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

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

COVID-19 outcomes of patients with gynecologic cancer in New York City: An updated analysis from the initial surge of the pandemic.

BACKGROUND: Despite significant increase in COVID-19 publications, characterization of COVID-19 infection in patients with gynecologic cancer remains limited. Here we present an update of COVID-19 outcomes among people with gynecologic cancer in New York City (NYC) during the initial surge of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]). METHODS: Data were abstracted from gynecologic oncology patients with COVID-19 infection among 8 NYC area hospital systems between March and June 2020. Multivariable logistic regression was utilized to estimate associations between factors and COVID-19 related hospitalization and mortality. RESULTS: Of 193 patients with gynecologic cancer and COVID-19, the median age at diagnosis was 65.0 years (interquartile range (IQR), 53.0-73.0 years). One hundred six of the 193 patients (54.9%) required hospitalization; among the hospitalized patients, 13 (12.3%) required invasive mechanical ventilation, 39 (36.8%) required ICU admission. Half of the cohort (49.2%) had not received anti-cancer treatment prior to COVID-19 diagnosis. No patients requiring mechanical ventilation survived. Thirty-four of 193 (17.6%) patients died of COVID-19 complications. In multivariable analysis, hospitalization was associated with an age ≥ 65 years (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.11, 4.07), Black race (OR 2.53, CI 1.24, 5.32), performance status ≥2 (OR 3.67, CI 1.25, 13.55) and ≥ 3 comorbidities (OR 2.00, CI 1.05, 3.84). Only former or current history of smoking (OR 2.75, CI 1.21, 6.22) was associated with death due to COVID-19 in multivariable analysis. Administration of cytotoxic chemotherapy within 90 days of COVID-19 diagnosis was not predictive of COVID-19 hospitalization (OR 0.83, CI 0.41, 1.68) or mortality (OR 1.56, CI 0.67, 3.53). CONCLUSIONS: The case fatality rate among patients with gynecologic malignancy with COVID-19 infection was 17.6%. Cancer-directed therapy was not associated with an increased risk of mortality related to COVID-19 infection.

Web-based tools for family cancer history and cancer risk modeling: what are the barriers to successful implementation?

More than 80% of individuals with hereditary cancer syndromes are unaware of and, therefore, cannot take advantage of strategies for cancer prevention. The COVID-19 pandemic has resulted in a revolution in healthcare clinical workflows, moving away from the face-to-face model and towards digital strategies. Collection of family health history (FHH) and automated generation of disease risk models is a powerful digital tool that can be performed remotely and safely during a pandemic and help identify those at-risk for hereditary cancer syndromes. We aimed to evaluate barriers to completion of a web-based application (WBA) for FHH and cancer risk models (CRM). Patients scheduled for a gynecologic oncology new patient appointment between 9/2019-9/2020 were offered enrollment in a prospective trial randomizing participants to collection of FHH during the office face-to-face physician interview vs FHH collection via WBA at home or in the office (randomized 1:1:1). The WBA included embedded CRMs (BRCAPRO, Claus, Tyrer-Cuzick, Gail, colorectal and endometrial MMRPRO, MELAPRO, and PANCRO). 66 patients were randomized to utilization of the WBA with median age 60 years (range 22-88). 53 (80.3%) accessed the application and 13 (19.7%) did not for the following reasons: Home arm (11) - forgot (3), WBA was confusing (1), technological issues (1), uncertain of family history (1), concerned about privacy (1), unsure (3), lost to follow-up (1);Office arm (2) - insufficient time to complete (2). Among patients accessing the WBA, 28 (52.8%) successfully input all necessary information to compute the CRM. Thirty-five patients (66%) had at least one validation error including seven patients with two errors and one with three errors. Causes of validation errors included: patient not eligible due to age or cancer history (17, 32.1%), incomplete entry of personal health information (13, 24.5%), incomplete entry of relative(s) health information (10, 18.9%) and user error (misunderstanding questions) (4, 7.5%). Fifty-two patients, 98.1% of those who accessed the application, had at least one successfully generated CRM. There was no difference in completion of CRM between patients competing the web-based application at home versus in the office prior to the appointment. [Display omitted] WBA for collection of FHH and generation of CRM are a promising part of the current health care digital revolution;however, as with all new technology, it is critical to assess usability and efficacy. In our study of WBA FHH collection, 20% of patients did not successfully access the WBA and only 27% of patients randomized to the WBA successfully completed all risk models. Barriers include difficulty accessing the application, concern about privacy, incomplete entry of personal and relative information and user error. Design of future health information collection systems must emphasize clear patient instructions on accessing the digital tool and comprehensively completing included questions. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Web-based tool to assess breast cancer risk for women presenting to a gynecologic oncology visit

