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Sia TY, Wan V, Finlan M, Zhou QC, Iasonos A, Zivanovic O, Sonoda Y, Chi DS, Long Roche K, Jewell E, Tew WP, O'Cearbhaill RE, Cohen S, Makker V, Liu YL, Friedman CF, Kyi C, Zamarin D, Gardner G. Procedural interventions for oligoprogression during treatment with immune checkpoint blockade in gynecologic malignancies: a case series. Int J Gynecol Cancer 2024; 34:594-601. [PMID: 38296517 DOI: 10.1136/ijgc-2023-004842] [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] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To evaluate the feasibility and outcomes of performing procedural interventions, defined as surgical resection, tumor ablation, or targeted radiation therapy, for oligoprogressive disease among patients with gynecologic malignancies who are treated with immune checkpoint blockade. METHODS Patients with gynecologic cancers treated with immune checkpoint blockade between January 2013 and October 2021 who underwent procedural interventions including surgical resection, interventional radiology ablation, or radiation therapy for oligoprogressive disease were identified. Procedures performed before immune checkpoint therapy initiation or ≥6 months after therapy completion were excluded. Long immunotherapy duration prior to intervention was defined as ≥6 months. Progression-free survival and overall survival were calculated from procedure date until disease progression or death, respectively. RESULTS During the study period, 886 patients met inclusion criteria and received immune checkpoint blockade therapy. Of these, 34 patients underwent procedural interventions for oligoprogressive disease; 7 underwent surgical resection, 3 underwent interventional radiology ablation, and 24 underwent radiation therapy interventions. Primary disease sites included uterus (71%), ovary (24%), and cervix (6%). Sites of oligoprogression included abdomen/pelvis (26%), bone (21%), lung (18%), distant lymph node (18%), brain (9%), liver (6%), and vagina (3%). Most tumors (76%) did not exhibit microsatellite instability or mismatch repair deficiency. Approximately half (53%) of the patients had long immune checkpoint therapy duration prior to intervention. Median progression-free survival following the procedure was 5.3 months (95% CI, 3.1-9.9), and median overall survival was 21.7 months (95% CI, 14.9-not estimable). Long versus short immune checkpoint therapy duration prior to procedure and length of immune checkpoint therapy had no effect on progression-free or overall survival. CONCLUSIONS Procedural interventions for patients with oligoprogression on immune checkpoint blockade therapy are feasible and demonstrate favorable outcomes. With expanding use of immune checkpoint therapy, it is important to investigate combined modalities to maximize therapeutic benefit for patients with gynecologic cancers.
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Affiliation(s)
- Tiffany Y Sia
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vivian Wan
- Obstetrics & Gynecology, Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Michael Finlan
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Qin C Zhou
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexia Iasonos
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oliver Zivanovic
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Yukio Sonoda
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Dennis S Chi
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Kara Long Roche
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Elizabeth Jewell
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - William P Tew
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roisin E O'Cearbhaill
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Seth Cohen
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vicky Makker
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ying L Liu
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Claire F Friedman
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chrisann Kyi
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dmitriy Zamarin
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ginger Gardner
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
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Ghanem AI, Gilbert M, Keller C, Gardner G, Mayerhoff R, Siddiqui F. Definitive and Salvage Radiotherapy Compared to Other Modalities for Laryngeal Carcinoma in Situ. Int J Radiat Oncol Biol Phys 2023; 117:e583. [PMID: 37785769 DOI: 10.1016/j.ijrobp.2023.06.2519] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We sought to analyze survival endpoints for laryngeal carcinoma in situ (CIS) undergoing definitive radiotherapy (RT) compared to other modalities. MATERIALS/METHODS Usingour prospectively maintained head and neck cancer database, we identified laryngeal CIS patients treated between 6/2001 and 12/2021. We excluded low-grade dysplasia, CIS with any synchronous invasive squamous cell carcinoma (SCC) within 3 months of the initial CIS biopsy and cases with inadequate follow up. Patients were offered either definitive RT, CO2/KTP laser ablation, photodynamic therapy (PDT) or any sort of therapeutic excision. After first line treatment, follow-up includes visits every 3-6 months with laryngoscopy and biopsies as appropriate. For recurrent CIS beyond 6 months of first line treatment, we reported salvage therapies received and long-term outcomes were reported. Using Kaplan-Meier curves and log-rank test we investigated recurrence free (RFS), progression to invasive SCC free (IFS) and overall (OS) survival across treatment groups. Patients managed with salvage RT were compared to first line RT recipients. RESULTS Atotal of 85 CIS cases were included: median age 65 years (IQR: 55-74), 73 males (85%) and 70 white (82.4%). 86% had a history of smoking with median pack year of 38 (IQR: 20-55) and 66% had a history of alcohol use. CIS was glottic in most of the cases (90.6%: 66% unilateral, 21% bilateral & 13% involved commissure); with only 9.4% in the supraglottic region. RT was used in 49.4% (n = 42) after biopsy (55%) or surgery (45%) with median dose of 63 Gy/28 fractions, mainly by 3D conformal RT (76%). The remaining 50.6% (n = 43) got therapeutic excision alone (commonly microflap excision) (46.5%), CO2/KTP laser (32.6%) or PDT (20.9%). Demographics and clinicopathological details were non-different between RT and non-RT patients except for Charlson comorbidity index: median 2 (IQR 1-3) in non-RT vs 1 (IQR 0-2) in 1ry RT; p = 0.007. After a median follow-up of 4.8 years (IQR 3.5), 51.8% had recurrent disease, 21.2% progressed to invasive SCC and 9.4% had laryngectomies mainly for invasive SCC after RT. First line RT had improved 2-(83% vs 39%) and 5-(74% vs 22%) year RFS vs non-RT therapies (p<0.001). Nevertheless, 2- and 5-year IFS (89% vs 98% and 80% vs 79%) and OS (92% vs 93% and 81% vs 77%) were non-significant among both (p>0.05 for all). Among non-RT cases with CIS recurrences, 12/35 (34%) had salvage RT. Following RT, salvage RT patients had similar 2- and 5-year RFS (81% vs 83% and 81% vs 74%) and IFS (81% vs 89% and 81% vs 80%) compared to first line RT (p>0.05 for all). All cases with CIS recurrences were salvaged successfully with 100% living with no CIS at latest follow-up. CONCLUSION Laryngeal CIS can be treated with a wide range of modalities including 1ry RT which has better recurrence free survival. Nevertheless, non-RT recurrent CIS can be salvaged successfully with many options including RT with equivalent long-term results.
