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Tankou J, Foley OW, Liu CY, Melamed A, Schantz-Dunn J. Dermoid cyst management and outcomes: A review of over 1,000 cases at a single institution. Am J Obstet Gynecol 2024:S0002-9378(24)00527-1. [PMID: 38670445 DOI: 10.1016/j.ajog.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Mature cystic teratomas represent nearly 60% of benign ovarian neoplasms across all age groups. We aim to update existing descriptive studies of ovarian teratomas including the epidemiology, rate of torsion/malignancy, and treatment modalities in a large modern cohort of patients. STUDY DESIGN This is a retrospective cross-sectional study of all pathology-confirmed cases of ovarian teratoma who underwent surgery at one tertiary care institution from 2004-2015. Patient demographics, ovarian cyst characteristics, surgical approach and timing, rate of spillage, and surgical complications were examined. RESULTS 1,054 cases of ovarian teratoma were identified during the study period. There were 113 cases of bilateral teratoma (10.7%). Mean age at diagnosis was 38 years. Average cyst size was 6.26cm. The overall rate of torsion was 5.6%, with a higher rate of torsion with increasing cyst size. Over 70% of cases were treated with minimally invasive surgery, which was associated with decreased perioperative complications but an increased risk of cyst spillage. Among 394 patients with cyst spillage, only one developed chemical peritonitis. The malignant transformation rate of mature cystic teratoma in this cohort was 1.1%. This cohort included 100 pregnant women with mature teratoma. Pregnant patients were more likely to have minimally invasive surgery in the 1st trimester and more likely to undergo laparotomy in the 2nd or 3rd trimester. CONCLUSIONS In this large modern cohort, we found similar rates of bilaterality, torsion, malignant transformation, and struma ovarii in ovarian teratomas when compared to previous literature. Most cases of ovarian teratoma can be managed laparoscopically, which is associated with a lower surgical complication rate. Despite increased risk of cyst spillage with a minimally invasive approach, chemical peritonitis is a rare complication.
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Affiliation(s)
- Jo'an Tankou
- Brigham and Women's Hospital, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street CWN3, Boston MA 02115; Present address: Trinity Health of New England, 133 Scovill Street Suite 201, Waterbury CT 06706
| | - Olivia W Foley
- Brigham and Women's Hospital, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street CWN3, Boston MA 02115; Present address: Northwestern Memorial Hospital Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Prentice Women's Hospital, 250 E Superior Street 5-2175, Chicago IL 60611.
| | - Christina Y Liu
- Brigham and Women's Hospital, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street CWN3, Boston MA 02115
| | - Alexander Melamed
- Brigham and Women's Hospital, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street CWN3, Boston MA 02115; Present address: Massachusetts General Hospital Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 55 Fruit Street Yawkey 9E, Boston MA 02114
| | - Julianna Schantz-Dunn
- Brigham and Women's Hospital, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street CWN3, Boston MA 02115
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Huang Y, Rauh-Hain JA, McCoy TH, Hou JY, Hillyer G, Ferris JS, Hershman D, Wright JD, Melamed A. Comparing survival of older ovarian cancer patients treated with neoadjuvant chemotherapy versus primary cytoreductive surgery: Reducing bias through machine learning. Gynecol Oncol 2024; 186:9-16. [PMID: 38554626 DOI: 10.1016/j.ygyno.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To develop and evaluate a multidimensional comorbidity index (MCI) that identifies ovarian cancer patients at risk of early mortality more accurately than the Charlson Comorbidity Index (CCI) for use in health services research. METHODS We utilized SEER-Medicare data to identify patients with stage IIIC and IV ovarian cancer, diagnosed in 2010-2015. We employed partial least squares regression, a supervised machine learning algorithm, to develop the MCI by extracting latent factors that optimally captured the variation in health insurance claims made in the year preceding cancer diagnosis, and 1-year mortality. We assessed the discrimination and calibration of the MCI for 1-year mortality and compared its performance to the commonly-used CCI. Finally, we evaluated the MCI's ability to reduce confounding in the association of neoadjuvant chemotherapy (NACT) and all-cause mortality. RESULTS We included 4723 patients in the development cohort and 933 in the validation cohort. The MCI demonstrated good discrimination for 1-year mortality (c-index: 0.75, 95% CI: 0.72-0.79), while the CCI had poor discrimination (c-index: 0.59, 95% CI: 0.56-0.63). Calibration plots showed better agreement between predicted and observed 1-year mortality risk for the MCI compared with CCI. When comparing all-cause mortality between NACT with primary cytoreductive surgery, NACT was associated with a higher hazard of death (HR: 1.13, 95% CI: 1.04-1.23) after controlling for tumor characteristics, demographic factors, and the CCI. However, when controlling for the MCI instead of the CCI, there was no longer a significant difference (HR: 1.05, 95% CI: 0.96-1.14). CONCLUSIONS The MCI outperformed the conventional CCI in predicting 1-year mortality, and reducing confounding due to differences in baseline health status in comparative effectiveness analysis of NACT versus primary surgery.
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Affiliation(s)
- Yongmei Huang
- Columbia University Vagelos College of Physicians and Surgeons, Department of Obstetrics and Gynecology, United States of America
| | - J Alejandro Rauh-Hain
- University of Texas MD Anderson Cancer Center, Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, United States of America
| | - Thomas H McCoy
- Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - June Y Hou
- Columbia University Vagelos College of Physicians and Surgeons, Department of Obstetrics and Gynecology, United States of America
| | - Grace Hillyer
- Columbia University Mailman School of Public Health, Department of Epidemiology, United States of America
| | - Jennifer S Ferris
- Columbia University Mailman School of Public Health, Department of Epidemiology, United States of America
| | - Dawn Hershman
- Columbia University Vagelos College of Physicians and Surgeons, Department of Medicine Columbia University Vagelos College of Physicians and Surgeons, Department of Internal Medicine, United States of America
| | - Jason D Wright
- Columbia University Vagelos College of Physicians and Surgeons, Department of Obstetrics and Gynecology, United States of America
| | - Alexander Melamed
- Massachusetts General Hospital, Vincent Department of Obstetrics and Gynecology, Meigs Division of Gynecologic Oncology, United States of America.
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Jorgensen KA, Agusti N, Wu CF, Kanbergs A, Pareja R, Ramirez PT, Rauh-Hain JA, Melamed A. Fertility-sparing surgery vs standard surgery for early-stage cervical cancer: difference in 5-year life expectancy by tumor size. Am J Obstet Gynecol 2024:S0002-9378(24)00084-X. [PMID: 38365097 DOI: 10.1016/j.ajog.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Cervical cancer incidence among premenopausal women is rising, and fertility-sparing surgery serves as an important option for this young population. There is a lack of evidence on what tumor size cutoff should be used to define candidacy for fertility-sparing surgery. OBJECTIVE We sought to describe how the association between fertility-sparing surgery (compared with standard surgery) and life expectancy varies by tumor size among patients with cervical cancers measuring ≤4 cm in largest diameter. Our secondary objective was to quantify the probability of undergoing adjuvant radiotherapy among patients who underwent fertility-sparing surgery as a function of tumor size. STUDY DESIGN We identified patients in the National Cancer Database aged ≤45 years, diagnosed with stage I cervical cancer with tumors ≤4 cm between 2006 and 2018, who received no preoperative radiation or chemotherapy, and who underwent either fertility-sparing surgery (cone or trachelectomy, either simple or radical) or standard surgery (simple or radical hysterectomy) as their primary treatment. Propensity-score matching was performed to compare patients who underwent fertility-sparing surgery with those who underwent standard surgery. A flexible parametric model was employed to quantify the difference in life expectancy within 5 years of diagnosis (restricted mean survival time) based on tumor size among patients who underwent fertility-sparing and those who underwent standard surgery. In addition, among those who underwent fertility-sparing surgery, a logistic regression model was used to explore the relationship between tumor size and the probability of receiving adjuvant radiation. RESULTS A total of 11,946 patients met the inclusion criteria of whom 904 (7.6%) underwent fertility-sparing surgery. After propensity-score matching, 897 patients who underwent fertility-sparing surgery were matched 1:1 with those who underwent standard surgery. Although the 5-year life expectancy was similar among patients who had fertility sparing surgery and those who had standard surgery regardless of tumor sizes, the estimates of life-expectancy differences associated with fertility-sparing surgery were more precise among patients with smaller tumors (1-cm tumor: restricted mean survival time difference, -0.10 months; 95% confidence interval, -0.67 to 0.47) than among those with larger tumors (4-cm tumor: restricted mean survival time difference, -0.11 months; 95% confidence interval, -3.79 to 3.57). The probability of receiving adjuvant radiation increased with tumor size, ranging from 5.6% (95% confidence interval, 3.9-7.9) for a 1-cm tumor to 37% (95% confidence interval, 24.3-51.8) for a 4-cm tumor. CONCLUSION Within 5 years of diagnosis, young patients with stage I cancers measuring ≤4 cm had similar survival outcomes after either fertility-sparing surgery or standard surgery. However, because few patients with tumors >2 cm underwent fertility-sparing surgery, a clinically important survival difference could not be excluded in this population.
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Affiliation(s)
- Kirsten A Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Nuria Agusti
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexa Kanbergs
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rene Pareja
- Clínica de Oncología Astorga, Medellín, Colombia; Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexander Melamed
- Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
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Freret TS, Cohen JL, Gyamfi-Bannerman C, Kaimal AJ, Lorch SA, Wright JD, Melamed A, Clapp MA. Regional Variation in Antenatal Late Preterm Steroid Use Following the ALPS Trial. JAMA Netw Open 2024; 7:e2350830. [PMID: 38194234 PMCID: PMC10777258 DOI: 10.1001/jamanetworkopen.2023.50830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/20/2023] [Indexed: 01/10/2024] Open
Abstract
Importance The publication of the Antenatal Late Preterm Steroids (ALPS) trial in February 2016 demonstrated that antenatal administration of betamethasone in the late preterm period (between 34 to 36 weeks of gestation) for individuals with a high risk of delivery decreased neonatal respiratory morbidity. National estimates have suggested the trial did change obstetric practice, but little is known if the evidence was adopted uniformly or equitably. Objective To assess regional variation in the use of late preterm steroids after the publication of the Antenatal Late Preterm Steroids (ALPS) Trial and to understand factors associated with a region's pace of adoption. Design, Setting, and Participants This cross-sectional study used US natality data from February 2015 to October 2017 from hospital referral regions (HRRs) within the US. Inclusion criteria included live-born, nonanomalous, singleton, late preterm (34 to 36 completed weeks of gestation) neonates born to individuals without pregestational diabetes. This study was conducted from November 15, 2022, to January 13, 2023. Main Outcome and Measures HRRs were categorized as either a slower adopter or faster adopter of antenatal late preterm steroids based on the observed vs expected pace of antenatal steroid adoption in a 1-year period after the trial's dissemination. Patient and regional factors hypothesized a priori to be associated with the uptake of late preterm steroids were compared between faster and slower adopters. Comparisons were made using Student t test or Wilcoxon rank-sum test, as appropriate. A multivariable logistic regression was constructed to identify factors associated with faster adopter status in the postperiod. Results There were 666 097 late preterm births in 282 HRRs. The mean (SD) maternal age in HRRs was 27.9 (1.2) years. The median (IQR) percentage of births by race categories in HRRs for patients identifying as American Indian or Alaskan Native was 0.5% (0.2%-1.3%); Asian or Pacific Islander, 3.0% (1.7%-5.3%); Black, 12.9% (5.1%-29.1%); and White, 78.6% (66.6%-87.0%). The median percentage of births in HRRs to patients of Hispanic ethnicity was 11.2% (6.3%-27.4%). In this study, 136 HRRs (48.2%) were classified as faster adopters and 146 (51.8%) were classified as slower adopters. Faster adopters increased their steroid use by 12.1 percentage points (from 5.9% to 18.0%) compared with a 5.5 percentage point increase (from 3.7% to 9.2%) among slower adopters (P < .001). Most examined patient and regional factors were not associated with a region's pace of adoption, with the exception of the regional prevalence of prior preterm birth (adjusted odds ratio [aOR], 2.04 [95% CI, 1.48-2.82]) and the percentage of deliveries at 34 to 35 weeks of gestation (aOR, 0.68 [95% CI, 0.47-0.99]) compared with 36 weeks. Conclusions and Relevance In this cross-sectional study, there was widespread geographic variation in the adoption of antenatal steroid administration for late preterm births that largely remained unexplained by population factors. These findings should prompt further investigations to barriers to timely or equitable access to new evidence-based practices and guide future dissemination strategies with the goal of more uniform adoption.
