Gynecologic Oncology Patients Research Articles

Attitudes and beliefs regarding complementary and alternative medicine in a diverse gynecologic oncology patient population

ObjectivesTo measure prevalence of complementary and alternative medicine (CAM) use in a diverse gynecologic oncology patient population and evaluate how attitudes and beliefs regarding CAM relate to demographic factors. MethodsA validated Attitudes and Beliefs about Complementary and Alternative Medicine (ABCAM) survey was distributed to patients with gynecologic malignancy. Results were evaluated using Pearson's Chi-squared and Fisher's exact tests for categorical variables and Wilcoxon ranks sum and Kruskal-Wallace tests for non-normally distributed variables. ResultsOne-hundred thirty patients completed the ABCAM survey. Self-reported race and ethnicity included Asian or Pacific Islander (n = 54; 42%), Hispanic/Latino (n = 23; 18%), White (n = 21; 16%), Black or African American (n = 20; 15%), American Indian/Alaska Native (n = 8; 6.2%) and Other (n = 4; 3.1%). Twenty-four respondents (18%) reported use of CAM. There was a significant difference in expected benefits to CAM between respondents of different races/ethnicities (p < 0.001). Black and Asian respondents reported greater expected benefit to CAM. Hispanic/Latino, American Indian/Alaskan Native, and White respondents reported fewer expected benefits. A significant association was found between perceived barriers to CAM and race/ethnicity (p 0.043), with Asian, Hispanic/Latino and White respondents perceiving more barriers while Black and American Indian/Alaskan Natives reported perceiving fewer barriers to CAM. Respondents with incomes greater than $100,000 reported fewer barriers to CAM. ConclusionsUse of CAM among gynecologic oncology patients is lower than previously thought. Income, race, and ethnicity inform patient engagement with CAM and can be used to better tailor the provision of evidence-based CAM interventions to benefit a greater number of gynecologic cancer patients.

Quality of life of older gynecologic oncology patients at the initiation of chemotherapy.

To evaluate older gynecologic oncology patients' quality of life (QOL) at the initiation of chemotherapy and compare their QOL scores with a female age-matched general population (GP) sample. Cross-sectional. Older (n = 122) gynecologic oncology patients completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) that evaluates global health and five functional scales (range from 0 to 100). Differences in QOL scores between our sample and the GP were evaluated using one-sample t-tests and effect sizes were calculated using Cohen's d. Patients' mean age was 70.7 years (±6.6). Mean scores for the function scales ranged from 58.5 (±31.1) for role function to 86.1 (±17.0) for cognitive function. Compared to the GP, our sample reported significantly lower scores for global health status, social, role and physical functioning, and a significantly higher score for cognitive functioning. No differences were found in emotional functioning scores. No patient or public contribution.

Enhanced Recovery After Surgery Protocols in Obese Gynecological Oncology Patients: A Single-Center Experience.

Objective The aim of this study is to present our experience and evaluate the safety and outcomes of the implementation of EnhancedRecoveryAfterSurgery (ERAS) protocols in obese patients who underwent surgery for suspected or confirmed gynecological malignancies. Method From January 2020 to September 2021, 217 patients underwent laparotomy for a confirmed or suspected gynecological malignancy following a 19-element ERAS pathway. The patients were divided into two groups: obese (BMI≥ 30 kg/m2, n = 104) and non-obese (BMI < 30, n =113). Both groups were treated with a 19-element ERAS protocol. Results After dividing the 217 patients into two groups, significantly more comorbidities were observed in the obese group (diabetes mellitus: 23% vs. 8%, p = 0.004; ASA score grade 3: 25.0% vs. 6.2%, p < 0.001), as well as higher rates of endometrial cancer (51.9% vs. 17.7%, p < 0.001) compared to the non-obese group. The overall ERAS compliance rates when matched element by element were similar. Postoperatively, complication rates of all grades were significantly higher in the obese group (46.1% vs. 27.4%, p < 0.001) without differences in the length of stay, readmission, and reoperation rates. Conclusion In this retrospective study, we showed that obese gynecological oncology patients can be safely managed with ERAS protocols perioperativelywhile potentially minimizing the adverse outcomes in these otherwise high-risk patients.

