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Background: It has been almost three years since the COVID-19 outbreak, yet evidence of its impact on the cancer care landscape remains scant. The present single-center study examines patterns in gynecological cancer diagnoses before and during the pandemic. Method(s): All female patients diagnosed in our academic hospital with gynecological cancer, between January 2017 and December 2020, were retrospectively identified. Pre-defined subgroup analyses were performed in patients who had been newly diagnosed during 2020 and in the pre-pandemic 3-year period. The study was approved by the Institutional Ethical Committee and was conducted in accordance with the Declaration of Helsinki and the International Conference on Harmonization for Good Clinical Practice. Result(s): In total, 1,193 women were included in this case-control study;1,001 (83.91%) were identified in the pre-pandemic period as a control, while 192 (16.09%) cases were allocated in the pandemic group. The two cohorts were similar regarding demographic and clinical characteristics. For the pre-pandemic period, the mean yearly number of patients with newly identified cancer was highest for endometrial (149;44.61%), followed by ovarian (92;27.5%) carcinomas. During the first year of the pandemic, the number of new diagnoses significantly decreased by 42.5% (from 334 to 192) for all types of malignancies combined (one sample t-test p-value= 0.014). Declines ranged from 36.96% to 49% for ovarian and endometrial cancer, respectively. Conclusion(s): This is the first study to appraise a timely snapshot of the effect of COVID-19 on newly diagnosed gynecological tumors in a European Society of Gynaecological Oncology (ESGO)-certified center in Greece, demonstrating an alarmingly sharp decline in the number of new cases during the pandemic. It is of utmost importance the gynecologic oncologists to ensure the continuum of care for their patients. [Formula presented] Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023 European Society for Medical Oncology
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Objectives: Obesity is an epidemic in gynecologic oncology, leading to an increased risk of surgical complications and poor cancer outcomes. Cognitive-behavioral therapy (CBT) is an effective weight loss strategy. We aimed to determine whether group CBT is an effective weight loss tool when offered in an outpatient gynecologic oncology setting. Methods: We established a CBT-based weight management intervention for gynecologic oncology patients at an NCI-designated cancer center. The intervention was a 12-week group-based weight loss program offered to patients from the gynecologic oncology clinic with body mass indices (BMI) between 25-50 kg/m2. Sessions were free of charge, led by a psychologist and dietitian, and transitioned from in-person to tele-visits due to the COVID-19 pandemic. The program combined nutritional education, lifestyle changes, and CBT approaches, with 12 weekly group visits followed by three monthly individual follow-up visits. Each participant was given a goal weight loss of 7% total body weight (TBW). Retrospective data were collected from patients enrolled in the intervention from September 2019 through March 2021. Paired t-tests were performed to compare the pre-program and ending weights for all participants. Weight loss data were tested for normality using the Shapiro-Wilk test. Results: A total of 29 patients were enrolled in four cohorts during the study timeframe. Fifty-nine percent of participants were White, 38% were Black. The mean age among participants was 56 years, and the mean BMI was 41 kg/m2. Most participants had a history of endometrial hyperplasia or malignancy (58%) and had stage I disease (59%). Among the participants, 22 (76%) completed the program. The average weight loss among all participants during the 12-week program was 5.6 pounds (CI: -8.9- -2.1, p = 0.002), equivalent to an average 2% change in TBW. Among the 22 participants who completed the program, the average weight loss was 7.4 pounds (CI: -11.1- -3.8, p <0.001), equivalent to an average 3% change in TBW. Weight loss was sustained at the 6-month mark, with an average change in TBW of 2-3% when comparing weight at 6 months to pre-program weight. Conclusions: This CBT-based weight loss intervention was feasible and acceptable to gynecologic oncology patients. While the average weight loss fell short of the goal of 7% TBW, the 2-3% change in TBW achieved on average with this intervention was stable over six months. Additionally, retention within the intervention was high and maintained during COVID-19 with tele-visits. Given that weight loss plateaued when transitioning from weekly to monthly sessions, our findings suggest that longer, more intensive treatment may be needed to promote sustainable weight loss among gynecologic oncology patients. Collaboration between psychologists, oncology dietitians, and gynecologic oncologists, with continued support for psychologists and dieticians at cancer centers, is critical to the success of such programs. CBT is a feasible behavioral intervention to add further multidisciplinary efforts to tackle the complexity of obesity in cancer survivors. [Formula presented]
