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Javaid M, Ashrawi D, Landgren R, Stevens L, Bello R, Foxhall L, Mims M, Ramondetta L. Human Papillomavirus Vaccine Uptake in Texas Pediatric Care Settings: A Statewide Survey of Healthcare Professionals. J Community Health 2018; 42:58-65. [PMID: 27473752 DOI: 10.1007/s10900-016-0228-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to identify barriers to and facilitators of human papillomavirus (HPV) vaccination in children aged 9-17 years across Texas. A literature review informed the development of a web-based survey designed for people whose work involves HPV vaccination in settings serving pediatric patients. The survey was used to examine current HPV vaccine recommendation practices among healthcare providers, barriers to HPV vaccination, reasons for parent/caregiver vaccine refusal, staff and family education practices, utilization of reminder and recall systems and status of vaccine administration (payment, ordering and stocking). 1132 responses were received representing healthcare providers, administrative and managerial staff. Respondents identified perceived barriers to HPV vaccination as parental beliefs about lack of necessity of vaccination prior to sexual debut, parental concerns regarding safety and/or side effects, parental perceptions that their child is at low risk for HPV-related disease, and parental lack of knowledge that the vaccine is a series of three shots. Of responding healthcare providers, 94 % (n = 582) reported they recommend the vaccine for 9-12 year olds; however, same-day acceptance of the vaccine is low with only 5 % (n = 31) of providers reporting the HPV vaccine is "always" accepted the same day the recommendation is made. Healthcare providers and multidisciplinary care teams in pediatric care settings must work to identify gaps between recommendation and uptake to maximize clinical opportunities. Training in methods to communicate an effective HPV recommendation and patient education tailored to address identified barriers may be helpful to reduce missed opportunities and increase on-time HPV vaccinations.
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Pal N, Broaddus RR, Urbauer DL, Balakrishnan N, Milbourne A, Schmeler KM, Meyer LA, Soliman PT, Lu KH, Ramirez PT, Ramondetta L, Bodurka DC, Westin SN. Treatment of Low-Risk Endometrial Cancer and Complex Atypical Hyperplasia With the Levonorgestrel-Releasing Intrauterine Device. Obstet Gynecol 2018; 131:109-116. [PMID: 29215513 PMCID: PMC5739955 DOI: 10.1097/aog.0000000000002390] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess efficacy of the levonorgestrel-releasing intrauterine device (LNG-IUD) for treatment of complex atypical hyperplasia or low-grade endometrial cancer. METHODS This retrospective case series included all patients treated with the LNG-IUD for complex atypical hyperplasia or early-grade endometrial cancer from January 2003 to June 2013. Response rates were calculated and the association of response with clinicopathologic factors, including age, body mass index, and uterine size, was determined. RESULTS Forty-six patients diagnosed with complex atypical hyperplasia or early-grade endometrial cancer were treated with the LNG-IUD. Of 32 evaluable patients at the 6-month time point, 15 had complex atypical hyperplasia (47%), nine had G1 endometrial cancer (28%), and eight had grade 2 endometrial cancer (25%). Overall response rate was 75% (95% CI 57-89) at 6 months; 80% (95% CI 52-96) in complex atypical hyperplasia, 67% (95% CI 30-93) in grade 1 endometrial cancer, and 75% (CI 35-97) in grade 2 endometrial cancer. Of the clinicopathologic features evaluated, there was a trend toward the association of lack of exogenous progesterone effect in the pathology specimen with nonresponse to the IUD (P=.05). Median uterine diameter was 1.3 cm larger in women who did not respond to the IUD (P=.04). CONCLUSION Levonorgestrel-releasing IUD therapy for the conservative treatment of complex atypical hyperplasia or early-grade endometrial cancer resulted in return to normal histology in a majority of patients.
