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Mutch D, Gaffney D, Matias-Guiu X, Fotopoulou C, Concin N, Berek JS. Response: Analysis of adjuvant therapy in early staged endometrioid endometrial cancer-FIGO 2023 classification. Int J Gynaecol Obstet 2024; 165:1304-1305. [PMID: 38512105 DOI: 10.1002/ijgo.15478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Xavier Matias-Guiu
- Department of Pathology, Centro de Investigación Biomédica en Red de Cáncer, Instituto de Investigación Biomédica de BellvitgeHospital U de Bellvitge and Hospital U Arnau de Vilanova, Universities of Lleida and Barcelona, Barcelona, Spain
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
- Kliniken Essen- Mitte, Essen, Germany
| | - Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, California, USA
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Gaffney D, Matias-Guiu X, Mutch D, Scambia G, Creutzberg C, Fotopoulou C, Berek JS, Concin N. 2023 FIGO staging system for endometrial cancer: The evolution of the revolution. Gynecol Oncol 2024; 184:245-253. [PMID: 38447389 DOI: 10.1016/j.ygyno.2024.02.002] [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: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Embracing the complex and diverse nature of the heterogenous group of malignancies that are included under the umbrella of "endometrial cancer" (EC) to better align prognosis with treatment recommendations, requires a more comprehensive staging system. Our goal at the development of the new FIGO staging was to provide 1) high accuracy in the predictive prognosis for a patient with EC, which is the genuine purpose of a staging system, and 2) identification of distinct treatment relevant subgroups. Since the publication of the 2009 staging system by the International Federation of Gynecology and Obstetrics (FIGO) 14 years ago (1, 2), our understanding of the biology and natural history of EC has undergone a radical transformation. The TGCA results in 2013 (3), and the many validation reports published since then (4-9), have taught us that "EC" is composed of at least four distinct molecularly defined diseases. Strong histopathologic markers reflecting tumor biology such as lymph vascular space invasion (LVSI) were identified. Importantly, anatomical borders were shown to lose their prognostic relevance for EC patients in the presence of dominant tumor biology-markers such as molecular subtypes/LVSI (10, 11). This emphasizes the integration of these novel markers into a prognostic staging system that aims to be relevant to patients. The 2023 FIGO staging system for EC harmonizes and integrates old and new knowledge on anatomic, histopathologic, and molecular features (12). It requires a change in our perception of a staging system, from a traditional purely anatomical borders-based system to an integrated staging system integrating anatomical borders and tumor biology as pivotal prognostic factors for EC patients while providing important information for treatment decision making. Therefore, the 2023 FIGO staging system demonstrates the logical next step in the evolution of the revolution in a patient-centric staging approach. Below, we elucidate the rationale for the FIGO 2023 endometrial cancer staging system.
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Affiliation(s)
- David Gaffney
- University of Utah, Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT, USA
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U de Bellvitge and Hospital U Arnau de Vilanova, Universities of Lleida and Barcelona, Institut de Recerca Biomèdica de Lleida, Instituto de Investigación Biomédica de Bellvitge, Centro de Investigación Biomédica en Red de Cáncer, Barcelona, Spain
| | - David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria; Department of Gynaecology and Gynaecological Oncology, Medical University of Vienna, Vienna, Austria.
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Roncolato F, King MT, O'Connell RL, Lee YC, Joly F, Hilpert F, Lanceley A, Yoshida Y, Bryce J, Donnellan P, Oza A, Avall-Lundqvist E, Berek JS, Ledermann JA, Berton D, Sehouli J, Kaminsky MC, Stockler MR, Friedlander M. Hidden in plain sight - Survival consequences of baseline symptom burden in women with recurrent ovarian cancer. Gynecol Oncol 2024; 185:128-137. [PMID: 38412736 DOI: 10.1016/j.ygyno.2024.02.025] [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: 11/28/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To describe the baseline symptom burden(SB) experienced by patients(pts) with recurrent ovarian cancer(ROC) prior and associations with progression free survival (PFS) and overall survival (OS). METHODS We analysed baseline SB reported by pts. with platinum resistant/refractory ROC (PRR-ROC) or potentially‑platinum sensitive ROC receiving their third or greater line of chemotherapy (PPS-ROC≥3) enrolled in the Gynecologic Cancer InterGroup - Symptom Benefit Study (GCIG-SBS) using the Measure of Ovarian Symptoms and Treatment concerns (MOST). The severity of baseline symptoms was correlated with PFS and OS. RESULTS The 948 pts. reported substantial baseline SB. Almost 80% reported mild to severe pain, and 75% abdominal symptoms. Shortness of breath was reported by 60% and 90% reported fatigue. About 50% reported moderate to severe anxiety, and 35% moderate to severe depression. Most (89%) reported 1 or more symptoms as moderate or severe, 59% scored 6 or more symptoms moderate or severe, and 46% scored 9 or more symptoms as moderate or severe. Higher SB was associated with significantly shortened PFS and OS; five symptoms had OS hazard ratios larger than 2 for both moderate and severe symptom cut-offs (trouble eating, vomiting, indigestion, loss of appetite, and nausea; p < 0.001). CONCLUSION Pts with ROC reported high SB prior to starting palliative chemotherapy, similar among PRR-ROC and PPS-ROC≥3. High SB was strongly associated with early progression and death. SB should be actively managed and used to stratify patients in clinical trials. Clinical trials should measure and report symptom burden and the impact of treatment on symptom control.
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Affiliation(s)
- Felicia Roncolato
- The University of Sydney, NHMRC Clinical Trials Centre, School of Medicine, Australia; Western Sydney University, Australia; Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Madeleine T King
- The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Rachel L O'Connell
- The University of Sydney, NHMRC Clinical Trials Centre, School of Medicine, Australia
| | - Yeh Chen Lee
- The University of Sydney, NHMRC Clinical Trials Centre, School of Medicine, Australia; School of Clinical Medicine, UNSW, Sydney, Australia; Department of Medical Oncology, Prince of Wales and Royal Hospital for Women, Randwick, NSW, Australia
| | - Florence Joly
- Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Paris, France; Centre Francois Baclesse, Caen, France
| | - Felix Hilpert
- Arbeitsgesmeinschaft Gynakologische Onkologie Studiengruppe (AGO) und North-Eastern German Society of Gynecological Oncology (NOGGO), Kiel, Germany; Onkologisches Therapiezentrum, Krankenhaus, Jerusalem, Hamburg, Germany
| | - Anne Lanceley
- Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London, UK
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, Japan
| | - Jane Bryce
- Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO), Napoli, Italy; Ascension St. John Clinical Research Institute, Tulsa, OK, USA; Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Paul Donnellan
- Cancer Trials Ireland, Galway University Hospital, Galway, Ireland
| | - Amit Oza
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elisabeth Avall-Lundqvist
- Nordic Society of Gynaecological Oncology (NSGO), Copenhagen, Denmark; Department of Oncology and Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden; Department of Oncology-Pathology, Karolinksa Institutet, Stockholm, Sweden
| | - Jonathan S Berek
- Cooperative Gynecologic Oncology Investigators (COGI), Stanford, CA, USA; Stanford Women's Cancer Centre, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Dominique Berton
- Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Paris, France; Institut de Cancerologie de l'Ouest, Centre Rene, Gauducheau, Saint Herblain, France
| | - Jalid Sehouli
- Arbeitsgesmeinschaft Gynakologische Onkologie Studiengruppe (AGO) und North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany; Department of Gynecology and Oncological Surgery, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Marie-Christine Kaminsky
- Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Paris, France; Institut de Cancerologie de Lorraine, Vandoeuvre Les Nancy, France
| | - Martin R Stockler
- The University of Sydney, NHMRC Clinical Trials Centre, School of Medicine, Australia
| | - Michael Friedlander
- School of Clinical Medicine, UNSW, Sydney, Australia; Department of Medical Oncology, Prince of Wales and Royal Hospital for Women, Randwick, NSW, Australia.
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Concin N, Matias-Guiu X, Fotopoulou C, Creutzberg C, Mutch D, Gaffney D, Lindemann K, Kehoe S, Berek JS. Response: FIGO staging of endometrial cancer 2023. Int J Gynaecol Obstet 2024; 164:369-372. [PMID: 38055215 DOI: 10.1002/ijgo.15277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U. de Bellvitge and Hospital U. Arnau de Vilanova, Universities of Lleida and Barcelona, Institut de Recerca Biomèdica de Lleida, Instituto de Investigación Biomédica de Bellvitge, Centro de Investigación Biomédica en Red de Cáncer, Barcelona, Spain
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Kristina Lindemann
- Department of Gynaecological Cancer, Oslo University Hospital, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sean Kehoe
- Oxford Gynaecological Cancer Centre, Churchill Hospital, Oxford, UK
| | - Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, California, USA
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Henry L, Berek JS, Diaz I, Feldberg D, Mocanu E, Niederberger CC, Ohlander S, Purandare N, Rosenwaks Z, Tulandi T, Wasson M, Wilailak S, Malhotra J. FIGO statement: Fertility preservation. Int J Gynaecol Obstet 2023; 163:790-794. [PMID: 37807831 DOI: 10.1002/ijgo.15187] [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: 10/10/2023]
Abstract
Fertility preservation is a growing field in reproductive medicine that may raise ethical questions. Preservation of fertility must be discussed with the patient if gonadotoxic treatment is required, whether in the case of benign or malignant pathology, or in the management of transgender identity. As a result, surgery or chemotherapy that has fewer adverse impacts on fertility should be proposed if this does not alter the prognosis of the disease. If the risk of infertility persists, then fertility cryopreservation should be proposed for children and adults of reproductive age. Sperm, oocytes, and gonadal tissue can be cryopreserved for many years. FIGO wishes to emphasize the importance of fertility preservation in the medical and surgical management of patients, and the importance of a specialized, multidisciplinary approach.
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Affiliation(s)
- Laurie Henry
- ART Center of the Department of Obstetrics and Gynecology, CHU of Liège-Citadelle Site, University of Liège, Liège, Belgium
| | - Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Ivonne Diaz
- Nueva Granada and Unisanitas University, Bogotá, Colombia
| | - Dov Feldberg
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Edgar Mocanu
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - C Craig Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
- Department of Bioengineering, University of Illinois at Chicago College of Engineering, Chicago, Illinois, USA
| | - Samuel Ohlander
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Nikhil Purandare
- Department of Obstetrics and Gynecology, Galway University Hospital, Galway, Ireland
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montréal, Quebec, Canada
| | - Megan Wasson
- Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, Arizona, USA
| | - Sarikapan Wilailak
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Crum AJ, Heathcote LC, Morrison Z, Yielder R, Leibowitz K, Petousis-Harris H, Thomas MG, Prober CG, Berek JS, Petrie KJ. Changing Mindsets About Side Effects of the COVID-19 Vaccination: A Randomized Controlled Trial. Ann Behav Med 2023; 57:901-909. [PMID: 37279932 PMCID: PMC10578416 DOI: 10.1093/abm/kaad020] [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: 06/08/2023] Open
Abstract
BACKGROUND Side-effect concerns are a major barrier to vaccination against COVID-19 and other diseases. Identifying cost- and time-efficient interventions to improve vaccine experience and reduce vaccine hesitancy-without withholding information about side effects-is critical. PURPOSE Determine whether a brief symptom as positive signals mindset intervention can improve vaccine experience and reduce vaccine hesitancy after the COVID-19 vaccination. METHODS English-speaking adults (18+) were recruited during the 15-min wait period after receiving their second dose of the Pfizer COVID-19 vaccination and were randomly allocated to the symptom as positive signals mindset condition or the treatment as usual control. Participants in the mindset intervention viewed a 3:43-min video explaining how the body responds to vaccinations and how common side effects such as fatigue, sore arm, and fever are signs that the vaccination is helping the body boost immunity. The control group received standard vaccination center information. RESULTS Mindset participants (N = 260) versus controls (N = 268) reported significantly less worry about symptoms at day 3 [t(506)=2.60, p=.01, d=0.23], fewer symptoms immediately following the vaccine [t(484)=2.75, p=.006, d=0.24], and increased intentions to vaccinate against viruses like COVID-19 in the future [t(514)=-2.57, p=.01, d=0.22]. No significant differences for side-effect frequency at day 3, coping, or impact. CONCLUSIONS This study supports the use of a brief video aimed at reframing symptoms as positive signals to reduce worry and increase future vaccine intentions. CLINICAL TRIAL INFORMATION Australian New Zealand Clinical Trials Registry: ACTRN12621000722897p.
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Affiliation(s)
- Alia J Crum
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Zara Morrison
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Rachael Yielder
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Kari Leibowitz
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Helen Petousis-Harris
- Department of General Practice and Primary Care, University of Auckland, Auckland, New Zealand
| | - Mark G Thomas
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Charles G Prober
- Professor of Pediatrics, Microbiology, & Immunology, Stanford Center for Health Education, Stanford University, Stanford, CA, USA
| | - Jonathan S Berek
- Stanford Women’s Cancer Center, Stanford Center for Health Education, Stanford Medicine, Stanford, CA, USA
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Peters WA, Liu PY, Barrett RJ, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W, Alberts DS. Concurrent Chemotherapy and Pelvic Radiation Therapy Compared With Pelvic Radiation Therapy Alone as Adjuvant Therapy After Radical Surgery in High-Risk Early-Stage Cancer of the Cervix. J Clin Oncol 2023; 41:4605-4612. [PMID: 37797409 DOI: 10.1200/jco.22.02769] [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: 10/07/2023] Open
Abstract
PURPOSE To determine whether the addition of cisplatin-based chemotherapy (CT) to pelvic radiation therapy (RT) will improve the survival of early-stage, high-risk patients with cervical carcinoma. PATIENTS AND METHODS Patients with clinical stage IA2, IB, and IIA carcinoma of the cervix, initially treated with radical hysterectomy and pelvic lymphadenectomy, and who had positive pelvic lymph nodes and/or positive margins and/or microscopic involvement of the parametrium were eligible for this study. Patients were randomized to receive RT or RT + CT. Patients in each group received 49.3 GY RT in 29 fractions to a standard pelvic field. Chemotherapy consisted of bolus cisplatin 70 mg/m2 and a 96-hour infusion of fluorouracil 1,000 mg/m2/d every 3 weeks for four cycles, with the first and second cycles given concurrent to RT. RESULTS Between 1991 and 1996, 268 patients were entered onto the study. Two hundred forty-three patients were assessable (127 RT + CT patients and 116 RT patients). Progression-free and overall survival are significantly improved in the patients receiving CT. The hazard ratios for progression-free survival and overall survival in the RT only arm versus the RT + CT arm are 2.01 (P = .003) and 1.96 (P = .007), respectively. The projected progression-free survivals at 4 years is 63% with RT and 80% with RT + CT. The projected overall survival rate at 4 years is 71% with RT and 81% with RT + CT. Grades 3 and 4 hematologic and gastrointestinal toxicity were more frequent in the RT + CT group. CONCLUSION The addition of concurrent cisplatin-based CT to RT significantly improves progression-free and overall survival for high-risk, early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix.
