Patterns Of Care For Women Research Articles

Overall survival and patterns of care for women with rare ovarian cancers: A prospective study from the Australian National Gynae-Oncology Registry (NGOR).

e17554 Background: Ovarian cancer (OC) is a heterogenous group of malignancies, most of which are rare. Data on patterns of care and survival of the most-rare sub-groups of OC (incidence rates < 6 per 100,000) in the real-world setting is limited. This study aims to describe patterns of care and overall survival (OS) for women with rare ovarian cancers in Australia. Methods: Clinical data were sourced from the NGOR and assessed for accuracy and completeness. High grade serous and endometrioid OC subtypes were excluded. Due to incompleteness of survival follow-up data, 3-year OS was only calculated for the state of Victoria. Results: Data on 2812 women with newly diagnosed OC from 2017-2023 within NGOR were collected and 716 women were subsequently identified with rare subtypes of OC. The 5 sub-types with the highest incidences were clear cell (n = 168, 23.4%), mucinous (n=151, 21.1%), adult granulosa cell (n=111, 15.5%), low grade serous (n=98, 13.7%) and carcinosarcoma (n=59, 8.2%). A further 23 additional rare subtypes included germ cell tumours and sex cord stromal tumours. The median follow-up time was 2.6 years and median age at diagnosis was 55 years. Most women had an ECOG 0-1 performance status (n=551, 77.0%). The primary treatment modality was surgery only (n=360, 50%), followed by surgery and systemic therapy (n = 317, 44.2%), systemic therapy only (n=28, 3.9%) and no treatment (n=11, 1.5%). Most women were discussed at a multi-disciplinary meeting (n=701, 97.9%). The diagnosis was confirmed on histology for all women. The 30-day post-operative adverse events (Clavien-Dindo >III severity) was 3.6 % (n=26), with the highest rate of post-operative events in the carcinosarcoma group of 12% (n=6). Using Fisher’s exact test across the 5 most common sub-types described above, there were significant differences in treatment modalities (p<0.001), rates of 30-day post-operative events (p=0.002), age adjusted charlson comorbidity index (p<0.001) and metropolitan versus remote regional status (p=0.007) between the sub-types. Survival at 3 years for these five sub-types of rare OC within the state of Victoria are summarised in the table. The highest 3-year OS was in adult granulosa and low grade serous sub-types. Conclusions: This is a large, real-world analysis of patterns of care and survival for women with rare sub-types of OC. Combining data with international sites will likely further enhance research on patterns of care and outcomes for women with rare OC. [Table: see text]

Patterns of Care and Utilization of Radiation for Women With Good-Risk Ductal Carcinoma In Situ: A National Cancer Database Analysis.

Purpose/objective(s)Lumpectomy followed by whole-breast radiation therapy (WBRT) provides a 50% recurrence rate reduction in ductal carcinoma in situ (DCIS) patients when compared to lumpectomy alone. Certain factors increase the risk of recurrence, including higher nuclear grade, large size, age less than 50, and close margins. RTOG 9804 demonstrated a reduction in local failure after WBRT with the use of adjuvant radiation in women with "good-risk disease" (mammographically detected, measuring less than or equal to 2.5 cm, with a predominant nuclear grade of 1 or 2, and a margin of greater than or equal to 1 cm, or a negative re-excision). The purpose of this study is to retrospectively identify the patterns of care in women with low-risk DCIS utilizing the National Cancer Database (NCDB). We hypothesize that with the utilization of hypofractionation, there may be an increase in the delivery of RT for these "good-risk" patients.Materials/methodsThe National Cancer Database was queried to identify women treated with lumpectomy for <2.5 cm, nuclear grade 1 or 2 DCIS of the breast from 2004 to 2016. Data were collected regarding age, tumor size, endocrine therapy use, ER receptor status, race, insurance type, and distance from the treatment center. The distance was stratified into quartiles consisting of 0-3.9, 4-8, 8.1-15.8, and > 15.8 miles, respectively. Radiation fractionation was collected and categorized as hypofractionation, standard fractionation, or other if fractionation could not be ascertained. Clinical and patient-related factors were compared between patients who received radiation and those who received no radiation. The frequency distributions between categorical variables were compared using the Chi-square test. Multivariable logistic regression was used to identify covariables that impacted the receipt of radiation.ResultsThe eligibility criteria were met by a total of 12,846 patients. Of those, 6,600 (51.4%) received adjuvant WBRT. On multivariable regression, patients whose tumors were ER (OR 1.24, P<0.001) and those who had not received endocrine therapy (OR 2.24, P<0.001) were more likely to receive WBRT. Factors less likely to receive WBRT included increasing age over 50 (age 50-65 OR 0.83, P<0.001; age>65 OR 0.58, P<0.001), and distance of >15.8 miles (OR 0.78, P<0.001). The fractionation technique was categorized as standard or hypofractionated in 52.2% of patients. Of those, the use of hypofractionation increased from 0.4% in 2004 to 8.9% in 2010 and to 53.8% in 2016.ConclusionThis NCDB analysis demonstrated that patients who meet the RTOG 9804 criteria for "good-risk" DCIS are less likely to receive RT as time progresses despite an increase in the utilization of hypofractionation techniques. Overall, slightly more than half of these patients receive adjuvant RT.

