Society Of Gynecologic Oncology Research Articles

Rare tumors in gynecologic oncology fellowship: A novel, longitudinal integrated curriculum initiative

Rare tumors in gynecologic oncology fellowship: A novel, longitudinal integrated curriculum initiative

Rare tumors in gynecologic oncology fellowship: A novel longitudinal integrated curriculum (LIC) initiative

Rare tumors in gynecologic oncology fellowship: A novel longitudinal integrated curriculum (LIC) initiative

Beyond grades: Factors shaping academic career trajectory in gynecologic oncology fellowship applicants

Beyond grades: Factors shaping academic career trajectory in gynecologic oncology fellowship applicants

The road less traveled: A mixed methods study of patterns and perceptions of training timelines among gynecologic oncology fellowship applicants, trainees, and graduates

The road less traveled: A mixed methods study of patterns and perceptions of training timelines among gynecologic oncology fellowship applicants, trainees, and graduates

Unconscious bias in letters of recommendation for gynecologic oncology fellowship applicants impacts entry into the field

Unconscious bias in letters of recommendation for gynecologic oncology fellowship applicants impacts entry into the field

Opportunity for increasing applicant diversity in gynecologic oncology fellowship programs

Opportunity for increasing applicant diversity in gynecologic oncology fellowship programs

Cross-sectional survey of preparedness for gynecologic oncology fellowship among recent gynecologic oncology graduates

Cross-sectional survey of preparedness for gynecologic oncology fellowship among recent gynecologic oncology graduates

Comparison of parental leave policies available to gynecologic oncology fellows in the United States

Comparison of parental leave policies available to gynecologic oncology fellows in the United States

Pumping in the OR: A mixed-methods study of family-building and parenting among current and past gynecologic oncology fellows

Pumping in the OR: A mixed-methods study of family-building and parenting among current and past gynecologic oncology fellows

Abstract B161: Has much changed? A scoping review on the nature of racial/ethnic disparities in endometrial cancer research since the release of the Society of Gynecologic Oncology statement

Abstract Introduction: Endometrial cancer is prevalent in the United States and has well documented disparities across race and ethnicity. The Society of Gynecologic Oncology’s (SGO) 2014 review on racial/ethnic disparities in gynecologic cancers, including endometrial, ended with a call to action to increase research on endometrial cancer disparities and to shift focus from identification of disparities to solutions. With a decade passed since the publication, it is unknown how the landscape of research on racial/ethnic disparities in endometrial cancer has changed. Objectives: A scoping review was conducted to identify the nature of research on racial/ethnic disparities in endometrial cancer since the publication of the SGO review in 2014, including summarizing the proportion of studies that focused on disparities across patient, provider and systemic spheres. Secondarily, to understand the proportion and nature of studies that proposed a solution to the identified racial/ethnic disparities. Methods: Scoping review was designed following the PRISM-SCa protocol. MEDLINE, EMBASE and Web of Science were searched to identify relevant studies. Inclusion criteria included: publication following the SGO statement, in English, published in the United States, on human subjects, primary study, specifically mentioned a racial or ethnic disparity in endometrial cancer. Reviews, meta- analyses, and opinion pieces were excluded. Relevant studies were coded for nature of disparity and solutions offered using a standardized data abstraction tool. Results: 182 studies were included, 141 (77.5%) focused on racial disparities, 34 (18.8%) on racial and ethnic, and 7 (3.8%) on ethnic, mainly Hispanic. Of those, 138 (75.8%) focused only on Black or African American disparities. When evaluating the level at which the disparity was identified, 116 (63.7%) were at the patient level, 25 (13.7%) at the provider level, 21 (11.5%) systemic, and 20 (11.5%) identified disparities on multiple levels. Half of the studies included offered solutions (91, 50.0%), however, the majority of the solutions suggested an increase in disparity research (32, 35.2%) and expanding clinical trials (15, 16.5%); many of these were included as further directions of the study itself. Other solutions included expanding access to health care (15, 16.5%), enhancing patient education (12, 13.2%), increasing patient participation in care (4, 4.4%), increasing diversity in the workforce (1, 1.1%), and other (12, 13.2%). Conclusions: Though much research on racial/ethnic disparities in endometrial cancer has been conducted since the SGO statement, many studies focused on patient-level factors instead of challenging provider/systemic level factors. When it came to a call to action, only half of the studies discussed a solution, the majority of which were included as future directions and suggested expansion of research. A small minority of articles outlined tangible solutions to the disparity discussed, leaving a continued need to shift research from identification of the disparity to creating solutions. Citation Format: Sarah Battiston, Victoria Kelley, Molly Wilson, Morolayo Ilori, Katerina Furman, Layla Hak, Madison Miller. Has much changed? A scoping review on the nature of racial/ethnic disparities in endometrial cancer research since the release of the Society of Gynecologic Oncology statement [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B161.