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Affiliation(s)
- William A Peters
- From the Puget Sound Oncology Consortium; and Southwest Oncology Group Statistical CenterSeattle, WA; Bowman Gray School of Medicine, Winston-Salem, NC; Walter Reed Army Medical Center, Washington, DC; University of California at Irvine, Irvine; University of California at Los Angeles, Los Angeles, CA; McGill University, Montreal, Quebec, Canada; Mallinckrodt Institute of Radiology, St Louis, MO; Clear Lake Regional Medical Center, Webster, TX; University of Arizona Cancer Center, Tucson, AZ
| | - P Y Liu
- From the Puget Sound Oncology Consortium; and Southwest Oncology Group Statistical CenterSeattle, WA; Bowman Gray School of Medicine, Winston-Salem, NC; Walter Reed Army Medical Center, Washington, DC; University of California at Irvine, Irvine; University of California at Los Angeles, Los Angeles, CA; McGill University, Montreal, Quebec, Canada; Mallinckrodt Institute of Radiology, St Louis, MO; Clear Lake Regional Medical Center, Webster, TX; University of Arizona Cancer Center, Tucson, AZ
| | - Rolland J Barrett
- From the Puget Sound Oncology Consortium; and Southwest Oncology Group Statistical CenterSeattle, WA; Bowman Gray School of Medicine, Winston-Salem, NC; Walter Reed Army Medical Center, Washington, DC; University of California at Irvine, Irvine; University of California at Los Angeles, Los Angeles, CA; McGill University, Montreal, Quebec, Canada; Mallinckrodt Institute of Radiology, St Louis, MO; Clear Lake Regional Medical Center, Webster, TX; University of Arizona Cancer Center, Tucson, AZ
| | - Richard J Stock
- From the Puget Sound Oncology Consortium; and Southwest Oncology Group Statistical CenterSeattle, WA; Bowman Gray School of Medicine, Winston-Salem, NC; Walter Reed Army Medical Center, Washington, DC; University of California at Irvine, Irvine; University of California at Los Angeles, Los Angeles, CA; McGill University, Montreal, Quebec, Canada; Mallinckrodt Institute of Radiology, St Louis, MO; Clear Lake Regional Medical Center, Webster, TX; University of Arizona Cancer Center, Tucson, AZ
| | - Bradley J Monk
- From the Puget Sound Oncology Consortium; and Southwest Oncology Group Statistical CenterSeattle, WA; Bowman Gray School of Medicine, Winston-Salem, NC; Walter Reed Army Medical Center, Washington, DC; University of California at Irvine, Irvine; University of California at Los Angeles, Los Angeles, CA; McGill University, Montreal, Quebec, Canada; Mallinckrodt Institute of Radiology, St Louis, MO; Clear Lake Regional Medical Center, Webster, TX; University of Arizona Cancer Center, Tucson, AZ
| | - Jonathan S Berek
- From the Puget Sound Oncology Consortium; and Southwest Oncology Group Statistical CenterSeattle, WA; Bowman Gray School of Medicine, Winston-Salem, NC; Walter Reed Army Medical Center, Washington, DC; University of California at Irvine, Irvine; University of California at Los Angeles, Los Angeles, CA; McGill University, Montreal, Quebec, Canada; Mallinckrodt Institute of Radiology, St Louis, MO; Clear Lake Regional Medical Center, Webster, TX; University of Arizona Cancer Center, Tucson, AZ
| | - Luis Souhami
- From the Puget Sound Oncology Consortium; and Southwest Oncology Group Statistical CenterSeattle, WA; Bowman Gray School of Medicine, Winston-Salem, NC; Walter Reed Army Medical Center, Washington, DC; University of California at Irvine, Irvine; University of California at Los Angeles, Los Angeles, CA; McGill University, Montreal, Quebec, Canada; Mallinckrodt Institute of Radiology, St Louis, MO; Clear Lake Regional Medical Center, Webster, TX; University of Arizona Cancer Center, Tucson, AZ
| | - Perry Grigsby
- From the Puget Sound Oncology Consortium; and Southwest Oncology Group Statistical CenterSeattle, WA; Bowman Gray School of Medicine, Winston-Salem, NC; Walter Reed Army Medical Center, Washington, DC; University of California at Irvine, Irvine; University of California at Los Angeles, Los Angeles, CA; McGill University, Montreal, Quebec, Canada; Mallinckrodt Institute of Radiology, St Louis, MO; Clear Lake Regional Medical Center, Webster, TX; University of Arizona Cancer Center, Tucson, AZ
| | - William Gordon
- From the Puget Sound Oncology Consortium; and Southwest Oncology Group Statistical CenterSeattle, WA; Bowman Gray School of Medicine, Winston-Salem, NC; Walter Reed Army Medical Center, Washington, DC; University of California at Irvine, Irvine; University of California at Los Angeles, Los Angeles, CA; McGill University, Montreal, Quebec, Canada; Mallinckrodt Institute of Radiology, St Louis, MO; Clear Lake Regional Medical Center, Webster, TX; University of Arizona Cancer Center, Tucson, AZ
| | - David S Alberts
- From the Puget Sound Oncology Consortium; and Southwest Oncology Group Statistical CenterSeattle, WA; Bowman Gray School of Medicine, Winston-Salem, NC; Walter Reed Army Medical Center, Washington, DC; University of California at Irvine, Irvine; University of California at Los Angeles, Los Angeles, CA; McGill University, Montreal, Quebec, Canada; Mallinckrodt Institute of Radiology, St Louis, MO; Clear Lake Regional Medical Center, Webster, TX; University of Arizona Cancer Center, Tucson, AZ
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Berek JS, Matias-Guiu X. Response: FIGO staging of endometrial cancer: 2023. Int J Gynaecol Obstet 2023; 163:331. [PMID: 37548599 DOI: 10.1002/ijgo.15046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
- Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U de Bellvitge and Hospital U Arnau de Vilanova, Universities of Lleida and Barcelona, Institut de Recerca Biomèdica de Lleida, Instituto de Investigación Biomédica de Bellvitge, Centro de Investigación Biomédica en Red de Cáncer, Barcelona, Spain
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Zion SR, Schapira L, Berek JS, Spiegel D, Dweck CS, Crum AJ. Changing cancer mindsets: A randomized controlled feasibility and efficacy trial. Psychooncology 2023; 32:1433-1442. [PMID: 37529924 DOI: 10.1002/pon.6194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/02/2023] [Revised: 06/20/2023] [Accepted: 07/16/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE A cancer diagnosis and subsequent treatment can disrupt the full spectrum of physical, social, emotional, and functional quality of life. But existing psychological treatments are focused primarily on specific psychological symptoms as opposed to improving the overall patient experience. We studied the feasibility and efficacy of a novel digital intervention targeting patient mindsets-core assumptions about the nature and meaning of illness-designed to improve overall health-related quality of life (HRQoL) in newly diagnosed cancer patients undergoing treatment with curative intent. METHODS Recently diagnosed (≤150 days) adult patients with non-metastatic cancers undergoing systemic treatment (N = 361) were recruited from across the United States to participate in this decentralized clinical trial. Patients were randomized 1:1 to receive the Cancer Mindset Intervention (CMI) or Treatment as Usual (TAU). Participants in the CMI group completed seven online modules over 10 weeks (2.5 h total) targeting mindsets about cancer and the body. The primary outcome was overall HRQoL, and secondary outcomes were coping behaviors and symptom distress. RESULTS Patients in the CMI group reported significant (p < 0.001) improvements in adaptive mindsets about cancer and the body over time. Compared with the TAU condition, the CMI group reported significant improvements in overall HRQoL (B = 0.60; 95% CI 0.34-0.85; p < 0.001), increased engagement in adaptive coping behaviors (B = 0.03; 95% CI 0.02-0.04; p < 0.001), and reduced distress from physical symptoms (B = -0.29; 95% CI -0.44 to -0.14; p < 0.01). Effect sizes of these changes ranged from d = 0.42-d = 0.54. CONCLUSION A brief mindset-focused digital intervention was effective at improving physical, social, emotional, and functional HRQoL, increasing adaptive coping behaviors, and reducing physical symptom distress in newly diagnosed cancer patients.
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Affiliation(s)
- Sean R Zion
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan S Berek
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
- Stanford Women's Cancer Center, Stanford University School of Medicine, Stanford, California, USA
| | - David Spiegel
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Carol S Dweck
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, California, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
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10
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Abstract
INTRODUCTION Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the publication of The Cancer Genome Atlas (TCGA) data and provide improved clarity on the diverse biological nature of this collection of endometrial cancers and their differing prognostic outcomes. The goals of the new staging system are to better define these prognostic groups and create substages that indicate more appropriate surgical, radiation, and systemic therapies. METHODS The FIGO Women's Cancer Committee appointed a Subcommittee on Endometrial Cancer Staging in October 2021, represented by the authors. Since then, the committee members have met frequently and reviewed new and established evidence on the treatment, prognosis, and survival of endometrial cancer. Based on these data, opportunities for improvements in the categorization and stratification of these factors were identified in each of the four stages. Data and analyses from the molecular and histological classifications performed and published in the recently developed ESGO/ESTRO/ESP guidelines were used as a template for adding the new subclassifications to the proposed molecular and histological staging system. RESULTS Based on the existing evidence, the substages were defined as follows: Stage I (IA1): non-aggressive histological type of endometrial carcinoma limited to a polyp or confined to the endometrium; (IA2) non-aggressive histological types of endometrium involving less than 50% of the myometrium with no or focal lymphovascular space invasion (LVSI) as defined by WHO criteria; (IA3) low-grade endometrioid carcinomas limited to the uterus with simultaneous low-grade endometrioid ovarian involvement; (IB) non-aggressive histological types involving 50% or more of the myometrium with no LVSI or focal LVSI; (IC) aggressive histological types, i.e. serous, high-grade endometrioid, clear cell, carcinosarcomas, undifferentiated, mixed, and other unusual types without any myometrial invasion. Stage II (IIA): non-aggressive histological types that infiltrate the cervical stroma; (IIB) non-aggressive histological types that have substantial LVSI; or (IIC) aggressive histological types with any myometrial invasion. Stage III (IIIA): differentiating between adnexal versus uterine serosa infiltration; (IIIB) infiltration of vagina/parametria and pelvic peritoneal metastasis; and (IIIC) refinements for lymph node metastasis to pelvic and para-aortic lymph nodes, including micrometastasis and macrometastasis. Stage IV (IVA): locally advanced disease infiltrating the bladder or rectal mucosa; (IVB) extrapelvic peritoneal metastasis; and (IVC) distant metastasis. The performance of complete molecular classification (POLEmut, MMRd, NSMP, p53abn) is encouraged in all endometrial cancers. If the molecular subtype is known, this is recorded in the FIGO stage by the addition of "m" for molecular classification, and a subscript indicating the specific molecular subtype. When molecular classification reveals p53abn or POLEmut status in Stages I and II, this results in upstaging or downstaging of the disease (IICmp53abn or IAmPOLEmut). SUMMARY The updated 2023 staging of endometrial cancer includes the various histological types, tumor patterns, and molecular classification to better reflect the improved understanding of the complex nature of the several types of endometrial carcinoma and their underlying biologic behavior. The changes incorporated in the 2023 staging system should provide a more evidence-based context for treatment recommendations and for the more refined future collection of outcome and survival data.
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Affiliation(s)
- Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, CA, USA.
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U de Bellvitge and Hospital U Arnau de Vilanova, Universities of Lleida and Barcelona, Institut de Recerca Biomèdica de Lleida, Instituto de Investigación Biomédica de Bellvitge, Centro de Investigación Biomédica en Red de Cáncer, Barcelona, Spain
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - Sean Kehoe
- Oxford Gynaecological Cancer Centre, Churchill Hospital, Oxford, UK
| | - Kristina Lindemann
- Department of Gynaecological Cancer, Oslo University Hospital, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
- Kliniken Essen-Mitte, Essen, Germany
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11
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Berek JS, Matias-Guiu X, Creutzberg C, Fotopoulou C, Gaffney D, Kehoe S, Lindemann K, Mutch D, Concin N. FIGO staging of endometrial cancer: 2023. Int J Gynaecol Obstet 2023; 162:383-394. [PMID: 37337978 DOI: 10.1002/ijgo.14923] [Citation(s) in RCA: 109] [Impact Index Per Article: 109.0] [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: 06/21/2023]
Abstract
INTRODUCTION Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the publication of The Cancer Genome Atlas (TCGA) data and provide improved clarity on the diverse biological nature of this collection of endometrial cancers and their differing prognostic outcomes. The goals of the new staging system are to better define these prognostic groups and create substages that indicate more appropriate surgical, radiation, and systemic therapies. METHODS The FIGO Women's Cancer Committee appointed a Subcommittee on Endometrial Cancer Staging in October 2021, represented by the authors. Since then, the committee members have met frequently and reviewed new and established evidence on the treatment, prognosis, and survival of endometrial cancer. Based on these data, opportunities for improvements in the categorization and stratification of these factors were identified in each of the four stages. Data and analyses from the molecular and histological classifications performed and published in the recently developed ESGO/ESTRO/ESP guidelines were used as a template for adding the new subclassifications to the proposed molecular and histological staging system. RESULTS Based on the existing evidence, the substages were defined as follows: Stage I (IA1): non-aggressive histological type of endometrial carcinoma limited to a polyp or confined to the endometrium; (IA2) non-aggressive histological types of endometrium involving less than 50% of the myometrium with no or focal lymphovascular space invasion (LVSI) as defined by WHO criteria; (IA3) low-grade endometrioid carcinomas limited to the uterus with simultaneous low-grade endometrioid ovarian involvement; (IB) non-aggressive histological types involving 50% or more of the myometrium with no LVSI or focal LVSI; (IC) aggressive histological types, i.e. serous, high-grade endometrioid, clear cell, carcinosarcomas, undifferentiated, mixed, and other unusual types without any myometrial invasion. Stage II (IIA): non-aggressive histological types that infiltrate the cervical stroma; (IIB) non-aggressive histological types that have substantial LVSI; or (IIC) aggressive histological types with any myometrial invasion. Stage III (IIIA): differentiating between adnexal versus uterine serosa infiltration; (IIIB) infiltration of vagina/parametria and pelvic peritoneal metastasis; and (IIIC) refinements for lymph node metastasis to pelvic and para-aortic lymph nodes, including micrometastasis and macrometastasis. Stage IV (IVA): locally advanced disease infiltrating the bladder or rectal mucosa; (IVB) extrapelvic peritoneal metastasis; and (IVC) distant metastasis. The performance of complete molecular classification (POLEmut, MMRd, NSMP, p53abn) is encouraged in all endometrial cancers. If the molecular subtype is known, this is recorded in the FIGO stage by the addition of "m" for molecular classification, and a subscript indicating the specific molecular subtype. When molecular classification reveals p53abn or POLEmut status in Stages I and II, this results in upstaging or downstaging of the disease (IICmp53abn or IAmPOLEmut ). SUMMARY The updated 2023 staging of endometrial cancer includes the various histological types, tumor patterns, and molecular classification to better reflect the improved understanding of the complex nature of the several types of endometrial carcinoma and their underlying biologic behavior. The changes incorporated in the 2023 staging system should provide a more evidence-based context for treatment recommendations and for the more refined future collection of outcome and survival data.
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Affiliation(s)
- Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, California, USA
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U de Bellvitge and Hospital U Arnau de Vilanova, Universities of Lleida and Barcelona, Institut de Recerca Biomèdica de Lleida, Instituto de Investigación Biomédica de Bellvitge, Centro de Investigación Biomédica en Red de Cáncer, Barcelona, Spain
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Sean Kehoe
- Oxford Gynaecological Cancer Centre, Churchill Hospital, Oxford, UK
| | - Kristina Lindemann
- Department of Gynaecological Cancer, Oslo University Hospital, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
- Kliniken Essen-Mitte, Essen, Germany
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Kurian AW, Abrahamse P, Furgal A, Ward KC, Hamilton AS, Hodan R, Tocco R, Liu L, Berek JS, Hoang L, Yussuf A, Susswein L, Esplin ED, Slavin TP, Gomez SL, Hofer TP, Katz SJ. Germline Genetic Testing After Cancer Diagnosis. JAMA 2023; 330:43-51. [PMID: 37276540 PMCID: PMC10242510 DOI: 10.1001/jama.2023.9526] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023]
Abstract
Importance Germline genetic testing is recommended by practice guidelines for patients diagnosed with cancer to enable genetically targeted treatment and identify relatives who may benefit from personalized cancer screening and prevention. Objective To describe the prevalence of germline genetic testing among patients diagnosed with cancer in California and Georgia between 2013 and 2019. Design, Setting, and Participants Observational study including patients aged 20 years or older who had been diagnosed with any type of cancer between January 1, 2013, and March 31, 2019, that was reported to statewide Surveillance, Epidemiology, and End Results registries in California and Georgia. These patients were linked to genetic testing results from 4 laboratories that performed most germline testing for California and Georgia. Main Outcomes and Measures The primary outcome was germline genetic testing within 2 years of a cancer diagnosis. Testing trends were analyzed with logistic regression modeling. The results of sequencing each gene, including variants associated with increased cancer risk (pathogenic results) and variants whose cancer risk association was unknown (uncertain results), were evaluated. The genes were categorized according to their primary cancer association, including breast or ovarian, gastrointestinal, and other, and whether practice guidelines recommended germline testing. Results Among 1 369 602 patients diagnosed with cancer between 2013 and 2019 in California and Georgia, 93 052 (6.8%) underwent germline testing through March 31, 2021. The proportion of patients tested varied by cancer type: male breast (50%), ovarian (38.6%), female breast (26%), multiple (7.5%), endometrial (6.4%), pancreatic (5.6%), colorectal (5.6%), prostate (1.1%), and lung (0.3%). In a logistic regression model, compared with the 31% (95% CI, 30%-31%) of non-Hispanic White patients with male breast cancer, female breast cancer, or ovarian cancer who underwent testing, patients of other races and ethnicities underwent testing less often: 22% (95% CI, 21%-22%) of Asian patients, 25% (95% CI, 24%-25%) of Black patients, and 23% (95% CI, 23%-23%) of Hispanic patients (P < .001 using the χ2 test). Of all pathogenic results, 67.5% to 94.9% of variants were identified in genes for which practice guidelines recommend testing and 68.3% to 83.8% of variants were identified in genes associated with the diagnosed cancer type. Conclusions and Relevance Among patients diagnosed with cancer in California and Georgia between 2013 and 2019, only 6.8% underwent germline genetic testing. Compared with non-Hispanic White patients, rates of testing were lower among Asian, Black, and Hispanic patients.