Approximately 40,000 women die from breast cancer each year in the United States, highlighting the importance of identifying high-risk women prior to breast cancer development. Risk models exist, including the Tyrer-Cusick (TC) model but have not been widely implemented due to the time required to perform the risk assessment and interpret results. We aim to report our experience with a web-based application (WBA) to complete the TC model for women prior to a scheduled gynecologic oncology clinic visit. All patients scheduled for a gynecologic oncology new patient appointment between 9/2020-9/2021 were offered enrollment in an institutional review board-approved prospective trial. Patients were randomized to standard of care gynecologic oncology visit versus utilization of a WBA completed either at home or in the office prior to the appointment (randomized 1:1:1). The WBA collects personal and family health history and utilizes this information to generate a TC score. As part of the trial protocol, all women with a TC score reflecting a lifetime risk of breast cancer ≥ 20% were referred to the institution's high risk breast clinic which provides counseling on genetic testing, breast screening and breast cancer prevention. The WBA also generated additional information on personal and family cancer, the results of which are reported separately. Sixty-six patients were randomized to utilization of the WBA which included completion of the TC model. Median patient age was 60 (range 22-88). Twenty-six patients (39.4%) did not complete the model for the following reasons: 13 (50%) were not able to access the application, 11 (42.3%) did not answer all required questions and 4 (15.4%) were ineligible due to prior breast cancer. Forty patients (60.6%) successfully completed the TC model and among those patients, 6 (15%) had a significantly elevated lifetime breast cancer risk score (defined as ≥ 20%), all of whom were referred to a high risk breast clinic. The COVID-19 pandemic has pressed the healthcare system to better utilize technology to provide safe and equitable medical care. A WBA for collection of personal and family health history and generation of cancer risk models completed prior to the physician appointment is an exciting application of such technology. When piloted in a gynecologic oncology practice, 60.6% of patients were able to complete the risk model and 15% of these patients were found to have a significantly elevated breast cancer risk warranting follow-up care. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Stressors and the adaptation of telemedicine for women on poly(ADP-ribose) polymerase (PARP) inhibitor maintenance during the COVID-19 pandemic