P-326 Current real-world patterns of care for women diagnosed with uterine fibroids (UF) and heavy menstrual bleeding (HMB) in a predominantly African American (AA) population database

Abstract Study question What are the clinical characteristics and patterns of care in African American women diagnosed with UF and HMB compared to White women? Summary answer The majority of the women were African American. Though similar in age, there were significant differences between the groups in multiple comorbidities and therapies. What is known already UF (leiomyomas) are common, benign uterine tumors affecting approximately 80% of African American and 70% of White women by age 50. In the United States, marked differences exist in disease presentation, severity, treatment, outcomes, and quality of life for African American women compared with White women. African American women typically develop uterine leiomyomas at a younger age, progress to clinically significant disease at an earlier age, have larger uteri at diagnosis and are more likely to be anemic. Limited data exist on the current clinical real-world characteristics and patterns of care for African American women with UF and HMB. Study design, size, duration This retrospective observational study identified women 18-55 years, with UF and HMB from IBM-Watson’s MarketScan® Multi-state Medicaid claims database between 2010-2019. The focus was on women with diagnoses of UF (index) and HMB, appearing on the same or different claims, continuously enrolled for &amp;gt; 12 months pre- and post-index (censored on claim for hysterectomy). A total of ≥ 24 months of observation was available for most patients. Participants/materials, setting, methods A total of 27,122 women met the inclusion criteria, 16,776 African Americans, 7,353 Whites, and 2,993 others or race unknown. The statistical analyses were carried out on the African American and White patients only. Descriptive analyses of baseline demographics, pre-index comorbidities and post-index treatment were performed. Chi-square tests analyses were applied to counts and t-tests analyses were applied to means. All tests used an alpha value of 0.05 for significance. Main results and the role of chance The majority of the analytical cohort of 24,129 women was African American (AA:69.5%; W:30.5 %). The mean (SD) follow-up time was 40.5 (24.7) months. The mean age was similar for both groups (AA:39.6 ± 7.11 years; W: 40.2 ± 7.23 years, p &amp;lt; 0.1). There were 48 pre-indexed comorbidities identified for analyses. The groups significantly differed on 14(29%) comorbidities. For 11 of the comorbidities, African American women were less likely to be diagnosed than White women (all Ps &amp;lt; 0.0001). Many of these diseases were related to bulk symptoms (e.g., pelvic pressure/pain), anxiety and depression. More African American women had diagnoses for diabetes (p = 0.0143), hypertension, and obesity (Ps &amp;lt; 0.0001). Though bulk symptoms were common in both groups, again fewer African American women were diagnosed than White (AA: 68.4%; W:77.0%, p &amp;lt; 0.0001). Post-index, African American women were more likely treated with hormone-based therapy (42.4% vs. 38.5%, p &amp;lt; 0.0001). Contraceptives were the most frequent form of hormonal treatment prescribed (AA:39.9%; W:35.6%). African American were on contraceptives slightly longer than White women (AA: 377.3 (522.2 days); W: 323.1 (460.2 days) (p &amp;lt; 0.001). Fewer African American women had a hysterectomy (AA:32.0%; W:46.8%, p &amp;lt; 0.001). Limitations, reasons for caution This study was observational and descriptive in nature, which limits the ability to make conclusions regarding causality or identify women beyond the age and time constraints within the study. Additionally, claims data may be subject to reporting errors. This data is specific to Medicaid populations and may not be generalizable. Wider implications of the findings In this Medicaid population differences in clinical characteristics and UF treatment were evident between African American and White women. The breakdown of some comorbidities did not match national prevalence by race for these conditions (e.g., depression). Further analyses are needed to determine if these differences are clinically and socially meaningful. Trial registration number NA