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Affiliation(s)
- Taylor S. Freret
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston
| | - Jessica L. Cohen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Diego, La Jolla
| | - Anjali J. Kaimal
- Department of Obstetrics and Gynecology, University of South Florida, Tampa
| | - Scott A. Lorch
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason D. Wright
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Alexander Melamed
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston
| | - Mark A. Clapp
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston
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Melamed A, Eisenhauer EL. Minimally invasive interval cytoreductive surgery for advanced ovarian cancer. J Surg Oncol 2024; 129:126-127. [PMID: 38073159 DOI: 10.1002/jso.27553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023]
Abstract
With the increasing use of neoadjuvant chemotherapy, it has also become apparent that some patients will require a less extensive interval cytoreductive surgery which could be performed as a minimally invasive procedure. This observation, and expertise with minimally invasive surgery for other indications in gynecologic oncology, has driven surgeons in the United States and other countries to perform an increasing portion of interval cytoreductive surgery using minimally invasive techniques. Further observational and trial data will continue to inform which patients are best suited for this approach.
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Affiliation(s)
- Alexander Melamed
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, USA
| | - Eric L Eisenhauer
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, USA
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Jorgensen K, Denham C, Kanbergs A, Wu CF, Nitecki R, Agusti N, Meernik C, Melamed A, Rauh-Hain JA. All-cause and cancer-specific mortality after fertility-sparing surgery for stage IA and IC epithelial ovarian cancer. Gynecol Oncol 2023; 178:60-68. [PMID: 37801736 DOI: 10.1016/j.ygyno.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To compare all-cause and cancer-specific mortality between women who underwent fertility-sparing surgery (FSS) versus standard surgery for stage IA and IC epithelial ovarian cancer. METHODS Reproductive aged patients (18-45) with stage IA or IC epithelial ovarian cancer diagnosed between 2000 and 2015 were identified in the California Cancer Registry. FSS was defined as retention of the contralateral ovary and the uterus, and standard surgery included at least removal of both ovaries and the uterus. The primary outcome was all-cause mortality and the secondary outcome was cancer-specific mortality. Inverse probability of treatment weighting (IPTW) was used to create two groups balanced on covariates of interest. The Kaplan-Meier method and Cox proportional hazards analysis were used to model survival outcomes. RESULTS Among 1119 women who met inclusion criteria, 390 (34.9%) underwent FSS. IPTW yielded a balanced cohort of 394 women who underwent FSS and 723 women who underwent standard surgery. Among patients who underwent FSS, there were 45 deaths corresponding to an 85.4% (95% confidence interval [CI] 0.79-0.92) 10-year all-cause survival probability, compared to 81 deaths and 86.4% 10-year all-cause survival probability (95% CI 0.83-0.90) among patients who underwent standard surgery. FSS was not associated with increased all-cause mortality (HR 1.04, 95% CI 0.72-1.49) or cancer-specific mortality (HR 1.50, 95%CI 0.97-2.31). CONCLUSIONS Among reproductive-aged patients with early-stage epithelial ovarian cancer fertility-sparing surgery was not associated with an increased risk of death compared to standard surgery.
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Affiliation(s)
- Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Chloe Denham
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alexa Kanbergs
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nuria Agusti
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clare Meernik
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Agustí N, Viveros-Carreño D, Mora-Soto N, Ramírez PT, Rauh-Hain A, Wu CF, Rodríguez J, Grillo-Ardila CF, Salazar C, Jorgensen K, Segarra-Vidal B, Chacón E, Melamed A, Pareja R. Diagnostic accuracy of sentinel lymph node frozen section analysis in patients with early-stage cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2023; 177:157-164. [PMID: 37703622 DOI: 10.1016/j.ygyno.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To assess the diagnostic accuracy of intraoperative SLN frozen section analysis compared with ultrastaging in patients with early-stage cervical cancer. METHODS A systematic literature review was conducted following the PRISMA checklist. MEDLINE (via Ovid), Embase, and the Cochrane Central Register of Controlled Trials were searched from inception until February 2023. The inclusion criteria were patients with early-stage cervical cancer (2018 FIGO stage I-II), consisting of the histological subtype squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma (≥90% of the patients in each study), who underwent SLN detection (with any tracer) and intraoperative frozen section followed by SLN ultrastaging. Randomized controlled trials, prospective and retrospective observational studies were considered. The detection rates and measures of diagnostic accuracy were pooled using a random effects univariate model. A preplanned subgroup meta-analysis was conducted, with isolated tumor cells excluded as positive lymph nodes. The review was registered in PROSPERO (CRD42023397147). RESULTS The search identified 190 articles, with 153 studies considered potentially eligible after removing duplicates. Fourteen studies met the selection criteria, including a total of 1720 patients. Seven studies were retrospective, and the other seven were prospective. Frozen section analysis detected 159 of 292 (54.5%) patients with lymph node metastases. In 281 patients the type of volume metastasis was reported: 1 of 41 (2.4%) patients had isolated tumor cells, 21 of 78 (26.9%) patients had micrometastases, and 133 of 162 (82.1%) patients had macrometastases. The pooled sensitivity of intraoperative SLN frozen section analysis was 65% (95% CI, 51-77%) for macrometastases, micrometastases, and isolated tumor cells. When we excluded patients with isolated tumor cells, the pooled sensitivity increased to 72% (95% CI, 60-82%). CONCLUSION SLN frozen section detects 65% of lymph node metastases compared with SLN ultrastaging and may prevent unnecessary radical surgery in some patients with early-stage cervical cancer.
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Affiliation(s)
- Nuria Agustí
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - David Viveros-Carreño
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia; Department of Gynecologic Oncology, Clínica Universitaria Colombia and Centro de Tratamiento (e) Investigación sobre Cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
| | - Nathalia Mora-Soto
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Pedro T Ramírez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, United States of America
| | - Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juliana Rodríguez
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia; Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Department of Obstetrics and Gynecology, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Catherin Salazar
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Blanca Segarra-Vidal
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, Castellon, Spain
| | - Enrique Chacón
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, New York, NY, United States of America
| | - René Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia; Department of Gynecologic Oncology, Clínica ASTORGA, Medellín, Colombia
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Silberman JN, Bercow AS, Gockley AA, Eisenhauer EL, Sisodia R, Randall T, Del Carmen MG, Goodman A, Castro CM, Melamed A, Bregar AJ. Trends in the use of neoadjuvant chemotherapy for low-grade serous ovarian cancer in the United States. Gynecol Oncol 2023; 175:60-65. [PMID: 37327540 DOI: 10.1016/j.ygyno.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To describe trends in neoadjuvant chemotherapy (NACT) use for low-grade serous ovarian carcinoma (LGSOC) and to quantify associations between NACT and extent of cytoreductive surgery. METHODS We identified women treated for stage III or IV serous ovarian cancer in a Commission on Cancer accredited program between January 2004-December 2020. Regression models were developed to evaluate trends in NACT use for LGSOC, to identify factors associated with receipt of NACT, and to quantify associations between NACT and bowel or urinary resection at the time of surgery. Demographic and clinical factors were used for confounder control. RESULTS We observed 3350 patients who received treatment for LGSOC during the study period. The proportion of patients who received NACT increased from 9.5% in 2004 to 25.9% in 2020, corresponding to an annual percent change of 7.2% (95% CI 5.6-8.9). Increasing age (rate ratio (RR) 1.15; 95% CI 1.07-1.24), and stage IV disease (RR 2.66; 95% CI 2.31-3.07) were associated with a higher likelihood of receiving NACT. For patients with high-grade disease, NACT was associated with a decrease in likelihood of bowel or urinary surgery (35.3% versus 23.9%; RR 0.68, 95% CI 0.65-0.71). For LGSOC, NACT was associated with a higher likelihood of these procedures (26.6% versus 32.2%; RR 1.24, 95% CI 1.08-1.42). CONCLUSION NACT use among patients with LGSOC has increased from 2004 to 2020. While NACT was associated with a lower rate of gastrointestinal and urinary surgery among patients with high-grade disease, patients with LGSOC receiving NACT were more likely to undergo these procedures.
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Affiliation(s)
- Jason N Silberman
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Alexandra S Bercow
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Allison A Gockley
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Eric L Eisenhauer
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Rachel Sisodia
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Thomas Randall
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Marcela G Del Carmen
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Annekathryn Goodman
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Cesar M Castro
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Alexander Melamed
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States; Division of Gynecologic Oncology, Wentworth-Douglass Hospital, Dover, NH, United States
| | - Amy J Bregar
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States; Division of Gynecologic Oncology, Wentworth-Douglass Hospital, Dover, NH, United States
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9
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Kulkarni A, Chen L, Gockley A, Khoury-Collado F, Hou J, Clair CST, Melamed A, Hershman DL, Wright JD. Patterns of cervical cancer screening follow-up in the era of prolonged screening intervals. Gynecol Oncol 2023; 175:53-59. [PMID: 37327539 DOI: 10.1016/j.ygyno.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Little is known as to how prolonged screening recommendations for cervical cancer have affected compliance. OBJECTIVE We examined compliance with repeat cervical cancer screening among U.S. women aged 30-64 who underwent index screening between 2013 and 2019. STUDY DESIGN The IBM Watson Health MarketScan Database was used to identify commercially-insured women 30-64 years old who underwent cervical cancer screening from 2013 to 2019. The cohort was limited to women with continuous insurance 12 months before and ≥ 2 months after index testing. Patients with prior hysterectomy, more frequent surveillance needs, or a history of abnormal cytology, histology, or HPV test were excluded. Index screening included cytology, co-testing, or primary HPV testing. Cumulative incidence curves described screening intervals. Compliance was considered if repeat screening occurred 2.5-4 years after index cytology and 4.5-6 years after index co-testing. Cause-specific hazard models examined factors associated with compliance. RESULTS Of 5,368,713 patients identified, co-testing was performed in 2,873,070 (53.5%), cytology in 2,422,480 (45.1%), and primary HPV testing in 73,163 (1.4%). The cumulative incidence of repeat screening among all women by seven years was 81.9%. Of those who underwent repeat screening, 85.7% with index cytology and 96.6% with index co-testing were rescreened early. Only, 12.2% with index cytology had appropriate rescreening and 2.1% had delayed rescreening. Among the index co-testing group, 3.2% had appropriate rescreening and 0.3% had delayed rescreening. CONCLUSION Appropriate cervical cancer follow-up screening is highly variable. The cumulative incidence rate of repeat screening was 81.9% and among women rescreened, the vast majority are tested earlier than recommended by current guidelines.
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Affiliation(s)
- Amita Kulkarni
- Columbia University College of Physicians and Surgeons, USA
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, USA
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - June Hou
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Caryn S T Clair
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA; Joseph L. Mailman School of Public Health, Columbia University, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA.
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10
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Abel MK, Myers EL, Minkin E, Tahir P, Haynes AB, Wright JD, Rauh-Hain JA, Melamed A. Cancer-directed surgery in patients with metastatic cancer: A systematic review and meta-analysis of randomized evidence. Cancer Med 2023. [PMID: 37309837 DOI: 10.1002/cam4.6061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/17/2023] [Accepted: 04/30/2023] [Indexed: 06/14/2023] Open
Abstract
PURPOSE To assess the impact of primary-site surgery plus systemic therapy compared to systemic therapy alone on overall survival in common metastatic cancer types. METHODS Data sources included Embase, PubMed, and Web of Science (January 1, 1995-March 22, 2023). Randomized controlled trials were included that enrolled patients diagnosed with the 10 most common de novo metastatic cancer types in the Surveillance, Epidemiology, and End Results database and randomized patients to resection of the primary site and systemic therapy versus systemic treatment alone. Random-effects models were used to pool associations by cancer type. RESULTS Eight studies with 1774 patients evaluating the efficacy of surgery in breast, renal, stomach, and colorectal cancer were included. There was no statistically significant reduction in risk of all-cause mortality associated with surgical intervention for metastatic breast (HR = 0.94, 95% CI 0.63-1.40) or renal cancer (HR = 0.79, 95% CI 0.53-1.20), although results were heterogeneous (I2 = 73.7% and 80.6%, respectively). One study evaluating gastrectomy in metastatic stomach cancer found no benefit (HR = 1.09, 95% CI 0.78-1.52), while a small trial suggested that surgery and hyperthermic intraperitoneal chemotherapy might be beneficial for colorectal cancer with peritoneal metastasis (HR = 0.55, 95% CI 0.32-0.95). CONCLUSIONS Few randomized trials have evaluated cancer-directed surgery among patients with metastatic solid malignancies.