Gynecologic oncology patients’ perception of physician empathy in the age of COVID-19.

e24186 Background: Since the beginning of the COVID-19 pandemic there have been major changes to the medical office experience, including universal masking. Prior studies had shown that the environmental layout1, the ability of the patients to see the physician’s face2, as well as the interactions with other office staff members3, as well as the length of the patient-physician relationship4 all played into the patient’s perception of physician empathy and that this perceived. Because establishing care during the pandemic would undercut many of these known factors, it was hypothesized that those who established care after the onset of the pandemic would have lower scores on the Jefferson scale of Physician empathy (JSPE) and European Quality of life survey (EQ-5D™). Methods: Patients of the Carole and Ray Neag Cancer Center department of Gynecologic Oncology at UConn Health were surveys at the time of their appointments. Sampling occurred between June and November of 2022. Surveys collected demographic information including age, stage of cancer, and number of visits since the onset of the pandemic in March 2020; the JSPE along with questions directly related to care during the pandemic scored the same way; the EQ-5D™; and a checkable list of changes noted in the office. The results of the “Pre-COVID” and “Post-COVID” cohorts were compared using a two-group t-test for statistical significance. An n of 30 per cohort was needed for a power of &gt; 80%. Results: Results showed that patients who had established care prior to the pandemic (n = 29) were more likely to be seen while in remission while those who established care after the onset of the pandemic (n = 33) were more likely to be seen for postoperative surgical care or an active cancer. Patients who established care prior to the pandemic had statistically significantly lower scores on the JSPE than those who did not (6.08 +/- 2.00 vs 6.73 +/- 0.71 p = &lt; 0.001). However, individuals who established care prior to the pandemic had statistically higher qualities of life as measured by the EQ-5D™ compared to those who established care after the onset of the pandemic (4.57 +/- 0.72 vs 4.22 +/- 0.85 p = &lt; 0.001). There was no statistically significant difference in the number of changes notes (4.483 +/- 1.57 vs. 5.09 +/- 1.38 p = 0.189). Conclusions: While statistically significant differences between the cohorts were found, the overlapping standard deviations, the fact that the JSPE and EQ-5D™ went in separate directions, and the generally favorable responses lead to the conclusion that the differences were not clinically significant. This means that, contrary to research conducted prior to widespread masking and the COVID-19 pandemic, providers are still able to be perceived as empathetic and provide quality care to their patients despite the changes that have taken place in the medical office setting since the onset of the pandemic.

Reduced symptom burden after implementation of an electronic symptom management program.

12006 Background: The SIMPRO consortium implemented an electronic patient reported outcomes (ePRO) symptom management program as part of routine clinical care for patients (pts) receiving systemic cancer therapy or surgery across six health systems including rural and community cancer centers. To evaluate impact of the Epic-integrated electronic symptom management (eSyM) program on quality of life, pre- and post-implementation surveys were sent to a subset of gastrointestinal, thoracic, and gynecologic medical oncology (MO) and surgical (Surg) patients at all sites. Methods: A survey assessing symptom burden, health literacy, and self-efficacy was administered to separate groups of MO and Surg pts before (Pre-Implementation) and after (Post-Implementation) eSyM deployment. A waiver of documentation of consent was obtained for participation. Questions were derived from validated instruments including PROMIS, a standardized measurement tool for patient-reported symptoms. Surveys were completed 30-90 days after surgery or start of systemic therapy. PROMIS item responses were scored individually then translated into standardized T-scores with a mean of 50 based on an established reference population. Mean T-scores for PROMIS depression, anxiety, fatigue, and pain interference were calculated. Higher T-score correlated with greater symptom burden. Comparison between groups utilized non-parametric Kruskal-Wallis testing. Results: The number of survey responses were 498 MO Pre-Implementation, 518 MO Post-Implementation, 566 Surg Pre-Implementation, and 507 Surg Post-Implementation. MO pts reported significantly lower PROMIS mean T-scores for depression, anxiety, fatigue, and pain interference after eSyM compared to a similar group of MO pts prior to eSyM. Surg pts reported lower T-scores for depression, anxiety, fatigue, and pain interference after eSyM compared to a similar group of Surg pts prior to eSyM, although reduction in pain interference was not statistically significant. Conclusions: eSyM deployment in MO was associated with a significant reduction in patient reported depression, anxiety, fatigue, and pain interference. Surgical pts after eSyM deployment reported significantly lower rates of depression, anxiety, and fatigue. External validation with PROMIS based surveys demonstrated small but meaningful benefits of ePRO symptom monitoring as part of routine clinical care across six diverse health systems. Clinical trial information: NCT03850912 . [Table: see text]

