Diagnosis Of Gynecologic Cancer Research Articles

FACTORS THAT CONTRIBUTE TO DELAYED DIAGNOSIS AND TREATMENT OF GYNECOLOGICAL MALIGNANCIES IN A TERTIARY CARE CENTRE - A CROSS SECTIONAL STUDY

Background: The diagnosis and management of primary gynecological cancers are often delayed in low- and middle-income countries. Women mostly seek help in well advanced stages when treatment options are limited. Early diagnosis and treatment will ensure a better quality of life. A cross sectionalMaterials & Methods: study design was used to screen women attending the Outpatient Department (OPD) of Gynaecology at Government Medical College, Thrissur for gynaecological cancers, during the study period. All those admitted for evaluation and treatment for a primary genital tract malignancy were recruited. Demographic particulars, symptoms, time from onset of symptoms to seeking professional help, interval from diagnosis to treatment and reasons for delay in initiating treatment were recorded and analysed. Eighty-four women met the criteria for the study. Most (71.4%) of the women with cancer wereResults &Discussion: 50 years old or more. Many of them (70.3%) were from families that were Below Poverty Line. Educational status, lack of awareness of preventive public health programs, ignorance about warning symptoms, nancial issues, lack of care givers, fear and embarrassment about symptoms were found to be contributory factors for the delay in seeking treatment. Referral and treatment delays and diagnoses at an advanced stage . Scaling up of public awareness of early warningConclusion: symptoms and the available preventive programs are essential to enable optimal utilization of health services for early diagnosis and treatment of gynaecological cancers.

Development and Validation of a Nomogram Based on Geriatric Nutritional Risk Index to Predict Surgical Site Infection Among Gynecologic Oncology Patients.

BackgroundThe geriatric nutritional risk index (GNRI) is a commonly used method to assess nutritional risk for predicting potential surgical site infections (SSI) in cancer patients. This study aims to create and verify a simple nomogram and a dynamic web-based calculator for predicting the risk of SSI among gynecologic oncology patients.MethodsA retrospective evaluation was conducted on patients who were admitted into a tertiary hospital in China with confirmed diagnosis of gynecologic cancer between 01 August 2017 and 30 November 2021. A two-piecewise linear regression model with a smoothing function was used to investigate the non-linear association between GNRI and SSI to determine the ideal cut-off point. Three models were developed on the basis of different variables to predict SSI in gynecologic oncology patients. Through a nomogram the concordance index (C-index), the Akaike information criterion (AIC), and the integrated discrimination index (IDI) were used to determine the final model. Finally, the performance of the nomogram was validated using the 1,000-bootstrap resamples method and analyzed using C-index, GiViTI calibration belts, and decision curve. Also, a user-friendly dynamic web-based calculator was developed.ResultsA total of 1,221 patients were included in the analysis. A non-linear association could be observed between GNRI and SSI risk with a GNRI cut-off value of 101.7. After adding GNRI to Model 2 (which comprised Morse Fall Scale score, preoperative length of stay, operation time, and estimated blood loss), the AIC value decreased, the C-index value increased and IDI increased significantly. The nomogram C-index in the development cohort and internal validation cohort demonstrates a moderate-high degree of discrimination. The GiViTI calibrated belt showed a good agreement between the observed and predicted probabilities of SSI. The decision curve validates the clinical feasibility of the nomogram with a threshold value between 0 and 49%.ConclusionThe GNRI cut-off value of 101.7 allowed for appropriate stratification of patients into distinct SSI risk groups. This study found that including GNRI in the above nomogram (Model 2) would enhance its potential to predict SSI in gynecologic oncology patients.

Effect of chronic comorbidities on quality of life of gynecologic cancer patients in Puerto Rico.