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Fu S, Lairson DR, Chan W, Wu CF, Ramondetta L. Mean medical costs associated with vaginal and vulvar cancers for commercially insured patients in the United States and Texas. Gynecol Oncol 2017; 148:342-348. [PMID: 29274828 DOI: 10.1016/j.ygyno.2017.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/07/2017] [Accepted: 12/16/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the average medical costs for vaginal and vulvar cancers in a commercially insured population in the U.S. and Texas. METHODS 2011-2014U.S. MarketScan databases were used to estimate the average medical costs associated with vaginal and vulvar cancers. Women with newly diagnosed vaginal or vulvar cancer were matched to a comparison group without cancer using propensity score. Year 1 and year 2 costs after index diagnosis date were estimated. A generalized linear model was used to estimate the cost for censored months. The differential costs between groups were defined as the net costs associated with cancer diagnosis and treatment. RESULTS The analysis included 355 women with vaginal cancer and 997 with vulvar cancer in the U.S. The year 1 and year 2 costs for vaginal cancer were $86,995 and $51,107, respectively. The year 1 and year 2 costs for vulvar cancer were $37,657 and $19,139, respectively. The major factors associated with higher monthly vaginal and vulvar cancer costs were higher Charlson Comorbidity Index score and higher medical costs prior to cancer diagnosis. Monthly costs for vaginal and vulvar cancers decreased rapidly from month 1 to month 6 after diagnosis and then remained stable. CONCLUSIONS Seventy to 75% of all vaginal and vulvar cancers are due to HPV infections and mean medical costs associated with these cancers are substantial. These data will serve as key cost parameters in the economic evaluation of HPV vaccination dissemination and estimation of the long-term net economic benefit of promoting HPV vaccination.
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Ramondetta L. Response to Harper and De Mars, HPV vaccines: A review of the first decade. Gynecol Oncol Rep 2017; 22:113-114. [PMID: 29296654 PMCID: PMC5741802 DOI: 10.1016/j.gore.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 12/26/2022] Open
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Ramondetta L, Thaker P, Hu W, Urbauer D, Chisholm G, Sood A. Beta Adrenergic Blockade Is Feasible During Primary Treatment for Ovarian Cancer [10J]. Obstet Gynecol 2017. [DOI: 10.1097/01.aog.0000514985.46810.b0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prinsloo S, Novy D, Driver L, Lyle R, Ramondetta L, Eng C, McQuade J, Lopez G, Cohen L. Randomized controlled trial of neurofeedback on chemotherapy-induced peripheral neuropathy: A pilot study. Cancer 2017; 123:1989-1997. [PMID: 28257146 DOI: 10.1002/cncr.30649] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/17/2016] [Accepted: 12/07/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a significant problem for cancer patients, and there are limited treatment options for this often debilitating condition. Neuromodulatory interventions could be a novel modality for patients trying to manage CIPN symptoms; however, they are not yet the standard of care. This study examined whether electroencephalogram (EEG) neurofeedback (NFB) could alleviate CIPN symptoms in survivors. METHODS This was a randomized controlled trial with survivors assigned to an NFB group or a wait-list control (WLC) group. The NFB group underwent 20 sessions of NFB, in which visual and auditory rewards were given for voluntary changes in EEGs. The Brief Pain Inventory (BPI) worst-pain item was the primary outcome. The BPI, the Pain Quality Assessment Scale, and EEGs were collected before NFB and again after treatment. Outcomes were assessed with general linear modeling. RESULTS Cancer survivors with CIPN (average duration of symptoms, 25.3 mo), who were mostly female and had a mean age of 62.5 years, were recruited between April 2011 and September 2014. One hundred percent of the participants starting the NFB program completed it (30 in the NFB group and 32 in the WLC group). The NFB group demonstrated greater improvement than the controls on the BPI worst-pain item (mean change score, -2.43 [95% confidence interval, -3.58 to -1.28] vs 0.09 [95% confidence interval, -0.72 to -0.90]; P =·.001; effect size, 0.83). CONCLUSIONS NFB appears to be effective at reducing CIPN symptoms. There was evidence of neurological changes in the cortical location and in the bandwidth targeted by the intervention, and changes in EEG activity were predictive of symptom reduction. Cancer 2017;123:1989-1997. © 2017 American Cancer Society.