The insights of mutations of gynecological oncology by liquid biopsy for Chinese patients.

e17501 Background: Liquid biopsy drew dramatic attention in the field of cancer research because of its attribution of nontraumatic, easy to obtain, providing overall state of tumor, allowing for real-time monitoring and so on. However, the transformation from research to application of liquid biopsy technique in clinical gynecological oncology management require more evidence and further investigation. Methods: Blood samples of 104 patients were collected, of whom 33 were diagnosed as cervical cancer, 20 were diagnosed as endometrial cancer, and 51 were diagnosed as ovarian cancer. cfDNA were extracted from blood and examined by next-generation sequencing technique with Haplox HapOnco panel. cfDNA mutations were analyzed and compared with genomic mutations in tumor tissues in publications. Results: In cfDNA, there were 120 genes mutated in cervical cancer patients, 150 genes mutated in endometrial cancer patients, and 58 genes mutated in ovarian cancer patients. Detecting by cfDNA, the average number of mutations was 6 (4.1 to 7.9, 95% CI) for each cervical cancer patient, 8.1 (2.1 to 14.1, 95% CI) for each endometrial cancer patient, and 5.1 (3.7 to 6.5, 95% CI) for each ovarian cancer patient. As the mutations in cfDNA compared with those in tumor tissues, the results revealed that there was no significant difference in mutation rate for 94.2% genes in blood and tumor tissues for cervical cancer patients, 93.3% for endometrial cancer patients, and 98.3% for ovarian cancer patients. Besides, there were no significant differences in microsatellite instability rates in blood and tumor tissues for cervical cancer patients and endometrial cancer patients. Conclusions: Most mutated genes in tumor tissues were detected in blood for gynecological oncology patients. The mutation rate for most genes and microsatellite instability rate had no significant difference in blood and tumor tissues, which suggested that liquid biopsy using cfDNA is helpful in gynecological oncology management.

Cost of care associated with utilization of telehealth in clinical trials.

e13682 Background: Due to COVID-19 pandemic restrictions, telehealth was incorporated into standard oncologic care and clinical trials. Existing data show that telehealth in clinical trials is safe, feasible, and reduces barriers to participation. We sought to analyze whether telehealth changed the cost of care compared to traditional clinical trial operations. Methods: We conducted a retrospective cohort study of gynecologic oncology patients enrolled in therapeutic clinical trials at a NCCN designated cancer center, comparing health care reimbursement cost of care on trial pre-TELEhealth (9/30/2019 to 3/15/2020) with those during TELEhealth (3/16/2020 to 8/20/2020). Inclusion required trial enrollment during both study periods, at least 1 telehealth visit, and identifiable billing records. Health care costs were collected. Cost data included: 2020 Medicare reimbursements for procedures, provider billing, DRG for hospital admissions, drug average sales price, and GoodRx for outpatient prescriptions. Encounters unrelated to cancer care were excluded. Overall cost per patient and patient-per-month on trial were calculated for scheduled (per protocol) and unscheduled (non-protocol) encounters. Pairwise t-tests between pre-TELE and TELE periods were performed. Results: 28 patients were included (86% White, 7% Black, 6% other) with 26 (93%) ovarian, 1 (4%) uterine, and 1 (4%) concurrent ovarian/uterine cancer. The majority (89%) had stage 3 or 4 cancer at diagnosis. Overall care utilization was similar in pre-TELE and TELE periods, with 292 vs. 321 scheduled visits, and 31 vs. 37 unscheduled visits. Mean total cost per patient was similar in pre-TELE and TELE periods, including scheduled encounters ($15794.58 (SD 17719.92) vs. $20714.47 (SD 25338), p= 0.118) and unscheduled encounters ($759.96 (SD 2066.72) vs. $2911.71 (SD 6060.18), p=0.080). Per month on trial, mean cost per patient did not differ. No differences were seen in total scheduled or total unscheduled encounters, nor office visits, admissions, ED visits and outpatient procedures. Conclusions: Incorporation of telehealth in gynecologic cancer clinical trials did not increase cost of scheduled or unscheduled care. Telehealth is a critical component to decentralizing clinical trials, reducing barriers to trial participation and improving the value of cancer care. [Table: see text]

