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Ostby SA, Blanchard CT, Sanjanwala AR, Szychowski JM, Leath CA, Huh WK, Subramaniam A. Feasibility, Safety, and Provider Perspectives of Bipolar Electrosurgical Cautery Device for (Opportunistic or Complete) Salpingectomy at the Time of Cesarean Delivery. Am J Perinatol 2024; 41:804-813. [PMID: 35728603 DOI: 10.1055/s-0042-1748525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate the use of a bipolar electrocautery device for complete salpingectomy at cesarean to improve procedure completion rates, operative time, and surgeon reported satisfaction as compared with standard bilateral tubal ligation (BTL) and suture-cut-tie salpingectomy. STUDY DESIGN This is a prospective cohort study of women undergoing planned, non-emergent cesarean with desired sterilization with complete salpingectomy utilizing a bipolar electrocautery device. Study patients were compared with historic controls from a randomized controlled trial (RCT) of complete salpingectomy via suture-cut-tie method versus BTL conducted at our institution (SCORE trial, NCT02374827). Outcomes were compared with groups from the original RCT. RESULTS Thirty-nine women were consecutively enrolled (12/2018-11/2019) into the device arm of the study and compared with the original SCORE cohort (n = 40 BTL, n = 40 salpingectomy without a device). Salpingectomy performance with the bipolar electrocautery device was successfully completed in 100% (39/39) of enrolled women, with one device failure requiring the use of a second device, as compared with 95% (38/40) in the BTL (p = 0.49) and 67.5% (27/40) in salpingectomies without a device (p < 0.001). Mean operative time of sterilization procedure alone demonstrated device use as having the shortest operative time of all (device salpingectomy 5.0 ± 3.6 vs. no device 18.5 ± 8.3 minutes, p < 0.001; and vs. BTL 6.9 ± 5.0, p = 0.032). Mean sterilization procedure endoscopic band ligation (EBL) was demonstrated to be significantly different between each group, least amongst BTL followed by device (6.3 ± 4.8 vs. 8.4 ± 24.8, p < 0.001), and most by suture-cut-tie method (17.7 ± 14.3, p < 0.001 compared with device). Surgeon reported attitudes of complete salpingectomy performance in general practice outside an academic setting was greater with a device than without (79.5 vs. 35.3%; p < 0.001). CONCLUSION Use of a bipolar electrocautery device improved operative times and surgeon satisfaction for salpingectomy at cesarean over standard suture ligation. Device use improved surgeon reported outcomes and may improve incorporation of complete salpingectomy at cesarean. KEY POINTS · Electrocautery bipolar device use was safe at the time of salpingectomy during cesarean.. · Greater surgeon satisfaction occurs using a device than without.. · Decreased surgical time with device use is seen making the procedure equal to BTL..
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Affiliation(s)
- Stuart A Ostby
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Aalok R Sanjanwala
- Division of Maternal-Fetal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeff M Szychowski
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
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Liang MI, Dholakia JD, Lee GM, Wang L, Kako TD, Blair I, Williams CP, Arend RC, Huh WK, Rocque GB, Pisu M. Dedicated financial hardship screening adds value to routine distress screening among gynecologic cancer patients. Gynecol Oncol 2024; 183:53-60. [PMID: 38518528 DOI: 10.1016/j.ygyno.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVES To evaluate existing distress screening to identify patients with financial hardship (FH) compared to dedicated FH screening and assess patient attitudes toward FH screening. METHODS We screened gynecologic cancer patients starting a new line of therapy. Existing screening included: (1) Moderate/severe distress defined as Distress Thermometer score ≥ 4, (2) practical concerns identified from Problem Checklist, and (3) a single question assessing trouble paying for medications. FH screening included: (1) Comprehensive Score for Financial Toxicity (COST) tool and (2) 10-item Financial Needs Checklist to guide referrals. FH was defined as COST score < 26. We calculated sensitivity (patients with moderate/severe distress + FH over total patients with FH) and specificity (patients with no/mild distress + no FH over total patients with no FH) to assess the extent distress screening could capture FH. Surveys and exit interviews assessed patient perspectives toward screening. RESULTS Of 364 patients screened for distress, average age was 62 years, 25% were Black, 45% were Medicare beneficiaries, 32% had moderate/severe distress, 15% reported ≥1 practical concern, and 0 reported trouble paying for medications. Most (n = 357, 98%) patients also completed FH screening: of them, 24% screened positive for FH, 32% reported ≥1 financial need. Distress screening had 57% sensitivity and 77% specificity for FH. Based on 79 surveys and 43 exit interviews, FH screening was acceptable with feedback to improve the timing and setting of screening. CONCLUSIONS Dedicated FH screening was feasible and acceptable, but sensitivity was low. Importantly, 40% of women with FH would not have been identified with distress screening alone.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jhalak D Dholakia
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grace M Lee
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lingling Wang
- Division of Preventive Medicine, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tavonna D Kako
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Isabella Blair
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney P Williams
- Division of Preventive Medicine, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rebecca C Arend
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabrielle B Rocque
- Division of Hematology & Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pisu
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Preventive Medicine, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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Wang CC, Foley OW, Blank SV, Huh WK, Barber EL. Shifting trends and sicker patients: Reassessing hysterectomy performed for benign indications by gynecologic oncologists. Gynecol Oncol 2024; 184:43-50. [PMID: 38277920 DOI: 10.1016/j.ygyno.2024.01.030] [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: 12/18/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE To assess trends and differences in patient characteristics, complications, and distributions of hysterectomy for benign indications by benign gynecologists (BG) and gynecologic oncologists (GO). METHODS This retrospective cohort study identified patients undergoing hysterectomy for benign indications using the National Surgical Quality Improvement Program data from 2014 to 2021. Exclusions were made for gynecologic or disseminated cancers, ascites, non-gynecologic surgeons, and cesarean hysterectomies. Primary outcome was major (≥Grade 3) 30-day complications, categorized into any complications, wound, cardiovascular and pulmonary, renal, infectious, andthromboembolic complications. Thirty-day readmissions, reoperations, and mortality were also analyzed. Propensity score matching was performed in a 1:1 match of GO to BG patients and was compared. Linear regressions assessed trends. RESULTS Among 198,767 patients, 18% (n = 37,707) underwent hysterectomy for benign indications with GO. GO patients exhibited more risk factors for complications and differed significantly from BG patients in comorbidities and perioperative characteristics. Overall, GO patients had higher major complication rates (3.1% vs 2.2%, p < 0.001) and for several other composite complications. After matching, compared to BG, GO-performed hysterectomies had similar rates of major complications (3.0% vs 3.0%, p = 0.55) and no differences in other composite complications, except fewer reoperations (1.2 % vs 1.5%, p < 0.01) and wound complications (0.4% vs 0.5%, p = 0.02) in GO patients. Over the eight years, the percentage of GO-performed hysterectomy (β = 0.41, R2 = 0.71,p < 0.01) increased significantly whereas BG-performed surgeries decreased by the same magnitude. BG had a significant decrease in frail patients (β = -0.47, R2 = 0.90, p < 0.01), but GO did not (β = -0.36, R2 = 0.38, p = 0.10). CONCLUSIONS GO are performing more hysterectomies for benign indications on higher-risk patients. However, on a matched cohort, risks of major complications were similar between GO and BG.
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Affiliation(s)
- Connor C Wang
- Northwestern University Feinberg School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA.
| | - Olivia W Foley
- Northwestern University Feinberg School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA
| | - Stephanie V Blank
- Icahn School of Medicine at Mount Sinai, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, New York, NY, USA
| | - Warner K Huh
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Birmingham, AL, USA
| | - Emma L Barber
- Northwestern University Feinberg School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA
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Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, Huh WK, Kim JJ, Moscicki AB, Nayar R, Saraiya M, Sawaya GF, Wentzensen N, Schiffman M. 2019 ASCCP Risk-Based Management Consensus Guidelines: Updates Through 2023. J Low Genit Tract Dis 2024; 28:3-6. [PMID: 38117563 PMCID: PMC10755815 DOI: 10.1097/lgt.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
ABSTRACT This Research Letter summarizes all updates to the 2019 Guidelines through September 2023, including: endorsement of the 2021 Opportunistic Infections guidelines for HIV+ or immunosuppressed patients; clarification of use of human papillomavirus testing alone for patients undergoing observation for cervical intraepithelial neoplasia 2; revision of unsatisfactory cytology management; clarification that 2012 guidelines should be followed for patients aged 25 years and older screened with cytology only; management of patients for whom colposcopy was recommended but not completed; clarification that after treatment for cervical intraepithelial neoplasia 2+, 3 negative human papillomavirus tests or cotests at 6, 18, and 30 months are recommended before the patient can return to a 3-year testing interval; and clarification of postcolposcopy management of minimally abnormal results.
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Affiliation(s)
| | | | - Philip E. Castle
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - David Chelmow
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Mark H. Einstein
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Francisco Garcia
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Warner K. Huh
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Jane J. Kim
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Anna-Barbara Moscicki
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Ritu Nayar
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Mona Saraiya
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - George F. Sawaya
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Nicolas Wentzensen
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Mark Schiffman
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - 2019 ASCCP Risk-Based Management Consensus Guidelines Committee
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
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Huh WK, Valea FA, Chalas E, Blank SV. Houston, We Have a Problem: How Changes in Gynecologic Oncology Represent Broader Concerns for the Future of Obstetrics and Gynecology. Obstet Gynecol 2023; 142:1-3. [PMID: 37290095 DOI: 10.1097/aog.0000000000005242] [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: 06/10/2023]
Affiliation(s)
- Warner K Huh
- Warner K. Huh is from the UAB Heersink School of Medicine, Birmingham, Alabama; . Fidel A. Valea is from the Northwell Health, Zucker School of Medicine, New Hyde Park, New York. Eva Chalas is from the NYU Long Island School of Medicine, Mineola, New York. Stephanie V. Blank is from the Icahn School of Medicine at Mount Sinai, New York, NY
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Mileshkin LR, Moore KN, Barnes EH, Gebski V, Narayan K, King MT, Bradshaw N, Lee YC, Diamante K, Fyles AW, Small W, Gaffney DK, Khaw P, Brooks S, Thompson JS, Huh WK, Mathews CA, Buck M, Suder A, Lad TE, Barani IJ, Holschneider CH, Van Dyk S, Quinn M, Rischin D, Monk BJ, Stockler MR. Adjuvant chemotherapy following chemoradiotherapy as primary treatment for locally advanced cervical cancer versus chemoradiotherapy alone (OUTBACK): an international, open-label, randomised, phase 3 trial. Lancet Oncol 2023; 24:468-482. [PMID: 37080223 DOI: 10.1016/s1470-2045(23)00147-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Standard treatment for locally advanced cervical cancer is chemoradiotherapy, but many patients relapse and die of metastatic disease. We aimed to determine the effects on survival of adjuvant chemotherapy after chemoradiotherapy. METHODS The OUTBACK trial was a multicentre, open-label, randomised, phase 3 trial done in 157 hospitals in Australia, China, Canada, New Zealand, Saudi Arabia, Singapore, and the USA. Eligible participants were aged 18 year or older with histologically confirmed squamous cell carcinoma, adenosquamous cell carcinoma, or adenocarcinoma of the cervix (FIGO 2008 stage IB1 disease with nodal involvement, or stage IB2, II, IIIB, or IVA disease), Eastern Cooperative Oncology Group performance status 0-2, and adequate bone marrow and organ function. Participants were randomly assigned centrally (1:1) using a minimisation approach and stratified by pelvic or common iliac nodal involvement, requirement for extended-field radiotherapy, FIGO 2008 stage, age, and site to receive standard cisplatin-based chemoradiotherapy (40 mg/m2 cisplatin intravenously once-a-week for 5 weeks, during radiotherapy with 45·0-50·4 Gy external beam radiotherapy delivered in fractions of 1·8 Gy to the whole pelvis plus brachytherapy; chemoradiotherapy only group) or standard cisplatin-based chemoradiotherapy followed by adjuvant chemotherapy with four cycles of carboplatin (area under the receiver operator curve 5) and paclitaxel (155 mg/m2) given intravenously on day 1 of a 21 day cycle (adjuvant chemotherapy group). The primary endpoint was overall survival at 5 years, analysed in the intention-to-treat population (ie, all eligible patients who were randomly assigned). Safety was assessed in all patients in the chemoradiotherapy only group who started chemoradiotherapy and all patients in the adjuvant chemotherapy group who received at least one dose of adjuvant chemotherapy. The OUTBACK trial is registered with ClinicalTrials.gov, NCT01414608, and the Australia New Zealand Clinical Trial Registry, ACTRN12610000732088. FINDINGS Between April 15, 2011, and June 26, 2017, 926 patients were enrolled and randomly assigned to the chemoradiotherapy only group (n=461) or the adjuvant chemotherapy group (n=465), of whom 919 were eligible (456 in the chemoradiotherapy only group and 463 in the adjuvant chemotherapy group; median age 46 years [IQR 37 to 55]; 663 [72%] were White, 121 [13%] were Black or African American, 53 [6%] were Asian, 24 [3%] were Aboriginal or Pacific islander, and 57 [6%] were other races) and included in the analysis. As of data cutoff (April 12, 2021), median follow-up was 60 months (IQR 45 to 65). 5-year overall survival was 72% (95% CI 67 to 76) in the adjuvant chemotherapy group (105 deaths) and 71% (66 to 75) in the chemoradiotherapy only group (116 deaths; difference 1% [95% CI -6 to 7]; hazard ratio 0·90 [95% CI 0·70 to 1·17]; p=0·81). In the safety population, the most common clinically significant grade 3-4 adverse events were decreased neutrophils (71 [20%] in the adjuvant chemotherapy group vs 34 [8%] in the chemoradiotherapy only group), and anaemia (66 [18%] vs 34 [8%]). Serious adverse events occurred in 107 (30%) in the adjuvant chemotherapy group versus 98 (22%) in the chemoradiotherapy only group, most commonly due to infectious complications. There were no treatment-related deaths. INTERPRETATION Adjuvant carboplatin and paclitaxel chemotherapy given after standard cisplatin-based chemoradiotherapy for unselected locally advanced cervical cancer increased short-term toxicity and did not improve overall survival; therefore, it should not be given in this setting. FUNDING National Health and Medical Research Council and National Cancer Institute.
