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Rives TA, Orellana TJ, Mumford BS, Sukumvanich P, Courtney-Brooks M, Berger J, Conger J, Vargo JA, Beriwal S, Lesnock J, Wang L, Orr BC, Taylor SE. The role of obesity in treatment planning for early-stage cervical cancer. Gynecol Oncol 2024; 181:60-67. [PMID: 38134755 DOI: 10.1016/j.ygyno.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/28/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Optimal management of obese patients with early-stage cervical cancer is debated despite evidence of non-inferior survival in obese patients undergoing radical hysterectomy with pelvic lymphadenectomy (RH) compared to primary radiation with or without radiosensitizing chemotherapy (RT). Objectives included describing patient factors affecting disposition to RH versus RT; comparing RH outcomes for obese (BMI >30 mg/m2) and non-obese patients; and comparing differences in recurrence free survival (RFS) and overall survival (OS). METHODS This was a single institution cohort study of all cervical cancer patients who underwent RH or were candidates for RH based on clinical stage. Demographic, clinicopathologic and treatment outcomes were collected and analyzed. RESULTS RT patients (n = 39, 15%) had a higher BMI (p = 0.004), older age (p < 0.001), more life-limiting comorbidities (LLC) (p < 0.001), larger tumor size (p = 0.001), and higher clinical stage (p = 0.013) compared to RH patients (n = 221, 85%). On multivariable survival analysis there was no difference in OS based on treatment modality; significant predictors of worse OS were larger tumor size, higher number of LLC and recurrence. Among the RH group, obese patients had a longer operative time (p = 0.01) and more LLC (p = 0.02); there were no differences in demographic or clinicopathologic characteristics, operative outcomes, RFS or OS compared to non-obese patients. CONCLUSION In this cohort of RH-eligible cervical cancer patients, BMI was independently associated with disposition to RT. Studies demonstrate that RH is feasible and safe in obese patients with no difference in RFS or OS when compared to non-obese patients. Thus, the decision for disposition to RT should not be based on obesity alone.
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Affiliation(s)
- Taylor A Rives
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America.
| | - Taylor J Orellana
- Division of Gynecologic Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Brigid S Mumford
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Paniti Sukumvanich
- Division of Gynecologic Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Madeleine Courtney-Brooks
- Division of Gynecologic Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Jessica Berger
- Division of Gynecologic Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Jason Conger
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - John A Vargo
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States of America
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States of America
| | - Jamie Lesnock
- Division of Gynecologic Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Li Wang
- University of Pittsburgh, Clinical and Translational Science Institute, Pittsburgh, PA, United States of America
| | - Brian C Orr
- Division of Gynecologic Oncology, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, United States of America
| | - Sarah E Taylor
- Division of Gynecologic Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
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Rives TA, Pavlik H, Li N, Qasrawi L, Yan D, Pickarski J, Dietrich CS, Miller RW, Ueland FR, Kolesar JM. Implementation of Nurse Navigation Improves Rate of Molecular Tumor Testing for Ovarian Cancer in a Gynecologic Oncology Practice. Cancers (Basel) 2023; 15:3192. [PMID: 37370804 DOI: 10.3390/cancers15123192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE The purpose of this study was to assess the impact of implementing a Nurse Navigator (NN) to improve the rate and timeliness of molecular tumor testing. METHODS This is an evaluation of the impact of education sessions, consensus building, and NN implementation for molecular tumor testing in patients with epithelial ovarian cancer. The NNs' responsibilities included attending tumor boards and ensuring Next Generation Sequencing (NGS) is ordered, reviewed, and coordinated for appropriate patients. RESULTS NNs significantly improved NGS testing rates from 35.29% to 77.27%, p = 0.002. Ordering a targeted panel test (TPT) was the most common reason for not ordering NGS in the pre-NN cohort (13/22, 59%). The total turnaround time for testing was reduced after the introduction of NNs from 145.2 days to 42.8 days, p < 0.0001. The post-NN group had a significantly higher rate of actionable mutations identified for the recurrent setting [67.6% versus 20.8% (p = 0.0005)] and a trend towards a higher rate of actionable mutations identified in the frontline setting [41.2% versus 33.3% (p = 0.41)]. CONCLUSION NNs significantly improved somatic tumor testing rates and timeliness for patients with ovarian cancer. Discontinuing TPT in favor of NGS revealed a higher rate of actionable tumor mutations that would have been missed with TPT alone.
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Affiliation(s)
- Taylor A Rives
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
| | - Heather Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Ning Li
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA
| | - Lien Qasrawi
- College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
| | - Donglin Yan
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA
| | - Justine Pickarski
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Charles S Dietrich
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Rachel W Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Jill M Kolesar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
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