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Smith AJB, Gleason EG, Andriani L, Heintz J, Ko EM. Variation in telemedicine usage in gynecologic cancer: Are we widening or narrowing disparities? Gynecol Oncol 2024; 184:160-167. [PMID: 38320467 DOI: 10.1016/j.ygyno.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Telemedicine rapidly increased with the COVID-19 pandemic and could reduce cancer care disparities. Our objective was to evaluate sociodemographic (race, insurance), patient, health system, and cancer factors associated with telemedicine use in gynecologic cancers. METHODS We conducted a retrospective cohort study of patients with endometrial cancer and epithelial ovarian cancer with at least one visit from March 2020 to October 2021, using a real-world electronic health record-derived database, representing approximately 800 sites in US academic (14%) and community practices (86%). We used multivariable Poisson regression modeling to analyze the association of ever using telemedicine with patient, sociodemographic, health system, and cancer factors. RESULTS Of 3950 patients with ovarian cancer, 1119 (28.3%) had at least one telemedicine visit. Of 2510 patients with endometrial cancer, 720 (28.7%) had at least one telemedicine visit. At community cancer practices, patients who identified as Black were less likely to have a telemedicine visit than patients who identified as white in both ovarian and endometrial cancer (Ovarian: RR 0.62, 95% CI 0.42-0.9; Endometrial: RR 0.56, 95% CI 0.38-0.83). Patients in the Southeast, Midwest, West, and Puerto Rico were less likely to have telemedicine visits than patients in the Northeast. Uninsured patients were less likely, and patients with Medicare were more likely, to have one or more telemedicine visit than patients with private insurance. CONCLUSIONS In this national cohort study, <30% of patients ever used telemedicine, and significant racial and regional disparities existed in utilization. Telemedicine expansion efforts should include programs to improve equity in access to telemedicine.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA.
| | - Emily G Gleason
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie Andriani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Jonathan Heintz
- Biostatistics Analysis Center, Perelman School of Medicine, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
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Mayer CM, O'Connor RM, Do AT, Cerda VR, Wang SM, Scott ME, Li AJ, Rimel BJ, Manuel MR, Taylor KN, Kim KH. Association between adherence to posttreatment National Comprehensive Cancer Network (NCCN) surveillance guidelines and detection of recurrent uterine cancer. Gynecol Oncol 2024; 181:8-11. [PMID: 38096674 DOI: 10.1016/j.ygyno.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To identify correlations between disease recurrence and adherence to NCCN posttreatment surveillance guidelines in patients who develop recurrent uterine cancer. METHODS Retrospective analysis identified patients (n = 60) with recurrent uterine cancer and at least one surveillance visit with a gynecologic oncologist between 2011 and 2020. Adherence to NCCN guidelines and details of recurrence were recorded. RESULTS Recurrent uterine cancer was identified in 60 patients with an average time to recurrence (TTR) of 25 months. Of those, 39 (65%) were adherent to NCCN surveillance guidelines and 36 (60%) were symptomatic at the time of recurrence diagnosis. Asymptomatic recurrence was diagnosed by imaging in 11 (46%), physical exam in 7 (29%), and blood work in 6 (25%) patients. Patients who were adherent to NCCN guidelines were diagnosed with recurrence on average 11 months earlier (p = 0.0336). Adherence was an independent predictor of TTR for all patients regardless of symptoms. There was no significant effect of age, race, primary language, or stage of disease on adherence. CONCLUSION Adherence to NCCN posttreatment surveillance guidelines for uterine cancer is independently associated with an earlier diagnosis of recurrence.