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Affiliation(s)
- Linda R Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia.
| | - Kathleen N Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - Elizabeth H Barnes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Kailash Narayan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Madeleine T King
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Nathan Bradshaw
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Yeh Chen Lee
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Katrina Diamante
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Anthony W Fyles
- National Cancer Institute of Canada Clinical Trial Group, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Chicago, Maywood, IL, USA
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Pearly Khaw
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Susan Brooks
- Department of Medical Oncology, Auckland City Hospital, Auckland, New Zealand
| | - J Spencer Thompson
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cara A Mathews
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown University, Providence, RI, USA
| | - Martin Buck
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Aneta Suder
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Thomas E Lad
- Division of Hematology-Oncology, Cook County Hospital, Chicago, IL, USA
| | - Igor J Barani
- Department of Radiation Oncology, St Joseph's Hospital and Medical Centre, Phoenix, AZ, USA
| | | | - Sylvia Van Dyk
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Michael Quinn
- Oncology Unit, Royal Women's Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Bradley J Monk
- Division of Gynecologic Oncology, HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, AZ, USA
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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7
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Blank SV, Huh WK, Bell M, Dilley S, Hardesty M, Hoskins ER, Lachance J, Musa F, Prendergast E, Rimel BJ, Shahin M, Valea F. Doubling down on the future of gynecologic oncology: The SGO future of the profession summit report. Gynecol Oncol 2023; 171:76-82. [PMID: 36827841 DOI: 10.1016/j.ygyno.2023.02.008] [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: 12/22/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
The original vision of the field of gynecologic oncology was to establish a multidisciplinary approach to the management of patients with gynecologic cancers. Fifty years later, scientific advances have markedly changed the overall practice of gynecologic oncology, but the profession continues to struggle to define its value-financial and otherwise. These issues were examined in full at the Society of Gynecologic Oncology (SGO) Future of the Profession Summit and the purpose of this document is to summarize the discussion, share the group's perceived strengths, weaknesses, opportunities, and threats (SWOT) for gynecologic oncologists, further educate members and others within the patient care team about the unique role of gynecologic oncologists, and plan future steps in the short- and long- term to preserve the subspecialty's critical mission of providing comprehensive, longitudinal care for people with gynecologic cancers.
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Affiliation(s)
- Stephanie V Blank
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Warner K Huh
- University of Alabama Birmingham, Birmingham, AL, United States of America
| | - Maria Bell
- MBA Sanford Women's Health, Sioux Falls, SD, United States of America
| | - Sarah Dilley
- Emory Healthcare, Atlanta, GA, United States of America
| | - Melissa Hardesty
- Alaska Women's Cancer Care, Anchorage, AK, United States of America
| | - Ebony R Hoskins
- Medstar Washington Hospital Center, Washington, D.C, United States of America
| | - Jason Lachance
- Maine Medical Partners, Scarborough, ME, United States of America
| | - Fernanda Musa
- Swedish Cancer Institute, Seattle, WA, United States of America
| | | | - B J Rimel
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Mark Shahin
- Abington Hospital, Jefferson Health, Willow Grove, PA, United States of America
| | - Fidel Valea
- Northwell Health, Zucker School of Medicine, New Hyde Park, NY, United States of America
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8
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Boitano TK, Ketch PW, Scarinci IC, Huh WK. An Update on Human Papillomavirus Vaccination in the United States. Obstet Gynecol 2023; 141:324-330. [PMID: 36649341 PMCID: PMC9858349 DOI: 10.1097/aog.0000000000005056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/01/2022] [Indexed: 01/18/2023]
Abstract
Cervical cancer remains a significant disease in the United States. Although the human papillomavirus (HPV) vaccine has been approved for those aged 9-26 years and for some individuals up to age 45 years, there are many circumstances in which health care professionals may not know whether the vaccine should be recommended, such as for patients with previous infection, health care workers, and those older than age 26 years. This article highlights the evidence that the HPV vaccine is a safe and highly effective way to prevent cervical cancer, with the strongest predictor of vaccine uptake being practitioner recommendation.
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Affiliation(s)
- Teresa K.L. Boitano
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Peter W. Ketch
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama
| | - Isabel C. Scarinci
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Warner K. Huh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
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9
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Glaser GE, Lara OD, Pothuri B, Grimaldi CG, Prescott LS, Mastroyannis SA, Kim S, ElNaggar AC, Torres D, Conrad LB, McGree M, Weaver A, Huh WK, Cohn DE, Yamada SD, Fader AN. Clinical outcomes in patients with COVID-19 and gynecologic cancer: A society of gynecologic oncology COVID-19 and gynecologic cancer registry study. Gynecol Oncol 2022; 167:146-151. [PMID: 36154761 PMCID: PMC9499739 DOI: 10.1016/j.ygyno.2022.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Patients with gynecologic malignancies may have varied responses to COVID-19 infection. We aimed to describe clinical courses, treatment changes, and short-term clinical outcomes for gynecologic oncology patients with concurrent COVID-19 in the United States. METHODS The Society of Gynecologic Oncology COVID-19 and Gynecologic Cancer Registry was created to capture clinical courses of gynecologic oncology patients with COVID-19. Logistic regression models were employed to evaluate factors for an association with hospitalization and death, respectively, within 30 days of COVID-19 diagnosis. RESULTS Data were available for 348 patients across 7 institutions. At COVID-19 diagnosis, 125 patients (36%) had active malignancy. Delay (n = 88) or discontinuation (n = 10) of treatment due to COVID-19 infection occurred in 28% with those on chemotherapy (53/88) or recently receiving surgery (32/88) most frequently delayed. In addition to age, performance status, diabetes, and specific COVID symptoms, both non-White race (adjusted odds ratio (aOR) = 3.93, 95% CI 2.06-7.50) and active malignancy (aOR = 2.34, 95% CI 1.30-4.20) were associated with an increased odds of hospitalization. Eight percent of hospitalized patients (8/101) died of COVID-19 complications and 5% (17/348) of the entire cohort died within 30 days after diagnosis. CONCLUSIONS Gynecologic oncology patients diagnosed with COVID-19 are at risk for hospitalization, delay of anti-cancer treatments, and death. One in 20 gynecologic oncology patients with COVID-19 died within 30 days after diagnosis. Racial disparities exist in patient hospitalizations for COVID-19, a surrogate of disease severity. Additional studies are needed to determine long-term outcomes and the impact of race.
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Affiliation(s)
- Gretchen E Glaser
- Mayo Clinic Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, United States of America.
| | - Olivia D Lara
- Department of Obstetrics and Gynecology, NYU Langone Health, Perlmutter Cancer Center, New York, NY, United States of America
| | - Bhavana Pothuri
- Department of Obstetrics and Gynecology, NYU Langone Health, Perlmutter Cancer Center, New York, NY, United States of America
| | | | | | | | - Sarah Kim
- University of Pennsylvania, United States of America
| | - Adam C ElNaggar
- West Cancer Center and Research Institute, Memphis, TN, United States of America
| | | | - Lesley B Conrad
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Creighton University School of Medicine, Omaha, NE, United States of America
| | - Michaela McGree
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States of America
| | - Amy Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States of America
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham Heersink School of Medicine, United States of America
| | - David E Cohn
- Ohio State University, James Cancer Hospital and Solove Research Institute, United States of America
| | - S Diane Yamada
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medicine, United States of America
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, United States of America
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10
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Dholakia J, Woo Lee Y, Lu KH, Huh WK, Diane Yamada S, Fuh KC, Kumar AS, Liang MI, Nair N, Kim KH. Identity-Related Experiences of Asian American Trainees in Gynecologic Oncology. Gynecol Oncol Rep 2022; 44:101097. [DOI: 10.1016/j.gore.2022.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022] Open
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11
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Wall JA, Lipking K, Smith HJ, Huh WK, Salter T, Liang MI. Moderate to severe distress in half of ovarian cancer patients undergoing treatment highlights a need for more proactive symptom and psychosocial management. Gynecol Oncol 2022; 166:503-507. [PMID: 35778291 PMCID: PMC9678245 DOI: 10.1016/j.ygyno.2022.06.016] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Distress screening and management is a recommended component of oncology care. Our objective was to evaluate distress rate, sources, and compliance with psychosocial follow-up among ovarian cancer patients receiving chemotherapy. METHODS We reviewed patient distress surveys completed by ovarian cancer patients receiving chemotherapy from 10/2017-6/2019. Lay or nurse navigators conducted screening with the NCCN Distress Thermometer from 0 (none) to 10 (highest distress). A distress score ≥ 4 (moderate/severe) was considered a positive screen. A recommendation for psychosocial follow-up was automatically generated in the treatment care plan based upon a yes response to any depression-related concern, independent of distress score. Documentation of referral to a mental health professional or social worker for counseling was considered compliant with psychosocial follow-up. We performed descriptive statistics and bivariate analyses. RESULTS 97/211 (46%) ovarian cancer patients screened positive for distress. Average score was 6.1 for those who screened positive and 3.3 for the entire cohort (range 0-10). Unmarried status (p < 0.01) was associated with positive screen, whereas non-white race (p = 0.26) and recurrent disease (p = 0.21) were not. Median age was older for patients with a positive distress screen (p < 0.01). Among screened patients, the most frequent sources of distress were: cognitive/physical (87%), psychosocial (62%), practical (84%), and family concerns (40%). Of 50 patients recommended to have psychosocial referral, 4 (8%) patients had documented psychiatric follow-up and 19 (38%) patients had documented psychosocial counseling by a social worker. CONCLUSIONS Nearly half of ovarian cancer patients screened positive for moderate/severe distress. Cancer/treatment-related cognitive/physical symptoms were the most frequent sources. Improved methods of symptom monitoring and management during treatment and resources to address psychosocial concerns are needed to improve distress management of ovarian cancer patients.
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Affiliation(s)
- Jaclyn A Wall
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States of America.
| | - Kelsey Lipking
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Haller J Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States of America; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States of America; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Terri Salter
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States of America; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
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12
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Liang MI, Simons JL, Herbey II, Wall JA, Rucker LR, Ivankova NV, Huh WK, Pisu M. Navigating job and cancer demands during treatment: A qualitative study of ovarian cancer patients. Gynecol Oncol 2022; 166:481-486. [PMID: 35902296 PMCID: PMC10910482 DOI: 10.1016/j.ygyno.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our objective was to obtain perspectives from ovarian cancer patients on job demands, cancer demands, and workplace or cancer resources and strategies to manage the cancer-work interface using the cancer-work management conceptual framework. METHODS We recruited ovarian cancer patients receiving systemic therapy who screened positive for financial distress using Comprehensive Score for Financial Toxicity <26. Interviews were conducted with participants about their costs of care, including employment concerns. Interviews were recorded, transcribed verbatim, and analyzed by three researchers using an inductive thematic analysis. RESULTS Of 22 participants, the average age was 57 years old, 36% were Black, 68% had income <$40,000, 41% had public insurance, and 68% were being treated for recurrent disease. Job demands included decreased productivity, inability to return to work, and worry about losing a job or employer-based health insurance coverage. Cancer demands included physical and cognitive limitations due to cancer treatment and reliance on caregivers, especially for transportation. Workplace resources/strategies including having a supportive employer, modifying job responsibilities, and utilizing family medical leave. Cancer care resources/strategies included planning appointments ahead of time and utilizing resources, such as disability. CONCLUSIONS Cancer care teams should consider screening patients for employment concerns; streamline care to minimize the side effects, time, and transportation demands of treatment on patients and caregivers; maximize utilization of available resources; and proactively communicate with employers to accommodate patients and caregivers who want or need to work.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, United States of America; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - J Leahgrace Simons
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Ivan I Herbey
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jaclyn A Wall
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Lindsay R Rucker
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Nataliya V Ivankova
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, United States of America; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Maria Pisu
- Division of Preventive Medicine, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
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Boitano TK, Ketch P, Maier JG, Nguyen CT, Huh WK, Michael Straughn J, Scarinci IC. Increased disparities associated with black women and abnormal cervical cancer screening follow-up. Gynecol Oncol Rep 2022; 42:101041. [PMID: 35898199 PMCID: PMC9309676 DOI: 10.1016/j.gore.2022.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/26/2022] [Accepted: 07/02/2022] [Indexed: 11/25/2022] Open
Abstract
Timely follow-up and treatment after abnormal cervical cancer screening is lacking in over half of all women. Black women have the lowest rate of follow-up after abnormal screening. One-fourth of Black and Hispanic women have delayed follow-up. Insurance status is also associated with timely follow-up with abnormal cervical cancer screening.
Background To determine whether race and ethnicity impacts patient adherence to follow-up for colposcopy after abnormal cervical cancer screening. Methods This retrospective chart review included women that were randomly selected from patients presenting to our colposcopy clinic from 1/2019 to 12/2019. Inclusion criteria were females age ≥21 years-old and appropriate referral for colposcopy. Patients were grouped into three categories: (1) ADHERENT to follow-up if they came to their first scheduled appointment; (2) DELAYED if they presented more than three months from their original referral (usually missing 1–3 appointments); and (3) NOT ADHERENT if they did not show for their appointment after referral. Analysis was performed using SPSS v.26. Results 284 women met inclusion criteria for the study. The majority of women were Black (65.2 %) followed by non-Hispanic Whites (20.0 %) and Latinx (14.8 %). Overall, 39.1 % were ADHERENT, 18.6 % were DELAYED, and 42.3 % were NOT ADHERENT. When compared with non-Hispanic White women, there was a significant difference between race/ethnicity and timing of follow-up (p = 0.03). Blacks were more likely to be NOT ADHERENT (45.9 %; p = 0.03), and Latinx and Blacks were the most likely to be DELAYED (35.7 % and 21.1 %; p = 0.03). Private insurance patients were more likely to be ADHERENT for care compared with un-/underinsured patients (78.9 vs 27.8 %, p = 0.0001). Conclusion There is inadequate follow-up after abnormal cervical cancer screening across all races/ethnicities; however, lack of adherence is higher in Black patients. Moreover, 25% of Hispanic and Black women present in a delayed fashion. Culturally relevant assessments and interventions are needed to understand and address these gaps.
