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Data evaluating change in body composition during treatment of advanced cancer are limited. Here we evaluated computed tomography (CT)–based changes in muscle mass during treatment for advanced ovarian cancer (OC) and association with outcomes. We analyzed the preoperative and posttreatment skeletal muscle index (SMI), skeletal muscle area normalized for height of 109 patients with advanced OC who underwent primary surgery and platinum-based chemotherapy from 2006 to 2016. Based on an SMI less than 39 cm2/m2, 54.1% of patients were never sarcopenic, 24.8% were sarcopenic on both CT scans, and 21.1% were newly sarcopenic upon treatment completion. Patients who lost muscle during treatment had the worst survival of the 3 groups identified: median survival 2.6 years vs 4.6 years if sarcopenic on both CT scans and 4.8 years if never sarcopenic. Loss of muscle portends a poor prognosis among patients with OC. Additional research is needed to better understand and best mitigate these changes.

Patients with gynecologic malignancies may have varied responses to COVID-19 infection. We aimed to describe clinical courses, treatment changes, and short-term clinical outcomes for gynecologic oncology patients with concurrent COVID-19 in the United States.The Society of Gynecologic Oncology COVID-19 and Gynecologic Cancer Registry was created to capture clinical courses of gynecologic oncology patients with COVID-19. Logistic regression models were employed to evaluate factors for an association with hospitalization and death, respectively, within 30 days of COVID-19 diagnosis.Data were available for 348 patients across 7 institutions. At COVID-19 diagnosis, 125 patients (36%) had active malignancy. Delay (n = 88) or discontinuation (n = 10) of treatment due to COVID-19 infection occurred in 28% with those on chemotherapy (53/88) or recently receiving surgery (32/88) most frequently delayed. In addition to age, performance status, diabetes, and specific COVID symptoms, both non-White race (adjusted odds ratio (aOR) = 3.93, 95% CI 2.06-7.50) and active malignancy (aOR = 2.34, 95% CI 1.30-4.20) were associated with an increased odds of hospitalization. Eight percent of hospitalized patients (8/101) died of COVID-19 complications and 5% (17/348) of the entire cohort died within 30 days after diagnosis.Gynecologic oncology patients diagnosed with COVID-19 are at risk for hospitalization, delay of anti-cancer treatments, and death. One in 20 gynecologic oncology patients with COVID-19 died within 30 days after diagnosis. Racial disparities exist in patient hospitalizations for COVID-19, a surrogate of disease severity. Additional studies are needed to determine long-term outcomes and the impact of race.

Example of CNA profiles obtained in LMS. Copy-number plots: x-axis represents the position on the full genome (chromosome numbers are indicated). Red dots represent normalized read count for bins of 50Kb (log R value). Y-values around 0 represent copy-number (CN) of 2 (grey line). Lower values indicate a deletion and higher values indicate a gain. The horizontal green line represents the segmented CN profiles

Significant focal events detected in leiomyosarcoma from EISAI 309 trial

Purpose:A randomized phase III study evaluated the efficacy of eribulin versus dacarbazine in patients with advanced liposarcoma and leiomyosarcoma. Improved overall survival (OS) led to approval of eribulin for liposarcoma, but not for leiomyosarcoma.Experimental Design:We explored the molecular profile of 77 archival leiomyosarcoma samples from this trial to identify potential predictive biomarkers, utilizing low-coverage whole-genome and whole-exome sequencing. Tumor molecular profiles were correlated with clinical data, and disease control was defined as complete/partial response or stable disease (RECIST v1.1).Results:Overall, 111 focal copy-number alterations were observed in leiomyosarcoma. Gain of chromosome 17q12 was the most common event, present in 43 of 77 cases (56%). In the eribulin-treated group, gains of 4q26, 20p12.2, 13q13.3, 8q22.2, and 8q13.2 and loss of 1q44 had a negative impact on progression-free survival (PFS), while loss of 2p12 correlated with better prognosis. Gains of 4q22.1 and losses of 3q14.2, 2q14.1, and 11q25 had a negative impact on OS in patients with leiomyosarcoma receiving eribulin. The most commonly mutated genes were TP53 (38%), MUC16 (32%), and ATRX (17%). The presence of ATRX mutations had a negative impact on PFS in both treatment arms; however, the correlation with worse OS was observed only in the eribulin-treated patients. TP53 mutations were associated with longer PFS on eribulin.Conclusions:Leiomyosarcoma has a complex genetic background, with multiple copy-number alterations and mutations affecting genes implicated in tumorigenesis. We identified several molecular changes with potential impact on survival of patients with leiomyosarcoma when treated with eribulin.