Early-career and fellow gynecologic oncologists perceive underpreparedness for the business of medicine: A Society of gynecologic oncology survey study

ObjectiveThere is a research gap on the impact of payment, reimbursement, and academic productivity in career decision-making for early-career (EC) attendings in gynecologic oncology. We sought to assess gynecologic oncology fellows and EC attendings on their knowledge and perceptions regarding the business of medicine. MethodsAn anonymous survey was electronically disseminated to fellow and EC SGO members. Key themes were the business of medicine, productivity, and compensation/negotiation. A 5-point Likert scale was utilized; descriptive statistics were calculated using SPSS. ResultsThere was a 29 % response rate: 82 fellows and 102 EC attendings. Most were white (n = 143, 78 %) and female (n = 138, 75 %.) Most fellows (n = 67, 82 %) were interested in, and most EC (n = 82, 82 %) were employed in, academic/non-private practice. Fellows and EC attendings reported insufficient education on RVUs (relative value units) and reimbursement (80 %, n = 66; 81 %, n = 83) and did not feel prepared for the business aspect of practice (80 %, n = 66; 73 %, n = 75). Over 40 % of fellows did not understand how RVUs relate to practice. Thirty-three percent of EC attendings did not understand RVU assignments; 29 % were satisfied with methods used to determine productivity, and 17 % did not understand their compensation. Over 60 % of fellows felt unprepared to negotiate clinical productivity expectations. For EC attendings, 47 % were uncomfortable negotiating clinical expectations, 32 % negotiating academic expectations, and 52 % negotiating compensation changes. Female EC felt less prepared than male EC regarding the business of medicine (p = 0.02), RVU assignments (p < 0.01), and compensation negotiations (p < 0.01). ConclusionMost gynecologic oncology fellows and early-career attendings do not feel prepared for the business of medicine. Women were less comfortable with these concepts than men. Formal education should be incorporated into career development curricula.

Global distribution and career outcomes of international fellows trained in Canadian gynecologic oncology programs

ObjectiveWe assessed the global distribution and academic, administrative and research outcomes of international fellows (IFs) trained in Canadian gynecologic oncology (GO) programs. MethodsA web-based survey was sent to IFs who completed GO training in Canada. Using the Web of science database, we identified the publication list, citation record and H-index of IFs and classified them according to their region of practice: high-income countries (HIC), middle income countries (MIC), and low-income countries (LIC). ResultsFrom 1996 to 2020, 81 IFs from 23 countries were trained in English-speaking (62,9%) and French-speaking Canadian universities (37,1%). Most IFs came from HIC (87,6%) and none from LIC. Only 12 IFs (14,8%) are now practicing in Canada. Of the 55 IFs who completed the survey (response rate: 67,9%), the majority (58,2%) reported working in an academic hospital and 29,1% were holding an executive position in a national scholar organization. IFs participated in mentoring residents (96.4 %) and medical students (83,6%) and 36,3% initiated a GO fellowship program in their home country. 67,3% of IFs were involved in international research collaboration and 52,7% participated in international clinical trials. The mean number of publications (22,36 vs 7,75, p = 0.007), citations (369,15 vs 45,12 p = 0.0006) and H-Index (6,88 vs 2,37 p = 0.0001) were significantly higher among IFs working in HIC compared to those in MIC. Most IFs (98,2%) recommended their Canadian GO fellowship program to a colleague from their home country. ConclusionMost IFs trained in Canadian GO fellowship programs returned to their home countries and achieved important milestones in terms of academic, clinical and research accomplishments.