ABSTRACTObjective.To describe prevalence of chronic diseases and evaluate associations between comorbidities and quality of life in gynecologic cancer patients in Puerto Rico.Methods.A cross-sectional study among 233 women aged ≥21 years with a gynecologic cancer diagnosis. Through telephone interviews, information on comorbidities, quality of life, and other covariates were assessed. Quality of life included six items, assessing physical and mental health. Multivariate logistic regression models were used to estimate magnitude of association between the comorbidities under study (diabetes, cardiovascular and autoimmune diseases) and quality-of-life items, through adjusted prevalence odds ratio (aPOR; 95% confidence interval [CI]).Results.Most women (90.1%) reported one or more comorbidities in addition to their cancer diagnosis; cardiovascular diseases (63.1%) were more common than autoimmune diseases (37.3%) and diabetes (33.9%). Between 30% and 40% of the sample indicated dysfunctions in their general health (39.5%) and frequent physical (33.9%) and mental distress (31.8%). Adjusting for age and gross family income, women with autoimmune diseases presented higher prevalence of frequent limitations for daily activities (aPOR 2.00; 95% CI 1.05–3.81), poor general health (aPOR 3.52; 95% CI 1.90–6.49), frequent mental distress (aPOR 2.19; 95% CI 1.19–4.03), and dissatisfaction with life (aPOR 4.86; 95% CI 1.82–12.95) compared to those who did not report autoimmune diseases. No associations with cardiovascular diseases and diabetes were observed.Conclusions.Quality-of-life dysfunctions were highly prevalent in this population of gynecologic cancer patients. Suffering from autoimmune comorbidities significantly exacerbated those dysfunctions.

A Review of Nuclear Medicine Approaches in the Diagnosis and the Treatment of Gynecological Malignancies.

Simple SummaryIn this literature review, we will provide a short overview of the role of nuclear medicine in the diagnosis of obstetric and gynecological cancers.Nuclear medicine is defined as the diagnosis and the treatment of disease using radiolabeled compounds known as radiopharmaceuticals. Single-photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography/computer tomography (PET/CT) based radiopharmaceuticals have proven reliable in diagnostic imaging in nuclear medicine and cancer treatment. One of the most critical cancers that also relies on an early diagnosis is gynecological cancer. Given that approximately 25% of all cancers in developing countries are a subset of gynecological cancer, investigating this cancer subtype is of significant clinical worth, particularly in light of its high rate of mortality. With accurate identification of high grade distant abdominal endometrial cancer as well as extra abdominal metastases, 18F-Fluorodeoxyglucose ([18F]FDG) PET/CT imaging is considered a valuable step forward in the investigation of gynecological cancer. Considering these factors, [18F]FDG PET/CT imaging can assist in making management of patient therapy more feasible. In this literature review, we will provide a short overview of the role of nuclear medicine in the diagnosis of obstetric and gynecological cancers.

Modifiable pre-treatment factors are associated with quality of life in women with gynaecological cancers at diagnosis and one year later: Results from the HORIZONS UK national cohort study

ObjectivePersonalised care requires the identification of modifiable risk factors so that interventions can be implemented rapidly following a gynaecological cancer diagnosis. Our objective was to determine what pre-treatment factors are associated with quality of life (QOL) at baseline (pre-treatment) and 12 months. Methods1222 women with a confirmed diagnosis of endometrial, ovarian, cervical or vulvar cancer from 82 UK NHS hospitals agreed to complete questionnaires at baseline, three and 12 months. Questionnaires included measures of QOL, health, lifestyle, support and self-management. The primary outcome measure was QOL as measured by Quality of Life in Adult Cancer Survivors (QLACS). Sites provided clinical data at baseline, six and 12 months. Linear regression models were constructed to examine the association between baseline characteristics and QOL outcomes. ResultsQOL declined between baseline and 3 months, followed by an improvement at 12 months. Baseline (pre-treatment) factors associated with worse QOL at both baseline and 12 months were depression, anxiety, living in a more deprived area and comorbidities which limit daily activities, whereas higher self-efficacy and age of 50+ years were associated with better QOL. ConclusionsDepression, anxiety and self-efficacy are modifiable risk factors that can impact on QOL. Screening for these, and assessment of whether comorbidities limit daily activities, should be incorporated in a holistic needs assessment and interventions to improve self-efficacy should be made available. Care can then be personalised from the outset to enable all women with a gynaecological cancer the opportunity to have the best QOL.