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Affiliation(s)
- Mary Kathryn Abel
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ellen L Myers
- Department of Obstetrics and Gynecology, Christiana Hospital, Newark, Delaware, USA
| | - Ellen Minkin
- University of Southern California, Los Angeles, California, USA
| | - Peggy Tahir
- Library, University of California, San Francisco, San Francisco, California, USA
| | - Alex B Haynes
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York, USA
| | - J Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander Melamed
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Jorgensen K, Melamed A, Wu CF, Nitecki R, Pareja R, Fagotti A, Schorge JO, Ramirez PT, Rauh-Hain JA. Minimally invasive interval debulking surgery for advanced ovarian cancer after neoadjuvant chemotherapy. Gynecol Oncol 2023; 172:130-137. [PMID: 36977622 PMCID: PMC10192032 DOI: 10.1016/j.ygyno.2023.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Assess outcomes of interval debulking surgery (IDS) after neoadjuvant chemotherapy via minimally invasive surgery (MIS) compared with laparotomy in patients with advanced epithelial ovarian cancer. METHODS Patients diagnosed with stage IIIC or IV epithelial ovarian cancer between 2013 and 2018 who received neoadjuvant chemotherapy and IDS were identified in the National Cancer Database. Primary outcome was overall survival. Secondary outcomes were 5-year survival, 30- and 90-day postoperative mortality, extent of surgery, residual disease, hospitalization duration, surgical conversions, and unplanned readmissions. Propensity score matching was used to compare MIS and laparotomy for IDS. Association of treatment approach with overall survival was assessed using Kaplan-Meier method and Cox regression. Sensitivity analysis was conducted for effect of unmeasured confounders. RESULTS A total of 7897 patients met inclusion criteria; 2021 (25.6%) underwent MIS. Percentage undergoing MIS increased from 20.3%-29.0% over the study period. After propensity score matching, median overall survival was 46.7 months in the MIS group versus 41.0 months in the laparotomy group [hazard ratio (HR) 0.86 (95%CI 0.79-0.94)]. Five-year survival probability was higher in MIS versus laparotomy (38.3% vs 34.8%, p < 0.01). There was lower 30- and 90-day mortality (0.3% vs 0.7% [p = 0.04] and 1.4% vs 2.5% [p = 0.01], respectively), shorter length of stay (median 3 vs 5 days, p < 0.01), lower residual disease (23.9% vs 26.7%, p < 0.01), and lower additional cytoreductive procedures (59.3% vs 70.8%, p < 0.01) in MIS compared to laparotomy, with similar rates of unplanned readmission (2.7% vs 3.1%, p = 0.39). CONCLUSIONS Patients who undergo IDS by MIS have similar overall survival and decreased morbidity compared with laparotomy.
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Affiliation(s)
- Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
| | - Chi-Fang Wu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rene Pareja
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
| | - Anna Fagotti
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - John O Schorge
- Department of Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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12
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Matsuo K, Chen L, Matsuzaki S, Mandelbaum RS, Ciesielski KM, Silva JP, Klar M, Roman LD, Accordino MK, Melamed A, Elkin E, Hershman DL, Wright JD. Opportunistic Salpingectomy at the Time of Laparoscopic Cholecystectomy for Ovarian Cancer Prevention: A Cost-effectiveness Analysis. Ann Surg 2023; 277:e1116-e1123. [PMID: 35129467 DOI: 10.1097/sla.0000000000005374] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To perform a cost-effectiveness analysis to examine the utility and effectiveness of OS performed at the time of elective cholecystectomy [laparoscopic cholecystectomy (LAP-CHOL)]. SUMMARY BACKGROUND DATA OS has been adopted as a strategy to reduce the risk of ovarian cancer in women undergoing hysterectomy and tubal sterilization, although the procedure is rarely performed as a risk reducing strategy during other abdominopelvic procedures. METHODS A decision model was created to examine women 40, 50, and 60 years of age undergoing LAP-CHOL with or without OS. The lifetime risk of ovarian cancer was assumed to be 1.17%, 1.09%, and 0.92% for women age 40, 50, and 60 years, respectively. OS was estimated to provide a 65% reduction in the risk of ovarian cancer and to require 30 additional minutes of operative time. We estimated the cost, quality-adjusted life-years, ovarian cancer cases and deaths prevented with OS. RESULTS The additional cost of OS at LAP-CHOL ranged from $1898 to 1978. In a cohort of 5000 women, OS reduced the number of ovarian cancer cases by 39, 36, and 30 cases and deaths by 12, 14, and 16 in the age 40-, 50-, and 60-year-old cohorts, respectively. OS during LAP-CHOL was cost-effective, with incremental cost-effectiveness ratio of $11,162 to 26,463 in the 3 age models. In a probabilistic sensitivity analysis, incremental cost-effectiveness ratio for OS were less than $100,000 per quality-adjusted life-years in 90.5% or more of 1000 simulations. CONCLUSIONS OS at the time of LAP-CHOL may be a cost-effective strategy to prevent ovarian cancer among average risk women.
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Affiliation(s)
- Koji Matsuo
- University of Southern California, Los Angeles, CA
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | | | | | - Jack P Silva
- University of Southern California, Los Angeles, CA
| | - Maximilian Klar
- University of Freiburg Faculty of Medicine, Freiburg im Breisgau, Germany; and
| | | | | | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Elena Elkin
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, NY
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, NY
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13
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Suzuki Y, Chen L, Hou JY, St Clair CM, Khoury-Collado F, de Meritens AB, Matsuo K, Melamed A, Hershman DL, Wright JD. Systemic Progestins and Progestin-Releasing Intrauterine Device Therapy for Premenopausal Patients With Endometrial Intraepithelial Neoplasia. Obstet Gynecol 2023; 141:979-987. [PMID: 37023446 DOI: 10.1097/aog.0000000000005124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/12/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To estimate trends in use and outcomes of progestin therapy for premenopausal patients with endometrial intraepithelial neoplasia. METHODS The MarketScan Database was used to identify patients aged 18-50 years with endometrial intraepithelial neoplasia from 2008 to 2020. Primary treatment was classified as hysterectomy or progestin-based therapy. Within the progestin group, treatment was classified as systemic therapy or progestin-releasing intrauterine device (IUD). The trends in use of progestins and the pattern of progestin use were examined. A multivariable logistic regression model was fit to examine the association between baseline characteristics and the use of progestins. The cumulative incidence of hysterectomy, uterine cancer, and pregnancy since initiation of progestin therapy was analyzed. RESULTS A total of 3,947 patients were identified. Hysterectomy was performed in 2,149 (54.4%); progestins were used in 1,798 (45.6%). Use of progestins increased from 44.2% in 2008 to 63.4% in 2020 (P=.002). Among the progestin users, 1,530 (85.1%) were treated with systemic progestin, and 268 (14.9%) were treated with progestin-releasing IUD. Among progestin users, use of IUD increased from 7.7% in 2008 to 35.6% in 2020 (P<.001). Hysterectomy was ultimately performed in 36.0% (95% CI 32.8-39.3%) of those who received systemic progestins compared with 22.9% (95% CI 16.5-30.0%) of those treated with progestin-releasing IUD (P<.001). Subsequent uterine cancer was documented in 10.5% (95% CI 7.6-13.8%) of those who received systemic progestins compared with 8.2% (95% CI 3.1-16.6%) of those treated with progestin-releasing IUD (P=.24). Venous thromboembolic complications occurred in 27 (1.5%) of those treated with progestins; the venous thromboembolism (VTE) rate was similar for oral progestins and progestin-releasing IUD. CONCLUSION The rate of conservative treatment with progestins in premenopausal individuals with endometrial intraepithelial neoplasia has increased over time, and among progestin users, progestin-releasing IUD use is increasing. Progestin-releasing IUD use may be associated with a lower rate of hysterectomy and a similar rate of VTE compared with oral progestin therapy.
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Affiliation(s)
- Yukio Suzuki
- Columbia University College of Physicians and Surgeons, the NewYork-Presbyterian Hospital, and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York; the University of Southern California, Los Angeles, California; and Massachusetts General Hospital, Boston, Massachusetts
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14
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Bercow AS, Rauh-Hain JA, Melamed A, Mazina V, Growdon WB, Del Carmen MG, Goodman A, Bouberhan S, Randall T, Sisodia R, Bregar A, Eisenhauer EL, Minami C, Molina G. Association of hospital-level factors with utilization of sentinel lymph node biopsy in patients with early-stage vulvar cancer. Gynecol Oncol 2023; 169:47-54. [PMID: 36508758 DOI: 10.1016/j.ygyno.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate utilization of sentinel lymph node biopsy (SLNB) for early-stage vulvar cancer at minority-serving hospitals and low-volume facilities. METHODS Between 2012-2018, individuals with T1b vulvar squamous cell carcinoma were identified using the National Cancer Database. Patient, facility, and disease characteristics were compared between patients undergoing SLNB or inguinofemoral lymph node dissection (IFLD). Multivariable logistic regression, adjusted for patient, facility, and disease characteristics, was used to evaluate factors associated with SLNB. Kaplan-Meier survival analysis using log rank test and Cox regression was performed. RESULTS Of the 3,532 patients, 2,406 (68.1%) underwent lymph node evaluation, with 1,704 (48.2%) undergoing IFLD and 702 (19.8%) SLNB. In a multivariable analysis, treatment at minority-serving hospitals (OR 0.39, 95% CI 0.19-0.78) and low-volume hospitals (OR 0.44, 95% CI 0.28-0.70) were associated with significantly lower odds of undergoing SLNB compared to receiving care at non-minority-serving and high-volume hospitals, respectively. While SLNB utilization increased over time for the entire cohort and stratified subgroups, use of the procedure did not increase at minority-serving hospitals. After controlling for patient and tumor characteristics, SLNB was not associated with worse OS compared to IFLD in patients with positive (HR 1.02, 95% CI 0.63-1.66) or negative (HR 0.92, 95% CI 0.70-1.21) nodal pathology. CONCLUSIONS For patients with early-stage vulvar cancer, treatment at minority-serving or low-volume hospitals was associated with significantly decreased odds of undergoing SLNB. Future efforts should be concentrated toward ensuring that all patients have access to advanced surgical techniques regardless of where they receive their care.