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Objectives: To evaluate the surgical volume, surgical outcomes, and the evolving role of gynecologic oncologists in peripartum hysterectomies (PPH). Methods: We conducted an IRB-approved retrospective chart review of PPH cases performed at our institution from June 1, 2014, to June 30, 2021. Clinical-pathologic information was ed into a REDCap database. All analyses were conducted using STATA 17. Results: A total of 109 cases were performed over the 7-year period. Gynecologic oncologists (GYO) involvement in the cases increased from 33% in 2014 to 80% in 2021. The mean age was 36 (range: 23-47) years. Most patients were White (81/109, 74.3%), and the median BMI was 30.7 (range: 21-57) kg/m2. Surgical indications included placenta accreta syndrome (PAS) in 84 (77%) cases, uterine atony in ten (9.2%), uterine rupture in three (2.8%), malignancy in five (4.6%), and hemorrhage other than atony in seven cases (6.4%). Intraoperative complications included bladder injury (or intentional dissection) in eight (7.3%), ureter injury in four (3.7%), vascular injury in three (2.8%), and femoral pseudoaneurysm in one (0.9%) of the cases. Postoperative complications included urinary tract infection in 11 (10.1%), nerve injury in one (0.9%), surgical site infection in 13 (11.2%), and venous thromboembolism in five (4.6%) cases. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) usage started in 2019 with one case followed by six cases in 2020 (31.6%) and 3/16 cases in the first half of 2020 (15.8%). A higher REBOA usage in 2020 corresponded with blood products shortages during the COVID crisis.[Formula presented] Conclusions: Overall volume and complexity of peripartum hysterectomy are increasing. This trend is likely driven by an increased incidence of placenta accreta syndrome cases. Gynecologic oncologists are increasingly delegated as primary surgeons in many institutions. Fellowship training programs should strongly consider training in peripartum hysterectomy for trainees.
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Background: Cervical cancer is the leading cause of cancer and cancer-related deaths among women in Nepal, due in part to a lack of access to screening and limited medical providers trained to diagnose and treat women with preinvasive cervical disease. Cancer Care Nepal has partnered with The University of Texas MD Anderson Cancer Center (MD Anderson) and the American Society of Clinical Oncology (ASCO) to implement a 'train the trainer' (TOT) program to teach visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, cryotherapy, thermal ablation, and loop electrosurgical excision procedure (LEEP). Methods: An initial cervical cancer prevention course was held in Kathmandu, Nepal in November 2019, supported by ASCO and with faculty from Civil Service Hospital, Bhaktapur Cancer Hospital, and National Academy of Medical Sciences and MD Anderson. As a continuation of this program, a TOT course was implemented for local specialists from five participating institutions throughout Nepal to learn how to deliver these trainings. Each participating institution then holds their own local course for nurses and doctors in their region. The training is complemented with monthly Project ECHO (Extension for Community Healthcare Outcomes) telementoring videoconferences. Results: The program was launched in November 2021. To date, two TOT training courses (2-day duration) have been held for clinicians from the 5 participating regions. Due to COVID-19 pandemic travel restrictions, didactic lectures were held virtually with MD Anderson and ASCO staff and included epidemiology of cervical cancer, screening guidelines, colposcopy, and treatment of cervical dysplasia. This was followed by hands-on training using simulation models to teach VIA, colposcopy, ablation and LEEP, led by the Nepalese faculty who had participated in the 2019 course. There were 41 participants in total (23 in the first course and 18 in the second course), including 21 gynecologists, 4 gynecologic oncologists, 1 medical oncologist, 1 general practitioner, and 14 nurses. 39 participants (73%) completed both the pre-and post-survey results. 86% of respondents from the first course and 100% of respondents from the second course reported that they intended to change their practice as a result of knowledge gained from the course. In addition, Cancer Care Nepal became a new hub for Project ECHO and held its first session in January 2022, with 20 participants representing two regions. The specialists from each of the 5 participating sites will be holding local courses for doctors and nurses in their respective regions throughout 2022. Conclusions: Our work shows that the TOT strategy can widen the reach of training in cervical cancer prevention in Nepal. Despite travel restrictions during the COVID-19 pandemic, global health training and mentoring can continue, though they require adaptions and use of virtual platforms.
