Pilot study assessing distressors affecting patients with cancer using the distress screening tool.

68 Background: Distress is a non-stigmatic description of emotional, physical, spiritual or psychiatric stressors experienced by patients (pts) diagnosed with cancer. We sought to determine the prevalence of distress in different cancer population of pts seen in our cancer center as they are commencing chemotherapy. Methods: We retrospectively examined data using the Distress Thermometer (DT) based on the National Comprehensive Cancer Network (NCCN) and assessed a single encounter on 240 consecutive patients undergoing their first chemotherapy session. Univariate associations were examined between specific problems and overall distress levels with a 2-tailed between-group t-test. Problem area scores were computed for each subject by taking the mean number of problems rated positive within each area, and associations between each problem area score and distress was examined using Spearman correlations. Results: Among the 240 patients in the sample, mean age was 60 ± 14, 61% were female, and 82% had solid tumors. The overall mean distress, based on the DT reading, was 3.6 ± 3.0. Specific problems reported by the largest number of patients included worry (n = 85), nervousness (n = 79), fatigue (n = 70), sleep (n = 66), and fears (n = 57). Of these, all but fatigue were significantly associated with global distress in univariate analysis. When mean problems per area were calculated, and correlated with global distress, each problem area (practical, emotional, family, physical) had a significant univariate association with global distress, with emotional problems having the highest correlation (r = .52, p < .0001). The only predictors with significant independent associations to predict global distress in the general linear model were emotional problems (p = .0001) and family problems (p = .0062), independent of age, sex and tumor types. Conclusions: In cancer patients undergoing distress screening as they receive their first chemotherapy, emotional and family problems appear to have the highest correlation with distress. Improvement of supportive care services geared towards the betterment of these symptoms is of paramount importance in improving outcomes.

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Comprehensive distress screening and referral at a tertiary cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.134 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 134-134

Author(s):

Elizabeth Trice Loggers ◽

Stephen Duane Watkins King ◽

Jesse R Fann ◽

Kerry K McMillin ◽

Jodie HN David ◽

...

Keyword(s):

Cancer Patients ◽

Well Being ◽

Cancer Center ◽

Screening Methods ◽

Distress Screening ◽

Web Based ◽

Care Services ◽

Existential Crisis ◽

Patient Health ◽

English Speaking

134 Background: Addressing distress in cancer patients is now broadly recognized as critical to well-being and associated with increased survival. Cancer centers are developing innovative distress screening methods; we describe our novel process and results. Methods: New patients from 9/2015 to 3/2017 received an email requesting completion of a 44-item web-based survey assessing depression (2-item Patient Health Questionnaire), anxiety (2-item Generalized Anxiety Disorder), quality of life (QOL, 28-item Functional Assessment of Cancer Treatment-General), malnutrition (3-item Malnutrition Screening Tool), and 9 items addressing existential crisis, physical function, symptoms, tangible needs and concerns for dependent children. Results were computer scored, with positive screens resulting in direct, automated referrals to supportive care services (SCR). Analysis includes descriptive statistics and logistic regression using SAS 9.4. Results: 71% (n = 2629 of 3724) of those approached provided an email and completed the survey; 73% reporting no survey burden. Non-responders were more likely to be minority, non-English speaking, with non-commercial insurance (all p < 0.001). 59% (n = 1543) of responders screened positive for one or more SCR, including 6% to palliative care for poor QOL or symptoms. Receipt of SCR was more likely with Medicaid insurance (1.36 odds ratio [OR], 95% confidence interval [CI] 1.06-1.76, p = .0061); plan to receive care (1.27 OR, CI 1.07-1.50, p = .0061); and any report of survey burden (2.26 OR, CI 1.83-2.80, p < .0001). Conclusions: Web-based distress screening is feasible, efficient and not burdensome for the majority of cancer patients. Those who find this screening burdensome are two-fold more likely to have distress. Future efforts should address screening of vulnerable populations.