The EPH/Ephrin System in Gynecological Cancers: Focusing on the Roots of Carcinogenesis for Better Patient Management.

Gynecological cancers represent some of the most common types of malignancy worldwide. Erythropoietin-producing hepatocellular receptors (EPHs) comprise the largest subfamily of receptor tyrosine kinases, binding membrane-bound proteins called ephrins. EPHs/ephrins exhibit widespread expression in different cell types, playing an important role in carcinogenesis. The aim of the current review was to examine the dysregulation of the EPH/ephrin system in gynecological cancer, clarifying its role in ovarian, endometrial, and cervical carcinogenesis. In order to identify relevant studies, a literature review was conducted using the MEDLINE and LIVIVO databases. The search terms ephrin, ephrin receptor, ovarian cancer, endometrial cancer, and cervical cancer were employed and we were able to identify 57 studies focused on gynecological cancer and published between 2001 and 2021. All researched ephrins seemed to be upregulated in gynecological cancer, whereas EPHs showed either significant overexpression or extensive loss of expression in gynecological tumors, depending on the particular receptor. EPHA2, the most extensively studied EPH in ovarian cancer, exhibited overexpression both in ovarian carcinoma cell lines and patient tissue samples, while EPHB4 was found to be upregulated in endometrial cancer in a series of studies. EPHs/ephrins were shown to exert their role in different stages of gynecological cancer and to influence various clinicopathological parameters. The analysis of patients’ gynecological cancer tissue samples, most importantly, revealed the significant role of the EPH/ephrin system in the development and progression of gynecological cancer, as well as overall patient survival. In conclusion, the EPH/ephrin system represents a large family of biomolecules with promising applications in the fields of diagnosis, prognosis, disease monitoring, and treatment of gynecological cancer, with an established important clinical impact.

Geographic Variation in Apical Support Procedures for Pelvic Organ Prolapse.

To measure geographic variation in rates of apical support procedures for the treatment of pelvic organ prolapse (POP) among female Medicare beneficiaries. We conducted a retrospective, cross-sectional study and used 100% Medicare fee-for-service claims to identify a cohort of women aged 65-99 years who had an apical support procedure, defined by Current Procedural Terminology codes, in 2016-2018. We included all vaginal and abdominal approaches (native tissue and mesh colpopexies) and obliterative procedures. We excluded vaginectomies with a diagnosis of gynecologic cancer that did not have a diagnosis for prolapse. We created rates of apical POP procedures by hospital referral region and computed coefficients of variation to measure the degree of geographic variation. An average of 26,005 apical POP procedures were performed annually from 2016 to 2018. The majority of patients were aged 65-74 years (64.3%), and 28.5% had concomitant hysterectomy. From 2016 to 2018, there was a mean of 1.79 apical POP procedures per 1,000 female beneficiaries performed across hospital referral regions (95% CI 1.74-1.84). Rate estimates ranged between 0.87 (95% CI 0.63-1.11) apical POP procedures per 1,000 female beneficiaries (Alexandria, Louisiana) and 3.33 (95% CI 2.91-3.74) per 1,000 beneficiaries (Akron, Ohio), a nearly fourfold difference in rates. Variation between hospital referral regions for abdominal apical prolapse procedures was the greatest (coefficient of variation 0.52). Vaginal and obliterative approaches demonstrated less variation between hospital referral regions (respectively, coefficient of variation 0.36 and 0.40). There is wide geographic variation among hospital referral regions for the treatment of POP. Women may be treated differently based on where they live and seek care, which raises questions about possible overuse in some regions and concerns about underuse and lack of access in other regions.

Health Disparities in Uterine Cancer: Report From the Uterine Cancer Evidence Review Conference.

The Centers for Disease Control and Prevention recognized the need for educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines for the development of evidence-based educational materials for women's health care clinicians about uterine cancer. This article is the evidence summary of the literature review of health disparities and inequities related to uterine cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.