Purpose:A randomized phase III study evaluated the efficacy of eribulin versus dacarbazine in patients with advanced liposarcoma and leiomyosarcoma. Improved overall survival (OS) led to approval of eribulin for liposarcoma, but not for leiomyosarcoma.Experimental Design:We explored the molecular profile of 77 archival leiomyosarcoma samples from this trial to identify potential predictive biomarkers, utilizing low-coverage whole-genome and whole-exome sequencing. Tumor molecular profiles were correlated with clinical data, and disease control was defined as complete/partial response or stable disease (RECIST v1.1).Results:Overall, 111 focal copy-number alterations were observed in leiomyosarcoma. Gain of chromosome 17q12 was the most common event, present in 43 of 77 cases (56%). In the eribulin-treated group, gains of 4q26, 20p12.2, 13q13.3, 8q22.2, and 8q13.2 and loss of 1q44 had a negative impact on progression-free survival (PFS), while loss of 2p12 correlated with better prognosis. Gains of 4q22.1 and losses of 3q14.2, 2q14.1, and 11q25 had a negative impact on OS in patients with leiomyosarcoma receiving eribulin. The most commonly mutated genes were TP53 (38%), MUC16 (32%), and ATRX (17%). The presence of ATRX mutations had a negative impact on PFS in both treatment arms; however, the correlation with worse OS was observed only in the eribulin-treated patients. TP53 mutations were associated with longer PFS on eribulin.Conclusions:Leiomyosarcoma has a complex genetic background, with multiple copy-number alterations and mutations affecting genes implicated in tumorigenesis. We identified several molecular changes with potential impact on survival of patients with leiomyosarcoma when treated with eribulin.

Background Patient medication administration is one of the major responsibilities of the professional nurse. Prelicensure nursing students and new nursing graduates often lack competency to safely administer medications. Method This was a descriptive comparative design of 98 junior and 90 senior baccalaureate nursing students using the Medication Administration Safety Assessment Tool via observation during simulation. Results Independent samples t-tests comparing medication safety competency revealed 29.6% of juniors and 14.4% of seniors demonstrated competence on all eight Medication Administration Safety Assessment Tool checklist items. Seniors did not demonstrate greater medication safety competence than juniors on total scores. Conclusions Study findings can guide undergraduate curriculum planning to improve medication safety competencies in nursing students.

To examine the impact of access to and utilization of a commercially available question bank (TrueLearn) for in-training examination (ITE) preparation in Obstetrics and Gynecology (OBGYN).This was a retrospective cohort study examining the impact of TrueLearn usage on ITE examination performance outcomes. Produced by the educational arm of the American College of Obstetricians and Gynecologists, the Council on Resident Education in Obstetrics and Gynecology (CREOG) exam is a multiple-choice test given to all residents annually. Residency programs participating in this study provided residency program mean CREOG scores from the year prior (2015), and the first (2016) and second (2017) years of TrueLearn usage. Programs also contributed resident-specific CREOG scores for each resident for 2016 and 2017. This data was combined with each resident's TrueLearn usage data that was provided by TrueLearn with residency program consent. The CREOG scores consisted of the CREOG score standardized to all program years, the CREOG score standardized to the same program year (PGY) and the total percent (%) correct. TrueLearn usage data included number of practice questions completed, number of practice tests taken, average number of days between successive tests, and percent correct of answered practice questions.OBGYN Residency Training Programs.OBGYN residency programs that purchased and utilized TrueLearn for the 2016 CREOG examination were eligible for participation (n = 14). Ten residency programs participated, which consisted of 212 residents in 2016 and 218 residents in 2017.TrueLearn was used by 78.8% (167/212) of the residents in 2016 and 84.9% (185/218) of the residents in 2017. No significant difference was seen in the average CREOG scores available on a per- program level before versus after the first year of implementation either using the CREOG score standardized to all PGYs (mean difference 1.0; p = 0.58) or standardized to the same PGY (mean difference 3.1; p = 0.25). Using resident-level data, there was no significant difference in mean CREOG score standardized to all PGYs between users and non-users of TrueLearn in 2016 (mean, 199.4 vs 196.7; p = 0.41) or 2017 (mean, 198.2 vs 203.4; p = 0.19). The percent of practice questions answered correctly on TrueLearn was positively correlated with the CREOG score standardized to all PGYs (r = 0.47 for 2016 and r = 0.60 for 2017), as well as with the CREOG total percent correct (r = 0.47 for 2016 and r = 0.61 for 2017). Based on a simple linear regression, for every 500 practice questions completed, the CREOG score significantly increased for PGY-2 residents by an average (±SE) of 7.3 ± 2.8 points (p = 0.013); the average increase was 0.7 ± 2.5 (p = 0.79) for PGY-3 residents and 5.8 ± 3.3 points (p = 0.09) for PGY-4 residents.Adoption of an online question bank did not result in higher mean CREOG scores at participating institutions. However, performance on the TrueLearn questions correlated with ITE performance, supporting predictive validity and the use of this question bank as a formative assessment for resident education and exam preparation.