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Affiliation(s)
- Alexandra S Bercow
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America.
| | - J Alejandro Rauh-Hain
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Alexander Melamed
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Varvara Mazina
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Whitfield B Growdon
- Division of Gynecologic Oncology, New York University Langone Medical Center, New York, NY, United States of America
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Annekathryn Goodman
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Sara Bouberhan
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Thomas Randall
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Rachel Sisodia
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Amy Bregar
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Eric L Eisenhauer
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Christina Minami
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America; Division of Breast Surgery, Department of Surgery, Dana-Farber/Brigham and Women's Hospital, Boston, MA, United States of America
| | - George Molina
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America; Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
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15
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Dioun S, Chen L, Hillyer G, Tatonetti NP, May BL, Melamed A, Wright JD. Association between neighborhood socioeconomic status, built environment and SARS-CoV-2 infection among cancer patients treated at a Tertiary Cancer Center in New York City. Cancer Rep (Hoboken) 2023; 6:e1714. [PMID: 36307215 PMCID: PMC9874553 DOI: 10.1002/cnr2.1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Racial and ethnic minority groups experience a disproportionate burden of SARS-CoV-2 illness and studies suggest that cancer patients are at a particular risk for severe SARS-CoV-2 infection. AIMS The objective of this study was examine the association between neighborhood characteristics and SARS-CoV-2 infection among patients with cancer. METHODS AND RESULTS We performed a cross-sectional study of New York City residents receiving treatment for cancer at a tertiary cancer center. Patients were linked by their address to data from the US Census Bureau's American Community Survey and to real estate tax data from New York's Department of City Planning. Models were used to both to estimate odds ratios (ORs) per unit increase and to predict probabilities (and 95% CI) of SARS-CoV2 infection. We identified 2350 New York City residents with cancer receiving treatment. Overall, 214 (9.1%) were infected with SARS-CoV-2. In adjusted models, the percentage of Hispanic/Latino population (aOR = 1.01; 95% CI, 1.005-1.02), unemployment rate (aOR = 1.10; 95% CI, 1.05-1.16), poverty rates (aOR = 1.02; 95% CI, 1.0002-1.03), rate of >1 person per room (aOR = 1.04; 95% CI, 1.01-1.07), average household size (aOR = 1.79; 95% CI, 1.23-2.59) and population density (aOR = 1.86; 95% CI, 1.27-2.72) were associated with SARS-CoV-2 infection. CONCLUSION Among cancer patients in New York City receiving anti-cancer therapy, SARS-CoV-2 infection was associated with neighborhood- and building-level markers of larger household membership, household crowding, and low socioeconomic status. NOVELTY AND IMPACT We performed a cross-sectional analysis of residents of New York City receiving treatment for cancer in which we linked subjects to census and real estate date. This linkage is a novel way to examine the neighborhood characteristics that influence SARS-COV-2 infection. We found that among patients receiving anti-cancer therapy, SARS-CoV-2 infection was associated with building and neighborhood-level markers of household crowding, larger household membership, and low socioeconomic status. With ongoing surges of SARS-CoV-2 infections, these data may help in the development of interventions to decrease the morbidity and mortality associated with SARS-CoV-2 among cancer patients.
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Affiliation(s)
- Shayan Dioun
- Columbia Universtiy College of Physicians and SurgeonsNew YorkNew YorkUSA
- New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Ling Chen
- Columbia Universtiy College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Grace Hillyer
- Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer CenterNew YorkNew YorkUSA
| | - Nicholas P. Tatonetti
- Columbia Universtiy College of Physicians and SurgeonsNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer CenterNew YorkNew YorkUSA
| | - Benjamin L. May
- Columbia Universtiy College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Alexander Melamed
- Columbia Universtiy College of Physicians and SurgeonsNew YorkNew YorkUSA
- New York Presbyterian HospitalNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer CenterNew YorkNew YorkUSA
| | - Jason D. Wright
- Columbia Universtiy College of Physicians and SurgeonsNew YorkNew YorkUSA
- New York Presbyterian HospitalNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer CenterNew YorkNew YorkUSA
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16
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Melamed A, Lin YL, Hassan AM, Rauh-Hain JA, Herring B, Keating NL, Offodile AC. Trends in Episode-of-Care Spending for Cancer-Directed Surgery Among US Medicare Beneficiaries From 2011 to 2019. JAMA Surg 2023; 158:216-218. [PMID: 36477545 PMCID: PMC9856890 DOI: 10.1001/jamasurg.2022.4493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This cross-sectional study examines trends in the number of cancer-directed surgeries from 2011 to 2019 among US patients aged 65 years or older and in Medicare spending for those surgeries overall and by inpatient vs outpatient sites of care.
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Affiliation(s)
- Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
| | - Yu-Li Lin
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abbas M. Hassan
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J. Alejandro Rauh-Hain
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bradley Herring
- Peter T. Paul College of Business and Economics, University of New Hampshire, Durham
| | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts,Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Anaeze C. Offodile
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas,Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas,Baker Institute for Public Policy, Rice University, Houston, Texas
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17
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Li AH, Chen L, Melamed A, Hershman DL, Wright JD. Medical and surgical retreatment for uterine leiomyoma after myomectomy. BJOG 2023; 130:835-837. [PMID: 36705431 DOI: 10.1111/1471-0528.17409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/03/2022] [Accepted: 12/06/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Alicia H Li
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
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18
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Cogan JC, Raghunathan RR, Beauchemin MP, Accordino MK, Huang Y, Elkin EB, Melamed A, Wright JD, Hershman DL. New and Persistent Sedative-Hypnotic Use After Adjuvant Chemotherapy for Breast Cancer. J Natl Cancer Inst 2022; 114:1698-1705. [PMID: 36130058 PMCID: PMC9745429 DOI: 10.1093/jnci/djac170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/19/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Sedative-hypnotic medications are used to treat chemotherapy-related nausea, anxiety, and insomnia. However, prolonged sedative-hypnotic use can lead to dependence, misuse, and increased health-care use. We aimed to estimate the rates at which patients who receive adjuvant chemotherapy for breast cancer become new persistent users of sedative-hypnotic medications, specifically benzodiazepines and nonbenzodiazepine sedative-hypnotics (Z-drugs). METHODS Using the MarketScan health-care claims database, we identified sedative-hypnotic-naïve patients who received adjuvant chemotherapy for breast cancer. Patients who filled 1 and more prescriptions during chemotherapy and 2 and more prescriptions up to 1 year after chemotherapy were classified as new persistent users. Univariate and multivariable logistic regression analyses were used to estimate odds of new persistent use and associated characteristics. RESULTS We identified 22 039 benzodiazepine-naïve patients and 23 816 Z-drug-naïve patients who received adjuvant chemotherapy from 2008 to 2017. Among benzodiazepine-naïve patients, 6159 (27.9%) filled 1 and more benzodiazepine prescriptions during chemotherapy, and 963 of those (15.6%) went on to become new persistent users. Among Z-drug-naïve patients, 1769 (7.4%) filled 1 and more prescriptions during chemotherapy, and 483 (27.3%) became new persistent users. In both groups, shorter durations of chemotherapy and receipt of opioid prescriptions were associated with new persistent use. Medicaid insurance was associated with new persistent benzodiazepine use (odds ratio = 1.88, 95% confidence interval = 1.43 to 2.47) compared with commercial or Medicare insurance. CONCLUSIONS Patients who receive sedative-hypnotic medications during adjuvant chemotherapy for breast cancer are at risk of becoming new persistent users of these medications after chemotherapy. Providers should ensure appropriate sedative-hypnotic use through tapering dosages and encouraging nonpharmacologic strategies when appropriate.
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Affiliation(s)
- Jacob C Cogan
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Rohit R Raghunathan
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melissa P Beauchemin
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melissa K Accordino
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Yongmei Huang
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elena B Elkin
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
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19
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Abstract
This cross-sectional study evaluates the association between dissemination of the Antenatal Late Preterm Steroid trial and changes in steroid exposure among term newborns.
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Affiliation(s)
- Taylor S. Freret
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston
| | - Kaitlyn E. James
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla
| | - Anjali J. Kaimal
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston
| | - Mark A. Clapp
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston
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20
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Jorgensen K, Nitecki R, Nichols HB, Fu S, Wu CF, Melamed A, Brady P, Chavez Mac Gregor M, Clapp MA, Giordano S, Rauh-Hain JA. Obstetric and Neonatal Outcomes 1 or More Years After a Diagnosis of Breast Cancer. Obstet Gynecol 2022; 140:939-949. [PMID: 36357983 PMCID: PMC9712170 DOI: 10.1097/aog.0000000000004936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate obstetric and neonatal outcomes of the first live birth conceived 1 or more years after breast cancer diagnosis. METHODS We performed a population-based study to compare live births between women with a history of breast cancer (case group) and matched women with no cancer history (control group). Individuals in the case and control groups were identified using linked data from the California Cancer Registry and California Office of Statewide Health Planning and Development data sets. Individuals in the case group were diagnosed with stage I-III breast cancer at age 18-45 years between January 1, 2000, and December 31, 2012, and conceived 12 or more months after breast cancer diagnosis. Individuals in the control group were covariate-matched women without a history of breast cancer who delivered during 2000-2012. The primary outcome was preterm birth at less than 37 weeks of gestation. Secondary outcomes were preterm birth at less than 32 weeks of gestation, small for gestational age (SGA), cesarean delivery, severe maternal morbidity, and neonatal morbidity. Subgroup analyses were used to assess the effect of time from initial treatment to fertilization and receipt of additional adjuvant therapy before pregnancy on outcomes of interest. RESULTS Of 30,021 women aged 18-45 years diagnosed with stage I-III breast cancer during 2000-2012, 553 met the study inclusion criteria. Those with a history of breast cancer and matched women in the control group had similar odds of preterm birth at less than 37 weeks of gestation (odds ratio [OR], 1.29; 95% CI 0.95-1.74), preterm birth at less than 32 weeks of gestation (OR 0.77; 95% CI 0.34-1.79), delivering an SGA neonate (less than the 5th percentile: OR 0.60; 95% CI 0.35-1.03; less than the 10th percentile: OR 0.94; 95% CI 0.68-1.30), and experiencing severe maternal morbidity (OR 1.61; 95% CI 0.74-3.50). Patients with a history of breast cancer had higher odds of undergoing cesarean delivery (OR 1.25; 95% CI 1.03-1.53); however, their offspring did not have increased odds of neonatal morbidity compared with women in the control group (OR 1.15; 95% CI 0.81-1.62). CONCLUSION Breast cancer 1 or more years before fertilization was not strongly associated with obstetric and neonatal complications.
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Affiliation(s)
- Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, the Department of Breast Oncology, the Department of Health Services Research, and the Division of Cancer Prevention and Population Sciences, the University of Texas MD Anderson Cancer Center, and the University of Texas Health Science Center at Houston, Houston, Texas; the UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NewYork-Presbyterian/Columbia University Medical Center, and the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York; and the Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Program, Massachusetts General Hospital, Boston, Massachusetts
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21
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Dioun S, Chen L, Melamed A, Gockley A, St. Clair CM, Hou JY, Khoury‐Collado F, Hur C, Elkin E, Accordino M, Hershman DL, Wright JD. Dostarlimab For Recurrent Mismatch Repair Deficient Endometrial Cancer: A
Cost‐Effectiveness
Study. BJOG 2022; 130:214-221. [DOI: 10.1111/1471-0528.17338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Shayan Dioun
- Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - Ling Chen
- Columbia University College of Physicians and Surgeons
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center
| | - Caryn M. St. Clair
- Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center
| | - June Y. Hou
- Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center
| | - Fady Khoury‐Collado
- Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center
| | - Chin Hur
- Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center
| | - Elena Elkin
- Joseph L. Mailman School of Public Health Columbia University
- Herbert Irving Comprehensive Cancer Center
| | - Melissa Accordino
- Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center
| | - Dawn L. Hershman
- Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center
| | - Jason D. Wright
- Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center
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22
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Freret TS, James KE, Melamed A, Gyamfi-Bannerman C, Kaimal AJ, Clapp MA. Late-preterm steroid use among individuals with pregestational diabetes mellitus and with twin gestations. Am J Obstet Gynecol 2022; 227:788-790.e3. [PMID: 35988756 DOI: 10.1016/j.ajog.2022.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Taylor S Freret
- Department of Obstetrics and Gynecology and Reproductive Biology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114.
| | - Kaitlyn E James
- Department of Obstetrics and Gynecology and Reproductive Biology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Columbia University, New York City, NY
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, San Diego, CA
| | - Anjali J Kaimal
- Department of Obstetrics and Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Mark A Clapp
- Department of Obstetrics and Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA
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23
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Wright JD, Chen L, Melamed A, Clair CMS, Hou JY, Khoury-Collado F, Gockley A, Accordino M, Hershman DL, Xu X. Containment Bag Use Among Women Who Undergo Hysterectomy With Laparoscopic Power Morcellation. Obstet Gynecol 2022; 140:371-380. [PMID: 35926199 DOI: 10.1097/aog.0000000000004886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/19/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To estimate trends in use of laparoscopic power morcellators in women undergoing minimally invasive hysterectomy and to examine use of containment systems in these patients in relation to safety guidance from the U.S. Food and Drug Administration (FDA). METHODS We examined data that were recorded in the Premier Healthcare Database from patients who underwent laparoscopic supracervical hysterectomy from 2010 to 2018. Patients were stratified based on use of laparoscopic power morcellators. The cohort was further stratified as either pre-FDA guidance (2010 quarter 1-2014 quarter 1) or post-FDA guidance (2014 quarter 2-2018 quarter 2). Interrupted time series analyses were performed to determine the effect of FDA guidance on the use of laparoscopic power morcellators and containment bags. RESULTS Among 67,115 patients, laparoscopic power morcellator use decreased from 66.7% in 2013 quarter 4 to 13.3% by 2018 quarter 2. The likelihood of laparoscopic power morcellator use decreased by 9.5% for each quarter elapsed in the post-FDA warning period (risk ratio [RR] 0.91, 95% CI 0.90-0.91). Containment bag use rose from 5.2% in 2013 quarter 4 to 15.2% by 2018 quarter 2. The likelihood of containment bag use increased by 3% for each quarter elapsed in the post-FDA warning period (RR 1.03, 95% CI 1.02-1.05). Among women who had laparoscopic power morcellator use, uterine cancers or sarcomas were identified in 54 (0.17%) before the FDA guidance compared with seven (0.12%) after the guidance ( P =.45). Containment bags were used in 11.1% of women with uterine cancers or sarcomas before the FDA guidance compared with 14.3% after the guidance ( P =.12). The perioperative complication rate was 3.3% among women who had laparoscopic power morcellator use without a containment bag compared with 4.5% ( P =.001) in those with a containment bag (aRR 1.35, 95% CI 1.12-1.64). CONCLUSION Use of laparoscopic power morcellators has decreased over time. Containment bag use increased after the FDA's 2014 guidance; however, most procedures employing laparoscopic power morcellators are still performed without a containment bag.