Poly(ADP-ribose) polymerase inhibitor maintenance (PARPm) therapy is now available to all women with advanced ovarian cancer following response to initial chemotherapy. As the COVID-19 pandemic has resulted in unprecedented challenges for cancer patients, we aimed to evaluate the unique experience for women on maintenance PARP inhibitors. Women with a current or prior diagnosis of ovarian cancer completed an online survey focusing on treatment interruptions and quality of life (QOL). QOL was measured with the Cancer Worry Scale and Hospital Anxiety and Depression Scale. The survey was distributed through survivor networks and social media. The chi-square and ANOVA test were used with a Bonferroni correction to account for multiple comparison testing. Six hundred and three women, from 41 states, visited the survey website between March 30 and April 13, 2020 and 525 (87%) completed the survey and provided information on current treatment status. Sixty-four women (12%) were on PARPm, 153 (29%) on other anti-cancer therapy and 308 (59%) on no treatment. Other anticancer therapies included intravenous chemotherapy (61, 40%), anti-angiogenic (29, 19%), hormonal (25, 16%), oral chemotherapy (12, 8%), immunotherapy (10, 6.5%) and other (16, 10%). There were no differences among women on PARPm, no treatment or other treatment for disease stage, medical comorbidities, COVID-19 symptoms or treatment delays. Women on PARPm were more likely to be self-described as immunocompromised versus women not on treatment (79% vs. 34%, P<0.001) and women on hormonal therapy (79% vs. 40%, P=0.002) and similar to women on oral -anti-cancer therapy (78% vs. 58%, P=0.336). Women on PARPm were more likely to use telemedicine versus women not on treatment (44% vs. 16%, P<0.001) and had similar use of telemedicine compared to all other treatment groups. For women on PARPm, higher cancer worry scores were associated with increased use of telemedicine (used telemedicine - 14.4 vs. did not use telemedicine - 13.3, P=0.007). There were no significant differences in reported cancer worry, anxiety or depression between women on PARPm, other anti-cancer therapy and no treatment. [Display omitted] The COVID-19 crisis is impacting cancer care and it is critical that providers consider and address the unique stressors facing women with ovarian cancer during this challenging time. Women on PARPm, in particular, perceive themselves as immunocompromised, perhaps making them more open to alternative means of care delivery, as demonstrated by their willingness to adopt telemedicine. Women with ovarian cancer on PARPm report similar cancer worry, anxiety and depression to women not on treatment and those on other anti-cancer treatment. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Leveraging health information technology to collect family cancer history: a systematic review and meta-analysis

Collection of an accurate and comprehensive family cancer history (FCH) can help to identify millions of individuals at risk-for familial cancer syndromes. However, there are no formal guidelines for FCH collection and, as a result, there is wide variability in in strategies employed and accuracy of family health history across medical systems. Information technology (IT) provides a promising solution, a tool that has been shown to improve clinical documentation, workflows, quality of care, patient safety, communication and clinical decision support, and that can be completed remotely and safely during a pandemic. The aim of this study is to evaluate the literature on existing strategies whereby medical providers utilize information technology (IT) to assemble FCH. A systematic search of online databases (PubMed, EMBASE, MEDLINE, and the Cochrane Library) between 1980 and 2020 was performed. Meta-analysis was used to estimate pooled results across studies. Statistical heterogeneity was assessed through the chi-square test (i.e., Cochrane Q test) and the inconsistency statistic (I2). A random effects analysis was used to calculate the pooled proportions and means. The comprehensive search produced 4005 publications. Thirty-two peer-reviewed studies met inclusion criteria. Twenty-seven distinct IT tools were evaluated which included the following categories: electronic survey administered prior to visit (21, 65.6%), electronic survey administered via tablet in the medical office (6, 18.8%), electronic survey via kiosk (4, 12.5%) and animated virtual counselor (1, 3.1%). Among the 196,566 included patients, 87.0% completed the FCH tool (electronic survey prior to the visit - 85.0 %;electronic survey in the medical office - 89.0 %). The time required for survey completion was 35.2 minutes (CI 14.3 -56.2). Twelve percent of patients (n=11,093) were referred for genetic assessment based on the output of the FCH tool. Among the studied methods of FCH collection, 7 (21.9%) had the capacity to interface directly with the patient's electronic medical record. [Display omitted] The rapidly advancing field of germline cancer genetics coupled with a growing emphasis on disease prevention and incorporation of technology into medical care algorithms prior to and accelerated by the COVID-19 pandemic make utilization of IT strategies for collection of FCH a promising option. Our systematic review and meta-analysis found that electronic FCH collection can be completed successfully by patients in a time efficient manner. This information may be useful as many healthcare systems continue to restructure the way in which patients interact with their healthcare teams. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Family health history of gynecologic oncology patients: can we do better?

