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Objective Mutations in the MAP kinase pathway (KRAS, NRAS, BRAF) are common in low grade serous ovarian carcinoma (LGSOC). The effect of these and other mutations on RNA transcription in this disease is poorly understood. Our objective was to describe patterns of somatic mutations and gene transcription in a racially diverse population with LGSOC. Methods Utilizing an institutional tumor registry, patients with LGSOC were identified and charts were reviewed. RNA was extracted from available tumor tissue. Commercial tumor profiling results were analyzed with PanCancer pathway nanoString mRNA expression data. Along with nanoString n-Solver software, Chi-squared, Fishers Exact, and Cox proportional hazards models were used for statistical analysis, with significance set at p Results 39 patients were identified—20% Black, 43% Hispanic, and 36% non-Hispanic White. 18 patients had commercial somatic DNA test results, and 23 had available tumor tissue for RNA extraction and nanoString analysis. The most common somatic alterations identified was KRAS (11 patients, 61%), followed by ERCC1 and TUBB3 (9 each, 50%). KRAS mutations were less common in smokers (14.3% vs 90.9%, p = 0.002). RNA expression analysis demonstrated a greater than two-fold decrease in expression of HRAS in tumors from older patients (p = 0.04), and a greater than two-fold decrease in the expression of HRAS in recurrent tumors (p = 0.007). No significant differences were seen in somatic testing results, RNA expression analysis, or progression free survival between different racial and ethnic cohorts. Conclusions Somatic deficiencies in ERCC1, TUBB3, and KRAS are common in LGSOC in a population of minority patients. HRAS demonstrates decreased expression in tumors from older patients and recurrent tumors.

Objectives: Despite new developments in the treatment of cervical cancer, intracavitary brachytherapy (ICBRT) continues to be part of the standard of care treatment for locally advanced cervical cancer. The objective of our study was to evaluate clinical and socio-demographic factors associated with not receiving indicated ICBRT and its impact on overall survival (OS) in women with locally advanced cervical cancer. Methods: Patients diagnosed with cervical cancer between 1993-2017 receiving care at 2 large academic centers were included in this retrospective case control study. Demographic and clinical data were retrospectively abstracted. Data analysis was done using Mann-Whitney U test, Fischer's Exact test, logistic regression. Kaplan-Meier curves were constructed for OS and the log rank test was utilized to detect differences in OS. Results: Of 274 patients with cervical cancer, 130 were candidates to receive ICBRT. Mean age was 50.19 (±12.6). The majority of patients included were underrepresented minorities including 60.8% White-Hispanic patients and 30.8% Black. Spanish was identified as the primary language for 48.5% of women. The average median household income based on zip code was $45,387 (± $17,135) for the cohort. A total of 50.5% of subjects were foreign born with only 11.5% identified as USA born. Squamous cell carcinoma was the most common histologic type in the group at 86.2%. Majority of subjects included in cohort (53.8%) were Stage IIB at time of diagnosis. ECOG performance status was 0 in 72% of the subjects included. On univariate analysis, older patients (55.52±11.7years, p=0.012) (OR 0.957 [0.924, 990], p=0.012), those with ECOG PS 4cm), country of birth, BMI, and histologic type were not associated with completion of ICBRT (all p > 0.05). On multivariate analysis, Black race OR 0.216 CI (0.091-0.579) and Medicare status OR 0.039 CI (0.14-2.085) continued to be significantly associated with lack of receipt of brachytherapy. A total of 29 (22.3%) subjects did not complete the indicated ICBRT as part of their treatment. Among the reasons for not receiving ICBRT included distorted anatomy (17%), poor response to EBRT (28%), patient refusal or noncompliance (17%), ICBRT not available at the institution (7%), and inability to achieve desired dose (10%). Women who did not receive ICBRT were more likely to die of disease with a HR of 2.85 [1.071, 7.617], p=0.046, even when external beam boost was performed. On Cox proportional-hazard analysis, receipt of ICBRT continued to be associated with OS. Receipt of intensity-modulated radiation therapy (IMRT) boost instead of ICBRT did not improve survival. Conclusions: While ICBRT remains the standard of care for locally advanced cervical cancer, 22.3% of subjects (93% minority patients) did not receive it for various reasons. Sociodemographic and clinical factors are both associated with receipt of brachytherapy. Regardless of the reasons for not receiving, and even when external beam boost is given in an effort to compensate for lack of receipt of brachytherapy, patients who do not receive ICBRT have a lower OS.