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Lairson DR, Fu S, Chan W, Xu L, Shelal Z, Ramondetta L. Mean direct medical care costs associated with cervical cancer for commercially insured patients in Texas. Gynecol Oncol 2017; 145:108-113. [PMID: 28196673 DOI: 10.1016/j.ygyno.2017.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the mean cervical cancer medical care costs for patients enrolled in commercial insurance in Texas. Cost is represented by insurer and patient payments for care. METHODS We estimated the mean medical care costs during the first 2years after the index diagnosis date for patients with cervical cancer (cases). Cases were identified using claims-based International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9), diagnosis codes and matched to controls without a claims-based ICD-9 code for cancer using a 2-step propensity score matching method. Index dates for the cases were randomly assigned to potential controls, and cases and controls were matched by index date. Data for cancer cases and controls were obtained from the de-identified 2011-2014 U.S. MarketScan databases. A generalized linear model was employed to compute the cost for censored months during the 2-year follow-up period. Differential costs were assessed by subtracting the medical costs incurred by controls from those incurred by cases. RESULTS During 2011-2014, 475 commercially insured Texas patients with newly diagnosed cervical cancer met the inclusion criteria. The first-year and second-year mean medical costs were $60,828 and $37,721 for cases and $9982 and $10,066 for controls, respectively. The differential costs of cervical cancer for the first and second years were $50,846 and $27,656, respectively. The major correlates of higher monthly cervical cancer costs were higher Charlson Comorbidity Index score during 6months period prior to diagnosis, higher healthcare costs between 6months and 3months prior to diagnosis, and residence in the western region of Texas. Costs for cervical cancer patients decreased steeply between month 1 and month 5 after diagnosis and then were stable, while costs for the control group were stable throughout the follow-up period. CONCLUSIONS Mean direct medical costs associated with cervical cancer in Texas were substantial. These data will serve as key cost parameters in models of costs associated with human papillomavirus (HPV)-related cancers in Texas and the economic evaluation of HPV vaccination dissemination in Texas.
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Soliman PT, Zhang Q, Broaddus RR, Westin SN, Iglesias D, Munsell MF, Schmandt R, Yates M, Ramondetta L, Lu KH. Prospective evaluation of the molecular effects of metformin on the endometrium in women with newly diagnosed endometrial cancer: A window of opportunity study. Gynecol Oncol 2016; 143:466-471. [PMID: 27745917 DOI: 10.1016/j.ygyno.2016.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Metformin reduces cancer incidence and improves overall survival in diabetic patients. In preclinical studies, metformin decreases endometrial cancer (EC) cell growth by activation of AMPK/mTOR inhibition. We sought to determine the effects of metformin on serum/tumor biomarkers in women with EC. METHODS In this prospective trial, newly diagnosed EC patients underwent pre-treatment blood draw/endometrial biopsy, were administered oral metformin 850mg daily for ≥7days, and underwent post-treatment blood draw/definitive surgery. Pre- and post- serum analyses were performed. Tumor samples were evaluated for changes in AMPK, PI3K/AKT pathway, proliferation, and apoptosis by immunohistochemistry. RESULTS Twenty patients completed the trial. Median age and BMI were 57years (range: 27-67) and 34.5kg/m2 (range: 21.9-50.0). Median duration of metformin was 9.5days (range: 7-24). A majority of women had endometrioid adenocarcinomas (90%) and were early stage (85%). After metformin, there were significant decreases in serum IGF-1 (p=0.046), omentin (p=0.007), insulin (p=0.012), C-peptide (p=0.018), and leptin (p=0.0035). Compared to baseline, post-treatment tissue showed decreased phospho-AKT in 18/20 patients (90%, p=0.0002), decreased phospho-S6rp in 14/20 patients (70%, p=0.057), and decreased phospho-p44/42MAPK in 15/18 patients (83.3%, p=0.0038). There was no difference in Ki67, phospho-ACC, or caspase 3. Changes did not correlate with BMI, grade, or KRAS mutation. CONCLUSION In this prospective window of opportunity study, we demonstrated that relevant serum and molecular changes occur in patients with newly diagnosed EC after a short course of metformin. Ongoing clinical trials will help determine the appropriate role for metformin in the treatment of women with EC.