Postoperative Acute Kidney Injury in Geriatric Gynecologic Oncology Patients After Major Open Abdominal Surgery: A Retrospective Cohort Study

Introduction: This investigation’s purpose was to determine the incidence of acute kidney injury, the associated risk factors, and the 90-day outcomes and kidney function of geriatric patients who underwent major open abdominal gynecologic oncologic surgery. Materials and Method: This retrospective cohort study involved patients aged ≥ 65 years who underwent major open abdominal gynecologic oncologic surgery. Results: The postoperative incidence of acute kidney injury in gynecologic oncologic surgical procedures was 22.1%, with a transient nature observed in 72% of patients. The in-hospital mortality rate was 4 %. Kidney function on the 90th day after acute kidney injury development revealed that estimated glomerular filtration rate regressed by over 25% in 6 patients (24%). Acute kidney injury development was associated with surgical time, intraoperative bleeding volume, bowel procedures, the presence of ascites, intraoperative hypotension, vasopressor use, postoperative diuretic use, postoperative hypoalbuminemia, prolonged post-anesthesia care unit, and hospital stay (p &lt; 0.05). A logistic regression analysis of the risk factors for acute kidney injury revealed that surgery duration was a significant one (p &lt; 0.05). Conclusion: Postoperative acute kidney injury is an important postoperative complication associated with the development or progression of chronic kidney disease. This leads to a prolonged stay in the post-anesthesia care unit and in the hospital. Although acute kidney injury is frequently transient in geriatric patients following major open abdominal gynecologic oncologic surgery, developing preventive measures, encouraging team collaboration, and monitoring serum creatinine concentration in the early postoperative period are critical in complex surgical procedures. Keywords: Postoperative Complications; Acute Kidney Injury; Geriatrics.

Exploring the benefits of therapeutic horticulture in patients in gynecologic oncology: A pilot study.

e24038 Background: Women who are diagnosed with gynecologic cancer experience a significant level of distress and symptoms that impact their quality of life. Recently, there has been an emphasis on quality of life for oncology patients. Non-pharmacological interventions such as therapeutic horticulture (TH) have been linked with enriching individual lives. TH is defined as the engagement of a person in gardening and plant-based activities, facilitated by a professionally registered horticultural therapist, to achieve specific treatment goals. The purpose this study is two-fold: 1) to determine the impact of TH on quality of life and anxiety for gynecologic oncology patients and 2) to test the feasibility and acceptability of implementing a pilot TH program for this specific patient population. Methods: This was an IRB approved study. Individuals were recruited from the oncology clinic. Inclusion criteria included adult women, age 18 and over, who were diagnosed with gynecologic cancer. They were included in the study independent of what stage they were in their cancer treatment. The intervention included attending eight 1-hour group-based gardening sessions that were led by a professionally registered horticultural therapist at Wilmot Botanical Gardens. Self-report psychometric assessments were administered to assess anxiety and quality of life before and after the intervention. Results: Over one month, ten patients were interested in the study. Due to limitations in funding, only seven were able to partake in the study. Three participants were able to complete the study in its entirety by attending eight out of the twelve sessions. Four participants were unable to complete at least eight sessions due to scheduling conflicts: one completed seven sessions and three completed less than five sessions. Given that only three patients completed the intervention, quantitative measures are not included. In the focus group at the end of the study, the three participants described the TH as engaging and felt that they were more physically active and mentally at peace. They felt that the sessions brought camaraderie amongst each other regardless of the number of sessions attended. Conclusions: While our participant accrual was limited, the study was noted to be feasible and acceptable with the sessions being overall helpful for well-being. Given the results from this study, more funding has been established for recruiting a larger cohort in Fall of 2023.