Evolution of patterns of care for women with cervical cancer in Morocco over a decade

BackgroundWe conducted a Pattern-of-care (POC) study at two premier-most public-funded oncology centers in Morocco to evaluate delays in care continuum and adherence to internationally accepted treatment guidelines of cervical cancer.MethodFollowing a systematic sampling method, cervical cancer patients registered at Centre Mohammed VI (Casablanca) and Institut National d’Oncologie (Rabat) during 2 months of every year from 2008 to 2017, were included in this retrospective study. Relevant information was abstracted from the medical records.ResultsA total of 886 patients was included in the analysis; 59.5% were at stage I/II. No appreciable change in stage distribution was observed over time. Median access and treatment delays were 5.0 months and 2.3 months, respectively without any significant temporal change. Concurrent chemotherapy was administered to 57.7% of the patients receiving radiotherapy. Surgery was performed on 81.2 and 34.8% of stage I and II patients, respectively. A very high proportion (85.7%) of operated patients received post-operative radiation therapy. Median interval between surgery and initiation of radiotherapy was 3.1 months. Only 45.3% of the patients treated with external beam radiation received brachytherapy. Radiotherapy was completed within 10 weeks in 77.4% patients. An overall 5-year disease-free survival (DFS) was observed in 57.5% of the patients – ranging from 66.1% for stage I to 31.1% for stage IV. Addition of brachytherapy to radiation significantly improved survival at all stages. The study has the usual limitations of retrospective record-based studies, which is data incompleteness.ConclusionDelays in care continuum need to be further reduced. Increased use of chemoradiation and brachytherapy will improve survival further.

Patterns of Care and Utilization of Radiation for Women With Good-Risk Ductal Carcinoma In Situ: A National Cancer Database Analysis

Lumpectomy followed by whole-breast radiation therapy (WBRT) provides a 50% recurrence rate-reduction in DCIS patients when compared to lumpectomy alone. Certain factors increase the risk of recurrence, including higher nuclear grade, large size, age less than 50, and close margins. RTOG 9804 demonstrated a reduction in local failure after WBRT with the use of adjuvant radiation in women with "good-risk disease" (mammographically detected, measuring less than or equal to 2.5 cm, with predominant nuclear grade of 1 or 2, and a margin of greater than or equal to 1 cm, or a negative re-excision). The purpose of this study is to retrospectively identify the patterns of care in women with low-risk DCIS utilizing the National Cancer Database. We hypothesize that with the utilization of hypofractionation, there may be an increase in delivery of RT for these "good-risk" patients.The National Cancer Database was queried to identify women treated with lumpectomy for a < 2.5 cm, nuclear grade 1 or 2 DCIS of the breast from 2004-2016. Data regarding age, tumor size, endocrine therapy use, ER receptor status, margin status, race, insurance type and distance from the treatment center were collected. Distance was stratified into quartiles consisting of 0-3.9, 4-8, 8.1-15.8, and > 15.8 miles respectively. Radiation fractionation was collected and categorized as hypofractionation, standard fractionation, or other, if fractionation could not be ascertained. Clinical and patient-related factors were compared between patients who received radiation and no radiation. Frequency distributions between categorical variables were compared using the Chi-square test. Multivariable logistic regression was used to identify covariables that impacted the receipt of radiation.A total of 13,313 patients met the eligibility criteria. Of those, 6,814 (51.2%) received adjuvant WBRT. On multivariable regression, patients whose tumors were ER- (OR 1.35, 95% CI 1.19-1.54, P < 0.001) and those who did not receive endocrine therapy (OR 2.34, 95% CI 1.94-2.95, P < 0.001) were more likely to receive WBRT. Factors less likely to receive WBRT included later year of diagnosis (OR 0.97, 95% CI 0.96-0.98, P < 0.001) increasing age over 50 (age 50-65 OR 0.84, P = 0.001; age > 65 OR 0.59, < 0.001), and distance of > 15.8 miles (OR 0.80, 95% CI 0.72-0.88, P < 0.001). Fractionation technique was categorized as standard or hypofractionated in 52.2% of patients. Of those, the use of hypofractionation increased from 0.4% in 2004 to 8.9% in 2010 and to 53.8% in 2016.This NCDB analysis demonstrated that patients who meet the RTOG 9804 criteria for "good-risk" DCIS are less likely to receive RT as time progresses despite an increase in utilization in hypofractionation techniques. Overall, slightly more than half of these patients receive adjuvant RT.

