa average of 0.6 with upper bound of 0.75. Conclusions Using novel site-specific collection methods, we identified an OC “fingerprint” with adequate sensitivity and specificity to warrant further evaluation in a larger cohort. Agreement of physician-collected and patient-collected samples were encouraging and could improve access to screening with a home self-collection if this screening test is validated in future studies.
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- 2022
16. Efficacy of risk-reducing salpingo-oophorectomy in BRCA1–2 variants and clinical outcomes of follow-up in patients with isolated serous tubal intraepithelial carcinoma (STIC)
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M Marchetti, Giulia Spagnol, Marco Noventa, Carlo Saccardi, Stefania Zovato, Antonio Simone Laganà, G Bonaldo, Angela Guerriero, Lara Alessandrini, Amerigo Vitagliano, and Silvia Tognazzo
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Adult ,medicine.medical_specialty ,Occult cancer ,Serous carcinoma ,Salpingo-oophorectomy ,Serous tubal intraepithelial carcinoma ,Primary peritoneal carcinoma ,BRCA mutation ,Peritoneal carcinoma ,Risk-reducing salpingo-oophorectomy ,medicine ,Fallopian Tube Neoplasms ,Humans ,Genetic Predisposition to Disease ,Watchful Waiting ,Pelvic examination ,Fallopian Tubes ,Germ-Line Mutation ,Retrospective Studies ,BRCA2 Protein ,Gynecology ,medicine.diagnostic_test ,BRCA1 Protein ,business.industry ,Incidence ,Obstetrics and Gynecology ,Cancer ,Retrospective cohort study ,Serous Tubal Intraepithelial Carcinoma ,Prophylactic Surgical Procedures ,Middle Aged ,medicine.disease ,Cystadenocarcinoma, Serous ,Serous fluid ,Treatment Outcome ,Oncology ,Female ,business ,Follow-Up Studies - Abstract
Objective Serous tubal intraepithelial carcinoma (STIC) is currently considered the precursor lesion of pelvic high-grade serous carcinoma. The management of STIC diagnosed after risk-reducing salpingo-oophorectomy (RRSO) in women with BRCA1–2 variants remains unclear. The aim of our study was to evaluate the incidence of STIC, serous tubal intraepithelial lesions (STIL) and occult invasive cancer (OC) and to determine the long-term outcomes of these patients. Methods We conducted a retrospective study of patients with BRCA 1–2 variants who underwent RRSO between January-2010 and Dicember-2020 at the Clinic of Gynaecology of University of Padova. Inclusion criteria: women with a negative pelvic examination at the last screening prior to RRSO, patients with fallopian tubes analysed using the SEE-FIM protocol. Exclusion criteria: patients with a positive gynaecologic screening or with ovarian/tubal cancer prior to RRSO. Results We included 153 patients. STICs were diagnosed in 4 patients (2.6%) and STILs in 6 patients (3.9%). None of the patients with STIC underwent restaging surgery or adjuvant chemotherapy; all patients were followed closely every 6 months. None of the patients developed primary peritoneal carcinomas (PPCs) with a median FUP of 54.5 months (15–106). OC was diagnosed in 3 patients (2%). All patients with OC underwent staging surgery, and one patient developed a peritoneal carcinoma (PC) after 18 months by staging surgery. Conclusion(s) The incidence of STIC, STIL and OC after RRSO in BRCA1–2 variants was low. Our results demonstrated that long-term close surveillance in patients diagnosed with STIC should be considered a possible management strategy.
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- 2021
17. Increased incidence of ovarian cancer in both endometriosis and adenomyosis
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Ruud L.M. Bekkers, Marjolein Hermens, Johan Bulten, Albert G. Siebers, Huib A.A.M. van Vliet, Anne M. van Altena, RS: GROW - R2 - Basic and Translational Cancer Biology, and Obstetrie & Gynaecologie
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Adult ,medicine.medical_specialty ,endocrine system diseases ,Endometriosis ,Carcinoma, Ovarian Epithelial ,Risk Assessment ,Cohort Studies ,All institutes and research themes of the Radboud University Medical Center ,Ovarian cancer ,medicine ,Humans ,Nevus ,Adenomyosis ,Registries ,Netherlands ,Ovarian Neoplasms ,RISK ,Gynecology ,business.industry ,Incidence ,Incidence (epidemiology) ,WOMEN ,Obstetrics and Gynecology ,Histology ,Middle Aged ,medicine.disease ,female genital diseases and pregnancy complications ,Women's cancers Radboud Institute for Health Sciences [Radboudumc 17] ,Oncology ,Cohort ,Female ,business ,Clear cell - Abstract
Objective. Assessing the association between endometriosis and/or adenomyosis and ovarian cancer. Methods. We identified all women with histological proven endometriosis (51,544 women) and/or adenomyosis (85,015 women) from the Dutch pathology database (1990-2015) and matched with women with a benign dermal nevus (132,654 women). Histology results for ovarian cancer were retrieved. We estimated crude and age-adjusted incidence rate ratios (IRR) for ovarian cancer. Results. We found 1017 (2.0%), 1284 (1.5%) and 471 (0.4%) ovarian cancer cases in the endometriosis, adenomyosis and nevus cohort, respectively. The age-adjusted IRRs were 19.75 (95% CI 16.70-23.35) in the endometriosis cohort and 5.93 (95% CI 4.91-7.16) in the adenomyosis cohort. The highest IRRs were found for endometrioid and clear cell ovarian cancer subtypes. Excluding the first year of follow-up did not result in a significant IRR for ovarian cancer overall but resulted in a statistically significant age-adjusted IRR of 3.92 (95% CI 2.19-7.01) for clear cell ovarian cancer and 2.39 (95% CI 1.28-4.45) for endometrioid ovarian cancer in the endometriosis cohort. Additionally, we found a statistically significant age-adjusted IRR of 2.51 (95% CI 1.29-4.90) for endometrioid ovarian cancer in the adenomyosis cohort. Conclusion. We found an increased ovarian cancer incidence in both histological proven endometriosis and adenomyosis. This increased incidence was largest for endometriosis. Excluding the first year of follow-up resulted in an increased incidence for endometrioid ovarian cancer in both cohorts and clear cell ovarian cancer in the endometriosis cohort. This study shows that gynecologist should also be aware of an increased ovarian cancer incidence in women with adenomyosis. (c) 2021 Elsevier Inc. All rights reserved.
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- 2021
18. The association of reproductive factors with risk of non-epithelial ovarian cancer and comparison with serous ovarian cancer
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Susanne K. Kjaer, Ane Katrine Kær Bennetsen, Louise Baandrup, Caroline H. Hemmingsen, and Christian Dehlendorff
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Adult ,0301 basic medicine ,Infertility ,medicine.medical_specialty ,Denmark ,Carcinoma, Ovarian Epithelial ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Humans ,Sex Cord-Gonadal Stromal Tumors ,Medicine ,Ovarian Neoplasms ,Gynecology ,business.industry ,Case-control study ,Obstetrics and Gynecology ,Odds ratio ,Middle Aged ,Neoplasms, Germ Cell and Embryonal ,Protective Factors ,medicine.disease ,Cancer registry ,Parity ,Serous fluid ,030104 developmental biology ,Oncology ,Case-Control Studies ,030220 oncology & carcinogenesis ,Female ,Germ cell tumors ,business ,Ovarian cancer ,Infertility, Female ,Contraceptives, Oral ,Ovarian Sex Cord-Stromal Tumor - Abstract
Objective To examine the association between reproductive factors and risk of non-epithelial ovarian cancer and to compare the associations with those in serous ovarian cancer. Methods From the Danish Cancer Registry, we identified all ovarian cancer cases (≥20 years old at diagnosis) of germ cell (n = 188), sex cord-stromal (n = 116), or serous (n = 4854) histology during 1982–2016. For each case, 15 age-matched female controls were selected with risk set sampling. Reproductive history was obtained from nationwide registries. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for the association between reproductive factors and the three ovarian cancer types. Results Compared with nulliparity, ever giving birth was associated with increased odds for germ cell tumors (OR = 1.28, 95% CI: 0.85–1.93) and decreased odds for sex cord-stromal (OR = 0.74, 95% CI: 0.44–1.26) and serous tumors (OR = 0.70, 95% CI: 0.64–0.76). Infertility decreased odds for germ cell tumors (OR = 0.63, 95% CI: 0.23–1.76) but increased odds for sex cord-stromal tumors (OR = 2.20, 95% CI: 0.89–5.43) and serous tumors (OR = 1.97, 95% CI: 1.69–2.30). Finally, use of oral contraceptives decreased the odds for all three tumor types (germ cell: OR = 0.50, 95% CI: 0.29–0.87; sex cord-stromal: OR = 0.40, 95% CI: 0.13–1.22; serous: OR = 0.50, 95% CI: 0.40–0.62). Conclusions Reproductive factors affected the risk of sex cord-stromal and serous ovarian cancer similarly with decreased risk associated with parity and use of oral contraceptives. Oral contraceptives also seemed to decrease the risk of germ cell tumors, whereas parity was associated with increased risk.
- Published
- 2021
19. Implementation of an abdominal closure bundle to reduce surgical site infection in patients on a gynecologic oncology service undergoing exploratory laparotomy.
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Bruce, Shaina F., Carr, Danielle N., Burton, Elizabeth R., Sorosky, Joel I., Shahin, Mark S., Naglak, Mary C., and Edelson, Mitchell I.