Advanced endometrial cancer—The next generation of treatment: A society of gynecologic oncology journal club clinical commentary

In February of 2024, the Society of Gynecologic Oncology (SGO) hosted a journal club focused on new treatment options for the management of advanced and metastatic endometrial cancer. This clinical commentary is intended to provide a summary report of that presentation. The session described the importance of molecular characterization shown in the work of The Cancer Genome Atlas (TCGA). The updated 2023 FIGO staging of endometrial cancer was reviewed. The panel then described the role of upfront immunotherapy for the treatment of advanced or recurrent endometrial cancer as demonstrated in four recent trials (RUBY, NRG-GY018, AtTEnd, and DUO-E studies). The DUO-E study uniquely examined the combination immunotherapy with a PARP inhibitor. The trials had unique differences in inclusion criteria, primary outcomes, and length of maintenance therapy, but all boasted similarly promising results particularly in mismatch repair deficient (dMMR) endometrial cancer. This era of rapid innovation in advanced and recurrent endometrial cancer will hopefully enhance individualized treatment approaches and improved outcomes for patients with endometrial cancer.

Technology enhanced multidisciplinary cancer conferences in gynecologic oncology.

e13652 Background: Multidisciplinary Cancer Conferences (MCCs) improve quality of care and patient outcomes. The goals of our study were to investigate the impact of an information technology platform, Navify Tumor Board Solution (NTBS) on the (1) efficiency of preparing and conducting MCCs and (2) educational quality of the gynecologic oncology MCCs. Methods: We conducted a prospective, mixed methods study involving participants of the biweekly gynecologic oncology MCC at a comprehensive cancer center. NTBS was introduced to the gynecologic oncology MCC for the preparation and presentation of tumor board cases. Data were collected before and after the introduction of NTBS. We used a validated observational tool to assess the impact of the platform on the quality of case presentation and discussion, as well as decision making (as measured by a composite mean score). We also evaluated compliance of care plans with national guidelines, changes in care plans, and concordance of actual treatment received with MCC recommendations. The survey consisted of five qualitative and two demographic questions. Interviews lasting 10 minutes were recorded using Microsoft Teams. Analyses were conducted using SAS v9.4 (Cary, NC) and Dedoose v9.0.17, (Los Angeles, CA). Results: Pre- and Post-NTBS cohorts consisted of 49 and 60 patients, respectively. When comparing pre- versus post-NTBS cohorts, there was a difference in the mean composite score (50.57 vs 54.11; p=0.016). While there was no statistical difference between cohorts, patient care plans were changed in 13% of the cases and were 92% concordant with treatment received. Additionally, MCC recommendations were 100% compliant with national guidelines. Surveys of 13 MCC participants revealed that post-NTBS, the presentation format was more cohesive, concise, and structured. Common themes from gynecologic oncology fellows’ responses included improvement of case preparation time and simplified process while using NTBS. However, trainees reported limited use of NTBS features, difficulty incorporating graphical, and lack of a comprehensive list of NCCN guidelines. All respondents had educational goals for their participation and reported a high educational value of the MCC. These goals included knowledge acquisition of clinical diagnosis, management of standard of care versus complex situations, sentinel clinical trials underlying NCCN treatment guidelines, primary literature review, management of preparation time and flow of discussion, and preparation for oral boards. Conclusions: NTBS contributed positively to the gynecologic oncology MCC and clinical care for patients. Overall, NTBS had a positive impact on case formatting, preparation time and quality of trainee education. Comprehensive user training in the NTBS features could further enhance its utilization within the MCC.