Evaluation of abnormal vaginal bleeding in the emergency department: opportunities to favorably impact a key cancer disparity

Evaluation of abnormal vaginal bleeding in the emergency department: opportunities to favorably impact a key cancer disparity

10. Patterns of contralateral symmetrisation, completion and revision following immediate breast reconstruction: Early results from the brighter long-term breast reconstruction outcome study

Introduction: Patients considering breast reconstruction (BR) require high-quality information about long-term clinical outcomes, including the need for additional surgery, to help them make informed decisions. Such information is currently lacking. We aimed to use routinely-collected data to explore patterns of care in women undergoing different reconstructive techniques.

Patterns of care for women with placenta accreta spectrum

Background Placenta accreta spectrum (PAS) is a spectrum of conditions in which the placenta is abnormally adherent and invades the uterine wall. This invasion can cause life-threatening hemorrhage and lead to significant adverse maternal outcomes. Numerous studies have shown an association between treatment of PAS at high volume, specialized centers and improved maternal outcomes; however, little is known about how these data have influenced practice. Objective The objective of the study was to examine the patterns of care for women with placenta accreta spectrum over time. Study design Data from New York Statewide Planning and Research Cooperative System (SPARCS) from 2000 to 2017 was used for this analysis. The study cohort comprised of women aged 15–54 years with PAS who underwent a hysterectomy during their delivery hospitalization. Study outcomes included severe maternal morbidity as defined by the Centers for Disease Control and Prevention, surgical complications, and transfusion. Hospitals were stratified into tertiles based on the volume of PAS hysterectomy cases. Patient demographic and clinical characteristics were compared across volume tertiles. Random intercept log-linear regression models with Poisson distributions and log link functions were fit to examine the association between hospital PAS volume and the outcomes of interest. Results A total of 1958 women with PAS who underwent hysterectomy at 123 hospitals were identified. The number of hospitals providing care ranged from 46 centers in 2000 to 52 hospitals in 2016. The median hospital-level case volume of PAS was 1 (interquartile range [IQR], 1–2) in 2000 and rose slightly to 2 (IQR, 1–4) by 2016. The PAS volume cut-point for the top decile of hospitals was three cases in 2000 and increased to six cases in 2016. There was no significant change in the median travel distance for women with PAS over time. The rate of severe maternal morbidity increased significantly from 14.1% (95% CI: 7.8–24.0%) in 2000 to 19.0% (95% CI: 13.6–25.8%) in 2016. Transfusion occurred in 66.2% (95% CI: 54.6–76.1%) of cases in 2000 compared to 60.1% (95% CI: 52.3–67.4%) in 2016. Surgical complications occurred in 16.9% (95% CI: 9.9–27.3%) of cases in 2000 to 24.7% (95% CI: 18.6–32.0) in 2016. There was no difference in the adjusted rates of transfusion or surgical complications based on hospital volume. Compared to low-volume centers, the risk of severe maternal morbidity was reduced by 33% (aRR = 0.67; 95% CI: 0.50–0.90) at the intermediate volume centers. Conclusion There has been little change in the patterns of care for women with PAS in New York State. While the volume of patients with PAS has increased at the highest volume centers, a large number of relatively low-volume centers still provide care for a significant number of women with PAS.

Referral Patterns for the Evaluation of Asymptomatic Microscopic Hematuria in Women in a Single Health Care System: Room for Improvement.