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Brown AJ, Shen MJ, Urbauer D, Taylor J, Parker PA, Carmack C, Prescott L, Kolawole E, Rosemore C, Sun C, Ramondetta L, Bodurka DC. Room for improvement: An examination of advance care planning documentation among gynecologic oncology patients. Gynecol Oncol 2016; 142:525-30. [PMID: 27439968 PMCID: PMC5444869 DOI: 10.1016/j.ygyno.2016.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/03/2016] [Accepted: 07/05/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The goals of this study were: (1) to evaluate patients' knowledge regarding advance directives and completion rates of advance directives among gynecologic oncology patients and (2) to examine the association between death anxiety, disease symptom burden, and patient initiation of advance directives. METHODS 110 gynecologic cancer patients were surveyed regarding their knowledge and completion of advance directives. Patients also completed the MD Anderson Symptom Inventory (MDASI) scale and Templer's Death Anxiety Scale (DAS). Descriptive statistics were utilized to examine characteristics of the sample. Fisher's exact tests and 2-sample t-tests were utilized to examine associations between key variables. RESULTS Most patients were white (76.4%) and had ovarian (46.4%) or uterine cancer (34.6%). Nearly half (47.0%) had recurrent disease. The majority of patients had heard about advance directives (75%). Only 49% had completed a living will or medical power of attorney. Older patients and those with a higher level of education were more likely to have completed an advance directive (p<0.01). Higher MDASI Interference Score (higher symptom burden) was associated with patients being less likely to have a living will or medical power of attorney (p=0.003). Higher DAS score (increased death anxiety) was associated with patients being less likely to have completed a living will or medical power of attorney (p=0.03). CONCLUSION Most patients were familiar with advance directives, but less than half had created these documents. Young age, lower level of education, disease-related interference with daily activities, and a higher level of death anxiety were associated with decreased rates of advance directive completion, indicating these may be barriers to advance care planning documentation. Young patients, less educated patients, patients with increased disease symptom burden, and patients with increased death anxiety should be targeted for advance care planning discussions as they may be less likely to engage in advance care planning.
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Montealegre JR, Hanser L, Daheri M, Chenier R, Valverde I, Chauca GS, Rustveld LO, Anderson ML, Ramondetta L, Gould-Suarez M, Benjamin ML, Scott LD, Nangia JR, Reed BC, Hoagland-Sorensen J, Rieber A, Jibaja-Weiss ML. Abstract B78: Using the Quality in the Continuum of Cancer Care framework to develop a multilevel intervention to improve cancer screening and follow-up among the medically underserved. Cancer Epidemiol Biomarkers Prev 2016. [DOI: 10.1158/1538-7755.disp15-b78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Screening for cervical, colorectal, and breast cancer is an evidence-based strategy to reduce the morbidity and mortality from these cancers. However a large proportion of medically underserved individuals do not obtain regular screening. Using the Quality in the Continuum of Cancer Care (QCCC) framework, we developed and implemented a comprehensive systems design intervention to improve the delivery, uptake, and follow-up of cervical, colorectal, and breast cancer screening within a network of healthcare institutions that serve the medically underserved in Harris County, Texas.
Methods: An academic-community partnership, the Community Network for Cancer Prevention, was established between an academic cancer center, the county's safety net healthcare system, and several academic and community-based healthcare institutions. Clinical advisory boards, comprised of physicians, nurses, and public health professionals, were established for each cancer line. The QCCC framework was used to identify system-level failures that impede processes and transitions in the continuum of care from risk assessment to detection and from detection to diagnosis. Project components were developed to address the identified failures.
Results: System failures identified at the risk assessment to detection phases included 1) failure to identify individuals in need of screening, 2) inadequate capacity to screen, and 3) inadequate access to care. Failures identified at the detection to diagnosis phases included 1) failures in the screening test results notification system, 2) failures in inter-provider communication, 3) failures in inter-institutional referrals for clinical follow-up, 4) patient non-adherence, and 5) inadequate access to care. Project components to address the identified failures include community outreach, patient education, and patient navigation. Community outreach involves a community theater program aimed to increase awareness of cancer risk and the current cancer screening guidelines among medically underserved individuals in the larger community; healthcare access navigators available at each performance assist audience members in applying for healthcare coverage through the safety net healthcare system. Patient education involves using the electronic medical record to identify patients due or past due for cervical, colorectal, and/or breast cancer screening. These patients are then targeted for a video-based patient education intervention while they wait to be seen by their healthcare provider. Motivational messaging in the videos encourages patients to discuss the particular screening test with their provider. Finally, patient navigation involves a team of navigators who actively communicate with patients and providers to ensure follow-up among patients with an abnormal screening test result. A real-time tracking database is used to monitor all screen-test positive patients as they move through the different stages of diagnostic and therapeutic follow-up.
Conclusion: The QCCC provides a systematic approach for assessing factors that influence cancer care processes at the risk assessment, screening, detection, and diagnosis phases, as well as transitions between them. Focusing on transitions between phases is particularly useful for developing systems-level interventions to improve the delivery, uptake, and follow-up of cancer screening.