(012) Gynecologic Oncology Survivorship: Seeking Help for Sexual Distress

Abstract Introduction Addressing sexual side effects is an important component of gynecologic cancer survivorship. In order to provide patient-centered care, it is important to determine which patients have the highest risk of sexual problems following treatment. Objective The purpose of this study is to quantify and identify predictors of help-seeking for sexual distress in gynecologic oncology patients undergoing routine surveillance. Methods We performed a cross-sectional study of patients who have completed treatment for gynecologic malignancy at a single academic institution. Sexual activity was defined to include masturbation, oral sex, and sexual intercourse. The instrument contained the validated Female Sexual Distress Survey-Revised (FSDS-R), for which a score of 11 or above indicates sexually-related personal distress. We also assessed patient experience and preferences regarding the communication of sexual information with their healthcare team and selected resources. We performed one-sided t-test and logistic regression statistical analyses using STATA version 17.0. Results Between May to November 2022, 250 (of 331) eligible patients completed the survey (75% response rate). The median age of respondents was 60-years-old (range 27-85; IQR 19). Thirty-eight percent of patients had ovarian cancer, 42% uterine, and 20% cervical/vaginal/vulvar cancer. The majority (64%) had Stage I disease. The median years from finishing treatment (IQR) was 3.6 (2) years. The sample was diverse, with 44% self-identified as non-white (Asian, Black, Latinx or pacific Islander), while the vast majority (93%) was cis-gender, and 83% were heterosexual. Sixty-seven percent were married or in a relationship. Overall, 133 (53%) reported being sexually active within the past 30 days. FSDS-R scores ranged from 0-52 with a median (IQR) of 5 (15). 38% met criteria for sexually-related personal distress. Age was significantly associated with less sexual distress (OR 0.96; 95% CI: 0.94–0.99; P = 0.01). Uterine cancer was significantly associated with less sexual distress (OR, 0.49; 95% CI: 0.24–0.97; P = 0.04). In contrast, the combined group of cervical/vagina/vulvar cancer patient were also found to have a significantly increased rate of sexual distress (OR, 3.56; 95% CI: 1.56–8.10; P&amp;lt;0.01). Twenty-five percent of patients “somewhat” or “strongly disagreed” that they were adequately informed about sexual side effects of their cancer-directed care while another 42% felt neutral. 86.6% believed that physicians should routinely ask about sexual health, with 75% welcoming this anytime throughout treatment. Over half (53.1%) of respondents reported that healthcare providers “never” or “rarely” asked about sexual difficulties over the past 3 years and 33% of patients had previously discussed their sexual health with their gynecologic oncologist. Most patients (86%) found a sexual health conversation helpful. Patients had varied interest in speaking to a sexual medicine expert (35%) or a psychologist and relationship counselor (22%). Conclusions Patients are interested in sexual health with their gynecologic oncologist. An even larger proportion of patients desired to connect with a sexual health specialist, psychologist or relationship counselor, emphasizing the need for a multidisciplinary approach in gynecologic oncology survivorship. Disclosure No

Does Closed Incision Negative Pressure Wound Therapy Reduce Surgical Site Infection in Endometrial Carcinoma Patients Undergoing Laparotomy? A Multicentre Retrospective Cohort Study

Background: Endometrial cancer is the most common gynaecological cancer and has a strong association with obesity. Surgical site infection (SSI) carries high morbidity and is more frequent in obese patients. Closed incision negative pressure wound therapy (ciNPWT) has been proposed to reduce wound morbidity but is more expensive than standard dressings whilst the evidence has been very heterogenous. There is limited evidence to justify this expensive dressing as related to its effectiveness in gynaecological oncology patients. ciNPWT was introduced in New Zealand in 2017 based on the available evidence from studies on SSI in the obstetric population. The aim of this study is to investigate the rate of SSI in patients with endometrial carcinoma undergoing laparotomy using standard surgical dressings compared to ciNPWT. Methods: We performed a retrospective analysis of 170 patients who underwent a laparotomy for endometrial carcinoma between 2018 and 2019 across three hospitals in New Zealand after the introduction of ciNPWT. Dressings were applied according to individual surgeons’ preferences. Standard dressings and ciNPWT were compared in the occurrence of SSI, wound dehiscence, readmission and return to theatre rates using logistic regression in order to account for potential confounding due to the patient demographics and oncologic and surgical characteristics. Results: There were 129 patients in the standard dressing group and 41 patients in the ciNPWT group. The mean age was 60.4 years (range 25–86). The mean body mass index (BMI) was 38.2 kg/m2 (range 20–69 kg/m2). The percentage of patients who experienced a SSI was higher in the ciNPWT group (34.2% vs. 20.9%; p = 0.159). There was no significant difference between the dressing groups in the occurrence of superficial SSI rate, return to theatre, or readmission. Wound dehiscence and deep/organ space SSI were however worse with ciNPWT (adjusted odds ratio (aOR) 4.09 and aOR 7.19, respectively). Conclusions: This study demonstrated no evidence for the benefit of ciNPWT, and higher rates of deep/organ space SSI. More randomised trials are needed to investigate whether gynaecological oncology patients may benefit from ciNPWT thus justifying the extra cost of this dressing.