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14
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Manga SM, Liang MI, Ye Y, Szychowski JM, Nulah KL, Tita AT, Scarinci I, Huh WK. Effect of Misoprostol on Type 3 Transformation Zone of the Cervix among Cameroonian Women. Gynecol Oncol Rep 2022; 40:100944. [PMID: 35265742 PMCID: PMC8899222 DOI: 10.1016/j.gore.2022.100944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/27/2022] Open
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15
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Liao CI, Francoeur AA, Kapp DS, Caesar MAP, Huh WK, Chan JK. Trends in Human Papillomavirus-Associated Cancers, Demographic Characteristics, and Vaccinations in the US, 2001-2017. JAMA Netw Open 2022; 5:e222530. [PMID: 35294540 PMCID: PMC8928005 DOI: 10.1001/jamanetworkopen.2022.2530] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Nearly 45 000 human papillomavirus (HPV)-associated cancers are diagnosed annually in the US. The HPV vaccine has been approved since 2006, but information on the association between vaccination and the incidence of HPV-attributable cancers is unclear. OBJECTIVE To evaluate the potential association of screening and vaccination on the trends of HPV-associated cancers. DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based cross-sectional study was conducted using data on HPV-associated (oropharyngeal squamous cell carcinoma [SCC], anal/rectal SCC, vulvar SCC, vaginal SCC, cervical carcinoma, and penile SCC) cancers from the US Cancer Statistics Public Use Database, representing 99% of the US population, between January 1, 2001, and December 31, 2017; HPV vaccination and screening data from the Behavioral Risk Factor Surveillance between January 1, 2001, and December 31, 2016; and TeenVaxView between January 1, 2008, and December 31, 2018. National Cancer Database and Behavioral Risk Factor Surveillance were used to correct for hysterectomy. Data analysis was performed from April 1, 2020, to June 30, 2021. EXPOSURES Patient demographic characteristics, including age, race and ethnicity, sex, region, and vaccination status. MAIN OUTCOMES AND MEASURES The main outcomes examined in this study were diagnoses of any HPV-associated cancer and HPV vaccination status. RESULTS A total of 657 317 HPV-associated cancers (exact ages not collected by the United States Cancer Statistics); of these, 264 019 (40.2%) developed in men and 393 298 (59.8%) in women; 14 520 individuals (2.2%) were non-Hispanic Asian/Pacific Islander, 74 641 (11.4%) were non-Hispanic Black, 59 841 (9.1%) were Hispanic, and 499 899 were non-Hispanic White (76.1%). More than half (206 075 [52.4%]) of cancers in women were cervical, whereas most (211 421 [80.1%]) cancers in men were oropharyngeal. In female adolescents (aged 13-17 years), the vaccination rate increased from 37.2% to 69.9% from 2008 to 2018 (annual percent change: 6.57% [95% CI, 5.83%-7.32%]). Before vaccination approval, cervical cancer rates in the 20- to 24-year age group were decreasing at 2.29% annually (P = .045); after vaccine approval, this rate has been decreasing at 9.50% (P = .003). In men, annual increases were noted in oropharyngeal (2.71%) and anal/rectal (1.83%) cancers (P < .001); in women, the incidence of oropharyngeal remained stable but anal/rectal cancer increased at 2.83% every year (P < .001). CONCLUSIONS AND RELEVANCE In the US, cervical cancer rates have decreased at a population level, especially in younger women. The findings of this study suggest this decrease may be associated with vaccination. Given the increase in oropharyngeal and anal/rectal cancers, particularly in men, it may be important to highlight vaccination uptake in both sexes.
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Affiliation(s)
- Cheng-I. Liao
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Michelle Ann P. Caesar
- California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, California
| | - Warner K. Huh
- Department of Obstetrics and Gynecology, University of Alabama Birmingham, Birmingham
| | - John K. Chan
- Division of Gynecologic Oncology, California Pacific/Palo Alto/Sutter Health Research Institute, San Francisco
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16
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Manga SM, Kincaid KD, Boitano TKL, Tita AT, Scarinci IC, Huh WK, Liang MI. Misoprostol and estradiol to enhance visualization of the transformation zone during cervical cancer screening: An integrative review. Eur J Obstet Gynecol Reprod Biol 2022; 269:16-23. [PMID: 34952401 PMCID: PMC10958763 DOI: 10.1016/j.ejogrb.2021.11.431] [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] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/07/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Abstract
The purpose of this integrative literature review was to appraise studies conducted worldwide using misoprostol and estradiol in converting Type 3 transformation zone (TZ) of the cervix into Types 1 or 2 and to assess which regimen could be more feasible in low-and-middle-income countries (LMICs). We reviewed the English language literature for peer-reviewed studies that evaluated strategies to convert Type 3 TZs to Types 1 or 2 for cervical cancer screening. Web of Science and PubMed searches were performed up to July 2020. Search terms included: "cervical colposcopy," "inadequate colposcopy", "cervical cancer screening", "transformation zone," "estrogen", "estradiol", and "misoprostol." Inclusion criteria were articles published in the English language, original research, and peer reviewed articles. A total of 127 articles were abstracted, 24 articles were reviewed, and 9 articles met all inclusion criteria. We found that intravaginal misoprostol, intravaginal estradiol, and oral estradiol can successfully convert Type 3 TZ to Types 1 or 2. A single dose of vaginal misoprostol had a similar maximum response rate (20-80%) to a multi-dose regimen over several days or weeks of both intravaginal estradiol (64-83%) and oral estradiol (50-70%). Misoprostol administration was associated with more side effects such as abdominal cramping and vaginal bleeding compared to estradiol, although these were generally mild. In conclusion, Oral estradiol, intravaginal estradiol, and intravaginal misoprostol can be used to convert Type 3 TZ to Types 1 or 2. Intravaginal misoprostol is well tolerated and more feasible in LMICs due to availability and shorter treatment schedule compared to oral or intravaginal estradiol.
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Affiliation(s)
- Simon M Manga
- Women's Health Program, Cameroon Baptist Convention Health Services, P.O. Box 1, Bamenda, Cameroon; Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 619(TH) Street South, Birmingham, AL 35249-7333, USA.
| | - Kaitlyn D Kincaid
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10360, 1700 6(th) Avenue South, Birmingham, AL, USA
| | - Teresa K L Boitano
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10360, 1700 6(th) Avenue South, Birmingham, AL, USA
| | - Alan T Tita
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 619(TH) Street South, Birmingham, AL 35249-7333, USA; Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 1700 6(th) Avenue South, Birmingham, AL, USA
| | - Isabel C Scarinci
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 619(TH) Street South, Birmingham, AL 35249-7333, USA; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10250, 1700 6(th) Avenue South, Birmingham, AL, USA
| | - Warner K Huh
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 619(TH) Street South, Birmingham, AL 35249-7333, USA; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10250, 1700 6(th) Avenue South, Birmingham, AL, USA
| | - Margaret I Liang
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 619(TH) Street South, Birmingham, AL 35249-7333, USA; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10250, 1700 6(th) Avenue South, Birmingham, AL, USA
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Arend RC, Scalise CB, Dholakia J, Kamal MZ, Thigpen HB, Crossman D, Huh WK, Leath CA. Identifying a molecular profile to predict the risk of recurrence in high-intermediate risk endometrial cancer. Cancer Med 2021; 10:8238-8250. [PMID: 34729947 PMCID: PMC8607249 DOI: 10.1002/cam4.4247] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/15/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Patients with high‐intermediate risk endometrial cancer (H‐IR EMCA) have an elevated risk of recurrence compared to low‐risk counterparts. Many H‐IR EMCA patients are treated with radiation or chemotherapy, but their overall survival is not significantly impacted by treatment. The objective of this study was to compare molecular profiles of H‐IR EMCA patients with disease recurrence to those without to identify characteristics that could better predict patient outcomes. Methods Tissue was acquired from H‐IR EMCA patients with disease recurrence (n=15) and without disease recurrence (n=15) who had not received adjuvant therapy and performed DNA and RNA analyses. Results In recurrent population, 5 patients had matchingrecurrent and initial tumor tissues. Of note, 5/7 (71%) African Americanpatients had disease recurrence compared to 10/23 (43%) White patients. Inaddition, several new mutations were found in individual patient’s recurrentcompared to initial tumors. Conclusions Currently the treatment ofendometrial cancer is rapidly changing with molecular profiling becoming partof the standard of care. Additionally, it and is being incorporated intoclinical trials in this group of patients. The specific gene mutations and RNAexpression signatures that were observed in our small cohort need to bevalidated in larger cohorts to determine their impact.
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Affiliation(s)
- Rebecca C Arend
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Carly B Scalise
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jhalak Dholakia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maahum Z Kamal
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Haley B Thigpen
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - David Crossman
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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18
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Levinson K, Beavis AL, Purdy C, Rositch AF, Viswanathan A, Wolfson AH, Kelly MG, Tewari KS, McNally L, Guntupalli SR, Ragab O, Lee YC, Miller DS, Huh WK, Wilkinson KJ, Spirtos NM, Le LV, Casablanca Y, Holman LL, Waggoner SE, Fader AN. Corrigendum to "Beyond Sedlis-A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis" [Gynecologic Oncology 162 (2021) 532-538]. Gynecol Oncol 2021; 163:616-617. [PMID: 34654574 DOI: 10.1016/j.ygyno.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kimberly Levinson
- Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Anna L Beavis
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Christopher Purdy
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Anne F Rositch
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Akila Viswanathan
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aaron H Wolfson
- Sylvester Comprehensive Cancer Center, Miami, FL, United States
| | - Michael G Kelly
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | | | - Leah McNally
- Duke Cancer Institute, Durham, NC, United States
| | | | - Omar Ragab
- Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Yi-Chun Lee
- SUNY Health Science Center at Brooklyn, Brooklyn, NY, United States
| | - David S Miller
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9032, United States
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kelly J Wilkinson
- University of Mississippi Medical Center, Jackson, MS, United States
| | | | - Linda Van Le
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | | | - Laura L Holman
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, 800 Northeast Tenth St., Oklahoma City, OK, United States
| | | | - Amanda N Fader
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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19
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Dholakia J, Kim J, Liang MI, Arend RC, Bevis KS, Straughn JM, Leath CA, Huh WK, Smith HJ. Gynecologic oncology patients are ready for telemedicine in routine care: Results from a pre-COVID survey. Gynecol Oncol Rep 2021; 38:100871. [PMID: 34646930 PMCID: PMC8501666 DOI: 10.1016/j.gore.2021.100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 11/02/2022] Open
Abstract
Objectives To assess telemedicine readiness of gynecologic oncology patients, particularly those at risk for care access disparities (increased distance to care, rural populations.). Methods Patients at all disease/treatment stages completed an anonymous survey during in-person outpatient appointments at an academic comprehensive cancer center from 1/6/2020 to 2/28/2020, conducted prior to the COVID-19 pandemic, before the introduction of telemedicine in this practice. Results Of 180 patients approached, 170 completed the survey (94.4%). Mean age was 59.6 years; 73.4% identified as White, 23.7% Black, and 2.9% other race. Ovarian cancer was most common (41.2%), followed by endometrial (27.1%), cervical (20.6%), and vaginal/vulvar (7.1%). Most patients traveled > 50 miles for appointments (63.8%); they were more likely from rural counties with significantly higher travel costs/visit ($60.77 vs $37.98, p = 0.026.) The majority expressed interest in using telemedicine (75.7%) or a smartphone app (87.5%) in their care. The majority of patients with difficulty attending appointments (88.9 vs 70.2%, p = 0.02) or from rural counties (88.7% vs 69.6%, p = 0.03) were interested in telemedicine; those with both characteristics reported 100% interest. The majority in both urban and rural counties had home internet access, and reported similarly high rates of daily use (79% vs 75%). Race and age were not associated with differences in internet access or use or telemedicine interest. Conclusions Telemedicine is attractive to the majority of patients and may offer financial/logistical advantages. Patients have high internet use rates and comfort with using technology for healthcare. Telemedicine should be incorporated into standard practice beyond the COVID-19 pandemic to reduce healthcare access disparities.
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Affiliation(s)
- J Dholakia
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - J Kim
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - M I Liang
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - R C Arend
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - K S Bevis
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - J M Straughn
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - C A Leath
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - W K Huh
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - H J Smith
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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20
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Arend RC, Goel N, Roane BM, Foxall ME, Dholakia J, Londoño AI, Wall JA, Leath CA, Huh WK. Systematic Next Generation Sequencing is feasible in clinical practice and identifies opportunities for targeted therapy in women with uterine cancer: Results from a prospective cohort study. Gynecol Oncol 2021; 163:85-92. [PMID: 34372972 DOI: 10.1016/j.ygyno.2021.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/29/2021] [Revised: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Both incidence and mortality of uterine cancer are on the rise and mortality is higher for African American women. The aim of our study was to evaluate how Next Generation Sequencing (NGS) may facilitate identification of and intervention for treatment disparities when integrated into clinical workflows. RESULTS Our cohort included 159 uterine cancer patients with recurrent/progressive and newly diagnosed advanced stage and/or high-risk histology. The most common tumor histological subtypes included EEC (n = 67), SEC (n = 34), UCS (n = 20), and mixed (n = 14). Black patients were most likely to present with aggressive histology: (SEC, 34.0%) and carcinosarcoma (UCS, 14.0%). The four most common mutations across all subtypes were TP53, PIK3CA, PTEN, and ARID1A. There was racial disparity between Black versus non-Black patients who were initiated on targeted therapy (28.2% vs. 38.2%, respectively) and clinical trial (15% vs. 22.6%, respectively). Compared to non-Black patients, Black patients had a significantly higher percentage TP53 mutations (p < 0.05) and a significantly lower percentage ARID1A mutations (p < 0.05). CONCLUSIONS NGS for uterine malignancies provides actionable information for targetable mutations and/or clinical trial enrollment in most patients; further investigation is necessary to identify potentially modifiable factors contributing to current disparities that may improve targeted therapy uptake and clinical trial participation.
