Society Of Gynecologic Oncology Research Articles

The impact of delayed surgical treatment of suspected stage I ovarian cancer: lessons for a pandemic

Objectives: During the COVID-19 pandemic, the Society of Gynecologic Oncology and other medical societies provided guidelines about acceptable delays in oncologic treatments for patients with a suspected malignancy. The objective of this study was to characterize the association between timing of treatment and survival and to evaluate how extended delays to guideline-concordant treatment for suspected stage I high grade serous ovarian cancer might impact survival. Methods: Using the National Cancer Data Base (2004-2015), patients surgically treated for clinical stage I high grade serous ovarian cancer were identified. Patients receiving surgery within 14 days of diagnosis were compared to those receiving surgery 2-4 months after diagnosis. The groups were propensity matched with 2:1 matching to balance baseline characteristics. Survival outcomes of the two cohorts were assessed using Kaplan-Meier analysis, the log-rank test, and multivariable Cox proportional hazards analysis. Results: During the study period, 10,957 patients underwent guideline-concordant surgery for stage I high-grade serous ovarian cancer within 14 days of diagnosis (early) and 171 patients underwent surgery 2-4 months following diagnosis (delayed). Between patients in the early versus delayed treatment groups, the delayed group was more likely to be Black (5.3% vs 11.8%, p=0.003) and have a smaller tumor size (8.0 vs. 6.2 cm, p Download : Download high-res image (81KB) Download : Download full-size image Conclusions: In this national analysis, extended delay of treatment for stage I high grade serous ovarian cancer was associated with similar survival outcomes when compared to timely treatment in pre-match and post-match cohorts. In the setting of the COVID-19 pandemic, where hospital resources may be limited, delays in surgery are concerning and prompt oncologic treatment is preferred; however, at least based on these retrospective data, delays in surgery for presumed stage I ovarian cancer may not be associated with significantly worse survival.

Patterns of genetic testing for women recently diagnosed with uterine cancer

<h3>Objectives:</h3> Genetic profiling is rapidly emerging as standard of care for women diagnosed with uterine cancer. Optimal strategies for ensuring that genetic profiling is performed in a timely manner and that uterine cancer patients understand genetic implications of their disease remain unclear. The primary objective of this study was to profile patterns of genetic testing and counseling performed by gynecologic oncologists actively practicing in the United States and identify potential barriers for effectively incorporating genetic counseling into care of their uterine cancer patients. <h3>Methods:</h3> With institutional review board (IRB) permission, a 31-question survey was emailed to active Society of Gynecologic Oncology (SGO) members. The survey evaluated demographic characteristics, practice setting, and contained questions examining practice patterns for both somatic and germline testing in newly diagnosed uterine cancer patients. All responses were anonymous. Associations between categorical variables and endpoints were analyzed using Chi-square or Fisher's exact tests. <h3>Results:</h3> Responses were received from 184 of 2178 active SGO members. Of these, 146 were complete and included in subsequent analyses. Mean age of respondents was 41 years. 34.2% (50/146) reported practicing >10 years. 51.4% of respondents (75/146) reported practicing in university-based academic settings, while the remaining practitioners (71/146; 48.6%) see patients in community-based settings. Trainees comprised a significant proportion of survey respondents, especially in academic settings (28/75 academic [37.0%] vs 5/71 community [7.0%], p<0.0001). 138/146 respondents reported screening for Lynch syndrome, and most of these (119/138; 86.2%) reported screening all or almost all newly diagnosed endometrial cancer patients. Screening strategies included mismatch repair gene evaluation on endometrial biopsy or hysterectomy specimens. Over 90% reported that they screened all grades of endometrioid histologic subtypes. Carcinosarcoma, clear cell, and serous subtypes varied in frequency of screening (61.0% to 71.2%). Academic practices were more likely to review results of Lynch syndrome genetic screening at a tumor board (82.7% vs 67.6%, p=0.04), and report that they had a genetic tumor board (24.0% vs 8.4%, p=0.02). 53.3% of participants (65/122) indicated interest in a separate genetics tumor board if they did not have one. A significant proportion of trainees in academic settings (18.7% vs 1.4% community, p<0.01) reported that they directly conveyed genetic testing results to patients. <h3>Conclusions:</h3> Gynecologic oncologists are actively involved in genetically profiling and counseling uterine cancer patients. Clinical trainees are frequently involved in genetic counseling of recently diagnosed uterine cancer patients, particularly at academic medical centers. Both observations underscore the importance of incorporating adequate training in genetics and genetic counseling into postgraduate education of trainees in our field.