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Affiliation(s)
- Allison W. Kurian
- Department of Medicine, School of Medicine, Stanford University, Stanford, California
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California
| | - Paul Abrahamse
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Allison Furgal
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ann S. Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Rachel Hodan
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Rachel Tocco
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Lihua Liu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Jonathan S. Berek
- Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, California
| | | | | | | | | | | | - Scarlett L. Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Timothy P. Hofer
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Steven J. Katz
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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Andersen BL, Lacchetti C, Ashing K, Berek JS, Berman BS, Bolte S, Dizon DS, Given B, Nekhlyudov L, Pirl W, Stanton AL, Rowland JH. Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update. J Clin Oncol 2023:JCO2300293. [PMID: 37075262 DOI: 10.1200/jco.23.00293] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors. METHODS A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted. RESULTS The evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations. RECOMMENDATIONS It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
| | | | | | | | | | - Sage Bolte
- Inova Health Foundation, Falls Church, VA
| | - Don S Dizon
- Legorreta Cancer Center at Brown University and Lifespan Cancer Institute, Providence, RI
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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Okunade KS, Badmos KB, Okoro AC, Ademuyiwa IY, Oshodi YA, Adejimi AA, Awolola NA, Ozonu O, Adelabu H, Olorunfemi G, Akanmu AS, Banjo AA, Anorlu RI, Berek JS. Comparative Assessment of p16/Ki-67 Dual Staining Technology for cervical cancer screening in women living with HIV (COMPASS-DUST)-Study protocol. PLoS One 2023; 18:e0278077. [PMID: 36701329 PMCID: PMC9879465 DOI: 10.1371/journal.pone.0278077] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
The risk of progression of low-grade (CIN1) to high-grade cervical intraepithelial neoplasia (CIN2/3) is 3-5 times higher for women living with HIV (WLHIV) than for HIV-negative women. Evidence suggests that the current cervical cancer screening methods perform less effectively in WLHIV. An emerging screening method-p16/Ki-67 dual staining technology (DUST) is a safe and rapid assay that could be used to detect CIN2/3 with higher sensitivity and specificity. The study in this protocol will evaluate the performance of DUST in cervical cancer screening among WLHIV. We will conduct an intra-participant comparative study (Phase 1) to enrol n = 1,123 sexually active WLHIV aged 25-65 years at two accredited adult HIV treatment centres in Lagos, Nigeria to compare the performance of DUST to the currently used screening methods (Pap smear, hr-HPV DNA, or VIA testing) in detecting high-grade CIN and cancer (CIN2+). Subsequently, a prospective cohort study (Phase 2) will be conducted by enrolling all the WLHIV who are diagnosed as having low-grade CIN (CIN1) in Phase 1 for a 6-monthly follow-up for 2 years to detect the persistence and progression of CIN1 to CIN2+. The findings of this study may provide evidence of the existence of a better performance screening method for the primary and triage detection of CIN2+ in WLHIV. It may also demonstrate that this high-performance test can improve the long-term predictive accuracy of screening by extending the intervals between evaluations and thus decrease the overall cost and increase screening uptake and follow-up compliance in WLHIV.
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Affiliation(s)
- Kehinde S. Okunade
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
- Center for Clinical Trial, Research, and Implementation science (CCTRIS), College of Medicine, University of Lagos, Lagos, Nigeria
- * E-mail:
| | - Kabir B. Badmos
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Austin C. Okoro
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iyabo Y. Ademuyiwa
- Department of Nursing Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Yusuf A. Oshodi
- Department of Obstetrics & Gynaecology, Lagos State University College of Medicine, Lagos, Nigeria
| | - Adebola A. Adejimi
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Nicholas A. Awolola
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Oluchi Ozonu
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Hameed Adelabu
- Center for Clinical Trial, Research, and Implementation science (CCTRIS), College of Medicine, University of Lagos, Lagos, Nigeria
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Alani S. Akanmu
- Department of Haematology & Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adekunbiola A. Banjo
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rose I. Anorlu
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Jonathan S. Berek
- Department of Obstetrics & Gynaecology, Stanford University School of Medicine, Stanford, United States of America
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15
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Benedict C, Fisher S, Kumar D, Pollom E, Schapira L, Kurian AW, Berek JS, Palesh O. Examining Associations Among Sexual Health, Unmet Care Needs, and Distress in Breast and Gynecologic Cancer Survivors. Semin Oncol Nurs 2022; 38:151316. [PMID: 35902337 PMCID: PMC9809304 DOI: 10.1016/j.soncn.2022.151316] [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: 03/31/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study evaluated breast and gynecologic cancer patients' sexual function, unmet needs related to sexuality, and distress. DATA SOURCES Secondary analyses of a cross-sectional survey study evaluated measures of sexual function (Female Sexual Function Index [FSFI]), unmet needs (Supportive Care Needs Scale), and distress (Patient Health Questionnaire). χ2 test, t tests, and analysis of variances (ANOVAs) tested bivariate relationships. Subgroup comparisons were made based on the Female Sexual Function Index sexual dysfunction diagnostic cut-off score (<26.55; lower scores indicate greater dysfunction). A regression model tested associations between sexual function and unmet needs with distress as the outcome variable. CONCLUSION Clinically significant sexual dysfunction was common in this cohort of women. In multivariate modeling, worse sexual function and greater unmet sexuality needs related to greater distress. Future work should explore reasons behind the high levels of sexual dysfunction and unmet needs in female survivors. IMPLICATIONS FOR NURSING PRACTICE It is important to routinely screen for sexual health concerns among female cancer survivors at all phases of the cancer trajectory including years posttreatment.
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Affiliation(s)
- Catherine Benedict
- Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA.
| | | | - Dhanya Kumar
- University of Massachusetts School of Medicine, Worcester, MA
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16
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Palesh O, Tolby LT, Hofmeister EN, Fisher S, Solomon NL, Sackeyfio S, Berek JS, Kurian AW, Cassidy-Eagle E, Schapira L. Symptoms and survivorship needs differences between "good sleepers" and "bad sleepers" in survivors of breast and gynecologic cancers. Sleep Med 2022; 100:49-55. [PMID: 36007431 PMCID: PMC10931244 DOI: 10.1016/j.sleep.2022.07.002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/10/2022] [Accepted: 07/03/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Although 80% of cancer survivors report symptoms of insomnia, only 28-43% meet DSM-5 criteria for this diagnosis. We sought to characterize the association between patient-reported insomnia symptoms, patient outcomes, and supportive care variables, as well as explore clinically meaningful insomnia thresholds in a sample of women diagnosed with breast and gynecologic cancers. METHODS From July 2018-March 2019, all breast and gynecologic cancer survivors seen at the Stanford Women's Cancer Center were approached and invited to participate in the study (15% declined). Of those who consented, 273 survivors completed an online survey related to their sleep (ISI), quality of life (FACT-G), distress (PHQ-4), supportive care needs (SCNS-SF34), and symptom severity (MDASI). Survivors who scored <8 on ISI were categorized as "good sleepers," survivors with ISI ≥8 were categorized as "bad sleepers." RESULTS 126 (46.2%) of survivors were "good sleepers," 147 (53.8%) were "bad sleepers." Good sleepers were older than bad sleepers (p < .05) but did not differ in any other demographic or any medical variables. Using hierarchical linear regression models, we found that good sleep (ISI <8) was associated with higher quality of life, lower psychological distress, increased social support, lower symptom severity, and lower supportive care needs, after accounting for demographic, medical, and treatment variables. The findings were largely replicated with an ISI cut off of 15. CONCLUSIONS Among women treated for breast and gynecologic cancers, survivors who were good sleepers had better psychosocial outcomes, fewer supportive care needs, and lower symptom severity compared to those who reported insomnia symptoms. Results also indicate that degree of sleep impairment, whether mild or severe, has similarly poor associations with most aspects of patient functioning and symptomatic burden. Further research is needed to determine causality of these findings.
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Affiliation(s)
- Oxana Palesh
- Department of Psychiatry, Massey Cancer Center, Virginia Commonwealth University, United States.
| | - Leah T Tolby
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Elisa N Hofmeister
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Sophie Fisher
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Natalie L Solomon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Sarah Sackeyfio
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Jonathan S Berek
- Stanford Cancer Institute, Stanford University School of Medicine, United States
| | - Allison W Kurian
- Stanford Cancer Institute, Stanford University School of Medicine, United States
| | - Erin Cassidy-Eagle
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford University School of Medicine, United States
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17
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Mirza MR, Lindahl G, Mahner S, Redondo A, Fabbro M, Rimel BJ, Herrstedt J, Oza AM, Canzler U, Berek JS, González-Martín A, Follana P, Lord R, Azodi M, Estenson K, Wang Z, Li Y, Gupta D, Matulonis U, Feng B. Ad hoc Analysis of the Phase III ENGOT-OV16/NOVA Study: Niraparib Efficacy in Germline BRCA Wild-type Recurrent Ovarian Cancer with Homologous Recombination Repair Defects. Cancer Research Communications 2022; 2:1436-1444. [PMID: 36970052 PMCID: PMC10035404 DOI: 10.1158/2767-9764.crc-22-0240] [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] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022]
Abstract
In this analysis, we examined the relationship between progression-free survival (PFS) and mutation status of 18 homologous recombination repair (HRR) genes in patients in the non-germline BRCA-mutated (non-gBRCAm) cohort of the ENGOT-OV16/NOVA trial (NCT01847274), which evaluated niraparib maintenance therapy for patients with recurrent ovarian cancer. This post hoc exploratory biomarker analysis was performed using tumor samples collected from 331 patients enrolled in the phase III ENGOT-OV16/NOVA trial's non-gBRCAm cohort. Niraparib demonstrated PFS benefit in patients with either somatic BRCA-mutated (sBRCAm; HR, 0.27; 95% confidence interval, CI, 0.08–0.88) or BRCA wild-type (BRCAwt; HR, 0.47; 95% CI, 0.34–0.64) tumors. Patients with BRCAwt tumors with other non-BRCA HRR mutations also derived benefit from niraparib (HR, 0.31; 95% CI, 0.13–0.77), as did patients with BRCAwt/HRRwt (HRR wild-type) tumors (HR, 0.49; 95% CI, 0.35–0.70). When patients with BRCAwt/HRRwt tumors were further categorized by genomic instability score (GIS), clinical benefit was observed in patients with homologous recombination–deficient (GIS ≥ 42; HR, 0.33; 95% CI, 0.18–0.61) and in patients with homologous recombination–proficient (HRp; GIS < 42; HR, 0.60; 95% CI, 0.36–0.99) disease. Although patients with sBRCAm, other non-BRCA HRR mutations, or GIS ≥ 42 benefited the most from niraparib treatment, PFS benefit was also seen in HRp (GIS < 42) patients without HRR mutations. These results support the use of niraparib in patients with recurrent ovarian cancer regardless of BRCA/HRR mutation status or myChoice CDx GIS.
Significance:
We retrospectively evaluated the mutational profile of HRR genes in tumor samples from 331 patients from the non-germline BRCA-mutated cohort of the phase III NOVA trial of patients with platinum-sensitive high-grade serous ovarian cancer. Patients with non-BRCA HRR mutations generally benefited from second-line maintenance treatment with niraparib compared with placebo.
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Affiliation(s)
- Mansoor Raza Mirza
- Nordic Society of Gynaecological Oncology (NSGO) and Department of Oncology Rigshospitalet–Copenhagen University Hospital, Copenhagen, Denmark
| | - Gabriel Lindahl
- Nordic Society of Gynaecological Oncology (NSGO) and Department of Oncology, Linköping University Hospital, Linköping, Sweden
| | - Sven Mahner
- Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO) and Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrés Redondo
- Grupo Español de Investigación en Cáncer de Ovario (GEICO) and Department of Medical Oncology, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Michel Fabbro
- ICM Val d'Aurelle Parc Euromedecine, Oncologie Médicale, Montpellier, GINECO, Paris, France
| | - Bobbie J. Rimel
- Cedars-Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care Zealand University Hospital Roskilde and Næstved, University of Copenhagen, Copenhagen, Denmark
| | - Amit M. Oza
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ulrich Canzler
- Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO) and Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - Jonathan S. Berek
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, California
| | - Antonio González-Martín
- Medical Oncology Department, Clínica Universidad de Navarra, Madrid, Program in Solid Tumors, Center for Applied Medical Research (CIMA), Pamplona, Spain, Grupo Español de Investigación en Cáncer de Ovario (GEICO), Madrid, Spain
| | | | - Rosemary Lord
- Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, United Kingdom
| | - Masoud Azodi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | | | - Ursula Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Bin Feng
- GSK, Waltham, Massachusetts
- Corresponding Author: Bin Feng, Experimental Medicine Unit, GlaxoSmithKline, Waltham, MA 02451. Phone: 339-234-8293; E-mail:
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18
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Vergote I, Gonzalez-Martin A, Lorusso D, Gourley C, Mirza MR, Kurtz JE, Okamoto A, Moore K, Kridelka F, McNeish I, Reuss A, Votan B, du Bois A, Mahner S, Ray-Coquard I, Kohn EC, Berek JS, Tan DSP, Colombo N, Zang R, Concin N, O'Donnell D, Rauh-Hain A, Herrington CS, Marth C, Poveda A, Fujiwara K, Stuart GCE, Oza AM, Bookman MA, Mahner S, Reuss A, du Bois A, Grimm C, Marth C, Berger R, Concin N, Chang TC, Ochiai K, Gebski V, Davis A, Beale P, Vergote I, Kridelka F, Denys H, Vandecaveye V, Cancido dos Reis FJ, Del Pilar Estevez Diz M, Stuart G, MacKay H, Carey M, Cibula D, Dundr (path) P, Dorigo O, Berek J, O'Donnell D, Saadeh A, Boere I, Lok C, Coronado P, Ottevanger N, Tan DSP, Ng J, Gonzalez Martin A, Oaknin A, Poveda A, Perez Fidalgo A, Rauh-Hain A, Lu K, López-Zavala C, Gómez-García EM, Ray-Coquard I, Paoletti X, Kurtz JE, Joly F, Votan B, Bookman M, Moore K, Arend R, Fujiwara K, Fujiwara H, Hasegawa K, Bruchim I, Tsoref D, Oda K, Okamoto A, Enomoto T, Michel D, Kim HS, Lee JY, Mukhopadhyay A, Katsaros D, Colombo N, Pignata S, Lorusso D, Scambia G, Kohn E, Lee JM, McNeish I, Nicum S, Farrelly L, Sehouli J, Keller M, Braicu E, Bjørge L, Mirza MR, Auranen A, Welch S, Oza AM, Heinzelmann V, Gourley C, Roxburgh P, Herrington CS, Glasspool R, Zang R, Zhu J. Clinical research in ovarian cancer: consensus recommendations from the Gynecologic Cancer InterGroup. Lancet Oncol 2022; 23:e374-e384. [PMID: 35901833 PMCID: PMC9465953 DOI: 10.1016/s1470-2045(22)00139-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/13/2022]
Abstract
The Gynecologic Cancer InterGroup (GCIG) sixth Ovarian Cancer Conference on Clinical Research was held virtually in October, 2021, following published consensus guidelines. The goal of the consensus meeting was to achieve harmonisation on the design elements of upcoming trials in ovarian cancer, to select important questions for future study, and to identify unmet needs. All 33 GCIG member groups participated in the development, refinement, and adoption of 20 statements within four topic groups on clinical research in ovarian cancer including first line treatment, recurrent disease, disease subgroups, and future trials. Unanimous consensus was obtained for 14 of 20 statements, with greater than 90% concordance in the remaining six statements. The high acceptance rate following active deliberation among the GCIG groups confirmed that a consensus process could be applied in a virtual setting. Together with detailed categorisation of unmet needs, these consensus statements will promote the harmonisation of international clinical research in ovarian cancer.