Despite a growing understanding of familial cancer, multiple studies demonstrate that the quality of family health history (FHH) as currently collected in a clinic setting is inadequate to assess disease risk. Proposed challenges in FHH collection include lack of patient preparation, lack of FHH standardization, and time requirement (especially during the COVID-19 pandemic with intentional minimization of office time). Prior to implementation of a web-based application for FHH collection, we aimed to review the quality of collected FHH in a gynecologic oncology clinic and to determine if any patient factors affect FHH collection. This was a single institution retrospective study of FHH collection for new patient appointments at a gynecologic oncology outpatient practice between 4/2019-7/2019. FHH was collected verbally during the patient face-to-face interview. FHH was evaluated for the following, previously published, quality measures on a point system: 1) Three generations, 2) Relative gender, 3) Relative lineage (maternal vs paternal), 4) Pertinent negatives (absence of hereditary cancers), 5) Age of relatives' cancer diagnosis, and for deceased relatives, 6) Age of death and 7) Cause of death. Among the 200 evaluable patients, 185 (92.5%) had FHH documented in the medical record. The median age was 52 years (range 23-93). Eighty-nine (44.5%) included three generations, 154 (77%) relatives' gender, 109 (54.5%) relatives' lineage, and 77 (38.5%) pertinent negatives (Figure 1). Among 147 patients reporting a history of cancer in their family, 23 (15.6%) included age of relatives' cancer diagnosis. Among 75 patients listing deceased relatives, 13 (17.3%) included age of death and 48 (64%) cause of death. Age and personal cancer diagnosis were not associated with quality of FHH. Patients with family history of cancer scored higher in quality of FHH than those without family history (median=3.0 [IQR 3.0;4.0] vs. 1.0 [0.0;2.0], P <0.001) and were more likely to have inclusion of three generations (57.1% vs. 9.4%, P <0.001). Forty-three patients (21.5%) had previously undergone genetic testing and these patients had higher FHH scores than those without prior genetic testing (3.0 [3.0;4.0] vs. 3.0 [1.0;4.0], P=0.01) and were more likely to include age of relatives' cancer diagnosis (27.0% vs. 11.0%, P =0.04), age of relatives' death (35.7% vs. 13.1%, P=0.04), and cause of relatives' death (92.3% vs. 58.1%, P=0.02). Overall, patients with higher quality FHH had increased likelihood of being referred to genetic assessment (4.0 [3.0;4.75] vs. 3.0 [1.0;4.0], P=0.002). [Display omitted] Our data are consistent with the literature suggesting that standard collection of family history may not adequately capture all measures of a high quality oncologic FHH. Patients without prior genetic testing and no family history of cancer had the lowest scores for FHH quality and might benefit from a web-based FHH collection tool, allowing them to contact relatives for more information prior to an office visit and permitting better patient preparation and efficiency. In light of the COVID-19 pandemic, tools that minimize inoffice time are increasingly important. A prospective evaluation of a web-based FHH collection tool to address these issues is ongoing. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Factors contributing to treatment delays among Medicaid-insured patients with gynecologic malignancies during COVID-19 in New York City