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Affiliation(s)
- Rebecca C Arend
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America.
| | - Nidhi Goel
- University of Alabama School of Medicine, Birmingham, AL, United States of America
| | - Brandon M Roane
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - McKenzie E Foxall
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Jhalak Dholakia
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Angelina I Londoño
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Jaclyn A Wall
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Charles A Leath
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Warner K Huh
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
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21
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Abu-Rustum NR, Yashar CM, Bean S, Bradley K, Campos SM, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Fisher CM, Frederick P, Gaffney DK, Giuntoli R, Han E, Huh WK, Lurain Iii JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Sisodia R, Tillmanns T, Ueda S, Urban R, Wyse E, McMillian NR, Motter AD. NCCN Guidelines Insights: Cervical Cancer, Version 1.2020. J Natl Compr Canc Netw 2021; 18:660-666. [PMID: 32502976 DOI: 10.6004/jnccn.2020.0027] [Citation(s) in RCA: 167] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Cervical Cancer provide recommendations for diagnostic workup, staging, and treatment of patients with the disease. These NCCN Guidelines Insights focus on recent updates to the guidelines, including changes to first- and second-line systemic therapy recommendations for patients with recurrent or metastatic disease, and emerging evidence on a new histopathologic classification system for HPV-related endocervical adenocarcinoma.
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Affiliation(s)
| | | | | | | | | | | | | | - David Cohn
- 8The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | | | | | - John R Lurain Iii
- 17Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - David Mutch
- 19Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Christa Nagel
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | - Todd Tillmanns
- 25St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Stefanie Ueda
- 26UCSF Helen Diller Family Comprehensive Cancer Center
| | - Renata Urban
- 27Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
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22
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Manga SM, Ye Y, Szychowski JM, Nulah KL, Ngalla C, Kincaid K, Boitano TK, Tita AT, Scarinci I, Huh WK, Sando Z, Liang MI. Pathology findings among women with alterations in uterine bleeding patterns in cameroon. Gynecol Oncol Rep 2021; 37:100821. [PMID: 34258361 PMCID: PMC8253902 DOI: 10.1016/j.gore.2021.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Endometrial cancer is on the rise in high-income countries but it has not been adequately studied in low-and-middle income countries especially in sub-Saharan Africa (SSA), likely due to scarce pathology facilities. The purpose of this study was to characterize and quantify the prevalence of endometrial hyperplasia or cancer in a cohort of women with abnormal uterine bleeding (AUB) who underwent endometrial biopsy in Cameroon. METHODS We designed a cross-sectional study using medical records to characterize women who underwent endometrial biopsy in the Cameroon Baptist Convention Health Services (CBCHS) from 2008 to 2019. Pathologic diagnoses were classified as either endometrial hyperplasia, endometrial cancer, or no endometrial hyperplasia/cancer. We reported the overall prevalence of endometrial hyperplasia or cancer. Bivariate analyses compared patient characteristics between women with endometrial cancer, endometrial hyperplasia, and neither. RESULTS The average age was 46.2 years and women had an average of 5.1 parity. We found that, 61 [(36.7% of 166 women; 95% CI (27.6-47.0%)] had endometrial hyperplasia or cancer. There were no cases of hyperplasia with atypia and 13 women had endometrial cancer. The remainder were comprised of benign or infectious pathologic findings. In bivariate analysis, mean ages were statistically different among the three groups (hyperplasia, cancer, and no hyperplasia/cancer), p < 0.001, and women with cancer had the highest age. Parity was statistically significantly different among the three groups (p = 0.002) and women with endometrial cancer had higher parity. CONCLUSION We found that just over 1 in 3 women with AUB who underwent endometrial biopsy at a health system in SSA were found to have pathologic findings of endometrial hyperplasia or cancer, with no cases of hyperplasia with atypia. Women with endometrial cancer had higher mean age and parity.
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Affiliation(s)
- Simon M. Manga
- Women’s Health Program, Cameroon Baptist Convention Health Services, Bamenda, P.O. Box 1, Nkwen, Bamenda, Cameroon
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
| | - Yuanfan Ye
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
| | - Jeff M. Szychowski
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
| | - Kathleen L. Nulah
- Women’s Health Program, Cameroon Baptist Convention Health Services, Bamenda, P.O. Box 1, Nkwen, Bamenda, Cameroon
| | - Calvin Ngalla
- Women’s Health Program, Cameroon Baptist Convention Health Services, Bamenda, P.O. Box 1, Nkwen, Bamenda, Cameroon
| | - Kaitlyn Kincaid
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6 Avenue South, Suite 10360, Birmingham, AL 35233, USA
| | - Teresa K.L. Boitano
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6 Avenue South, Suite 10360, Birmingham, AL 35233, USA
| | - Alan T. Tita
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6 Avenue South, Suite 10360, Birmingham, AL 35233, USA
| | - Isabel Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, MT Birmingham, AL 35233, USA
| | - Warner K. Huh
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite10250, Birmingham, AL 35233, USA
| | - Zacharie Sando
- Department of Pathology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
| | - Margaret I. Liang
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite10250, Birmingham, AL 35233, USA
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23
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Abu-Rustum NR, Yashar CM, Bradley K, Campos SM, Chino J, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Diver E, Fisher CM, Frederick P, Gaffney DK, George S, Giuntoli R, Han E, Howitt B, Huh WK, Lea J, Mariani A, Mutch D, Nekhlyudov L, Podoll M, Remmenga SW, Reynolds RK, Salani R, Sisodia R, Soliman P, Tanner E, Ueda S, Urban R, Wethington SL, Wyse E, Zanotti K, McMillian NR, Motter AD. NCCN Guidelines® Insights: Uterine Neoplasms, Version 3.2021. J Natl Compr Canc Netw 2021; 19:888-895. [PMID: 34416706 DOI: 10.6004/jnccn.2021.0038] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The NCCN Guidelines for Uterine Neoplasms provide recommendations for diagnostic workup, clinical staging, and treatment options for patients with endometrial cancer or uterine sarcoma. These NCCN Guidelines Insights focus on the recent addition of molecular profiling information to aid in accurate diagnosis, classification, and treatment of uterine sarcomas.
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Affiliation(s)
| | | | | | | | | | | | | | - David Cohn
- The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | - Jayanthi Lea
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | - David Mutch
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | | | | | - Edward Tanner
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Stefanie Ueda
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Renata Urban
- Fred Hutchinson Cancer Research CenterSeattle Cancer Care Alliance
| | | | | | - Kristine Zanotti
- Case Comprehensive Cancer CenterUniversity Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; and
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24
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Levinson K, Beavis AL, Purdy C, Rositch AF, Viswanathan A, Wolfson AH, Kelly MG, Tewari KS, McNally L, Guntupalli SR, Ragab O, Lee YC, Miller DS, Huh WK, Wilkinson KJ, Spirtos NM, Van Le L, Casablanca Y, Holman LL, Waggoner SE, Fader AN. Beyond Sedlis-A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis. Gynecol Oncol 2021; 162:532-538. [PMID: 34217544 DOI: 10.1016/j.ygyno.2021.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The Sedlis criteria define risk factors for recurrence warranting post-hysterectomy radiation for early-stage cervical cancer; however, these factors were defined for squamous cell carcinoma (SCC) at an estimated recurrence risk of ≥30%. Our study evaluates and compares risk factors for recurrence for cervical SCC compared with adenocarcinoma (AC) and develops histology-specific nomograms to estimate risk of recurrence and guide adjuvant treatment. METHODS We performed an ancillary analysis of GOG 49, 92, and 141, and included stage I patients who were surgically managed and received no neoadjuvant/adjuvant therapy. Multivariable Cox proportional hazards models were used to evaluate independent risk factors for recurrence by histology and to generate prognostic histology-specific nomograms for 3-year recurrence risk. RESULTS We identified 715 patients with SCC and 105 with AC; 20% with SCC and 17% with AC recurred. For SCC, lymphvascular space invasion (LVSI: HR 1.58, CI 1.12-2.22), tumor size (TS ≥4 cm: HR 2.67, CI 1.67-4.29), and depth of invasion (DOI; middle 1/3, HR 4.31, CI 1.81-10.26; deep 1/3, HR 7.05, CI 2.99-16.64) were associated with recurrence. For AC, only TS ≥4 cm, was associated with recurrence (HR 4.69, CI 1.25-17.63). For both histologies, there was an interaction effect between TS and LVSI. For those with SCC, DOI was most associated with recurrence (16% risk); for AC, TS conferred a 15% risk with negative LVSI versus a 25% risk with positive LVSI. CONCLUSIONS Current treatment standards are based on the Sedlis criteria, specifically derived from data on SCC. However, risk factors for recurrence differ for squamous cell and adenocarcinoma of the cervix. Histology-specific nomograms accurately and linearly represent risk of recurrence for both SCC and AC tumors and may provide a more contemporary and tailored tool for clinicians to base adjuvant treatment recommendations to their patients with cervical cancer.
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Affiliation(s)
- Kimberly Levinson
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Anna L Beavis
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Christopher Purdy
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Anne F Rositch
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Akila Viswanathan
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Aaron H Wolfson
- Sylvester Comprehensive Cancer Center, Miami, FL, United States of America.
| | - Michael G Kelly
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States of America.
| | | | - Leah McNally
- Duke Cancer Institute, Durham, NC, United States of America.
| | | | - Omar Ragab
- Keck School of Medicine of USC, Los Angeles, CA, United States of America.
| | - Yi-Chun Lee
- SUNY Health Science Center at Brooklyn, Brooklyn, NY, United States of America.
| | - David S Miller
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9032, United States of America.
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Kelly J Wilkinson
- University of Mississippi Medical Center, Jackson, MS, United States of America.
| | | | - Linda Van Le
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
| | - Yovanni Casablanca
- Walter Reed National Medical Center, Bethesda, MD, United States of America.
| | - Laura L Holman
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, 800 Northeast Tenth St., Oklahoma City, OK, United States of America.
| | - Steven E Waggoner
- Case Western Reserve University, Cleveland, OH, United States of America.
| | - Amanda N Fader
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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25
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Benard VB, Jackson JE, Greek A, Senkomago V, Huh WK, Thomas CC, Richardson LC. A population study of screening history and diagnostic outcomes of women with invasive cervical cancer. Cancer Med 2021; 10:4127-4137. [PMID: 34018674 PMCID: PMC8209614 DOI: 10.1002/cam4.3951] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite advances to prevent and detect cervical cancer, national targets for screening have not been met in the United States. Previous studies suggested that approximately half of women who developed cervical cancer were not adequately screened. This study aimed to provide an updated examination of women's screening and diagnostic practices five years prior to an invasive cervical cancer diagnosis. METHODS The study included women age 21 years and older diagnosed with invasive cervical cancer in 2013-2016 from three population-based state cancer registries in the United States. Medical records abstraction identified screening history and diagnostic follow-up. A mailed survey provided sociodemographic data. Screening was a Pap or human papillomavirus (HPV) test between 6 months and 5 years before diagnosis. Adequate follow-up was defined per management guidelines. RESULTS Of the 376 women, 60% (n = 228) had not been screened. Among women who received an abnormal screening result (n = 122), 67% (n = 82) had adequate follow-up. Predictors of: (a) being screened were younger age, having a higher income, and having insurance; (b) adequate follow-up were having a higher income, and (c) stage 1 cervical cancer were being screened and younger age. CONCLUSION Unlike other cancer patterns of care studies, this study uses data obtained from medical records supplemented with self-report information to understand a woman's path to diagnosis, her follow-up care, and the stage of her cervical cancer diagnosis. This study provides findings that could be used to reach more unscreened or under screened women and to continue lowering cervical cancer incidence in the United States.
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Affiliation(s)
- Vicki B Benard
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Virginia Senkomago
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cheryll C Thomas
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Esselen KM, Gompers A, Hacker MR, Bouberhan S, Shea M, Summerlin SS, Rucker LR, Huh WK, Pisu M, Liang MI. Evaluating meaningful levels of financial toxicity in gynecologic cancers. Int J Gynecol Cancer 2021; 31:801-806. [PMID: 33858954 DOI: 10.1136/ijgc-2021-002475] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 01/29/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The Comprehensive Score for Financial Toxicity (COST) is a validated instrument measuring the economic burden experienced by patients with cancer. We evaluated the frequency of financial toxicity at different COST levels and stratified risk factors and associations with cost-coping strategies by financial toxicity severity. METHODS We analyzed previously collected survey data of gynecologic oncology patients from two tertiary care institutions. Both surveys included the COST tool and questions assessing economic and behavioral cost-coping strategies. We adapted a proposed grading scale to define three groups: no/mild, moderate, and severe financial toxicity and used χ2, Fisher's exact test, and Wilcoxon rank sum test to compare groups. We used Poisson regression to calculate crude and adjusted risk ratios for cost-coping strategies, comparing patients with moderate or severe to no/mild financial toxicity. RESULTS Among 308 patients, 14.9% had severe, 32.1% had moderate, and 52.9% had no/mild financial toxicity. Younger age, non-white race, lower education, unemployment, lower income, use of systemic therapy, and shorter time since diagnosis were associated with worse financial toxicity (all p<0.05). Respondents with moderate or severe financial toxicity were significantly more likely to use economic cost-coping strategies such as changing spending habits (adjusted risk ratio (aRR) 2.7, 95% CI 1.8 to 4.0 moderate; aRR 3.6, 95% CI 2.4 to 5.4 severe) and borrowing money (aRR 5.5, 95% CI 1.8 to 16.5 moderate; aRR 12.7, 95% CI 4.3 to 37.1 severe). Those with severe financial toxicity also had a significantly higher risk of behavioral cost-coping through medication non-compliance (aRR 4.6, 95% CI 1.2 to 18.1). CONCLUSIONS Among a geographically diverse cohort of gynecologic oncology patients, nearly half reported financial toxicity (COST <26), which was associated with economic cost-coping strategies. In those 14.9% of patients reporting severe financial toxicity (COST <14) there was also an increased risk of medication non-compliance, which may lead to worse health outcomes in this group.