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19
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Campbell R, Costa DSJ, Stockler MR, Lee YC, Ledermann JA, Berton D, Sehouli J, Roncolato FT, Connell RO, Okamoto A, Bryce J, Oza AM, Avall-Lundqvist E, Berek JS, Lanceley A, Joly F, Hilpert F, Feeney A, Kaminsky MC, Diamante K, Friedlander ML, King MT. Measure of Ovarian Symptoms and Treatment concerns (MOST) indexes and their associations with health-related quality of life in recurrent ovarian cancer. Gynecol Oncol 2022; 166:254-262. [PMID: 35718565 DOI: 10.1016/j.ygyno.2022.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/14/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The Measure of Ovarian Symptoms and Treatment (MOST) concerns is a validated patient-reported symptom assessment tool for assessing symptom benefit and adverse effects of palliative chemotherapy in women with recurrent ovarian cancer (ROC). We aimed to examine (i) how symptoms within MOST symptom indexes track together (i.e. co-occur) and (ii) the association between MOST symptom indexes and key aspects of health-related quality of life (HRQL). METHOD A prospective cohort of women with ROC completed the MOST-T35, EORTC QLQ-C30 and EORTC QLQ-OV28 at baseline and before each cycle of chemotherapy. Analyses were conducted on baseline and end-of-treatment data. Exploratory factor analysis and hierarchical cluster analysis identified groups of co-occurring symptoms. Path models examined associations between MOST symptom indexes and HRQL. RESULTS Data from 762 women at baseline and 681 at treatment-end who completed all 22 symptom-specific MOST items and at least one HRQL measure were analysed. Four symptom clusters emerged at baseline and treatment-end: abdominal symptoms, symptoms associated with peripheral neuropathy, nausea and vomiting, and psychological symptoms. Psychological symptoms (MOST-Psych) and symptoms due to disease (ovarian cancer) or treatment (MOST-DorT) were associated with poorer scores on QLQ-C30 and OV28 functioning domains and worse overall health at both time points. CONCLUSION Four MOST symptom clusters were consistent across statistical methods and time points. These findings suggest that routine standardized assessment of psychological and physical symptoms in clinical practice with MOST plus appropriate symptom management referral pathways is an intervention for improving HRQL that warrants further research.
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Affiliation(s)
- Rachel Campbell
- University of Sydney, Faculty of Science, School of Psychology, Australia.
| | - Daniel S J Costa
- University of Sydney, Faculty of Science, School of Psychology, Australia
| | - Martin R Stockler
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Yeh Chen Lee
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; Australia New Zealand Gynaecological Oncology Group (ANZGOG), Australia; Department of Medical Oncology, Prince of Wales Hospital, New South Wales, Australia
| | - Jonathan A Ledermann
- The Cancer Research UK & UCL Cancer Trials Centre, NCRI UK, London, United Kingdom
| | - Dominique Berton
- GINECO-Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France; Institut de Cancerologie de l'Ouest (ICO), Centre René Gauducheau, Saint Herblain, France
| | - Jalid Sehouli
- Arbeitsgesmeinschaft Gynäkologische Onkologie Studiengruppe (AGO) und North-Eastern German Society of Gynecologcial Oncology (NOGGO), Berlin, Germany; Department of Gynecology and Oncological Surgery, Charité, University of Berlin, Berlin, Germany
| | - Felicia T Roncolato
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; Australia New Zealand Gynaecological Oncology Group (ANZGOG), Australia; Department of Medical Oncology, Prince of Wales Hospital, New South Wales, Australia; Macarthur Cancer Therapy Centre, Campbelltown Hospital, NSW, Australia
| | - Rachel O Connell
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Aikou Okamoto
- Japanese Gynecologic Oncology Group (JGOG), Tokyo, Japan; Jikei University School of Medicine, Tokyo, Japan
| | - Jane Bryce
- Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Napoli, Italy; Ascension St. John Clinical Research Institute, Tulsa, USA
| | - Amit M Oza
- Princess Margaret Consortium (PMHC), Toronto, Canada; Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Elisabeth Avall-Lundqvist
- Nordic Society of Gynaecological Oncology (NSGO), Copenhagen, Denmark; Department of Oncology and Department of Clinical and Experimental Medicine, Linkoping University, NSGO, Linkoping, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonathan S Berek
- Cooperative Gynecologic Oncology Investigators (COGI), Stanford, CA, USA; Stanford Women's Cancer Centre, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Anne Lanceley
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Florence Joly
- GINECO-Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France; Centre Francois Baclesse, Caen, France
| | - Felix Hilpert
- Arbeitsgesmeinschaft Gynäkologische Onkologie Studiengruppe (AGO) und North-Eastern German Society of Gynecologcial Oncology (NOGGO), Berlin, Germany; Onkologisches Therapiezentrum, Krankenhaus Jerusalem, Hamburg, Germany
| | - Amanda Feeney
- The Cancer Research UK & UCL Cancer Trials Centre, NCRI UK, London, United Kingdom
| | - Marie C Kaminsky
- GINECO-Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France; Institut de Cancérologie de Lorraine, Alexis Vautrin, Vandoeuvre Les Nancy, France
| | - Katrina Diamante
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Michael L Friedlander
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Australia; Department of Medical Oncology, Prince of Wales Hospital, New South Wales, Australia
| | - Madeleine T King
- University of Sydney, Faculty of Science, School of Psychology, Australia
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20
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Zeidman A, Benedict C, Zion SR, Fisher S, Tolby L, Kurian AW, Berek JS, Woldeamanuel YW, Schapira L, Palesh O. Association of illness mindsets with health-related quality of life in cancer survivors. Health Psychol 2022; 41:389-395. [PMID: 35604702 PMCID: PMC9870319 DOI: 10.1037/hea0001186] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study aimed to examine the association between mindsets-established, but mutable beliefs that a person holds-and health-related quality of life in survivors of breast and gynecologic cancer. METHOD A cross-sectional survey study was conducted with breast and gynecologic cancer survivors. Measures included the Illness Mindset Questionnaire and Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS Two hundred seventy-three survivors (74% breast/26% gynecologic) who were on average 3.9 years post-diagnosis (SD = 4.2), Mage 55 (SD = 12) completed the survey (response rate 80%). Of the survivors, 20.1% (N = 55) endorsed ("agree" or "strongly agree") that Cancer is a Catastrophe, 52.4% (N = 143) endorsed that Cancer is Manageable, and 65.9% (N = 180) endorsed that Cancer can be an Opportunity (not mutually exclusive). Those who endorsed a maladaptive mindset (Cancer is a Catastrophe) reported lower health-related quality of life (HRQOL) compared with those who did not hold this belief (p < .001). Alternatively, those who endorsed more adaptive mindsets (Cancer is Manageable or Cancer can be an Opportunity) reported better HRQOL compared with those who disagreed (all p-values < .05). All three mindsets were independent correlates of HRQOL, explaining 6-15% unique variance in HRQOL, even after accounting for demographic and medical factors. CONCLUSIONS Mindsets about illness are significantly associated with HRQOL in cancer survivors. Our data come from a one-time evaluation of cancer survivors at a single clinic and provide a foundation for future longitudinal studies and RCTs on the relationship between mindsets and psychosocial outcomes in cancer survivors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Anna Zeidman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine,Stanford Women’s Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine
| | | | - Sophie Fisher
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Leah Tolby
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Allison W. Kurian
- Departments of Medicine and of Epidemiology and Population Health, Stanford University School of Medicine
| | - Jonathan S. Berek
- Stanford Women’s Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine
| | | | - Lidia Schapira
- Stanford Women’s Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine,Stanford Women’s Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine
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21
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Chung YM, Tsai WB, Khan PP, Ma J, Berek JS, Larrick JW, Hu MCT. FOXO3-dependent suppression of PD-L1 promotes anticancer immune responses via activation of natural killer cells. Am J Cancer Res 2022; 12:1241-1263. [PMID: 35411241 PMCID: PMC8984903] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/24/2022] [Indexed: 06/14/2023] Open
Abstract
Boosting anticancer immunity by blocking immune checkpoints such as the programmed death-1 (PD-1) or its ligand (PD-L1) is a breakthrough anticancer therapy. However, many cancer patients do not respond well to immune checkpoint blockades (ICBs) alone. Here we show that low-dose pharmacological immunoactivators (e.g., SN38, topotecan, sorafenib, etc.) notably downregulate PD-L1 and upregulate FOXO3 expression in various human and murine cancer cell lines. In a mouse tumor model, low-dose SN38 treatment markedly suppresses tumor growth, reduces PD-L1 expression, and enhances FOXO3 expression in primary tumor specimens. SN38 therapy engages the tumor-infiltrating mouse NK1.1/CD49b/NKG2D-positive natural killer (NK) cells to attack tumor cells by inducing mouse IFN-γ and granzyme-B secretion in the tumor microenvironment (TME) in vivo. SN38 treatment also promotes tumor cell apoptosis in the TME. SN38 treatment significantly decreases STAT3-pY705 and IL-6 protein levels; FOXO3 is essential for SN38-mediated PD-L1 downregulation. Collectively, these findings may contribute to future translational or clinical investigations tackling difficult-to-treat cancers with immune-activating medicines or combined with ICB immunotherapy.
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Affiliation(s)
- Young Min Chung
- Panorama Institute of Molecular Medicine & Panorama Research InstituteSunnyvale, CA 94089, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of MedicineStanford, CA 94305, USA
| | - Wen Bin Tsai
- Panorama Institute of Molecular Medicine & Panorama Research InstituteSunnyvale, CA 94089, USA
- Department of Genomic Medicine, University of Texas M. D. Anderson Cancer CenterHouston, TX 77030, USA
| | - Pragya P Khan
- Panorama Institute of Molecular Medicine & Panorama Research InstituteSunnyvale, CA 94089, USA
| | - Jessica Ma
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of MedicineStanford, CA 94305, USA
| | - Jonathan S Berek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of MedicineStanford, CA 94305, USA
| | - James W Larrick
- Panorama Institute of Molecular Medicine & Panorama Research InstituteSunnyvale, CA 94089, USA
| | - Mickey C-T Hu
- Panorama Institute of Molecular Medicine & Panorama Research InstituteSunnyvale, CA 94089, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of MedicineStanford, CA 94305, USA
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22
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Chuang LT, Temin S, Berek JS. Management and Care of Patients With Invasive Cervical Cancer: ASCO Resource-Stratified Guideline Rapid Recommendation Update. JCO Glob Oncol 2022; 8:e2200027. [PMID: 35245079 PMCID: PMC8920468 DOI: 10.1200/go.22.00027] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
ASCO Rapid Recommendations Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options.
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Affiliation(s)
- Linus T Chuang
- Stanford University School of Medicine, Stanford, CA.,Danbury Hospital and Norwalk Hospital, Nuvance Health, Norwalk, CT.,American Society of Clinical Oncology, Alexandria, VA
| | - Sarah Temin
- Stanford University School of Medicine, Stanford, CA.,Danbury Hospital and Norwalk Hospital, Nuvance Health, Norwalk, CT.,American Society of Clinical Oncology, Alexandria, VA
| | - Jonathan S Berek
- Stanford University School of Medicine, Stanford, CA.,Danbury Hospital and Norwalk Hospital, Nuvance Health, Norwalk, CT.,American Society of Clinical Oncology, Alexandria, VA
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23
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Lee YC, King MT, O'Connell RL, Lanceley A, Joly F, Hilpert F, Davis A, Roncolato FT, Okamoto A, Bryce J, Donnellan P, Oza AM, Avall-Lundqvist E, Berek JS, Ledermann JA, Berton D, Sehouli J, Feeney A, Kaminsky MC, Diamante K, Stockler MR, Friedlander ML. Symptom burden and quality of life with chemotherapy for recurrent ovarian cancer: the Gynecologic Cancer InterGroup-Symptom Benefit Study. Int J Gynecol Cancer 2022; 32:761-768. [PMID: 35086926 PMCID: PMC9185817 DOI: 10.1136/ijgc-2021-003142] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The Gynecologic Cancer InterGroup (GCIG)-Symptom Benefit Study was designed to evaluate the effects of chemotherapy on symptoms and health-related quality of life (HRQL) in women having chemotherapy for platinum resistant/refractory recurrent ovarian cancer (PRR-ROC) and potentially platinum sensitive with ≥3 lines of chemotherapy (PPS-ROC ≥3). Methods Participants completed the Measure of Ovarian Cancer Symptoms and Treatment (MOST) and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30 questionnaires at baseline and every 3–4 weeks until progression. Participants were classified symptomatic if they rated ≥4 of 10 in at least one-third of symptoms in the MOST index. Improvement in MOST was defined as two consecutive scores of ≤3 in at least half of the symptomatic items at baseline. Improvement in HRQL was defined as two consecutive scores ≥10 points above baseline in the QLQ-C30 summary score scale (range 0–100). Results Of 948 participants enrolled, 910 (96%) completed baseline questionnaires: 546 with PRR-ROC and 364 with PPS-ROC ≥3. The proportions of participants symptomatic at baseline as per MOST indexes were: abdominal 54%, psychological 53%, and disease- or treatment-related 35%. Improvement was reported in MOST indexes: abdominal 40%, psychological 35%, and disease- or treatment-related 38%. Median time to improvement in abdominal symptoms occurred earlier for PRR-ROC than for PPS-ROC ≥3 (4 vs 6 weeks, p=0.044); median duration of improvement was also similar (9.0 vs 11.7 weeks, p=0.65). Progression-free survival was longer among those with improvement in abdominal symptoms than in those without (median 7.2 vs 2.5 months, p<0.0001). Improvements in HRQL were reported by 77/448 (17%) with PRR-ROC and 61/301 (20%) with PPS-ROC ≥3 (p=0.29), and 102/481 (21%) of those with abdominal symptoms at baseline. Conclusion Over 50% of participants reported abdominal and psychological symptoms at baseline. Of those, 40% reported an improvement within 2 months of starting chemotherapy. Approximately one in six participants reported an improvement in HRQL. Symptom monitoring and supportive care is important as chemotherapy palliated less than half of symptomatic participants.
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Affiliation(s)
- Yeh Chen Lee
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Camperdown, New South Wales, Australia.,University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Madeleine T King
- University of Sydney, Quality of Life Office of Psycho-Oncology Research Group (PoCoG), Camperdown, New South Wales, Australia
| | - Rachel L O'Connell
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Anne Lanceley
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Florence Joly
- GINECO-Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France.,Oncology, Ctr Francois Baclesse, Caen, France
| | - Felix Hilpert
- Arbeitsgesmeinschaft Gynäkologische Onkologie Studiengruppe (AGO) und North-Eastern German Society of Gynecologcial Oncology (NOGGO), Kiel, Germany.,Onkologisches Therapiezentrum, Krankenhaus Jerusalem, Hamburg, Germany
| | - Alison Davis
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Camperdown, New South Wales, Australia.,Medical Oncology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Felicia T Roncolato
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Camperdown, New South Wales, Australia.,University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Aikou Okamoto
- Japanese Gynecologic Oncology Group (JGOG), Tokyo, Japan.,Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Japan
| | - Jane Bryce
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy.,Ascension St John Clinical Research Institute, Tulsa, Oklahoma, USA.,MITO Multicentre Italian Trials in Ovarian and gynecologic cancer, Italy
| | - Paul Donnellan
- Cancer Trials Ireland, Galway University Hospital, Galway, Ireland
| | - Amit M Oza
- Princess Margaret Consortium (PMHC), Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elisabeth Avall-Lundqvist
- Nordic Society of Gynaecological Oncology (NSGO), Copenhagen, Denmark.,Department of Oncology and Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonathan S Berek
- Cooperative Gynecologic Oncology Investigators (COGI), Stanford, California, USA.,Stanford Women's Cancer Centre, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | | | - Dominique Berton
- GINECO-Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France.,Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Saint Herblain, France
| | - Jalid Sehouli
- Arbeitsgesmeinschaft Gynäkologische Onkologie Studiengruppe (AGO) und North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany.,Department of Gynecology and Oncological Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Amanda Feeney
- The Cancer Research UK and UCL Cancer Trials Centre, NCRI UK, London, UK
| | - Marie-Christine Kaminsky
- GINECO-Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France.,Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France
| | - Katrina Diamante
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Martin R Stockler
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Michael L Friedlander
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Camperdown, New South Wales, Australia .,Prince of Wales Clinical School, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
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Benedict C, Fisher S, Schapira L, Chao S, Sackeyfio S, Sullivan T, Pollom E, Berek JS, Kurian AW, Palesh O. Greater financial toxicity relates to greater distress and worse quality of life among breast and gynecologic cancer survivors. Psychooncology 2022; 31:9-20. [PMID: 34224603 PMCID: PMC9809212 DOI: 10.1002/pon.5763] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 02/04/2021] [Revised: 05/29/2021] [Accepted: 06/15/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Financial toxicity includes distress and burden from cancer-related costs. Women are more likely to experience worse cancer-related financial outcomes than men. This study evaluated breast and gynecologic cancer patients' subjective experiences of financial toxicity and associations with distress and quality of life (QOL). METHODS A cross-sectional survey study included measures of financial toxicity (Comprehensive Score for Financial Toxicity [COST] Version 2), distress (Patient Health Questionnaire), and QOL (Functional Assessment of Cancer Therapy). Chi-square, t-tests, and ANOVAs examined bivariate relationships. Two regression models tested associations between financial toxicity and distress and QOL, controlling for covariates. Financial toxicity subgroups were compared based on a validated grading system. RESULTS Participants (N = 273; 74% breast cancer) averaged 54.65 years (SD = 12.08), were 3.42 years (SD = 4.20) post-diagnosis, and 33% reported cancer-related change in employment status. Financial toxicity was "mild" overall (COST M = 26.11, SD = 11.14); 32% worried about cancer-related financial problems (quite a bit/very much; item-level analysis). Worse financial toxicity related to younger age (p < 0.001), identifying as a non-Asian minority (p = 0.03) or Hispanic (p = 0.01), being single (p < 0.001), lower education (p = 0.004), lower income (p < 0.001), late-stage disease (p = 0.001), recurrent disease (p = 0.004), and active treatment (p < 0.001). In separate multivariable models, greater financial toxicity related to greater distress (β = -0.45 p < 0.001) and worse QOL (β = 0.58, p < 0.001). Financial toxicity subgroups reported clinically significant differences in distress and QOL (p's < 0.05). CONCLUSIONS Cancer-related financial burden is associated with pervasive negative effects and may impact subgroups differently. Future research should explore financial experiences across subgroups, aiming to better identify those at risk and build targeted interventions.