When New York City (NYC) emerged as a COVID-19 epicenter, hospitals and clinicians were forced to quickly change practice models of health care delivery. We sought to determine the impact of COVID-19 on treatment delays that occurred during the peak of the pandemic among low-income gynecologic oncology patients in NYC. Medicaid-insured patients receiving gynecologic oncology care at two affiliated centers between March 15 and April 15, 2020 were identified for telephone interview. Eligible patients included those with precancerous or cancerous gynecologic diseases or hereditary breast and ovarian cancer (HBOC) syndromes. Demographics, clinical characteristics, and reasons for treatment delays were identified through self-report and confirmed with chart review at the time of interview and at 6-month follow up. Outcomes were classified as delays in the following: surgery, adjuvant treatment (chemotherapy/radiation), and surveillance visits. Of the 158 eligible patients identified, 100 completed the interview. A total of 47 patients experienced an average treatment delay of 85.3 days (range: 7-210): surveillance visit (n=33), surgery (n=10), chemotherapy (n=3), radiation (n=1). Within this group, the median age was 58 years (range: 19-86). Self-identified race included: African-American (23.5%), Hispanic (31.9%), non-Hispanic White (17%), Asian (9.1%), Other (8.5%). The majority of patients (80.9%) had an annual income < $40,000. Clinically relevant surveillance delays occurred in 3 patients. A delayed diagnosis of vulvar cancer due to missed biopsy (follow up at 49 days) and 2 patients with delayed diagnosis of recurrent ovarian/primary peritoneal cancer;one died from disease and the other is undergoing chemotherapy. Surgical delays were identified in 10 patients: high grade cervical/vulvar dysplasia (n=3);endometrial intraepithelial neoplasia (EIN) (n=2);endometrial cancer (n=2);risk reducing surgery for HBOC syndromes (n=2);metastatic gastrointestinal adenocarcinoma to the ovary (n=1). Among the patients with endometrial cancer, one procedure delayed by 1 week was able to proceed and one transferred care. No upstaging of cancer diagnosis resulted from delays. Chemotherapy delays occurred in 3 patients with an average delay of 47.7 days. Of these patients, 2 were found to have progression of disease resulting in death (n=1) and decision to pursue hospice (n=1);one had a personal COVID-19 diagnosis. A delay in radiation treatment of 70 days was reported in 2.1% (n=1). A total of 9 patients were lost to follow up. Characteristics of patients lost to follow up include Hispanic/Latino race/ethnicity, essential worker, living with children in a high COVID-positive area (37.5%, n=3) or individuals who experienced a change in employment status (25%;n=2). [Display omitted] COVID-19 resulted in significant treatment delays among Medicaid-insured gynecologic oncology patients. As we continue to minimize clinical encounters, interventions aimed at providing timely oncology care during the COVID-19 pandemic is essential to prevent widening disparities in low-income populations. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Using health information technology to improve collection of family cancer history: prospective randomized trial of web-based tool in a gynecologic oncology outpatient clinic

In the US there are approximately 4 million individuals with a genetic cancer predisposition syndrome, however, the majority are not aware and cannot benefit from genetically-targeted cancer prevention. Family cancer history (FCH) can identify high risk patients and triage them to genetic assessment, however there is wide variability in accuracy, breadth and strategies for FCH collection. We aim to evaluate whether a web-based tool (WBT) can result in improved quality of FCH versus standard FCH collection via face-to-face interview. All patients scheduled for a gynecologic oncology new patient visit between 9/2019-9/2020 were offered enrollment in an institutional review board-approved prospective trial. Patients were randomized to one of three arms: 1) standard of care FCH collection during the interview, 2) WBT administered at home prior to the visit, 3) WBT administered in the office prior to the visit. The primary endpoint was evaluation of FCH quality based on established quality measures. Chi-square test was used to compare FCH quality between intervention arms and ANOVA test for the number of relatives/generations in the pedigree. A Bonferroni correction was used to account for multiple comparison testing. A total of 100 patients were enrolled. The mean age was 56.2 years (SD 15.2). The WBT was completed successfully by 67% (22) of patients randomized to home administration vs 94% (31) randomized to office administration (P=0.01). Patients cited the following reasons for failure to complete the WBT at home: difficulty with technology, concern about privacy and forgetting about the WBT invitation. In the intention-to-treat analysis, office WBT collection resulted in significantly higher quality FCH vs the control and home arms (Table 1). The WBT resulted in significantly greater mean number of relatives included in the pedigree (Arm 1 - 3.9 [SD 3.0], Arm 2 - 32.4 [SD 16.8], Arm 3 - 29.0 [SD 18.3], P<0.001) and significantly greater number of included generations (2.2 [SD 0.9], 3.9 [SD 0.4], 3.7 [SD 0.6], P<0.001). Patient age, race, ethnicity, and personal/family cancer history were not associated with FCH quality. When excluding patients who could not access the WBT at home, there were no differences in FCH quality when WBT was completed at home vs in the office. A total of 39 patients utilizing the WBT (74%) completed a satisfaction survey following the office visit;38 (97%) reported that the WBT was easy to understand and 30 (77%) reported being satisfied with the tool. [Display omitted] FCH collection is an exciting application of information technology in the current healthcare setting with a growing emphasis on cancer genetics, disease prevention and thoughtful use of WBTs. In our cohort of gynecologic-oncology patients, a WBT resulted in significantly higher quality and more comprehensive family cancer pedigrees. With the COVID-19 pandemic inspired drive to minimize in-office time, future studies must assess strategies to improve patient engagement with WBT at home prior to the visit. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sex-Related Differences in Clinical Presentation and Risk Factors for Mortality in Patients Hospitalized With Coronavirus Disease 2019 in New York City.