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SURGICAL site infections , *GYNECOLOGIC oncology , *ABDOMINAL surgery , *COHORT analysis ,TUMOR surgery - Abstract
Objective Surgical site infections (SSI) are associated with increased morbidity, mortality, and healthcare costs. This study investigated whether implementation of an abdominal closure bundle reduces surgical site infection rates. We aimed to identify sub-populations that would benefit the most from this intervention. Methods We conducted a retrospective cohort study of all patients that underwent exploratory laparotomy by a Gynecologic Oncologist from January 1, 2011 to April 1, 2017. The abdominal closure bundle was implemented on May 6, 2014. SSI rates were assessed overall and within subgroups. Results 875 patients were included in the analysis. Overall, SSI rate was reduced, albeit not significantly, from 48/471 (10.2%) to 32/404 (7.9%) ( p = 0.148) with implementation of the closing bundle. In patients that underwent a tumor debulking procedure, SSI was noted in 36/277 (13.0%) in the pre-bundle group and 14/208 (6.7%) in the post-bundle cohort ( p = 0.017). In patients with malignant pathology, the pre-bundle cohort had an SSI rate of 38/282 (13.5%), which reduced to 18/215 (8.4%) in the post-bundle group ( p = 0.049). In patients with FIGO stage III or IV disease, the SSI rate was reduced from 21/114 (18.4%) to 8/87 (8.4%) with implantation of the closure bundle ( p = 0.028). In patients with intra-operative ascites, SSI rate decreased from 19/119 (15.9%) pre-bundle to 4/104 (3.8%) in the post-bundle group ( p = 0.002). Conclusions Implementation of an abdominal closure bundle was not associated with a significant reduction in overall SSI rate. However, multiple subpopulations associated with advanced gynecologic cancer benefited from this intervention. [ABSTRACT FROM AUTHOR]
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- 2018
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20. The GOG partners: A program for industry sponsored clinical trials in gynecologic oncology within the GOG foundation
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Robert S. Mannel, Ramez N. Eskander, Thomas J. Herzog, Bhavana Pothuri, Laura L. Reese, Robert L. Coleman, Larry J. Copeland, Bradley J. Monk, Brian M. Slomovitz, David M. O'Malley, Kathleen N. Moore, and Leslie M. Randall
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0301 basic medicine ,Drug Industry ,Genital Neoplasms, Female ,media_common.quotation_subject ,Gynecologic oncology ,Medical Oncology ,03 medical and health sciences ,0302 clinical medicine ,Mentorship ,Excellence ,Humans ,Medicine ,Randomized Controlled Trials as Topic ,media_common ,Clinical Trials as Topic ,Medical education ,business.industry ,Obstetrics and Gynecology ,Foundation (evidence) ,Clinical trial ,030104 developmental biology ,Patient accrual ,Transformative learning ,Oncology ,Gynecology ,030220 oncology & carcinogenesis ,Female ,Organizational structure ,business - Abstract
The GOG Foundation, Inc. (GOG-F) is a non-profit 501(c)(3) organization with the purpose of promoting excellence in the quality and integrity of clinical and basic scientific research in the field of gynecologic malignancies. GOG Partners (GOG-P) is a program of the GOG-F and is positioned alongside NRG Oncology under the GOG-F organizational umbrella. GOG-P operates outside of the federally funded NCI NRG Oncology, a key distinguishing feature. By functioning as a site management organization (SMO), GOG-P provides an additional platform for clinical trial development, mentorship opportunities, patient accrual, and site infrastructure support yielding an expanded gynecologic oncology clinical trials infrastructure in the US. GOG-P has a consistent track record of conducting high quality clinical trials that lead to bringing novel FDA approved treatments for gynecologic cancer. This manuscript summarizes the history and organizational structure of the GOG-P. In addition, we outline the other key supportive programs within the GOG-F that help support the GOG-P effort to perform transformative gynecologic cancer research.
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- 2021
21. Race reporting and representation in clinical trials from 2007-2020: An analysis of gynecologic oncology and other gynecology specialties (556).
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Steinberg, Jecca, Turner, Brandon, DiTosto, Julia, Young, Anna Marie, Zhang, Naixin, Lu, Connie, Wolgemuth, Tierney, Laasiri, Nora, Holder, Kai, Weeks, Brannon, Richardson, Michael, Anderson, Jill, Squires, Natalie, Roque, Dario, and Yee, Lynn
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RACE , *GYNECOLOGIC oncology , *GYNECOLOGY , *LOGISTIC regression analysis - Abstract
Objectives: To characterize race and ethnicity reporting and representation in United States (US) gynecologic oncology (Gyn-Onc) clinical trials and compare reporting and representation across gynecology subspecialties. Methods: In this cross-sectional study, we investigated all US-based gynecology clinical trials that reported results on ClinicalTrials.gov from October 2007-March 2020, with a focus on Gyn-Onc. We evaluated two outcomes: (1) reporting of participant race/ethnicity and (2) representation (proportion of trial enrollees of a given race/eth- nicity). We analyzed associations of trial funding and subspecialty with each outcome using descriptive and multivariable logistic regression analyses. We modeled representation using logistic regression with a binary outcome (> or <20% Black, Indigenous, and People of Color [BIPOC] enrollment) controlling for a trial year, phase, and funder. [Display omitted] Results: Of 8,515 registered gynecology trials, 3,214 were based in the US. Only 888 of 3,214 (27.6%) reported trial results, of which 505 (56.9%; 190,147 participants) included participant race/ethnicity data. There was a significant increase in race/ethnicity reporting over the study period (p<0.001). Race/ethnicity reporting varied by funder (government/academic 14.2%, industry 19.4%, p<0.001) and subspecialty (Gyn-Onc 13.9%, Benign Gynecology 16.6%, p=0.002), but these reporting differences were not persistent in multivariable analysis. Among trials that reported race/ethnicity, all BIPOC groups were underrepresented relative to their national population representation (Table). No significant difference in representation was seen by funding status. However, differences by subspecialty were noted; in aggregate, Benign Gynecology trials had more than twice as much diversity as Gyn-Onc trials (39.6% vs 17.7% average BIPOC representation per trial). Compared with Gyn-Onc clinical trials, REI (aOR: 2.78, 95% CI: 1.36-6.47), family planning (aOR: 3.68, 95% CI 1.87-8.16), and other benign gynecology trials (aOR: 1.79, 95% CI: 1.26-2.55) all had greater odds of enrolling at least 20% BIPOC participants. No difference was demonstrated between Gyn-Onc and Urogynecology trials. Conclusions: Reporting of race/ethnicity in US gynecology clinical trials is poor but improving. Among trials with race-ethnicity reporting, BIPOC participants were consistently underrepresented. Gyn-Onc trials demonstrated the least diversity of all gynecology subspecialties. This trend excludes BIPOC communities from health innovation conferred through trial participation, biases medical evidence, and worsens disparities in gynecology. [ABSTRACT FROM AUTHOR]
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- 2022
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22. Financial toxicity of surgical treatment for gynecological cancer: A growing malignancy
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Sarah Marion, Emeline Aviki, and Fumiko Chino
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Oncology ,Genital Neoplasms, Female ,Gynecology ,Obstetrics and Gynecology ,Humans ,Female ,Financial Stress - Published
- 2022
23. Live births and maintenance with levonorgestrel IUD improve disease-free survival after fertility-sparing treatment of atypical hyperplasia and early endometrial cancer
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Ksenia V. Krasnopolskaya, Yulia Yu. Andreeva, Vladimir Panov, Olga Novikova, Alexey S. Shevchuk, Novikova Eg, and Vladimir B. Nosov
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Adult ,0301 basic medicine ,medicine.medical_specialty ,Antineoplastic Agents, Hormonal ,media_common.quotation_subject ,Fertility ,Levonorgestrel ,Intrauterine device ,Disease-Free Survival ,Atypical hyperplasia ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Prospective Studies ,Atypical Endometrial Hyperplasia ,media_common ,Gynecology ,business.industry ,Endometrial cancer ,Intrauterine Devices, Medicated ,Fertility Preservation ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Endometrial Neoplasms ,Treatment Outcome ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Endometrial Hyperplasia ,Hormonal therapy ,Female ,business ,Carcinoma, Endometrioid ,Live Birth ,medicine.drug - Abstract
Our objectives were to (1) compare different regimens of hormonal therapy (HT) in young women with atypical endometrial hyperplasia (AEH) and early endometrial cancer (EC), (2) assess reproductive and oncologic outcomes and (3) explore possible predictors of complete response (CR) and disease free survival (DFS).Reproductive age women with AEH and Grade 1-2 endometrioid EC with no or minimal myometrial invasion on MRI treated with different regimens of HT were prospectively analyzed. Treatment protocols included levonorgestrel intrauterine device (LNG IUD), gonadotropin-releasing hormone agonist (aGnRH) or high-dose oral medroxyprogesteron acetate (MPA) separately and in combinations.Total of 418 patients with AEH (n = 228) and EC (n = 190) aged 19-46 years received HT. Overall CR rate was 96% in AEH and 88% in EC patients (р 0.001). None of the regimens used in AEH (LNG IUD + 2 DC vs. LNG IUD + aGnRH vs. LNG IUD + 3 DC) was found inferior to the others (CR of 98%, 95%, 100%, respectively, p 0.05) except for MPA alone (CR 87%, р = 0.009). Out of four HT regimens used in EC LNG IUD + aGnRH+3 DC was superior to all others (CR 96%, р = 0.026) where 2 DCs were performed or oral MPA was prescribed. The median follow-up for 339 patients was 33 months (range: 3-136), 68% of patients (n = 232) attempted conception, 38% (n = 89) of them used ART. The birth rate was 42% (n = 97). The rate of recurrence was 26% (50/196) in AEH group and 36% (51/143) in EC group (p = 0.05). Birth after treatment (HR = 0.24) or LNG IUD maintenance (HR = 0.18) were associated with superior DFS (p 0.001 for both). ART use did not influence DFS.Hormonal therapy of AEH and early EC with LNG IUD is superior to MPA-containing regimens, however still carries high risk of recurrence. Post-treatment pregnancy rates are satisfactory and can be further improved by broader ART use which was proven safe. Initial diagnosis of AEH, post-treatment child birth and LNG IUD maintenance were associated with decreased rates of recurrence.