Executive Summary of the Uterine Cancer Evidence Review Conference.

The Centers for Disease Control and Prevention recognized the need for educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines as a first step toward developing evidence-based educational materials for women's health care clinicians about uterine cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at a virtual meeting of stakeholder professional and patient advocacy organizations in January 2021. This article is the evidence summary of the relevant literature and existing recommendations to guide clinicians in the prevention, early diagnosis, and special considerations of uterine cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.

Insurance-Mediated Disparities in Gynecologic Oncology Care.

With 102,000 new cases of gynecologic cancer, 30,000 associated deaths annually, and increasing rates of endometrial cancer, gynecologic cancer is a growing problem. Although gynecologic cancer care has advanced significantly in the past decade owing to new therapeutics and specialized training in radical surgery, even insured women face major barriers to accessing and affording quality gynecologic cancer care. This commentary reviews current literature on insurance-mediated disparities in gynecologic cancer and provides education to clinicians on barriers to care. One third of women with a gynecologic cancer never see a gynecologic oncologist. Up to 40% of Medicare Advantage plans lack an in-network gynecologic oncologist, and 33% of private insurance plans do not include an in-network National Cancer Institute-accredited cancer center, limiting access to surgical advances and clinical trials. Women with Medicaid insurance and gynecologic cancer are 25% less likely to receive guideline-concordant care. Among insured women, 50% experience financial toxicity during gynecologic cancer treatment, and costs may be even higher for certain Medicare enrollees. Addressing these insurance-mediated disparities will be important to help our patients fully benefit from the scientific advances in our field and thrive after a gynecologic cancer diagnosis.

Epidemiological Clinical and Histological Aspects of Gynecological and Breast Cancer in Pointe Noire (Congo Brazzaville)

INTRODUCTION: The objective of our study was to determine the epidemiological clinical and histological aspects of gynecological and breast cancers in Pointe-Noire. PATIENTS AND METHODS: This was a retrospective descriptive study that took place in the cancerology and internal medicine department during the period from January 1, 2012 to December 31, 2021, i.e. a period of 10 years. Women with histological diagnosis of gynecological and breast cancers were included in our study. The variables studied were: frequency, age, alcohol and tobacco consumption, histological type, stage of extension, location of cancer. Bivariate analysis was done between age and location of the tumour. The statistical test used was the KHI2 test. The results were statistically significant for a value of p RESULTS: We collected 400 files from women with cancer. Among the 400 files, 265 were represented by gynecological and breast cancers, that is a frequency of 65.43%. Among the 265 cases of gynecological and breast cancer identified during this study period, breast cancer represented the first rank with 52% frequency. Cervical cancer accounted for 41% followed by ovarian cancer (5%) and endometrial (2%). Cancer of vulva was represented by a single case. The average age of patients with gynecological and breast cancers during our study was 52 ± 12 years. The average age of patients with cancer of the breast, cervix, ovarian, endometrial was respectively 49 ± 11.97 years, 54.73 ± 12.91 years old, 50 ± 14 years, 67 ± 14.24 years, the age of the vulva cancer patient was 51 years old. The histological type of breast cancer was represented by infiltrating ductal adenocarcinoma in 91% of cases, invasive lobular carcinoma in 7% and sarcoma in 2%. Cervical cancers were represented by squamous cell carcinomas in 95% of cases and adenocarcinomas in 5% of cases. Vulva cancer was represented by squamous cell carcinoma, ovarian cancer was represented by epithelial tumors (adenocarcinoma) in 100% of cases. Endometrial cancers were represented by endometrial adenocarcinoma. All cancers were diagnosed at advanced stages (locoregional and metastatic stage). Patients over the age of 50 had more gynecological and breast cancers; but this result was not significant. CONCLUSION: Gynecological and breast cancers are frequent and constitute the first cancer of Congolese women in Pointe-Noire. Breast cancer is the first cancer followed by cancer of the cervix and ovaries. The histological types are those of the literature. Patients with gynecological and breast cancers consult at very advanced stages.