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PathWell: The development of a triage center and access hub for comprehensive palliative care in oncology.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.162 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 162-162

Author(s):

Kavitha Ramchandran ◽

Erika Lauren Tribett ◽

Marcy Winget ◽

LaTisha Webster ◽

Dorothy Valmayor ◽

...

Keyword(s):

Palliative Care ◽

Cancer Center ◽

Patient Needs ◽

Supportive Services ◽

Distress Screening ◽

Oncology Nurse ◽

Early Access ◽

Care Services ◽

Quality Cancer Care ◽

Tumor Boards

162 Background: Routine screening to identify palliative care (PC) needs, followed by assessment and management of needs is critical for high-quality cancer care. Our current healthcare system there is poor screening for PC needs, low referral rates to PC services, and unmet needs. In response to these gaps, we developed a dedicated triage center to streamline the assessment of PC needs and better connect patients with appropriate supportive care services. Methods: We identified 24 services at our academic cancer center that provide PC and supportive services. Examples include PC, psycho-oncology, survivorship, nutrition, and social work. Representatives from these groups convened to map service overlap and develop referral structures based on patient need and acuity. A triage hub (PathWell) was established to complete uniform assessments of patient needs and determine appropriate referrals. The hub utilized a centralized scheduling platform, new patient coordinators, and an oncology nurse for assessment and triage. Referrals to the hub were made via EHR, direct patient contact, or prompted by routine distress screening. Results: PathWell launched on February 1, 2016. Referral volume to the hub was 54 in February, 91 in March and 74 in April. Referrals from PathWell were distributed amongst the 24 services, the majority of referrals going to PC, psycho-oncology and nutrition. All programs that were part of the triage center experienced growth in volume; PC 41%, psycho-oncology 14%, nutrition 16%. Conclusions: Partnerships between specialist services and dedicated triage staff can improve early access to resources for PC needs. Early data from PathWell reveals improved assessment and management of patient needs via referrals to appropriate services. The hub has also unveiled important resource gaps (e.g. physical therapy, integrative medicine). These gaps were not previously quantified, and thus not prioritized by leadership. Future state for PathWell includes reporting operational and health-related outcomes, optimizing distress screening, establishing care pathways for patient subtypes (e.g., metastatic disease), and hosting interdisciplinary tumor boards for complex distress management.

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Promoting quality breast cancer care: Psychosocial distress screening

Palliative & Supportive Care ◽

10.1017/s147895151300059x ◽

2013 ◽

Vol 12 (1) ◽

pp. 75-80 ◽

Cited By ~ 4

Author(s):

M. Tish Knobf ◽

Maureen Major-Campos ◽

Anees Chagpar ◽

Andrea Seigerman ◽

Ruth Mccorkle

Keyword(s):

Administrative Support ◽

Medical Oncology ◽

Surgical Oncology ◽

Psychosocial Distress ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Distress Screening ◽

Two Phase ◽

Breast Center ◽

Number Of Patients

AbstractObjective:To evaluate the feasibility of implementing psychosocial distress screening in a breast center of a comprehensive cancer center, using a model of structure (personnel, resources), process (screening), and outcome (number of patients screened, number referred).Methods:The first step in the project was to establish administrative support, educate and engage breast center staff, identify stakeholders and persons with expertise in the conduct of evidence based initiatives. A two-phase implementation approach was agreed upon with Phase I being screening of new patients in surgical oncology and Phase II being screening women in medical oncology.Results:A total of 173 patients were screened. The new patients screened in surgical oncology reported higher average distress scores compared to patients in medical oncology (5.7 vs. 4.0). However, a greater number of patients in medical oncology reported scores >4 compared to the new patients screened in surgery (54% vs. 35%). Psychological distress was the most commonly reported distress for patients in surgery. In contrast, 60% of scores >4 in medical oncology were symptom related, managed by the nurse or physician.Significance of results:Nurse led implementation of psychosocial distress screening is feasible, addressing this important quality indicator of patient-centered care.