To identify patterns of care for women referred for asymptomatic microhematuria in a single, hospital-based health care system and estimate the cost of unindicated evaluation. We conducted a retrospective study of 100 women with a diagnosis of asymptomatic microhematuria referred to a tertiary female pelvic medicine and reconstructive surgery practice. Our analysis focused on referral patterns by obstetrician-gynecologists and primary care physicians. Data analyzed included whether asymptomatic microhematuria was documented using urine microscopy (vs urine dipstick) and whether the urine microscopy correctly identified asymptomatic microhematuria with three red blood cells (RBCs). Forty-six patients were referred who met the American Urological Association's guidelines for asymptomatic microhematuria with a workup estimated at $8,298 per patient. Fifty-four were referred to a female pelvic medicine and reconstructive surgery specialist despite clearly not meeting the American Urological Association's definition of asymptomatic microhematuria. Of these, 33 patients were referred based on dipstick-positive results only, 11 were referred based on microscopic urinalysis demonstrating fewer than three RBCs per high-power field (HPF), and the remaining 10 patients were referred with urine microscopy demonstrating at least 3 RBC/HPF but in the setting of a clearly benign cause, such as infection or menstruation. The total estimated cost of the unnecessary asymptomatic microhematuria workup in patients who did not meet American Urological Association criteria for referral was $1,213 per patient. Fewer than half of the referrals for asymptomatic microhematuria were appropriate, leading to wasted and entirely preventable health care expenditures. This study highlights the need for education of health care providers making these referrals.

National Patterns of Filled Prescriptions and Third-Line Treatment Utilization for Privately Insured Women With Overactive Bladder

The aim of this study was to evaluate national patterns of care for women with overactive bladder (OAB) in an administrative data set and identify potential areas for improvement. We performed an analysis using the OptumLabs Data Warehouse, which contains deidentified administrative claims data from a large national US health insurance plan. The study included women, older than 18 years, with a new OAB diagnosis from January 1, 2007, to June 30, 2017. We excluded those with an underlying neurologic etiology, with interstitial cystitis/painful bladder syndrome, were pregnant, or did not have continuous enrollment for 12 months before and after OAB diagnosis. Trends in management were assessed via the Cochran-Armitage test. Time to discontinuation among medications was compared using t test. Of 1.4 million women in the database during the study time frame, 60,246 (4%) were included in the study. Median age was 61 years [interquartile range (IQR), 50-73], and median follow-up was 2.6 years (IQR, 1.6-4.2). Overall, 37% were treated with anticholinergics, 5% with beta-3 agonists, 7% with topical estrogen, and 2% with pelvic floor physical therapy; 26% saw a specialist; and 2% underwent third-line therapy. Median time to cessation of prescription filling was longer for beta-3 agonists versus anticholinergics [median, 4.1 months (IQR, 1-15) vs 3.6 months (IQR, 1-10); P < 0.0001]. Use of third-line therapies significantly increased over the study time frame, from 1.1% to 2.2% (P < 0.0001). Most of the patients do not continue filling prescriptions for OAB medications, and a minority of patients were referred for specialty evaluation. Although third-line therapy use is increasing, it is used in a small proportion of women with OAB. Given these patterns, there may be underutilization of specialist referral and other OAB therapies.

Patterns of care in women with high-intermediate risk endometrioid adenocarcinoma in the PORTEC-2 era: A SEER database analysis

PurposeWe examined the radiotherapy patterns of care over an 8-year period during which the PORTEC-2 trial and other series were published. Methods and MaterialsPatients diagnosed with Stage I endometrioid adenocarcinoma (EA) between 2004 and 2011 were identified in the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Adjuvant radiation treatments were analyzed by year. Patterns of care from 2004 to 2008 were compared to those from 2009 to 2011 using the χ2 test. ResultsAnalysis included 31,688 patients with Stage I EA. Among those diagnosed in 2004, 9.3% received adjuvant external beam radiotherapy (EBRT) and 5.0% received adjuvant brachytherapy. In 2011, 4.5% received EBRT and 9.3% received brachytherapy. In those diagnosed with high-intermediate risk (H-IR) EA in 2004, 58.8% received no adjuvant treatment, 28.3% received EBRT, and 12.9% received brachytherapy. In 2011, 57.8% of patients with H-IR disease received no adjuvant treatment, 14.3% received EBRT, and 27.9% received brachytherapy. There was a significant difference in the proportion of patients with H-IR EA treated with EBRT vs. brachytherapy alone before and after 2008 (p < 0.0001) with an increase in use of brachytherapy and a decrease in the use of EBRT. ConclusionsThe use of brachytherapy alone after hysterectomy has increased over time in all women with Stage I EA and in those with H-IR disease. In almost all subsets, the proportion of women being treated with brachytherapy increased and the proportion treated with EBRT decreased. Less than 30% received adjuvant brachytherapy and over 50% of women were treated without adjuvant radiotherapy.