Objectives: To characterize socioeconomic and clinical factors associated with refusal of gynecologic cancer surgery. Methods: The National Cancer DataBase (NCDB) was surveyed for patients with uterine, cervical, or ovarian cancer treated at participating Commission on Cancer sites between 2004 and 2017. Demographic and clinical data were abstracted, descriptive statistics and Pearson's chi squared tests performed. Univariate and multivariate logistic regression were performed to examine the association between variables and refusal of surgery, with the threshold for two-sided significance set at p Results: Of the 938 773 patients with gynecologic cancer included in the NCDB, 5875 patients (0.6%) did not undergo surgery and had documented refusal. On univariate analysis, age, race, Hispanic ethnicity, rural residence, lower median household income, regional high school graduation rate, facility type (academic vs community), geographic location and distance to treating hospital, disease site, stage, and increasing Charlson comorbidity index were all associated with refusal of surgery (p 3 (OR 1.34 95% CI 1.16-1.56). Clinical trial enrollment was not associated with refusal. Conclusions: Multiple social, racial, economic, and systematic factors that impact marginalized members of society are independently associated with refusal of NCCN guideline-indicated surgery. Refusal of surgery is more common in underserved patients and may represent another aspect of healthcare disparity that deserves closer attention.

Objectives: Uterine serous carcinoma (USC) is a rare but aggressive histologic variant of endometrial cancer that accounts for less than 10% of cases but 80% of endometrial cancer deaths. Initial treatment strategies have remained largely unchanged over the years, with the mainstay of treatment being primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy with or without tailored radiotherapy. More recent strategies have incorporated the use of neoadjuvant chemotherapy (NAC) in certain cases with bulky nodal disease or stage IV disease. This study compares survival outcomes between PCS and neoadjuvant chemotherapy followed by an interval cytoreductive surgery (ICS). Methods: Retrospective data spanning 7 years was collected for patients with stage III or IV USC in a large academic institution. PCS was categorized as initial surgical treatment for stage III or IV disease. This was further stratified into microscopic and bulky disease at the time of surgery. ICS was defined as initial treatment with NAC with interval cytoreductive surgery. Overall survival (OS) and progression free survival (PFS) were calculated for each group with Kaplan-Meier estimation and analyzed using the Chi-Square test. Results: Forty-seven patients were identified to have stage III or IV disease at the time of diagnosis. 35 patients underwent PCS and 12 underwent ICS. The PCS and ICS groups were matched for race, age and BMI. Among the PCS patients, 52% had bulky disease. OS was 82.1 months compared to 40.1 months for PCS and ICS respectively (p=0.23). PFS of PCS patients was 42.9 months compared to 18.1 months of ICS patients (p=0.03). PCS of non-bulky disease, PCS of bulky disease and ICS had OS of 82.1, 40.9, and 31.8 months respectively (p=0.47) while PFS was 42.9, 19.6 and 13.8 months for PCS of non-bulky disease, PCS of bulky disease and ICS respectively (p=0.02). For patients with non-bulky disease and bulky disease, OS was 82.1 vs 40.1 months respectively (p=0.23) while PFS was 42.9 and 18.1 months respectively (p=0.32). Patients with bulky disease who had PCS had an OS of 40.9 months compared to 31.8 months for ICS (p=0.86) and PFS of 19.7 months vs 13.9 months (p=0.13). Conclusions: While no statistical difference in OS was observed between the groups, there was a significant improvement in PFS in the PCS patients compared to ICS patients. PFS was significantly longer after PCS regardless of bulky disease. PFS appears to favor PCS over ICS. This study is limited by the small sample size. Additional studies are needed to better determine optimal treatment strategies for patients with advance stage USC.