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Affiliation(s)
- Christopher M Mayer
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA.
| | - Reed M O'Connor
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Anthony T Do
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Victoria R Cerda
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Stephanie M Wang
- George Washington University, Department of Obstetrics & Gynecology, Washington, DC 20052, USA
| | - Marla E Scott
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Andrew J Li
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - B J Rimel
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Michael R Manuel
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Kristin N Taylor
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Kenneth H Kim
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
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Gomez SL, Chirikova E, McGuire V, Collin LJ, Dempsey L, Inamdar PP, Lawson-Michod K, Peters ES, Kushi LH, Kavecansky J, Shariff-Marco S, Peres LC, Terry P, Bandera EV, Schildkraut JM, Doherty JA, Lawson A. Role of neighborhood context in ovarian cancer survival disparities: current research and future directions. Am J Obstet Gynecol 2023; 229:366-376.e8. [PMID: 37116824 PMCID: PMC10538437 DOI: 10.1016/j.ajog.2023.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/01/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
Ovarian cancer is the fifth leading cause of cancer-associated mortality among US women with survival disparities seen across race, ethnicity, and socioeconomic status, even after accounting for histology, stage, treatment, and other clinical factors. Neighborhood context can play an important role in ovarian cancer survival, and, to the extent to which minority racial and ethnic groups and populations of lower socioeconomic status are more likely to be segregated into neighborhoods with lower quality social, built, and physical environment, these contextual factors may be a critical component of ovarian cancer survival disparities. Understanding factors associated with ovarian cancer outcome disparities will allow clinicians to identify patients at risk for worse outcomes and point to measures, such as social support programs or transportation aid, that can help to ameliorate such disparities. However, research on the impact of neighborhood contextual factors in ovarian cancer survival and in disparities in ovarian cancer survival is limited. This commentary focuses on the following neighborhood contextual domains: structural and institutional context, social context, physical context represented by environmental exposures, built environment, rurality, and healthcare access. The research conducted to date is presented and clinical implications and recommendations for future interventions and studies to address disparities in ovarian cancer outcomes are proposed.
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Affiliation(s)
- Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.
| | - Ekaterina Chirikova
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Valerie McGuire
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Lauren Dempsey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Pushkar P Inamdar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Katherine Lawson-Michod
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Edward S Peters
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Juraj Kavecansky
- Department of Hematology and Oncology, Kaiser Permanente Northern California, Antioch, CA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Paul Terry
- Department of Medicine, University of Tennessee, Knoxville, TN
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jennifer A Doherty
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Andrew Lawson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC; Usher Institute, School of Medicine, University of Edinburgh, Edinburgh, United Kingdom
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Luk HM, Ngu SF, Lau LSK, Tse KY, Chu MMY, Kwok ST, Ngan HYS, Chan KKL. Patient-Initiated Follow-Up in Ovarian Cancer. Curr Oncol 2023; 30:3627-3636. [PMID: 37185389 PMCID: PMC10136438 DOI: 10.3390/curroncol30040276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
This study aimed to assess the feasibility of patient-initiated follow-up (PIFU) in combination with regular tumour marker monitoring as an alternative to conventional hospital follow-up for ovarian cancer survivors. Women who had recently completed treatment for ovarian cancer and had a raised pre-treatment tumour marker were recruited. Participants were allocated to PIFU (intervention group) or conventional hospital follow-up (control group) according to their own preference. Both groups had regular tumour marker monitoring. The change in fear of cancer recurrence (FCR) score as measured by the FCR inventory, and the supportive care need (SCN) scores as measured by the SCN survey at baseline and at 6 months between PIFU and hospital follow-up were compared. Out of 64 participants, 37 (58%) opted for hospital follow-up and 27 (42%) opted for PIFU. During the 6-month study period, there was no significant difference in the change of FCR between the two groups (p = 0.35). There was a significant decrease in the sexuality unmet needs score in the intervention group from baseline to 6-month FU (mean difference −8.7, 95% confidence interval −16.1 to −1.4, p = 0.02). PIFU with tumour marker monitoring is a feasible follow-up approach in ovarian cancer survivorship care. FCR and SCN were comparable between PIFU and conventional hospital follow-up.
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Nestlerode C, Pavelka J, Basil J, Schuler K, Fellner AN, Ghaderian M, Neff R. Patient perspectives of telemedicine in gynecologic oncology during COVID. Gynecol Oncol Rep 2022; 43:101071. [PMID: 36185100 PMCID: PMC9514970 DOI: 10.1016/j.gore.2022.101071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022] Open
Abstract
Contrary to past studies, gynecologic oncology patients are hesitant to telemedicine. The pandemic did not increase patient’s comfort with telemedicine. Patients are more agreeable to telemedicine under specific circumstances.
Objectives Methods Results Conclusions
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