Diagnostic and therapeutic advances in gynecologic oncology: screening for gynecologic cancer

1998 ◽  
pp. 253-276 ◽  
Author(s):  
Young B. Kim ◽  
Kris Ghosh ◽  
Steven Ainbinder ◽  
Jonathan S. Berek
Keyword(s):  
Gynecologic Oncology ◽  
Gynecologic Cancer

scholarly journals Approach to Palliative Care Consultation for Patients With Malignant Bowel Obstruction in Gynecologic Oncology: A Qualitative Analysis of Physician Perspectives

2020 ◽  
Vol 16 (8) ◽  
pp. 483-489
Author(s):  
Claire Hoppenot ◽  
Fay J. Hlubocky ◽  
Julie Chor ◽  
S. Diane Yamada ◽  
Nita K. Lee
Keyword(s):  
Palliative Care ◽  
Qualitative Analysis ◽  
Bowel Obstruction ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Malignant Bowel Obstruction ◽  
Specific Patient ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Nonsurgical Patients

PURPOSE: Malignant bowel obstruction (MBO) from gynecologic cancer is associated with increased symptoms and short survival. A gynecologic oncologist’s approach to palliative care consultation in the setting of MBO has not been well studied—it could be an opportune time for collaboration with palliative care. MATERIALS AND METHODS: This qualitative analysis of interviews with gynecologic oncologists focuses on their perspectives on palliative care consultation at the time of MBO. Interviews were analyzed using a framework analysis, and key themes and quotations were extracted. RESULTS: We interviewed 15 gynecologic oncologists from 8 institutions in Chicago. They described a variety of expectations from palliative care consultation. Most frequently, they consulted palliative care for specific questions but managed the remainder of the care. Most participants frequently consulted palliative care, but they also worried about fragmentation of care, the timing of when to introduce a new team during MBO, and the selection of appropriate patients for a limited resource. Many participants preferred earlier palliative care consultation, and many described an emotional toll of caring for patients with MBO. Palliative care consultation was most readily discussed for nonsurgical patients. CONCLUSION: Participants’ expectations of palliative care consultations during MBO varied and were not always met. We recommend strengthening communication and protocols for palliative care involvement that meet the needs of specific patient populations and physician teams for surgical and nonsurgical patients. More research is needed to better understand how to integrate palliative care into oncologic and surgical care with gynecologic oncologists.

Patterns of Care for Radiotherapy in Vulvar Cancer: A Gynecologic Cancer Intergroup Study

2009 ◽  
Vol 19 (1) ◽  
pp. 163-167 ◽  
Author(s):  
David K. Gaffney ◽  
Andreas Du Bois ◽  
Kailash Narayan ◽  
Nick Reed ◽  
Takafumi Toita ◽  
...  
Keyword(s):  
Vulvar Cancer ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Neoadjuvant Treatment ◽  
Study Groups ◽  
Cooperative Groups ◽  
Computed Tomographic ◽  
Gynecology And Obstetrics ◽  
Initial Surgery ◽  
Individualize Treatment

Background:This study aimed to describe radiotherapeutic practice in the treatment of vulvar cancer in member study groups of the Gynecologic Cancer Intergroup (GCIG).Methods:A survey was developed and distributed to representatives of the member study groups of the GCIG, targeting the use of radiotherapy (RT) in vulvar cancer.Results:Thirty-two surveys were returned from 12 different cooperative groups. The most common indications for neoadjuvant RT include unresectable disease or International Federation of Gynecology and Obstetrics stage ≥III. For the neoadjuvant treatment of vulvar cancer, pelvic doses were 48.2 ± 5.0 Gy (mean ± SD). The upper border of the pelvic field was L4/5 in 4, L5/S1 in 12, and not specified in 4. Of 21 groups that perform neoadjuvant RT, 17 use concomitant chemotherapy and 4 individualize treatment. Weekly cisplatin was the most commonly used chemotherapy. For the neoadjuvant RT treatment of the inguinal region, doses were 49.9 ± 5.5 Gy (mean ± SD). Sixteen of 18 groups used computed tomographic simulation for planning. After initial surgery, the most common indications for RT included positive lymph nodes or positive margins. Chemotherapy was not routinely used after surgery.Conclusions:Doses of RT among GCIG members are similar; however, the indications for treatment, treatment fields, and use of chemotherapy differ somewhat between groups. This is likely due to the rarity of the disease. The lack of randomized trials may contribute to the absence of a broadly accepted standard. This underscores the importance of international cooperation as in GCIG to gather more reliable data for uncommon tumors in gynecologic oncology.