A national survey of obstetrics and gynecology resident perspectives on their preparedness to provide care for racially and socioeconomically diverse gynecologic oncology populations.

9037 Background: Despite 83% female representation, Obstetrics and Gynecology (Ob/Gyn) lags behind other residencies in racial diversity, with 35.2% of trainees classified as Underrepresented in Medicine (URM). Fellowships are markedly less diverse, with Gynecologic Oncology representing 26.1% URM. While studies have examined Ob/Gyn residents’ self-perceived preparedness for surgical skills, little is known about their confidence in treating vulnerable patients with gynecologic malignancies. This survey assessed resident confidence in providing Gynecologic Oncology care to patient populations diverse in racial/ethnic background and insurance status, while accounting for residents’ own racial/ethnic backgrounds. Methods: An anonymous, novel Qualtrics survey was disseminated to current US Ob/Gyn residents, to elicit their self-reported preparedness to provide NCCN guideline-based care to diverse Gynecologic Oncology patient populations. Subjects were asked multiple-choice questions to record their own demographics followed by Likert scale questions which ranged from strongly disagree (1) to strongly agree (5) regarding their perceived readiness to care for patients diverse in insurance and racial background. Differences in responses between racial groups were analyzed using the Kruskal-Wallis Rank Sum test while differences in responses between ethnic groups were evaluated using the Wilcoxon Rank Sum test. Results: 207 residents complete the survey, mirroring sample sizes of national surveys of Ob/Gyn residents. There was no statistical difference in self-perceived preparedness between Hispanic and non-Hispanic Ob/Gyn residents regarding providing care for diverse racial minorities (mean Likert Non-Hispanic = 4.1 vs. Hispanic = 4.2; p = 0.222) or insurance types (mean Likert Non-Hispanic= 4.0 vs. Hispanic = 4.0; p=0.563). There was a significant difference in the number of Hispanic residents who felt that patients with Medicaid insurance experienced more difficulty obtaining non-operative gynecologic care compared to those with other insurance types (Hispanic = 3.7 vs. non-Hispanic = 3.2; p = 0.044). Further, there was a significant difference in the number of Hispanic residents who felt that patients with Medicaid insurance had to wait longer for outpatient appointments with a gynecologic oncologist (Hispanic = 3.6 vs. non-Hispanic = 3.0; p=0.016). Conclusions: All Ob/Gyn residents will encounter, screen for, and diagnose gynecologic malignancies, regardless of pursuit of Gynecologic Oncology fellowship. This study evaluated Ob/Gyn resident perceptions, finding that they feel overall prepared to provide Gynecologic Oncology care to socioeconomically diverse patient populations, though differences exist when residents are compared based on their backgrounds.

Quality of care measurement for patients with ovarian cancer in Japan.

Quality of care is important to reduce disease progression, and improve both survival and quality of life. The Japan Society of Gynecologic Oncology has published treatment guidelines to promote standardized high-quality care for ovarian cancer in Japan. We developed quality indicators based on the guideline recommendations and used them on large datasets of health service use to examine the quality of ovarian cancer care. A panel of experts developed the indicators using a modified Delphi method. Adherence to each indicator was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2018. All patients receiving first-line treatment at participating facilities were included. The adherence rates were returned to participating hospitals, and reasons for nonadherence were collected. A total of 580 hospitals participated, and the study examined the care received by 6611 patients with ovarian cancer and 1879 with borderline tumors using 11 measurable quality indicators. The adherence rate ranged from 22.6% for "Estrogen replacement within 6 months of operation" to 93.5% for "Bleomycin, etoposide, and cisplatin for germ cell tumor more than Stage II." Of 580 hospitals, 184 submitted the reasons for nonadherence. The quality of ovarian cancer care should be continuously assessed to encourage the use of best practices. These indicators may be a useful tool for this purpose.