ObjectivesLow grade serous ovarian carcinoma is a rare subtype of ovarian cancer with an indolent and chemorefractory course. As such, treatment strategies among practitioners are not uniformly known. The primary objective of this study was to identify differences in practice patterns among physicians who treat low grade serous carcinoma.Methods MaterialsA de novo survey was distributed to members of the Society of Gynecologic Oncology. Questions about demographics, management of primary and recurrent disease, and use of consolidation therapy were included. Statistical analyses were performed using χ2and Fisher’s exact tests.Results194 gynecologic oncologists completed the survey. Approximately two-thirds of respondents practiced in a university based setting and treated a high volume of ovarian cancers, including low grade serous carcinoma. 82% recommended somatic testing during treatment and 84% routinely sent patients for genetic counseling. Treatment preferences for primary disease varied by debulking status. 48% of practitioners used hormone antagonism as consolidation after primary treatment. Secondary cytoreduction was preferred for patients with platinum sensitive recurrence and a long disease free interval following primary treatment (PConclusionsThere was significant variation in the preferred management of low grade serous carcinoma among practitioners. Further efforts to improve knowledge of this disease, identify optimal treatment modalities, and provide guidelines for management should be encouraged.

Objectives: Ovarian Germ Cell Tumors (GCT) are rare, and understudied, subtypes of ovarian cancer. Our objective was to evaluate the effects of race, ethnicity, and clinicopathologic characteristics on treatment selection, treatment delays, and overall survival in this disease. Methods: Data from the National Cancer Database between 2004 and 2015 were evaluated for adult women with invasive ovarian GCT. Mann-Whitney U-test and Chi Square analysis were used to identify differences in sociodemographic factors based on race and ethnicity. Logistic regression and Poisson regression were used to evaluate associations between treatment receipt and treatment delays, respectively. Time to treatment initiation (TTI) was defined as the duration between date of diagnosis and the first treatment received, and overall survival (OS) was defined as the time from date of diagnosis to either date of death from any cause or date of last contact. Cox proportional hazards regression model was used to calculate hazard ratios for OS. Statistical significance was set at p Results: There were 3,049 evaluable women with GCT. 74.1% of patients were White and 15.6% were Black. 15.6% were Hispanic and 78.2% were non-Hispanic. The median age of the overall cohort was 27 (range 18-90). There was no difference in mean age at diagnosis between Blacks and Whites, while Hispanics were diagnosed significantly younger than Non-Hispanics (28.0 vs 30.8 years, p Conclusions: Multiple clinical, socioeconomic, and systematic factors are associated with increasing time to treatment and adjuvant therapy selection after primary surgical resection in GCT. Of these factors, type of insurance, and accreditation status of the treating institution are associated with worse overall survival, reflecting the possible need for centralization of care for this rare tumor.

Background Preparation in the business of medicine is reported to be poor across a number of specialties. No data exist about such preparation in gynecologic oncology training programs. Our objectives were to evaluate current time dedicated to these initiatives, report recent graduate perceptions about personal preparedness, and assess areas where improvements in training can occur. Methods Two separate surveys were created and distributed, one to 183 Society of Gynecologic Oncology candidate members and the other to 48 gynecologic oncology fellowship program directors. Candidate member surveys included questions about perceived preparedness for independent research, teaching, job-hunting, insurance, and billing. Program director surveys assessed current and desired time dedicated to the topics asked concurrently on the candidate survey. Statistical analysis was performed using Chi-squared (or Fisher’s exact test if appropriate) and logistic regression. Results Survey response rates of candidate members and program directors were 28% and 40%, respectively. Candidate members wanted increased training in all measures except retrospective protocol writing. Female candidates wanted more training on writing letters of intent (LOI) (p = 0.01) and billing (p

Serous borderline tumors are rare, benign ovarian neoplasms that may recur and undergo malignant transformation to low-grade serous carcinomas (LGSCs). In this report, a 50-year-old female with a remote history of a serous borderline ovarian tumor experienced a recurrence of LGSC, presenting as a large solitary subcutaneous mass anterior to the sternum after a 33-year disease-free interval. The described case highlights the unpredictable nature of this disease and the importance of implementing lifelong surveillance strategies.