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Affiliation(s)
- Catherine Benedict
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| | - Sophie Fisher
- Stanford University School of Medicine, Palo Alto, CA
| | - Lidia Schapira
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| | - Sabrina Chao
- Stanford University School of Medicine, Palo Alto, CA
| | | | - Tara Sullivan
- Stanford University School of Medicine, Palo Alto, CA
| | - Erqi Pollom
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| | - Jonathan S. Berek
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| | - Allison W. Kurian
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| | - Oxana Palesh
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
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Kurian AW, Abrahamse P, Ward KC, Hamilton AS, Deapen D, Berek JS, Hoang L, Yussuf A, Dolinsky J, Brown K, Slavin T, Hofer TP, Katz SJ. Association of Family Cancer History With Pathogenic Variants in Specific Breast Cancer Susceptibility Genes. JCO Precis Oncol 2021; 5:PO.21.00261. [PMID: 34977446 PMCID: PMC8710333 DOI: 10.1200/po.21.00261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/12/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Family cancer history is an important component of genetic testing guidelines that estimate which patients with breast cancer are most likely to carry a germline pathogenic variant (PV). However, we do not know whether more extensive family history is differentially associated with PVs in specific genes. METHODS All women diagnosed with breast cancer in 2013-2017 and reported to statewide SEER registries of Georgia and California were linked to clinical genetic testing results and family history from two laboratories. Family history was defined as strong (suggestive of PVs in high-penetrance genes such as BRCA1/2 or TP53, including male breast, ovarian, pancreatic, sarcoma, or multiple female breast cancers), moderate (any other cancer history), or none. Among established breast cancer susceptibility genes (ATM, BARD1, BRCA1, BRCA2, CDH1, CHEK2, NF1, PALB2, PTEN, RAD51C, RAD51D, and TP53), we evaluated PV prevalence according to family history extent and breast cancer subtype. We used a multivariable model to test for interaction between affected gene and family history extent for ATM, BRCA1/2, CHEK2, and PALB2. RESULTS A total of 34,865 women linked to genetic results. Higher PV prevalence with increasing family history extent (P < .001) was observed only with BRCA1 (3.04% with none, 3.22% with moderate, and 4.06% with strong history) and in triple-negative breast cancer with PALB2 (0.75% with none, 2.23% with moderate, and 2.63% with strong history). In a multivariable model adjusted for age and subtype, there was no interaction between family history extent and PV prevalence for any gene except PALB2 (P = .037). CONCLUSION Extent of family cancer history is not differentially associated with PVs across established breast cancer susceptibility genes and cannot be used to personalize genes selected for testing.
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Affiliation(s)
- Allison W. Kurian
- Departments of Medicine and of Epidemiology & Population Health, Stanford University, Stanford, CA,Allison W. Kurian, MD, MSc, Department of Medicine and of Epidemiology & Population Health, Stanford University School of Medicine, HRP Redwood Building, Room T254A, 150 Governor's Lane, Stanford, CA 94305; e-mail:
| | - Paul Abrahamse
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI,Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Ann S. Hamilton
- Department of Preventive Medicine in the Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dennis Deapen
- Department of Preventive Medicine in the Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jonathan S. Berek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and Stanford Women's Cancer Center, Stanford University, Stanford, CA
| | | | | | | | | | | | - Timothy P. Hofer
- Department of Internal Medicine, University of Michigan and Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Steven J. Katz
- Department of Internal Medicine, University of Michigan and Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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Abstract
In 2014, FIGO's Committee for Gynecologic Oncology revised the staging of ovarian cancer, incorporating ovarian, fallopian tube, and peritoneal cancer into the same system. Most of these malignancies are high-grade serous carcinomas (HGSC). Stage IC is now divided into three categories: IC1 (surgical spill); IC2 (capsule ruptured before surgery or tumor on ovarian or fallopian tube surface); and IC3 (malignant cells in the ascites or peritoneal washings). The updated staging includes a revision of Stage IIIC based on spread to the retroperitoneal lymph nodes alone without intraperitoneal dissemination. This category is now subdivided into IIIA1(i) (metastasis ≤10 mm in greatest dimension), and IIIA1(ii) (metastasis >10 mm in greatest dimension). Stage IIIA2 is now "microscopic extrapelvic peritoneal involvement with or without positive retroperitoneal lymph node" metastasis. This review summarizes the genetics, surgical management, chemotherapy, and targeted therapies for epithelial cancers, and the treatment of ovarian germ cell and stromal malignancies.
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Affiliation(s)
- Jonathan S. Berek
- Stanford Women’s Cancer CenterStanford Cancer InstituteStanford University School of MedicineStanfordCaliforniaUSA
| | - Malte Renz
- Stanford Women’s Cancer CenterStanford Cancer InstituteStanford University School of MedicineStanfordCaliforniaUSA
| | - Sean Kehoe
- Oxford Gynecological Cancer CenterChurchill HospitalOxfordUK
- St Peter’s CollegeOxfordUK
| | - Lalit Kumar
- Department of Medical OncologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Michael Friedlander
- Royal Hospital for WomenSydneyAustralia
- Prince of Wales Clinical SchoolUniversity of New South WalesSydneyAustralia
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Okunade KS, Soibi-Harry A, John-Olabode S, Adejimi AA, Allsop MJ, Onyeka TC, Akaba GO, Oshodi YA, Salako O, Ugwu AO, Adefemi A, Anorlu RI, Berek JS. Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial. JCO Glob Oncol 2021; 7:1418-1425. [PMID: 34554814 PMCID: PMC8478387 DOI: 10.1200/go.21.00258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We assessed the impact of mHealth on Pap test screening uptake and also determined the factors that affect screening uptake among women in Lagos, Nigeria. MATERIALS AND METHODS A randomized controlled trial was carried out among women in two tertiary health institutions in Lagos, Nigeria, between July 2020 and March 2021. Participants were randomly assigned to either a text message (mHealth) intervention or usual care arm. The main study outcome was the uptake of Pap smear testing within 6 months of enrollment in the study. We tested the associations between two groups of continuous variables using the unpooled independent-sample t-test (normal distribution) and that of two groups of categorical variables with the chi-square (χ2) test. Using a multinomial logistic regression model, we adjusted for relevant sociodemographic and clinical predictors of uptake of Pap smear screening. Statistical significance was defined as P < .05. RESULTS There was a significantly higher rate of uptake of Pap smear screening among women in the mHealth arm compared with those in the usual care arm (51.0% v 35.7%, P = .031). Following adjustment in the final multivariate model, level of income (odds ratio [OR] = 5.13, 95% CI, 1.55 to 16.95), awareness of Pap smear (OR = 16.26; 95% CI, 2.49 to 76.64), General Outpatient clinic attendance, and introduction of mHealth intervention during follow-up (OR = 4.36; 95% CI, 1.44 to 13.22) were the independent predictors of Pap smear uptake. CONCLUSION The use of mHealth technologies intervention via short-text message services is a feasible solution for cervical cancer prevention in low- and middle-income countries, and thus, the widespread use of mHealth services by health care providers and policymakers could contribute to the implementation of cervical cancer prevention services in Nigeria and in the settings of other low- and middle-income countries.
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Adaiah Soibi-Harry
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Sarah John-Olabode
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Adebola A Adejimi
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Tonia C Onyeka
- Department of Anaesthesia, College of Medicine, University of Nigeria, Enugu, Enugu State, Nigeria
| | - Godwin O Akaba
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Abuja, Gwadalada, Abuja FCT, Nigeria
| | - Yusuf A Oshodi
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Omolola Salako
- Department of Radiation Biology, Radiotherapy, Radio-diagnosis and Radiography, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Aloy O Ugwu
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Ayodeji Adefemi
- Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Rose I Anorlu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Jonathan S Berek
- Department of Obstetrics and Gynaecology, Stanford University School of Medicine, Stanford, CA
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28
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Olawaiye AB, Cotler J, Cuello MA, Bhatla N, Okamoto A, Wilailak S, Purandare CN, Lindeque G, Berek JS, Kehoe S. FIGO staging for carcinoma of the vulva: 2021 revision. Int J Gynaecol Obstet 2021; 155:43-47. [PMID: 34520062 PMCID: PMC9290586 DOI: 10.1002/ijgo.13880] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To revise the FIGO staging for carcinoma of the vulva using a new approach that involves analyses of prospectively collected data. The FIGO Committee for Gynecologic Oncology reviewed the recent literature to gain an insight into the impact of the 2009 vulvar cancer staging revision. The Committee resolved to revise the staging with a goal of simplification and actively collaborated with the United States National Cancer Database to analyze prospectively collected data on carcinoma of the vulva. Many tumor characteristics were collected for all stages of vulvar cancer treated between 2010 and 2017. Statistical analysis was performed with SAS software. Overall survival was estimated based on tumor characteristics. Log‐rank and Wilcoxon tests were used to analyze overall survival similarities between and within groups of tumor characteristics. Characteristics with similar survivals were then grouped into the same stages and substages. Kaplan–Meier overall survival curves were generated for the resulting stages and substages. There were 12 063 cases with available data. The resulting new staging for carcinoma of the vulva has two substages in Stage I, no substage in Stage II, three substages in Stage III, and two substages in Stage IV. The Kaplan–Meier overall survival curves showed clear separation between stages and substages. The 2021 vulvar cancer staging is the first from the FIGO Committee for Gynecologic Oncology to be derived from data analyses. This revision has a new definition for depth of invasion, uses the same definition for lymph node metastases utilized in cervical cancer, and allows findings from cross‐sectional imaging to be incorporated into vulvar cancer staging. The 2021 FIGO staging for carcinoma of the vulva is data‐derived, validated, and much simpler than earlier revisions. The FIGO Committee for Gynecologic Oncology's last revision of vulvar cancer staging was published over a decade ago. This 2021 revision is data‐derived, simplified, and user‐friendly.
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Affiliation(s)
- Alexander B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joseph Cotler
- National Cancer Database, American College of Surgeons, Chicago, Illinois, USA
| | - Mauricio A Cuello
- Department of Gynecology, Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sarikapan Wilailak
- Department of Obstetrics and Gynecology, Mahidol University, Bangkok, Thailand
| | | | - Gerhard Lindeque
- Department of Obstetrics and Gynecology, University of Pretoria, Pretoria, South Africa
| | - Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Sean Kehoe
- Oxford Gynecological Cancer Center, Churchill Hospital, Oxford, UK.,St Peter's College, Oxford, UK
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29
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Kurian AW, Abrahamse P, Bondarenko I, Hamilton AS, Deapen D, Gomez SL, Morrow M, Berek JS, Hofer TP, Katz SJ, Ward KC. Association of Genetic Testing Results with Mortality Among Women with Breast Cancer or Ovarian Cancer. J Natl Cancer Inst 2021; 114:245-253. [PMID: 34373918 DOI: 10.1093/jnci/djab151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/15/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast cancer and ovarian cancer patients increasingly undergo germline genetic testing. However, little is known about cancer-specific mortality among carriers of a pathogenic variant (PV) in BRCA1/2 or other genes in a population-based setting. METHODS Georgia and California Surveillance Epidemiology and End Results (SEER) registry records were linked to clinical genetic testing results. Women were included who had stages I-IV breast cancer or ovarian cancer diagnosed in 2013-2017; received chemotherapy; and linked to genetic testing results. Multivariable Cox proportional hazard models were used to examine the association of genetic results with cancer-specific mortality. RESULTS 22,495 breast and 4,320 ovarian cancer patients were analyzed, with a median follow-up of 41 months. PVs were present in 12.7% of breast cancer patients with estrogen and/or progesterone receptor-positive, HER2-negative cancer, 9.8% with HER2-positive cancer, 16.8% with triple-negative breast cancer and 17.2% with ovarian cancer. Among triple-negative breast cancer patients, cancer-specific mortality was lower with BRCA1 (hazard ratio [HR] = 0.49, 95% confidence interval [CI] = 0.35-0.69) and BRCA2 PVs (HR = 0.60, 95% CI = 0.41-0.89), and equivalent with PVs in other genes (HR = 0.65, 95% CI = 0.37-1.13), versus non-carriers. Among ovarian cancer patients, cancer-specific mortality was lower with PVs in BRCA2 (HR = 0.35, 95% CI = 0.25-0.49) and genes other than BRCA1/2 (HR = 0.47, 95% CI = 0.32-0.69). No PV was associated with higher cancer-specific mortality. CONCLUSIONS Among breast cancer and ovarian cancer patients treated with chemotherapy in the community, BRCA1/2 and other gene PV carriers had equivalent or lower short-term cancer-specific mortality than non-carriers. These results may reassure newly diagnosed patients and longer follow-up is ongoing.
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Affiliation(s)
- Allison W Kurian
- Departments of Medicine and of Epidemiology & Population Health, Stanford University, Stanford, California
| | - Paul Abrahamse
- Department of Health Management and Policy, School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Irina Bondarenko
- Department of Health Management and Policy, School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Ann S Hamilton
- Department of Preventive Medicine in the Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Dennis Deapen
- Department of Preventive Medicine in the Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Scarlett L Gomez
- Department of Epidemiology & Biostatistics and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | - Monica Morrow
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Jonathan S Berek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and Stanford Women's Cancer Center, Stanford University, Stanford, California
| | - Timothy P Hofer
- Department of Internal Medicine, University of Michigan and Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Steven J Katz
- Department of Health Management and Policy, School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Okunade KS, Adejimi AA, Ohazurike EO, Salako O, Osunwusi B, Adenekan MA, Ugwu AO, Soibi-Harry A, Dawodu O, Okunowo AA, Anorlu RI, Berek JS. Predictors of Survival Outcomes After Primary Treatment of Epithelial Ovarian Cancer in Lagos, Nigeria. JCO Glob Oncol 2021; 7:89-98. [PMID: 33449803 PMCID: PMC8081541 DOI: 10.1200/go.20.00450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study was designed to investigate the clinicopathologic predictors of progression-free survival (PFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC) following primary treatment in Lagos, Nigeria. MATERIALS AND METHODS Using data from a retrospective cohort of 126 patients who received treatment for EOC between 2010 and 2018, we identified 83 patients with a complete clinical record for subsequent data analysis. Patients' demographics and updated 2-year follow-up status were abstracted from medical records. Kaplan-Meier survival curves were compared using the log-rank test, and Cox proportional hazard models were used for multivariate analysis to identify independent predictors of survivals following treatment in EOC patients. RESULTS The median PFS and OS were 12 and 24 months, respectively. After adjusting for covariates in the multivariate analysis, younger age ≤ 55 years (hazard ratio [HR] = 0.40; 95% CI, 0.22 to 0.74; P = .01) and International Federation of Gynecology and Obstetrics (FIGO) stage I/II (HR = 0.02; 95% CI, 0.01 to 0.08; P = .01) were independent predictors of improved PFS, whereas being premenopausal (HR = 2.34; 95% CI, 1.16 to 4.75; P = .02) was an independent predictor of reduced OS after 2-year follow-up. CONCLUSION PFS could be predicted by the age and FIGO stage of the disease, whereas menopausal status was predictive of OS in patients with EOC. This knowledge should form the basis for counseling patients with ovarian cancer during their primary treatment and lend support to the importance of aggressive follow-up and monitoring for the older, premenopausal patients and those with an advanced stage of epithelial ovarian cancer. However, robust longitudinal research should be carried out to provide additional reliable insight to this information.