Current perspectives of gynecologic oncology fellowship training and preparedness for practice

<h3>Objectives:</h3> The field of gynecologic oncology practice has evolved over decades, yet there is little known on how current fellowships are preparing gynecologic oncologists for practice in the era of these changes. Thus, we sought to investigate gynecologic oncology fellowship graduates' training experience and preparedness for practice following fellowship. <h3>Methods:</h3> This is a cross-sectional web-based survey study using REDCap, an electronic web-based application. We surveyed members of the Society of Gynecologic Oncology (SGO) who graduated from gynecologic oncology fellowship in 2015-2020. Email invitations to participate were sent with de-identified survey links. The survey included 51 questions assessing fellowship training experiences and level of comfort in performing core gynecologic oncology surgical procedures and administering cancer-directed therapies, including chemotherapy, immunotherapy, and PARP inhibitors. Additional questions addressed factors driving participants' selection of fellowship programs, education experience, research and preparedness for independent practice. Descriptive statistics were used for analyses. <h3>Results:</h3> A total of 297 SGO members were invited to participate, one was excluded due to a non-working email. The response rate was 43.9% (n=130) and n=123 completed surveys were included for final analysis. Over half (55.2% n=68) of responders were in their first 3 years of independent practice. The highest ranked factor for fellowship selection was fit with program (36.6% n=45) followed by surgical volume (29.3% n=36). Upon completing fellowship, most were uncomfortable performing radical surgeries in ureteral conduit formation (83.8% n=103), ureteroneocystostomy (76.4% n=94), exenteration (67.5%, n=83), splenectomy (66.7% n=83) and lower anterior bowel resection (41.5%, n=51). Most were comfortable managing intraoperative complications (84.5% n=104) and obstetrical hemorrhages (88.6% n=109), as well as standard open and minimally invasive staging (range: 61%-99.2%). More than half of those who did not have off-service surgical rotations in fellowship indicated they would have wanted rotations in surgical oncology (58% n=58), urology (57% n=59) and colorectal surgery (71.5% n=73) in fellowship training. Majority of respondents (91.1% n=112) used cancer-directed therapies in their current practice and were most uncomfortable managing immunotherapy side effects (30.1% n=37). Over a third (34.1% n=42) were somewhat or not confident that their fellowship thesis project will be suitable for oral boards defense and 22.8% (n=28) were unprepared to continue research in their career. Upon completing fellowship, 77.2% (n=95) report having mentorship that met their expectations during fellowship and 94.4% (n=116) overall were prepared for independent practice as gynecologic oncologists. <h3>Conclusions:</h3> Majority of recent gynecologic oncology fellowship graduates were prepared for independent practice and felt comfortable performing routine surgical procedures. However, most are not comfortable with radical gynecologic oncology surgeries; for this reason mentorship in early gynecologic oncology faculty development remains important. Many graduates also desired incorporating non-gynecologic oncology surgery service experience during fellowship, which could help supplement this discrepancy for less common procedures.

Listening to our peers so we can listen to our patients: a survey of racism experienced by gynecologic oncologists

<h3>Objectives:</h3> To examine the role of race and ethnicity in the professional experiences and development of physicians in gynecologic oncology. <h3>Methods:</h3> We conducted a survey of US physician members of the Society of Gynecologic Oncology. Participants were queried about demographics, perceived role of their self-identified race and ethnicity on daily professional activities, development, and experiences with discrimination. Responses were collected on a continuous scale from 0-100, where 0 is strongly disagree and 100 is strongly agree. For the analysis, we dichotomized the continuous response to a binary outcome where the collected response > 50 is 1, and 0 otherwise. All survey responses and demographic and outcome questions were analyzed descriptively using frequency (percent). The outcome questions were also summarized by whether participant self-identified as White/non-White, and chi-square and Fisher's exact tests were performed to test independence. <h3>Results:</h3> The survey was sent to 1455 members; 21% (309) responded. A total of 80 respondents were excluded because none of the outcome questions were answered. Of the 229 remaining respondents, 69% (159) were female. A total of 78 percent (178) identified as White/Caucasian, 11% (26) as Black, 1% (2) as American Indian or Alaska Native, 10% (22) as Asian, and 5% (11) as Hispanic/Latino. Median age was 42 years (range, 30-82). A total of 14 (32) were trainees. Demographics can be found in Table 1. Non-white respondents (NW) were more likely to report negative experiences in their medical training and/or professional career (p<0.01) and experiences with discrimination at work (p<0.01) as a result of their racial/ethnic background. NW were also more likely to report their race/ethnicity affected interactions with their peers or trainees, staff, and patients (p=0.004). When asked about race/ethnicity contributing to inconsistent professional expectations, there was no reported difference between White and NW participants (p=0.2). However, NW were more likely to suspect their racial/ethnic background negatively impacted their ability to be promoted or considered for job opportunities (p<0.001) and felt their actions/outcomes were unfairly critiqued because of their race/ethnicity (p<0.001). More NW participants reported feeling like an outsider in social interactions at work (p=0.004) and often felt they could not relate to their colleagues (p=0.002). However, there was no difference among respondents regarding reported social and professional support within and outside the workplace (p=0.9 and p=0.5, respectively) or with difficulty finding mentorship (p=0.6). A total of 85% of respondents, regardless of race, felt there is a need for increased diversity amongst gynecologic oncologists, and 66% indicated they were comfortable talking about issues of race; 65% believed race often negatively influences the care minority patients receive; 71% of felt compelled to protect minority patients; and 68% felt compelled to protect minority trainees. There was no statistically significant difference between White and NW participants for any of these questions. <h3>Conclusions:</h3> Gynecologic oncologists appear to have different professional experiences associated with their race/ethnicity. NW respondents more commonly report negative and discriminatory experiences. However, in this national survey, gynecologic oncologists across all race/ethnicities recognize the inequalities and disparities that exist and appear to be motivated to address them.