Gynecologic Oncologist Perspective About ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer

2017 ◽  
Vol 27 (4) ◽  
pp. 826-831 ◽  
Author(s):  
Polat Dursun ◽  
Ali Ayhan
Keyword(s):  
Endometrial Cancer ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Daily Practice ◽  
Consensus Conference ◽  
Point Of View ◽  
Great Effort ◽  
Care Providers ◽  
Nccn Guidelines ◽  
Huge Impact

AbstractESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer was simultaneously published in 3 prestigious journals and is sure to have a huge impact on the clinical practice of gynecologic oncology community and other gynecologic cancer care providers.It is a tremendous report representative of great effort. Hovewer, as practicing gynecologic oncologists, endometrial carcinoma is the most common clinical entity encountered in our routine daily practice; as such, we find some of the report confusing and object to some of its findings, as detailed in this brief report.We also attempted to summarize the differences between the well-known NCCN guidelines and the ESMO-ESGO-ESTRO Consensus Conference guidelines and try to give the point of view of gynecologic oncologic perspective. It is obvious that differences in the management of endometrial carcinomas will continue to be debated by the scientific community.

Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country

2017 ◽  
Vol 5 (1) ◽  
pp. 23-27
Author(s):  
Erum S Khan ◽  
Sheikh Irfan ◽  
Natasha Khalid
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Cancer Patients ◽  
Developing Country ◽  
Gynecologic Oncology ◽  
Tertiary Care ◽  
Gynecologic Cancer ◽  
Care Facility ◽  
Site Infection ◽  
Tertiary Care Facility

ABSTRACT Introduction Surgical site infections (SSIs) are among the most common complications in surgical patients and have serious consequences for outcomes and costs. There is a dearth of information on risk factors for developing SSI in patients undergoing gynecologic cancer surgery, and this has not been studied using national data. Objectives The objectives of this study were to estimate the prevalence, preoperative and operative risk factors associated with the higher risk of SSIs in gynecologic cancer patients undergoing surgery in a tertiary care facility in a developing country. Setting Department of Obstetrics and Gynaecology, Aga Khan University Hospitals, Karachi, Sindh, Pakistan. Materials and methods Retrospective record review of gynecologic oncology patients admitted for surgery from January 2015 to December 2015 was performed. Results A total of 100 patients met the inclusion criteria. Of these, 15 were identified with SSIs, which were all found to be of the superficial type. Approximately, 44, 40, and 7% were diagnosed with endometrial, ovarian, and cervical cancers respectively. The mean time from surgery to developing SSI was 12.9 days. Among endometrial cancer, 22.7% (10/44) had SSI compared with 7.5% (3/40) for ovarian cancer and 14.2% (1/7) for cervical cancer. The significant predictors of SSI were body mass index ≥35 (p-value <0.004), endometrial cancer diagnosis, the American Society of Anesthesiologists class more than 3, modified surgical complexity scoring system 3 to 4, and blood sugar levels more than 180 mg/dL within 48 hours after surgery in known diabetics. Conclusion About 15% of patients undergoing laparotomy for gynecologic malignancy developed SSIs. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSIs, and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery. How to cite this article Khan ES, Irfan S, Khalid N. Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country. J South Asian Feder Menopause Soc 2017;5(1):23-27.

Why are patients lost to follow-up in a gynecologic oncology clinic?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17571-e17571 ◽  
Author(s):  
V. C. Garcia ◽  
A. M. Manalo ◽  
J. B. Toral ◽  
M. L. Siasu
Keyword(s):  
Educational Attainment ◽  
Marital Status ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Cancer Type ◽  
Monthly Income ◽  
Family Commitment ◽  
Number Of Patients ◽  
Lost To Follow Up

e17571 Background: The aim of this study is to investigate why patients are lost to follow-up in a gynecologic oncology clinic. Methods: Patients who had been lost to follow up previously, and eventually followed up between April and August 2007 were given a consent form and questionnaire to answer. An approximately equal number of patients who were not lost to follow-up were given the same questionnaire as controls. The first part of the questionnaire included the age, marital status, location, diagnosis/type of gynecologic cancer, type of intervention, educational attainment, occupation and monthly income. The second part asked directly the reason why they were lost to follow-up. Data were recorded in a computerized database via Microsoft Excel. Descriptive statistics were presented in mean, median, standard deviation, minimum, maximum and frequencies. Differences between patients who failed to follow-up (LF) and their controls (NLF) with respect to demographics, disease and treatment characteristics were assessed by an x2 test or independent t test, depending on the variable. SPSS version 15 was used to perform all analyses. A p < 0.05 was considered significant. Results: There were 50 patients who were not lost and 52 patients who were lost to follow-up. The demographic characteristics between these two groups; i.e., age, marital status, location, diagnosis/type of gynecologic cancer, type of intervention, educational attainment, occupation, and monthly income of patients were all not statistically significant. The most common reason why patients were lost to follow-up was they had no money. Other reasons included: symptoms became better or problems resolved, the follow up was at an inconvenient time and I had family commitment. Conclusions: Patients expressed that the main reason for not following-up was the lack of funds. The majority in these respondents lived below the minimum salary wages. No significant financial relationships to disclose.