Abdominal paracentasis: provisional sample protocol for gynaecologic oncology patients, pilgrim hospital,united Lincolnshire hospitals NHS trust

Aims and Objectives: The thesis or central idea about this protocol was to create a provisional or sample protocol which could be programmed to evolve and improve over time, through a systematic review process, say, every two years, in the department. Thus, its aim was to provide a harmonise surgical care approach to performing abdominal paracentesis through evidence-based initial sample protocol, which if later approved, would be used by all staff including trainees, involved in the management of gynaecological oncology patients, who needed abdominal paracentesis performed on them, for therapeutic and investigative reasons, and for symptomatic relief. Thus, the ultimate goal was the development of new, harmonized approach or model for surgical care, and for the training of the next generation of surgical specialists, with high standards of clinical practice to improved care outcomes, for this group of patients. Definitions: Abdominal paracentesis is a surgical procedure in which a specially designed needle is used to remove a sample of fluid or to drain an abnormal accumulation of intra-abdominal fluid. It is sometimes called or generally referred to as peritoneocentesis. In the latter, the peritoneal cavity is punctured with a specially designed needle to sample peritoneal fluid. This procedure is used to remove fluid from the peritoneal cavity, especially when this cannot be removed by the use of medication. In another way, it can be defined as a procedure which involves the surgical puncture of the abdominal cavity with a needle followed by a placement of a catheter line for the removal of excess peritoneal fluid. It is thus, a safe effective procedure used for therapeutic and diagnostic assessment, and evaluation of many intra-abdominal pathological problems. It often provides significant symptomatic relief which enables patients to engage and perform other recuperative activities. Historically, it has evolved as with other procedures and currently many specialists would perform ultrasound before attempting manual abdominal paracentesis. Others advocate ultrasound-guided abdominal paracentesis, as it appears to be comparatively less painful and less time-consuming; that is; the abdominal paracentesis can be performed at the same time that abdominal and pelvic ultrasound is performed to locate ascitic fluid and mark safe site(s) for its sampling or removal. Materials and methods: As this is an initial sample protocol, there was no specific methods or approaches used other than collation of approaches in gynaecology oncology literature. These were then analysed and synthesized to bring about what could be a more generally acceptable sample, or a “common or middle ground” acceptable template. These published works were also systematically referenced accordingly. The final provisional sample protocol must then be reviewed by relevant senior practitioners at multidisciplinary meetings, and make recommendation(s) to amendment or reviewed before the final draft sample would be adopted for use. Results: The below sample was produced and sent to be reviewed by the relevant senior practioners in the Gynaecology Oncology Team. Conclusion: As new scientific knowledge and technology emerge, the produced protocol (template) can be reviewed and updated. It is suggested that the approved protocol be reviewed and updated every two years, in line with the emergence of new evidence or scientific knowledge.

PO-1427 Risk factors for unplanned acute care visits in gynecologic oncology patients receiving radiotherapy

PO-1427 Risk factors for unplanned acute care visits in gynecologic oncology patients receiving radiotherapy

Web-based tool for cancer family history collection: A prospective randomized controlled trial

ObjectivesApproximately 1% of individuals have a hereditary cancer predisposition syndrome, however, the majority are not aware. Collecting a cancer family history (CFH) can triage patients to receive genetic testing. To rigorously assess different methods of CFH collection, we compared a web-based tool (WBT) to usual care (clinician collects CFH) in a randomized controlled trial. MethodsNew gynecologic oncology patients (seen 9/2019–9/2021) were randomized to one of three arms in a 2:2:1 allocation ratio: 1) usual care clinician CFH collection, 2) WBT completed at home, or 3) WBT completed in office. The WBT generated a cancer-focused pedigree and scores on eight validated cancer risk models. The primary outcome was collection of an adequate CFH (based on established guidelines) with usual care versus the WBT. ResultsWe enrolled 250 participants (usual care - 110; WBT home - 105; WBT office - 35 [closed early due to COVID-19]). Within WBT arms, 109 (78%) participants completed the tool, with higher completion for office versus home (33 [94%] vs. 76 [72%], P = 0.008). Among participants completing the WBT, 63 (58%) had an adequate CFH versus 5 (5%) for usual care (P < 0.001). Participants completing the WBT were significantly more likely to complete genetic counseling (34 [31%] vs. 15 [14%], P = 0.002) and genetic testing (20 [18%] vs. 9 [8%], P = 0.029). Participant and provider WBT experience was favorable. ConclusionsWBTs for CFH collection are a promising application of health information technology, resulting in more comprehensive CFH and a significantly greater percentage of participants completing genetic counseling and testing.