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- 2021
24. Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients
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Michael O'Rorke, Jacob Oleson, Sherri L. Stewart, Michele M. West, Megan E McDonald, Kristin S. Weeks, Charles F. Lynch, Mary E. Charlton, and Ryan M. Carnahan
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Adult ,Rural Population ,0301 basic medicine ,medicine.medical_specialty ,Adolescent ,Urban Population ,Referral ,Ovariectomy ,Medical Oncology ,Health Services Accessibility ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Urban Health Services ,medicine ,Humans ,Healthcare Disparities ,Young adult ,Referral and Consultation ,Aged ,Retrospective Studies ,Aged, 80 and over ,Ovarian Neoplasms ,Travel ,Missouri ,business.industry ,General surgery ,Obstetrics and Gynecology ,Cancer ,Retrospective cohort study ,Cytoreduction Surgical Procedures ,Guideline ,Odds ratio ,Kansas ,Middle Aged ,medicine.disease ,Iowa ,030104 developmental biology ,Oncology ,Gynecology ,030220 oncology & carcinogenesis ,Female ,Rural Health Services ,Ovarian cancer ,business ,Gynecologic Oncologist - Abstract
Objective Up to one-third of women with ovarian cancer in the United States do not receive surgical care from a gynecologic oncologist specialist despite guideline recommendations. We aim to investigate the impact of rurality on receiving surgical care from a specialist, referral to a specialist, and specialist surgery after referral, and the consequences of specialist care. Methods We utilized a retrospective cohort created through an extension of standard cancer surveillance in three Midwestern states. Multivariable adjusted logistic regression was utilized to assess gynecologic oncologist treatment of women 18–89 years old, who were diagnosed with primary, histologically confirmed, malignant ovarian cancer in 2010–2012 in Kansas, Missouri and Iowa by rurality. Results Rural women were significantly less likely to receive surgical care from a gynecologic oncologist specialist (adjusted odds ratio (OR) 0.37, 95% confidence interval (CI) 0.24–0.58) and referral to a specialist (OR 0.37, 95% CI 0.23–0.59) compared to urban women. There was no significant difference in specialist surgery after a referral (OR 0.56, 95% CI 0.26–1.20). Rural women treated surgically by a gynecologic oncologist versus non-specialist were more likely to receive cytoreduction and more complete tumor removal to ≤1 cm. Conclusion There is a large rural-urban difference in receipt of ovarian cancer surgery from a gynecologic oncologist specialist (versus a non-specialist). Disparities in referral rates contribute to the rural-urban difference. Further research will help define the causes of referral disparities, as well as promising strategies to address them.
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- 2021
25. Underrepresented minority representation trends in gynecologic oncology fellowships in the United States
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Nkiruka Aniagolu, Auja Mcdougale, Nealie Tan Ngo, Jacob Lang, and Obi Ekwenna
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0301 basic medicine ,medicine.medical_specialty ,education ,Graduate medical education ,Ethnic group ,Specialty ,Gynecologic oncology ,Medical Oncology ,Accreditation ,03 medical and health sciences ,0302 clinical medicine ,Obstetrics and gynaecology ,Underrepresented Minority ,Humans ,Medicine ,Minority Groups ,Retrospective Studies ,business.industry ,Internship and Residency ,Obstetrics and Gynecology ,Cultural Diversity ,Hispanic or Latino ,United States ,Black or African American ,030104 developmental biology ,Oncology ,Gynecology ,030220 oncology & carcinogenesis ,Family medicine ,Workforce ,Pacific islanders ,business - Abstract
To evaluate representation trends of historically underrepresented minority (URM) groups in gynecologic oncology fellowships in the United States using a nationwide database collected by the Accreditation Council for Graduate Medical Education (ACGME).Data on self-reported ethnicity/race of filled residency positions was collected from ACGME Database Books across three academic years from 2016 to 2019. Primary chi-square analysis compared URM representation in gynecologic oncology to obstetrics and gynecology, other surgical specialties, and other medical specialties. Secondary analysis examined representation of two URM subgroups: 1) Asian/Pacific Islander, and 2) Hispanic, Black, Native American, Other (HBNO), across specialty groups.A total of 528 gynecologic oncology positions, 12,559 obstetrics and gynecology positions, 52,733 other surgical positions, and 240,690 other medical positions from ACGME accredited medical specialties were included in analysis. Primary comparative analysis showed a statistically significant lower proportion (P 0.05) of URM trainees in gynecologic oncology in comparison to each of obstetrics and gynecology, other surgical fields, and other medical fields. Secondary analysis also demonstrated a significantly lower proportion (P 0.05) of HBNO physicians in gynecologic oncology in comparison to obstetrics and gynecology, as well as all other medical and surgical specialties.This study illustrates the disparities in URM representation, especially those who identify as HBNO, in gynecologic oncology fellowship training in comparison to obstetrics and gynecology as well as other medical and surgical fields. Improvements to the current recruitment and selection practices in gynecologic oncology fellowships in the United States are necessary in order to ensure a diverse and representative workforce.
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- 2021
26. Discrepancies between author- and industry-reported disclosures of financial relationships at an annual gynecologic oncology research meeting
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Christianne Persenaire, Susan Folsom, Eseohi Ehimiaghe, Matthew Cowan, Edward J. Tanner, Xiaoyue M. Guo, and Emma L. Barber
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0301 basic medicine ,Genital Neoplasms, Female ,media_common.quotation_subject ,Concordance ,Health Care Sector ,Disclosure ,Gynecologic oncology ,Medical Oncology ,Ethics, Research ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Humans ,Medicine ,Drug industry ,media_common ,Finance ,Conflict of Interest ,business.industry ,Publications ,Conflict of interest ,Obstetrics and Gynecology ,Congresses as Topic ,Payment ,Transparency (behavior) ,Authorship ,Cross-Sectional Studies ,030104 developmental biology ,Oncology ,Gynecology ,030220 oncology & carcinogenesis ,ComputingMilieux_COMPUTERSANDSOCIETY ,Female ,Observational study ,business ,Inclusion (education) - Abstract
Objective Trillions of dollars pass to physicians from industry-related businesses annually, leading to many opportunities for financial conflicts of interest. The Open Payments Database (OPD) was created to ensure transparency. We describe the industry relationships as reported in the OPD for presenters at the 2019 Society of Gynecologic Oncology (SGO) Annual Meeting and evaluate concordance between author disclosures of their financial interests and information provided by the OPD. Methods This is an observational, cross-sectional study. Disclosure data were collected from authors with oral and featured abstract presentations in the 2019 SGO annual conference. These disclosures were compared to data available for each author in the 2018 OPD, which included the amount and nature of industry payments. Results We examined the disclosures of 301 authors who met inclusion criteria. Of 161 authors who had disclosure statements on their presentations,147 reported “no disclosures,” and 14 disclosed industry relationships. The remaining 140 did not list any disclosure information. Sixty percent (184/301) of authors had industry relationships in the 2018 OPD, including 173 of 287 (60.3%) of authors who either reported no disclosures or did not have disclosure data available in their presentations. These transactions totaled over 43 million USD from 122 different companies, with most payments (46%) categorized as “Research or Associated Research.” Accurate disclosure reporting was associated with receiving higher payments or research payments, and being a presenting author. Conclusions Most authors at the SGO annual conference did not correctly disclose their industry relationships when compared with their entries in the OPD.
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- 2021
27. An increase in multi-site practices: The shifting paradigm for gynecologic cancer care delivery
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Marilyn M. Schapira, Nawar A. Latif, Robert L. Giuntoli, Mark A. Morgan, Genevieve P. Kanter, Robert A. Burger, Justin E. Bekelman, Ashley Haggerty, Emily M. Ko, and Katherine Hicks-Courant
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0301 basic medicine ,Genital Neoplasms, Female ,Cross-sectional study ,MEDLINE ,Medical Oncology ,Zip code ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Gynecologic cancer ,Humans ,Medicine ,Practice Patterns, Physicians' ,Retrospective Studies ,business.industry ,Multi site ,Obstetrics and Gynecology ,Retrospective cohort study ,United States ,Cross-Sectional Studies ,030104 developmental biology ,Oncology ,Gynecology ,030220 oncology & carcinogenesis ,Geographic regions ,Female ,business ,Delivery of Health Care ,Gynecologic Oncologist ,Demography - Abstract
To assess whether the number of practice sites per gynecologic oncologist (GO) and geographic access to GOs has changed over time.This is a retrospective repeated cross-sectional study using the 2015-2019 Physician Compare National File. All GOs in the 50 United States and Washington, DC, who had completed at least one year of practice were included in the study. All practice sites with complete addresses were included. Linear regression analyses estimated trends in GOs' number of practice sites and geographic dispersion of practice sites. Secondary analyses assessed temporal trends in the number of geographic areas served by at least one GO.Although there was no significant change in the number of GOs from 2015 to 2019 (n = 1328), there was a significant increase in the number of practice sites (881 to 1416, p = 0.03), zip codes (642 to 984, p = 0.03), HSAs (404 to 536, p = 0.04), and HRRs (218 to 230, p = 0.03) containing a GO practice. The mean number of practice sites (1.64 versus 2.13, p 0.001) and dispersion of practice sites (0.03 versus 0.43 miles, p = 0.049) per GO increased significantly.Between 2015 and 2019, an increasing number of GOs have multi-site practices, and more geographic regions contain a GO practice. Improvements in geographic access to GOs may represent improved access to care for many women in the US, but its effect on patients, physicians, and geographic disparities is unknown.