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Affiliation(s)
- Katharine McKinley Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA .,Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Bouberhan
- Department of Hematology/Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meghan Shea
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah S Summerlin
- School of Medicine, The University of Alabama, Birmingham, Alabama, USA
| | - Lindsay R Rucker
- Department of Obstetrics and Gynecology, The University of Alabama, Birmingham, Alabama, USA
| | - Warner K Huh
- Department of Obstetrics and Gynecology, The University of Alabama, Birmingham, Alabama, USA
| | - Maria Pisu
- Department of Internal Medicine, The University of Alabama, Birmingham, Alabama, USA
| | - Margaret I Liang
- Department of Obstetrics and Gynecology, The University of Alabama, Birmingham, Alabama, USA
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Wenzel L, Osann K, McKinney C, Cella D, Fulci G, Scroggins MJ, Lankes HA, Wang V, Nephew KP, Maxwell GL, Mok SC, Conrads TP, Miller A, Mannel RS, Gray HJ, Hanjani P, Huh WK, Spirtos N, Leitao MM, Glaser G, Sharma SK, Santin AD, Sperduto P, Lele SB, Burger RA, Monk BJ, Birrer M. Quality of Life and Adverse Events: Prognostic Relationships in Long-Term Ovarian Cancer Survival. J Natl Cancer Inst 2021; 113:1369-1378. [PMID: 33729494 DOI: 10.1093/jnci/djab034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/15/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a critical need to identify patient characteristics associated with long-term ovarian cancer survival. METHODS Quality of life (QOL), measured by the Functional Assessment of Cancer Therapy-Ovarian-Trial Outcome Index (FACT-O-TOI), including physical, functional and ovarian-specific subscales, was compared between long-term (LTS) (8+ years) and short-term (STS) (<5 years) survivors of GOG 218 at baseline, before cycles 4, 7, 13, 21, and 6 months post-treatment using linear and longitudinal mixed models adjusted for covariates. Adverse events (AEs) were compared between survivor groups at each assessment using generalized linear models. All p-values are two-sided. RESULTS QOL differed statistically significantly between STS (N = 1115) and LTS (N = 260) (p < .001). Baseline FACT-O-TOI and FACT-O-TOI change were independently associated with long-term survival (OR = 1.05, 95% CI = 1.03-1.06 and OR = 1.06, 95% CI = 1.05-1.07, respectively). A 7-point increase in baseline QOL was associated with a 38.0% increase in probability of LTS, while a 9-point increase in QOL change was associated with a 67.0% increase in odds for LTS. QOL decreased statistically significantly with increasing AE quartiles (cycle 4 quartiles: 0-5 v. 6-8 v. 9-11 v. ≥12 AEs, p = .01; cycle 21 quartiles: 0-2 v. 3 v. 4-5 v. ≥6 AEs, p = .001). Further, LTS reported statistically significantly better QOL compared to STS (p = .03 and p = .01, cycles 4 and 21, respectively), with similar findings across higher AE grades. CONCLUSION Baseline and longitudinal QOL change scores distinguished long versus short-term survivors and are robust prognosticators for long term survival. Results have trial design and supportive care implications, providing meaningful prognostic value in this understudied population.
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Affiliation(s)
- Lari Wenzel
- Department of Medicine and Program in Public Health, University of California, Irvine
| | - Kathryn Osann
- Department of Medicine and Program in Public Health, University of California, Irvine
| | - Chelsea McKinney
- Department of Medicine and Program in Public Health, University of California, Irvine
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Health System
| | | | | | | | - Victoria Wang
- Dana-Farber Cancer Institute, Department of Data Science
| | - Kenneth P Nephew
- Medical Sciences Program, Indiana University School of Medicine-Bloomington
| | - George L Maxwell
- Women's Health Integrated Research Center at Inova Health System, Women's Service Line, Inova Health System
| | - Samuel C Mok
- Department of Gynecological Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center
| | - Thomas P Conrads
- Women's Health Integrated Research Center at Inova Health System, Women's Service Line, Inova Health System
| | | | - Robert S Mannel
- Stephenson Cancer Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma
| | - Heidi J Gray
- Gynecologic Oncology, University of Washington Medical Center
| | | | | | | | - Mario M Leitao
- Memorial Sloan Kettering Cancer and Weill Cornell Medical Center
| | | | | | - Alessandro D Santin
- Department of Obstetrics, Gynecology & Reproductive Services, Yale University School of Medicine
| | - Paul Sperduto
- Minneapolis Radiation Oncology and Metro-Minnesota Community Oncology Research Consortium
| | | | | | - Bradley J Monk
- Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), University of Arizona College of Medicine
| | - Michael Birrer
- Winthrop P. Rockefeller Cancer Institute University of Arkansas for Medical Sciences
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Liang MI, Summerlin SS, Blanchard CT, Boitano TKL, Huh WK, Bhatia S, Pisu M. Measuring Financial Distress and Quality of Life Over Time in Patients With Gynecologic Cancer-Making the Case to Screen Early in the Treatment Course. JCO Oncol Pract 2021; 17:e1576-e1583. [PMID: 33596114 DOI: 10.1200/op.20.00907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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
PURPOSE Our objective was to measure the trajectory of financial distress and to determine its relationship with quality of life (QOL) among patients with cancer. MATERIALS AND METHODS We conducted a longitudinal survey of patients with gynecologic cancer starting a new line of systemic therapy at baseline, 3 months, and 6 months. Financial distress was measured using a Comprehensive Score for Financial Toxicity (COST) < 26, and QOL was measured using Functional Assessment of Cancer Therapy-General (FACT-G) with lower scores indicating worse responses. One-way repeated analysis of variances, generalized estimating equation models, and correlation coefficients were used to evaluate financial distress and QOL over time. RESULTS There were 90 of 121 (74%) baseline participants with a 6-month follow-up. The average age was 60 years, 29% were African-American, 57% had an annual income < $40,000 in US dollars, and 6% were uninsured. At baseline, 54% of patients screened positive for financial distress, which was unchanged at 3 months (50%, P = .27) but decreased at 6 months (46%, P = .04) compared with baseline. There was no change in average COST (23.6, 25.1, 25.6; P = .33) or FACT-G (70.8, 71.0, 72.8; P = .68) over time. Less financial distress was moderately correlated with better QOL (r = 0.63, 0.61, 0.60) at each time point. The presence of financial distress was associated with a 16-point decrease in FACT-G QOL score over time. CONCLUSION Upfront screening with COST identified 90% of patients who experienced financial distress, and COST did not change significantly over time. More severe financial distress was moderately correlated with worse QOL, and its presence was associated with a clinically meaningful 16-point decrease in QOL.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Sarah S Summerlin
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Christina T Blanchard
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Teresa K L Boitano
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Maria Pisu
- Division of Preventive Medicine, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL
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Goldsberry WN, Summerlin SS, Guyton A, Caddell B, Huh WK, Kim KH, Liang MI. The financial burden of PARP inhibitors on patients, payors, and financial assistance programs: Who bears the cost? Gynecol Oncol 2021; 160:800-804. [PMID: 33414026 DOI: 10.1016/j.ygyno.2020.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/27/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Poly(ADP-ribose) polymerase (PARP) inhibitors are expensive and their use is expanding. We aimed to evaluate cost sharing patterns between patients, payors, and financial assistance programs. METHODS We identified ovarian cancer patients prescribed a PARP inhibitor from 5/2015-9/2019 using our pharmacy database. Cost information was collected for patients who filled their prescription at our specialty pharmacy. We calculated descriptive statistics for monthly PARP inhibitor costs for patients, payors, and financial assistance programs. We used Wilcoxon rank sum tests to evaluate monthly costs based on insurance characteristics. RESULTS Seventy-six patients filled 94 different PARP inhibitor prescriptions with 42 (45%) prescriptions obtained using any type of financial assistance program. We analyzed 232 prescription months for the 41 prescriptions with available cost data. This included 18 (44%) prescriptions for rucaparib, 18 (44%) for niraparib, and 5 (12%) for olaparib. The total monthly drug cost was average $12,422 and median $13,700. The monthly out-of-pocket (OOP) cost for patients was average $46 and median $0 (IQR $0-4). Payors had the highest monthly costs with average $12,019 and median $13,662 (IQR $9914-14,709). Financial assistance programs contributed average $358 and median $0 per month (IQR $0-150). Patients with public (p<0.01) or Medicare insurance (p<0.01) had higher OOP costs than without. CONCLUSIONS OOP costs were generally low with 75% of patients paying <$5 per month. While limited by small sample size at a single institution, financial assistance programs appear to play a critical role to ensure access to PARP inhibitors as nearly 50% of patients utilized these programs.
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Affiliation(s)
- Whitney N Goldsberry
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Sarah S Summerlin
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Allison Guyton
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Brittani Caddell
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kenneth H Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
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Liang MI, Chen L, Hershman DL, Hillyer GC, Huh WK, Guyton A, Wright JD. Total and out-of-pocket costs for PARP inhibitors among insured ovarian cancer patients. Gynecol Oncol 2020; 160:793-799. [PMID: 33375989 DOI: 10.1016/j.ygyno.2020.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/01/2020] [Accepted: 12/15/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate total and out-of-pocket costs for poly(ADP-ribose) polymerase (PARP) inhibitors and differences based on insurance characteristics. METHODS We identified ovarian cancer patients who were prescribed niraparib, olaparib, or rucaparib from the MarketScan (2014-2017) and Surveillance, Epidemiology, and End Results (SEER)-Medicare (2014-2016) databases. Drug costs were estimated for a 30-day supply. Descriptive statistics and Wilcoxon rank sum tests were performed. RESULTS 590 commercially insured beneficiaries from MarketScan and 213 SEER-Medicare beneficiaries were prescribed PARP inhibitors for a median 112 days. For commercially insured beneficiaries, median total cost was $13,342 (IQR $12,022-$14,256). Median out-of-pocket cost was $44 (IQR $0-$120) and PARP inhibitors accounted for a median 90.8% of patients' total out-of-pocket drug spending. High-deductible health plan was not associated with higher out-of-pocket costs (N = 570; median $0 vs. $45, P = 0.87). For SEER-Medicare beneficiaries, median total cost was $12,798 (IQR $11,704-$13,180). Median out-of-pocket cost was $370 (IQR $2-$1234) and PARP inhibitors accounted for a median 99.0% of patients' total out-of-pocket drug spending. Out-of-pocket costs were lower for dual-eligible patients with supplemental Medicaid prescription coverage (N = 209; median $1 vs. $911, P < 0.001). CONCLUSIONS Although insurers are responsible for a large proportion of PARP inhibitor costs, out-of-pocket costs for PARP inhibitors account for a majority of patients' drug spending. SEER-Medicare beneficiaries had higher out-of-pocket costs than patients with commercial insurance, which was offset for those with supplemental Medicaid prescription coverage.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Ling Chen
- Columbia University Vagelos College of Physicians and Surgeons, United States of America
| | - Dawn L Hershman
- Columbia University Vagelos College of Physicians and Surgeons, United States of America; Mailman School of Public Health, Columbia University, United States of America; Herbert Irving Comprehensive Cancer Center of Columbia University, United States of America
| | - Grace C Hillyer
- Mailman School of Public Health, Columbia University, United States of America; Herbert Irving Comprehensive Cancer Center of Columbia University, United States of America
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Allison Guyton
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jason D Wright
- Columbia University Vagelos College of Physicians and Surgeons, United States of America; Herbert Irving Comprehensive Cancer Center of Columbia University, United States of America
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Huh WK. 51st Annual Meeting of the Society of Gynecologic Oncology. Gynecol Oncol 2020; 159 Suppl 1:1. [PMID: 33087246 PMCID: PMC7568846 DOI: 10.1016/j.ygyno.2020.06.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Warner K Huh
- 2019-2020 President, Society of Gynecologic Oncology, United States of America.
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Wang C, Wang Z, Rosner GL, Huh WK, Roden RBS, Bae S. A batch-effect adjusted Simon's two-stage design for cancer vaccine clinical studies. Biometrics 2020; 77:1075-1088. [PMID: 32822525 DOI: 10.1111/biom.13358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/25/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
In the development of cancer treatment vaccines, phase II clinical studies are conducted to examine the efficacy of a vaccine in order to screen out vaccines with minimal activity. Immune responses are commonly used as the primary endpoint for assessing vaccine efficacy. With respect to study design, Simon's two-stage design is a popular format for phase II cancer clinical studies because of its simplicity and ethical considerations. Nonetheless, it is not straightforward to apply Simon's two-stage design to cancer vaccine studies when performing immune assays in batches, as outcomes from multiple patients may be correlated with each other in the presence of batch effects. This violates the independence assumption of Simon's two-stage design. In this paper, we numerically explore the impact of batch effects on Simon's two-stage design, propose a batch-effect adjusted Simon's two-stage design, demonstrate the proposed design by both a simulation study and a therapeutic human papillomavirus vaccine trial, and briefly introduce a software that implements the proposed design.