We evaluated sex-related differences in symptoms and risk factors for mortality in 4798 patients hospitalized with coronavirus disease 2019 in New York City. When adjusted for age and comorbidities, being male was an independent predictor of death with mortality significantly higher than females, even with low severe acute respiratory syndrome coronavirus 2 viral load at admission.

Financial toxicity, mental health, and gynecologic cancer treatment: The effect of the COVID-19 pandemic among low-income women in New York City.

BACKGROUND: New York City (NYC) emerged as an epicenter of the COVID-19 pandemic, and marginalized populations were affected at disproportionate rates. The authors sought to determine the impact of COVID-19 on cancer treatment, anxiety, and financial distress among low-income patients with gynecologic cancer during the peak of the NYC pandemic. METHODS: Medicaid-insured women who were receiving gynecologic oncology care at 2 affiliated centers were contacted by telephone interviews between March 15 and April 15, 2020. Demographics and clinical characteristics were obtained through self-report and retrospective chart review. Financial toxicity, anxiety, and cancer worry were assessed using modified, validated surveys. RESULTS: In total, 100 patients completed the telephone interview. The median age was 60 years (range, 19-86 years), and 71% had an annual income <$40,000. A change in employment status and early stage cancer (stage I and II) were associated with an increase in financial distress (P < .001 and P = .008, respectively). Early stage cancer and telehealth participation were significantly associated with increased worry about future finances (P = .017 and P = .04, respectively). Lower annual income (<$40,000) was associated with increased cancer worry and anxiety compared with higher annual income (>$40,000; P = .036 and P = .017, respectively). When controlling for telehealth participation, income, primary language, and residence in a high COVID-19 prevalence area, a delay in medical care resulted in a 4-fold increased rate of anxiety (P = .023, 95% CI, 1.278-14.50). Race was not significantly associated with increased financial distress, cancer worry, or anxiety. CONCLUSIONS: Low socioeconomic status was the most common risk factor for increased financial distress, cancer worry, and anxiety. Interventions aimed at improving access to timely oncology care should be implemented during this ongoing pandemic.

Impact of the coronavirus disease 2019 pandemic on the quality of life for women with ovarian cancer.