Pre-Operative Neutrophil-to-Lymphocyte Ratio as a Predictor of Post-Operative Infectious Morbidity in Gynecologic Oncology Patients.

Background: Neutrophil-to-lymphocyte ratio (NLR) has been described as a predictor of progression-free and overall survival, and in the field of peri-operative care it seems to be a factor that can help discriminate patients at risk of developing post-operative complications. In the present study we sought to determine whether NLR is useful as a biomarker in predictive models that aim to identify patients with gynecologic cancer undergoing surgery at risk of developing post-operative infectious morbidity. Patients and Methods: We designed a prospective cohort study that enrolled 208 patients with gynecologic cancer. Post-operative infectious morbidity was evaluated based on a 30-day follow-up interval from the procedure. Results: Forty-three patients (20.5%) developed post-operative infectious morbidity. Using an optimal cutoff value of 1.7 for the pre-operative NLR we observed that the sensitivity of the biomarker was 76.7% and the specificity 73.3% with a produced area under the curve of 0.760 (95% confidence interval [CI], 0.680-0.839). Univariable logistic regression indicated that NLR is a predictor of post-operative morbidity. Cox regression analysis revealed that NLR was the only factor that was associated with the timing of infectious morbidity (hazard ratio [HR], 1.339; 95% CI, 1.180-1.519; p < 0.001). Using random forest analysis and decision trees we achieved a diagnostic accuracy of the predictive model that exceeded 90%. Conclusions: Neutrophil-to-lymphocyte ratio may be a factor that could potentially help evaluate the risk of post-operative morbidity in patients with gynecologic cancer.

Calculating surgical readmission rates in gynecologic oncology: The impact of patient factors

ObjectiveTo determine the 30-day surgical readmission rate after major gynecologic oncology surgeries at a high-volume academic institution and correlated risk factors. MethodsRetrospective cohort study was conducted of surgical admissions from January 2016 – December 2019 at a single institution. Data were extracted from patient charts, including reason for readmission and length of stay. A readmission rate was calculated. Nested case control design was used to identify correlations between readmission and patient specific risk-factors. Multivariable logistic regression models were used to determine risk factors with readmission. ResultsA total of 2152 patients were included. The readmission rate was 3.5%, most commonly due to GI disturbance and surgical site infection. Average readmission length was 5 days. Prior to adjusting for covariates, insurance status, primary diagnosis, index admission length, and disposition at discharge differed between patients who were and were not readmitted. After adjusting for co-variates, younger patients, index admission >2 days, and higher Charlson co-morbidity index were associated with readmission. ConclusionsOur surgical readmission rate was lower than previously reported rates in gynecologic oncology patients. Patient factors associated with readmission included younger age, longer index hospital admission, and higher medical co-morbidity index scores. Provider factors and institutional practice patterns could contribute to the decreased readmission rate. These findings underscore the importance of standardizing how we calculate readmission rate and interpret these data. Varying readmission rates and institutional practice patterns deserve closer scrutiny to inform best practice and future policies.

A pilot evaluation of social needs among gynecologic oncology patients in inpatient versus outpatient settings

The WHO defines social determinants of health (SDoH) as the conditions in which we are born, grow, work, and live as well as other large systems that positively or negatively affect our health. Many healthcare systems currently lack the resources and strategies required to accurately assess and address SDoH. Action must be taken because studies have found that chronic diseases, including cancer, are affected by SDoH. The aim of this study is to identify the incidence of social needs in an inpatient gynecologic oncology population and its relation to patient demographics and clinical diagnostic data to guide and inform future intervention. Patients agreeing to participate in the study completed a needs assessment survey during their inpatient stay at the hospital between November 2020 to March 2021. The survey contained seven questions, six of which were questions screening for social needs including food and housing security, transportation means, financial stability, health literacy, and social support. Responses were considered positive if any degree of need was reported. Demographic and cancer diagnosis data were then collected and included zip code, race, cancer stage and age at diagnosis, treatment history, and number of hospital admissions and length of stay over the past 12 months. The most substantial reported needs across all gynecologic malignancies were social support (65%), health literacy (37%), and financial need (22%). Less need was reported in the categories of food (11%), housing (7%), and transportation (4%). SDoH have been studied in the outpatient gynecologic population and the needs seen in this study are similar to the needs of that population. However, there are likely different challenges and frequencies of unmet need in the different types of gynecologic cancers that may affect the stage at which their cancer is diagnosed as well as the number of hospital admissions related to their cancer care.