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- 2021
28. Direct oral anticoagulant use in gynecologic oncology: A Society of Gynecologic Oncology Clinical Practice Statement
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Abdulrahman K. Sinno, Mary M. Mullen, Jenna Z. Marcus, and Gregory M. Gressel
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0301 basic medicine ,medicine.medical_specialty ,Genital Neoplasms, Female ,Gynecologic oncology ,Vte prophylaxis ,Medical Oncology ,03 medical and health sciences ,0302 clinical medicine ,Extant taxon ,medicine ,Humans ,Intensive care medicine ,Randomized Controlled Trials as Topic ,business.industry ,Anticoagulants ,Obstetrics and Gynecology ,Cancer ,Venous Thromboembolism ,Perioperative ,medicine.disease ,Clinical Practice ,030104 developmental biology ,Oncology ,Gynecology ,030220 oncology & carcinogenesis ,Oral anticoagulant ,Female ,business ,Venous thromboembolism - Abstract
Venous thromboembolism (VTE) is a common cause of morbidity and mortality in women with gynecologic malignancies. This practice statement provides clinical data and overall quality of evidence regarding the use of direct oral anticoagulants (DOACs) in this patient population. Specifically, it reviews patient selection, safety measures, and nuances of perioperative use of these medications. The scope of this document is limited to DOAC use in gynecologic oncology rather than a broad discussion of VTE prophylaxis and management in general. The following recommendations and examination of extant data are based on DOAC trials conducted primarily in mixed populations with different cancer subtypes. Many of these trials include few, or no, women with gynecologic cancer. However, because there is very limited data in gynecologic cancer-specific populations, the results of these studies represent the best available evidence to support treatment recommendations in our patients. The members of the Society of Gynecologic Oncology (SGO) Clinical Practice Committee believe that the results of these studies may be extrapolated, with caution, to VTE treatment and prophylaxis for patients with gynecologic cancer.
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- 2021
29. Sexual harassment and gender discrimination in gynecologic oncology
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Kenneth Seier, Carol L. Brown, C.M. Tarney, Marina Stasenko, and Yovanni Casablanca
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Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Gender discrimination ,Demographics ,Attitude of Health Personnel ,Sexism ,Specialty ,Gynecologic oncology ,Medical Oncology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Humans ,Medicine ,Societies, Medical ,Response rate (survey) ,business.industry ,Compensation (psychology) ,Obstetrics and Gynecology ,Middle Aged ,Reprisal ,030104 developmental biology ,Sexual Harassment ,Oncology ,Gynecology ,030220 oncology & carcinogenesis ,Family medicine ,Harassment ,Female ,business - Abstract
Objective To determine the prevalence of sexual harassment and perceptions of gender disparities affecting the careers of physicians in gynecologic oncology. Methods We conducted a survey of US physician members of the Society of Gynecologic Oncology. Participants were queried about demographics, sexual harassment experiences during training/practice, and perceptions of gender disparities in compensation and career advancement. Responses were categorized as “never” versus “ever” and compared using Fisher's exact test. Results The survey was sent to 1566 members—405 (255 females, 147 males, 3 other) responded (response rate 26%). Sixty-four percent reported having experienced sexual harassment during training/practice. Sexual harassment was experienced by 71% of females and 51% of males. Of these respondents, only 14.5% reported it. Reasons for not reporting included: “incident did not seem important enough” (40%); “did not think anything would be done about it” (37%); and “fear of reprisal” (34%). Female respondents were more likely to report gender affected their career advancement (34% vs. 10%; p ≤ .001) and compensation (64% vs. 19%; p ≤ .001); males were more likely to report no gender income disparity (91% vs. 57%; p ≤ .001). Conclusions Sexual harassment during training/practice appears common among male and female gynecologic oncologists. Although most are aware of how to report an incident, few do so, mostly for fear of reprisal or concern nothing will be done. Despite practicing in a field defined by caring for women, female physicians more often perceive gender influences their compensation and career advancement. Awareness of these issues can lead to their elimination from our specialty.
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- 2020
30. Multiplex profiling identifies distinct local and systemic alterations during intraperitoneal chemotherapy for ovarian cancer: An NRG Oncology/Gynecologic Oncology Group Study.
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Grabosch, Shannon, Tseng, George, Edwards, Robert P., Lankes, Heather A., Moore, Kathleen, Odunsi, Kunle, Vlad, Anda, Ma, Tianzhou, Strange, Mary, Brozick, Joan, Lugade, Amit, Omilian, Angela, Bshara, Wiam, Stuckey, Ashley R., Walker, Joan L., and Birrer, Michael
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- *
OVARIAN cancer treatment , *HYPERTHERMIC intraperitoneal chemotherapy , *GYNECOLOGY , *CLINICAL trials , *MICRORNA , *BIOMARKERS - Abstract
Objectives Ovarian cancer leads to abdominal carcinomatosis and late stage (III/IV) diagnosis in 75% of patients. Three randomized phase III trials have demonstrated that intraperitoneal (IP) chemotherapy improves outcomes in epithelial ovarian cancer. While IP treatment is validated by clinical trials, there is a poor understanding of the mechanism(s) leading to the survival advantage other than the increased concentration of cytotoxic drugs within the tumor microenvironment. A better understanding of this process through analysis of dynamic biomarkers should promote novel approaches that may enhance tumor clearance. We propose this pilot study to confirm the feasibility of collecting serial peritoneal samples from implanted catheters in women receiving IP chemotherapy. We believe these specimens may be used for multiplex analysis to reveal unique biomarker fluctuations when compared to peripheral blood. Methods From 13 women participating on GOG 252, 30 whole blood, 12 peritoneal fluid (PF), and 20 peritoneal wash (PW) with 30 mL saline were obtained. Samples were requested prior to the first three chemotherapy cycles. Samples were assessed for volume, cell populations, protein, RNA, and miRNA content changes. Results Median volume for PF was 1.6 mL and 3.1 mL for PW. PW is a dilution of PF capable of capturing measurable biomarkers. Peritoneal aspirates contain a unique profile of biomarkers distinct from blood. miRNA undergo earlier alteration with chemotherapy than genes. Flow cytometry does not adequately capture biomarker fluctuations. Conclusions As a proof of principle study, this trial provides evidence that sampling the peritoneal cavity can be adapted for biomarker analysis. [ABSTRACT FROM AUTHOR]
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- 2017
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31. Incidence and survival of glandular vulvar malignancies in the Netherlands.
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van der Linden, Michelle, Schuurman, Melinda, Bulten, Johan, van der Aa, Maaike, Massuger, Leon, and de Hullu, Joanne
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- *
VULVAR cancer , *CELLULAR pathology , *GYNECOLOGY , *HISTOPATHOLOGY , *EPIDEMIOLOGY , *DIAGNOSIS , *CANCER - Abstract
Aim There is limited knowledge in the field of glandular vulvar malignancies. The aim of this study is to describe the incidence and survival of women with glandular vulvar malignancies. Methods We searched PALGA, a nation-wide database registering all histo- and cytopathology in the Netherlands, for all cases of glandular vulvar malignancies between 2000 and 2015. Additional data were retrieved via the Netherlands Cancer Registry. Incidence rates were calculated per 1,000,000 women per year. Five-year net survival rates were calculated. Results We identified 197 patients with a glandular vulvar malignancy. Of these patients 55% had a primary malignancy while 45% had secondary malignancies: expansion of another tumour in 17% and metastases or recurrences of another malignancy in 28%. There is a great variety of different diagnoses of primary vulvar malignancies: 11 different types were identified. We found an overall incidence rate of glandular vulvar malignancies of 0.9–2.5 per 1,000,000 women per year. Five-year net survival for patients with a primary malignancy was 68.5%. Most of the secondary vulvar malignancies originated from (ano-)rectal malignancies. Conclusion Glandular vulvar malignancies are extremely rare and primary tumours are slightly more common. Overall survival of patients with primary glandular vulvar malignancies is comparable to patients with a vulvar squamous cell carcinoma, with five-year survival around 70%. The great variety in diagnoses combined with the low incidence should lead to routine pathologic revision and treatment in specialised gynaecologic oncology centres. [ABSTRACT FROM AUTHOR]
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- 2017
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32. Cross-sectional survey of surgical practices among gynecologic oncologists in the United States.