An exploration of the prevalence and patterns of care for women presenting with mid-trimester loss.

Mid-trimester loss (MTL) is an area that is poorly defined in the literature and often under reported in clinical practice. The prevalence of MTL in Ireland is uncertain and has a huge impact on the woman, her family and maternity care services. To explore the prevalence and patterns of care for women with MTL in a large Maternity hospital in Ireland. A descriptive, exploratory study was used involving a retrospective chart audit. 220 women presented with MTL over the 3year data collection period (January 2011-December 2013), giving a rate of 0.8% of all deliveries. The majority of women had no previous pregnancy losses and were multiparous (i.e., had a previous pregnancy >500g). The mean gestational age was 17.69weeks (SD=2.73). The mean length of hospital stay was 1.89days. Intra muscular (IM) analgesia was the most commonly (58.5%) used medication. Follow up hospital care was received in over 78% of cases. The majority of women were referred the CMS Bereavement and Chaplain services, with a small number (approx. 5%) referred to the social worker. Over 46.4% of families availed of the hospital burial service. Results suggest the incidence of mid-trimester loss may be slightly lower than the 1 or 2% of pregnancies reported in the literature. The incidence of mid-trimester loss in multiparous women is approximately twice that of nulliparous women. The referral services offered in the study were utilised by most of the women, as were follow-up clinic appointments.

The Impact of Presentation/Publication of PORTEC II on Patterns of Care in Women With High-Intermediate Risk Endometrioid Adenocarcinoma: A SEER Database Analysis

The Impact of Presentation/Publication of PORTEC II on Patterns of Care in Women With High-Intermediate Risk Endometrioid Adenocarcinoma: A SEER Database Analysis

Colposcopic Episodes of Care: Referral, Treatment, Follow-Up, and Exit Patterns of Care for Women With Abnormal Pap Smears

ObjectiveTo define the patterns of care of women after they have been referred to a colposcopic service. MethodsWe carried out this population-based study by linking databases of health care provision for 2010. We defined“colposcopic episodes of care” as a series of colposcopic evaluations beginning at the time of referral for colposcopy because of a new cervical cytology abnormality and continuing until no colposcopy or cytology service had been performed for≥365days. ResultsCytology reports indicating low-grade squamous intraepithelial lesions and atypical squamous cells of uncertain significance account for 88% of referrals of women for colposcopy. Women aged 20 to 29 had the highest rates of referral and treatments. Up to 87% of women referred for low-grade squamous intraepithelial lesions cytology did not require treatment after colposcopic evaluation, while 54% of women referred for high-grade squamous intraepithelial lesions cytology required treatment. The duration of colposcopic episodes of care in which treatment was carried out lasted up to 327days, with a median three colposcopic evaluations per episode, whereas episodes of care in which no treatment was carried out lasted up to 190days with a median of one or two colposcopic examinations per episode. ConclusionYoung women aged 20 to 29 have the highest rates of colposcopic services. Women referred because of cytology showing high-grade squamous intraepithelial lesions in whom treatment is not carried out require more extensive follow-up to ensure that lesions are not missed. We recommend the incorporation of colposcopy services into centralized cervical cancer screening programs.

Trends in management of pelvic organ prolapse among female Medicare beneficiaries