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Problem areas identified by cancer patients with a positive distress screen in the medical clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.63 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 63-63 ◽

Cited By ~ 1

Author(s):

Teresa L. Deshields ◽

Mary Jane Ruhland

Keyword(s):

Medical Record ◽

Rating Scale ◽

Gynecologic Oncology ◽

Screening Method ◽

Well Being ◽

Problem Area ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Problem List ◽

Distress Screening

63 Background: NCCN has been advocating for distress screening since the inaugural Distress Management Guidelines in 1999. ASCO’s Quality Oncology Practice Initiative incorporated an indicator of patients’ emotional well-being in 2009. The ACoS Commission on Cancer established mandatory distress screening as an accreditation requirement for cancer programs in January 2015. This latter requirement dramatically increased the number of cancer programs doing routine distress screening. We examined distress screening results at a comprehensive cancer center. Methods: Results of distress screening were reviewed in the following clinical areas: medical oncology, radiation oncology, gynecologic oncology, and otolaryngology. Distress screening was completed verbally as a part of the vitals assessment, using the NCCN Distress Thermometer and Problem List. Only patients with a positive screen ( < 6 on 0-10 rating scale) completed the Problem List, identifying relevant problem areas (Emotional, Family, Practical, Physical, Spiritual and Other). The MA or RN doing the distress screening entered the distress rating and the endorsed problem area(s) in the electronic medical record. Results: In the first 5 months of 2017, 11,155 screening results were entered into the medical record. The percent of positive screens ranged from 5.7 to 8.6%, with X = 6.6% of screens being positive for distress. The most common problem areas were Emotional, endorsed with X = 72.5% of positive screens (range = 33.5-96.6%); Physical, endorsed with X = 67.52% of positive screens (range = 42.8-86.4%); and Practical, endorsed with X = 43.1% of positive screens (range = 20.1-59.9%). Conclusions: While some cancer centers use a psychologically-focused screening method (e.g. PHQ-9, BDI), distress is a bio-psychosocial construct, which requires a screening method that includes multiple domains. Furthermore, the triage related to distress screening may best be accomplished by the cancer team at the clinic visit, so that physical problems can be further assessed and addressed during the visit. The medical team can also make referrals to social work or psychological services to address related problem areas, when identified by patients.

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Distress screening through PROMIS at an academic cancer center and network site: Implementation of a hybrid model.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2021 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2021-2021

Author(s):

Mohana Roy ◽

Joel W. Neal ◽

Kelly Bugos ◽

Christopher Sharp ◽

Patricia Falconer ◽

...

Keyword(s):

Supportive Care ◽

Screening Tool ◽

Cancer Center ◽

Patient Portal ◽

Supportive Services ◽

Distress Screening ◽

Positive Screen ◽

Network Site ◽

Care Services ◽

Patient Reported

2021 Background: The NCCN guidelines recommend routine distress screening of patients with cancer, but the implementation of such programs is inconsistent. Up to one in three such patients experience distress, however fewer than half of them are identified and referred for supportive services. Methods: We implemented a hybrid (electronic and paper) distress screening tool, using a modified version of the PROMIS-Global Health questionnaire. Patients received either an electronic or in-clinic paper questionnaire to assess overall health and distress at the Stanford Cancer Center and its associated integrated network site. Iterative changes were made including integration with the electronic health record (EHR) to trigger questionnaires for appointments every 60 days. A consensus “positive screen” threshold was defined, with data collected on responses and subsequent referrals placed to a supportive care services platform. Results: Between June 2015 and December 2017, 53,954 unique questionnaires representing 12,744 distinct patients were collected, with an average completion rate of 58%. Approximately 30% of the questionnaires were completed prior to the visit electronically through a patient portal. The number of patients meeting the positive screen threshold remained ~ 40% throughout this period. Following assessment by the clinical team, there were 3763 referrals to cancer supportive services. Among the six most common referral categories, those with a positive screen were more likely to have a referral placed (OR 6.4, 95% CI 5.8-6.9 p- < 0.0001), with a sensitivity of 80% and a specificity of 61%. However, 89% of responses with a positive screen did not have a referral to supportive care services. Conclusions: The hybrid electronic and paper use of a commonly available patient reported outcome tool, as a high throughput distress screening tool, is feasible at a multi-site academic cancer center. Our positive screen rate for referrals was sensitive and consistent, but with a low positive predictive value. This screening also resulted in variable clinical response and overall increased clinical burden. Future directions for our group have included refining the threshold for a positive screen and implementation of a real-time response system, especially to address acute concerns.