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Affiliation(s)
- Jason D Wright
- Columbia University College of Physicians and Surgeons, the Joseph L. Mailman School of Public Health, Columbia University, the Herbert Irving Comprehensive Cancer Center, and NewYork-Presbyterian Hospital, New York, New York; and Yale University School of Medicine, New Haven, Connecticut
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24
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Rauh-Hain JA, Zubizarreta J, Nitecki R, Melamed A, Fu S, Jorgensen K, Brady PC, Baker VL, Chavez-MacGregor M, Giordano SH, Keating NL. Survival outcomes following pregnancy or assisted reproductive technologies after breast cancer: A population-based study. Cancer 2022; 128:3243-3253. [PMID: 35767282 PMCID: PMC9378486 DOI: 10.1002/cncr.34371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study sought to determine the impact of pregnancy or assisted reproductive technologies (ART) on breast-cancer-specific survival among breast cancer survivors. METHODS The authors performed a cohort study using a novel data linkage from the California Cancer Registry, the California birth cohort, and the Society for Assisted Reproductive Technology Clinic Outcome Reporting System data sets. They performed risk-set matching in women with stages I-III breast cancer diagnosed between 2000 and 2012. For each pregnant woman, comparable women who were not pregnant at that point but were otherwise similar based on observed characteristics were matched at the time of pregnancy. After matching, Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of pregnancy with breast-cancer-specific survival. We repeated these analyses for women who received ART. RESULTS Among 30,021 women with breast cancer, 553 had a pregnancy and 189 attempted at least one cycle of ART. In Cox proportional hazards modeling, the pregnancy group had a higher 5-year disease-specific survival rate; 95.6% in the pregnancy group and 90.6% in the nonpregnant group (HR, 0.43; 95% CI, 0.24-0.77). In women with hormone receptor-positive cancer, we found similar results (HR, 0.43; 95% CI, 0.2-0.91). In the ART analysis, there was no difference in survival between groups; the 5-year disease-specific survival rate was 96.9% in the ART group and 94.1% in the non-ART group (HR, 0.44; 95% CI, 0.17-1.13). CONCLUSION Pregnancy and ART are not associated with worse survival in women with breast cancer. LAY SUMMARY We sought to determine the impact of pregnancy or assisted reproductive technologies (ART) among breast cancer survivors. We performed a study of 30,021 women by linking available data from California and the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. For each pregnant woman, we matched at the time of pregnancy comparable women who were not pregnant at that point but were otherwise similar based on observed characteristics. We repeated these analyses for women who received ART. We found that pregnancy and ART were not associated with worse survival.
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Affiliation(s)
- J. Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jose Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Shuangshuang Fu
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Paula C. Brady
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Valerie L. Baker
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD, United States
| | - Mariana Chavez-MacGregor
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sharon H. Giordano
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
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25
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Casey JA, Kioumourtzoglou MA, Ogburn EL, Melamed A, Shaman J, Kandula S, Neophytou A, Darwin KC, Sheffield JS, Gyamfi-Bannerman C. Long-Term Fine Particulate Matter Concentrations and Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2: Differential Relationships by Socioeconomic Status Among Pregnant Individuals in New York City. Am J Epidemiol 2022; 191:1897-1905. [PMID: 35916364 PMCID: PMC9384549 DOI: 10.1093/aje/kwac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023] Open
Abstract
We aimed to determine whether long-term ambient concentrations of fine particulate matter (particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5)) were associated with increased risk of testing positive for coronavirus disease 2019 (COVID-19) among pregnant individuals who were universally screened at delivery and whether socioeconomic status (SES) modified this relationship. We used obstetrical data collected from New-York Presbyterian Hospital/Columbia University Irving Medical Center in New York, New York, between March and December 2020, including data on Medicaid use (a proxy for low SES) and COVID-19 test results. We linked estimated 2018-2019 PM2.5 concentrations (300-m resolution) with census-tract-level population density, household size, income, and mobility (as measured by mobile-device use) on the basis of residential address. Analyses included 3,318 individuals; 5% tested positive for COVID-19 at delivery, 8% tested positive during pregnancy, and 48% used Medicaid. Average long-term PM2.5 concentrations were 7.4 (standard deviation, 0.8) μg/m3. In adjusted multilevel logistic regression models, we saw no association between PM2.5 and ever testing positive for COVID-19; however, odds were elevated among those using Medicaid (per 1-μg/m3 increase, odds ratio = 1.6, 95% confidence interval: 1.0, 2.5). Further, while only 22% of those testing positive showed symptoms, 69% of symptomatic individuals used Medicaid. SES, including unmeasured occupational exposures or increased susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to concurrent social and environmental exposures, may explain the increased odds of testing positive for COVID-19 being confined to vulnerable pregnant individuals using Medicaid.
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Affiliation(s)
- Joan A Casey
- Correspondence Address: Correspondence to Joan A. Casey, Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 W 168th St, Rm 1206 New York, NY 10032-3727 ()
| | - Marianthi-Anna Kioumourtzoglou
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, United States
| | - Elizabeth L Ogburn
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, United States
| | - Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, United States
| | - Andreas Neophytou
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, United States
| | - Kristin C Darwin
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeanne S Sheffield
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, United States,Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego School of Medicine and UC San Diego Health
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26
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Dioun S, Chen L, Gockley A, Melamed A, Clair CS, Hou J, Khoury-Collado F, Wright J. Uptake and survival outcomes of sentinel lymph node mapping in vulvar melanoma (552). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01773-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Kulkarni A, Chen L, Collado FK, Hou J, St. Clair C, Melamed A, Gockley A, Wright J. Loss to follow-up associated with prolonged cervical cancer screening intervals (365). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01587-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Suzuki Y, Huang Y, Melamed A, Hou J, St. Clair C, Gockley A, Khoury-Collado F, Wright J. Trends in use of estrogen replacement therapy for premenopausal women with gynecologic cancer after surgical menopause (372). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Zhou ZN, Chen L, Clair CS, Hou J, Collado FK, Gockley A, Melamed A, Wright J. Adoption of minimally invasive surgery after neoadjuvant chemotherapy in women with metastatic uterine cancer (462). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01684-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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30
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Kulkarni A, Daifotis H, Melamed A, Dottino J, Wright J, Collado FK, Hou J, St. Clair C, Gockley A. Black and Hispanic patient representation in NCCN-recommended systemic therapy regimens for endometrial cancer (015). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01233-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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31
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Liao L, Chen L, Gockley A, Khoury-Collado F, St. Clair C, Hou J, Melamed A, Wright J. Temporal trends in cervical cancer screening practices and downstream abnormalities and procedures in the U.S. (362). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Dioun S, Chen L, Melamed A, Gockley A, St Clair CM, Hou JY, Khoury-Collado F, Hershman DL, Wright JD. Uptake and outcomes of sentinel lymph node mapping in women undergoing minimally invasive surgery for endometrial cancer. BJOG 2022; 129:1591-1599. [PMID: 34962708 DOI: 10.1111/1471-0528.17085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the patterns and outcomes of sentinel lymph node (SLN) assessment in women with endometrial cancer. DESIGN Retrospective cohort study. SETTING United States inpatient and outpatient hospital services. POPULATION Women with endometrial cancer who underwent a laparoscopic or robotic-assisted hysterectomy. METHODS The Perspective Database from 2012 to 2018 was used. Performance of lymph node dissection was classified as SLN mapping, lymph node dissection or no nodal evaluation. Adjusted regression models were developed to examine the association between SLN mapping and morbidity and cost. MAIN OUTCOME MEASURES Utilisation rates, morbidity and cost of both lymph node dissection and SLN mapping. RESULTS Among 45 381 patients, SLN mapping was performed for 7768 patients (17.1%), lymph node dissection was performed for 23 214 patients (51.2%) and no lymphatic evaluation was performed for 14 399 patients (31.7%). SLN mapping increased from 1.8% in 2012 to 35.3% in 2018, whereas the rate of lymph node dissection decreased from 63.5% to 39.1% (p < 0.001). Among women who underwent nodal evaluation, residence in the west, White race and use of robotic-assisted hysterectomy were associated with SLN mapping (p < 0.05 for all). The complication rate was 5.9% for SLN mapping, compared with 7.3% in those that underwent lymph node dissection (aRR 0.85, 95% CI 0.77-0.95). The median hospital costs for women who underwent SLN mapping ($10 479) and lymph node dissection ($10 747) were higher than for those who did not undergo nodal assessment ($9149) (p < 0.001). CONCLUSIONS The performance of SLN mapping is increasing for endometrial cancer. Compared with lymph node dissection, SLN mapping is associated with lower morbidity. SLN mapping significantly increases the costs compared with hysterectomy alone. TWEETABLE ABSTRACT SLN mapping is increasing rapidly for endometrial cancer and is associated with decreased perioperative morbidity.
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Affiliation(s)
- Shayan Dioun
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Caryn M St Clair
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - June Y Hou
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
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Nitecki R, Melamed A. Extra cycles of neoadjuvant chemotherapy before interval surgery for ovarian cancer: the more the merrier or too much of a good thing? Int J Gynecol Cancer 2022; 32:ijgc-2022-003796. [PMID: 35858713 PMCID: PMC9852356 DOI: 10.1136/ijgc-2022-003796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Roni Nitecki
- Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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34
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Cogan JC, Accordino MK, Beauchemin MP, Spivack JH, Ulene SR, Elkin EB, Melamed A, Taback B, Wright JD, Hershman DL. Efficacy of a password-protected, pill-dispensing device with mail return capacity to enhance disposal of unused opioids after cancer surgery. Cancer 2022; 128:3392-3399. [PMID: 35819926 DOI: 10.1002/cncr.34384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/22/2022] [Accepted: 06/15/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Opioid misuse is a public health crisis, and unused postoperative opioids are an important source. Although 70% of pills prescribed go unused, only 9% are discarded. This study evaluated whether an inexpensive pill-dispensing device with mail return capacity could enhance disposal of unused opioids after cancer surgery. METHODS A prospective pilot study was conducted among adult patients who underwent major cancer-related surgery. Patients received opioid prescriptions in a mechanical device (Addinex) linked to a smartphone application (app). The app provided passwords on a prescriber-defined schedule. Patients could enter a password into the device and receive a pill if the prescribed time had elapsed. Patients were instructed to return the device and any unused pills in a disposal mailer. The primary end point was feasibility of device return, defined as ≥50% of patients returning the device within 6 weeks of surgery. Also explored was total pill use and return as well as patient satisfaction. RESULTS Among 30 patients enrolled, the majority (n = 24, 80%) returned the device, and 17 (57%) returned it within 6 weeks of surgery. In total, 567 opioid pills were prescribed and 170 (30%) were used. Of 397 excess pills, 332 (84% of unused pills, 59% of all pills prescribed) were disposed of by mail. Among 19 patients who obtained opioids from the device, most (n = 14, 74%) felt the benefits of the device justified the added steps involved. CONCLUSIONS Use of an inexpensive pill-dispensing device with mail return capacity is a feasible strategy to enhance disposal of unused postoperative opioids.