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Affiliation(s)
- Kehinde Sharafadeen Okunade
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Adebola A Adejimi
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ephraim O Ohazurike
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Omolola Salako
- Department of Clinical and Radiation Oncology, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Benedetto Osunwusi
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Muisi A Adenekan
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Aloy O Ugwu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Adaiah Soibi-Harry
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Olayemi Dawodu
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adeyemi A Okunowo
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Rose I Anorlu
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Jonathan S Berek
- Department of Obstetrics & Gynaecology, Stanford University School of Medicine, Stanford, CA
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31
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Kurian AW, Abrahamse P, Hamilton AS, Deapen D, Gomez SL, Morrow M, Berek JS, Katz SJ, Ward KC. Cancer-specific mortality associated with germline genetic testing results among women with breast cancer or ovarian cancer treated with chemotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10517] [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
10517 Background: Breast and ovarian cancer patients increasingly undergo germline genetic testing. While studies suggest a greater chemotherapy benefit for carriers of BRCA1/2 pathogenic variants, little is known about whether pathogenic variants in other genes are associated with cancer mortality. Methods: Georgia and California Surveillance, Epidemiology and End Results (SEER) registry records of women diagnosed with breast cancer or ovarian cancer from 2013-2017 were linked to results of clinical germline genetic testing from four participating laboratories. Patients were included if they linked to a genetic result, had stages I-III breast cancer or I-IV epithelial ovarian cancer and received chemotherapy. Multivariable Cox proportional hazard models were used to examine the association of genetic results, demographic and clinical factors with cancer-specific mortality. Results: 21,348 breast and 4,320 ovarian cancer patients were analyzed with median follow-up of 41 months. Pathogenic variants were present in 12% of patients with estrogen and progesterone receptor-positive, HER2-negative breast cancer, 9% with HER2-positive breast cancer, 17% with triple-negative breast cancer and 18% with ovarian cancer. Pathogenic variants were most common in BRCA1/2, CHEK2, PALB2, ATM and BRIP1. Among triple-negative breast cancer patients, mortality was lower with pathogenic variants in BRCA1 (hazard ratio (HR) 0.27, 95% confidence interval (CI) 0.17-0.45) and genes other than BRCA1/2 (HR 0.33, CI 0.13-0.81) versus no pathogenic variant. Genetic results were not associated with mortality in other breast cancer subtypes. Among ovarian cancer patients, mortality was lower with pathogenic variants in BRCA2 (HR 0.36, CI 0.26-0.49) and in genes other than BRCA1/2 (HR 0.48, CI 0.33-0.70). Conclusions: Among breast and ovarian cancer patients treated with chemotherapy, those with germline pathogenic variants in several cancer-associated genes had equivalent or lower short-term mortality than those testing negative. These results may guide patient counseling and clinical trial design.
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Affiliation(s)
- Allison W. Kurian
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | | | - Ann S. Hamilton
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan S. Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, CA
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32
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Kurtz JE, Gebski V, Sukhin V, Carey M, Kong I, Glasspool RM, Berek JS, de Paiva Batista M, Hall M, Kim JW, Yeoshoua E, Fujiwara N, Nam BH, Polleis S, Lee JY, Strojna A, Farrelly L, Schwameis R, Fossati R, Darlington AS, Lai CH, Wright AA, Rosenblat O, Harter P, Roxburgh P, Chowdhury RR, Chang TC, Paoletti X, Friedlander M. Incorporating patient centered benefits as endpoints in randomized trials of maintenance therapies in advanced ovarian cancer: A position paper from the GCIG symptom benefit committee. Gynecol Oncol 2021; 161:502-507. [PMID: 33612336 DOI: 10.1016/j.ygyno.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/27/2020] [Accepted: 02/08/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Quality of life and patient reported outcome measures (PROMs) are important secondary endpoints and incorporated in most contemporary clinical trials. There have been deficiencies in their assessment and reporting in ovarian cancer clinical trials, particularly in trials of maintenance treatment where they are of particular importance. The Gynecologic Cancer InterGroup (GCIG) symptom benefit committee (SBC) recently convened a brainstorming meeting with representation from all collaborative groups to address questions of how to best incorporate PROMs into trials of maintenance therapies to support the primary endpoint which is usually progression free survival (PFS). These recommendations should harmonize the collection, analysis and reporting of PROM's across future GCIG trials. METHODS Through literature review, trials analysis and input from international experts, the SBC identified four relevant topics to address with respect to promoting the role of PROMs to support the PFS endpoint in clinical trials of maintenance treatment for OC. RESULTS The GCIG SBC unanimously accepted the importance of integrating PROM's in future maintenance trials and developed four guiding principles to be considered early in trial design. These include 1) adherence to SPIRIT-PRO guidelines, 2) harmonization of selection, collection and reporting of PROM's; 3) combining Health Related Quality of Life (HRQL) measures with clinical endpoints and 4) common approaches to dealing with incomplete HRQL data. CONCLUSIONS Close attention to incorporating HRQL and PROM's is critical to interpret the results of ovarian cancer clinical trials of maintenance therapies. There should be a consistent approach to assessing and reporting patient centered benefits across all GCIG trials to enable cross trial comparisons which can be used to inform practice.
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Affiliation(s)
- Jean-Emmanuel Kurtz
- GINECO - Department of Medical and Surgical Oncology & Hematology, ICANS, 17 rue Albert Calmettes, 67200 Strasbourg, France.
| | - Val Gebski
- ANZGOG - NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia
| | - Vladyslav Sukhin
- CEEGOG - Grigoriev Institute for Medical Radiology, 82 Pushkinskaya St., Kharkiv, 61024, Ukraine Kharkiv, Ukraine
| | - Mark Carey
- CCTG - Division of Gynecologic Oncology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Iwa Kong
- CCTG - Department of Oncology, Division of Radiation Oncology, McMaster University and Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario, Canada
| | - Rosalind M Glasspool
- SGCTG - Cancer Research UK Trials Unit, Level 0, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Jonathan S Berek
- COGI - Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University, 900 Blake Wilbur Dr, Stanford, CA 94305, USA
| | - Mariana de Paiva Batista
- BRASGYN - Hospital Sao Luiz Jabaquara, 1° floor - Cinical Oncology Department, Rua das Perobas, 344 - Jabaquara, São Paulo, SP, 04321-120, Brazil
| | - Marcia Hall
- NCRI - Department of Medical Oncology, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood HA6 2RN, United Kingdom
| | - Jae-Weon Kim
- KGOG - Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Effi Yeoshoua
- ISGO - Department of Obstetrics and Gynecology, Rabin Medical Center, Zeev Jabutinsky Rd 39, Petah Tikva, 49100 Tel Aviv, Israel
| | - Noriko Fujiwara
- GOTIC - Department of Palliative Medicine and Advanced Clinical Oncology, IMSUT Hospital of the Institute of Medical Science, The University of Tokyo, Japan
| | - Byung-Ho Nam
- KGOG - The Institute of Advanced Clinical & Biomedical Research, 560 Eonju-ro, 14F Gangnam-gu, Seoul, 06144, Republic of Korea
| | - Sandra Polleis
- AGO - Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom, Kaiser-Friedrich-Ring 71, 65185 Wiesbaden, Germany
| | - Jung-Yun Lee
- KGOG - Yonsei University, 50 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, Republic of Korea
| | - Aleksandra Strojna
- CEEGOG - Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Laura Farrelly
- NCRI - Cancer Research UK & University College London Cancer Trials Centre, University College London, 90 Tottenham Court Road, London, United Kingdom
| | - Richard Schwameis
- AGO-Austria Department of Gynecology and Obstetrics Section for Gynecology and Gynecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Roldano Fossati
- MANGO - IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156, Milano, Italy
| | - Anne-Sophie Darlington
- EORTC - Faculty of Health Sciences, University of Southampton, Highfield, SO17 1BJ, Southampton, Hampshire, United Kingdom
| | - Chyong-Huey Lai
- AGOG, Chang Gung Memorial Hospital Linkou Medical Center, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Alexi A Wright
- GOG-F - GOG Foundation - Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Orgad Rosenblat
- ISGO - ISGO - Department of Gynecological oncology, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Phillip Harter
- AGO - Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Henricistrasse 40, 45136 Essen, Germany
| | - Patricia Roxburgh
- SGCTG - Scottish Gynaecological Cancer Trials Group, Wolfson Wohl Cancer Research Center G61 1BD, University of Glasgow, UK
| | - Rahul Roy Chowdhury
- KolGOTrg - Kolkata Gynecological Oncology Trials & Translational Research Group Room 404A, Chittaranjan National Cancer Institute 37, Shyamaprasad Mukherjee Rd, Bakul Bagan, CNCI, 404A, Kolkata, West Bengal 700026,India
| | - Ting-Chang Chang
- AGOG - Chang Gung Memorial Hospital Linkou Medical Center, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Xavier Paoletti
- GINECO - Biostatistics for Personalized Medicine Team, Institut Curie, 26 rue d'Ulm, Paris, France
| | - Michael Friedlander
- ANZGOG - The Prince of Wales Clinical School UNSW and Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Kurian AW, Ward KC, Abrahamse P, Bondarenko I, Hamilton AS, Deapen D, Morrow M, Berek JS, Hofer TP, Katz SJ. Time Trends in Receipt of Germline Genetic Testing and Results for Women Diagnosed With Breast Cancer or Ovarian Cancer, 2012-2019. J Clin Oncol 2021; 39:1631-1640. [PMID: 33560870 DOI: 10.1200/jco.20.02785] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Genetic testing is important for breast and ovarian cancer risk reduction and treatment, yet little is known about its evolving use. METHODS SEER records of women of age ≥ 20 years diagnosed with breast or ovarian cancer from 2013 to 2017 in California or Georgia were linked to the results of clinical germline testing through 2019. We measured testing trends, rates of variants of uncertain significance (VUS), and pathogenic variants (PVs). RESULTS One quarter (25.2%) of 187,535 patients with breast cancer and one third (34.3%) of 14,689 patients with ovarian cancer were tested; annually, testing increased by 2%, whereas the number of genes tested increased by 28%. The prevalence of test results by gene category for breast cancer cases in 2017 were BRCA1/2, PVs 5.2%, and VUS 0.8%; breast cancer-associated genes or ovarian cancer-associated genes (ATM, BARD1, BRIP1, CDH1, CHEK2, EPCAM, MLH1, MSH2, MSH6, NBN, NF1, PALB2, PMS2, PTEN, RAD51C, RAD51D, STK11, and TP53), PVs 3.7%, and VUS 12.0%; other actionable genes (APC, BMPR1A, MEN1, MUTYH, NF2, RB1, RET, SDHAF2, SDHB, SDHC, SDHD, SMAD4, TSC1, TSC2, and VHL) PVs 0.6%, and VUS 0.5%; and other genes, PVs 0.3%, and VUS 2.6%. For ovarian cancer cases in 2017, the prevalence of test results were BRCA1/2, PVs 11.0%, and VUS 0.9%; breast or ovarian genes, PVs 4.0%, and VUS 12.6%; other actionable genes, PVs 0.7%, and VUS 0.4%; and other genes, PVs 0.3%, and VUS 0.6%. VUS rates doubled over time (2013 diagnoses: 11.2%; 2017 diagnoses: 26.8%), particularly for racial or ethnic minorities (47.8% Asian and 46.0% Black, v 24.6% non-Hispanic White patients; P < .001). CONCLUSION A testing gap persists for patients with ovarian cancer (34.3% tested v nearly all recommended), whereas adding more genes widened a racial or ethnic gap in VUS results. Most PVs were in 20 breast cancer-associated genes or ovarian cancer-associated genes; testing other genes yielded mostly VUS. Quality improvement should focus on testing indicated patients rather than adding more genes.
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Affiliation(s)
- Allison W Kurian
- Departments of Medicine and of Epidemiology & Population Health, Stanford University, Stanford, CA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Paul Abrahamse
- Department of Health Management and Policy, School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Irina Bondarenko
- Department of Health Management and Policy, School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Ann S Hamilton
- Department of Preventive Medicine in the Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dennis Deapen
- Department of Preventive Medicine in the Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Monica Morrow
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jonathan S Berek
- Department of Obstetrics and Gynecology and Women's Cancer Center, Stanford University, Stanford, CA
| | - Timothy P Hofer
- Department of Internal Medicine, University of Michigan and Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Steven J Katz
- Department of Health Management and Policy, School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI
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Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A, Berek JS, Chen LM, Cristea M, DeRosa M, ElNaggar AC, Gershenson DM, Gray HJ, Hakam A, Jain A, Johnston C, Leath CA, Liu J, Mahdi H, Matei D, McHale M, McLean K, O'Malley DM, Penson RT, Percac-Lima S, Ratner E, Remmenga SW, Sabbatini P, Werner TL, Zsiros E, Burns JL, Engh AM. NCCN Guidelines Insights: Ovarian Cancer, Version 1.2019. J Natl Compr Canc Netw 2020; 17:896-909. [PMID: 31390583 DOI: 10.6004/jnccn.2019.0039] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States, with less than half of patients living >5 years from diagnosis. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. The best outcomes are observed in patients whose primary treatment includes complete resection of all visible disease plus combination platinum-based chemotherapy. Research efforts are focused on primary neoadjuvant treatments that may improve resectability, as well as systemic therapies providing improved long-term survival. These NCCN Guidelines Insights focus on recent updates to neoadjuvant chemotherapy recommendations, including the addition of hyperthermic intraperitoneal chemotherapy, and the role of PARP inhibitors and bevacizumab as maintenance therapy options in select patients who have completed primary chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Lee-May Chen
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | - Adam C ElNaggar
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Heidi J Gray
- University of Washington/Seattle Cancer Care Alliance
| | | | | | | | - Charles A Leath
- University of Alabama at Birmingham Comprehensive Cancer Center
| | - Joyce Liu
- Dana-Farber/Brigham and Women's Cancer Center
| | - Haider Mahdi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Daniela Matei
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - David M O'Malley
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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Okunade KS, Salako O, Adejimi AA, Akinsola OJ, Fatiregun O, Adenekan MA, Moses OE, Ebenso B, Allsop MJ, Anorlu RI, Berek JS. Impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria (mHealth-Cervix): Protocol for a randomised controlled trial. F1000Res 2020; 9:322. [PMID: 32528665 PMCID: PMC7265590 DOI: 10.12688/f1000research.22991.1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Incidence and mortality from cervical cancer have remained high due to many obstacles facing the implementation of organized screening programs in resource-constrained countries such as Nigeria. The application of mobile technologies (mHealth) to health services delivery has the potential to reduce inequalities, empower patients to control their health, and improve the cost-effectiveness of health care delivery. Aim: To assess the efficacy of mobile technology intervention on Pap test screening adherence compared to a control condition and also determine the factors affecting the uptake of Pap smear screening practices among women in Lagos. Methods: This is a multi-center randomized controlled trial that will involve women aged 25 to 65 years attending the General Outpatient clinics of the two tertiary health institutions in Lagos, Nigeria between April and December 2020. At baseline, a total of 200 National Health Insurance Scheme (NHIS) enrollees will be randomized to either a text message arm or usual care (control) arm. The primary outcome is the completion of a Pap smear within 6 months of enrolment in the study. The associations between any two groups of continuous variables will be tested using the independent sample t-test (normal distribution) or the Mann-Whitney U test (skewed data) and that of two groups of categorical variables with Chi-square
X
2or Fisher's exact test where appropriate. Using binary logistic regression model, we will adjust for age and other relevant sociodemographic and clinical variables and adherence to Pap test screening. Statistical significance will be defined as
P-value less than 0.05. Discussion: The mHealth-Cervix study will evaluate the impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria as a way of contributing to the reduction in the wide disparities in cervical cancer incidence through early detection facilitated using health promotion to improve Pap smear screening adherence. Registration:
PACTR202002753354517 13/02/2020
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics and Gynaecology, University of Lagos, Lagos, Lagos, 2345, Nigeria
| | - Omolola Salako
- Department of Radiation Biology, Radiotherapy and Radiodiagnosis, University of Lagos, Lagos, 2345, Nigeria
| | - Adebola A Adejimi
- Department of Community Health and Primary Care, University of Lagos, Lagos, Lagos, 2345, Nigeria
| | - Oluwatosin J Akinsola
- Department of Community Health and Primary Care, University of Lagos, Lagos, Lagos, 2345, Nigeria
| | - Omolara Fatiregun
- Department of Clinical and Radiation Oncology, Lagos State University Teaching Hospital,, Ikeja, Lagos, 2345, Nigeria
| | - Muisi A Adenekan
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital,, Lagos, Lagos, 2345, Nigeria
| | - Olusanjo E Moses
- Department of Obstetrics and Gynaecology, State University Teaching Hospital, Ikeja, Lagos, 2345, Nigeria
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, LS2 9JT, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, University of Leeds, Leeds, LS2 9JT, UK
| | - Rose I Anorlu
- Department of Obstetrics and Gynaecology, University of Lagos, Lagos, Lagos, 2345, Nigeria
| | - Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California, 94304, USA
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Moore K, Secord A, Geller M, Miller D, Cloven N, Fleming G, Hendrickson AEW, Azodi M, Disilvestro P, Oza A, Cristea M, Berek JS, Chan J, Li Y, Sun K, Luptakova K, Matulonis UA, Monk BJ. Abstract NT-101: QUADRA: A PHASE 2, OPEN-LABEL, SINGLE-ARM STUDY TO EVALUATE SINGLE-AGENT NIRAPARIB TREATMENT IN PATIENTS WITH RELAPSED OVARIAN CANCER (ROC) WHO HAVE RECEIVED ≥3 PRIOR CHEMOTHERAPY REGIMENS. Clin Cancer Res 2019. [DOI: 10.1158/1557-3265.ovcasymp18-nt-101] [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
BACKGROUND: Patients with ROC have limited treatment options in later lines of therapy, as many become platinum-resistant or -ineligible. Poly(ADP-ribose) polymerase inhibitor (PARPi) treatment is one option, however these agents are currently not approved for BRCAwt patients in the treatment setting. Niraparib, a PARPi, has demonstrated increased progression-free survival vs placebo as maintenance therapy for platinum-responsive ROC. Niraparib was effective regardless of BRCAmut or homologous recombination deficiency (HRD) status, although an increased treatment effect was observed in the HRDpos population. QUADRA (NCT02354586) evaluated niraparib treatment in heavily pretreated ROC patients, regardless of BRCAmut or HRD status, platinum sensitivity, or prior PARPi use.