BACKGROUND: The coronavirus disease 2019 pandemic has resulted in unprecedented challenges for the oncology community. For people living with cancer, treatments are interrupted, surgeries cancelled, and regular oncology evaluations rescheduled. People with cancer and their physicians must balance plausible fears of coronavirus disease 2019 and cancer treatment with the consequences of delaying cancer care. OBJECTIVE: We aim to evaluate the experience of women with ovarian cancer during the coronavirus disease 2019 pandemic. STUDY DESIGN: Women with a current or previous diagnosis of ovarian cancer completed an online survey focusing on treatment interruptions and quality of life. The quality of life was measured with the Cancer Worry Scale and Hospital Anxiety and Depression Scale. The survey was distributed through survivor networks and social media. Univariate and multivariable linear regression analysis were used to evaluate the effect of participant characteristics on quality of life survey scores. RESULTS: A total of 603 women, from 41 states, visited the survey website between March 30, 2020, and April 13, 2020, and 555 (92.0%) completed the survey. The median age was 58 years (range, 20-85). At the time of survey completion, 217 participants (43.3%) were in active treatment. A total of 175 participants (33%) experienced a delay in some component of their cancer care. Ten (26.3%) of the 38 participants scheduled for surgery experienced a delay, as did 18 (8.3%) of the 217 participants scheduled for nonsurgical cancer treatment. A total of 133 participants (24.0%) had a delayed physician appointment, 84 (15.1%) laboratory tests, and 53 (9.6%) cancer-related imaging. Among the cohort, 88.6% (489) reported significant cancer worry, 51.4% (285) borderline or abnormal anxiety, and 26.5% (147) borderline or abnormal depression. On univariate analysis, age less than 65 years, being scheduled for cancer treatment or cancer surgery, delay in oncology care, being self-described as immunocompromised, and use of telemedicine were all associated with higher levels of cancer worry. Higher anxiety scores were associated with age less than 65 years and being self-described as immunocompromised. Higher depression scores were associated with age less than 65 years, being scheduled for cancer surgery, delay in oncology care, being self-described as immunocompromised, and use of telemedicine. On multivariable linear regression analysis, age less than 65 and being self-described as immunocompromised were independently predictive of greater cancer worry, anxiety, and depression, and delay in cancer care was predictive of anxiety and depression. CONCLUSION: The coronavirus disease 2019 crisis is affecting care of patients with ovarian cancer; surgeries, treatments, scheduled physician appointments, laboratory tests, and imaging are cancelled or delayed. Younger age, presumed immunocompromise, and delay in cancer care were associated with significantly higher levels of cancer worry, anxiety, and depression. Providers must work with patients to balance competing risks of coronavirus disease 2019 and cancer, recognizing that communication is a critical clinical tool to improve quality of life in these times.

Racial disparities in patients with coronavirus disease 2019 infection and gynecologic malignancy.

BACKGROUND: Mounting evidence suggests disproportionate coronavirus disease 2019 (COVID-19) hospitalizations and deaths because of racial disparities. The association of race in a cohort of gynecologic oncology patients with severe acute respiratory syndrome-coronavirus 2 infection is unknown. METHODS: Data were abstracted from gynecologic oncology patients with COVID-19 infection among 8 New York City area hospital systems. A multivariable mixed-effects logistic regression model accounting for county clustering was used to analyze COVID-19-related hospitalization and mortality. RESULTS: Of 193 patients who had gynecologic cancer and COVID-19, 67 (34.7%) were Black, and 126 (65.3%) were non-Black. Black patients were more likely to require hospitalization compared with non-Black patients (71.6% [48 of 67] vs 46.0% [58 of 126]; P = .001). Of 34 (17.6%) patients who died from COVID-19, 14 (41.2%) were Black. Among those who were hospitalized, compared with non-Black patients, Black patients were more likely to: have ≥3 comorbidities (81.1% [30 of 37] vs 59.2% [29 of 49]; P = .05), to reside in Brooklyn (81.0% [17 of 21] vs 44.4% [12 of 27]; P = .02), to live with family (69.4% [25 of 36] vs 41.6% [37 of 89]; P = .009), and to have public insurance (79.6% [39 of 49] vs 53.4% [39 of 73]; P = .006). In multivariable analysis, among patients aged <65 years, Black patients were more likely to require hospitalization compared with non-Black patients (odds ratio, 4.87; 95% CI, 1.82-12.99; P = .002). CONCLUSIONS: Although Black patients represented only one-third of patients with gynecologic cancer, they accounted for disproportionate rates of hospitalization (>45%) and death (>40%) because of COVID-19 infection; younger Black patients had a nearly 5-fold greater risk of hospitalization. Efforts to understand and improve these disparities in COVID-19 outcomes among Black patients are critical.