Provider perception of racial healthcare disparities among women with gynecologic malignancies

Objectives: To identify patterns in provider perception of healthcare disparities among black patients with gynecologic malignancies. Methods: An anonymous survey was distributed among the US physician members of the Society of Gynecologic Oncology. Participants were queried about demographics and their perceptions of healthcare disparities among patients with gynecologic malignancies. Responses to the outcome questions were collected on a continuous scale from 0-100, where 0 represented ‘strongly disagree’ and 100 represented ‘strongly agree’. For the analysis, we dichotomized the continuous response to a binary outcome where the collected response >50 is 1, and 0 otherwise. All survey responses, demographic and outcome questions, were analyzed descriptively using frequency (percent). The outcome questions were also summarized by whether the participant self-identified as white/non-White. Chi-square and Fisher's exact tests were performed to test independence. Results: A total of 229 responses to the survey were analyzed. Of the respondents, 74% identified as White/Caucasian, 10% identified as Black/African American, 2.2% identified as Hispanic or Latino, 8.7% identified as Asian, 0.4% identified as American Indian or Alaskan native, and 3.9% identified as mixed race. A total of 31% of respondents were male and 69% female. Irrespective of their own identified race, respondents felt strongly that Black women with gynecologic malignancies have worse outcomes than White women, with 94% of respondents with a score >50. However, respondents remained more neutral when queried about their own black patients’ outcomes, with only 48% of respondents answering with a score >50. This did not vary when comparing white to non-white respondents (p=0.9). When queried about the 2 most significant contributors to poor outcomes among Black patients, 70% of respondents cited socioeconomic status. Other cited contributors included systemic racism (58%), distrust of the medical field (49%), unconscious bias/prejudice (47%), education/health literacy (45%), and intrinsic biological differences (31%). A total of 86% agreed that they could contribute to addressing healthcare disparities (87% responding >50 for white respondents vs 84% responding >50 for non-white respondents; p=0.8). Non-white respondents were more likely than white respondents to disagree that their institutions have measures to address healthcare disparities in black women (73% responding <50 vs 47%, respectively; p=0.002). The most commonly cited metric addressing disparities at respondents’ respective institutions was cancer care navigation, cited by 67% of respondents, followed closely by financial navigation at 64%. These measures were more often identified by white/Caucasian respondents vs non-white (cancer care navigation 72% vs 48%, financial navigation 68% vs 45%). A total of 35% of respondents cited disease prevention and enhanced screening programs as a measure to address disparities in black patients at their institutions. Community outreach was cited as a measure by 59% of the respondents; however, this was cited more by white/Caucasian respondents than non-white respondents (63% vs 41%). Conclusions: Though most respondents agreed that Black patients have worse oncologic outcomes, most did not perceive these issues within their own patients. There remains room for improvement in the identification of healthcare disparities within our own patients and implementation of well-studied measures used to address these gaps in outcomes. To identify patterns in provider perception of healthcare disparities among black patients with gynecologic malignancies. An anonymous survey was distributed among the US physician members of the Society of Gynecologic Oncology. Participants were queried about demographics and their perceptions of healthcare disparities among patients with gynecologic malignancies. Responses to the outcome questions were collected on a continuous scale from 0-100, where 0 represented ‘strongly disagree’ and 100 represented ‘strongly agree’. For the analysis, we dichotomized the continuous response to a binary outcome where the collected response >50 is 1, and 0 otherwise. All survey responses, demographic and outcome questions, were analyzed descriptively using frequency (percent). The outcome questions were also summarized by whether the participant self-identified as white/non-White. Chi-square and Fisher's exact tests were performed to test independence. A total of 229 responses to the survey were analyzed. Of the respondents, 74% identified as White/Caucasian, 10% identified as Black/African American, 2.2% identified as Hispanic or Latino, 8.7% identified as Asian, 0.4% identified as American Indian or Alaskan native, and 3.9% identified as mixed race. A total of 31% of respondents were male and 69% female. Irrespective of their own identified race, respondents felt strongly that Black women with gynecologic malignancies have worse outcomes than White women, with 94% of respondents with a score >50. However, respondents remained more neutral when queried about their own black patients’ outcomes, with only 48% of respondents answering with a score >50. This did not vary when comparing white to non-white respondents (p=0.9). When queried about the 2 most significant contributors to poor outcomes among Black patients, 70% of respondents cited socioeconomic status. Other cited contributors included systemic racism (58%), distrust of the medical field (49%), unconscious bias/prejudice (47%), education/health literacy (45%), and intrinsic biological differences (31%). A total of 86% agreed that they could contribute to addressing healthcare disparities (87% responding >50 for white respondents vs 84% responding >50 for non-white respondents; p=0.8). Non-white respondents were more likely than white respondents to disagree that their institutions have measures to address healthcare disparities in black women (73% responding <50 vs 47%, respectively; p=0.002). The most commonly cited metric addressing disparities at respondents’ respective institutions was cancer care navigation, cited by 67% of respondents, followed closely by financial navigation at 64%. These measures were more often identified by white/Caucasian respondents vs non-white (cancer care navigation 72% vs 48%, financial navigation 68% vs 45%). A total of 35% of respondents cited disease prevention and enhanced screening programs as a measure to address disparities in black patients at their institutions. Community outreach was cited as a measure by 59% of the respondents; however, this was cited more by white/Caucasian respondents than non-white respondents (63% vs 41%). Though most respondents agreed that Black patients have worse oncologic outcomes, most did not perceive these issues within their own patients. There remains room for improvement in the identification of healthcare disparities within our own patients and implementation of well-studied measures used to address these gaps in outcomes.