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Affiliation(s)
- Chenguang Wang
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Zhixin Wang
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary L Rosner
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Warner K Huh
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard B S Roden
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Sejong Bae
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
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Abel MK, Huh WK, Chan JK. Human papillomavirus: The other invisible enemy. Gynecol Oncol 2020; 158:254-255. [PMID: 32518014 PMCID: PMC7275186 DOI: 10.1016/j.ygyno.2020.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022]
Abstract
The world is working with unprecedented fervor and spending billions of dollars to find a vaccine for COVID-19. Nearly 381,500 people worldwide died from human papillomavirus-related cancers in 2018 despite a safe and effective vaccine. With the momentum from our fight against this pandemic, we can improve vaccine implementation.
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Affiliation(s)
- Mary Kathryn Abel
- University of California, San Francisco School of Medicine, San Francisco, CA, United States of America
| | - Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - John K Chan
- Division of Gynecologic Oncology, Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, United States of America.
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Huh WK, Brady WE, Fracasso PM, Dizon DS, Powell MA, Monk BJ, Leath CA, Landrum LM, Tanner EJ, Crane EK, Ueda S, McHale MT, Aghajanian C. Phase II study of axalimogene filolisbac (ADXS-HPV) for platinum-refractory cervical carcinoma: An NRG oncology/gynecologic oncology group study. Gynecol Oncol 2020; 158:562-569. [PMID: 32641240 DOI: 10.1016/j.ygyno.2020.06.493] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Women with persistent, recurrent, and/or metastatic cervical cancer have a poor prognosis. Even with the availability of cisplatin plus paclitaxel and bevacizumab, median overall survival (OS) is only 17.0 months, with median post-progression survival of approximately seven months. We studied the therapeutic vaccine, Axalimogene filolisbac (ADXS-HPV), in women who had progressed following at least one prior line of therapy (Gynecologic Oncology Group protocol 265/NCT01266460). METHODS Volunteers ≥18 years with advanced cervical cancer and GOG performance status score of 0 or 1 were eligible for participation in this 2-stage, phase II trial. In stage 1, women received up to three doses of ADXS-HPV (1 × 109 colony-forming units in 250 mL IV over 15 min every 28 days) and were monitored for tumor progression. In stage 2, women were treated until progression, intolerable adverse events (AEs), or voluntary withdrawal of consent. Co-primary endpoints were safety and proportion of volunteers surviving ≥12 months. An estimated, combined (stages 1 + 2) 12-month OS of 35% was calculated from historical GOG cohorts to declare ADXS-HPV sufficiently active in this platinum-pre-treated population. Secondary endpoints were OS and progression-free survival (PFS). RESULTS Among 50 evaluable volunteers, the 12-month OS was 38% (n = 19). Median OS was 6.1 months (95% CI: 4.3-12.1) and median PFS was 2.8 months (95% CI: 2.6-3.0). The most common treatment-related AEs were fatigue, chills, fever, nausea, and anemia. The majority of AEs were grade 1 or 2 and resolved spontaneously or with appropriate treatment. CONCLUSION At the dose and schedule studied, ADXS-HPV immunotherapy was tolerable and met the protocol-specified benchmark for activity required to warrant further investigation in volunteers with cervical carcinoma.
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Affiliation(s)
- Warner K Huh
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL 35249, United States of America.
| | - William E Brady
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park, Buffalo, NY 14263, United States of America
| | - Paula M Fracasso
- Department of Medicine, University of Virginia, UVA Cancer Center, Charlottesville, VA 22908, United States of America.
| | - Don S Dizon
- Division of Hematology-Oncology, Lifespan Cancer Institute, Rhode Island Hospital, Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, United States of America
| | - Matthew A Powell
- Washington University School of Medicine, Saint Louis, MO 63110, United States of America.
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St. Joseph Hospital, Phoenix, AZ 85016, United States of America.
| | - Charles A Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL 35249, United States of America.
| | - Lisa M Landrum
- Oklahoma University Health Science Center, OB/GYN, Oklahoma City, OK 73104, United States of America.
| | - Edward J Tanner
- Johns Hopkins Medical Institutions, Baltimore, MD 21287, United States of America.
| | - Erin K Crane
- Department of Gynecologic Oncology, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC 28203, United States of America.
| | - Stefanie Ueda
- University of California, San Francisco, OB/GYN & Reproductive Sciences, Division of Gyn Onc., San Francisco, CA 94115, United States of America.
| | - Michael T McHale
- Moores UCSD Cancer Center, La Jolla, CA 92093, United States of America.
| | - Carol Aghajanian
- Memorial Sloan-Kettering Cancer Center, Dept. of Medical Oncology, New York, NY 10021, United States of America.
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Goel N, Londono AI, Farrukh N, Beer HM, Roane B, Arquiette J, Huh WK, Leath CA, Arend RC. Abstract A04: Real-world usage of NGS testing in high-grade serous ovarian cancer (HGSOC)—the landscape is quickly changing. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.ovca19-a04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The Precision Medicine Initiative (PMI) study at the University of Alabama at Birmingham (UAB) was developed to include next-generation sequencing (NGS) as part of patients’ standard of care and to follow them prospectively. The objective of this study was to analyze how the usage of NGS in patients with high-grade serous ovarian cancer (HGSOC) affected their management.
Methods: Between 5/2015–2/2019, 224 ovarian cancer patients (167 HGSOC) signed informed consent and were enrolled. Archival tissue was sent to Foundation Medicine for NGS analysis; 324 genes, including genes involved in homologous recombination repair deficiency (HRD genes), microsatellite instability (MSI) status, and tumor mutation burden (TMB) were assessed. A subset of these patients were tested for LOH status and PD-L1 expression. Demographics including germline BRCA status, treatments, duration of targeted therapy, and platinum sensitivity were collected. Correlation between LOH status and both germline and somatic mutations in HRD genes was analyzed, in addition to the correlation between PD-L1 positivity and MSI status and TMB.
Results: 62% (103/167) of HGSOC patients had at least 1 targetable mutation and 40 patients received targeted therapy. 16% (27/167) were germline BRCA+ (gBRCAm+), 12 (10%) somatic BRCA + (sBRCAm+), and 120 wtBRCA. Of the gBRCAm+ patients, 81% were platinum sensitive, compared to 66% of all patients. 22% (36/167) of patients underwent LOH testing: 39% (14/36) were LOH-high. 43% (6/14) of LOH-high patients had an alteration in one of the HRD genes. Of the LOH-low patients, 23% (5/22) harbored mutations in HRD genes: (3) BRCA2, (2) CHEK2. 7% (8/114) of platinum-sensitive patients were placed on PARPi maintenance therapy after two or more lines of platinum-based therapy. Of the s/gBRCA+ patients, 24% (11/39) received PARPi monotherapy; 8 received both maintenance PARPi and monotherapy. 33% (13/167) of patients received a non-PARPi targeted therapy based on their NGS testing. Patients on maintenance PARPi received it for an average of 560 days (range 345-890 days), PARPi monotherapy: 254 days (range 30-750 days), and non-PARP targeted therapy: 186 days (range 24- 435 days). PD-L1 staining was completed for 38 patients; 6 patients had a PD-L1 Tumor Proportion Score > 1, although none of the patients were MSI-H or high TMB and none received immunotherapy.
Conclusions: NGS testing potentially affected the treatment of 23.9% of HGSOC patients. Our division has developed a streamlined mechanism for HGSOC patients to undergo routine NGS testing with limited out-of-pocket patient cost regardless of insurance status. Given the recent upfront approval of PARPi maintenance for all HGSOC who are s/gBRCAm+, we have now integrated both germline and somatic testing during front-line therapy. More information will be required to further elucidate how LOH status affects treatment decisions and outcomes for patients.
Citation Format: Nidhi Goel, Angelina I. Londono, Naveed Farrukh, Hannah M. Beer, Brandon Roane, Jaclyn Arquiette, Warner K. Huh, Charles A. Leath III, Rebecca C. Arend. Real-world usage of NGS testing in high-grade serous ovarian cancer (HGSOC)—the landscape is quickly changing [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr A04.
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Affiliation(s)
- Nidhi Goel
- University of Alabama at Birmingham, Birmingham, AL
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Huh WK, Johnson JL, Elliott E, Boone JD, Leath CA, Kovar JL, Kim KH. Fluorescence Imaging of the Ureter in Minimally Invasive Pelvic Surgery. J Minim Invasive Gynecol 2020; 28:332-341.e14. [PMID: 32615331 DOI: 10.1016/j.jmig.2020.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVE Determine near-optimal dose, safety, and efficacy of nerindocianine in pelvic ureter detection with near-infrared fluorescence imaging in women undergoing minimally invasive pelvic surgery with 3 Food and Drug Administration-cleared imaging systems. DESIGN Open label, phase 1/2a study. SETTING University of Alabama at Birmingham. PATIENTS Forty-one female subjects undergoing minimally invasive gynecologic surgery. INTERVENTIONS Subjects received a single dose of nerindocianine sodium, starting at 0.06-mg/kg body weight and increased/decreased until the near-optimal dose was determined (part A). Examine the degree of concordance between endoscopic and robotic devices (part B). MEASUREMENTS AND MAIN RESULTS In part A, composite scores were collected every 10 minutes for 30 minutes and then every 15 minutes through 90 minutes using a scale measuring the anatomy/laterality of ureter visualization. In part B (paired imaging system efficacy), 2 cohorts of 8 subjects each received the near-optimal dose. Composite scores for visualization of the ureter were collected at 10 and 30 minutes postinfusion with the Firefly Imaging System and either the PINPOINT or 1588 AIM endoscope. Composite scores were compared to examine the degree of concordance between devices. Part A comprised 25 total subjects enrolled in dosing groups 1, 2, and 3 (0.06-, 0.12-, and 0.045-mg/kg, respectively). Median time to first ureter visualization was 10 minutes (all groups). The nerindocianine 0.06-mg/kg and 0.12-mg/kg groups had longer length of time of visualization than the 0.045-mg/kg group, resulting in the selection of 0.06 mg/kg as the near-optimal dose. Part B enrolled 16 total subjects in 2 groups dosed at 0.06 mg/kg. Efficacy analysis showed no statistically significant difference in composite scores with Firefly versus PINPOINT or 1588 AIM. CONCLUSION Nerindocianine was well tolerated with visualization of the ureter demonstrated in 88.9% of the subjects through 90 minutes postdosing. No meaningful visualization differences were observed among the Food and Drug Administration-cleared surgical imaging systems used.
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Affiliation(s)
- Warner K Huh
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar).
| | - John L Johnson
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
| | - Emily Elliott
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
| | - Jonathan D Boone
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
| | - Joy L Kovar
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
| | - Kenneth H Kim
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
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Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, Chon HS, Chu C, Clark R, Cohn D, Crispens MA, Damast S, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, Han E, Huh WK, Lurain JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Ueda S, Wyse E, Yashar CM, McMillian NR, Scavone JL. Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 17:64-84. [PMID: 30659131 DOI: 10.6004/jnccn.2019.0001] [Citation(s) in RCA: 576] [Impact Index Per Article: 144.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cervical cancer is a malignant epithelial tumor that forms in the uterine cervix. Most cases of cervical cancer are preventable through human papilloma virus (HPV) vaccination, routine screening, and treatment of precancerous lesions. However, due to inadequate screening protocols in many regions of the world, cervical cancer remains the fourth-most common cancer in women globally. The complete NCCN Guidelines for Cervical Cancer provide recommendations for the diagnosis, evaluation, and treatment of cervical cancer. This manuscript discusses guiding principles for the workup, staging, and treatment of early stage and locally advanced cervical cancer, as well as evidence for these recommendations. For recommendations regarding treatment of recurrent or metastatic disease, please see the full guidelines on NCCN.org.
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Suehiro TT, Damke GMZF, Damke E, de Azevedo Ramos PLR, de Andrade Pereira Silva M, Pelloso SM, Huh WK, Franco RAF, da Silva VRS, Scarinci IC, Consolaro MEL. Cervical and oral human papillomavirus infection in women living with human immunodeficiency virus (HIV) and matched HIV-negative controls in Brazil. Infect Agent Cancer 2020; 15:31. [PMID: 32426032 PMCID: PMC7216672 DOI: 10.1186/s13027-020-00301-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background Despite the demonstrated role of human Papillomavirus (HPV) in the etiology of cervical cancer and the strong evidence suggesting the importance of HPV in the development of oropharyngeal cancer, several aspects of the interrelationship between HPV infection in both body sites remain unknown, specifically in female human immunodeficiency virus (HIV)-positive (HIV+) patients. We aimed to assess the prevalence, distribution, and concordance of cervical and oral HPV in HIV+ women and matched HIV-negative (HIV-) controls in Brazil. Material and methods Cervical and endocervical samples for cytological screening and HPV detection and oral samples were collected from 115 HIV+ women using highly active antiretroviral therapy (HAART) and 139 HIV-matched controls (HIV-) in Maringá City, Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding HIV infection were obtained from the patients’ medical records. HPV detection and typing were performed using the Kit Multiplex XGEN Multi HPV Chip HS12. Results HIV infection was well controlled in this cohort, but women who exhibited detectable HIV loads were significantly associated with HPV-positive status overall (P = 0.03) and in cervical mucosa (P = 0.01). HIV+ women had significantly more abnormal cytological findings (P = 0.04) than HIV- women. Of the 115 HIV+ women, 48.7% were positive for cervical and/or oral HPV DNA; of the 139 HIV- women, 41% were positive for cervical and/or oral HPV (P = 0.25). Both HIV+ and HIV- women had a statistically higher prevalence of cervical HPV infection than oral infection. The concurrent HPV infection in two anatomical sites was similar in HIV+ and HIV- women; however, HPV type concordance was not observed. HPV type distribution was different between the anatomical sites in both groups, and HIV+ women presented less common types, mainly in oral mucosa. Conclusion Our data support the importance of testing HPV infection in HIV+ women, even when the HIV infection is well controlled. Prospective studies are required to better understand the natural history of HPV infection in both anatomical sites, specifically in HIV+ women.