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Straubhar AM, Zhou Q, Iasonos A, Clarke-Pearson DL, Cliby WA, Hoffman MS, and Chi DS
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- Female, Humans, United States, Cross-Sectional Studies, Lymph Node Excision, Surveys and Questionnaires, Gynecology, Oncologists
- Abstract
Objective: We sought to document current surgical practices among gynecologic oncologists in the United States., Methods: In March/April 2020, we conducted a cross-sectional survey among members of the Society of Gynecologic Oncology to identify gynecologic oncology practice trends in the United States. The survey collected demographic data and queried participants on types of surgical procedures performed and chemotherapy use. Univariant and multivariant analyses were used to evaluate the association between surgeon practice type, region of practice, working with gynecologic oncology fellows, time in practice, and dominant surgical modality of practice on performance of specific procedures., Results: Among 1199 gynecologic oncology surgeons who were emailed the survey, 724 completed the survey (60.4% response rate). Of these respondents, 170 (23.5%) were within 6 years of fellowship graduation, 368 (50.8%) identified as female; and 479 (66.2%) worked in an academic setting. Surgeons who worked with gynecologic oncology fellows were more likely to perform bowel surgery, upper abdominal surgery, complex upper abdominal surgery, and prescribe chemotherapy. Surgeons who were ≥ 13 years out from fellowship graduation were more likely to perform bowel surgery and complex abdominal surgery and less likely to prescribe chemotherapy and perform sentinel lymph node dissections (P < 0.05)., Conclusions: These findings highlight the variation in surgical procedures performed by gynecologic oncologists in the United States. These data support that there are practice variations that would benefit from further investigation., Competing Interests: Declaration of Competing Interest Outside the submitted work, D. Chi reports personal fees from Apyx Medical, Verthermia Inc., Biom ‘Up, and AstraZeneca, as well as recent or current stock/options ownership of Apyx Medical, Verthemia, Intuitive Surgical, Inc., TransEnterix, Inc., Doximity, Moderna, and BioNTech SE. A. Iasonos reports consulting fees from Mylan. The other authors do not have potential conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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33. Highlights from the recent 2020 Annual Global IGCS Meeting
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Saketh R. Guntupalli, Remi A. Nout, Greta Dreyer, and Radiation Oncology
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medicine.medical_specialty ,Genital Neoplasms, Female ,business.industry ,MEDLINE ,Obstetrics and Gynecology ,Oncology ,SDG 3 - Good Health and Well-being ,Gynecology ,Family medicine ,Genital neoplasm ,Humans ,Medicine ,Female ,business ,Societies, Medical - Abstract
The 2020 International Gynecologic Cancer Society (IGCS) Annual Global Meeting, originally planned as a live meeting in Rome, was conducted from September 10–13 as a fully digital meeting. Due to the COVID-19 pandemic and related health risks, the IGCS leadership made the difficult decision to change from live to digital. The society and organizing committee should be congratulated with this successful rapid transformation which ensured the availability of much needed continued scientific communication and resulted in maintaining good attendance numbers. Here we describe some selected highlights, interesting or practice changing research reports, and important debates for each of the major gynecologic organs from the authors' perspective.
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- 2021
34. Real world experience of poly (ADP-ribose) polymerase inhibitor use in a community oncology practice
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Agnes Ewongwo, Lee Pendleton, Bradley J. Monk, Cortney M. Eakin, and Dana M. Chase
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0301 basic medicine ,Oncology ,Indoles ,Cost-Benefit Analysis ,Administration, Oral ,Medical Oncology ,Piperazines ,law.invention ,chemistry.chemical_compound ,0302 clinical medicine ,Piperidines ,Maintenance therapy ,Randomized controlled trial ,law ,Randomized Controlled Trials as Topic ,Aged, 80 and over ,Ovarian Neoplasms ,Obstetrics and Gynecology ,Middle Aged ,030220 oncology & carcinogenesis ,PARP inhibitor ,Female ,Adult ,medicine.medical_specialty ,Indazoles ,Medication Therapy Management ,Workload ,Poly(ADP-ribose) Polymerase Inhibitors ,Drug Costs ,Olaparib ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Adverse effect ,Rucaparib ,Aged ,Retrospective Studies ,Dose-Response Relationship, Drug ,business.industry ,Community Health Centers ,medicine.disease ,Discontinuation ,030104 developmental biology ,chemistry ,Gynecology ,Phthalazines ,Neoplasm Recurrence, Local ,business ,Ovarian cancer ,Follow-Up Studies - Abstract
Objective This study aims to describe the real-world experience, including the clinical and financial burden, associated with PARP inhibitors in a large community oncology practice. Methods Retrospective chart review identified patients prescribed olaparib, niraparib or rucaparib for maintenance therapy or treatment of recurrent ovarian, primary peritoneal or fallopian tube cancer across twelve gynecologic oncologists between December 2016 and November 2018. Demographic, financial and clinical data were extracted. One PARP cycle was defined as a single 28-day period. For patients treated with more than one PARPi, each course was described separately. Results A total of 47 patients and 506 PARP cycles were identified (122 olaparib, 24%; 89 rucaparib, 18%; 294 niraparib, 58%). Incidence of grade ≥ 3 adverse events were similar to previously reported. Toxicity resulted in dose interruption, reduction and discontinuation in 69%, 63% and 29% respectively. Dose interruptions were most frequent for niraparib but resulted in fewer discontinuations (p-value 0.01). Mean duration of use was 7.46 cycles (olaparib 10.52, rucaparib 4.68, niraparib 7.34). Average cost of PARPi therapy was $8018 per cycle. A total of 711 phone calls were documented (call rate 1.4 calls/cycle) with the highest call volume required for care coordination, lab results and toxicity management. Conclusions Although the toxicity profile was similar to randomized clinical trials, this real-world experience demonstrated more dose modifications and discontinuations for toxicity management than previously reported. Furthermore, the clinical and financial burden of PARP inhibitors may be significant and future studies should assess the impact on patient outcomes.
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- 2020
35. Epidemiological guideline influence on the therapeutic trend and patient outcome of uterine cervical cancer in Japan: Japan society of gynecologic oncology guideline evaluation committee project
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Shogo Shigeta, Fumiaki Takahashi, Mikio Mikami, Daisuke Aoki, Wataru Yamagami, Masako Shida, Satoru Nagase, Nobuo Yaegashi, Takeo Shibata, Masae Ikeda, and Hidetaka Katabuchi
- Subjects
Adult ,0301 basic medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Uterine Cervical Neoplasms ,Gynecologic oncology ,Hysterectomy ,Medical Oncology ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Obstetrics and gynaecology ,Epidemiology ,medicine ,Humans ,Registries ,Practice Patterns, Physicians' ,Stage (cooking) ,Societies, Medical ,Survival analysis ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Evidence-Based Medicine ,business.industry ,General surgery ,Obstetrics and Gynecology ,Guideline ,Middle Aged ,Survival Analysis ,Neoadjuvant Therapy ,Cancer registry ,Survival Rate ,Radiation therapy ,Treatment Outcome ,030104 developmental biology ,Oncology ,Chemotherapy, Adjuvant ,Gynecology ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Female ,Radiotherapy, Adjuvant ,Guideline Adherence ,business - Abstract
Objective The Japan Society of Gynecologic Oncology published its first clinical guidelines for uterine cervical cancer in 2007 which has been revised twice in 2011 and 2017. The aim of this study was to investigate the influence of the first guideline publication on the therapeutic trend and patient outcome by analyzing uterine cervical cancer cases registered to the cancer registry organized by the Japan Society of Obstetrics and Gynecology. Methods Data of uterine cervical cancer cases registered to the cancer registry from 2000 to 2012 were provided. Epidemiological and clinical trend were analyzed by the Chi-squared test with subsequent standardized residual analysis. Overall survival among the patients registered between 2004 and 2009 was analyzed using the Fine and Gray competing risk model. Results 68,707 cases were registered during the study period. A trend analysis revealed that the guideline publication may have led to a decrease in neoadjuvant chemotherapy in parallel with an increase in radiation therapy mainly in stage II and III patients undergoing primary treatment. A survival analysis indicated that the introduction of the guideline may have improved overall survival among stage III uterine cervical cancer patients, even though a significant difference was not observed in all of the cases. Conclusions This study demonstrated the potential influence of the guideline publication on the clinical trend and patient outcome. As this is the first assessment of the guideline for uterine cervical cancer in Japan, continuous evaluation is necessary to further comprehend the significance of this guideline.