Performance characteristics of brief family history questionnaire to screen for Lynch syndrome in women with newly diagnosed ovarian cancers

<h3>Objectives:</h3> Ovarian cancer (OC) is the third most common Lynch syndrome (LS)-associated cancer in women but there is no established screening strategy to identify LS in this population. In centers without access to universal tumor immunohistochemistry (IHC) testing for mismatch repair (MMR) deficiency, family history may identify patients with OC suspected of LS, prompting a referral to genetic counseling. We have previously developed and shown that patient-administered 4-item brief Family History Questionnaire (bFHQ) can effectively identify women with confirmed LS in those with newly diagnosed endometrial cancers. The objective of this study was to assess whether bFHQ can be used as a screening tool to identify women with OC at high risk of LS. <h3>Methods:</h3> Prospective cohort study recruited women with newly diagnosed non-serous/non-mucinous OC from three cancer centers in Ontario, Canada. Participants completed bHFQ, extended Family History Questionnaire (eFHQ; encompassing Amsterdam II criteria, Society of Gynecologic Oncology 20-25% criteria and Ontario Ministry of Health criteria), IHC for MMR proteins and universal germline testing (reference standard) for LS. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) were compared between the family history screening strategies and MMR IHC to identify LS. <h3>Results:</h3> Of 215 women, 169 (79%) were evaluable with both bFHQ and germline mutation status; 12 of these 169 were confirmed to have LS (7%). Median age was 53 years (range 21-71), and for all 12 patients with LS, OC was their sentinel malignancy (100%). Nine of 12 patients (75%) with LS were correctly identified by bFHQ, compared to 6 of 11 (55%) by eFHQ and 11 of 13 (85%) by IHC. The sensitivity, specificity, PPV and NPV values of bFHQ were 75%, 66%, 15% and 98%, compared to 55%, 92%, 35% and 96% for eFHQ and 85%, 90%, 39% and 99% for IHC respectively (Table 1). IHC was the most sensitive and specific approach. The 4-item bFHQ was more sensitive than eFHQ and took less than 10 minutes for each patient to complete. <h3>Conclusions:</h3> Patient-administered bFHQ may serve as an adequate screening tool to triage women with OC for further genetic assessment for LS, especially in centers without access to universal tumor testing for IHC for MMR or microsatellite instability.

The gynecologic oncologist as the HPV champion: missed opportunities for cancer prevention

Objectives: The Human Papillomavirus (HPV) vaccine is FDA approved up to age 45 and emerging evidence suggests it may prevent recurrent infections. This has important implications for patients commonly seen by gynecologic oncologists. Our objective was to describe factors that influence HPV vaccine recommendation amongst gynecologic oncologists and identify barriers and missed opportunities for vaccination. Methods: A pilot-tested online survey was electronically sent to all members of the Society of Gynecologic Oncology in the U.S. Questions evaluated the following domains: demographics, practice patterns, barriers and knowledge regarding the HPV vaccine. We defined HPV vaccine champions as providers who both recommended and either administered, stocked or prescribed the vaccine in the outpatient setting, and surveyed their practice patterns to identify possible missed opportunities for vaccination. Descriptive statistics were used to calculate the rate of HPV vaccine recommendation, explore barriers to vaccination and identify practice patterns. Univariate logistic regression was used to identify factors associated with vaccine recommendation. Results: A total of 183 gynecologic oncology providers completed the survey, representing 10% of invitations sent. Most were ≤ 45 years old (65%, n=99), practicing in urban (57%, n=105) and academic settings (67%, n=122). Eighty-one percent (n=147) had completed training, and of these, 68% (n=101) had been in practice for > 5 years. Ten percent (n=18/174) of respondents had not recommended the HPV vaccine in the past 12 months. Vaccine recommendation was associated with better HPV vaccine knowledge (Odds Ratio (OR) 1.7, 95% Confidence Interval (CI) 1.0-2.9), being a non-trainee (OR 3.8, CI 1.3-11.2) and practicing in the South (OR 10.8, CI 1.3-90.7). Among all providers, the most commonly reported barriers to vaccinating were that the patient's cancer diagnosis took precedence (88%, n=146/165), the cost to the clinic (48%, n=79/165), uncertainty about insurance coverage (43%, n=71/165) and that the vaccine history was not asked (48%, n=79/165). Forty eight percent (n=87) met criteria as HPV vaccine champions. Of those, 96% (n=78/81) at least sometimes offer the HPV vaccine at a visit for vulvar or cervical dysplasia. Eighty-three percent (n=67/81) offer it to patients with an HPV-related cancer diagnosis. In contrast, only 35% (n=29/82) were likely to offer it in a consultation for BRCA management and 28% (n=23/82) were likely to offer it at a surgical consultation for fibroids (Figure). Download : Download high-res image (89KB) Download : Download full-size image Conclusions: Gynecologic oncologists have a unique opportunity to educate and increase vaccination rates in eligible women. There are significant barriers to HPV vaccine administration in the gynecologic oncology office, and we identify examples of missed opportunities to vaccinate in non-HPV related clinical scenarios.