Plenum of the Interdepartmental Scientific Council on Obstetrics and Gynecology of the Russian Academy of Medical Sciences M3 RF "Oncological screening, carcinogenesis and early stages of cancer in the practice of a gynecologist"

October 31 - November 1, 2000 in Izhevsk the Plenum of the Interdepartmental Scientific Council on Obstetrics and Gynecology of the Russian Academy of Medical Sciences M3 of the Russian Federation was held. Despite the allocation of two different specialties in clinical medicine - gynecology and gynecological oncology, the problems of risk and early diagnosis of gynecological cancer occupy a prominent place in the activities of an obstetrician-gynecologist. Diseases of the breast are of no less importance for clinical practice. The topic of this Plenum is a logical continuation of previous discussions on topical issues of modern gynecology - "Ways of development of modern gynecology" and "Ovarian tumors", held within the framework of the Ministry of Taxes and Communications.

Accuracy of Opportunistic Bone Mineral Density Assessment on Staging Computed Tomography for Gynaecological Cancers.

Background and Objectives: Women with gynecological cancers constitute a high-risk cohort for loss of bone density. International guidance stipulates women undergoing cancer treatments associated with bone loss should have a quantitative assessment of bone density. Access to Dual-energy X-ray Absorptiometry (DXA) is limited. This study aimed to assess the accuracy of opportunistic bone density measurement on staging computed tomography (CT) scans for gynaecological malignancies, in comparison to the gold standard DXA. Materials and Methods: Women with a staging CT scan of the abdomen and pelvis for a new diagnosis of gynecological cancer were recruited. DXA was performed within 6 weeks of treatment for gynaecological cancer. Lumbar bone density was measured by CT attenuation values, in Hounsfield units (HU), of the anterior trabecular region. Correlations between CT and DXA parameters were analysed. Receiver Operating Characteristic(ROC) curves for diagnosis of low bone density and osteoporosis were analysed. Results: Final cohort included 48 of 50 women recruited. There was good diagnostic accuracy for abnormal bone density and osteoporosis, with areas under the ROC curve at L1 of 0.77 (p = 0.002) and 0.80 (p = 0.020) respectively. CT-HU of 170–190 yielded sensitivities of 87–90%, positive predictive values of 75–84% and negative predictive values of 71–75% for the diagnosis of low bone mineral density. CT-HU of 90–110 yielded specificities of 85–93% for the diagnosis of osteoporosis. Moderate correlations were found between CT-HU and both DXA T-scores and diagnostic categories. Conclusions: This is the first study to assess the opportunistic application of CT in the assessment of bone health in women with gynaecological cancer, a cohort at high-risk of osteoporosis. The correlation between bone density assessment in CT-HU and DXA, and strong AUC values for the diagnosis of low bone density (0.77) and osteoporosis (0.80) support this pragmatic solution in resolving the care-gap in cancer treatment-induced bone loss, often associated with poor access to DXA.

LASSO and Bioinformatics Analysis in the Identification of Key Genes for Prognostic Genes of Gynecologic Cancer.