Citation Format: Jane R. Montealegre, Loretta Hanser, Maria Daheri, Roshanda Chenier, Ivan Valverde, Glori S. Chauca, Luis O. Rustveld, Matthew L. Anderson, Lois Ramondetta, Milena Gould-Suarez, Musher L. Benjamin, Larry D. Scott, Juli R. Nangia, Brian C. Reed, Janet Hoagland-Sorensen, Alyssa Rieber, Maria L. Jibaja-Weiss. Using the Quality in the Continuum of Cancer Care framework to develop a multilevel intervention to improve cancer screening and follow-up among the medically underserved. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B78.
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Fu S, Shi N, Wheler J, Naing A, Janku F, Piha-Paul S, Gong J, Hong D, Tsimberidou A, Zinner R, Subbiah V, Hou MM, Ramirez P, Ramondetta L, Lu K, Meric-Bernstam F. Characteristics and outcomes for patients with advanced vaginal or vulvar cancer referred to a phase I clinical trials program: the MD Anderson cancer center experience. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2015; 2:10. [PMID: 27231570 PMCID: PMC4880813 DOI: 10.1186/s40661-015-0018-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/03/2015] [Indexed: 11/16/2022]
Abstract
Background Early-stage vaginal and vulvar cancer can be cured. But outcomes of patients with metastatic disease are poor. Thus, new therapeutic strategies are urgently required. Methods In this retrospective study, we analyzed the clinical outcomes of consecutive patients with metastatic vaginal or vulvar cancer who were referred to a phase I trial clinic between January 2006 and December 2013. Demographic and clinical data were obtained from patients’ electronic medical records. Results Patients with metastatic vaginal (n = 16) and vulvar (n = 20) cancer who were referred for phase I trial therapy had median overall survival durations of 6.2 and 4.6 months, respectively. Among those who underwent therapy (n = 27), one experienced a partial response and three experienced stable disease for at least 6 months. Patients with a body mass index ≥30 had a significantly longer median overall survival duration than did those with a body mass index <30 (13.2 months versus 4.4 months, p = 0.04). Preliminary data revealed differences in molecular profiling between patients with advanced vaginal cancer and those with advanced vaginal cancer. Conclusions Metastatic vaginal and vulvar cancers remain to be difficult-to-treat diseases with poor clinical outcomes. The currently available phase I trial agents provided little meaningful clinical benefits. Understanding these tumors’ molecular mechanisms may allow us to develop more effective therapeutic strategies than are currently available regimens.
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Chase DM, Kauderer J, Wenzel L, Ramondetta L, Cella D, Long HJ, Monk BJ. Factors associated with grade 3 or 4 treatment-related toxicity in women with advanced or recurrent cervical cancer: an exploratory analysis of NRG Oncology/Gynecologic Oncology Group trials 179 and 204. Int J Gynecol Cancer 2015; 25:303-8. [PMID: 25405577 DOI: 10.1097/igc.0000000000000328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE This study aimed to describe pretreatment patient characteristics and baseline quality-of-life scores as they relate to the development of grade 3 or 4 toxicity in patients receiving chemotherapy for advanced/recurrent cervical cancer. METHODS The study sample was drawn from Gynecologic Oncology Group protocols 179 and 204. Grade 3 or 4 toxicities were considered in 4 specified categories as follows: peripheral neuropathy, fatigue, hematological, and gastrointestinal (GI). The data variables explored included age, stage, pretreatment radiation, performance status (PS) at treatment initiation, and baseline Functional Assessment of Cancer Therapy-Cervix (FACT-Cx) score. A logistic regression model was developed with various adverse events as binary (0/1) outcomes. RESULTS Six hundred seventy-three patient-reported questionnaires were used in the analyses. At baseline, pain was the most severe patient-reported symptom. Baseline line-item patient concerns did demonstrate specific correlations with the development of individual toxicities. In 401 patients who were enrolled on Gynecologic Oncology Group 204 (fatigue not measured on 179), a worse PS predicted the development of grade 3 or 4 fatigue (odds ratio, 2.78; 95% confidence interval, 1.66-4.68). Exposure to previous radiation, treatment regimen, and a worse FACT-Cx score were associated with the reporting of both grade 3 or 4 leukopenia (P < 0.05) and anemia (P < 0.0005). Performance status and treatment regimen (P < 0.05) were associated with the development of grade 3 or 4 thrombocytopenia. Age and treatment regimen (P < 0.05) were associated with the development of grade 3 or 4 neutropenia. The FACT-Cx score (P = 0.0016) predicted grade 3 or 4 GI toxicity. CONCLUSIONS The development of fatigue, hematological, and GI toxicity might be predictable based on factors other than treatment assignment such as age, PS, and patient-reported quality-of-life measurement.