Adapting and avoiding coping strategies for women with ovarian cancer during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has resulted in unprecedented challenges for people living with cancer, impacting not only physical health but psychological well-being. The psychological response affects the individual as well as the community and can persist long after the outbreak. We aim to assess coping strategies employed by women with ovarian cancer during the COVID-19 pandemic. METHODS: Women with a current or prior diagnosis of ovarian cancer completed an online survey which included a query about coping strategies during the COVID-19 pandemic. The survey was distributed from March 30th through April 13, 2020 through survivor networks and social media. RESULTS: Six hundred and three women visited the survey website during the study period and 555 (92.0%) completed the survey. Four hundred and eight (73.5%) provided information on coping strategies utilized during COVID-19. Among those who responded, the median age was 58 years (range 20-85) and 150 participants (40.8%) were undergoing active cancer treatment. Commonly utilized adaptive coping strategies included emotional support (159, 39.0%), self care (148, 36.3%), hobbies (139, 34.1%), planning (87, 21.3%), positive reframing (54, 13.2%), religion (50, 12.3%) and instrumental support (38, 9.3%). Many participants also relied on avoidance coping strategies including self distraction (111, 27.2%) and substance use (19, 4.7%). CONCLUSIONS: Most ovarian cancer survivors are using adaptive, problem-focused coping strategies during the COVID-19 pandemic, however many are practicing avoidance strategies as well. As coping mechanisms profoundly impact quality of life, oncology providers must assist patients in identifying coping strategies that optimize physical and psychological well-being.

Gynecologic oncology care during the COVID-19 pandemic at three affiliated New York City hospitals.

BACKGROUND: New York City was among the epicenters during the COVID-19 pandemic. Oncologists must balance plausible risks of COVID-19 infection with the recognized consequences of delaying cancer treatment, keeping in mind the capacity of the health care system. We sought to investigate treatment patterns in gynecologic cancer care during the first two months of the COVID-19 pandemic at three affiliated New York City hospitals located in Brooklyn, Manhattan and Queens. METHODS: A prospective registry of patients with active or presumed gynecologic cancers receiving inpatient and/or outpatient care at three affiliated New York City hospitals was maintained between March 1 and April 30, 2020. Clinical and demographic data were abstracted from the electronic medical record with a focus on oncologic treatment. Multivariable logistic regression analysis was explored to evaluate the independent effect of hospital location, race, age, medical comorbidities, cancer status and COVID-19 status on treatment modifications. RESULTS: Among 302 patients with gynecologic cancer, 117 (38.7%) experienced a COVID-19-related treatment modification (delay, change or cancellation) during the first two months of the pandemic in New York. Sixty-four patients (67.4% of those scheduled for surgery) had a COVID-19-related modification in their surgical plan, 45 (21.5% of those scheduled for systemic treatment) a modification in systemic treatment and 12 (18.8% of those scheduled for radiation) a modification in radiation. Nineteen patients (6.3%) had positive COVID-19 testing. On univariate analysis, hospital location in Queens or Brooklyn, age ≤65 years, treatment for a new cancer diagnosis versus recurrence and COVID-19 positivity were associated with treatment modifications. On multivariable logistic regression analysis, hospital location in Queens and COVID-19 positive testing were independently associated with treatment modifications. CONCLUSIONS: More than one third of patients with gynecologic cancer at three affiliated New York City hospitals experienced a treatment delay, change or cancellation during the first two months of the COVID-19 pandemic. Among the three New York City boroughs represented in this study, likelihood of gynecologic oncology treatment modifications correlated with the case burden of COVID-19.