The aim of this study is to identify potential biomarkers for early diagnosis of gynecologic cancer in order to improve survival. Cervical cancer (CC) and endometrial cancer (EC) are the most common malignant tumors of gynecologic cancer among women in the world. As the underlying molecular mechanisms in both cervical and endometrial cancer remain unclear, a comprehensive and systematic bioinformatics analysis is required. In our study, gene expression profiles of GSE9750, GES7803, GES63514, GES17025, GES115810, and GES36389 downloaded from Gene Expression Omnibus (GEO) were utilized to analyze differential gene expression between cancer and normal tissues. A total of 78 differentially expressed genes (DEGs) common to CC and EC were identified to perform the functional enrichment analyses, including gene ontology and pathway analysis. KEGG pathway analysis of 78 DEGs indicated that three main types of pathway participate in the mechanism of gynecologic cancer such as drug metabolism, signal transduction, and tumorigenesis and development. Furthermore, 20 diagnostic signatures were confirmed using the least absolute shrink and selection operator (LASSO) regression with 10-fold cross validation. Finally, we used the GEPIA2 online tool to verify the expression of 20 genes selected by the LASSO regression model. Among them, the expression of PAMR1 and SLC24A3 in tumor tissues was downregulated significantly compared to the normal tissue, and found to be statistically significant in survival rates between the CC and EC of patients (p < 0.05). The two genes have their function: (1.) PAMR1 is a tumor suppressor gene, and many studies have proven that overexpression of the gene markedly suppresses cell growth, especially in breast cancer and polycystic ovary syndrome; (2.) SLC24A3 is a sodium–calcium regulator of cells, and high SLC24A3 levels are associated with poor prognosis. In our study, the gene signatures can be used to predict CC and EC prognosis, which could provide novel clinical evidence to serve as a potential biomarker for future diagnosis and treatment.

The Role of Omics Approaches to Characterize Molecular Mechanisms of Rare Ovarian Cancers: Recent Advances and Future Perspectives.

Rare ovarian cancers are ovarian cancers with an annual incidence of less than 6 cases per 100,000 women. They generally have a poor prognosis due to being delayed diagnosis and treatment. Exploration of molecular mechanisms in these cancers has been challenging due to their rarity and research efforts being fragmented across the world. Omics approaches can provide detailed molecular snapshots of the underlying mechanisms of these cancers. Omics approaches, including genomics, transcriptomics, proteomics, and metabolomics, can identify potential candidate biomarkers for diagnosis, prognosis, and screening of rare gynecological cancers and can aid in identifying therapeutic targets. The integration of multiple omics techniques using approaches such as proteogenomics can provide a detailed understanding of the molecular mechanisms of carcinogenesis and cancer progression. Further, omics approaches can provide clues towards developing immunotherapies, cancer recurrence, and drug resistance in tumors; and form a platform for personalized medicine. The current review focuses on the application of omics approaches and integrative biology to gain a better understanding of rare ovarian cancers.

Catastrophic health expenditures, insurance churn, and nonemployment among gynecologic cancer patients in the United States

In recent years, there has been growing recognition of the financial burden of severe illness, including associations with higher rates of nonemployment, uninsurance, and catastrophic out-of-pocket health spending. Patients with gynecologic cancer often require expensive and prolonged treatments, potentially disrupting employment and insurance coverage access, and putting patients and their families at risk for catastrophic health expenditures. This study aimed to describe the prevalence of insurance churn, nonemployment, and catastrophic health expenditures among nonelderly patients with gynecologic cancer in the United States, to compare within subgroups and to other populations and assess for changes associated with the Affordable Care Act. We identified respondents aged 18 to 64 years from the Medical Expenditure Panel Survey, 2006 to 2017, who reported care related to gynecologic cancer in a given year, and a propensity-matched cohort of patients without cancer and patients with cancers of other sites, as comparison groups. We applied survey weights to extrapolate to the US population, and we described patterns of insurance churn (any uninsurance or insurance loss or change), catastrophic health expenditures (>10% annual family income), and nonemployment. Characteristics and outcomes between groups were compared with the adjusted Wald test. We identified 683 respondents reporting care related to a gynecologic cancer diagnosis from 2006 to 2017, representing an estimated annual population of 532,400 patients (95% confidence interval, 462,000-502,700). More than 64% of patients reported at least 1 of 3 primary negative outcomes of any uninsurance, part-year nonemployment, and catastrophic health expenditures, with 22.4% reporting at least 2 of 3 outcomes. Catastrophic health spending was uncommon without nonemployment or uninsurance reported during that year (1.2% of the population). Compared with patients with other cancers, patients with gynecologic cancer were younger and more likely with low education and low family income (≤250% federal poverty level). They reported higher annual risks of insurance loss (8.8% vs 4.8%; P=.03), any uninsurance (22.6% vs 14.0%; P=.002), and part-year nonemployment (55.3% vs 44.6%; P=.005) but similar risks of catastrophic spending (12.6% vs 12.2%; P=.84). Patients with gynecologic cancer from low-income families faced a higher risk of catastrophic expenditures than those of higher icomes (24.4% vs 2.9%; P<.001). Among the patients from low-income families, Medicaid coverage was associated with a lower risk of catastrophic spending than private insurance. After the Affordable Care Act implementation, we observed reductions in the risk of uninsurance, but there was no significant change in the risk of catastrophic spending among patients with gynecologic cancer. Patients with gynecologic cancer faced high risks of uninsurance, nonemployment, and catastrophic health expenditures, particularly among patients from low-income families. Catastrophic spending was uncommon in the absence of either nonemployment or uninsurance in a given year.