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Chemotherapy Delays Are Associated with Inferior Outcome in Acute Lymphoblastic Leukemia: A Retrospective Study from a Tertiary Cancer Center in South India

Indian Journal of Medical and Paediatric Oncology ◽

10.1055/s-0041-1729513 ◽

2021 ◽

Vol 42 (01) ◽

pp. 051-060

Author(s):

Vineet Agrawal ◽

Smita Kayal ◽

Prasanth Ganesan ◽

Biswajit Dubashi

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Univariate Analysis ◽

Cancer Center ◽

Survival Outcomes ◽

Separate Analysis ◽

Term Survival ◽

Free Survival ◽

Intensive Phase ◽

The Impact

Abstract Background Treatment protocols for acute lymphoblastic leukemia (ALL) have evolved over time to give excellent cure rates in children and moderate outcomes in adults; however, little is known how delays in chemotherapy affect long-term survival. Objectives To find the association of delays during different treatment phases on the survival outcomes. Materials and Methods Data from 149 ALL cases treated between 2009 and 2015 were retrospectively analyzed. Treatment course in commonly used protocols was divided into three phases—induction, consolidation (postremission), maintenance, and also a combined intensive phase (induction plus consolidation) for the purpose of analysis, and delay in each phase was defined based on clinically acceptable breaks. Analysis was done to find the impact of treatment delay in each phase on the survival outcomes. Results The median age was 12 years (range, 1–57). Multi-center Protocol-841 (MCP-841) was used for 72%, German Multicenter Study Group for Adult ALL (GMALL) for 19%, and Berlin, Frankfurt, Muenster, 95 protocol (BFM-95) for 9% of patients. Delay in induction was seen in 52%, consolidation in 66%, and during maintenance in 42% of patients. The median follow-up was 41 months, and 3-year survival outcomes for the entire cohort were event-free survival (EFS)—60%, relapse-free survival (RFS)—72%, and overall survival (OS)—68%. On univariate analysis, delay in induction adversely affected EFS (hazard ratio [HR] = 1.78, p = 0.04), while delay in intensive phase had significantly worse EFS and RFS (HR = 2.41 [p = 0.03] and HR = 2.57 [p = 0.03], respectively). On separate analysis of MCP-841 cohort, delay in intensive phase affected both EFS (HR = 3.85, p = 0.02) and RFS (HR = 3.42, p = 0.04), whereas delay in consolidation significantly affected OS with (HR = 4.74, p = 0.04) independently. Conclusion Treatment delays mostly in intensive phase are associated with worse survival in ALL; attempts should be made to maintain protocol-defined treatment intensity while adequately managing toxicities.

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Disease course of Neurofibromatosis Type 2; a 30-year follow-up study of 353 patients seen at a single institution

Neuro-Oncology ◽

10.1093/neuonc/noaa284 ◽

2020 ◽

Author(s):

Claire Forde ◽

Andrew T King ◽

Scott A Rutherford ◽

Charlotte Hammerbeck-Ward ◽

Simon K Lloyd ◽

...

Keyword(s):