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Background Genetic testing for ovarian cancer patients is essential to consideration of PARP inhibitor therapy. To improve access, we piloted a Genetic Testing Station (GTS) which allowed patients to have a drop-in, same-day genetic testing visit facilitated by Genetic Counselor Assistants (GCAs) under the supervision of Genetic Counselors (GCs). Methods The GTS was implemented in December 2018 and operated through February 2020. Gynecologic Oncologist offered ovarian cancer patients a same-day GTS visit with a GCA, where the patient received education via videos designed by GCs. The patient also provided consent, a brief family history, and a sample for a standardized 133-gene panel. Results were provided by a telehealth or clinic visit with a GC. We compared uptake of genetic testing post-GTS, and also time from referral to delivery of testing results. Patients were retrospectively identified by querying the medical record for ovarian cancer patients seen 12 months prior to and 18 months after GTS implementation. Results A total of 482 patients pre-GTS were compared to 625 patients post-GTS. Genetic testing increased from 68.5% to 75.66665% (p = 0.012) after implementation of the GTS, with the majority of the increase in patients with epithelial histologies (80% vs 89% in pre-GTS vs post-GTS, p = 0.005). Time from referral to genetic testing to obtaining results was evaluated in the post-GTS cohort, comparing patients who had traditional counseling to those who utilized the GTS. The time to obtaining results was shorter in the GTS group at 21 days (95% CI [10, 34]) compared to 56 days (95% CI [41,76]) in the traditional genetic counseling group. Discussion The GTS reduces barriers to care and facilitates discussion of precision treatment and prevention strategies with patients and their families in a timely fashion while optimizing Genetic Counselor clinic time. Post-COVID, access improvement remains integral to improving uptake of genetic testing.
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Introduction and aims of the study: In early vulvar cancer, lymph node status is the most important prognostic factor. Sentinel lymph node biopsy (SLNB) is the minimally invasive procedure that lead to the most significant reduction in the classical high morbidity associated with the sistematic inguinal-femoral lymphadenectomy. Besides quality control, the aim of this study is to document the overall experience around SLNB at this referral Centre before the Covid pandemic, in order to monitor and possibly prevent future related changes. Methods: Retrospective analysis of patient files in cases where SLNB was performed as part of the treatment for vulvar cancer at the authors’ Department, from January, 2016 to December, 2019. A single surgeon performed the SLNB with the combined technique (technetium and patent blue). Data collected included demographics, pathology, accuracy, surgery and perioperative results, feasibility and survival. Results: 18 patients with vulvar squamous cell cancer were enrolled in the study. Median age was 68 years, average BMI 27.5kg/m2, 61.1% were married and Charlson score ≥5 was 55.6%. Primary site was labia majora in 44.4% and mid-line was affected in 27.8%. FIGO stage IB in 72.2% of cases, mean tumour diameter was 20.2 (7-39)mm. SLNB was bilateral in 27.8%, 1 out of 38 nodes removed was positive and average number of nodes per patient was 2.1. Mean hospital stay was 13.2 days, blood loss 72ml and no surgical complications. There was a single case of groin recurrence in 45.1 months mean follow-up time and 2 cases of non-related deaths. 33.3% and 5.6% patients had short and long-term postoperative complications, respectively, mostly infectious. Conclusions: SLNB is a reliable and safe minimally invasive technique that should be performed by experienced gynaecological oncologists in well-equipped and multidisciplinary Centres. The Covid pandemic is believed to be causing severe difficulties in the management of patients with vulvar cancer, from diagnosis to follow-up and treatment of recurrences. This study allows a future comparison with positive results at this Centre, possibly reflecting other similar scenarios in Europe.
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Introduction/Background∗ The COVID-19 pandemic has had a dramatic impact on many aspects of healthcare, with changes in clinical practice aimed at reducing hospital appointments for patients who are classified as clinically vulnerable. In oncology this has resulted in a move towards the uptake of innovative follow-up schemes, such as patient-initiated or telephone follow-up, in particular for patients who are deemed to be at lower risk of recurrence. The aim of this study was to explore clinician's views of the impact of the COVID19 pandemic on the uptake of such schemes and the challenges in maintaining such schemes in the future. Methodology A mixed methods study was performed consisting of an online questionnaire of clinical nurse specialists and a qualitative interview study of clinicians involved in the follow-up of patients after a diagnosis of endometrial cancer. The interviews were conducted virtually, audio recorded, transcribed verbatim and analysed using framework analysis. Result(s)∗ In total, 22 clinical nurse specialists responded to the survey. Interview participants included gynaecological oncologists, cancer unit gynaecologist, oncologists and clinical nurse specialists. There was universal support to reduce faceto- face consultations during the COVID-19 pandemic and strong support for telephone and patient initiated follow-up. 70% of the participants of the online survey reported that in their opinion COVID-19 pandemic had had an impact on their clinic service by causing accelerated transition to patient initiated or telephone follow-up. The participants also reported patient support for the introduction of virtual follow- up compared to face-to-face appointments. Conclusion∗ The COVID-19 pandemic has resulted in a transition towards telephone and patient initiated follow-up for the follow-up of endometrial cancer. Further research is needed to ensure that these schemes are able to address patients' clinical and information needs if the change from face-to-face clinical follow-up is to be continued following the COVID-19 pandemic.