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Affiliation(s)
- A I Ghanem
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI; Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt
| | - M Gilbert
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - C Keller
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI
| | - G Gardner
- Department of Otolaryngology, Henry Ford Cancer Institute, Detroit, MI
| | - R Mayerhoff
- Department of Otolaryngology, Henry Ford Cancer Institute, Detroit, MI
| | - F Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
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Kahn R, Boerner T, An A, Gardner G, Roche KL, Sonoda Y, Zivanovic O, Grisham R, Abu-Rustum N, Chi D. A preoperative tool for estimating the risk of blood transfusion over an ovarian cancer debulking surgery (113). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01339-7] [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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Kahn R, Filippova O, Straubhar A, An A, Zivanovic O, Gardner G, O’Cearbhaill R, Tew W, Sonoda Y, Roche KL, Chi D. Ten-year conditional probability of survival for patients with ovarian cancer: A new metric for the new millennium (480). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01701-2] [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: 11/27/2022]
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Ehmann S, Lam C, Zhou Q, Grisham R, Roche KL, Zivanovic O, Sonoda Y, Chi D, Gardner G. Oncologic outcomes of secondary cytoreductive surgery in the era of poly (ADP-ribose) polymerase inhibitors maintenance (549). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01770-x] [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: 11/16/2022]
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Mueller J, Rios-Doria E, Park K, Broach V, Jewell E, Zivanovic O, Sonoda Y, Abu-Rustum N, Leitao M, Gardner G. Sentinel lymph node mapping in patients with endometrial hyperplasia: A practice to preserve or abandon? (117). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01343-9] [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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Nosyk B, Min JE, Pearce LA, Zhou H, Homayra F, Wang L, Piske M, McCarty D, Gardner G, O'Briain W, Wood E, Daly P, Walsh T, Henry B. Development and validation of health system performance measures for opioid use disorder in British Columbia, Canada. Drug Alcohol Depend 2022; 233:109375. [PMID: 35231716 DOI: 10.1016/j.drugalcdep.2022.109375] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/11/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Performance measurement provides an evidence-based means to inform development of interventions to improve the quality of care for people who use opioids. We aimed to develop and assess the predictive validity of health system performance measures for opioid use disorder (OUD) in British Columbia (BC), Canada. METHODS Performance measures were generated using retrospective population-level administrative datasets (both provincial and regional) and publicly-reported retrospective data according to four domains (care engagement, clinical guideline compliance, integration, and healthcare utilization). The adjusted odds ratio was estimated via generalized linear mixed models to determine predictive validity for all-cause hospitalization or mortality within 6 months of measurement. FINDINGS A total of 102 performance measures were constructed. We identified 55,470 diagnosed PWOUD, and 39,456 ever engaged in opioid agonist treatment (OAT). We found divergent rates of treatment for concurrent conditions (7.4% for alcohol use disorder to 80.1% for HIV/AIDS), low levels of linkage to OAT and other outpatient care following acute care, and increasing levels of service provision, including increases in OAT prescribers and pharmacies, naloxone kit distribution and overdose prevention site visitation. Our analyses on the predictive validity measures largely supported a priori hypotheses on the direction of effect on the outcome. CONCLUSIONS We identified a range of priorities to improve the quality of care for PWOUD, with critical gaps in linkage to care through acute care settings and long-term engagement in OAT. The proposed measures can be derived for geographic and clinical subgroups and updated over time, providing a basis to monitor and evaluate efforts to address the public health burden of OUD.
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Affiliation(s)
- B Nosyk
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Rm 11300 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
| | - J E Min
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - L A Pearce
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - H Zhou
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - F Homayra
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - L Wang
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - M Piske
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - D McCarty
- Oregon Health & Science University, 1810 SW 5th Ave, Flrs 2 5 and 6, Portland, OR 97201, USA
| | - G Gardner
- British Columbia Ministry of Mental Health and Addictions, PO Box 9672 Stn Prov Govt, Victoria, British Columbia V8W 9P6, Canada
| | - W O'Briain
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada
| | - E Wood
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 -2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - P Daly
- Vancouver Coastal Health Authority, 601 West Broadway, Vancouver, British Columbia V5Z 4C2, Canada
| | - T Walsh
- British Columbia Ministry of Mental Health and Addictions, PO Box 9672 Stn Prov Govt, Victoria, British Columbia V8W 9P6, Canada
| | - B Henry
- Office of the Provincial Health Officer, PO Box 9648, Stn Prov Govt, Victoria, British Columbia V8W 9P4, Canada
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Rios-Doria E, Filippova O, Straubhar A, Chi A, Awowole I, Sandhu J, Broach V, Mueller J, Gardner G, Jewell E, Zivanovic O, Leitao M, Roche KL, Abu-Rustum N, Sonoda Y. A modern day experience with Brunschwig's operation: advancements in pelvic exenteration. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00784-8] [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: 10/20/2022]
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9
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Filippova O, Straubhar A, Santiago NL, Zivanovic O, Gardner G, Tew W, O'Cearbhaill R, Grisham R, Sonoda Y, Roche KL, Chi D. 10-year survival in patients diagnosed with high-grade epithelial ovarian cancer: a new metric for a new millennium. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00781-2] [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: 11/28/2022]
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Singh N, Huang I, Singleton M, Bays A, Sabo J, Chung S, Gardner G, Schaeffer J, Wysham K, Andrews J, Patel R, Simard J, Liew J. POS1422 CORRELATES OF TESTING POSITIVE FOR SARS-COV-2 IN PATIENTS WITH RHEUMATIC AD MUSCULOSKELETAL DISEASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Many studies on COVID-19 outcomes in patients with RMD have either restricted to COVID positive RMD patients or compared them to the general clinic population as a comparator. Given heterogeneity in behaviors and risks, clinical characteristics associated with a positive diagnosis among patients with RMD seeking testing for Sars-CoV-2 remain less well studied.Objectives:Among patients with RMD receiving a Sars-CoV-2 PCR test, we aimed to identify RMD-related factors associated with a positive test result.Methods:Among patients seen at least once in the University of Washington (UW) rheumatology clinics between March 2018 to March 2020, we reviewed electronic medical records to identify patients undergoing Sars-CoV-2 PCR testing from March 1 through October 31, 2020. Patients with RMD were categorized into two groups: those who tested positive for Sars-CoV-2 and those who tested negative. We randomly selected patients from the negative group in a 2:1 ratio for further data abstraction. Student’s t-test and Chi-squared tests were used to compare continuous and categorical variables, respectively, between the groups. To determine the correlates of testing positive for Sars-CoV-2, specifically RMD medication use and disease activity, we constructed different multivariable