Geographic disparities in care: The Maryland gynecologic oncology experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16546-e16546
Author(s):  
Saroj Fleming ◽  
Selma Amrane ◽  
Gautam G. Rao ◽  
Sarah Madhu Temkin
Keyword(s):  
African American Women ◽  
Cancer Care ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Insurance Status ◽  
Racial Groups ◽  
Gynecologic Malignancies ◽  
Specialized Care ◽  
Barrier To Care ◽  
To Receive

e16546 Background: Women with gynecologic malignancies require highly specialized care that is often unavailable at local centers. Prior reports have suggested that distance from residence to treatment facility is a barrier to care. We hypothesize that insurance status influences the distance women travel to receive gynecologic cancer care. Methods: Patients with incident gynecologic cancer diagnoses at a single urban, academic Institution were identified. Distance from the patients’ homes to the hospital was calculated in miles as well as time. Insurance status at diagnosis was captured as private (P), Medicaid (MA), Medicare (MC) or uninsured (UI). Results: 153 patients were identified. The median distance travelled to the hospital was 18.1 miles with a median time travel of 28 minutes. 48 (31%) of patients were insured by P, 42 (27%) by MA, 35 (23%) by MC and 28 (18%) were UI. Patients with MC were older than those with MA, P or UI (p<0.01). Patients with P were more likely to present with cancer of the uterine corpus (p<0.01). African American women were more likely to be covered by MA than other racial groups (p<0.01). Rates of medical comorbidities (obesity, diabetes and hypertension) were similar between insurance groups, although there was a trend towards higher body mass index in UI (p=0.08). Mean distance and time to the hospital by insurance category is shown in Table 1. The distances and times were different between groups (p=0.04, p=0.03 respectively). These differences remained significant when adjusted for site of primary disease and race (p<0.01). Adherence with treatment recommendations was similar regardless of insurance status or distance travelled. Conclusions: Insurance status plays a role in the distance women travel to receive gynecologic cancer care. The neediest patients may be shouldering an unfair burden in terms of access to specialty oncology treatments. [Table: see text]

Predictors of referral to outpatient specialty palliative care (SPC) in gynecologic cancer (GC) patients.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 159-159
Author(s):  
Rachel Ruskin ◽  
Michelle Renee Rowland ◽  
Katherine N Moore ◽  
Katrina Slaughter ◽  
Adam Walter ◽  
...  
Keyword(s):  
Palliative Care ◽  
Sexual Dysfunction ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Routine Care ◽  
Multivariate Model ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Future Research ◽  
Cross Sectional

159 Background: Prior studies in GC patients have described predictors of inpatient palliative care (PC) consultation, but predictors of outpatient SPC consultation have not been elucidated. We sought to identify factors predictive of referral and associated care outcomes. Methods: We performed a cross-sectional study of GC patients seen in the gynecologic oncology clinic at a comprehensive cancer center over a three month period. As a part of routine care, patients completed a symptom questionnaire. Patients previously seen at the outpatient PC clinic were compared to those who had not with respect to demographics, disease characteristics, symptom scores, and provider factors using univariate statistics. A multivariate model was created to identify independent predictors of referral. Results: 913 patients completed the symptom survey. 76 patients (8%) had been seen in the outpatient PC clinic. Disease factors associated with referral included site (p < 0.01), stage (p < 0.01), evidence of disease (p < 0.01), active treatment (p < 0.01), and time point in the disease trajectory (p < 0.01). Women with moderate to severe pain (p < 0.01), sadness (p = 0.03), distress (p < 0.01), fatigue (p < 0.01), neuropathy (p = 0.03), and sexual dysfunction (p < 0.01) were more likely to have seen PC. Marital status, number of symptoms, and patient provider were also predictive of referral (all p < 0.01). In a multivariate model, site, stage, number of symptoms, moderate to severe sexual dysfunction, and provider were independently associated with referral. Compared to women who had not been referred, patients seen in the PC clinic were more likely to have a health care proxy documented in the electronic medical record (p < 0.01). Among patients with related symptoms, patients referred to PC more often had an opioid prescribed for pain (p < 0.01) and medications prescribed for depression (p < 0.01), anxiety (p = 0.04), insomnia (p < 0.01), and fatigue (p < 0.01). Conclusions: Women with depression, anxiety, insomnia, and fatigue were more likely to receive pharmacologic treatment for these symptoms from a SPC provider. Future research should identify referral triggers for those patients most likely to benefit from outpatient SPC consultation.

Sign in / Sign up

Export Citation Format

Share Document