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Affiliation(s)
- Jacob C Cogan
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Melissa K Accordino
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Melissa P Beauchemin
- Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA.,Columbia University School of Nursing, New York, New York, USA
| | - John H Spivack
- Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Sophie R Ulene
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Elena B Elkin
- Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Bret Taback
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
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35
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Cherston C, Yoh K, Huang Y, Melamed A, Gamble CR, Prabhu VS, Li Y, Hershman DL, Wright JD. Relative importance of individual insurance status and hospital payer mix on survival for women with cervical cancer. Gynecol Oncol 2022; 166:552-560. [PMID: 35787803 DOI: 10.1016/j.ygyno.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the relative contributions of individual insurance status and hospital payer mix (safety net status) to quality of care and survival for patients with cervical cancer. METHODS We used the National Cancer Database to identify patients with cervical cancer diagnosed from 2004 to 2017. Patients were classified by insurance (uninsured/Medicaid/private/Medicare/other) and hospitals were grouped into quartiles based on the proportion of uninsured/Medicaid patients (payer mix) (top quartile defined as safety-net hospital (SNHs) and lowest as Q1 hospitals). Quality-of-care was assessed by adherence to evidence-based metrics. Individual contributions of insurance status and payer mix to survival was assessed with a proportional hazards Cox model. RESULTS A total of 124,339 patients including 11,338 uninsured (9.1%) and 27,281 Medicaid (21.9%) recipients treated at 1156 hospitals were identified. Quality-of-care was not significantly different across hospital quartiles. Adjusting for patients' clinical/demographic characteristics, treatment at a SNH was associated with a 14% higher mortality (HR = 1.14; 95% CL, 1.08-1.20) than at Q1 hospitals. Testing for individual insurance, uninsured patients had 32% increased mortality (HR = 1.32; 95% CI,1.26-1.38) and Medicaid recipients 40% increased (HR = 1.40; 95%CI,1.35-1.44) compared to privately insured patients. Examining both payer mix and insurance, only individual insurance retained a significant impact on mortality. CONCLUSIONS Individual insurance may be a more important predictor of survival than site-of-care and hospital payer mix for women with cervical cancer. There is substantial variation in outcomes within hospitals based on individual insurance, regardless of hospital payer mix.
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Affiliation(s)
- Caroline Cherston
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Katherine Yoh
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Yongmei Huang
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Alexander Melamed
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Charlotte R Gamble
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | | | - Yeran Li
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Dawn L Hershman
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Jason D Wright
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA.
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36
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Ramirez PT, Rauh-Hain JA, Melamed A, Pareja R. Surgical technique and surgeon volume: the pursuit of data-driven outcomes. Int J Gynecol Cancer 2022; 32:ijgc-2022-003682. [PMID: 35725030 DOI: 10.1136/ijgc-2022-003682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander Melamed
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University, New York Presbyterian Hospital, New York, New York, USA
| | - Rene Pareja
- Gynecology, Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Medellin, Colombia
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37
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Diggs A, Sia TY, Huang Y, Gockley A, Melamed A, Khoury-Collado F, St Clair C, Hou JY, Hershman DL, Wright JD. Utilization and outcomes of adjuvant therapy for stage II and III uterine leiomyosarcoma. Gynecol Oncol 2022; 166:308-316. [PMID: 35660331 DOI: 10.1016/j.ygyno.2022.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/17/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The optimal adjuvant therapy for uterine leiomyosarcoma (uLMS) remains uncertain. We analyzed the utilization of adjuvant chemotherapy and radiation therapy for stage II and III uLMS and explored the association between use of adjuvant therapy and survival. METHODS Patients with stage II or III uLMS treated from 2004 to 2016 and recorded in the National Cancer Database were identified. Multivariable regression models were fit to estimate predictors of use of either adjuvant radiation therapy or chemotherapy. To analyze the impact of chemotherapy on all-cause mortality, an inverse probability of treatment weighted (IPTW) propensity score method was used to account for measured confounders, and the receipt of radiation therapy was adjusted in the outcome model. The process was repeated to analyze the impact of radiation therapy on all-cause mortality by using an IPTW propensity score method and adjusting for the receipt of adjuvant chemotherapy. RESULTS A total of 890 patients were identified. Adjuvant chemotherapy use increased from 62.2% in 2010 to 70.4% in 2016, whereas radiation usage decreased from 26.7% in 2010 to 10.4% in 2016. Patients with stage III (vs. stage II) disease were less likely to receive radiation therapy. After propensity score weighting, chemotherapy was associated with a 30% decreased risk of all-cause mortality in stage III patients (HR 0.70, 95% CI 0.45-0.98) but had no effect on mortality for stage II patients (HR 0.93, 95% CI 0.70-1.20). Radiation therapy was associated with a 26% decreased risk of mortality for stage II tumors (HR 0.74; 95% CI, 0.53-0.99) and a 57% decrease in mortality for stage III disease (HR 0.43, 95% CI 0.18-0.99). CONCLUSIONS Among women with stage II-III uLMS, use of chemotherapy is increasing while use of radiation therapy is decreasing. Radiation therapy is associated with improved survival in both stage II and III disease, while there was no association between use of adjuvant chemotherapy and survival in stage II patients.
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Affiliation(s)
- Alexandra Diggs
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; New York Presbyterian Hospital, United States of America
| | - Tiffany Y Sia
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Yongmei Huang
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Allison Gockley
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - Alexander Melamed
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - Fady Khoury-Collado
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - Caryn St Clair
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - June Y Hou
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - Dawn L Hershman
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - Jason D Wright
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America.
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38
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Bercow A, Melamed A, Eisenhauer E, Bregar A, Growdon WB, Molina G, Minami CA. Sentinel lymph node biopsy utilization in early-stage vulvar cancer: A National Cancer Database Study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17536 Background: Since 2012, sentinel lymph node biopsy (SLNB) has been considered equivalent in terms of survival to standard inguinofemoral lymphadenectomy (IFLD) in patients with early-stage vulvar cancer. Moreover, SLNB is associated with lower rates of postoperative short-term and long-term morbidity. However, uptake of SLNB has been limited and little information exists about factors associated with access to SLNB in vulvar cancer. Methods: Between 2012-2018, women with stage IB vulvar squamous cell carcinoma were identified using the National Cancer Database. Patient, facility, and disease characteristics were compared between patients who underwent SLNB versus IFLD. Multivariable logistic regression analyses, adjusted for patient, facility, and disease characteristics were used to evaluate factors associated with SLNB. Kaplan-Meier survival analysis using log rank test and Cox regression was performed. Results: Of the 3,454 patients, 1,094 (31.6%) did not undergo lymph node evaluation (LNE) and 2,360 (68.3%) underwent LNE, with 1,668 (82.0%) undergoing IFLD and 692 (29.3%) SLNB. On multivariable analysis, patients diagnosed between 2015-2018 were more likely to undergo SLNB than patients diagnosed 2012-2014 (OR 1.86, 95% CI 1.50-2.31). Patients residing in zip codes with the highest proportion of high school graduates were more likely to undergo SLNB than those residing in regions with lower levels of education (OR 2.00, 95% CI 1.28-3.13). Midwestern patients were less likely to undergo SLNB than those in the Northeast (OR 0.70, 95% CI 0.50-0.96). Hospital volume was significantly associated with SLNB rates, with low-volume hospitals defined as those performing 0-8 vulvectomies/year, moderate-volume performing 8-16, and high-volume performing 16-45. Moderate (OR 1.58, 95%CI 1.18-2.09) and high (OR 2.12, 95% CI 1.56-2.88) volume hospitals were associated with higher rates of SLNB compared to low-volume hospitals. Patients with tumors > 3cm in size were less likely to undergo SLNB than those < 1cm in size (OR 0.69, 95% CI 0.50-0.94). After controlling for patient and tumor characteristics, there was no difference in overall survival (OS) between patients who underwent SLNB and those who underwent IFLD with negative nodes (HR 0.90, 95% CI 0.70-1.15). Similarly, there was no difference in OS between patients who underwent SLNB (with or without subsequent IFLD) and those who underwent IFLD alone with positive nodes (HR 0.99, 95% CI 0.60-1.61). Conclusions: Utilization of SLNB in early-stage vulvar cancer continues to increase over time but significant variation in its use exists at the patient, hospital, and regional level. The lack of survival difference between the two procedures suggests overtreatment in the 71% of node-negative women who underwent IFLD. Further work is needed to de-escalate care that has previously been associated with worse postoperative outcomes in this population.
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Affiliation(s)
- Alexandra Bercow
- Meigs Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Eric Eisenhauer
- Meigs Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA
| | - Amy Bregar
- Meigs Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA
| | | | - George Molina
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Christina Ahn Minami
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
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Cogan JC, Accordino MK, Beauchemin MP, Ulene S, Elkin EB, Melamed A, Wright JD, Hershman DL. Efficacy of a password-protected, pill-dispensing device with mail return capacity to enhance disposal of unused opioids after cancer surgery. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12019 Background: Opioid misuse is a public health crisis. Initial opioid exposures often occur post-operatively, and 10% of opioid-naïve patients who undergo cancer surgery subsequently become long-term opioid users. It has been shown that 70% of opioids prescribed post-operatively go unused, but only 9% of unused pills are disposed of appropriately, which increases the risk of unintended use. We evaluated the impact of an inexpensive, password-protected pill-dispensing device with mail return capacity on disposal of unused pills after cancer surgery. Methods: We conducted a prospective, proof-of-concept pilot study among adult patients scheduled for major cancer-related surgery. Enrolled patients received opioid prescriptions in a pill-dispensing device (Addinex) from a specialty pharmacy. The mechanical device linked to a smartphone app, which provided passwords on a prescriber-defined schedule. Patients were able to enter unique passwords into the device to receive their pills if the prescribed time had elapsed. The smartphone app provided clinical guidance based on patient-reported pain levels, and suggested tapering strategies. Patients were instructed to return the device in a DEA-approved mailer when opioid use was no longer required for acute pain control. Unused pills were destroyed upon receipt. The primary objective was to determine the feasibility of device return, defined as > 50% within 6 weeks. We also explored total pill use and return, patterns of device use and patient satisfaction. Results: We enrolled 30 patients between October 2020 and December 2021. The median age was 46 (range 29–72). Surgical procedures included abdominal hysterectomy (13), mastectomy and reconstruction (10), and soft tissue tumor resections (7). Overall, the majority of participants (n = 24, 80%) returned the device, and more than half (n = 17, 57%) returned the device within 6 weeks of surgery. There were 19 patients who obtained opioids from the device. Among these patients, the majority were satisfied with the device (n = 14, 74%); felt the benefits of the device justified the added steps involved (n = 14, 74%); and would sign up to receive opioids in the device again (n = 13, 68%). The other 11 patients used no opioids. None of these non-users reported any opioid requirements for pain control, and all but one (n = 10, 91%) returned the device and unused pills. In total, 567 opioids were prescribed, and 170 (30%) were used. Of the 397 excess pills, 332 (84% of unused pills, 59% of all pills prescribed) were returned by mail. Conclusions: We found that use of an inexpensive pill-dispensing device with mail return capacity was a feasible and effective strategy to enhance disposal of unused post-operative opioids. Interestingly, a substantial number of prescribed pills were unused. This system also improves confidence with indicated opioid use while reducing diversion.