logistic regression models adjusted for age, sex, race/ethnicity, presence of comorbidities, body mass index, and smoking.Results:A total of 2768 RMD patients underwent SARS-CoV-2 PCR testing within the UW system, of whom 43 (1.5%) were positive at least once. Three patients with incomplete information were excluded. Patients who tested positive had higher prevalence of end stage renal disease (ESRD)/chronic kidney disease (CKD) (24% versus 11%), had higher rates of active disease (24% versus 20%), were older (>55 years) (mean age 57.3 versus 54.8 years), male (63% versus 55%), non-white race/ethnicity (32% versus 26%), and higher prevalence of multiple comorbidities (42% versus 31%) (Table 1). In the multivariable models, neither RMD medication use (versus no use, Table 1) nor high disease activity (vs low disease activity/remission) were statistically significantly associated with COVID-19 positivity. Among the 41 COVID-19 positive patients, a majority recovered without specific treatments, although approximately one third of the positive patients were hospitalized and three deaths were observed.Conclusion:In this study, patients who tested positive did not differ in many ways from those who tested negative.Table 1.Baseline characteristics of the patients prior to COVID testingVariablesAll(N=126)COVID Positive (N=41)COVID Negative(N=85)P valueAge in years – mean (SD)55.6 (15.3)57.3 (16.3)54.8 (14.9)0.40Sex0.39 Male73 (57.9)26 (63.4)47 (55.3) Female53 (42.1)15 (36.6)38 (44.7)Race0.39 White89 (71.2)26 (63.4)63 (74.1) Other race35 (28.2)13 (31.7)22 (25.9) Missing2 (1.6)2 (4.9)0 (0.0)Rheumatic disease0.64 OA/Crystal/Fibromyalgia37 (29.4)11 (26.8)26 (30.6) RA/SpA32 (25.4)9 (22.0)23 (27.1) All others57 (45.2)21 (51.2)36 (42.3)Rheumatic disease activity0.57 Active27 (21.4)10 (24.4)17 (20.0) Not active99 (78.6)31 (75.6)68 (80.0)Co-morbidities Diabetes mellitus (%)25 (19.8)9 (22.0)16 (18.8)0.68 Hypertension48 (38.1)20 (48.8)28 (32.9)0.09 Cardiovascular disease23 (18.3)9 (22.0)14 (16.5)0.46 Lung disease25 (19.8)10 (24.4)15 (17.7)0.37 Cancer10 (7.9)3 (7.3)7 (8.2)0.86 ESRD/CKD19 (15.1)10 (24.4)9 (10.6)0.04*BMI: Body mass index; SD: Standard deviation; OA: Osteoarthritis; Crystal: Crystalline diseases; RA: Rheumatoid arthritis; SpA: SpondyloarthritisAcknowledgements:The work in this study was supported by grant UL1 TR002319 to Dr Singh from the Institute of Translational Health Sciences of the University of Washington.Disclosure of Interests:None declared
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Cowan R, Nobre SP, Pradhan N, Yasukawa M, Zhou QC, Iasonos A, Soslow RA, Arnold AG, Trottier M, Catchings A, Roche KL, Gardner G, Robson M, Abu Rustum NR, Aghajanian C, Cadoo K. Outcomes of incidentally detected ovarian cancers diagnosed at time of risk-reducing salpingo-oophorectomy in BRCA mutation carriers. Gynecol Oncol 2021; 161:521-526. [PMID: 33712278 DOI: 10.1016/j.ygyno.2021.02.006] [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: 10/29/2020] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prior data suggested that women with incidentally detected occult invasive ovarian cancer (OIOC) at the time of risk-reducing salpingo-oophorectomy (RRSO) for BRCA mutation may have poorer prognoses than would be expected based on disease stage. We sought to evaluate prevalence and outcomes of patients with OIOC in a tertiary referral center. METHODS Patients with BRCA mutation undergoing RRSO from 01/2005 to 05/2017 were identified, and their records reviewed. Women with incidentally detected OIOC were included; those with clinical features raising preoperative suspicion for malignancy were excluded. RESULTS 548 patients with BRCA mutation who underwent RRSO were identified. 26 (4.7%) had an OIOC (median age 55 years; range 42-75); 15(58%) patients, BRCA1; 9(34%), BRCA2; 2(8%) had a mutation in both genes. All OIOCs were high-grade serous: 10 (38%) Stage I; 8 (31%) Stage II; 8(31%) Stage III. 24(92%) patients received adjuvant platinum/taxane therapy. Of Stage III patients, 4 (50%) were identified intraoperatively; the remaining 4 (50%) had microscopic nodal disease on final pathology only. At median follow-up of 67.3 months (28-166) no Stage I patients have recurred; 2 Stage II and 6 Stage III patients recurred. 5-year progression-free survival (PFS) was 72% (95%CI, 50.2-85.7%); median PFS for the cohort was 129 months (95%CI, 75.3-not estimable). 5-year disease-specific survival (DSS) was 96% (95%CI, 76-99%); median DSS not reached. CONCLUSION Consistent with prior reports, almost 5% of patients had an OIOC at RRSO. The majority with early-stage disease had excellent PFS and DSS outcomes, as would be expected based on disease stage.
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Affiliation(s)
- Renee Cowan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Silvana Pedra Nobre
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nisha Pradhan
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maya Yasukawa
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin C Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA
| | - Angela G Arnold
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Magan Trottier
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amanda Catchings
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA
| | - Ginger Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA
| | - Mark Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA; Robert and Kate Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA
| | - Carol Aghajanian
- Weill Medical College of Cornell University, New York, NY, USA; Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karen Cadoo
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA; Robert and Kate Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; HOPe Directorate, St. James's Hospital, Dublin, Ireland.
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Liu YL, Zhou QC, Iasonos A, Chi DS, Zivanovic O, Sonoda Y, Gardner G, Broach V, O'Cearbhaill R, Konner JA, Grisham R, Aghajanian CA, Abu-Rustum NR, Tew W, Long Roche K. Pre-operative neoadjuvant chemotherapy cycles and survival in newly diagnosed ovarian cancer: what is the optimal number? A Memorial Sloan Kettering Cancer Center Team Ovary study. Int J Gynecol Cancer 2020; 30:1915-1921. [PMID: 33106271 DOI: 10.1136/ijgc-2020-001641] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/20/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Although trials of neoadjuvant chemotherapy in ovarian cancer use 3 neoadjuvant cycles, real-world practice varies. We sought to evaluate the influence of increasing pre-operative cycles on survival, accounting for surgical outcomes. METHODS We identified 199 women with newly diagnosed ovarian cancer recommended for neoadjuvant chemotherapy who underwent interval debulking surgery from July 2015 to December 2018. Non-parametric tests were used to compare clinical characteristics by neoadjuvant cycles. The Kaplan-Meier method was used to estimate differences in progression-free and overall survival. The log-rank test was used to assess the relationship of covariates to outcome. RESULTS The median number of neoadjuvant cycles was 4 (range 3-8), with 56 (28%) women receiving ≥5 cycles. Compared with those receiving 3 or 4, women with ≥5 neoadjuvant cycles received fewer or no post-operative cycles (p<0.001) but had no other differences in clinical factors (p>0.05). Complete gross resection rates were similar among those receiving 3, 4, and ≥5 neoadjuvant cycles (68.5%, 70%, and 71.4%, respectively, p=0.96). There were no significant differences in progression-free or overall survival when comparing 3 versus 4 neoadjuvant cycles. However, more cycles (≥5 vs 4) were associated with worse progression-free survival, even after adjustment for BRCA status and complete gross resection (HR 2.20, 95% CI 1.45 to 3.33, p<0.001), and worse overall survival, even after adjustment for histology, response on imaging, and complete gross resection rates (HR 2.78, 95% CI 1.37 to 5.63, p=0.016). The most common reason for receiving ≥5 cycles was extent of disease requiring more neoadjuvant chemotherapy. CONCLUSIONS Despite maximal cytoreduction, patients receiving ≥5 neoadjuvant cycles have a poorer prognosis than those receiving 3-4 cycles. Future studies should focus on reducing surgical morbidity and optimizing novel therapies in this high-risk group.