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Affiliation(s)
- Tamy Taianne Suehiro
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | | | - Edilson Damke
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | | | | | | | - Warner K Huh
- 3School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Vânia Ramos Sela da Silva
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | | | - Marcia Edilaine Lopes Consolaro
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
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Park HG, Kim YI, Huh WK, Bae S. The association between social media use for health related information and compliance with breast and cervical cancer screenings. Res Rep (Montgomery, Ala.) 2020; 4:e1-e14. [PMID: 34278179 PMCID: PMC8281882] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is a need to investigate the impact of social media use on patient compliance with important health screenings due to the inconsistency of research findings on the effect of using social media on cervical cancer screenings. This study assessed associations between social media use and adherence in women at risk for breast and cervical cancer to mammograms and Pap smear screenings. A total of 6695 respondents from the Health Information National Trends Survey (HINTS) 5 Cycle 1 and 2 datasets were used for data analysis. Chi-square tests were used to explore social network activities and cancer screening compliance, and multivariate logistic regressions were used to identify factors associated with cancer screening compliance. Among respondents, 68% of women and 84% of women complied with mammograms and Pap smears, respectively. Women who used the Internet during last 12 months to visit a social networking site, participate in a forum support group for medical issue, or watch a health-related video on YouTube complied with Pap smears more significantly than women who did not use the Internet (p <.05, p <.0001, and p <.001, respectively). Variables associated with mammogram and Pap smear screening compliance were age, health insurance, regular provider, marital status, and internet use. There was no significant association between social network activities and compliance with mammogram screenings. It is critical to use the same and up-to-date guidelines when reporting cancer screening rates to effectively promote adherence to cancer prevention programs and make valid and reliable comparisons across studies.
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Affiliation(s)
- HyounKyoung G. Park
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave. South, Birmingham, Alabama 35205, United States
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 Univ. Blvd, Birmingham, Alabama 35205, United States
| | - Young-Il Kim
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave. South, Birmingham, Alabama 35205, United States
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 Univ. Blvd, Birmingham, Alabama 35205, United States
| | - Warner K. Huh
- Division of Gyn Oncology, University of Alabama at Birmingham, 1201 11th Ave. South, Birmingham, Alabama 35205, United States
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 Univ. Blvd, Birmingham, Alabama 35205, United States
| | - Sejong Bae
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave. South, Birmingham, Alabama 35205, United States
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 Univ. Blvd, Birmingham, Alabama 35205, United States
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Yoo W, Koskan A, Scotch M, Pottinger H, Huh WK, Helitzer D. Patterns and Disparities in Human Papillomavirus (HPV) Vaccine Uptake for Young Female Adolescents among U.S. States: NIS-Teen (2008-2016). Cancer Epidemiol Biomarkers Prev 2020; 29:1458-1467. [PMID: 32345710 DOI: 10.1158/1055-9965.epi-19-1103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/09/2019] [Accepted: 04/23/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Several studies have reported differential vaccine uptake outcomes that are associated with sociodemographic and socioeconomic characteristics, as well as provider type. However, none has examined a trend over a multiple-year span. In this study, we utilize a longitudinal data-based approach to examine state-level human papillomavirus (HPV) vaccine trends and their influences over time. METHODS We analyzed National Immunization Survey - Teen data (2008-2016) to estimate HPV vaccine initiation rate in young female adolescent ages 13-17 years old among U.S. States. We identified growth patterns using the latent class growth method and explored state-level characteristics, including socioeconomic and sociodemographic attributes, and health legislation and policy-related programs among patterns. RESULTS We identified three growth patterns, which showed gradually increasing vaccination trends but different baseline HPV uptake rates (high, moderate, low). States within Pattern 1 (highest HPV vaccination rates) included the lowest percentage of families with incomes below federal poverty level, the highest percentage of bachelor's degree or higher, and the lowest number of uninsured, while states within Pattern 3 (lowest HPV vaccination rates) included families with socioeconomic attributes along the opposite end of the spectrum. CONCLUSIONS Latent class growth models are an effective tool to be able to capture health disparities in heterogeneity among states in relation to HPV vaccine uptake trajectories. IMPACT These findings might lead to designing and implementing effective interventions and changes in policies and health care coverage to promote HPV vaccination uptake for states represented under the lowest trajectory pattern.
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Affiliation(s)
- Wonsuk Yoo
- College of Health Solutions, Arizona State University, Phoenix, Arizona.
| | - Alexis Koskan
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Matthew Scotch
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Heidi Pottinger
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona
| | - Warner K Huh
- Department of Obstetrics and Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deborah Helitzer
- College of Health Solutions, Arizona State University, Phoenix, Arizona
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Chase D, Huang HQ, Monk BJ, Ramondetta LM, Penson RT, Gil K, Landrum LM, Leitao M, Oaknin A, Huh WK, Pulaski HL, Robison K, Guntupalli SR, Richardson D, Salani R, Sill MW, Wenzel LB, Tewari KS. Patient-reported outcomes at discontinuation of anti-angiogenesis therapy in the randomized trial of chemotherapy with bevacizumab for advanced cervical cancer: an NRG Oncology Group study. Int J Gynecol Cancer 2020; 30:596-601. [PMID: 32114513 DOI: 10.1136/ijgc-2019-000869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/18/2020] [Accepted: 02/07/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION To describe patient-reported outcomes and toxicities at time of treatment discontinuation secondary to progression or toxicities in advanced/recurrent cervical cancer patients receiving chemotherapy with bevacizumab. METHODS Summarize toxicity, grade, and health-related quality of life within 1 month of treatment discontinuation for women receiving chemotherapy with bevacizumab in GOG240. RESULTS Of the 227 patients who received chemotherapy with bevacizumab, 148 discontinued study protocol treatment (90 for disease progression and 58 for toxicity). The median survival time from treatment discontinuation to death was 7.9 months (95% CI 5.0 to 9.0) for those who progressed versus 12.1 months (95% CI 8.9 to 23.2) for those who discontinued therapy due to toxicities. The most common grade 3 or higher toxicities included hematologic, gastrointestinal, and pain. Some 57% (84/148) of patients completed quality of life assessment within 1 month of treatment discontinuation. Those patients who discontinued treatment due to progression had a mean decline in the FACT-Cx TOI of 3.2 points versus 2.2 in patients who discontinued therapy due to toxicity. This was a 9.9 point greater decline in the FACT-Cx TOI scores than those who discontinued treatment due to progression (95% CI 2.8 to 17.0, p=0.007). The decline in quality of life was due to worsening physical and functional well-being. Those who discontinued treatment due to toxicities had worse neurotoxicity and pain. DISCUSSION Patients who discontinued chemotherapy with bevacizumab for toxicity experienced longer post-protocol survival but significantly greater declination in quality of life than those with progression. Future trial design should include supportive care interventions that optimize physiologic function and performance status for salvage therapies.
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Affiliation(s)
- Dana Chase
- Arizona Oncology, Paradise Valley, California, USA
| | - Helen Q Huang
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Bradley J Monk
- Ob Gyn/Gyn Onc, Creighton University School of Medicine at St Josephs Hospital and Medical Center, Phoenix, Arizona, USA
| | | | - Richard T Penson
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Gil
- Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa M Landrum
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Mario Leitao
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Ana Oaknin
- Vall d' Hebron Institute of Oncology, University Hospital, Barcelona, Spain
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Heather L Pulaski
- Gynecological Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Katina Robison
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Saketh R Guntupalli
- Gynecologic Oncology, University of Colorado Cancer Center, Aurora, Colorado, USA
| | | | - Ritu Salani
- Ob/Gyn, Ohio State University, Columbus, Ohio, USA
| | - Michael W Sill
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Lari B Wenzel
- University of California Irvine School of Medicine, Irvine, California, USA
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Santin AD, Filiaci V, Bellone S, Ratner ES, Mathews CA, Cantuaria G, Gunderson CC, Rutledge T, Buttin BM, Lankes HA, Frumovitz M, Khleif SN, Huh WK, Birrer MJ. Phase II evaluation of copanlisib, a selective inhibitor of Pi3kca, in patients with persistent or recurrent endometrial carcinoma harboring PIK3CA hotspot mutations: An NRG Oncology study (NRG-GY008). Gynecol Oncol Rep 2020; 31:100532. [PMID: 31934607 PMCID: PMC6951478 DOI: 10.1016/j.gore.2019.100532] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/15/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
Endometrial cancer commonly harbors hotspot mutations in the PIK3CA gene. NRG-GY008 evaluated the activity of copanlisib, an inhibitor of PIK3CA, in recurrent endometrial cancer patients. Copanlisib has an acceptable safety profile but low antitumor activity in endometrial cancer. Combinations of copanlisib may be necessary to increase clinical responses in endometrial cancer patients.
Purpose NRG Oncology conducted a phase II trial to assess the antitumor activity and tolerability of copanlisib, a selective inhibitor of PIK3CA, in persistent or recurrent endometrial carcinoma harboring hotspot PIK3CA mutations. Patients and methods Eligible patients had endometrial cancer with endometrioid, serous or mixed histology, a somatic PIK3CA gene mutation, measurable disease, and GOG performance status ≤2. Treatment consisted of IV copanlisib (60 mg weekly, day 1, 8 and 15 of 28-day cycle) until disease progression or prohibitive toxicity. The primary endpoints of the study were objective tumor response as assessed by RECIST 1.1 and to determine the nature and degree of toxicity of copanlisib as assessed by CTCAE version 4. The study used a 2-stage group sequential design. Results Eleven patients were enrolled onto stage I of the treatment trial. Five patients had endometrioid, four serous and two had a tumor of mixed histology. The most common PIK3CA mutation was Q546X (n = 3) in exon 9. The most common grade 3 or 4 AE was hyperglycemia. No grade 5 adverse events were reported. No clinical responses were detected. Six patients had a best overall response of stable disease. Of 11 who initiated treatment, 10 progressed on treatment. One patient with stable disease on copanlisib withdrew from treatment secondary to relocation. The median progression-free survival (PFS) was 2.8 months; at 6 months 27% were alive, progression-free. The median overall survival (OS) was 15.2 months. Due to the lack of CR/PR continuation of accrual to the second stage of accrual was not warranted. Conclusion Copanlisib is well tolerated but has limited activity as a single agent in this population.
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Affiliation(s)
- Alessandro D Santin
- Department of Obstetrics, Gynecology & Reproductive Services, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Virginia Filiaci
- NRG Oncology Statistical and Data Management Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Stefania Bellone
- Department of Obstetrics, Gynecology & Reproductive Services, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Elena S Ratner
- Department of Obstetrics, Gynecology & Reproductive Services, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Cara A Mathews
- Medical Oncology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA
| | | | - Camille C Gunderson
- Department of Obstetrics & Gynecology, University of Oklahoma, The Stephenson Cancer Center, 800 NE 10 Street, Suite 2500, Oklahoma City, OK 73104, USA
| | - Teresa Rutledge
- Gynecologic Oncology, University of New Mexico, 1201 Camino de Salud, Albuquerque, NM 87102, USA
| | - Barbara M Buttin
- Department of Obstetrics & Gynecology, Northwestern Medicine Regional Medical Group, 4405 Weaver Parkway, Warrenville, IL 60555-3269, USA
| | - Heather A Lankes
- NRG Oncology, Operations Center-Philadelphia East, Philadelphia, PA, USA.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Frumovitz
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Samir N Khleif
- Director, The Loop Immuno-Oncology Research Laboratory, Lombardi Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham AL 35205, USA
| | - Michael J Birrer
- Division of Hematology/Oncology, O'Neal Cancer Center University of Alabama, 176F 10390, 619 19 Street S, Birmingham, AL, USA
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Dilley S, Miller KM, Huh WK. Human papillomavirus vaccination: Ongoing challenges and future directions. Gynecol Oncol 2019; 156:498-502. [PMID: 31848025 DOI: 10.1016/j.ygyno.2019.10.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 12/26/2022]
Abstract
Studies with prophylactic HPV vaccination have demonstrated impressive efficacy, immunogenicity, and safety results; however, the implementation and uptake in both low and high-income countries continues to be challenging. Since 2006, administration guidelines have undergone multiple updates regarding age, dosing schedule, and gender. Despite these changes, the basic tenet remains the same: prioritize immunization before initiation of sexual activity and subsequent exposure to HPV. The importance of immunizing males and females equally and the role for catch-up vaccination in late adolescent and adulthood has also been supported by subsequent research. Very recently, the FDA approved to expand the range of eligible patients for the nonavalent (9vHPV) vaccine to women and men from age 27 to 45 for the prevention of HPV-related cancers and diseases. Furthermore, members of the ACIP voted to recommend that individuals between ages 27 and 45 who have not yet been vaccinated discuss the option with their physician. This review will highlight the history of the vaccine, barriers to vaccination, current recommendations, and future directions for success.