- Published
- 2020
36. Meeting report from the 2020 Annual (virtual) Meeting of the American Society of Clinical Oncology
- Author
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Joyce F. Liu and Ritu Salani
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Poly(ADP-ribose) Polymerase Inhibitors ,Medical Oncology ,Article ,Pregnancy ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Gestational Trophoblastic Disease ,Societies, Medical ,Ovarian Neoplasms ,Clinical Oncology ,business.industry ,Obstetrics and Gynecology ,Cytoreduction Surgical Procedures ,Congresses as Topic ,Combined Modality Therapy ,United States ,Oncology ,Gynecology ,Family medicine ,Uterine Neoplasms ,Videoconferencing ,Female ,Immunotherapy ,business ,Stem Cell Transplantation - Published
- 2020
37. Take me to your leader: Reporting structures and equity in academic gynecologic oncology
- Author
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Linda Hong, Lisa Rubinsak, Uma Chandavarkar, Bobbie J. Rimel, Michelle F. Benoit, Christine A. Heisler, Sarah M. Temkin, William P. McGuire, and Laurel K. Berry
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Faculty, Medical ,education ,Specialty ,Gynecologic oncology ,Subspecialty ,03 medical and health sciences ,0302 clinical medicine ,Obstetrics and gynaecology ,Academic department ,medicine ,Humans ,health care economics and organizations ,Health Equity ,business.industry ,Obstetrics and Gynecology ,030104 developmental biology ,Oncology ,Gynecology ,030220 oncology & carcinogenesis ,Family medicine ,Workforce ,Female ,Observational study ,business ,Inclusion (education) - Abstract
Gynecologic oncology includes increasing percentages of women. This study characterizes representation of faculty by gender and subspecialty in academic department leadership roles relevant to the specialty.The American Association of Medical Colleges accredited schools of medicine were identified. Observational data was obtained through institutional websites in 2019.144 accredited medical schools contained a department of obstetrics and gynecology with a chair; 101 a gynecologic oncology division with a director; 98 a clinical cancer center with a director. Women were overrepresented in academic faculty roles compared to the US workforce (66 vs 57%, p 0.01) but underrepresented in all leadership roles (p 0.01). Departments with women chairs were more likely to have50% women faculty (90.2 vs 9.8%, p 0.01); and have larger faculties (80.4 vs 19.6%20 faculty, p = 0.02). The cancer center director gender did not correlate to departmental characteristics. A surgically focused chair was also associated with50% women faculty (85.7 vs 68.3%, p = 0.03); faculty size20 (85.7 vs 61.4%, p 0.01); and a woman gynecologic oncology division director (57.6 vs 29.4%, p 0.01; 68.4 vs 31.7%, p 0.01) and gynecologic oncology fellowship (50 vs 30.4%, p 0.01; 59.1 vs 32%, p 0.01). Gynecologic oncology leadership within cancer centers was below expected when incidence and mortality to leadership ratios were examined (p 0.01, p 0.01).Within academic medical schools, women remain under-represented in obstetrics and gynecology departmental and cancer center leadership. Potential benefits to gynecologic oncology divisions of inclusion women and surgically focused leadership were identified.
- Published
- 2020
38. Effect of bilateral salpingo-oophorectomy on the overall survival of premenopausal patients with stage I low-grade endometrial stromal sarcoma; a National Cancer Database analysis
- Author
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Nawar A. Latif, S.H. Kim, Ashley Haggerty, Mark A. Morgan, Spyridon A. Mastroyannis, Emily M. Ko, Robert L. Giuntoli nd, and Dimitrios Nasioudis
- Subjects
Adult ,0301 basic medicine ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,Sarcoma, Endometrial Stromal ,medicine.medical_treatment ,Salpingo-oophorectomy ,Ovary ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Stage (cooking) ,Neoplasm Staging ,Retrospective Studies ,Gynecology ,Chemotherapy ,Endometrial stromal sarcoma ,Hysterectomy ,business.industry ,Obstetrics and Gynecology ,Cancer ,Middle Aged ,medicine.disease ,Survival Analysis ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Hormonal therapy ,Female ,Sarcoma ,Neoplasm Grading ,business - Abstract
Investigate the prevalence of bilateral salpingo-oophorectomy (BSO) for women ≤50 years with early stage low-grade endometrial stromal sarcoma (LGESS) and its impact on overall survival (OS).Women ≤50 years, diagnosed with stage I LGESS and managed with hysterectomy between 2004 and 2015 were identified from the National Cancer Database. Patient demographics were recorded and compared with the chi-square test. OS for patients diagnosed between 2004 and 2014 with at least one month of follow-up was assessed using Kaplan-Meier curves, and compared with the log-rank test.A total 743 patients with a median age of 44 years met the inclusion criteria. Use of radiatiotherapy (9%), chemotherapy (0.8%) and hormonal therapy (11%) was infrequent. BSO was performed in 541 (72.8%) patients. Patients who had ovarian preservation (OP) were younger (median age 43 vs 45 years, p 0.001), less likely to have comorbidities (6.9% vs 12.4%, p = 0.034), or undergo LND (30.7% vs 44.4%, p = 0.001). There were no differences between the two groups in terms of substage or patient race. Five year OS rates for patients who did (n = 490) and did not (n = 191) undergo BSO were 96.2% and 97.1% and there was no difference in OS, p = 0.50. Even after controlling for presence of comorbidities performance of BSO was not associated with better survival (HR: 1.28, 95% CI: 0.51, 3.19).Ovarian function was preserved in approximately one third of women ≤50 years with stage I LGESS with no clear detriment to overall survival. As BSO is associated with long term health effects in this patient population OP could be considered in selected women with stage I LGESS.
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- 2020
39. Risk of vulvar, vaginal and anal high-grade intraepithelial neoplasia and cancer according to cervical human papillomavirus (HPV) status: A population-based prospective cohort study
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Hanna Kristina Bertoli, Thomas Iftner, Susanne K. Kjaer, Louise T. Thomsen, and Christian Dehlendorff
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Adult ,0301 basic medicine ,medicine.medical_specialty ,Vaginal Neoplasms ,Adolescent ,Denmark ,Cohort Studies ,Uterine Cervical Diseases ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,Cervical cancer ,Gynecology ,Human papillomavirus 16 ,Intraepithelial neoplasia ,Vulvar Neoplasms ,business.industry ,Proportional hazards model ,Papillomavirus Infections ,Hazard ratio ,HPV infection ,Obstetrics and Gynecology ,Middle Aged ,Anus Neoplasms ,medicine.disease ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,High Grade Intraepithelial Neoplasia ,Cohort ,Female ,business ,Carcinoma in Situ - Abstract
Objectives All cervical cancers and some vulvar, vaginal and anal cancers are caused by high-risk human papillomavirus (hrHPV). However, little is known about the association between cervical HPV infection and subsequent intraepithelial neoplasia and cancer at other anogenital sites. In this prospective cohort study, we estimated the risk of vulvar, vaginal and anal intraepithelial neoplasia grade 2/3 or cancer (VIN2+, VaIN2+, AIN2+) according to cervical hrHPV status. Methods Liquid-based cervical cytology samples were collected from 40,399 women screened against cervical cancer in Copenhagen, Denmark, during 2002–2005. Samples were tested for hrHPV using Hybrid Capture 2 (HC2) and genotyped using INNO-LiPA. We linked the cohort with Danish nationwide registries to identify cases of VIN2+, VaIN2+ and AIN2+ during up to 15 years of follow-up. We estimated age-adjusted hazard ratios (HRs) using Cox regression and cumulative incidences using Aalen-Johansen's estimator. Results Women with cervical HPV16 infection had increased hazard of VIN2+ (HR = 2.6; 95% confidence interval [CI], 1.2–5.5), VaIN2+ (HR = 23.5; 95% CI, 6.8–81.6) and AIN2+ (HR = 3.7; 95% CI, 1.1–12.2) compared with HC2 negative women. Women with other hrHPV types than HPV16 also had increased hazard of VaIN2+ (HR = 7.1; 95% CI, 2.3–22.3) and a borderline statistically significantly increased risk of AIN2+ (HR = 2.2; 95% CI, 0.9–4.9) compared with HC2 negative women. The 10-year cumulative incidences of VIN2+, VaIN2+ and AIN2+ in women with cervical HPV16 were 0.3% (95% CI, 0.2%–0.7%), 0.2% (95% CI, 0.1%–0.5%) and 0.1% (95 CI, 0.0%–0.4%). Conclusions Cervical HPV16 infection is associated with increased risk of VIN2+, VaIN2+ and AIN2+.
- Published
- 2020
40. Clinical performance of Onclarity HPV assay and Cobas HPV test in detection of cervical precancer and cancer in Chinese women
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Wen Chen, Yuqian Zhao, Jianfeng Cui, Li Li, Feng Chen, Mingyue Jiang, Daokuan Liu, Qin-Jing Pan, Xun Zhang, Tingyuan Li, Bin Liu, Lulu Yu, Zeni Wu, Yu Qin, and You-Lin Qiao
- Subjects
Adult ,0301 basic medicine ,China ,medicine.medical_specialty ,Concordance ,Cervical precancer ,Uterine Cervical Neoplasms ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cytology ,Humans ,Medicine ,Hpv test ,Human papillomavirus ,Papillomaviridae ,Aged ,Gynecology ,Cervical cancer ,business.industry ,Papillomavirus Infections ,Clinical performance ,Obstetrics and Gynecology ,Cancer ,Middle Aged ,Uterine Cervical Dysplasia ,medicine.disease ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,DNA, Viral ,Female ,business ,Precancerous Conditions - Abstract
The Roche Cobas (Cobas) and BD Onclarity (Onclarity) human papillomavirus (HPV) assays are convenient, PCR-based, HPV DNA tests; currently, data on performance of Onclarity in Chinese women is limited. We aimed to evaluate the clinical performance of Onclarity for detecting cervical lesions in Chinese women.In total, 1122 women were enrolled into this study. Exfoliated cervical cells were collected in PreservCyt medium and were tested using Cobas and Onclarity. Cytology and histology were interpreted by senior cytologists and a panel of pathologists, respectively, at Cancer Hospital, Chinese Academy of Medical Sciences.The assays showed excellent concordance for HPV16 (kappa = 0.91, 95% CI: 0.85-0.97) and for 12 other high-risk types (HPV31/33/35/39/45/51/52/56/58/59/66/68, kappa = 0.84, 95% CI: 0.78-0.90), and very good concordance for HPV18 (kappa = 0.75, 95% CI: 0.69-0.81). No difference for ≥CIN2 sensitivity was observed between Onclarity and Cobas (both 90.5%); and theCIN2 specificity for detection was similar between Onclarity (84.2%, 95% CI: 81.6-86.4) and Cobas (80.4%, 95% CI: 77.6-82.8). When combined with cytology triage, the colposcopy referral rate point estimate was slightly lower for Onclarity (9.0%) than for Cobas (11.0%), with the same ≥CIN2 sensitivity of 75.0% (95% CI: 53.1-88.8) for Onclarity and Cobas.Onclarity exhibited comparable screening performance and triage efficiency compared to Cobas in detection of cervical lesions in Chinese women.