Changes in gynecologic and breast cancer diagnoses during the first wave of the COVID-19 pandemic: analysis from a tertiary academic gyneco-oncological center in Germany

PurposeWith the beginning of 2021, the world has been suffering from the COVID-19 pandemic for more than 1 year. More and more, we are able to evaluate side effects of the pandemic in the healthcare sector. A negative impact on cancer diagnoses is one of them. Careful observation of trends in an academic gyneco-oncological context appears important to identify potential negative developments.MethodsWe analyzed the case number of gynecologic and breast cancer diagnoses in the period from January to June 2020 compared to 2019 and during the period of the first general German lockdown (March 22nd until May 5th 2020). Patients were characterized by age, tumor type, FIGO or TNM stage and presence of symptoms at initial hospital presentation.ResultsThe frequency of newly diagnosed gynecologic and breast cancer cases from beginning of January until end of June changed by − 10% and by − 12% during the lockdown in 2020 compared to 2019. In both periods, reduction of breast cancer cases was relatively larger than decrease of gynecologic cancers. Moreover, median patient age decreased. For the first half of 2020, we found a shift towards higher tumor stages (N+/M1 or FIGO III–IV). During the lockdown period, the appearance of tumor-associated symptoms at diagnosis increased by about 12%.ConclusionThis analysis illustrates the anticipated general decrease in diagnoses of primary cancers during the lockdown periods in 2020 due to COVID-19 pandemic for gynecologic and breast cancer cases.

Is patient participation in multidisciplinary tumour conferences associated with their information needs? A multicentre prospective observational study

ObjectivesTo determine the association between participation of patients with breast cancer and patients with gynaecological cancer in their own multidisciplinary tumour conference (MTC) and their information needs with regard to...

Redefining readmissions in gynecologic cancer: readmissions resulting in hospital-to-hospice transitions may represent high value care

Objectives: Hospital readmissions are used as a marker of quality of care, with unplanned admissions identified as low value care. Hospice is a marker of high value care and a readmission resulting in discharge to hospice may indicate value in readmission. The primary objective of this study was to describe readmissions that resulted in discharge to hospice. Methods: We performed a retrospective cohort study of women with a diagnosis of gynecologic cancer who were readmitted within 30 days to a single urban academic hospital between July 2017 and April 2020. Patient demographics, oncology data, admission cost, discharge status, length of admission and length of hospice admission were collected from the electronic medical record. Length of hospice admission ≥3 days was defined as high value care. Descriptive statistics were performed to identify factors associated with discharge to hospice. Results: We identified 98 patients readmitted during the study period. 36.7% (n=36) had uterine cancer, 49.0% (n=48) had ovarian cancer, 12.2% (n=12) had cervical cancer and 2.0% (n=2) had vulvar cancer. 47% (n=46) had recurrent disease. 11.2% (n=11) of patients readmitted had a previous outpatient palliative care consult prior to the index admission and 28.6% (n=28) had an inpatient palliative care consult during the index admission. Patients were readmitted from the Emergency Department (n=50, 51.0%), ambulatory visit (n=31, 31.6%) or hospital transfer (n=17, 17.3%). The most common categories of reason for readmission were gastrointestinal (n=20, 20.4%), complication of metastases (n=15, 15.3%), and primary malignancy (n=12, 12.2%). The median time to readmission was 10 days (IQR 5-16 days) and the median length of readmission was 5 days (IQR 3-9 days). 23.5% (n=23) of patients had multiple readmissions, with a median of 2 readmissions (range 2-4). One-third of patients (n=36, 36.7%) received a palliative care consult and hospice was discussed with 21.4% (n=21) during readmission. 17.3% of patients (n=17) were discharged to hospice from a hospital readmission, with a median length of hospice admission, prior to death, of 7 days (IQR 2-14 days). 81% of patients with whom hospice was discussed were discharged to hospice. 70.6% of patients (n=12) had a length of hospice admission ≥3 days. There was a significant association of repeat readmission and discharge to hospice (p Conclusions: Hospital readmissions in gynecologic cancer patients resulted in a hospital-to-hospice transition in 17.3% of all patients, and 81% of patients with whom hospice was discussed. Multiple readmissions may precipitate a decision to enroll in hospice. Readmissions may not indicate substandard care and instead potentially demonstrate an opportunity to deliver high value care to patients, as both enrollment in hospice at end of life and hospice enrollment for ≥3 days are considered optimal quality oncology metrics.