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Wang M, Sharma A, Osazuwa-Peters N, Simpson MC, Schootman M, Piccirillo JF, Huh WK, Adjei Boakye E. Risk of subsequent malignant neoplasms after an index potentially-human papillomavirus (HPV)-associated cancers. Cancer Epidemiol 2019; 64:101649. [PMID: 31816512 DOI: 10.1016/j.canep.2019.101649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/12/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Since the number of cancer survivors is increasing, it is imperative that we better understand the long-term consequences of these survivors. We assessed the risk of developing a second primary malignant neoplasm (SPMN) after an index potentially-HPV-associated cancers (P-HPV-AC). METHODS We constructed a population-based cohort of patients with P-HPV-AC using Surveillance, Epidemiology, and End Results registry data (2000-2015). We limited patients to those with invasive P-HPV-AC [cervical, vagina, vulva, penile, anal, and oropharynx] based on the International Classification of Diseases for Oncology, 3rd edition. Excess SPMN risks were calculated based on standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). RESULTS A total of 105,644 patients with an index P-HPV-AC were identified, and 7.8 % developed a SPMN. In all P-HPV-AC patients, the overall SIR was 1.73 (95 % CI: 1.69-1.77) and EAR of 70.72 per 10,000 PYR. All index P-HPV-AC sites showed statistically significant increases in the risk of SPMN, except for anal cancer among men, compared with the general population. The greatest increase in risk of SPMN was observed among patients diagnosed with an index P-HPV-oropharyngeal cancer (SIR = 1.83; 95 % CI, 1.70-1.82 and SIR = 2.29; 95 % CI, 2.12-2.47 for men and women, respectively). Men developed SPMN mostly in aero-digestive tract whiles women developed SPMN both in aero-digestive tract and other HPV-associated cancer sites. CONCLUSIONS P-HPV-AC survivors experienced excess risk of SPMN. These findings have the potential to affect future surveillance practices and improve preventive healthcare for survivors of P-HPV-ACs.
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Affiliation(s)
- Maggie Wang
- Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, USA.
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, 720 N. Bond Street, Springfield, IL 62702, USA.
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3660 Vista Ave, St. Louis, MO 63110, USA; Saint Louis University Cancer Center, 3685 Vista Ave, St. Louis, MO 63110, USA.
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3660 Vista Ave, St. Louis, MO 63110, USA.
| | - Mario Schootman
- Center for Clinical Excellence, SSM Health, 10101 Woodfield Ln., St. Louis, MO 63132, USA.
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, USA.
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, 201 E. Madison Street, P. O. Box 19664, Springfield, IL 62794-9664, USA; Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge St, Springfield, IL 62702, USA; Simmons Cancer Institute at SIU, Southern Illinois University School of Medicine, 315 W Carpenter St, Springfield, IL 62702, USA.
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45
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Bernstock JD, Ostby S, Fox B, Sotoudeh H, Janssen A, Kang YJ, Chen J, Prattipati V, Elsayed G, Chagoya G, Yamashita D, Friedman GK, Nabors B, Huh WK, Lobbous M. Front Cover. Clin Case Rep 2019. [DOI: 10.1002/ccr3.2659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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46
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Bernstock JD, Ostby S, Fox B, Sotoudeh H, Janssen A, Kang YJ, Chen J, Prattipati V, Elsayed G, Chagoya G, Yamashita D, Friedman GK, Nabors B, Huh WK, Lobbous M. Cauda equina syndrome in an ovarian malignant-mixed müllerian tumor with leptomeningeal spread. Clin Case Rep 2019; 7:2341-2345. [PMID: 31893054 PMCID: PMC6935635 DOI: 10.1002/ccr3.2472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/10/2019] [Revised: 08/18/2019] [Accepted: 09/06/2019] [Indexed: 12/27/2022] Open
Abstract
Leptomeningeal metastasis is extremely rare in patients with ovarian cancer, but should be considered in patients presenting with neurologic deficits such as cauda equine syndrome. Given its poor prognosis and lack of data currently on management, additional studies are needed to optimize treatment regimens and improve outcomes.
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Affiliation(s)
- Joshua D. Bernstock
- Department of NeurosurgeryBrigham and Women's HospitalHarvard UniversityBostonMAUSA
| | - Stuart Ostby
- Division of Gynecologic OncologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Brandon Fox
- School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Houman Sotoudeh
- Department of Radiology, Neuroradiology SectionUniversity of Alabama at BirminghamBirminghamALUSA
| | - Andrew Janssen
- School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | | | - Jason Chen
- Medical Scientist Training ProgramUniversity of CaliforniaLos AngelesCAUSA
| | | | - Galal Elsayed
- Department of NeurosurgeryUniversity of Alabama at BirminghamBirminghamALUSA
| | - Gustavo Chagoya
- Department of NeurosurgeryUniversity of Alabama at BirminghamBirminghamALUSA
| | - Daisuke Yamashita
- Department of NeurosurgeryBrigham and Women's HospitalHarvard UniversityBostonMAUSA
| | - Gregory K. Friedman
- Division of Pediatric Hematology and OncologyDepartment of PediatricsUniversity of Alabama at BirminghamBirminghamALUSA
| | - Burt Nabors
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Warner K. Huh
- Division of Gynecologic OncologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Mina Lobbous
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamALUSA
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47
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Liang MI, Pisu M, Summerlin SS, Boitano TKL, Blanchard CT, Bhatia S, Huh WK. Extensive financial hardship among gynecologic cancer patients starting a new line of therapy. Gynecol Oncol 2019; 156:271-277. [PMID: 31771866 DOI: 10.1016/j.ygyno.2019.11.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Our objective was to evaluate the three domains of financial hardship (psychological response, material conditions, and coping behaviors) among gynecologic cancer patients receiving treatment. METHODS We conducted a single-institution survey of gynecologic cancer patients starting a new line of therapy for primary or recurrent disease. Psychological response was measured using Comprehensive Score for Financial Toxicity, with score < 26 indicating financial distress. We measured material conditions by patient-reported changes in employment or spending and coping behaviors by patient-reported medication non-adherence. We performed descriptive statistics, bivariate analysis, and multivariate logistic regression. RESULTS Among 121 participants, the mean age was 59 years, 28% were African-American, 50% reported income < $40,000, 74% had private insurance, 20% had only public insurance, and 7% were uninsured. Sixty-five (54%) participants screened positive for financial distress. Age < 65 years (aOR 2.61, 95% CI 1.04-6.52) and income < $40,000 (aOR 3.41, 95% CI 1.28-9.09) were associated with increased odds of screening positive for financial distress. Participants with financial distress were significantly more likely to report material hardship, including losing wages (46% vs. 18%, p < 0.01), not paying bills on time (40% vs. 7%, p < 0.01), and borrowing money (39% vs. 4%, p < 0.01). Financial distress was not associated with coping behaviors, such as not taking (6% vs. 2%, p = 0.37) or refilling medications (5% vs. 2%, p = 0.62). CONCLUSIONS Financial distress affects over half of gynecologic cancer patients starting a new line of treatment and is associated with material hardship. Younger age and lower income can be used to identify patients at increased risk.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Maria Pisu
- Division of Preventive Medicine, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Sarah S Summerlin
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Teresa K L Boitano
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Christina T Blanchard
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Smita Bhatia
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
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48
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Abu-Rustum NR, Yashar CM, Bean S, Bradley K, Campos SM, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, Han E, Huh WK, Lurain JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Sisodia R, Tillmanns T, Ueda S, Wyse E, McMillian NR, Scavone J. Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:1374-1391. [PMID: 31693991 DOI: 10.6004/jnccn.2019.0053] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gestational trophoblastic neoplasia (GTN), a subset of gestational trophoblastic disease (GTD), occurs when tumors develop in the cells that would normally form the placenta during pregnancy. The NCCN Guidelines for Gestational Trophoblastic Neoplasia provides treatment recommendations for various types of GTD including hydatidiform mole, persistent post-molar GTN, low-risk GTN, high-risk GTN, and intermediate trophoblastic tumor.
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Affiliation(s)
| | | | | | | | | | | | | | - David Cohn
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | | | | | | | - John R Lurain
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - David Mutch
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Christa Nagel
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | - Todd Tillmanns
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Stefanie Ueda
- UCSF Helen Diller Family Comprehensive Cancer Center
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Norwood TG, Wang MJ, Huh WK. Combination checkpoint inhibitor therapy induces multiple immune major related adverse events in the treatment of vaginal melanoma: A cautionary case report. Gynecol Oncol Rep 2019; 30:100508. [PMID: 31737773 PMCID: PMC6849148 DOI: 10.1016/j.gore.2019.100508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022] Open
Abstract
As more ICIs are approved, better education is needed for patients and providers. Major irAEs, signs of worsening immune toxicity, can present with benign symptoms. IrAEs should be considered when patients on ICIs present with new symptoms. Patients on ICIs may present to a variety of healthcare settings with irAEs. Providers should be educated on basic work-up and treatment options for irAEs.
Background Immune checkpoint inhibitors (ICI) eliminate cancer cells through release of inhibition of cytotoxic CD8+ lymphocytes. Potent systemic activation of immune cells provides unprecedented efficacy in some types of advanced cancer therapy, but also often induces serious immune related adverse events (irAEs) that can be devastating if not promptly identified and properly managed. Herein, we describe the case of multiple major irAEs manifesting after administration of combination ICI therapy in a patient with vaginal melanoma. Case: A 54-year-old, G2P0 woman with recurrent metastatic vaginal melanoma, following three doses of combination nivolumab-ipilimumab immunotherapy, presented for admission at our tertiary care center for the work-up of sudden-onset of colitis of unknown etiology. Prior to admission at our facility, the patient was diagnosed with a severe maculopapular rash, headaches and hyponatremia in the weeks immediately following initiation of therapy. During work up of the colitis, infectious etiologies were ruled out, and the patient was discharged on a steroid taper for treatment of presumed immune-related colitis. Consideration of salt-supplement resistant hyponatremia with new onset frontal headache in the setting of immune-related colitis indicated possible hypophysitis. With high suspicion for multiple high grade irAEs, ICI was discontinued, and the patient was given high dose intravenous steroids prior to discharge with a prednisone dose taper for outpatient management. After control of irAEs was achieved, ipilimumab therapy was subsequently discontinued to minimize the chance of recurrent irAEs, yet nivolumab monotherapy was resumed in an attempt to control disease progression that could occur in with iatrogenic immunosuppression. Conclusion ICIs have demonstrated the ability to induce improved long-term survival in metastatic cutaneous or mucosal melanomas, including those of gynecologic origin. As ICI therapy becomes more widespread, healthcare providers across all fields of medicine need be vigilant to recognize the symptoms of irAEs that can often masquerade as common illnesses to prevent potentially dangerous irreversible immune toxicities.
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Affiliation(s)
- T Graham Norwood
- University of Alabama at Birmingham, School of Medicine. Birmingham, AL, United States
| | - Michelle J Wang
- University of Alabama at Birmingham, School of Medicine. Birmingham, AL, United States
| | - Warner K Huh
- University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Division of Gynecology Oncology. Birmingham, AL, United States
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50
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Stoler MH, Baker E, Boyle S, Aslam S, Ridder R, Huh WK, Wright TC. Approaches to triage optimization in HPV primary screening: Extended genotyping and p16/Ki-67 dual-stained cytology-Retrospective insights from ATHENA. Int J Cancer 2019; 146:2599-2607. [PMID: 31490545 PMCID: PMC7078939 DOI: 10.1002/ijc.32669] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 03/25/2019] [Revised: 07/29/2019] [Accepted: 08/15/2019] [Indexed: 12/13/2022]
Abstract
The objective of our study was to assess the performance of different triage strategies for high‐risk human papillomavirus (hrHPV)‐positive results utilizing either extended genotyping or a p16/Ki‐67 dual‐stained cytology (DS) approach, with or without partial genotyping. A subset of women with hrHPV infections participating in the Addressing the Need for Advanced HPV Diagnostics (ATHENA) study were analyzed to determine the number of cervical intraepithelial neoplasia grade 3 or worse (≥CIN3) cases detected, and the absolute risk for ≥CIN3 of each genotype. A clinical utility table was constructed to compare the impact of different triage strategies. In all, 2,339 women with single‐genotype hrHPV infections were identified. Among these were 171 ≥CIN3 cases. The U.S. Food and Drug Administration (FDA)‐approved algorithm (HPV16/18 positive, or 12‐other hrHPV positive and Pap positive, i.e., ≥ atypical squamous cells of undetermined significance) for primary HPV screening detected 132/171 (77.2%) ≥CIN3 cases and required 964 colposcopies (colposcopies per ≥CIN3 ratio: 7.3). An approach that uses DS instead of cytology in the FDA‐approved algorithm detected 147/171 (86.0%) ≥CIN3 cases, requiring 1,012 colposcopies (ratio: 6.9). Utilizing DS for triage of all hrHPV‐positive women identified 126/171 (73.7%) ≥CIN3 cases, requiring 640 colposcopies (ratio: 5.1). A strategy that detected HPV16/18/31/33/35+ captured 130/171 (76.0%) ≥CIN3 cases, requiring 1,025 colposcopies (ratio: 7.9). Inclusion of additional genotypes resulted in greater disease detection at the expense of higher colposcopy ratios. Substituting cytology with a DS triage approach improved disease detection and the colposcopy detection rate. Further reduction of colposcopy rates can be achieved by using DS without partial genotyping. Extended genotyping strategies can identify a comparable number of cases but requires an increased number of colposcopies. What's new? Among HPV‐positive women, the goal is to maximize the number of CIN3 or greater cases detected while minimizing colposcopies. These authors compared various combinations of genotyping and dual‐stained cytology (DS) as triage strategies. From a pool of 2,339 hrHPV+ women, 171 cases with ≥CIN3 were identified. Only one algorithm they tested boosted sensitivity over the current approach without reducing specificity. This method used DS to triage women who tested positive for 12‐other HPV, and referring HPV16/18+ patients directly to colposcopy. This approach caught 147 of the 171 cases, while reducing the number of colposcopies per case from 7.4 to 6.9.
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Affiliation(s)
- Mark H Stoler
- Department of Pathology, University of Virginia Health System, Charlottesville, VA
| | - Ed Baker
- Roche Molecular Systems Inc., Pleasanton, CA
| | - Sean Boyle
- Roche Molecular Systems Inc., Pleasanton, CA
| | | | - Ruediger Ridder
- Ventana Medical Systems, Inc. (Roche Tissue Diagnostics), Tucson, AZ
| | - Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas C Wright
- Department of Pathology, Columbia University, New York City, NY
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