Impact of blinding interviewers to written application on ranking of applicants from underrepresented minorities (URM) in the gynecologic oncology fellowship match

<h3>Objectives:</h3> Preconceptions from application review in preparation for a professional interview may bias the professional interview. Biases may limit the access of underrepresented minorities (URM) to advanced medical training opportunities, such as subspecialty training. We evaluated whether blinding interviewers to applicants' written application was associated with difference in proportion of URM applicants ranked highly for our gynecologic oncology fellowship match compared to interviewers having reviewed written applications prior to the interviews. <h3>Methods:</h3> During our 2020 video Gynecologic Oncology interviews, we blinded one group of our interviewers to the written applications of the interviewees. Interviewers were able to visually interact with the candidates, but were blinded to the written aspects of the application, such as test scores and letters of reference. There were no opportunities to interact with the applicants before or after the interview, and interviewers submitted independent rank lists. Interviewers also did not know that they were being assessed as to ranking of URM candidates. We compared the pooled rankings of URM applicants of our blinded and non-blinded interviewers using a Medians Test and Mann-Whitney U test. <h3>Results:</h3> For 2 positions through the National Residency Program Match Process, we received 94 applications of which 18/94 (19%) were self-identified URM. Based on review of written application and minimum application criteria for our fellowship, we invited 36 applicants to interview and interviewed 30 over 6 half-day video sessions. A total of 11 of the 30 interviewees (37%) self-identified as URM. Of the eight faculty interviewers during each interview session, 3 or 4 were blinded to the written application. There was no statistically significant difference in rank order when comparing blinded to non-blinded reviewers overall. However, blinded interviewers were more likely to rank URM applicants towards the top of the rank list (p=0.05 Median Test, 0.044 Mann-Whitney U test). <h3>Conclusions:</h3> Interviewers blinded to written applications ranked URM applicants higher than interviewers who reviewed written applications prior to video interviews. Additional research is necessary to understand the etiology of this observed difference.

Factors associated with an increased risk of recurrence in patients diagnosed with high-grade endometrial cancer undergoing minimally invasive surgery: A study of the society of gynecologic oncology of Canada (GOC) community of practice (CoP)

BackgroundMinimally invasive surgery (MIS) is a standard surgical approach for comprehensive surgical staging in women with endometrial cancer. As rates and complexity of MIS are steadily increasing, it is important to identify potential risk factors which may be associated with this approach. This study evaluates the impact of local factors on the risk of disease recurrence. MethodsA retrospective cohort study was conducted of patients diagnosed with high grade endometrial cancer (HGEC) who underwent MIS between 2012 and 2016 at eight Canadian centers. Data was collected from medical records. The 75th percentile was calculated for estimated uterine volume and weight. All recurrences were categorized into two groups; intra-abdominal vs. extra-abdominal. To search for significant covariates associated with recurrence-free survival a Cox proportional hazard model was performed. ResultsA total of 758 patients were included in the study. Intra-uterine manipulator was used in 497 (35.8%) of patients. Vaginal lacerations were documented in 9.1%. Median follow-up was 30.5 months (interquartile range 20–47). There were 157 who had disease recurrence (20.71%), including 92 (12.14%) intra-abdominal and 60 (7.92%) extra-abdominal only recurrences. In univariate analysis myometrial invasion, LVI, stage, uterine volume and weight > 75th percentile and chemotherapy were associated with increased risk of intra-abdominal recurrence. In multivariable analysis only stage, and specimen weight > 75th percentile (OR 2.207, CI 1.123–4.337) remained significant. Uterine volume, and weight were not associated with increased risk of extra-abdominal recurrences. ConclusionFor patients diagnosed with HGEC undergoing MIS, extracting a large uterus is associated with a significantly increased risk for intra-abdominal recurrence.