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Affiliation(s)
| | | | | | | | | | - Alexander Melamed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | | | - Dawn L. Hershman
- Columbia University College of Physicians and Surgeons, New York, NY
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40
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Overton E, Booker WA, Mourad M, Moroz L, Nhan Chang CL, Breslin N, Syeda S, Laifer-Narin S, Cimic A, Chung DE, Weiner DM, Smiley R, Sheikh M, Mobley DG, Wright JD, Gockley A, Melamed A, St Clair C, Hou J, D'Alton M, Khoury Collado F. Prophylactic endovascular internal iliac balloon placement during cesarean hysterectomy for placenta accreta spectrum. Am J Obstet Gynecol MFM 2022; 4:100657. [PMID: 35597402 DOI: 10.1016/j.ajogmf.2022.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The utility of prophylactic endovascular internal iliac balloon placement in the surgical management of placenta accreta spectrum is debated. OBJECTIVE In this study, we review outcomes of surgical management of placenta accreta spectrum with and without prophylactic endovascular internal iliac balloon catheter use at a single institution. STUDY DESIGN This is a retrospective cohort study of consecutive viable singleton pregnancies with a confirmed pathologic diagnosis of placenta accreta spectrum undergoing scheduled delivery from October 2018 through November 2020. In the T1 period (October 2018-August 2019), prophylactic endovascular internal iliac balloon catheters were placed in the operating room before the start of surgery. Balloons were inflated after neonatal delivery and deflated after hysterectomy completion. In the T2 period (September 2019-November 2020), endovascular catheters were not used. In both time periods, all surgeries were performed by a dedicated multidisciplinary team using a standardized surgical approach. The outcomes compared included the estimated blood loss, anesthesia duration, operating room time, surgical duration, and a composite of surgical complications. Comparisons were made using the Wilcoxon rank-sum test and the Fisher exact test. RESULTS A total of 30 patients were included in the study (T1=10; T2=20). The proportion of patients with placenta increta or percreta was 80% in both groups, as defined by surgical pathology. The median estimated blood loss was 875 mL in T1 and 1000 mL in T2 (P=.84). The proportion of patients requiring any packed red blood cell transfusion was 60% in T1 and 40% in T2 (P=.44). The proportion of patients requiring >4 units of packed red blood cells was 20% in T1 and 5% in T2 (P=.25). Surgical complications were observed in 1 patient in each group. Median operative anesthesia duration was 497 minutes in T1 and 296 minutes in T2 (P<.001). Median duration of operating room time was 498 minutes in T1 and 205 minutes in T2 (P<.001). Median surgical duration was 227 minutes in T1 and 182 minutes in T2 (P<.05). The median duration of time for prophylactic balloon catheter placement was 74 minutes (range, 46-109 minutes). The median postoperative length of stay was similar in both groups (6 days in T1 and 5.5 days in T2; P=.36). CONCLUSION The use of prophylactic endovascular internal iliac balloon catheters was not associated with decreased blood loss, packed red blood cell transfusion, or surgical complications. Catheter use was associated with increased duration of anesthesia, operating room time, and surgical time.
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Affiliation(s)
- Eve Overton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado).
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Leslie Moroz
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Chia-Ling Nhan Chang
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Noelle Breslin
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Sbaa Syeda
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Sherelle Laifer-Narin
- Department of Diagnostic Radiology, Columbia University, New York, NY (Dr Laifer-Narin)
| | - Adela Cimic
- Department of Anatomic Pathology, Columbia University, New York, NY (Dr Cimic)
| | - Doreen E Chung
- Department of Urology, Columbia University, New York, NY (Drs Chung, and Weiner)
| | - David M Weiner
- Department of Urology, Columbia University, New York, NY (Drs Chung, and Weiner)
| | - Richard Smiley
- Department of Anesthesiology, Columbia University, New York, NY (Drs Smiley, and Sheikh)
| | - Maria Sheikh
- Department of Anesthesiology, Columbia University, New York, NY (Drs Smiley, and Sheikh)
| | - David G Mobley
- Division of Interventional Radiology, Columbia University, New York, NY (Dr Mobley)
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Allison Gockley
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Caryn St Clair
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - June Hou
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Mary D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Fady Khoury Collado
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
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Guida F, Dioun S, Fagotti A, Melamed A, Grossi A, Scambia G, Wright JD, Tergas AI. Role of tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: Systematic review and meta-analysis. Gynecol Oncol 2022; 166:181-187. [PMID: 35550711 DOI: 10.1016/j.ygyno.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the clinical utility of tertiary cytoreductive surgery (TCS) in recurrent ovarian cancer. METHODS MEDLINE via PubMed, Embase (Elsevier), ClinicalTrials.gov, Scopus (Elsevier) and Web of Science for studies from inception to 4/09/2021. Studies reporting disease specific survival (DSS) and overall survival (OS) among women who underwent optimal cytoreductive surgery as compared to those who had a suboptimal cytoreductive surgery at time of TCS were abstracted. Study quality was assessed with the Quality In Prognosis Studies (QUIPS) tool. The data were extracted independently by multiple observers. Random-effects models were used to pool associations and to analyze the association between survival and surgical outcomes. RESULTS 10 studies met all the criteria for inclusion in the systematic review. Patients with optimal tertiary cytoreductive surgery had better DSS (HR = 0.35; 95% CI, 0.19-0.64, P < 0.001), with low heterogeneity (I2 = 0%, P = 0.41) when compared to those with suboptimal tertiary cytoreductive surgery. Pooled results from these studies also demonstrated a better OS (HR = 0.34; 95% CI, 0.15-0.74, P < 0.007) with moderate heterogeneity (I2 = 59%, P = 0.09) when compared to patients with a suboptimal tertiary cytoreductive surgery. This remained significant in a series of sensitivity analyses. Due to the limited number of studies, we were unable to do further subgroup analyses looking at outcomes comparing tertiary cytoreductive surgery to chemotherapy. CONCLUSION In this systematic review and meta-analysis of observational studies examining tertiary cytoreductive surgery for recurrent ovarian cancer, optimal tertiary cytoreductive surgery was associated with improved OS and DSS survival compared to suboptimal tertiary cytoreductive surgery.
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Affiliation(s)
- Francesco Guida
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Shayan Dioun
- Columbia University College of Physicians and Surgeons, New York, USA; New York Presbyterian Hospital, New York, USA
| | - Anna Fagotti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, USA; New York Presbyterian Hospital, New York, USA; Herbert Irving Comprehensive Cancer Center, New York, USA
| | | | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, USA; New York Presbyterian Hospital, New York, USA; Herbert Irving Comprehensive Cancer Center, New York, USA
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Clapp MA, Melamed A, Freret TS, James KE, Gyamfi-Bannerman C, Kaimal AJ. US Incidence of Late-Preterm Steroid Use and Associated Neonatal Respiratory Morbidity After Publication of the Antenatal Late Preterm Steroids Trial, 2015-2017. JAMA Netw Open 2022; 5:e2212702. [PMID: 35583868 PMCID: PMC9118048 DOI: 10.1001/jamanetworkopen.2022.12702] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The Antenatal Late Preterm Steroids (ALPS) trial demonstrated a 20% reduction in the risk of respiratory complications in neonates at risk for a late-preterm birth who were exposed to antenatal corticosteroids compared with those who were not. OBJECTIVE To assess whether new evidence of steroid administration for neonatal respiratory benefit in the late-preterm period is associated with changes in obstetric practice and the use of assisted ventilation for the neonate after delivery. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of US births from February 1, 2015, to October 31, 2017, as ascertained from US natality data, included live-born, singleton neonates born between 34 and 36 completed weeks of gestation to people without pregestational diabetes. An interrupted time series analysis using Poisson regression models was conducted. Data were analyzed from July 11, 2022, to November 9, 2022. EXPOSURES Public dissemination of the ALPS trial results, which occurred during a 9-month period from February 1, 2016 (first published online), to October 31, 2016 (time of the last major professional society's guideline update in the months after the trial's publication). MAIN OUTCOMES AND MEASURES Steroid use, any assisted ventilation use, and assisted ventilation use for more than 6 hours immediately after the dissemination period. RESULTS A total of 707 862 births were included, divided among the 12-month predissemination period (n = 250 643), dissemination period (n = 195 736), and 12-month postdissemination period (n = 261 493). Most births were at 36 weeks of gestation (53.9% in the predissemination and postdissemination period; P = .10). Small but significant differences were found between the predissemination and postdissemination period cohorts: there were more individuals 35 years or older (19.5% vs 17.9%), fewer White individuals (67.8% vs 69.8%), and more publicly insured individuals (50.5% vs 50.1%) in the postdissemination period compared with the predissemination period, respectively (P < .001 for all). Compared with what rates were expected based on the predissemination trends, the adjusted rate of steroid use increased from 5.0% to 11.7% (adjusted incidence rate ratio [IRR], 2.34; 95% CI, 2.13-2.57), and assisted ventilation use decreased from 8.9% to 8.2% (adjusted IRR, 0.91; 95% CI, 0.85-0.98) after the dissemination period. No change was observed in assisted ventilation use for more than 6 hours (adjusted IRR, 0.98; 95% CI, 0.87-1.10). CONCLUSIONS AND RELEVANCE These findings suggest that there was an immediate change in practice of administering antenatal steroids and a reduction in neonatal morbidity among late-preterm births associated with the dissemination of the ALPS trial, suggesting that this evidence may be translating into a reduction in immediate respiratory morbidity outside the context of a clinical trial.
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Affiliation(s)
- Mark A. Clapp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Alexander Melamed
- New York–Presbyterian Hospital, Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Taylor S. Freret
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn E. James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | | | - Anjali J. Kaimal
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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Suzuki Y, Sukegawa A, Ueda Y, Sekine M, Enomoto T, Melamed A, Wright JD, Miyagi E. Effect of a web-based cervical cancer survivor story on the willingness and behavioral change for Human Papillomavirus Vaccination among Japanese parents with at least one daughter aged 11 to 18 years old: Randomized Controlled Trial. JMIR Public Health Surveill 2022; 8:e34715. [PMID: 35421848 PMCID: PMC9178460 DOI: 10.2196/34715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/25/2022] [Accepted: 04/12/2022] [Indexed: 01/23/2023] Open
Abstract
Background Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters. Objective The aim of this trial is to assess the effect of a cervical cancer survivor’s story on the willingness of parents to get HPV vaccination for their daughters. Methods In this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect. Results Of 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9%) in the intervention group and 72 (8.7%) in the control group. Conclusions A cervical cancer survivor’s story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination. Trial Registration UMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf
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Affiliation(s)
- Yukio Suzuki
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Yokohama, JP.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, US
| | - Akiko Sukegawa
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, JP
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, JP
| | - Masayuki Sekine
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JP
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JP
| | - Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, US
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, US
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, JP
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Offodile AC, Lin YL, Melamed A, Rauh-Hain JA, Kinzer D, Keating NL. Association of Maryland Global Budget Revenue With Spending and Outcomes Related to Surgical Care for Medicare Beneficiaries With Cancer. JAMA Surg 2022; 157:e220135. [PMID: 35385085 PMCID: PMC8988019 DOI: 10.1001/jamasurg.2022.0135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance In 2014, Maryland initiated the global budget revenue (GBR) model, placing caps on total hospital expenditures across all care sites. The GBR program aims to reduce unnecessary utilization while maintaining or improving care quality. To date, there has been limited examination of program effects on cancer care. Objective To compare changes in spending, clinical outcomes, and acute care utilization through 4 years of the GBR program among Medicare beneficiaries who undergo cancer-directed surgery in Maryland vs matched control states. Design, Setting, and Participants Drawing from a matched pool of hospitals in Maryland (n = 35) and 24 control states with a similar timing of Medicaid expansion (n = 101), we identified Medicare beneficiaries from Maryland and control states who underwent any cancer-directed surgery from 2011 through 2018. Using difference-in-differences analysis, we compared changes in outcomes from before (2011-2013) to after (2015-2018) GBR implementation between patients treated in Maryland and control states. We also performed a subgroup analysis among patients who underwent major surgical procedures that are usually performed in the inpatient setting (cystectomy, esophagectomy, gastrectomy, colorectal resection, nephrectomy, pancreatectomy, and lung resection). Main Outcomes and Measures Thirty-day episode spending, mortality, readmissions, and emergency department (ED) visits. Results Relative to Medicare beneficiaries undergoing cancer surgery in control states (n = 4737; 3323 [70.1%] female; 571 [12.1%] dual-eligible; mean [SD] age 74.9 [6.5] years), patients in Maryland (n = 20 320; 14 068 [69.2%] female; 1705 [8.4%] dual-eligible; mean [SD] age 74.9 [6.5] years) had a statistically significant reduction of 2.2 percentage points (95% CI, -4.3 to -0.1) in the 30-day readmission rate. We found no statistically significant changes in 30-day spending, mortality, or ED visits. We report no significant results in the subgroup analysis of patients undergoing major surgical procedures. Conclusions and Relevance Global budget revenue was not associated with changes in expenditures, ED utilization, or clinical outcomes after cancer-directed surgery through 4 years. There was a modest decline in 30-day readmissions. Specialty-specific definitions of care quality and better alignment across the entire care delivery value chain (ie, physician incentives) may be strategies that could improve delivery of high-value care for beneficiaries undergoing cancer surgery.