The past, present, and future of opioid prescribing: Perioperative opioid use in gynecologic oncology patients after laparotomy at a single institution from 2012 to 2021

ObjectiveTo describe the evolution of perioperative opioid management in gynecologic oncology patients after open surgeries and determine current opioid over-prescription rates. MethodsPart one of this two-part study was a retrospective chart review of adult patients who underwent laparotomy by a gynecologic oncologist from July 1, 2012 to June 30, 2021, comparing changes in clinical characteristics, pain management and discharge opioid prescription sizes between fiscal year 2012 (FY2012) and 2020 (FY2020). In part two, we prospectively surveyed patients after laparotomy in 2021 to determine opioid use after hospital discharge. Results1187 patients were included in the chart review. Demographic and surgical characteristics remained stable from FY2012 to FY2020 with differences notable for increased rates of interval cytoreductive surgeries for advanced ovarian cancer and decreased rates of full lymph node dissection. Median inpatient opioid use decreased by 62 % from FY2012 to FY2020. Median discharge opioid prescription size was 675 oral morphine equivalents (OME) per patient in FY2012 and decreased by 77.7 % to 150 OME in FY2020. Of 95 surveyed patients in 2021, median self-reported opioid use after discharge was 22.5 OME. Patients had an excess of opioids equivalent to 1331 doses of 5-milligram oxycodone tablets per 100 patients. ConclusionInpatient opioid use in our gynecologic oncology open surgical patients and post-discharge opioid prescription size significantly decreased over the last decade. Despite this progress, our current prescribing patterns continue to significantly overestimate patients’ actual opioid use after hospital discharge. Individualized point of care tools are needed to determine an appropriate opioid prescription size.

Apixaban for extended postoperative thromboprophylaxis in gynecologic oncology patients undergoing laparotomy

IntroductionVenous thromboembolic events represent the second most frequent cause of mortality in cancer patients. Recent literature shows that direct oral anticoagulants (DOAC) are at least as effective and safe as low molecular weight heparin for postoperative thromboprophylaxis. However, this practice has not been broadly adopted in gynecologic oncology. The aim of this study was to evaluate clinical effectiveness and safety of apixaban for extended thromboprophylaxis in comparison to enoxaparin after laparotomies for gynecologic oncology patients. MethodsThe Gynecologic Oncology Division at a large tertiary center transitioned from enoxaparin 40 mg daily to apixaban 2.5 mg BID for 28 days after laparotomies for gynecologic malignancies in November 2020. This real-world study compared patients post-transition (November 2020 to July 2021 (n = 112)) to a historical cohort (January to November 2020 (n = 144)), using the institutional National Surgical Quality Improvement Program (NSQIP) database. All Canadian gynecologic oncology centers were surveyed to assess postoperative DOAC utilization. ResultsPatient characteristics were similar between groups. No difference was found between total venous thromboembolism rates (4% vs. 3%, p = 0.49). No difference was found in postoperative readmission (5% vs. 6%, p = 0.50). Of the 7 readmissions in the enoxaparin group, one was due to bleeding requiring transfusion; there were no readmissions for bleeding in the apixaban group. No patient required a reoperation for bleeding. Thirteen percent of the 20 Canadian centers have transitioned to extended apixaban thromboprophylaxis. ConclusionsApixaban for 28-day postoperative thromboprophylaxis was found to be an effective and safe alternative to enoxaparin after laparotomies in a real-world cohort of gynecologic oncology patients.

Opioid and benzodiazepine use in gynecologic oncology patients

ObjectiveThe goals of this study were to describe opioid and benzodiazepine prescribing practices in the gynecologic oncology patient population and determine risks for opioid misuse in these patients.MethodsRetrospective study of...