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Affiliation(s)
- Ying L Liu
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Qin C Zhou
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexia Iasonos
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dennis S Chi
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oliver Zivanovic
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukio Sonoda
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ginger Gardner
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vance Broach
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Jason A Konner
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rachel Grisham
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carol A Aghajanian
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - William Tew
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kara Long Roche
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Boerner T, Filippova OT, Chi AJ, Iasonos A, Zhou QC, Long Roche K, Zivanovic O, Park BJ, Huang J, Jones DR, Abu-Rustum NR, Gardner G, Sonoda Y, Chi DS. Video-assisted thoracic surgery in the primary management of advanced ovarian carcinoma with moderate to large pleural effusions: A Memorial Sloan Kettering Cancer Center Team Ovary Study. Gynecol Oncol 2020; 159:66-71. [PMID: 32792282 DOI: 10.1016/j.ygyno.2020.07.101] [Citation(s) in RCA: 4] [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: 06/18/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We assessed the utility of video-assisted thoracic surgery (VATS) in defining extent of intrathoracic disease in advanced ovarian carcinoma with moderate-to-large pleural effusions. METHODS Beginning in 2001, VATS was performed on all patients with suspected advanced ovarian carcinoma and moderate-to-large pleural effusions, evaluating for macroscopic intrathoracic disease. The algorithm recommended primary debulking surgery (PDS) for ≤1 cm, neoadjuvant chemotherapy (NACT)/interval debulking surgery (IDS) for >1 cm intrathoracic disease. We reviewed records of patients undergoing VATS from 10/01-01/19. Differences between treatment groups were tested using standard statistical techniques. RESULTS One-hundred patients met eligibility criteria (median age, 60; median CA-125 level, 1158 U/mL; medium serum albumin, 3.8 g/dL). Macroscopic pleural disease was found in 70 (70%). After VATS, 50 (50%) underwent attempted PDS (PDS group), 50 (50%) received NACT (NACT/IDS group). Forty-seven (94%) underwent IDS. Median overall survival (OS) for the entire cohort (n = 100) was 44.5 months (95% CI: 37.8-51.7). The PDS group had significantly longer survival than the NACT/IDS group [45.8 (95% CI: 40.5-87.8) vs. 37.4 months (95% CI: 33.3-45.2); p = .016]. On multivariable analysis, macroscopic intrathoracic disease (HR 2.18, 95% CI: 1.14-4.18; p = .019) and age ≥ 65 (HR 1.98, 95% CI: 1.16-3.40; p = .013) were independently associated with elevated death risk. Patients with the best outcome had no macroscopic disease at VATS and underwent PDS (median OS, 87.8 months). CONCLUSIONS VATS is useful in therapeutic decision-making for PDS vs. NACT/IDS in advanced ovarian cancer with moderate-to-large pleural effusions.
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Affiliation(s)
- Thomas Boerner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Olga T Filippova
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrew J Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin C Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Bernard J Park
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - James Huang
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Ginger Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA.
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14
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Pedra Nobre S, Mazina V, Iasonos A, Zhou QC, Sonoda Y, Gardner G, Long-Roche K, Leitao MM, Abu-Rustum NR, Mueller JJ. Surveillance patterns of cervical cancer patients treated with conization alone. Int J Gynecol Cancer 2020; 30:1129-1135. [PMID: 32499392 PMCID: PMC8336762 DOI: 10.1136/ijgc-2020-001338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/03/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To determine surveillance patterns of stage I cervical cancer after cervical conization. METHODS A 25-question electronic survey was sent to members of the Society of Gynecologic Oncology. Provider demographics, surveillance during year 1, years 1-3, and >3 years after cervical conization, use of pelvic examination, cytology, Human papillomavirus testing, colposcopy, and endocervical curettage were queried. Data were analyzed. RESULTS 239/1175 (20.1%) responses were collected over a 5-week study period. All providers identified as gynecologic oncologists. During year 1, 66.7% of providers perform pelvic examination and 37.1% perform cytology every 3 months. During years 1-3, 61.6% perform pelvic examination and 46% perform cytology every 6 months. At >3 years, 54.4% perform pelvic examination every 6 months and 43% perform annual pelvic examination. 66.7% of respondents perform cytology annually, and 51.9% perform annual Human papilloma virus testing. 85% of providers do not offer routine colposcopy and 60% do not offer endocervical curettage at any point during 5-year follow-up. 76.3% of respondents screen patients for Human papilloma virus vaccination. CONCLUSIONS To date, there are no specific surveillance guidelines for patients with stage I cervical cancer treated with cervical conization. The most common surveillance practice reported is pelvic examination with or without cytology every 3 months in year 1 and every 6 months thereafter. However, wide variation exists in visit frequency, cytology, and Human papillomavirus testing, and there is a clear trend away from using colposcopy and endocervical curettage. These disparate surveillance practices indicate a need for well-defined, uniform surveillance guidelines.
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Affiliation(s)
- Silvana Pedra Nobre
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Varvara Mazina
- Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Alexia Iasonos
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Qin C Zhou
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukio Sonoda
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ginger Gardner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kara Long-Roche
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mario M Leitao
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer J Mueller
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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15
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Filippova OT, Kim SW, Cowan RA, Chi AJ, Iasonos A, Zhou QC, Broach V, Zivanovic O, Long Roche K, Sonoda Y, Gardner G, Chi DS. Hematologic changes after splenectomy for ovarian cancer debulking surgery, and association with infection and venous thromboembolism. Int J Gynecol Cancer 2020; 30:1183-1188. [PMID: 32665236 DOI: 10.1136/ijgc-2020-001368] [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: 03/09/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The spleen plays a role in the immune and coagulative responses, yet a splenectomy may be required during ovarian cancer surgery to achieve complete cytoreduction. The aim of the study was to correlate hematologic changes with the development of infection and venous thromboembolism in patients undergoing splenectomy. METHODS This single-institution retrospective review includes all patients undergoing splenectomy during cytoreductive surgery for advanced ovarian cancer, March 2001 to December 2016. We compared postoperative hematologic changes (evaluated daily before discharge) in patients developing infection within 30 days' post-surgery (Infection group) with those who did not (No-Infection group). We also compared patients developing venous thromboembolism with those without. RESULTS A total of 265 patients underwent splenectomy. Median age was 64 years (range 22-88): 146 (55%) patients had stage IIIC and 114 (43%) patients had stage IV. The majority, 201 (76%) patients underwent splenectomy during primary debulking. A total of 132 (50%) patients comprised the Infection group (most common: urinary tract infection, 54%). Median time from surgery to infection was 8 days (range, 0-29). After initial rise in white blood cell count in both groups, the Infection group had a second peak on postoperative day 10 (median 16.6K/mcL, IQR 12.5-21.2) not seen in the No-Infection group (median 12K/mcL, IQR 9.3-16.3). A total of 40 (15%) patients developed venous thromboembolism, median time of 6.5 days (range, 1-43). All patients demonstrated a continuous rise in platelets during postoperative days 0-15. Thrombocytosis was present in 38/40 (95%) patients with venous thromboembolism vs 183/225 (81%) patients without (P=0.036). Median days with thrombocytosis was higher in venous thromboembolism (8 days, range 1-15) vs non groups (6 days, range 1-16, P=0.049). CONCLUSION We identified initial leukocytosis after splenectomy in all patients. The Infection group had a second peak in white blood cell count on postoperative day 10, not present in the No-Infection group. Among patients with venous thromboembolism, thrombocytosis was more frequent and of longer duration.