Background. The recent randomized phase 3 trial Eisai Study 309 evaluated efficacy of eribulin (ERI) compared to dacarbazine (DTIC) in advanced liposarcoma (LPS) and leiomyosarcoma (LMS). Improved overall survival (OS) in ERI-treated patients led to US and EU regulatory approval of ERI for LPS, but not in LMS where DTIC has clinically relevant activity. As part of the translational effort in this trial we have now explored the molecular profile of LMS tumors from North American study sites, in order to identify potential predictive molecular factors for treatment with ERI. Material and Methods. From 82 archival primary tumor or metastatic LMS samples collected prior to study entry, 78 specimens were available for low-coverage whole genome sequencing. We analyzed copy number alterations (CNAs) and performed whole exome sequencing (WES) for mutational profiling. Forty patients received experimental treatment with ERI, while 38 were treated with DTIC. Treatment response was evaluated using RECIST v1.1; disease control was defined as complete/partial response and stable disease. Results. Overall 111 focal CNAs were observed in the entire group of LMS, including 55 gains and 56 loses. Gain of 17q12 was the most common CNA (43/78 cases; 55.1%) observed in the entire group analyzed, with 26 samples showing high level amplification. MYOCD is a suggested target of 17q12 gains in LMS, encodes myocardin which induces smooth muscle differentiation and promotes cell migration. In the ERI-treated group, gains of 4q26, 20p12.2, 13q13.3, 8q22.2, 8q13.2 and loss of 1q44 had a negative impact on progression-free survival (PFS) (p Using WES we detected an average of 266.1 (143-626) nonsynonymous substitutions and 4.7 indels (0-16) per sample, with an average of 11.5 (0-28) variants affecting Cancer Consensus Genes. The most commonly mutated genes in analyzed samples were TP53 (38%), MUC16 (31%) and ATRX (17%). In ERI-treated patients, the presence of ATRX mutations was more frequently observed in patients progressing on ERI (7/20 in patients with PD vs. 1/20 in group with disease control; p=0.0435). The presence of ATRX mutation had a negative impact on both PFS and OS. TP53 mutations were associated with longer PFS, and these mutations were more frequently observed in patients achieving disease control, although this was not statistically significant (11/20 vs. 5/20). ATRX andTP53 mutations were not linked with clinical benefit/response to DTIC. Conclusions. LMS has a complex genetic background, with multiple CNAs and mutations affecting genes implicated in tumorigenesis. We identified several molecular changes with potential impact on disease control and survival of LMS patients treated with ERI. These observations require further prospective validation. Citation Format: Agnieszka Wozniak, Bram Boecks, Elodie Modave, Amy Weaver, Diether Lambrechts, Bruce A. Littlefield, Patrick Schöffski. Potential molecular biomarkers of response to eribulin in patients with leiomyosarcoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4280.

Background Through debriefing, students reflect on their learning and performance during a simulation and accommodate new information into their existing knowledge base. Combining a videotaped model demonstration within a debriefing session provides an opportunity to enhance students' clinical, self-confidence, and satisfaction with the learning experience. Method Students participated in a simulation followed by either the usual structured debriefing or the usual structured debriefing that included a videotaped model demonstration of the simulation scenario. Students participated in a similar simulation 1 week later followed by the usual structured debriefing. Results The use of a model demonstration during debriefing was effective in developing clinical judgment and, to a lesser degree, self-confidence. Conclusions A model demonstration of a simulation scenario can be used to develop clinical judgment and possibly self-confidence during debriefing.