METHODS: Eligible patients had grade 2-3 serous ROC, ≥3 prior chemotherapy lines, and measurable disease. Patients were evaluated for BRCAmut and HRD status (MyChoice HRD Test). Patients received niraparib 300 mg once daily until progression; dose could be lowered to 200 mg or 100 mg due to treatment-emergent adverse events (TEAEs). The primary endpoint was objective response rate (ORR) per RECIST v1.1 in patients treated in 4th or 5th line who were HRDpos, platinum sensitive, and PARPi naïve.
RESULTS: 463 patients were treated. Of these, 161 were platinum refractory, 151 platinum resistant, and 120 platinum sensitive to their last line of platinum therapy. Of note, 83 patients were primary platinum resistant or refractory (42 and 41, respectively). Median number of prior lines of therapy was 4 (range 2-16), and 27% of patients were treated in 6th or later line. 100% of patients received prior platinum, 99.6% received prior taxane, 81% received prior doxorubicin, 63% received prior bevacizumab, and 59% received prior gemcitabine.
In the primary efficacy population (N=45), ORR was 29% (95% CI: 16-44, P=0.0003), disease control rate (DCR) was 71% (95% CI: 56-84), and duration of response (DOR) was 9.2 months (95% CI: 5.9-NE); overall survival (OS) was not reached (95% CI: 18.5-NE). The efficacy outcomes in all 456 patients with measurable disease at baseline treated in 4th or later line demonstrated a DCR of 49% with 2 complete responses (CR), 36 partial responses (PR), and 187 patients with stable disease (SD). The responses were durable with a median DOR of 9.4 months, a clinical benefit rate (CR+PR+SD) at 16 weeks of 29%, and median OS of 17.2 months (95% CI: 14.9-19.8) among all patients treated in 4th or later line.
266 (57.5%) patients had grade ≥3 treatment-related TEAEs. Grade ≥3 thrombocytopenia event (thrombocytopenia or decreased platelet count) by dose at onset of the event was 27.5% at 300 mg, 4.7% at 200 mg, and 2.7% at 100 mg. The other most common grade ≥3 TEAEs were anemia (26.3%) and neutropenia (8.2%). Hematologic TEAEs were most frequent in the first month and decreased in frequency and severity after dose reduction during months 2-3.
CONCLUSIONS: Niraparib demonstrated durable anticancer activity in this heavily treated (≥3 lines) ROC population, including platinum-resistant or BRCAwt patients. Toxicities were consistent with previous niraparib studies.
DISCLOSURE Funded by TESARO, Inc.
Citation Format: Kathleen Moore, Angeles Secord, Melissa Geller, David Miller, Noelle Cloven, Gini Fleming, Andrea E. Wahner Hendrickson, Masoud Azodi, Paul Disilvestro, Amit Oza, Mihaela Cristea, Jonathan S. Berek, John Chan, Yong Li, Kaiming Sun, Katarina Luptakova, Ursula A. Matulonis, Bradley J. Monk. QUADRA: A PHASE 2, OPEN-LABEL, SINGLE-ARM STUDY TO EVALUATE SINGLE-AGENT NIRAPARIB TREATMENT IN PATIENTS WITH RELAPSED OVARIAN CANCER (ROC) WHO HAVE RECEIVED ≥3 PRIOR CHEMOTHERAPY REGIMENS [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr NT-101.
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Affiliation(s)
- Kathleen Moore
- 1University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Melissa Geller
- 3University of Minnesota Medical School, Minneapolis, MN, USA
| | - David Miller
- 4UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Gini Fleming
- 6The University of Chicago Medicine, Chicago, IL, USA
| | | | - Masoud Azodi
- 8Smilow Cancer Hospital at Yale and Yale University, New Haven, CT, USA
| | | | - Amit Oza
- 10University Health Network and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - John Chan
- 13Sutter Health, San Francisco, CA, USA
| | - Yong Li
- 14TESARO, Inc., Waltham, MA, USA
| | | | | | | | - Bradley J. Monk
- 16Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Phoenix Creighton University School of Medicine at St. Joseph's Hospital, Phoenix, AZ, USA
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Del Campo JM, Matulonis UA, Malander S, Provencher D, Mahner S, Follana P, Waters J, Berek JS, Woie K, Oza AM, Canzler U, Gil-Martin M, Lesoin A, Monk BJ, Lund B, Gilbert L, Wenham RM, Benigno B, Arora S, Hazard SJ, Mirza MR. Niraparib Maintenance Therapy in Patients With Recurrent Ovarian Cancer After a Partial Response to the Last Platinum-Based Chemotherapy in the ENGOT-OV16/NOVA Trial. J Clin Oncol 2019; 37:2968-2973. [PMID: 31173551 PMCID: PMC6839909 DOI: 10.1200/jco.18.02238] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE In the ENGOT-OV16/NOVA trial (ClinicalTrials.gov identifier: NCT01847274), maintenance therapy with niraparib, a poly(ADP-ribose) polymerase inhibitor, prolonged progression-free survival in patients with platinum-sensitive, recurrent ovarian cancer who had a response to their last platinum-based chemotherapy. The objective of the study was to assess the clinical benefit and patient-reported outcomes in patients who had a partial response (PR) and complete response (CR) to their last platinum-based therapy. PATIENTS AND METHODS A total of 553 patients were enrolled in the trial. Of 203 patients with a germline BRCA mutation (gBRCAmut), 99 had a PR and 104 had a CR to their last platinum-based therapy; of 350 patients without a confirmed gBRCAmut (non–gBRCAmut), 173 had a PR and 177 had a CR. Post hoc analyses were carried out to evaluate safety and the risk of progression in these patients according to gBRCAmut status and response to their last platinum-based therapy. Ovarian cancer–specific symptoms and quality of life were assessed using the Functional Assessment of Cancer Therapy–Ovarian Symptom Index. RESULTS Progression-free survival was improved in patients treated with niraparib compared with placebo in both the gBRCAmut cohort (PR: hazard ratio [HR], 0.24; 95% CI, 0.131 to 0.441; P < .0001; CR: HR, 0.30; 95% CI, 0.160 to 0.546; P < .0001) and the non–gBRCAmut cohort (PR: HR, 0.35; 95% CI, 0.230 to 0.532; P < .0001; CR: HR, 0.58; 95% CI, 0.383 to 0.868; P = .0082). The incidence of any-grade and grade 3 or greater adverse events was manageable. No meaningful differences were observed between niraparib and placebo in PR and CR subgroups with respect to patient-reported outcomes. CONCLUSION Patients achieved clinical benefit from maintenance treatment with niraparib regardless of response to the last platinum-based therapy.
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Affiliation(s)
- Josep M Del Campo
- Grupo Español de Investigación en Cáncer de Ovario (GEICO) and Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | - Susanne Malander
- Nordic Society of Gynaecological Oncology (NSGO) and Lund University Hospital, Lund, Sweden
| | - Diane Provencher
- Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada
| | - Sven Mahner
- Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Philippe Follana
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) and Centre Antoine Lacassagne, Nice, France
| | - Justin Waters
- National Cancer Research Institute (NCRI) and Kent Oncology Centre, Maidstone Hospital, Kent, United Kingdom
| | - Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, CA
| | | | - Amit M Oza
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ulrich Canzler
- AGO and Technische Universität Dresden, Dresden, Germany
| | - Marta Gil-Martin
- GEICO and Institut Català d'Oncologia-IDIBELL, L'Hospitalet, Barcelona, Spain
| | - Anne Lesoin
- GINECO and Centre Oscar Lambret, Lille, France
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St Joseph's Hospital, Phoenix, AZ
| | - Bente Lund
- NSGO and Aalborg University Hospital, Aalborg, Denmark
| | - Lucy Gilbert
- McGill University, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert M Wenham
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Mansoor R Mirza
- NSGO and Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
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Roncolato F, O'Connell R, Joly F, Lanceley A, Hilpert F, Okamoto A, Aotani E, Pignata S, Donnellan PP, Oza AM, Avall-Lundqvist E, Berek JS, Sehouli J, Ledermann JA, Berton-Rigaud D, Kiely BE, Friedlander M, Stockler MR. How long have we got? The accuracy of physicians’ estimates and scenarios for survival time in 898 women with recurrent ovarian cancer (ROC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5549] [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
5549 Background: Predicting, formulating, and communicating prognosis in women with ROC is difficult. Best-case, worst-case, and typical scenarios for survival time based on simple multiples of an individual’s expected survival time (EST) estimated by their oncologist have proven accurate and useful in a range of advanced cancers. We sought the accuracy and prognostic significance of such estimates in the GCIG Symptom Benefit Study: a multinational, prospective cohort study of women with ROC (platinum resistant and potentially platinum sensitive ROC who have had more than 2 lines of chemotherapy). Methods: Oncologists estimated EST at baseline for each woman they recruited to the GCIG Symptom Benefit Study in 11 countries. We hypothesised a priori that oncologists’ estimates of EST would be unbiased (equal proportions [approximately 50%] of women living longer versus shorter than their EST), imprecise ( < 33% living within 0.75 to 1.33 times their EST), and provide accurate scenarios for survival time (approximately 10% dying within ¼ of their EST, 10% living longer than 3 times their EST, and 50% living from half to double their EST). We also hypothesised that oncologists’ estimates of EST would be independently significant predictors of survival in a multivariable Cox model adjusting for prognostic factors established in previous studies. Results: Oncologists’ individualised estimates of EST in 898 women with ROC were unbiased (55% of women lived longer than their EST) and imprecise (23% lived within 0.75 to 1.33 times their EST). Scenarios for survival time based on oncologists’ estimates of EST were remarkably accurate: 7% of women died within ¼ of their EST, 13% lived longer than 3 times their EST, and 53% lived from half to double their EST. The median EST was 12 months (range 3-70), and median observed was 12.7 months. Oncologists’ estimates of EST were independently significant predictors of overall survival (HR 0.96, CI 0.94-0.98, p < 0.0001) in Cox models accounting for previously established prognostic factors. Conclusions: Oncologists’ estimates of EST were unbiased, imprecise, and independently significant predictors of survival time. Best-case, worst-case and typical scenarios based on simple multiples of EST were remarkably accurate, and provide a useful approach for predicting, formulating, and explaining prognosis in women with recurrent ovarian cancer. Clinical trial information: ACTRN: 12607000603415.
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Affiliation(s)
| | - Rachel O'Connell
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Florence Joly
- GINECO and Regional Centre Control Against Cancer Francois Baclesse, Caen, France
| | - Anne Lanceley
- University College London Hospitals, London, United Kingdom
| | | | - Aikou Okamoto
- The Jikei University School of Medicine, Tokyo, Japan
| | - Eriko Aotani
- Kanagawa Academy of Science and Technology, Kawasaki, Japan
| | | | | | - Amit M. Oza
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Jalid Sehouli
- AGO and Charité Campus Virchow-Klinikum, Berlin, Germany
| | | | | | - Belinda Emma Kiely
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Martin R. Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
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Schapira L, Hofmeister E, Kurian AW, Zion S, Shen H, Torres T, Berek JS, Palesh O. Differences among Asian/Asian American, and Caucasian breast and gynecologic cancer patient-reported survivorship needs, symptoms, and illness mindsets (N=220). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11620] [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
11620 Background: Cancer experiences are mediated by host and disease factors and affected by social and cultural determinants of health. We sought to characterize perceived supportive care needs and domains of psychosocial functioning among a diverse group of women attending routine appointments for treatment or follow-up of breast and gynecologic cancers. Methods: From July 2018 until January 2019, all patients seen at the Stanford Women’s Cancers Program (serving women treated for breast and gynecologic cancers) were approached to participate. 220 cancer patients (78% breast and 22% gynecologic), mean age 54 (SD = 12) completed an online survey on their supportive care needs assessment (The Short-form Supportive Care Needs Survey Questionnaire) which contains physical, social, information, sexual and psychological scales, anxiety and depression (Patient Health Questionnaire-4) and mindsets about illness and the body mindset (Brief Illness Mindset Inventory). Only 14% of patients refused to take part in the survey. Results: T-test showed that Asian/Asian-American cancer patients (n = 57, 26%) reported fewer needs related to coping with physical symptoms, side effects of treatment and performing usual tasks and activities compared to Caucasian patients (n = 137, 62%), p = .038. Moreover, Asian/Asian-American cancer patients reported fewer depression symptoms (p = .049). Chi-square analyses showed that Asian/Asian-American patients reported less use of psychotherapy over their lifetimes (24.6% vs. 54.0%, p < .001), but significantly higher utilization of Chinese Medicine for cancer symptom management (24.6% vs. 5.8%; p < . 001) compared to the Caucasian patients. T-tests showed that Asian/Asian American patients reported significantly greater agreement with the mindsets that ‘cancer is a catastrophe’ (p = .006) and that their ‘body is an adversary’ (p = .047). Conclusions: In this population of breast and gynecologic patients and survivors we found differences in cancer mindsets, coping and use of mental health and complementary therapies between Asian and Asian-American and Caucasian women. Further analysis to understand the cultural differences are ongoing.