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Affiliation(s)
- Olga T Filippova
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sun Woo Kim
- University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Renee A Cowan
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Alexia Iasonos
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Qin C Zhou
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vance Broach
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oliver Zivanovic
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kara Long Roche
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukio Sonoda
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ginger Gardner
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dennis S Chi
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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16
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Carter J, Abu-Rustum N, Saban S, Chen L, Vickers A, Billanti G, Connors N, Broach V, Brown C, Chi D, Gardner G, Goldfrank D, Jewell E, Leitao M, Long Roche K, Mueller J, Sonoda Y, Zivanovic O. 013 The Development and Implementation of a Gynecologic Cancer Survivorship Tool. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.249] [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: 11/27/2022]
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17
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Liu YL, Zhou QC, Iasonos A, Filippova OT, Chi DS, Zivanovic O, Sonoda Y, Gardner G, Broach V, OCearbhaill R, Konner JA, Aghajanian CA, Long K, Tew W. Delays from neoadjuvant chemotherapy to interval debulking surgery and survival in ovarian cancer. Int J Gynecol Cancer 2020; 30:1554-1561. [PMID: 32522770 DOI: 10.1136/ijgc-2019-000989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/11/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Delays from primary surgery to chemotherapy are associated with worse survival in ovarian cancer, however the impact of delays from neoadjuvant chemotherapy to interval debulking surgery is unknown. We sought to evaluate the association of delays from neoadjuvant chemotherapy to interval debulking with survival. METHODS Patients with a diagnosis of stage III/IV ovarian cancer receiving neoadjuvant chemotherapy from July 2015 to December 2017 were included in our analysis. Delays from neoadjuvant chemotherapy to interval debulking were defined as time from last preoperative carboplatin to interval debulking >6 weeks. Fisher's exact/Wilcoxon rank sum tests were used to compare clinical characteristics. The Kaplan-Meier method, log-rank test, and multivariate Cox Proportional-Hazards models were used to estimate progression-free and overall survival and examine differences by delay groups, adjusting for covariates. RESULTS Of the 224 women, 159 (71%) underwent interval debulking and 34 (21%) of these experienced delays from neoadjuvant chemotherapy to interval debulking. These women were older (median 68 vs 65 years, P=0.05) and received more preoperative chemotherapy cycles (median 6 vs 4, P=0.003). Delays from neoadjuvant chemotherapy to interval debulking were associated with worse overall survival (HR 2.4 95% CI 1.2 to 4.8, P=0.01), however survival was not significantly shortened after adjusting for age, stage, and complete gross resection, HR 1.66 95% CI 0.8 to 3.4, P=0.17. Delays from neoadjuvant chemotherapy to interval debulking were not associated with worse progression-free survival (HR 1.55 95% CI 0.97 to 2.5, P=0.062). Increase in number of preoperative cycles (P=0.005) and lack of complete gross resection (P<0.001) were the only variables predictive of worse progression-free survival. DISCUSSION Delays from neoadjuvant chemotherapy to interval debulking were not associated with worse overall survival after adjustment for age, stage, and complete gross resection.
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Affiliation(s)
- Ying L Liu
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Qin C Zhou
- Epidemiology-Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Alexia Iasonos
- Epidemiology-Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Olga T Filippova
- Gynecologic Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Dennis S Chi
- Gynecologic Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Oliver Zivanovic
- Gynecologic Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Yukio Sonoda
- Gynecologic Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Ginger Gardner
- Gynecologic Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Vance Broach
- Gynecologic Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Roisin OCearbhaill
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Jason A Konner
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Carol A Aghajanian
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Kara Long
- Gynecologic Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - William Tew
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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18
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Stasenko M, Feit N, Lee SSK, Shepherd C, Soslow RA, Cadoo KA, Alektiar K, Da Silva EM, Martins Sebastião AP, Leitao MM, Gardner G, Selenica P, Abu-Rustum NR, Weigelt B, Mueller JJ. Clinical patterns and genomic profiling of recurrent 'ultra-low risk' endometrial cancer. Int J Gynecol Cancer 2020; 30:717-723. [PMID: 32376737 PMCID: PMC7295026 DOI: 10.1136/ijgc-2020-001241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/15/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Despite good prognosis for patients with low-risk endometrial cancer, a small subset of women with low-grade/low-stage endometrial cancer experience disease recurrence and death. The aim of this study was to characterize clinical features and mutational profiles of recurrent, low-grade, non-myoinvasive, 'ultra-low risk' endometrioid endometrial adenocarcinomas. METHODS We retrospectively identified patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA endometrioid endometrial cancers who underwent primary surgery at our institution, between January 2009 and February 2017, with follow-up of ≥12 months. 'Ultra-low risk' was defined as FIGO tumor grade 1, non-myoinvasive, and lacking lymphovascular space invasion. Tumor-normal profiling using massively parallel sequencing targeting 468 genes was performed. Microsatellite instability was assessed using MSIsensor. DNA mismatch repair (MMR) protein proficiency was determined by immunohistochemistry. RESULTS A total of 486 patients with ultra-low risk endometrioid endometrial cancers were identified: 14 (2.9%) of 486 patients developed a recurrence. Median follow-up for non-recurrent endometrioid endometrial cancers: 34 (range 12-116) months; for recurrent endometrioid endometrial cancers: 50.5 (range 20-116) months. Patients with recurrent disease were older, had lower body mass index, and were most commonly non-White (p=0.025, p<0.001, and p<0.001, respectively). Other clinical characteristics did not differ. MMR immunohistochemistry was obtained for 211 (43%) tumors: 158 (75%) MMR-proficient and 53 (25%) MMR-deficient. Primary tumors of 9 recurrent and 27 non-recurrent endometrioid endometrial cancers underwent mutational profiling. Most were microsatellite stable (6/9, 67% recurrent; 25/27, 93% non-recurrent). Recurrent PTEN and PIK3CA mutations were present in both groups. Exon 3 CTNNB1 hotspot mutations were found in 4/9 (44%) recurrent and 8/27 (30%) non-recurrent (p=0.44). CONCLUSIONS Patients diagnosed with ultra-low risk endometrioid endometrial cancers have an overall excellent prognosis. However, in our study, 2.9% of patients with no identifiable clinical or pathologic risk factors developed recurrence. Further work is warranted to elucidate the mechanism for recurrence in this population.