Identification of women at risk for hereditary breast and ovarian cancer in a sample of 1000 Slovenian women: a comparison of guidelines

BackgroundAn important number of breast and ovarian cancer cases is due to a strong genetic predisposition. The main tool for identifying individuals at risk is recognizing a suggestive family history of cancer. We present a prospective study on applying three selected clinical guidelines to a cohort of 1000 Slovenian women to determine the prevalence of at-risk women according to each of the guidelines and analyze the differences amongst the guidelines.MethodsPersonal and family history of cancer was collected for 1000 Slovenian women. Guidelines by three organizations: National Comprehensive Cancer Network (NCCN), American College of Medical Genetics in cooperation with National Society of Genetic Counselors (ACMG/NSGC), and Society of Gynecologic Oncology (SGO) were applied to the cohort. The number of women identified, the characteristics of the high-risk population, and the agreement between the guidelines were explored.ResultsNCCN guidelines identify 13.2% of women, ACMG/NSGC guidelines identify 7.1% of women, and SGO guidelines identify 7.0% of women from the Slovenian population, while 6.2% of women are identified by all three guidelines as having high-risk for hereditary breast and ovarian cancer.ConclusionsWe identified 13.7% of women from the Slovenian population as being at an increased risk for breast and ovarian cancer based on their personal and family history of cancer using all of the guidelines. There are important differences between the guidelines. NCCN guidelines are the most inclusive, identifying nearly twice the amount of women as high-risk for hereditary breast and ovarian cancer as compared to the AGMG/NSCG and SGO guidelines in the Slovenian population.

Current Practices and Preferences of Fellows and Program Directors on Taking the Certifying Examination During Subspecialty Fellowships.

Fellows in obstetrics and gynecology subspecialties often take their oral specialty certifying examination (referred to here as generalist certifying examination [GCE]) during fellowship. We sought to compare the opinions of current fellows and program directors (PDs) regarding their program's handling of GCE during fellowship. In this online, survey-based study, fellows and PDs currently affiliated with an accredited fellowship in maternal-fetal medicine, reproductive endocrinology and infertility, female pelvic medicine and reconstructive surgery, or gynecologic oncology (GO) received the link to an unvalidated survey. This survey was open for 8 weeks, between April and June 2020; eligible participants were contacted through their programs, society Listserv, and social media and received 3 reminder e-mails. Final analysis included 408 (408/834; response rate, 49%) fellows and 163 (163/223; response rate, 73%) PDs across the 4 subspecialties. There were significant differences in whether fellows responded that they were required or encouraged to take the GCE (52% maternal-fetal medicine, 65% reproductive endocrinology and infertility, 39% female pelvic medicine and reconstructive surgery, 8% GO; P < 0.01) during fellowship. Fewer GO fellows noted that they were permitted to use educational funds for GCE when compared with the other subspecialties (P < 0.01). Most fellows responded that the inability to take GCE during fellowship would decrease their satisfaction with fellowship, and this was significantly higher than PD estimates (78% vs 39%, P < 0.01). There are significant differences in reported ability to take GCE during fellowship across different obstetrics and gynecology subspecialty fellowships. Program directors significantly underestimate fellow dissatisfaction with inability to take GCE during fellowship.

The impact of live education on the competence and performance of oncology practitioners who care for patients with ovarian cancer.

e23010 Background: About a third of ovarian cancer patients in the US have limited access to a gynecologic oncologist (GO) due to geographic disparities. A survey by The Society of Gynecologic Oncology (SGO) found that the majority of GOs found it was vital to coordinate local access to care, from diagnosis to survivorship, for patients living in areas of disparity. This allows rural/underserved patients broader access to novel therapies, as they increasingly become standard of care. It is critical for not only GOs to be current on the latest ovarian cancer data, but all clinicians who care for these patients. Methods: CEC Oncology developed two educational initiatives focused on PARP inhibitor therapy in ovarian cancer, which was targeted to all US healthcare professionals caring for ovarian cancer patients. Evaluations were collected from attendees attending an SGO Symposium and Ground Round (GR) series to assess impact on practice, increased competency, and intent to make a change in practice. Learning, knowledge, and competence was objectively assessed by analyzing pre-test, post-test, and follow-up survey data (sent 4-6 weeks post-activity). Chi-square analysis was conducted with a priori significance set at 0.05. Results: A total of 830 clinicians were educated, with SGO attendees primarily practicing in academic settings and GR attendees mostly from community practices. SGO attendees were asked case questions at baseline, immediately after the activity, and 4-6 weeks after the activity. Knowledge increased from pre- to post-test regarding current genetic testing recommendations (23% increase; P= .004) and appropriate selection of PARP inhibitor therapy (25% increase; P= .017). Knowledge was sustained at follow-up analysis. At follow-up, 90% of SGO and 84% of GR attendees made a change as a result of attending the activities. More attendees were able to incorporate germline multigene testing into practice, than originally intended; increase of 29% for SGO and 7% for GR audiences. All attendees experienced the barrier lack of patient education about the importance of genetic testing/counseling more than anticipated; increase of 7% for SGO and 13% for GR audiences. At follow-up, there was a 9% increase in GR attendees listing staying current with trial data and practice guidelines as a barrier. Conclusions: There were some notable differences seen in competence/performance among attendees of the two ovarian cancer educational initiatives. Differences may be attributed to practice setting (SGO primarily academic; GR primarily community.) Overall, GR attendees were more likely to face barriers, suggesting that community-based clinicians have fewer resources and experience more barriers to implementing best practices. Thus, it is vital to offer education for clinicians in community-based practices, particularly in areas that are considered ‘geographically disparate’.