In January 2019, a group of basic, translational, and clinical investigators and patient advocates assembled in Miami, Florida, to discuss the current state of the science of low-grade serous carcinoma of the ovary or peritoneum-a rare ovarian cancer subtype that may arise de novo or following a diagnosis of serous borderline tumor. The purpose of the conference was to review current knowledge, discuss ongoing research by established researchers, and frame critical questions or issues for future directions. Following presentations and discussions, the primary objective was to initiate future collaborations, uniform database platforms, laboratory studies, and clinical trials to better understand this disease and to advance clinical care outside the boundaries of single academic institutions. This review summarizes the state of the science in five principal categories: epidemiology and patient outcomes, pathology, translational research, patient care and clinical trials, and patients' perspective.

Low-grade serous carcinoma (LGSC) is a rare histotype of ovarian cancer with a unique disease course. Little data exist regarding the influence of sociodemographic factors on diagnosis and outcomes in this disease. Our objective was to evaluate the associations between these factors and the clinical characteristics, treatment approaches, and survival in LGSC.The National Cancer Database (NCDB) was queried for data between 2004 and 2015 on patients with LGSC. LGSC was inclusive of invasive, grade 1, serous carcinoma of the ovary, fallopian tube, or peritoneum. Patient demographics, insurance status, disease characteristics, treatment approach, and survival were evaluated. ANOVA, Chi Square, Kaplan-Meier, and Cox regression were used in the analysis.3221 patients with LGSC were evaluated (89.5% White, 6.2% Black; 7.2% Hispanic, 92.8% non-Hispanic). Compared to Whites, Blacks were diagnosed younger (50.4 vs. 55.9 years, p 0.01), received less chemotherapy (61.8% vs 67.0%, p = 0.04), and had less CA-125 elevation (OR 4.14 [1.26-13.57], p = 0.02). Compared to non-Hispanics, Hispanics were younger (49.5 vs. 55.8 years, p 0.01) and received less chemotherapy (55% vs 67%, p 0.001). In contrast to private insurance, government insurance was associated with a higher 30-day mortality (1.5% vs 0.01%, p 0.001). Race/ethnicity were not predictive of OS, while older age (HR 1.013 [1.002-1.024], p = 0.03), advanced stage (HR 3.09 [2.15-4.43], p 0.001), and government insurance (HR 2.33 [1.65-3.30], p 0.001) were all independently associated with worse OS.Significant differences exist in the clinical characteristics, treatments, and outcomes of LGSC by sociodemographics, with Blacks and Hispanics being diagnosed younger and receiving less chemotherapy. Age, stage, and insurance status were predictive of overall survival.

INTRODUCTION: To assess the effectiveness of digital animations for postpartum intrauterine device (IUD) education in the hospital setting. METHODS: A digital animated video was produced in 2012 illustrating the pertinent information about IUD contraception. From February to September 2013 postpartum patients at Jackson Memorial Hospital were randomly assigned to counseling with a 5-minute digital animation displayed on an iPad or 10 minutes of verbal counseling. Demographic information was obtained with a questionnaire and chart review. After counseling a scored questionnaire was performed to assess the participants knowledge. Standard statistical analysis was performed using SPSS 20.0. RESULTS: Eighty-eight patients were enrolled: 41 digital animation and 47 verbal counseling. No difference was found on the postcounseling knowledge score of the groups (P=.85): digital animation mean 82 (standard deviation [SD] 18.9) verbal counseling 81 (SD 16.5). After adjusting for education there was no difference in scores. The high school-educated or less group digital animation mean 76.5 (SD 18.9) and verbal counseling mean 75.6 (SD 16.5) (P=5.4) and college-educated group digital animation mean 85.8 (SD 19.05) and verbal counseling mean 84.55 (SD 14.505) (P=.19). CONCLUSION AND IMPLICATIONS: A 5-minute digital animation is as effective as 10-minute verbal counseling to educate postpartum patients. Regardless of the level of education an animated video is an easily accessible and effective tool to deliver contraceptive information especially when time or language is a limiting factor.