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Bradford A, Fellman B, Urbauer D, Gallegos J, Meaders K, Tung C, Ramondetta L. Assessment of sexual activity and dysfunction in medically underserved women with gynecologic cancers. Gynecol Oncol 2015; 139:134-40. [PMID: 26325527 DOI: 10.1016/j.ygyno.2015.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/21/2015] [Accepted: 08/24/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sexual dysfunction is a common long-term side effect of treatments for gynecologic cancer. Studies of sexual problems in gynecologic cancer survivors overrepresent White non-Hispanic, highly educated, and married women. Less is known about the sexual health needs of women in medically underserved populations. We therefore conducted a study to characterize sexual activity and sexual function in this population. METHODS We recruited patients attending two gynecologic oncology clinics in a large public healthcare system that primarily serves uninsured and low-income patients. Participants were invited to complete a one-time survey to assess sexual function, sexual communication, sexual distress, relationship adjustment, depression, anxiety, prior help-seeking and help-seeking preferences, and reasons for sexual inactivity. Data were analyzed using descriptive statistics and multivariate models to predict sexual activity status and sexual dysfunction. RESULTS Among 243 participants, the majority (n=160, 65.8%) were not sexually active in the past 4weeks, most often due to lack of a partner or lack of desire for sex. Just over one-fourth of sexually active participants were identified as likely cases of sexual dysfunction. Greater endorsement of depressive symptoms predicted both sexual inactivity and sexual dysfunction in multivariate analyses. Prior help-seeking for sexual problems was uncommon; however, a significant minority of participants expressed interest in receiving care for sexual problems. CONCLUSIONS Gynecologic cancer survivors in our medically underserved population have high rates of sexual inactivity and sexual dysfunction. Future research should identify feasible strategies to address barriers to sexual healthcare in low-resource settings.
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Ramondetta L. What is the appropriate approach to treating women with incurable cervical cancer? J Natl Compr Canc Netw 2013; 11:348-55. [PMID: 23486459 DOI: 10.6004/jnccn.2013.0044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Women should not die of cervical cancer...but they do. Most cases of cervical cancer are preventable and, if caught early, highly curable. Despite this, cervical cancer is the second most common cause of cancer death in women worldwide. Unfortunately, cure is less likely when the disease is diagnosed at an advanced stage. Treatment of locally advanced disease often has serious lifelong side effects, including cystitis, proctitis, intestinal strictures, fistulas, vaginal agglutination/sexual dysfunction, and chronic pain. Unresectable recurrent disease may be associated with all these symptoms, in addition to disturbing malodorous discharge and bleeding and a life expectancy of less than 6 to 10 months. Supportive/palliative care interventions are needed at diagnosis and recurrence. Honest, conflict-free conversations about potential for response and expectations are needed for women with recurrent disease to help preserve and improve quality of life and avoid treatments that offer no benefit. Aims of trial design should include not only molecular targeting but also supportive care objectives, such as reducing pain, anxiety, depression, cachexia, and fatigue. A β-adrenergic blockade could potentially be part of these intervention trials. This article addresses the following questions and issues: whether therapeutic treatment of incurable cervical cancer is ever appropriate, the common symptoms of recurrent cervical cancer, the quantifying benefits of treatment, decision aids in treatment planning, doctor-patient candor, and integrating psychosocial factors into treatment.
