The frequency and persistence of lymphedema diagnosis and self-reported symptoms over 5 years in patients with endometrial carcinoma

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Numbness, aching, and poor physical function were commonly reported symptoms in endometrial cancer patients.

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Lymphedema symptoms that develop soon after diagnosis of endometrial cancer can persist for at least 5 years.

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Lymphedema symptoms could develop up to 7 years after initial diagnosis or treatment for endometrial cancer.

A potentially debilitating sequela of diagnosis or treatment for endometrial cancer islower limb lymphedema (LLL), which can have significant impacts on quality of life. Theobjective of this study was to determine the frequency of LLL symptoms in uterinecancer survivors over a 5-year study period. An IRB-approved prospective study of quality of life of endometrial cancer patients whounderwent surgical intervention was undertaken. The Gynecologic CancerLymphedema Questionnaire (GCLQ) was used to survey patients in 2011 and again in2016 to evaluate for symptoms of LLL.205 patients initially answered the survey, and 75 patients completed the follow upsurvey as well, with no differences in demographics between the cohorts. 90.7% ofpatients underwent lymph node dissection. Patients commonly reported symptoms ofnumbness (66.83%), aching (54.2%), and poor physical function (47.8%). On initialsurvey, 14.7% (n = 11) of patients met criteria for LLL by GCLQ criteria, with 8 patientsreporting improvement in symptoms and 3 reporting persistent diagnosis at follow up. At follow up survey, 12.0% (n = 9) patients meeting criteria five years later, with 6patients newly meeting criteria. The most persistent symptoms were poor physicalfunction (70.6%), numbness (72.5%), general swelling (55.6%), aching (64.1%), andlimb-related swelling (60%).While the rate of LLL was similar to previous reports, there were a number of newdiagnoses of LLL at interval follow up distant from surgery, up to 7 years later.Symptoms of LLL also persisted for many years after diagnosis.

Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care?

Objectives:

To evaluate the effects of the COVID-19 pandemic on emergency department (ED) utilization by gynecologic oncology patients in a large academic cancer center.

Methods:

Institutional data were captured from the EMR for the first 4 months of the US COVID-19 pandemic (March-June 2020) and compared to a historical control (March-June 2019). Data were collected from three major hospitals within an urban academic health system. Patients were identified as those with a gynecologic cancer diagnosis and active treatment (chemotherapy and/or radiation) within the prior 180 days of ED encounter, with an outpatient oncology visit within the last 90 days. Data including number and location of emergency department visits, admission outcomes, primary ICD-10 emergency department diagnosis, payer type, and patient demographics were collected. Descriptive statistics were performed.

Results:

Gynecologic oncology patients were significantly less likely to present to the ED for care during the first 4 months of COVID-19 (n=91) when compared to a historical control (n=144), p<0.01. Patients presenting during COVID were more likely to be admitted (43/91 vs 47/144, p<0.01), and to be kept for observation (18/43 vs 8/47, p=0.01). Of patients who were admitted, those presenting during COVID were significantly more likely to require an ICU stay during admission (12/43 vs 5/47, p=0.04). Six patients admitted during COVID (14%) died during their admission, while 3 patients (6%) died in the control group. There were no differences with respect to race, payor type, diagnosis, length of stay, or need for procedures when comparing patients admitted during COVID versus the control group. Four patients were COVID 19 positive during admission, which contributed to 1 patient death. Utilization of the health system's outpatient oncology urgent care center remained unchanged during COVID-19 (n=19 vs. n=15, p=0.43).

Conclusions:

Fewer gynecologic cancer patients presented to the ED during the COVID-19 pandemic, and those presenting had increased rates of indicated and complex care requirements. The concurrent stability in the outpatient urgent care center volume highlights a potential role for more stringent patient triaging to improve healthcare utilization in this vulnerable population going forward.

Sources of Palliative Care Knowledge Among Patients With Advanced or Metastatic Gynecologic Cancer

CONTEXT

A minority of patients with advanced or metastatic gynecologic cancer utilize palliative care and lack of knowledge may be a barrier to receiving palliative care services.

OBJECTIVES

To identify sources used by patients with advanced or metastatic gynecologic cancer to learn about palliative care and evaluate for differences in knowledge about palliative care and palliative care utilization by knowledge source.

METHODS

Patients with gynecologic cancer receiving treatment for advanced or metastatic gynecologic cancer at a single academic medical center were surveyed about their awareness of and knowledge about palliative care. Medical chart review was conducted.

RESULTS

Of the 111 women surveyed, 70 had heard of palliative care (63%). Sixty-eight specified from where they learned of palliative care: cancer care (n = 28; 41.2%), word of mouth (n = 26; 38.2%), work (n = 6; 8.8%), self-education (n = 4; 5.9%), personal experience (n = 2; 2.9%), or do not know (n = 2; 2.9%). Knowledge about palliative care (P = 0.35) and palliative care utilization (P = 0.81) did not differ by awareness of palliative care.

CONCLUSION

Most women receiving treatment for advanced gynecologic cancer have heard of palliative care from sources other than their cancer care providers. Knowledge about palliative care and source of knowledge about palliative care were not associated with palliative care utilization. Awareness of palliative care and palliative care utilization may be improved by increasing the low rate of health provider-based education and engaging cancer patients' social networks.