Minding the gap: Gynecologic oncology practices differ by gender.

11011 Background: Although most gynecologic oncologists (GOs) are now women, gender differences in clinical practice and compensation persist. Practice characteristics and infrastructural support that may influence gender-based differences were explored. Methods: Every 5 years, the Society of Gynecologic Oncology (SGO) conducts a member survey that provides details on member demographics, practice characteristics, activities, and revenue. Between 8/15-9/30/19 SGO members received a direct link to the survey. Gender was self-identified. Differences in responses were evaluated by gender. Results: Of 1425 surveys delivered, 690 were completed (48% response rate). 312 (45%) identified as male; 367 (53%) as female; 1 nonbinary; 1 other; 7 no response. Male GOs were more likely white (75 vs 68%, p=0.048), married (91 vs 81%, p&lt;0.001), heterosexual (94 vs 90%, p=0.045), and hold an academic rank of professor (23 vs 12%, p&lt;0.001). Practice setting and number of partners were similar. Chemotherapy prescribing was more common for females (82 vs 73%, p=0.004), but other clinical activities were similar (Table). Female GOs had lower clinical volumes than males for cervical, ovarian, vaginal/vulvar cancer and benign gynecologic procedures. Females reported fewer medical assistants and transcriptionists supporting their clinical activities. Overall and practice support was higher for male GOs although hospital support was similar for both genders. Female GOs reported more time spent on research (26 vs 19%, p=0.005), but the same research support. Conclusions: Clinical activities, specifically chemotherapy prescribing, and support differ for male and female GOs and may explain gender inequities. Clinical support should be equalized to maximize workplace productivity regardless of gender. Coordination of support between the practice and hospital and standard compensation for chemotherapy prescribing could decrease the large gender wage gap in this specialty.[Table: see text]

Performance characteristics of brief family history questionnaire to screen for Lynch syndrome in women with newly diagnosed ovarian cancers.

e22525 Background: Ovarian cancer (OC) is the third most common Lynch syndrome (LS)-associated cancer in women but there is no established screening strategy to identify LS in this population. An adequate family history may identify patients suspected of LS, prompting a referral to genetic assessment. We have previously validated the 4-item brief Family History Questionnaire (bFHQ) in endometrial cancers. The objective of this study was to assess whether bFHQ can be used as a screening tool to identify women with OC at risk of LS. Methods: Prospective cohort study recruited women with newly diagnosed non-serous/non-mucinous OC from three cancer centers in Ontario, Canada. Participants completed bHFQ, extended Family History Questionnaire (eFHQ; encompassing Amsterdam II criteria, Society of Gynecologic Oncology 20-25% criteria and Ontario Ministry of Health criteria), immunohistochemistry (IHC) for mismatch repair (MMR) proteins and universal germline testing for LS. The performance characteristics were compared between bFHQ, eFHQ, and IHC. Results: Of 215 participants, 169 (79%) were evaluable with both bFHQ and germline mutation status; 12 of these 169 were confirmed to have LS (7%). Nine of 12 patients (75%) with LS were correctly identified by bFHQ, compared to 6 of 11 (55%) by eFHQ and 11 of 13 (85%) by IHC. The sensitivity, specificity, positive predictive values and negative predictive values of bFHQ were 75%, 66%, 15% and 98%, compared to 55%, 92%, 35% and 96% for eFHQ and 85%, 90%, 39% and 99% for IHC respectively. IHC was the most sensitive and specific approach. The 4-item bFHQ was more sensitive than eFHQ and took less than 10 minutes for each patient to complete. Conclusions: Patient-administered bFHQ may serve as an adequate screening tool to triage women with OC for further genetic assessment for LS, especially in centers without access to universal tumor testing for IHC for MMR.[Table: see text]

Technique for inguino-femoral lymph node dissection in vulvar cancer: an international survey

BackgroundVulvar cancer is a rare disease and despite broad adoption of sentinel lymph node mapping to assess groin metastases, inguino-femoral lymph node dissection still plays a role in the management...

Universal Screening for Lynch Syndrome in Uterine Cancer Patients: A Quality Improvement Initiative

(Abstracted from Gynecol Oncol 2021;160:169–174) The Society of Gynecologic Oncology (SGO) recommends systematic clinical screening for Lynch syndrome through immunohistochemistry (IHC) testing of tumors identified in patients younger than 60 years or of any age and a thorough review of personal and family history. Testing targets expression of mismatch repair genes MLH1, MLH2, PMS2, and MSH6 to evaluate microsatellite instability.