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Tewari K, Sill M, Monk B, Long H, Ramondetta L, Landrum L, Oaknin A, Reid T, Leitao M, Michael H. Phase III randomized clinical trial of cisplatin plus paclitaxel vs the non-platinum chemotherapy doublet of topotecan plus paclitaxel in women with recurrent, persistent, or advanced cervical carcinoma: A Gynecologic Oncology Group study. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zaid T, Burzawa J, Schmeler K, Brown J, Ramondetta L, Frumovitz M. Using social media as a research platform for rare gynecologic tumors. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ramondetta L, Kang Y, Hu W, Sun C, Kott M, Deavers M, Klopp A, Thaker P, Smith J, Sood A. The clinical significance of beta adrenergic receptor expression in cervical cancer tissue. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Watkins J, Thaker P, Nick A, Ramondetta L, Kumar S, Matsuo K, Lutgendorf S, Ramirez P, Sood A. Improved outcomes with beta blocker use in epithelial ovarian cancer patients. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sun C, Jhingran A, Gallegos J, Bodurka D, Frumovitz M, Ramondetta L. Longitudinal quality of life in medically underserved women with locally advanced cervical cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Seth SG, Goka T, Harbison A, Hollier L, Peterson S, Ramondetta L, Noblin SJ. Exploring the role of religiosity and spirituality in amniocentesis decision-making among Latinas. J Genet Couns 2011; 20:660-73. [PMID: 21695589 DOI: 10.1007/s10897-011-9378-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 05/31/2011] [Indexed: 11/30/2022]
Abstract
Given the complex array of emotional and medical issues that may arise when making a decision about amniocentesis, women may find that their spiritual and/or religious beliefs can comfort and assist their decision-making process. Prior research has suggested that Latinas' spiritual and/or religious beliefs directly influence their amniocentesis decision. A more intimate look into whether Latinas utilize their beliefs during amniocentesis decision-making may provide an opportunity to better understand their experience. The overall goal of this study was to describe the role structured religion and spirituality plays in Latinas' daily lives and to evaluate how religiosity and spirituality influences health care decisions, specifically in prenatal diagnosis. Semi-structured interviews were conducted with eleven women who were invited to describe their religious beliefs and thoughts while considering the option of amniocentesis. All participants acknowledged the influence of religious and/or spiritual beliefs in their everyday lives. Although the women sought comfort and found validation in their beliefs and in their faith in God's will during their amniocentesis decision-making process, results suggest the risk of procedure-related complications played more of a concrete role than their beliefs.
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Ramondetta L, Brown A, Richardson G, Urbauer D, Thaker PH, Koenig HG, Gano JB, Sun C. Religious and spiritual beliefs of gynecologic oncologists may influence medical decision making. Int J Gynecol Cancer 2011; 21:573-81. [PMID: 21436706 PMCID: PMC3127444 DOI: 10.1097/igc.0b013e31820ba507] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Religious (R) and spiritual (S) beliefs often affect patients' health care decisions, particularly with regard to care at the end of life. Furthermore, patients desire more R/S involvement by the medical community; however, physicians typically do not incorporate R/S assessment into medical interviews with patients. The effects of physicians' R/S beliefs on willingness to participate in controversial clinical practices such as medical abortions and physician-assisted suicide has been evaluated, but how a physician's R/S beliefs may affect other medical decision-making is unclear. METHODS Using SurveyMonkey, an online survey tool, we surveyed 1972 members of the International Gynecologic Oncologists Society and the Society of Gynecologic Oncologists to determine the R/S characteristics of gynecologic oncologists and whether their R/S beliefs affected their clinical practice. Demographics, religiosity, and spirituality data were collected. Physicians were also asked to evaluate 5 complex case scenarios. RESULTS : Two hundred seventy-three (14%) physicians responded. Sixty percent "agreed" or "somewhat agreed" that their R/S beliefs were a source of personal comfort. Forty-five percent reported that their R/S beliefs ("sometimes," "frequently," or "always") play a role in the medical options they offered patients, but only 34% "frequently" or "always" take a R/S history from patients. Interestingly, 90% reported that they consider patients' R/S beliefs when discussing end-of-life issues. Responses to case scenarios largely differed by years of experience, although age and R/S beliefs also had influence. CONCLUSIONS Our results suggest that gynecologic oncologists' R/S beliefs may affect patient care but that most physicians fail to take an R/S history from their patients. More work needs to be done to evaluate possible barriers that prevent physicians from taking a spiritual history and engaging in discussions over these matters with patients.