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Affiliation(s)
| | | | | | | | | | | | | | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
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40
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Moore KN, Secord AA, Geller MA, Miller DS, Cloven N, Fleming GF, Wahner Hendrickson AE, Azodi M, DiSilvestro P, Oza AM, Cristea M, Berek JS, Chan JK, Rimel BJ, Matei DE, Li Y, Sun K, Luptakova K, Matulonis UA, Monk BJ. Niraparib monotherapy for late-line treatment of ovarian cancer (QUADRA): a multicentre, open-label, single-arm, phase 2 trial. Lancet Oncol 2019; 20:636-648. [DOI: 10.1016/s1470-2045(19)30029-4] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
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41
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Berek JS, Matulonis UA, Peen U, Ghatage P, Mahner S, Redondo A, Lesoin A, Colombo N, Vergote I, Rosengarten O, Ledermann J, Pineda M, Ellard S, Sehouli J, Gonzalez-Martin A, Berton-Rigaud D, Madry R, Reinthaller A, Hazard S, Guo W, Mirza MR. Safety and dose modification for patients receiving niraparib. Ann Oncol 2019; 30:859. [PMID: 30107447 DOI: 10.1093/annonc/mdy255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
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42
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Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, Kehoe ST, Konishi I, Olawaiye AB, Prat J, Sankaranarayanan R, Brierley J, Mutch D, Querleu D, Cibula D, Quinn M, Botha H, Sigurd L, Rice L, Ryu HS, Ngan H, Mäenpää J, Andrijono A, Purwoto G, Maheshwari A, Bafna UD, Plante M, Natarajan J. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet 2019; 145:129-135. [PMID: 30656645 DOI: 10.1002/ijgo.12749] [Citation(s) in RCA: 495] [Impact Index Per Article: 99.0] [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: 07/24/2018] [Revised: 11/05/2018] [Accepted: 12/20/2018] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To revise FIGO staging of carcinoma of the cervix uteri, allowing incorporation of imaging and/or pathological findings, and clinical assessment of tumor size and disease extent. METHODS Review of literature and consensus view of the FIGO Gynecologic Oncology Committee and related societies and organizations. RESULTS In stage I, revision of the definition of microinvasion and lesion size as follows. Stage IA: lateral extension measurement is removed; stage IB has three subgroups-stage IB1: invasive carcinomas ≥5 mm and <2 cm in greatest diameter; stage IB2: tumors 2-4 cm; stage IB3: tumors ≥4 cm. Imaging or pathology findings may be used to assess retroperitoneal lymph nodes; if metastatic, the case is assigned stage IIIC; if only pelvic lymph nodes, the case is assigned stage IIIC1; if para-aortic nodes are involved, the case is assigned stage IIIC2. Notations 'r' and 'p' will indicate the method used to derive the stage-i.e., imaging or pathology, respectively-and should be recorded. Routine investigations and other methods (e.g., examination under anesthesia, cystoscopy, proctoscopy, etc.) are not mandatory and are to be recommended based on clinical findings and standard of care. CONCLUSION The revised cervical cancer staging is applicable to all resource levels. Data collection and publication will inform future revisions.
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Affiliation(s)
- Neerja Bhatla
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Mauricio Cuello Fredes
- Division Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lynette A Denny
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Seija Grenman
- University of Turku and Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland
| | - Kanishka Karunaratne
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sean T Kehoe
- University of Birmingham and St. Peters College, Oxford, UK
| | - Ikuo Konishi
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Alexander B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jaime Prat
- Autonomous University of Barcelona, Barcelona, Spain
| | - Rengaswamy Sankaranarayanan
- International Agency for Research on Cancer (WHO-IARC), Lyon, France
- RTI International India, New Delhi, India
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43
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Berek JS, Matsuo K, Grubbs BH, Gaffney DK, Lee SI, Kilcoyne A, Cheon GJ, Yoo CW, Li L, Shao Y, Chen T, Kim M, Mikami M. Multidisciplinary perspectives on newly revised 2018 FIGO staging of cancer of the cervix uteri. J Gynecol Oncol 2018; 30:e40. [PMID: 30740962 PMCID: PMC6393641 DOI: 10.3802/jgo.2019.30.e40] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 12/23/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Brendan H Grubbs
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT, USA
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chong Woo Yoo
- Department of Pathology, National Cancer Center, Goyang, Korea
| | - Lu Li
- College of Basic Medical Sciences, Zhejiang Chinese Medical University (ZCMU), Hangzhou, China.,Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yifeng Shao
- Department of Obstetrics and Gynecology, 1st affiliated hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tianhui Chen
- Group of Molecular Epidemiology & Cancer Precision Prevention (GMECPP), Zhejiang Academy of Medical Sciences (ZJAMS), Hangzhou, China
| | - Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan.
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44
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Abstract
The Gynecologic Oncology Committee of FIGO in 2014 revised the staging of ovarian cancer, incorporating ovarian, fallopian tube, and peritoneal cancer into the same system. Most of these malignancies are high-grade serous carcinomas (HGSC). Stage IC is now divided into three categories: IC1 (surgical spill); IC2 (capsule ruptured before surgery or tumor on ovarian or fallopian tube surface); and IC3 (malignant cells in the ascites or peritoneal washings). The updated staging includes a revision of Stage IIIC based on spread to the retroperitoneal lymph nodes alone without intraperitoneal dissemination. This category is now subdivided into IIIA1(i) (metastasis ≤10 mm in greatest dimension), and IIIA1(ii) (metastasis >10 mm in greatest dimension). Stage IIIA2 is now "microscopic extrapelvic peritoneal involvement with or without positive retroperitoneal lymph node" metastasis. This review summarizes the genetics, surgical management, chemotherapy, and targeted therapies for epithelial cancers, and the treatment of ovarian germ cell and stromal malignancies.
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Affiliation(s)
- Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean T Kehoe
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Michael Friedlander
- Royal Hospital for Women, Randwick, Sydney, NSW, Australia.,University of New South Wales Clinical School, Sydney, NSW, Australia
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45
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Moore KN, Secord AA, Geller MA, Miller DS, Cloven NG, Fleming GF, Wahner Hendrickson AE, Azodi M, DiSilvestro P, Oza AM, Cristea MC, Berek JS, Chan JK, Li Y, Clark R, Matulonis UA, Monk BJ. QUADRA: A phase 2, open-label, single-arm study to evaluate niraparib in patients (pts) with relapsed ovarian cancer (ROC) who have received ≥3 prior chemotherapy regimens. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5514] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amit M. Oza
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | | | | | - Bradley J. Monk
- Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Phoenix Creighton University School of Medicine at St. Joseph's Hospital, Phoenix, AZ
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46
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Abstract
Surgery is the cornerstone of treatment of ovarian cancer. Given the importance of achieving no or minimal macroscopic residual disease at primary surgery, performing an assessment of the quality of ovarian cancer surgery is crucial. Assessing the quality of care and surgical outcome allows us to establish baseline information, set standards of care and clear priorities, enable benchmarking against peers, and sustain quality improvement. We know that suboptimal care exists and variation in outcomes results. One way to monitor variation in outcomes is through a clinical quality registry (CQR). A CQR collects a defined minimum dataset to measure performance of an individual or center against a range of clinical quality indicators and provides risk-adjusted, benchmarked data to participating institutions. CQR's are an excellent quality assurance measure as they capture all cases (an opt out system). They permit detection and analysis of unwarranted variations in care. This can provide indications of a systems or process problem, thereby motivating health care providers to improve services and care. Several groups have either developed quality indicators for advanced ovarian cancer surgery (The Scottish Cancer Taskforce and the European Society of Gynecological Oncology) or are in the process of doing so (Australian Society of Gynaecological Oncologists). Indicators should be evidence-based and determined by extensive discussion with experts and stakeholders to ensure appropriateness and buy-in. The Scottish Cancer Taskforce and European Society of Gynecological Oncology have set targets for their quality performance measures, which should provide a quantitative framework for improving care in the surgical management of ovarian cancer.
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Affiliation(s)
- A H Brand
- Department of Gynecological Oncology, Westmead Hospital, Sydney, Australia
| | - P A DiSilvestro
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Women & Infants Hospital of Rhode Island, Providence, USA
| | - J Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité Comprehensive Cancer Center, Medical University of Berlin, Berlin, Germany
| | - J S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, USA
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47
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Parker WH, Berek JS, Pritts EA, Olive D, Chalas E, Clarke-Pearson D. Regarding "Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy with Morcellation". J Minim Invasive Gynecol 2018; 25:1113. [PMID: 29679676 DOI: 10.1016/j.jmig.2018.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - David Olive
- Wisconsin Fertility Institute, Middleton, Wisconsin
| | - Eva Chalas
- Winthrop-University Hospital, Mineola, New York
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48
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Gonzalez VD, Samusik N, Chen TJ, Savig ES, Aghaeepour N, Quigley DA, Huang YW, Giangarrà V, Borowsky AD, Hubbard NE, Chen SY, Han G, Ashworth A, Kipps TJ, Berek JS, Nolan GP, Fantl WJ. Commonly Occurring Cell Subsets in High-Grade Serous Ovarian Tumors Identified by Single-Cell Mass Cytometry. Cell Rep 2018; 22:1875-1888. [PMID: 29444438 PMCID: PMC8556706 DOI: 10.1016/j.celrep.2018.01.053] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 12/18/2017] [Accepted: 01/17/2018] [Indexed: 01/16/2023] Open
Abstract
We have performed an in-depth single-cell phenotypic characterization of high-grade serous ovarian cancer (HGSOC) by multiparametric mass cytometry (CyTOF). Using a CyTOF antibody panel to interrogate features of HGSOC biology, combined with unsupervised computational analysis, we identified noteworthy cell types co-occurring across the tumors. In addition to a dominant cell subset, each tumor harbored rarer cell phenotypes. One such group co-expressed E-cadherin and vimentin (EV), suggesting their potential role in epithelial mesenchymal transition, which was substantiated by pairwise correlation analyses. Furthermore, tumors from patients with poorer outcome had an increased frequency of another rare cell type that co-expressed vimentin, HE4, and cMyc. These poorer-outcome tumors also populated more cell phenotypes, as quantified by Simpson's diversity index. Thus, despite the recognized genomic complexity of the disease, the specific cell phenotypes uncovered here offer a focus for therapeutic intervention and disease monitoring.
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Affiliation(s)
- Veronica D Gonzalez
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nikolay Samusik
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Tiffany J Chen
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Erica S Savig
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nima Aghaeepour
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - David A Quigley
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1450 Third Street, San Francisco, CA 94158, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, 1450 Third Street, San Francisco, CA 94158, USA
| | - Ying-Wen Huang
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Valeria Giangarrà
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Alexander D Borowsky
- Center for Comparative Medicine, University of California, Davis, Davis, CA 95616, USA; Department of Pathology and Laboratory Medicine, Comprehensive Cancer Center, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Neil E Hubbard
- Center for Comparative Medicine, University of California, Davis, Davis, CA 95616, USA; Department of Pathology and Laboratory Medicine, Comprehensive Cancer Center, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Shih-Yu Chen
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Guojun Han
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Alan Ashworth
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1450 Third Street, San Francisco, CA 94158, USA; Department of Medicine, University of California, San Francisco, 1450 Third Street, San Francisco, CA 94158, USA
| | - Thomas J Kipps
- Moores Cancer Center, University of California, San Diego, La Jolla, CA 92093, USA
| | - Jonathan S Berek
- Stanford Comprehensive Cancer Institute and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Garry P Nolan
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Wendy J Fantl
- Stanford Comprehensive Cancer Institute and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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49
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Park SH, Chung YM, Ma J, Yang Q, Berek JS, Hu MCT. Pharmacological activation of FOXO3 suppresses triple-negative breast cancer in vitro and in vivo. Oncotarget 2018; 7:42110-42125. [PMID: 27283899 PMCID: PMC5173120 DOI: 10.18632/oncotarget.9881] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/12/2016] [Indexed: 01/18/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is the most lethal form of breast cancer. Lacking effective therapeutic options hinders treatment of TNBC. Here, we show that bepridil (BPD) and trifluoperazine (TFP), which are FDA-approved drugs for treatment of schizophrenia and angina respectively, inhibit Akt-pS473 phosphorylation and promote FOXO3 nuclear localization and activation in TNBC cells. BPD and TFP inhibit survival and proliferation in TNBC cells and suppress the growth of TNBC tumors, whereas silencing FOXO3 reduces the BPD- and TFP-mediated suppression of survival in TNBC cells. While BPD and TFP decrease the expression of oncogenic c-Myc, KLF5, and dopamine receptor DRD2 in TNBC cells, silencing FOXO3 diminishes BPD- and TFP-mediated repression of the expression of these proteins in TNBC cells. Since c-Myc, KLF5, and DRD2 have been suggested to increase cancer stem cell-like populations in various tumors, reducing these proteins in response to BPD and TFP suggests a novel FOXO3-dependent mechanism underlying BPD- and TFP-induced apoptosis in TNBC cells.
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Affiliation(s)
- See-Hyoung Park
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA.,Current address: Department of Biological and Chemical Engineering, Hongik University, Sejong, 339-701, Korea
| | - Young Min Chung
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jessica Ma
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Qin Yang
- Cancer Biology Division, Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO 63108, USA
| | - Jonathan S Berek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Mickey C-T Hu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
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50
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Roncolato FT, Joly F, O'Connell R, Lanceley A, Hilpert F, Buizen L, Okamoto A, Aotani E, Pignata S, Donnellan P, Oza A, Avall-Lundqvist E, Berek JS, Heitz F, Feeney A, Berton-Rigaud D, Stockler MR, King M, Friedlander M. Reducing Uncertainty: Predictors of Stopping Chemotherapy Early and Shortened Survival Time in Platinum Resistant/Refractory Ovarian Cancer-The GCIG Symptom Benefit Study. Oncologist 2017; 22:1117-1124. [PMID: 28596446 DOI: 10.1634/theoncologist.2017-0047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 01/29/2017] [Accepted: 03/23/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Clinicians and patients often overestimate the benefits of chemotherapy, and overall survival (OS), in platinum resistant/refractory ovarian cancer (PRROC). This study sought to determine aspects of health-related quality of life and clinicopathological characteristics before starting chemotherapy that were associated with stopping chemotherapy early, shortened survival, and death within 30 days of chemotherapy. MATERIALS AND METHODS This study enrolled women with PRROC before starting palliative chemotherapy. Health-related quality of life was measured with EORTC QLQ-C30/QLQ-OV28. Chemotherapy stopped within 8 weeks of starting was defined as stopping early. Logistic regression was used to assess univariable and multivariable associations with stopping chemotherapy early and death within 30 days of chemotherapy; Cox proportional hazards regression was used to assess associations with progression-free and OS. RESULTS Low baseline global health status (GHS), role function (RF), physical function (PF), and high abdominal/gastrointestinal symptom (AGIS) were associated with stopping chemotherapy early (all p < .007); low PF and RF remained significant after adjusting for clinicopathological factors (both p < .0401). Most who stopped chemotherapy early had Eastern Cooperative Oncology Group Performance Score 0-1 at baseline (79%); PF, RF, and GHS remained independently significant predictors of stopping chemotherapy early in this subgroup. Death within 30 days of chemotherapy occurred in 14%. Low GHS, RF, and PF remained significantly associated with death within 30 days of chemotherapy after adjusting for clinicopathological factors (all p < .012). CONCLUSION Women with low GHS, RF, or PF before starting chemotherapy were more likely to stop chemotherapy early, with short OS. Self-ratings of GHS, RF, and PF could improve patient-clinician communication regarding prognosis and help decision-making in women considering chemotherapy for PRROC. IMPLICATIONS FOR PRACTICE Measuring aspects of health-related quality of life when considering further chemotherapy in platinum resistant/refractory ovarian cancer (PRROC) could help identify women with a particularly poor prognosis who are unlikely to benefit from chemotherapy and could therefore be spared unnecessary treatment and toxicity in their last months of life. Self-ratings of global health status, role function, and physical function could improve patient-clinician communication regarding prognosis and help decision-making in women considering chemotherapy for PRROC.
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Affiliation(s)
- Felicia T Roncolato
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), New South Wales, Australia
- Macarthur Cancer Therapy Centre, New South Wales, Australia
| | | | - Rachel O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Felix Hilpert
- Klinik fur Gynakologie und Geburtshilfe, UKSH, Kiel, Germany
| | - Luke Buizen
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Aikou Okamoto
- The Jikei University School of Medicine, Tokyo, Japan
| | - Eriko Aotani
- Kitasato Academic Research Organization, Tokyo, Japan
| | - Sandro Pignata
- Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione G. Pascale, IRCCS, Napoli (MITO), Italy
| | - Paul Donnellan
- Cancer Trials Ireland, Galway University Hospital, Galway, Ireland
| | - Amit Oza
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elisabeth Avall-Lundqvist
- Department of Oncology, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | - Jonathan S Berek
- Stanford Comprehensive Cancer Institute, Stanford, California, USA
| | - Florian Heitz
- AGO Study group and Department of Gynecology & Gynecologic Oncology, Kliniken Essen Mitte (KEM), Essen, Germany
| | - Amanda Feeney
- Cancer Research UK & UCL Cancer Trials Centre, London, England
| | | | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), New South Wales, Australia
| | - Madeleine King
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), New South Wales, Australia
- Psycho-oncology Research Group (PoCoG), School of Psychology and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michael Friedlander
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), New South Wales, Australia
- Prince of Wales Hospital, Sydney, Australia
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