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Affiliation(s)
- Marina Stasenko
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Noah Feit
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Simon S K Lee
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cassandra Shepherd
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert A Soslow
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Karen A Cadoo
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kaled Alektiar
- Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Edaise M Da Silva
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Mario M Leitao
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ginger Gardner
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Pier Selenica
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Britta Weigelt
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer J Mueller
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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19
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Moukarzel LA, Byrne ME, Leiva S, Wu M, Zhou QC, Iasonos A, Abu-Rustum NR, Sonoda Y, Gardner G, Leitao MM, Broach VA, Chi DS, Long Roche K, Zivanovic O. The impact of near-infrared angiography and proctoscopy after rectosigmoid resection and anastomosis performed during surgeries for gynecologic malignancies. Gynecol Oncol 2020; 158:397-401. [PMID: 32460995 DOI: 10.1016/j.ygyno.2020.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/18/2020] [Accepted: 05/13/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Reducing anastomotic leak rates after rectosigmoid resection and anastomosis is a priority in patients undergoing gynecologic oncology surgery. Therefore, we investigated the implications of performing near-infrared angiography (NIR) via proctoscopy to assess anastomotic perfusion at the time of rectosigmoid resection and anastomosis. METHODS We identified all patients who underwent rectosigmoid resection and anastomosis for a gynecologic malignancy between January 1, 2013 and December 31, 2018. NIR proctoscopy was assessed via the PINPOINT Endoscopic Imaging System (Stryker). RESULTS A total of 410 patients were identified, among whom NIR was utilized in 133 (32.4%). There were no statistically significant differences in age, race, BMI, type of malignancy, surgery, histology, FIGO stage, hypertension, diabetes, or preoperative chemotherapy between NIR and non-NIR groups. All cases of rectosigmoid resection underwent stapled anastomosis. The anastomotic leak rate was 2/133 (1.5%) in the NIR cohort compared with 13/277 (4.7%) in the non-NIR cohort (p = 0.16). Diverting ostomy was performed in 9/133 (6.8%) NIR and 53/277 (19.9%) non-NIR patients (p < 0.001). Postoperative abscesses occurred in 8/133 (6.0%) NIR and 44/277 (15.9%) non-NIR patients (p = 0.004). The NIR cohort had significantly fewer post-operative interventional procedures (12/133, 9.0% NIR vs. 55/277, 19.9% non-NIR, p = 0.006) and significantly fewer 30-day readmissions (14/133, 10.5% NIR vs. 61/277, 22% non-NIR, p = 0.004). CONCLUSIONS NIR proctoscopy is a safe tool for assessing anastomotic rectal perfusion after rectosigmoid resection and anastomosis, with a low anastomotic leak rate of 1.5%. Its potential usefulness should be evaluated in randomized trials in patients undergoing gynecologic cancer surgery.
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Affiliation(s)
- Lea A Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maureen E Byrne
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Leiva
- Department of Surgery, Hurley Medical Center, Flint, MI, USA
| | - Michelle Wu
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin C Zhou
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Ginger Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Vance A Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA.
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Broach V, Abu-Rustum NR, Sonoda Y, Brown CL, Jewell E, Gardner G, Chi DS, Zivanovic O, Leitao MM. Evolution and outcomes of sentinel lymph node mapping in vulvar cancer. Int J Gynecol Cancer 2020; 30:383-386. [PMID: 32075896 DOI: 10.1136/ijgc-2019-000936] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 09/17/2019] [Revised: 12/18/2019] [Accepted: 12/26/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To characterize our institutional experience with sentinel lymph node (SLN) biopsy in patients with vulvar cancer. We describe the oncologic outcomes of these patients and the utilization of SLN detection techniques over time. METHODS A retrospective analysis of all patients who underwent inguinofemoral SLN biopsy as part of their treatment for vulvar cancer at Memorial Sloan Kettering Cancer Center from January 1, 2000 to April 1, 2019. Patients were included in this analysis if they underwent inguinofemoral SLN biopsy for vulvar cancer, irrespective of presenting factors such as histology, tumor size or laterality. An "at-risk groin" was defined as either the right or left groin for which SLN biopsy of inguinofemoral lymph nodes was performed. RESULTS A total of 160 patients were included in our analysis, representing 265 at-risk groins. 114 patients had squamous cell histology representing 195 at-risk groins. Of the 169 negative groins in patients with squamous cell carcinoma, the 2 year isolated groin recurrence rate was 1.2%. SLN detection rate, irrespective of modality, was 96.2%. Technetium-99 (TC-99) + blue dye detected SLNs in 91.8% of groins; TC-99 + indocyanine green detected SLNs in 100% of groins (p=0.157). Among the 110 groins that underwent mapping with TC-99 and blue dye, 4 patients had failed mapping with blue dye and mapped with TC-99 alone (3.6%). Among the 96 groins that underwent mapping with TC-99 and ICG, 14 patients failed to map with TC-99 and mapped with indocyanine green alone (14.6%). CONCLUSIONS SLN mapping in vulvar cancer is reliable and oncologically effective. The utilization of indocyanine green for mapping has increased over the past decade and is associated with high rates of SLN detection.
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Affiliation(s)
- Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City, New York, USA .,Weill Cornell Medical College, New York, New York, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Carol L Brown
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Elizabeth Jewell
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Ginger Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City, New York, USA.,Weill Cornell Medical College, New York, New York, USA
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Carter J, Goldfarb S, Baser R, Goldfrank D, Seidel B, Milli L, Saban S, Kollmeier M, Stabile C, Canty J, Gardner G, Jewell E, Sonoda Y, Alektiar K. A Single-Arm Clinical Trial Investigating the Effectiveness of a Non-Hormonal Vaginal Moisturizer in Endometrial Cancer Survivors. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Brennan VS, Weg E, Beckham T, Damato A, Grisham R, Gardner G, Kollmeier M. Clinical Outcomes for Salvage High-Dose-Rate Brachytherapy in Patients with Recurrent Endometrial Cancer. Brachytherapy 2019. [DOI: 10.1016/j.brachy.2019.04.209] [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: 10/26/2022]
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Ortiz C, Kukreja K, Hayatghaibi S, Moturu A, Gardner G, Pezeshkmehr A, Desai S. 03:27 PM Abstract No. 36 Process map for interventional radiology at a large tertiary children’s hospital: understanding the workflow and identifying areas for improvement. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.075] [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: 10/27/2022] Open
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24
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Gardner G, Ziauddeen N, Alwan N. Investigating maternal risk factors for stillbirth in a population-based cohort in the South of England. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.097] [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: 11/16/2022] Open
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Johnson M, Villani T, Bachelor M, Oldach J, Gardner G. 696 Three dimensional IHC characterization of aging in 3D skin models. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.705] [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: 11/15/2022]
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Affiliation(s)
- J. Carryer
- School of Nursing College of Health Massey University Palmerston North New Zealand
| | - J. Wilkinson
- School of Public Health College of Health Massey University Palmerston North New Zealand
| | - A. Towers
- School of Nursing College of Health Massey University Wellington New Zealand
| | - G. Gardner
- Faculty of Health School of Nursing Queensland University of Technology Brisbane QLD Australia
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Abstract
AIM To identify the practice patterns of the Australian registered nurse workforce according to position title and to map these disparate titles across all jurisdictions of the country. INTRODUCTION Effective nursing workforce planning can contribute to improved patient care and increased effectiveness and efficiency of healthcare systems. BACKGROUND The prevailing approach to nursing workforce planning focuses on number of nursing staff needed in relation to the number of patients. The level of expertise and skill mix of registered nurses as a variable in workforce planning is rarely considered. METHODS A national cross-sectional electronic survey of registered nurses in Australia was conducted using the validated Advanced Practice Role Delineation tool developed from the Strong Model of Advanced Practice. The study involved a sample of 5599 registered nurses. RESULTS Sixty-six nursing position titles nationally were mapped using cluster analysis technique and gave rise to seven clusters of equivalent Australian jurisdictional nursing position titles and practice profiles. DISCUSSION Effective workforce policy and planning is reliant upon access to reliable evidence. This research is an international first in that it has provided comprehensive knowledge of the clinical level and practice profiles of a national nursing workforce. IMPLICATIONS FOR NURSING POLICY Effective, patient-centred workforce planning must consider both the numerical and expertise mix of a nursing workforce. This research provides Australian health service and policy planners with evidence-base knowledge of the nursing workforce. Internationally, this research establishes a platform from which to develop validated tools and established processes to support replication of this research.