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Bodurka D, Sun C, Jhingran A, Urbauer D, Levenback C, Eifel P, Ramondetta L, Ramirez P, Frumovitz M, Schover L. A longitudinal evaluation of sexual functioning and quality of life in cervical cancer survivors. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shen Q, Stanton ML, Feng W, Rodriguez ME, Ramondetta L, Chen L, Brown RE, Duan X. Morphoproteomic analysis reveals an overexpressed and constitutively activated phospholipase D1-mTORC2 pathway in endometrial carcinoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2010; 4:13-21. [PMID: 21228924 PMCID: PMC3016100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 11/09/2010] [Indexed: 05/30/2023]
Abstract
The mammalian target of rapamycin (MTOR) assembles into two distinct complexes: mTOR complex 1 (mTORC1) is predominantly cytoplasmic and highly responsive to rapamycin, whereas mTOR complex 2 (mTORC2) is both cytoplasmic and nuclear, and relatively resistant to rapamycin. mTORC1 and mTORC2 phosphorylatively regulate their respective downstream effectors p70S6K/4EBP1, and Akt. The resulting activated mTOR pathways stimulate protein synthesis, cellular proliferation, and cell survival. Moreover, phospholipase D (PLD) and its product, phosphatidic acid (PA) have been implicated as one of the upstream activators of mTOR signaling. In this study, we investigated the activation status as well as the subcellular distribution of mTOR, and its upstream regulators and downstream effectors in endometrial carcinomas (ECa) and non-neoplastic endometrial control tissue. Our data show that the mTORC2 activity is selectively elevated in endometrial cancers as evidenced by a predominant nuclear localization of the activated form of mTOR (p-mTOR at Ser2448) in malignant epithelium, accompanied by overexpression of nuclear p-Akt (Ser473), as well as overexpression of vascular endothelial growth factor (VEGF)-A isoform, the latter a resultant of target gene activation by mTORC2 signaling via hypoxia-inducible factor (HIF)-2alpha. In addition, expression of PLD1, one of the two major isoforms of PLD in human, is increased in tumor epithelium. In summary, we demonstrate that the PLD1/PA-mTORC2 signal pathway is overactivated in endometrial carcinomas. This suggests that the rapamycin-insensitive mTORC2 pathway plays a major role in endometrial tumorigenesis and that therapies designed to target the phospholipase D pathway and components of the mTORC2 pathway should be efficacious against ECa.
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Vergote I, Sella A, Bedell C, Ramondetta L, Shapiro G, Balic K, Prokopczuk E, Sauer L, Tseng L, Berger R. 407 Phase 2 study of XL184 in a cohort of ovarian cancer patients (pts) with measurable soft tissue disease. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72114-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cella D, Huang HQ, Monk BJ, Wenzel L, Benda J, McMeekin DS, Cohn D, Ramondetta L, Boardman CH. Health-related quality of life outcomes associated with four cisplatin-based doublet chemotherapy regimens for stage IVB recurrent or persistent cervical cancer: a Gynecologic Oncology Group study. Gynecol Oncol 2010; 119:531-7. [PMID: 20837359 DOI: 10.1016/j.ygyno.2010.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 08/01/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the differences in health-related quality of life (HRQL) of 4 cisplatin containing doublet chemotherapy combinations in women with advanced/recurrent cervical carcinoma. METHODS Patients were randomized to three-week cycles of paclitaxel + cisplatin (PC); vinorelbine + C (VC); gemcitabine + C (GC); or topotecan + C (TC). We report HRQL results from data available on 434 eligible patients enrolled into this 513 patient trial. HRQL was assessed with the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx) the FACT/Gynecologic Oncology Group (FACT/GOG) four-item neurotoxicity scale, and the 0-10 "worst pain" item from the Brief Pain Inventory, at baseline (pre-treatment), prior to beginning cycle 2, prior to beginning cycle 5, and at 9 months after enrollment. As reported by Monk et al. (2009) [13] VC, GC and TC were found not to be superior to PC with regard to progression-free survival or overall survival. RESULTS The trial was terminated early due to planned interim futility analysis, reducing power for HRQL analysis from 85% to 55%. Patients receiving VC, GC and TC doublets did not report significantly different HRQL, neuropathy, or pain from those who received the PC (control) doublet. Patients receiving PC tended to report worse neuropathy during treatment than patients who received other doublets (especially GC and TC), but the differences were not statistically significant. CONCLUSION None of the 3 experimental doublets was different from PC in terms of HRQL during treatment. Long-term toxicity data are inconclusive. Except where patients may wish to reduce their risk of worsening pre-treatment neuropathy, PC remains the standard of care for this disease.
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