Factors associated with increased financial toxicity after the completion of radiation treatment for gynecologic cancer

<h3>Objectives:</h3> Financial toxicity is estimated to impact up to 50% of patients with gynecologic malignancies, but little is known about the factors that may predispose patients receiving radiation treatment for gynecologic cancer to increased financial distress. <h3>Methods:</h3> Patients from an urban academic gynecologic radiation oncology practice completed a financial toxicity survey at their 1-month follow-up visit after completion of radiation treatment from August 2019-March 2020. The survey was modified from our prior study and included basic demographic questions, the Comprehensive Score for Financial Toxicity (COST) tool and the EQ-5D to measure quality of life. Consistent with our prior work, high financial toxicity was defined as COST score ≤23. We assessed correlation of COST scores with QOL. Demographic and disease characteristics between high and low financial toxicity groups were compared using Chi-square or Fisher's exact test for categorical variables and Wilcoxon rank sum test for continuous variables. We used log-binomial regression to examine associations between high financial toxicity and cost-coping strategies. <h3>Results:</h3> The response rate was 88%. Of the 49 patients surveyed, 71% were White, 14% Black and 10% Asian. The majority of patients had uterine cancer (65%), followed by cervical (23%) and vaginal (8%) cancer. Two-thirds (63%) received external beam radiation with or without brachytherapy; the remaining (37%) received brachytherapy alone. Median COST score was 13 (IQR 5-19) in the high financial toxicity group (n=18) and 32 (IQR 27-36) in the low toxicity group (n=31). Greater financial toxicity was significantly correlated with worse QOL (R=-0.36, P=0.02). No demographic, disease or treatment characteristics were associated with high financial toxicity aside from employment status (p=0.03), though income was borderline significant (p=0.053). Compared with the low financial toxicity group, patients with high financial toxicity were more likely to move from full-time to part-time employment since diagnosis (22% vs 0%, p=0.01) and reported that difficulty paying for transportation or parking was a consideration in making medical decisions (33.3 vs 3.2%, p=0.01). Patients with high financial toxicity were more likely to report delaying or avoiding medical care (22% vs 0%, P=0.01), 13.8 (95% CI 1.9-101.4, P<0.001) times more likely to borrow money, and 10.3 (95% CI 1.3-79.1, p=0.01) times more likely to report reduced spending on basic goods. <h3>Conclusions:</h3> Financial toxicity correlated with worse quality of life in patients who received radiation for their gynecologic cancer diagnosis and was associated with delays or avoidance of medical care and use of economic cost-coping strategies. A larger survey cohort may improve our ability to meaningfully detect other associations with high financial toxicity. Moreover, transportation and parking costs should be considered in the design of any future intervention study in this population.