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Affiliation(s)
- G Gardner
- School of Nursing, Institute for Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - C Duffield
- Nursing and Health Services Management, Centre for Health Services Management, University of Technology Sydney, Sydney, NSW, Australia
| | - A Doubrovsky
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - U T Bui
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - M Adams
- School of Nursing, Institute for Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Cleveland H, Pimpalwar S, Hernandez J, Ashton D, Gardner G, Kukreja K. Percutaneous ultrasound-guided liver biopsy in infants: Is it safe? J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.813] [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] Open
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29
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Cleveland H, Ashton D, Pimpalwar S, Hernandez J, Gardner G, Kukreja K. Percutaneous ultrasound-guided renal biopsy in pediatrics: Does pre-procedure hypertension matter? J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.816] [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] Open
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30
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Yang R, Ryan U, Gardner G, Carmichael I, Campbell AJD, Jacobson C. Prevalence, faecal shedding and genetic characterisation ofYersiniaspp. in sheep across four states of Australia. Aust Vet J 2016; 94:129-37. [DOI: 10.1111/avj.12428] [Citation(s) in RCA: 4] [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] [Received: 10/22/2014] [Revised: 07/01/2015] [Accepted: 08/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- R Yang
- School of Veterinary and Life Sciences; Murdoch University; Murdoch, Western Australia 6150 Australia
| | - U Ryan
- School of Veterinary and Life Sciences; Murdoch University; Murdoch, Western Australia 6150 Australia
| | - G Gardner
- School of Veterinary and Life Sciences; Murdoch University; Murdoch, Western Australia 6150 Australia
| | - I Carmichael
- South Australian Research and Development Institute; Glenside SA Australia
| | - AJD Campbell
- Mackinnon Project, Faculty of Veterinary Science; University of Melbourne; Werribee VIC Australia
| | - C Jacobson
- School of Veterinary and Life Sciences; Murdoch University; Murdoch, Western Australia 6150 Australia
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Hajj C, Kollmeier M, Gardner G, Sonoda Y, Abu-Rustum N, Alektiar K. Patterns of Relapse in Patients With Endometrial Cancer Treated With Postoperative Intensity Modulated Radiation Therapy (IMRT). Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1249] [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: 11/16/2022]
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Zumsteg Z, Kollmeier M, Gardner G, Abu-Rustum N, Alektiar K. A Redefined Risk Stratification System for Patients With Stage I-II Myometrial Invasive Endometrioid Adenocarcinoma. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.483] [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: 10/22/2022]
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Abstract
ACCESSIBLE SUMMARY Recent evidence suggests that the interactional work of mental health nursing has been eroded and redirected to the task-based roles of medicine. This study utilized work sampling methodology to observe the proportion of time nurses working in a mental health setting spend in direct care, indirect care and service-related activities. Nurses spent 32% of their time in direct care, 52% in indirect care and 17% in service-related activities. Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes. ABSTRACT The foundation of mental health nursing has historically been grounded in an interpersonal, person-centred process of health care, yet recent evidence suggests that the interactional work of mental health nursing is being eroded. Literature emphasizes the importance of person-centred care on consumer outcomes, a model reliant upon the intimate engagement of nurses and consumers. Yet, the arrival of medical interventions in psychiatry has diverted nursing work from the therapeutic nursing role to task-based roles delegated by medicine, distancing nurses from consumers. This study used work sampling methodology to observe the proportion of time nurses working in an inpatient mental health setting spend in the activities of direct care, indirect care and service-related activities. Nurses spent 32 of their time in direct care, 52% in indirect care and 17% in service-related activities. Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes.
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Affiliation(s)
- N Goulter
- Metro North Mental Health Services, Royal Brisbane & Women's Hospital & Queensland University of Technology, Brisbane, QLD, Australia
| | - D J Kavanagh
- School of Psychology, Queensland University of Technology & Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia
| | - G Gardner
- School of Nursing, Queensland University of Technology & Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia
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Wilson MB, Brinkman D, Spivak M, Gardner G, Cohen JD. Regional variation in composition and antimicrobial activity of US propolis against Paenibacillus larvae and Ascosphaera apis. J Invertebr Pathol 2014; 124:44-50. [PMID: 25450740 DOI: 10.1016/j.jip.2014.10.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 08/07/2014] [Revised: 10/16/2014] [Accepted: 10/20/2014] [Indexed: 12/11/2022]
Abstract
Propolis is a substance derived from antimicrobial plant resins that honey bees use in the construction of their nests. Propolis use in the hive is an important component of honey bee social immunity and confers a number of positive physiological benefits to bees. The benefits that bees derive from resins are mostly due to their antimicrobial properties, but it is unknown how the diversity of antimicrobial activities among resins might impact bee health. In our previous work, we found that resins from different North American Populus spp. differed in their ability to inhibit in vitro growth of the bee bacterial pathogen Paenibacillus larvae. The goal of our current work was to characterize the antimicrobial activity of propolis from 12 climatically diverse regions across the US against the bee pathogens P. larvae and Ascosphaera apis and compare the metabolite profiles among those samples using LC-MS-based metabolomic methods. Samples differed greatly in their ability to inhibit both bacterial and fungal growth in vitro, but propolis from Nevada, Texas, and California displayed high activity against both pathogens. Interestingly, propolis from Georgia, New York, Louisiana, and Minnesota were active against A. apis, but not very active against P. larvae. Metabolomic analysis of regional propolis samples revealed that each sample was compositionally distinct, and LC-FTMS profiles from each sample contained a unique number of shared and exclusive peaks. Propolis from Aspen, CO, Tuscon, AZ, and Raleigh, NC, contained relatively large numbers of exclusive peaks, which may indicate that these samples originated from relatively unique botanical sources. This is the first study to characterize how the diversity of bee preferred resinous plants in the US may affect bee health, and could guide future studies on the therapeutic potential of propolis for bees.