Surgical training of gynecologic oncology fellows: Long-term trends and implications for future education

ObjectivesThe surgical training of gynecologic oncology (GO) fellows is critical to providing excellent care to women with gynecologic cancers. We sought to evaluate changes in techniques and surgical volumes over an 18-year period among established GO fellowships across the US. MethodsWe emailed surveys to 30 GO programs that had trained fellows for at least 18 years. Surveys requested the number of surgical cases performed by a fellow for seventeen surgical procedures over each of five-time intervals. A One-Way Analysis of Variance was conducted for each procedure, averaged across institutions, to examine whether each procedure significantly changed over the 18-year span. Results14 GO programs responded and were included in the analysis using SPSS. We observed a significant increase in the use of minimally invasive (MIS) procedures (robotic hysterectomy (p < .001), MIS pelvic (p = .001) and MIS paraaortic lymphadenectomy (p = .008). There was a concurrent significant decrease in corresponding “open” procedures. There was a significant decrease in all paraaortic lymphadenectomies. Complex procedures (such as bowel resection) remained stable. However, there was a wide variation in the number of cases reported with extremely small numbers for some critical procedures. ConclusionsThe experience of GO fellows has shifted toward increased use of MIS. While these trends in care are appropriate, they do not diminish the need in many patients for complex open procedures. These findings should help spur the development of innovative training to maintain the ability to provide these core, specialty-defining procedures safely.

Impact of the Coronavirus Disease 2019 pandemic on neoadjuvant chemotherapy use in patients diagnosed with epithelial type ovarian cancer.

The Coronavirus Disease 2019 (COVID-19) pandemic posed critical challenges in providing care to ovarian cancer (OC) patients, including delays in OC diagnosis and treatment initiation. To accommodate for delays in OC surgery, the Society of Gynecologic Oncology (SGO) recommended preferential use of neoadjuvant chemotherapy during the pandemic. The purpose of this study was to assess the association of the COVID-19 pandemic with neoadjuvant chemotherapy use in patients diagnosed with OC. This retrospective cohort study included patients diagnosed with stage II-IV ovarian cancer of epithelial subtype between 01/01/2017-06/30/2021 at Kaiser Permanente Southern California (KPSC), a large integrated healthcare system in the United States. Ovarian cancer patients diagnosed between 2017-2020 were identified from KPSC's Surveillance, Epidemiology, and End Results (SEER)-affiliated cancer registry. Patients diagnosed in 2021 were identified from the electronic medical records (EMR) using ICD-10 diagnosis codes, followed by medical chart review to validate diagnosis and extract information on histology and stage at diagnosis. March 4, 2020 was used as the cut-off to define pre-pandemic and pandemic periods. Patients diagnosed with COVID-19 between OC diagnosis and treatment completion were excluded. Data on neoadjuvant chemotherapy use were extracted from the cancer registry and EMR, supplemented by chart review. Modified Poisson regression was used to evaluate the association of the pandemic with neoadjuvant chemotherapy use. Of 566 OC patients, 160 (28.3%) were diagnosed in the pandemic period. Patients diagnosed in the pandemic period were slightly younger (mean age 62.7 vs 64.9 years, p=0.07) and had a higher burden of Charlson comorbidities (p=0.05) than patients diagnosed in pre-pandemic period. No differences in time to treatment initiation were observed by pandemic periods. Neoadjuvant chemotherapy use was documented in 58.7% patients during the pandemic period compared to 47.3% in pre-pandemic period (p=0.01). After adjusting for covariates, patients diagnosed in the pandemic period were 29% more likely to receive neoadjuvant chemotherapy than patients diagnosed in pre-pandemic period [RR(95%CI): 1.29(1.12-1.49)]. Ovarian cancer patients diagnosed in the COVID-19 pandemic were more likely to receive neoadjuvant chemotherapy than patients diagnosed before the pandemic. Future research on patient outcomes and trends in the post-pandemic period are warranted.