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- 2020
41. The Society of Gynecologic Oncology wellness curriculum pilot: A groundbreaking initiative for fellowship training
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Gerald McGwin, Sgo Wellness Taskforce, David M. Kushner, Kenneth H. Kim, Jeffery M. Fowler, Stephanie V. Blank, T.B. Turner, and Abigail Ford Winkel
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0301 basic medicine ,Students, Medical ,Medical psychology ,education ,Reflective writing ,Specialty ,Health Promotion ,Burnout ,Medical Oncology ,Culture change ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Healthy Lifestyle ,Fellowships and Scholarships ,Curriculum ,Medical education ,business.industry ,Obstetrics and Gynecology ,Distress ,030104 developmental biology ,Oncology ,Education, Medical, Graduate ,Gynecology ,030220 oncology & carcinogenesis ,Female ,business ,Psychosocial - Abstract
Objectives Trainee well-being is a core component of ACGME program requirements and the SGO has recognized the high incidence of burnout among gynecologic oncologists and its negative impact. To foster a culture of wellness throughout the SGO community we sought to engage current fellows along with fellowship directors in a structured didactic program designed to teach wellness. We evaluated the feasibility of and preliminary responses to a pilot curriculum designed to teach skills that promote wellness and prevent burnout. Methods The SGO Wellness Taskforce developed a curriculum with topics based on established evidence as well as specialty specific stressors such as end of life discussions. Faculty leaders from 15 pilot-sites attended a full-day training course and then taught four modules over four months. Interactive modules engaged fellows through reflective writing, guided discussion, and multimedia presentations. Fellows completed the Perceived Stress Scale pre- and post-implementation and provided feedback regarding attitudes toward wellness and the individual modules. Faculty curriculum leaders completed surveys regarding their attitudes toward the curriculum as well as their trainees' reactions. Results Among 73 participating gynecologic oncology fellows, 95% (69/73) and 52/73 (71%) completed the pre-and post-surveys, respectively. Only 34/73 (49%) respondents reported that there was wellness programming at their institution prior to the initiation of the SGO curriculum. At institutions where such programming was available, 35% (12/34) reported not utilizing them. Fifty-five (80%) fellows had PSS scores greater than 12 compared to 39 (75%) post-intervention. After the curriculum, the percentage of fellows comfortable discussing wellness topics increased from 63 to 74%. Prior to the curriculum, 75% felt they could identify symptoms of burnout or psychosocial distress. This increased to 90% post-intervention. The modules were well received by fellows, and the time spent addressing wellness was widely appreciated. Conclusions A structured curriculum to promote wellness among gynecologic oncology fellows is feasible and was associated with observed decreased reported stress among fellows at participating programs. This curriculum addresses ACGME requirements regarding trainee well-being, and showed potential for more programmatic, nationwide implementation. Fellowship culture change was not directly measured, but may have been one of the most significant positive outcomes of the wellness program. Further longitudinal studies will be necessary to understand the natural course of fellow burnout and the impact of structured wellness programming.
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- 2020
42. Twenty-year surgical trends in a gynecologic oncology fellowship training program: Implications for practice
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Yin Xiong, Robert M. Wenham, Mitchel S. Hoffman, Sachin M. Apte, and William Roberts
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Gynecologic oncology ,Anastomosis ,Hysterectomy ,Medical Oncology ,03 medical and health sciences ,Gynecologic Surgical Procedures ,0302 clinical medicine ,Time frame ,Robotic Surgical Procedures ,medicine ,Humans ,Fellowships and Scholarships ,Practice Patterns, Physicians' ,Fellowship training ,business.industry ,General surgery ,Obstetrics and Gynecology ,Surgical training ,030104 developmental biology ,Oncology ,Education, Medical, Graduate ,Gynecology ,030220 oncology & carcinogenesis ,Preparedness ,Invasive surgery ,Florida ,Lymph Node Excision ,Female ,Laparoscopy ,Surgical education ,business - Abstract
Objective To assess whether there were any significant changes in surgical training volume over the past 20 years that might have ramifications toward preparedness for practice. Methods We used deidentified annual summaries of fellow case numbers for the academic years 1999 through 2018. Unpaired t-tests with Welch's correction were performed on all surgical categories for 10-year and 5-year periods. Results The total number of hysterectomies performed each year did not change significantly. The percent of hysterectomies performed by minimally invasive surgery increased significantly starting in 2008. There was a significant decline in the number of radical hysterectomies conducted starting after 2004, which then remained stable. There was also a significant decline in the number of bowel resections/anastomoses performed by fellows on the gynecologic oncology services that occurred and stabilized during the same time frame. There were other significant trends associated with the introduction of minimally invasive techniques. Conclusion The results of this study suggest the need to reevaluate fellowship training and/or the scope of surgical practice in gynecologic oncology.
- Published
- 2019
43. Social media in gynecologic oncology: A new frontier
- Author
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Gregg Nelson
- Subjects
Oncology ,Genital Neoplasms, Female ,Gynecology ,Humans ,Obstetrics and Gynecology ,Female ,Social Media - Published
- 2022
44. Association of gynecologic oncology versus medical oncology specialty with survival, utilization, and spending for treatment of gynecologic cancers
- Author
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Emily M. Ko, Justin E. Bekelman, Katherine Hicks-Courant, Colleen M. Brensinger, and Genevieve P. Kanter
- Subjects
Ovarian Neoplasms ,Obstetrics and Gynecology ,Uterine Cervical Neoplasms ,Antineoplastic Agents ,Medical Oncology ,Medicare ,United States ,Cohort Studies ,Survival Rate ,Oncology ,Gynecology ,Multivariate Analysis ,Uterine Neoplasms ,Humans ,Female ,Health Expenditures ,Emergency Service, Hospital ,Aged ,Proportional Hazards Models ,Retrospective Studies ,SEER Program - Abstract
We examined the association of gynecologic oncology (GYO) versus medical oncology (MEDONC) based care with survival, health care utilization and spending outcomes in women undergoing chemotherapy for advanced gynecologic cancers.Women with newly diagnosed stage III-IV uterine, ovarian, and cervical cancers from 2000 to 2015 were identified in SEER-Medicare. We assessed the association of provider specialty with overall survival, emergency department utilization, admissions, and spending. Outcomes were assessed using unadjusted and Inverse Treatment Probability Weighted propensity-score applied, multi-variable cox modeling, Poisson regression, and generalized models of log-transformed data.We identified 7930 gynecologic cancer patients (4360 ovarian, 2934 uterine, 643 cervix). 37% were treated by GYO and 63% by MEDONC. For ovarian patients, GYO care was associated with improved OS (median OS 3.3 v. 2.9 years; HR 0.85, 95%CI 0.80, 0.91, p .0001) and similar mean spending per month ($4015 v. $4316, mean ratio 0.97 (95% CI 0.93, 1.02), p = .19), compared to MEDONC in adjusted analyses. For uterine patients, GYO care was associated with similar OS, but decreased spending ($3573 v. $4081, mean ratio 0.87 (95% CI.81, 0.93), p .0001), and decreased ED utilization (RR 0.76, 95% CI 0.69, 0.85, p .0001). For cervical patients, GYO care was associated with similar OS, and similar spending. Admissions were more likely in ovarian (RR 1.23, 95%CI 1.11, 1.37, p = .0001) and cervical patients (RR 1.26, 95% CI 1.05, 1.51, p = .015) treated by GYO, in adjusted analyses.GYO based care was associated with improved OS and equal spending for patients with advanced stage ovarian cancer. Uterine and cervix patients had similar OS, and less or equal spending respectively, when treated by GYO compared to MEDONC.
- Published
- 2021
45. Doubling down on the future of gynecologic oncology: The SGO future of the profession summit report.
- Author
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Blank SV, Huh WK, Bell M, Dilley S, Hardesty M, Hoskins ER, Lachance J, Musa F, Prendergast E, Rimel BJ, Shahin M, and Valea F
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- Female, Humans, Medical Oncology, Gynecology, Genital Neoplasms, Female therapy, Oncologists
- Abstract
The original vision of the field of gynecologic oncology was to establish a multidisciplinary approach to the management of patients with gynecologic cancers. Fifty years later, scientific advances have markedly changed the overall practice of gynecologic oncology, but the profession continues to struggle to define its value-financial and otherwise. These issues were examined in full at the Society of Gynecologic Oncology (SGO) Future of the Profession Summit and the purpose of this document is to summarize the discussion, share the group's perceived strengths, weaknesses, opportunities, and threats (SWOT) for gynecologic oncologists, further educate members and others within the patient care team about the unique role of gynecologic oncologists, and plan future steps in the short- and long- term to preserve the subspecialty's critical mission of providing comprehensive, longitudinal care for people with gynecologic cancers., Competing Interests: Declaration of Competing Interest Dr. Huh reports personal fees from AstraZeneca, Roche, SeaGen and Inovio outside the submitted work. Dr. Hardesty reports personal fees from Immunogen, Axiom, GSK, Takeda, AZ-Mereck, and Intuitive outside the submitted work. Dr. Prendergast reports personal fees from Heron Therapeutics and AstraZeneca outside the submitted work. Dr. Rimel reports being an Advisory Board Participant for GSK, Merck, and Immunogen and a consultant for Deep 6AI. Dr. Shahin reports grants and personal fees from GSK, AstraZeneca, and Merck, personal fees from Eisai, Immunogen, and GenMab during the conduct of the study. All other authors have nothing to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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46. Being a caregiver to patients with ovarian cancer: A scoping review of the literature.