Survey of trends in authorship assignment in gynecologic oncology: Keeping score and playing fair

Authorship confers credit to those responsible for a publication. In 1985, the International Committee of Medical Journal Editors criteria were founded to standardize authorship assignment. We sought to investigate practices and values in authorship assignment in Society of Gynecologic Oncology (SGO) members. An anonymous online survey was distributed to SGO members from 09/2018–10/2018. Three multivariable logistic regression models were fit to predict ICJME authorship acceptance, assignment and denial. Of 1111 members surveyed, 266 responses were received (23.9%); 30.6% reported prior authorship assignment that did not meet ICMJE criteria, and 18.8% (n = 50) reported a history of accepting authorship not meeting ICJME criteria. Reasons for non-adherence included: inclusion of the author’s patients in the study (59.3%), resumé building (45.7%), and networking for career advancement (22.2%). The majority responded that ICJME criteria were generalizable (91.3%), helpful (83.8%), and considered non-adherence as scientific misconduct (66.0%). On multivariable analysis, practice duration of 5–20 years (HR 0.40, 95% CI 0.16, 0.99, p < 0.05) or > 20 years (HR 0.22, 95% CI 0.08, 0.59, p < 0.05) were significant predictors for adherence with ICMJE authorship assignment compared to fellows and those in practice < 5 years. Similarly, practice duration of 5–20 years (HR 10.0, 95% CI 2.0, 49.2, p < 0.05) or > 20 years (HR 25.9, 95% CI 1.06, 3.9, p < 0.05) were significant predictors for denial of authorship assignment compared to fellows and those in practice < 5 years. While the majority of respondents report that ICJME criteria are helpful, adherence to these criteria is a concern, especially in fellows and early-career faculty.

Quelles nouveautés pour la prise en charge du cancer de l’endomètre ? Le point sur les recommandations européennes de 2021

The new European guidelines for the management of patients with endometrial cancer were published in early 2021. These recommendations are joint to the three European Learned Societies of Gynecologic Oncology (ESGO), Radiation Therapy and Oncology (ESTRO) and Anatomical Pathology (ESP). On behalf of the French Society of Gynecologic Oncology (SFOG), we wish to bring to the knowledge of the French-speaking readership the main measures for the management of patients which represent an advance compared to the 2016 recommendations. The new European recommendations for the management of patients with endometrial cancer emphasize the generalization of micro-satellite instability (MSI) or immunohistochemical analysis of MMR system proteins for all patients. Also, the classification into 4 prognostic risk groups integrates data from molecular analysis (p53, MSI, POLE) to guide initial surgical management as well as adjuvant treatment modalities. The indocyanine green sentinel node procedure has also become the reference technique for FIGO I and II lymph node staging regardless of histological type. It should be remembered that management should be provided in a specialized institution by a team specialized in the management of gynecological cancers, particularly for high-risk and/or advanced cancer patients.

Impact of cytoreductive surgery on survival of patients with low-grade serous ovarian carcinoma: A multicentric study of Turkish Society of Gynecologic Oncology (TRSGO-OvCa-001).

The aim of this study was to analyze the factors affecting recurrence-free (RFS) and overall survival (OS) rates of women diagnosed with low-grade serous ovarian cancer (LGSOC). Databases from 13 participating centers in Turkey were searched retrospectively for women who had been treated for stage I-IV LGSOC between 1997 and 2018. Overall 191 eligible women were included. The median age at diagnosis was 49 years (range, 21-84 years). One hundred seventy-five (92%) patients underwent primary cytoreductive surgery. Complete and optimal cytoreduction was achieved in 148 (77.5%) and 33 (17.3%) patients, respectively. The median follow-up period was 44 months (range, 2-208 months). Multivariate analysis showed the presence of endometriosis (p = .012), lymphovascular space invasion (LVSI) (p = .022), any residual disease (p = .023), and the International Federation of Gynecology and Obstetrics (FIGO)stage II-IV disease (p = .045) were negatively correlated with RFS while the only presence of residual disease (p = .002) and FIGO stage II-IV disease (p = .003) significantly decreased OS. The maximal surgical effort is warranted for complete cytoreduction asachieving no residual disease is the single most important variable affecting the survival of patients with LGSOC. The prognostic role of LVSI and endometriosis should be evaluated by further studies asboth of these parameters significantly affected RFS.

Comparative Evaluation of Completeness of Traditional Narrative versus Electronic Synoptic Operative Reports for Ovarian, Peritoneal and Fallopian Tube Cancer Surgery in a Tertiary Government Hospital

Objective. This study aimed to compare the completeness and ease of use of narrative reports (NR) submitted by residents compared to electronic synoptic reports (SR) by gynecologic oncology fellows for patients who underwent ovarian, fallopian, and peritoneal cancer surgery.&#x0D; Methods. We conducted a cross-sectional study in the Department of Obstetrics-Gynecology of the Philippine General Hospital from August to November 2019. We assessed the NRs and electronic SRs for completeness of data using quality indicators.&#x0D; Results. The average percentage of completeness of quality indicators is 77.1% (35.7/65). Eight indicators were absent in all NRs. Reporting of residual lesions was low (29.1%). The mean time to accomplish SRs (10.4 minutes) was significantly shorter than the mean time to accomplish NRs (21.9 minutes) (p value = 0.0001). SRs were assessed to be superior to NRs in several areas of surgery for quality, completeness and timeliness.&#x0D; Conclusion. This study showed that the NRs should be improved and periodic audit must be done to maintain quality assurance. The use of SR appears to be favorable and superior in terms of time required to accomplish.