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Affiliation(s)
- M B Wilson
- Department of Entomology, University of Minnesota, 219 Hodson Hall, 1980 Folwell Ave, St. Paul, MN 55108, USA.
| | - D Brinkman
- Department of Horticultural Science, University of Minnesota, 305 Alderman Hall, 1970 Folwell Ave, St. Paul, MN 55108, USA.
| | - M Spivak
- Department of Entomology, University of Minnesota, 219 Hodson Hall, 1980 Folwell Ave, St. Paul, MN 55108, USA.
| | - G Gardner
- Department of Horticultural Science, University of Minnesota, 305 Alderman Hall, 1970 Folwell Ave, St. Paul, MN 55108, USA; Microbial and Plant Genomics Institute, University of Minnesota, USA.
| | - J D Cohen
- Department of Horticultural Science, University of Minnesota, 305 Alderman Hall, 1970 Folwell Ave, St. Paul, MN 55108, USA; Microbial and Plant Genomics Institute, University of Minnesota, USA.
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Jewell E, Juan J, Gardner G, Abu-Rustum N, Brown C, Sonoda Y, Barakat R, Levine D, Leitao M. Detection of sentinel lymph nodes using indocyanine green and near-in- frared fluorescence imaging for gynecological malignancies. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barlin J, Long K, Tanner E, Gardner G, Leitao M, Levine D, Sonoda Y, Abu-Rustum N, Barakat R, Chi D. Optimal but visible residual disease: Is extensive debulking warranted? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.331] [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: 10/26/2022]
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Shorter C, Connor D, Thakur J, Gardner G, Guthikonda B. Repair of Middle Fossa Cerebrospinal Fluid Leaks Using a Novel Combination of Materials: A Technical Note. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314258] [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: 10/28/2022]
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Cormier B, Tanner E, Ducie J, Long K, Wethington S, Wadhawan I, Leitao M, Barakat R, Chi D, Gardner G. Isolated Lymph Node Recurrence is Associated with Improved Survival in Advanced Stage Ovarian Cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.01.024] [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: 10/28/2022]
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Tanner E, Long K, Feffer J, Leitao M, Abu-Rustum N, Barakat R, Chi D, Gardner G. Parenchymal Splenic Metastasis is an Independent Negative Predictor of Overall Survival in Advanced Ovarian, Fallopian Tube and Primary Peritoneal Cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.01.042] [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: 10/28/2022]
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Cormier B, Long K, Ducie J, Tanner E, Wadhawan I, Jewell E, Leitao M, Barakat R, Chi D, Gardner G. Do patients with complete gross resection of advanced stage ovarian cancer benefit from lymphadenectomy? Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.056] [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: 10/28/2022]
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Cormier B, Tanner E, Ducie J, Long K, Wethington S, Wadhawan I, Leitao M, Barakat R, Chi D, Gardner G. Isolated lymph node recurrence is associated with improved survival in advanced stage ovarian cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.250] [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: 11/26/2022]
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Leitao M, Calderon B, Gardner G, Chi D, Sonoda Y, Barakat R. Feasibility and safety of same-day discharge after minimally invasive hysterectomy alone or with other procedures for benign and malignant indications. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.097] [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: 11/27/2022]
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Long K, Tanner E, Frey M, Cormier B, Gardner G, Sonoda Y, Levine D, Brown C, Barakat R, Chi D. Does intraoperative hypothermia contribute to postoperative morbidity in patients undergoing optimal primary surgical cytoreduction for advanced ovarian cancer? Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.249] [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: 11/26/2022]
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Wethington S, Park K, Soslow R, Kauff N, Brown C, Sonoda Y, Abu-Rustum N, Barakat R, Levine D, Gardner G. Clinical outcome of Serous Tubal Intraepithelial Carcinomas (STIC). Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.100] [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: 11/27/2022]
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Abstract
Meningiomas involving the temporal bone may originate from arachnoid cell nests present within the temporal bone (intratemporal), but more frequently originate from arachnoid cell nests of the posterior or middle cranial fossa with secondary invasion of the TB (extratemporal). In this study, we retrospectively reviewed the charts of 13 patients with meningiomas involving the temporal bone who underwent surgery. Tumors of the posterior fossa with only temporal bone hyperostosis, but without invasion, were excluded. Patients presented primarily with otologic symptoms and signs. The tumors originated in the temporal bone (5/13), jugular foramen (4/13), petroclival region (2/13), the asterion (1/13) or the internal auditory meatus (1/13). All of the intratemporal meningiomas had the radiological appearance of en-plaque menigiomas. The tumor extended into the middle ear (11/13), eustachian tube (5/13), and/or the labyrinth (3/13). A gross total resection was achieved in 11 patients and a subtotal resection in 2 patients. The lower cranial nerves were infiltrated by tumor in 4 patients, and were sacrificed. At a mean follow-up of approximately 6 years, 12 patients are currently alive and doing well and 1 died from tumor progression. Six patients showed tumor recurrence and were reoperated on (5/6) or followed conservatively (1/6). Surgical treatment of temporal bone meningiomas is associated with high recurrence rate due to indiscreet tumor margins. Combined surgical approaches (temporal craniotomy and mastoidectomy) by neurosurgical and otological teams are recommended for meningiomas originating in the temporal bone.
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Tanner E, Long K, Zhou Q, Brightwell R, Gardner G, Abu-Rustum N, Leitao M, Sonoda Y, Barakat R, Iasonos A, Chi D. Does operative start time impact the frequency of complete gross resection in patients undergoing primary cytoreduction for advanced serous ovarian carcinoma? Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2011.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Long K, Tanner E, Guy M, Leitao M, Gardner G, Sonoda Y, Brown C, Barakat R, Chi D. Cytoreductive surgery for serous ovarian cancer in patients 75years and older. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.160] [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: 10/18/2022]
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Leitao M, Khoury Collado F, Gardner G, Jewell E, Brown C, Sonoda Y, Levine D, Barakat R, Abu-Rustum N. Sentinel lymph node mapping in patients with endometrial cancer undergoing robot-assisted or standard laparoscopic procedures. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Leitao M, Gardner G, Briscoe G, Dholakiya P, Santos K, Jewell E, Abu-Rustum N, Sonoda Y, Barakat R, Malhotra V. Postoperative pain medication requirements in patients undergoing robotically assisted and standard laparoscopic procedures for newly diagnosed endometrial cancer. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.311] [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: 10/18/2022]
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50
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Leitao M, Gardner G, Briscoe G, Santos K, Jewell E, Abu-Rustum N, Brown C, Chi D, Sonoda Y, Barakat R. Comparison of robot-assisted and standard laparoscopic procedures in patients with endometrial cancer. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.303] [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: 11/17/2022]
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