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Petricone-Westwood, Danielle and Lebel, Sophie
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- *
CAREGIVERS , *OVARIAN cancer diagnosis , *CANCER relapse , *PSYCHOLOGICAL well-being ,OVARIAN cancer patients - Abstract
Objective Ovarian cancer differs from many other cancer diagnoses due to its late diagnosis and high rates and frequencies of recurrences. The physical and psychosocial wellbeing of patients are well documented in the literature, however limited research exists specifically on their friends and family, or caregivers. The goal of this review was to examine the state of the literature on ovarian cancer caregivers. Method A scoping review was conducted on any articles describing caregivers of patients with ovarian cancer. Databases were searched systematically using key terms related to ovarian cancer and caregiving. Both authors screened articles for eligibility. Grey literature was also consulted. Results 19 articles were identified after screening: nine quantitative, five qualitative, two mixed-methods, two case studies and a personal account. Quantitative studies were conducted over different time-points in the disease trajectory, whereas qualitative studies and the personal account spanned the whole trajectory. Collectively, the studies suggested that the experience of being a caregiver to patients with ovarian cancer changes overtime, as the first year post-diagnosis shows little compromise in wellbeing and quality of life, which then steadily declines throughout the rest of the disease trajectory. Studies commented on quality of life, distress, needs, social wellbeing, spirituality, relationships with healthcare providers, relationships with patients, physical health and financial wellbeing. Conclusions This scoping review of the literature demonstrates little peer-reviewed evidence on the experiences and quality-of-life of ovarian cancer caregivers. This population experiences physical and psychosocial challenges that merit exploration, to subsequently aid in designing interventions. [ABSTRACT FROM AUTHOR]
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- 2016
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47. Patient perceptions and willingness to participate in clinical trials.
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Igwe, Elena, Woodburn, Julie, Davolos, Jacyln, Shollenberger, Cori, Miller, Suzanne M., Hernandez, Enrique, and Ferriss, J. Stuart
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- *
GYNECOLOGY , *ANXIETY diagnosis , *MENTAL depression , *PSYCHOLOGICAL stress , *CLINICAL trials - Abstract
Objective To evaluate gynecologic oncology patients' perceptions and willingness to participate in randomized clinical trials (RCT) among an inner city population. Methods Informed consent was obtained. Demographics were collected and willingness to participate in a RCT was measured by the Attitudes on Randomized Trials Questionnaire (ARTQ). The Hospital Anxiety and Depression Scale estimated levels of anxiety and depression. A Perception Survey was created and tested as a screening tool for patients considering RCTs. Standard statistical tests were used. Results One hundred and one women participated, 54 (53.5%) were black, 31 (30.7%) were white, non-Hispanic and 15 (14.9%) were Hispanic. Screening for anxiety and depression revealed an 18.8% rate of moderate to severe anxiety and an 11.9% rate of moderate to severe depression. Willingness to participate in a RCT as measured by ARTQ scores was not significantly associated with race, levels of anxiety or depression. Twenty-eight percent of women would agree to participate in a clinical trial at baseline. An additional, 33 (32.7%), for a total of 61.4%, indicated agreement after targeted education with no statistical differences by race or psychological stressor. However, sixty-one percent of these women were black. The Perception Survey approximated the results of the ARTQ with reasonable accuracy (AUC 0.758, p < 0.001) Conclusions Neither race nor psychological stressor were significant indicators of willingness to participate in a RCT. Targeted education resulted in a majority of patients indicating willingness to participate in trials, especially among black women. Additionally, a novel screening tool was tested and performed well in this setting. [ABSTRACT FROM AUTHOR]
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- 2016
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48. A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs.
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Miralpeix, Ester, Nick, Alpa M., Meyer, Larissa A., Cata, Juan, Lasala, Javier, Mena, Gabriel E., Gottumukkala, Vijaya, Iniesta-Donate, Maria, Salvo, Gloria, and Ramirez, Pedro T.
- Subjects
- *
GYNECOLOGIC cancer , *PERIOPERATIVE care , *MEDICAL practice , *ONCOLOGIC surgery , *HEALTH outcome assessment , *CANCER treatment - Abstract
Enhanced recovery after surgery (ERAS) programs aim to hasten functional recovery and improve postoperative outcomes. However, there is a paucity of data on ERAS programs in gynecologic surgery. We reviewed the published literature on ERAS programs in colorectal surgery, general gynecologic surgery, and gynecologic oncology surgery to evaluate the impact of such programs on outcomes, and to identify key elements in establishing a successful ERAS program. ERAS programs are associated with shorter length of hospital stay, a reduction in overall health care costs, and improvements in patient satisfaction. We suggest an ERAS program for gynecologic oncology practice involving preoperative, intraoperative, and postoperative strategies including; preadmission counseling, avoidance of preoperative bowel preparation, use of opioid-sparing multimodal perioperative analgesia (including loco-regional analgesia), intraoperative goal-directed fluid therapy (GDT), and use of minimally invasive surgical techniques with avoidance of routine use of nasogastric tube, drains and/or catheters. Postoperatively, it is important to encourage early feeding, early mobilization, timely removal of tubes and drains, if present, and function oriented multimodal analgesia regimens. Successful implementation of an ERAS program requires a multidisciplinary team effort and active participation of the patient in their goal-oriented functional recovery program. However, future outcome studies should evaluate the efficacy of an intervention within the pathway, include objective measures of symptom burden and control, study measures of functional recovery, and quantify outcomes of the program in relation to the rates of adherence to the key elements of care in gynecologic oncology such as oncologic outcomes and return to intended oncologic therapy (RIOT). [ABSTRACT FROM AUTHOR]
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- 2016
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49. Wnt signalling in gynaecological cancers: A future target for personalised medicine?
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Ford, C.E., Henry, C., Llamosas, E., Djordjevic, A., and Hacker, N.
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- *
WNT proteins , *TARGETED drug delivery , *PROTEIN-tyrosine kinases , *INDIVIDUALIZED medicine , *GYNECOLOGY - Abstract
The three major gynaecological cancers, ovarian, uterine and cervical, contribute a significant burden to global cancer mortality, and affect women in both developed and developing countries. However, unlike other cancer types that have seen rapid advances and incorporation of targeted treatments in recent years, personalised medicine is not yet a reality in the treatment of gynaecological cancers. Advances in sequencing technology and international collaborations and initiatives such as The Cancer Genome Atlas are now revealing the molecular basis of these cancers, and highlighting key signalling pathways involved. One pathway which plays a role in all three cancer types, is the Wnt signalling pathway. This complex developmental pathway is altered in most human malignancies, and members of this pathway, particularly the recently linked ROR receptor tyrosine kinases may be attractive future therapeutic targets. This review provides an up-to-date summary of research into Wnt signalling and ovarian, uterine and cervical cancers, and discusses the potential of the Wnt pathway as a future target for personalised medicine in gynaecological cancers. [ABSTRACT FROM AUTHOR]
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- 2016
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50. Genetic characterization of early onset ovarian carcinoma.
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Bernards, Sarah S., Norquist, Barbara M., Harrell, Maria I., Agnew, Kathy J., Lee, Ming K., Walsh, Tom, and Swisher, Elizabeth M.
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OVARIAN cancer , *GENETIC mutation , *GERM cells , *BRCA genes , *GYNECOLOGY - Abstract
Objective Ovarian carcinoma (OC) is rare in young women and the fraction of early onset OC attributable to inherited mutations in known OC genes is uncertain. We sought to characterize the fraction of OC that is heritable in women diagnosed with ovarian, fallopian tube, or peritoneal carcinoma at forty years of age or younger. Methods We sequenced germline DNA from forty-seven women diagnosed with OC at age 40 or younger ascertained through a gynecologic oncology tissue bank or referred from outside providers using BROCA, a targeted capture and massively parallel sequencing platform that can detect all mutation classes. We evaluated 11 genes associated with ovarian carcinoma ( BARD1 , BRCA1 , BRCA2 , BRIP1 , MLH1 , MSH2 , MSH6 , PALB2 , PMS2 , RAD51D , and RAD51C ) and additional candidate genes in DNA repair ( ATM , BAP1 , CHEK2 , MRE11A , NBN , PTEN , TP53 ). We counted only clearly damaging mutations. Results Damaging mutations in OC genes were identified in 13 of 47 (28%) subjects, of which 10 (77%) occurred in BRCA1 and one each occurred in BRCA2 , MSH2 , and RAD51D. Women with a strong family history were no more likely to have an OC gene mutation (8/17, 47%) than those without a strong family history (9/30, 30%, P = 0.35). Additionally, damaging mutations in non-OC genes were identified, one in NBN and one in CHEK2 . Conclusions A high proportion of young women with invasive OC have mutations in BRCA1 , and a smaller fraction have mutations in other known OC genes. Family history was not associated with mutation status in these early onset cases. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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