In the last decade, many new surgical treatments have been developed to achieve less-invasive approaches to prolapse management. However, limited data exist on how the patterns of care for women with pelvic organ prolapse (POP) may have changed over the last decade, and whether mesh implantation techniques have influenced the type of specific compartment repair performed. We used a national data set to analyze the temporal trends in patterns of care for women with POP. Data were obtained from Public Use Files from the Centers for Medicare and Medicaid Services for a 5% random sample of national beneficiaries with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of POP from 1999 through 2009. Current Procedural Terminology, 4th Edition and International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes were used to evaluate nonsurgical and surgical management trends for this cohort. Types of surgery were categorized by prolapse compartment and combinations of repairs. After 2005, when applicable codes became available, mesh or graft repairs were also analyzed. Over the study time period, the number of women with adiagnosis of POP in any 1 year in our 5% sample of Medicare beneficiaries remained relatively stable (range, 21,245-23,268 per year). Rates of pessary insertion were also consistent at 11-13% over the study period. Of the women with a prolapse diagnosis, 14-15% underwent surgical repair, and there was little change over time in surgical management patterns based on compartment. Most commonly, multiple compartments were repaired simultaneously. There was a rapid increase in mesh use such that in 2009, 41% of all women who underwent surgery (5.8% of the total cohort) had mesh or graft inserted in their repair. Hysterectomy rates for prolapse decreased over time. Rates of vault suspension at the time of hysterectomy for prolapse were low; however, they showed a relative increase over time (22% in 1999 to 26% in 2009). Patterns and rates of prolapse repairs remained relatively unchanged from 1999 through 2009, with an exception ofa rapid rise in mesh use. These data suggest that the majority ofmesh techniques were used for augmentation purposes only, butdid not result in an increase in apical repairs performed in theUnited States. There remains a disappointingly low rate of vault suspension repairs concomitantly at time of hysterectomy for POP.

Patterns of care for locally advanced vulvar cancer

Patients with locally advanced vulvar carcinoma can be treated with primary surgery or neoadjuvant chemoradiation. Neoadjuvant treatment appears to be associated with decreased morbidity and acceptable long-term outcomes. We examined the patterns of care for women with locally advanced vulvar cancer. Data from the Surveillance, Epidemiology, and End Results (SEER) database was used to examine women with stage III-IVA vulvar cancer treated from 1988 to 2008. Primary therapy was classified as surgery or radiation. Multivariable logistic regression models were developed to examine the use of primary radiotherapy. We identified a total of 2292 women including 1757 who underwent primary surgery (76.7%) and 535 treated with primary radiation (23.3%). The use of primary radiation increased with time from 18.0% in 1988 to 30.1% in 2008. In a multivariable model, older women (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.03-1.72), black women (OR, 1.59; 95% CI, 1.14-2.23), and patients with stage IVA tumors (OR, 2.23; 95% CI, 1.78-2.81) were more likely to receive primary radiation. Among women treated with primary radiotherapy, only 17.8% ultimately underwent surgical resection. The use of primary radiation for locally advanced vulvar cancer is limited but has increased over time. Multiple patient and tumor factors influence use. The majority of patients with stage III-IVA vulvar cancer treated with primary radiation therapy did not undergo surgical resection.

PS3-16: The Influence of Travel Time on Breast Cancer Diagnosis and Treatment

Background and Aims: Longer travel time to health care services has been shown to be associated with more advanced stage at diagnosis and differences in surgical care for women with breast cancer. The influence of travel time on other disease characteristics at diagnosis and on use of other breast cancer treatments is not known. We examined travel time in relation to stage, nodal involvement, tumor size, primary and adjuvant treatments, and receipt of surveillance mammography to provide a more detailed examination of the role of travel time in access and utilization of breast cancer services to help further understand barriers to recommended care. Methods: Using an established cohort of women enrolled at Group Health, with an early stage breast cancer diagnosis from 1990–1999 (N=1306), we linked travel time estimates with tumor and treatment data. Travel time was estimated for each census block in Washington to the nearest radiology facility and was then attributed to women based on geocoded residence data. Tumor and treatment data were abstracted from chart review and from SEER data. We modeled bivariate relations between travel time and outcomes using log binomial generalized linear regression (glm). Results: Most women (90%) lived within 30 minutes of the nearest radiology facility. Travel time >45 min. was associated with a greater likelihood of mastectomy vs. breast conserving surgery (Referent group:travel time <10min: RR=1.48; 95%CI:1.03–2.13) and with use of adjuvant chemotherapy (RR=1.65; 95% CI:1.01–2.70). Travel time did not significantly influence stage at diagnosis, tumor size, radiation treatment, or receipt of surveillance mammography in the first two years following cancer treatment. Conclusions: In the Group Health population, travel time appears to differentially influence patterns of care for women with early stage breast cancer and does not appear to be related to tumor characteristics at diagnosis.