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines.

Surgical site infections (SSIs) refer to infections in the incision, organ, or postoperative space. As common healthcare-associated infections, SSIs correlate with prolonged hospital stay, additional procedures, ICU stay, and higher mortality rates. Around 8-10% of gynecologic surgery patients may experience infectious complications, influenced by microbial contamination, surgical nature, and patient factors. The goal of this narrative review is to compare and merge recommendations from globally published guidelines concerning the utilization of antibiotics in the perioperative phase. A comparative descriptive/narrative review of the guidelines issued by the American College of Obstetrics and Gynecology (ACOG), Society of Obstetricians and Gynecologists of Canada (SOGC), Royal College of Obstetricians and Gynecologists (RCOG), National Institute for Health and Care Excellence (NICE), Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG), European Society of Gynecologic Oncology (ESGO), Société Française d' Anésthesie et de Réanimation (SFAR), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and Hellenic Society of Obstetrics and Gynecology (HSOG) was conducted. For hysterectomy, first/second-generation cephalosporins are suggested, with metronidazole as an option. Laparoscopy without entering the bowel or vagina typically does not require prophylaxis. Uterine evacuation and hysteroscopy may involve doxycycline or azithromycin based on risk factors, whereas, for vulvectomy, cefazolin is recommended. Urogynecology procedures may include cefazolin with metronidazole. In cases of penicillin allergy, cephalosporins are suggested, and, for obese patients, adjusted doses are advised. Additional doses may be needed for prolonged procedures or excessive blood loss. Timing recommendations are 15-60 min before incision, adjusting for specific antibiotics. Clear indications exist for certain surgeries like hysterectomy, termination of pregnancy, and urogynecologic procedures. Conversely, procedures such as intrauterine device insertion, hysteroscopy, and laparoscopy typically do not necessitate antibiotic prophylaxis. For several other procedures, the evidence is inconclusive, while considering dose, timing, and indications can mitigate infectious complications and provide benefits for the healthcare system.

Ovarian cancer management in an ESGO ovarian cancer center of excellence: a systematic case study of the interprofessional and interdisciplinary interaction

PurposeWith growing knowledge about ovarian cancer over the last decades, diagnosis, evaluation and treatment of ovarian cancer patients have become highly specialized, and an individually adapted approach should be made in each woman by interdisciplinary cooperation. The present study aims to show the variety and extent of medical specialties involved at our institution according to the European Society of Gynecologic Oncology (ESGO) Quality indicators (QI).MethodsA woman, diagnosed with high-grade ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) class IVb was selected for a single case observational study. The observation period (total = 22d) comprised preoperative diagnostic procedures, including imaging, the in-patient stay for cytoreductive surgery, and the postoperative course and case discussion at our interdisciplinary tumor board. Data were obtained by self-reporting and by patient file review.ResultsPatient tracking demonstrated an interdisciplinary cooperation of 12 medical specialties [62 physicians (63% male, 37% female)], 8 different types of nursing staff [n = 59 (22% male, 78% female)], and 9 different types of perioperative/administrative staff (n = 23; male 17,4%, female n = 19, 82,6%). Contact with the patient was direct (n = 199; 76%) or without face-to-face interaction (n = 63; 24%).ConclusionThe present study demonstrates the high diversity of physicians and the affiliated medical staff, as well as interdisciplinary intersections within teams of a specialized hospital. Matching the ESGO QIs, this report underlines the requirement of an adequate infrastructure for the complex management of advanced ovarian cancer patients.Future prospective studies are warranted to evaluate the specific procedures and actions to optimize the interprofessional and interdisciplinary workflows.