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Affiliation(s)
- Anaeze C Offodile
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston.,Baker Institute for Public Policy, Rice University, Houston, Texas.,Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Yu-Li Lin
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - J Alejandro Rauh-Hain
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston.,Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston
| | | | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Huang Y, Hou JY, Melamed A, St Clair CM, Khoury-Collado F, Gockley A, Ananth CV, Neugut AI, Hershman DL, Wright JD. Pathologic characteristics, patterns of care, and outcomes of Asian-Americans and Pacific islanders with uterine cancer. Gynecol Oncol 2022; 165:160-168. [PMID: 35183383 DOI: 10.1016/j.ygyno.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To compare the patterns of care and outcomes of Asian-Americans/Pacific Islanders (AAPI) to non-Hispanic White (NHW) women with uterine cancer, and examine differences across Asian country of origin. METHODS National Cancer Database was used to identify AAPI and NHW women with uterine cancer diagnosed from 2004 to 2017. Marginal multivariable log-linear regression models and Cox proportional-hazards models were developed to estimate differences in quality-of-care and all-cause mortality between AAPI and NHW women and across AAPI ethnic groups. RESULTS We identified 13,454 AAPI and 354,693 NHW women. Compared to NHW women, AAPI patients were younger at diagnosis (median age 57 vs. 62 years), had fewer comorbidities, more often had serous or sarcoma histologic subtypes and stage III/IV cancer. AAPI women had a slightly higher rate of receiving pelvic lymphadenectomy for deeply invasive or high-grade tumors (77.6% vs. 74.3%), and a lower rate of undergoing minimally invasive surgery (70.4% vs. 74.8%) for stage I-IIIC tumors. Among patients undergoing hysterectomy, AAPI women had a lower mortality compared with NHW women for cancer stage I/II/III, and a 28% reduction for type I (grade 1 or 2 endometrioid cancers) disease (aHR = 0.72; 95% CI, 0.64-0.81). Among AAPI subgroups, Pacific Islanders had the worst survival across different cancer stage and disease type. CONCLUSION AAPI women are diagnosed with uterine cancer at a younger age and have more aggressive histologic subtypes and advanced stage than their White counterparts. They have a similar level of quality-of-care as NHW women, and an improved survival for early stage and type I disease.
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Affiliation(s)
- Yongmei Huang
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - June Y Hou
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Caryn M St Clair
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Cardiovascular Institute of New Jersey, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA; Environmental and Occupational Health Sciences Institute (EOHSI), Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Alfred I Neugut
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA.
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Breneman AN, Eber AE, Haque H, Levine L, Askanase A, Riley CS, Pomeranz MK, Hassan D, Mancebo SE, Polin M, Melamed A, Bordone LA, Rosser M, Gockley A, Gallitano SM. Vulvovaginal Pyoderma Gangrenosum in a Patient Treated With Ocrelizumab for Multiple Sclerosis. J Low Genit Tract Dis 2022; 26:189-191. [PMID: 35256568 DOI: 10.1097/lgt.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Alyssa N Breneman
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ariel E Eber
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Hoosna Haque
- Division of Gynecology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Libby Levine
- Department of Neurology and Multiple Sclerosis Center, Columbia University Irving Medical Center, New York, NY
| | - Anca Askanase
- Department of Rheumatology, Columbia University Irving Medical Center, New York, NY
| | - Claire S Riley
- Department of Neurology and Multiple Sclerosis Center, Columbia University Irving Medical Center, New York, NY
| | - Miriam Keltz Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Dahlia Hassan
- Department of Rheumatology, Columbia University Irving Medical Center, New York, NY
| | - Silvia E Mancebo
- Department of Dermatology, Weill Medical College of Cornell University, New York, NY
| | - Melanie Polin
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Lindsey A Bordone
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Mary Rosser
- Division of Gynecology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Allison Gockley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Cogan JC, Raghunathan RR, Beauchemin MP, Accordino MK, Elkin EB, Melamed A, Wright JD, Hershman DL. Abstract PD5-08: New and persistent sedative hypnotic use after adjuvant chemotherapy for breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd5-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Sedative-hypnotic medications, such as benzodiazepines (BZDs) and non-benzodiazepine sedative-hypnotics (Z-drugs), are used to treat chemotherapy-related nausea, anxiety and insomnia. While effective for these indications, prolonged use can lead to dependence, misuse and increased healthcare utilization. We aimed to estimate rates of new and persistent BZD and Z-drug use after adjuvant chemotherapy for breast cancer. Methods: We used the MarketScan health care claims database to identify patients who received adjuvant chemotherapy for breast cancer from 2008 to 2017. We categorized prescriptions for BZDs or Z-drugs into three periods: 365 days prior to chemotherapy to the start of chemotherapy (period 1); start of chemotherapy to 90 days after the end of chemotherapy (period 2); and 90 days to 365 days after chemotherapy (period 3). Patients who filled no BZD prescriptions in period 1 were considered BZD-naïve. Those who then filled at least one BZD prescription in period 2, and at least two BZD prescriptions in period 3, were classified as new persistent BZD users. The same definitions were used for Z-drugs. We used multivariable logistic regression to estimate associations between patient characteristics and new persistent use of BZDs and Z-drugs. Results: We identified 17,532 BZD-naïve patients and 21,863 Z-drug-naïve patients who received adjuvant chemotherapy for breast cancer. The median age was 57 for BZD-naïve patients (IQR = 13) and 56 for Z-drug-naïve patients (IQR = 13). The majority of patients had commercial or Medicare insurance (92.6% BZD-naïve, 92.7% Z-drug-naïve) versus Medicaid. A slight majority received lumpectomy (56.6% BZD-naïve, 55.1% Z-drug-naïve) versus mastectomy. Roughly half of patients received less than 4 months of chemotherapy (48.0% BZD-naïve, 48.6% Z-drug-naïve). Among BZD-naïve patients, 4,447 (25%) filled at least one BZD prescription during chemotherapy, and 1,192 (7% of all BZD-naïve patients, 27% of those filling at least one BZD prescription during chemotherapy) became new persistent BZD users after chemotherapy. Among Z-drug naïve patients, 2,160 (10%) filled at least one Z-drug prescription during chemotherapy, and 730 (3% of all Z-drug-naïve patients, 34% of those filling at least one prescription during chemotherapy) became new persistent Z-drug users afterwards. There were 115 patients who became new persistent users of both types of sedative-hypnotics. Several characteristics were associated with new persistent BZD use: age 50-65 (Table 1; OR = 1.23, p = 0.01) and age > 65 (OR = 1.38, p = 0.005) relative to age ≤ 49; as well as Medicaid insurance, relative to commercial and Medicare insurance (OR = 1.68, p < 0.0001). Chemotherapy duration of less than 4 months was associated with both new persistent BZD and Z-drug use relative to 4 or more months of chemotherapy (OR = 1.17, p = 0.03 for BZDs; OR = 1.58, p < 0.0001 for Z-drugs). Conclusion: Women who receive sedative-hypnotic medications during adjuvant chemotherapy for breast cancer are at risk of becoming persistent users of these medications after chemotherapy. With an awareness of this observation, providers can take steps to ensure appropriate use of these medications, through tapering dosages and encouraging non-pharmacologic strategies when appropriate.
Associations between Patient Characteristics and New Persistent Sedative-Hypnotic UseNew Persistent BZD UseNew Persistent Z-Drug UseVariableOdds Ratio95% CIp valueOdds Ratio95% CIp valueAge (years)≤ 49ReferentReferent50-651.231.05 - 1.430.011.210.99 - 1.480.07> 651.381.10 - 1.720.0050.950.68 - 1.310.7InsuranceMedicaid1.681.31 - 2.16<0.00010.760.50 - 1.150.2OtherReferentReferentSurgeryMastectomy1.090.95 - 1.250.20.890.74 - 1.070.2LumpectomyReferentReferentChemotherapy duration< 4 months1.171.02 - 1.340.031.581.31 - 1.89<0.0001≥ 4 monthsReferentReferent
Citation Format: Jacob C. Cogan, Rohit R. Raghunathan, Melissa P. Beauchemin, Melissa K. Accordino, Elena B. Elkin, Alexander Melamed, Jason D. Wright, Dawn L. Hershman. New and persistent sedative hypnotic use after adjuvant chemotherapy for breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD5-08.
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Cham S, Li A, Rauh-Hain JA, Tergas AI, Hershman DL, Wright JD, Melamed A. Association Between Neighborhood Socioeconomic Inequality and Cervical Cancer Incidence Rates in New York City. JAMA Oncol 2022; 8:159-161. [PMID: 34817550 PMCID: PMC8777563 DOI: 10.1001/jamaoncol.2021.5779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Stephanie Cham
- Division of Gynecologic Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts
| | - Alicia Li
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - J Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Ana I Tergas
- NewYork-Presbyterian Hospital, Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Dawn L Hershman
- NewYork-Presbyterian Hospital, Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jason D Wright
- NewYork-Presbyterian Hospital, Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Alexander Melamed
- NewYork-Presbyterian Hospital, Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Freret TS, James KE, Melamed A, Gyamfi-Bannerman C, Kaimal AJ, Clapp MA. ALPS Trial Dissemination: Effects on Pregnant People with Diabetes and their Infants. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nitecki R, Fu S, Jorgensen KA, Gray L, Lefkowits C, Smith BD, Meyer LA, Melamed A, Giordano SH, Ramirez PT, Rauh-Hain JA. Employment disruption among women with gynecologic cancers. Int J Gynecol Cancer 2022; 32:69-78. [PMID: 34785522 PMCID: PMC9035315 DOI: 10.1136/ijgc-2021-002949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/28/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Adverse employment outcomes pose significant challenges for cancer patients, though data patients with gynecologic cancers are sparse. We evaluated the decrease in employment among patients in the year following the diagnosis of a gynecologic cancer compared with population-based controls. METHODS Patients aged 18 to 63 years old, who were diagnosed with cervical, ovarian, endometrial, or vulvar cancer between January 2009 and December 2017, were identified in Truven MarketScan, an insurance claims database of commercially insured patients in the USA. Patients working full- or part-time at diagnosis were matched to population-based controls in a 1:4 ratio via propensity score. Multivariable Cox proportional hazards models were used to evaluate the risk of employment disruption in patients versus controls. RESULTS We identified 7446 women with gynecologic cancers (191 vulvar, 941 cervical, 1839 ovarian, and 4475 endometrial). Although most continued working following diagnosis, 1579 (21.2%) changed from full- or part-time employment to long-term disability, retirement, or work cessation. In an adjusted model, older age, the presence of comorbidities, and treatment with surgery plus adjuvant therapy versus surgery alone were associated with an increased risk of employment disruption (p<0.0003, p=0.01, and p<0.0001, respectively) among patients with gynecologic cancer. In the propensity-matched cohort, patients with gynecologic cancers had over a threefold increased risk of employment disruption relative to controls (HR 3.67, 95% CI 3.44 to 3.95). CONCLUSION Approximately 21% of patients with gynecologic cancer experienced a decrease in employment in the year after diagnosis. These patients had over a threefold increased risk of employment disruption compared with controls.
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Affiliation(s)
- Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Shuangshuang Fu
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kirsten A Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Lauren Gray
- Baylor College of Medicine, Houston, Texas, USA
| | - Carolyn Lefkowits
- Department of Gynecologic Oncology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander Melamed
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University, New York Presbyterian Hospital, New York, New York, USA
| | - Sharon H Giordano
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
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