Patterns of care for women with cervical cancer in the United States

Recommendations for pretreatment evaluation and treatment of cervical cancer have significantly evolved over the last decade because of the results of multiple randomized studies comparing the addition of platin-based chemoradiation as well as the widespread dissemination and use of imaging modalities. This analysis was initiated to determine any systemic changes in management of cervical cancers. Surveillance, Epidemiology, and End Results program data were used to sample newly diagnosed women in 1997, 2000, and 2001 with cancer of the cervix. A total of 3116 women with no previous diagnosis of cancer were selected. Data were reabstracted, additional information not routinely collected was obtained, therapy was verified with the treating physician, and multiple endpoints were analyzed. A marked rise was observed in the percentage receiving chemotherapy (34% to 85%) as well as concurrent chemoradiation (20% to 72%) from 1997 to 2001. The significant change in the management and treatment of cervical cancer appears to correspond temporally with the publication of 5 clinical trials, all of which showed a significant improvement in overall survival associated with chemoradiation. This change also corresponded with the NCI Clinical Announcement that was disseminated in 1999 to those oncologists most likely to treat women with cervical cancer.

Patterns of care analysis among women with ductal carcinoma in situ in North Carolina

BackgroundDuctal carcinoma in situ (DCIS) of the breast comprises approximately 25% of new breast cancer cases. The aim of this study was to delineate patterns of care for women with DCIS as related to age, tumor characteristics, and race/ethnicity. Further study goals included the identification of predictors of breast-conserving surgery (BCS), adjuvant radiation, and/or hormonal therapy, as well as breast reconstruction after mastectomy. MethodsThe North Carolina Cancer Registry was queried for primary DCIS treated in 1998 and 1999 (n = 1,893). Logistic regression analysis was performed to define the determinants of patterns of care. ResultsThirty-five percent of the women in this study sample underwent mastectomy. Positive predictors of mastectomy included young age (age <50 y vs 70+; odds ratio [OR], 1.55; 95% confidence interval [CI], 1.13–2.11) and larger tumor size (>2 mm vs 0–1 mm; OR, 2.43; 95% CI, 1.63–3.60). Approximately 48% of women who underwent BCS received adjuvant radiation therapy. Factors associated with receiving radiation therapy after BCS include younger age (age <50 vs 70+; OR, 2.12; 95% CI, 1.49–3.03). Approximately 19% of women who underwent BCS received adjuvant hormonal therapy. Positive predictors of receiving adjuvant hormonal therapy after BCS included age of 50 to 60 years versus 70+ (OR, 2.16; 95% CI, 1.36–3.44) and the receipt of radiation therapy (OR, 3.60; 95% CI, 2.55–5.06). Approximately 28% of women who underwent mastectomy received breast reconstruction surgery. Positive predictors of breast reconstruction after mastectomy included age younger than 50 years versus 70+ years (OR, 47.36; 95% CI, 19.45–115.32). African American race was associated negatively with receipt of breast reconstruction after mastectomy (OR, .46; 95% CI, .26–.84). ConclusionsTreatment strategies for primary surgical therapy for DCIS vary significantly by age. Inconsistencies exist surrounding the use of adjuvant radiation therapy after BCS in women with DCIS. Variations in approaches to reconstructive surgery after mastectomy may be related to age, ethnicity, and/or economic constraints.

Experiencia de mujeres que solicitan interrupción voluntaria del embarazo: relación con el entorno sanitario

To describe women's perception of health care after they decided to have a voluntary termination of pregnancy and their referral to the abortion clinic. Qualitative method, using semi-structured interviews carried out between April and June 2005. Primary Health Care District of Seville, Spain. Women living in the city of Seville and attending subsidized abortion clinics. Thirty-six women of varying ages and educational level were interviewed. The interview studied the assessment and information given by health professionals, and accessibility and use of family planning services. The results were analysed and triangulated with other studies and experts in the field. Most of the women interviewed were satisfied with the health care provided. Occasionally they perceived a bureaucratic attitude from physicians, who transmitted their disapproval and lack of support for an abortion decision. There were important differences in the way they were referred to abortion clinics, and in the information given to the women. Older women opted for private care, because this accelerated procedures and protected their privacy. Most women did not use family planning services before the abortion decision, except for requesting contraception. The study found there is a need to reduce the variety of patterns of care for women requesting an abortion, to speed up the proceedings and to train family doctors in assessment and information delivered to women during the process.