De Novo ◽

Radiation Treatment ◽

Univariate Analysis ◽

Age At Onset ◽

Neurofibromatosis Type ◽

Neurofibromatosis Type 2 ◽

Disease Course ◽

Number Of Patients

Abstract Background Limited data exists on the disease course of Neurofibromatosis Type 2 (NF2) to guide clinical trial design. Methods A prospective database of patients meeting NF2 diagnostic criteria, reviewed between 1990–2020, was evaluated. Follow-up to first vestibular schwannoma (VS) intervention and death was assessed by univariate analysis and stratified by age at onset, era referred and inheritance type. Interventions for NF2-related tumours were assessed. Cox regression was performed to determine the relationship between individual factors from time of diagnosis to NF2-related death. Results Three-hundred-and-fifty-three patients were evaluated. During 4643.1 follow-up years from diagnosis to censoring 60 patients (17.0%) died. The annual mean number of patients undergoing VS surgery or radiotherapy declined, from 4.66 and 1.65 respectively per 100 NF2 patients in 1990-1999 to 2.11 and 1.01 in 2010-2020, as the number receiving bevacizumab increased (2.51 per 100 NF2 patients in 2010-2020). Five patients stopped bevacizumab to remove growing meningioma or spinal schwannoma. 153/353 (43.3%) had at least one neurosurgical intervention/radiation treatment within 5 years of diagnosis. Patients asymptomatic at diagnosis had longer time to intervention and better survival compared to those presenting with symptoms. Those symptomatically presenting <16 and >40 years had poorer overall survival than those presenting at 26-39 years (P=0.03 and P=0.02 respectively) but those presenting between 16-39 had shorter time to VS intervention. Individuals with de novo constitutional variants had worse survival than those with de novo mosaic or inherited disease (P=0.004). Conclusion Understanding disease course improves prognostication, allowing for better informed decisions about care.

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Clinical and demographical factors associated with fertility counseling in colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24047 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24047-e24047

Author(s):

Chengwei Peng ◽

Lena Masri ◽

Stefanie Roman ◽

Scott Sherman ◽

Daniel Jacob Becker

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Univariate Analysis ◽

Cancer Center ◽

Survivorship Care ◽

Demographic Shift ◽

Curative Intent ◽

Younger Patients ◽

Future Fertility ◽

Fertility Counseling

e24047 Background: The incidence of colorectal cancer in patients younger than 50 has been increasing over the past 2 decades. This demographic shift has important implications for survivorship care, in particular regarding issues of future fertility especially in light of USPSTF’s recommendation for colorectal cancer screening to begin at 45. Although ASCO has longstanding recommendations for fertility counseling in patients with cancer, the rates of fertility counseling in younger patients with colorectal cancer are unknown. Methods: Records for new patient visits for colorectal cancer in patients younger than age 55 in a large academic cancer center between 2012 and 2019 were queried for patient demographics, disease characteristics, and documentation of fertility counseling. Associations between demographic/clinical characteristics and fertility counseling were explored. Univariate and multivariable logistical regression analyses were performed using SAS v9.4. Results: Among 194 patients who met inclusion criteria, 39.2% of patients were female, 10.4% were African American, 31.4% had rectal cancer, and 69.6% were treated with curative intent. Approximately 14.5% of patients had Medicaid insurance. Age ranged from 22-55. The overall rate of fertility counseling among all patients was 15.5%. Of these patients, 43.3% were male. In univariate analysis, age less than or equal to 40 (p < 0.01), female gender (p = 0.03) and curative intent therapy (p = 0.03) were associated with fertility counseling. These factors were again statistically significant in multivariate analysis: age < 40, female, and curative intent therapy (Table). Race, stage of cancer, insurance status, prior exposure to chemotherapy, year of diagnosis and colon vs rectal cancer were not associated with counseling. Conclusions: The rate of fertility counseling was very low among patients with colorectal cancer, and exceptionally low among men. Despite changes in the demographics of colorectal cancer, it does not appear that appropriate changes have been made in fertility counseling. Increases in fertility counseling were not seen in more recent years despite recognition of increasing incidence in younger patients. Additional studies to identify barriers to counseling and strategies to improve survivorship care are urgently needed.[Table: see text]

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Evaluation of Health Care Services Provided in Political Public Meetings in Turkey: A Forgotten Detail in Politics

Prehospital and Disaster Medicine ◽

10.1017/s1049023x18001048 ◽

2018 ◽

Vol 33 (6) ◽

pp. 607-613

Author(s):

Mehmet Ali Ceyhan ◽

Gültekin Günhan Demir ◽

Gamze Babur Güler

Keyword(s):

Health Care ◽

Political Parties ◽

Health Care Services ◽

Heat Index ◽

Election Campaign ◽

Medical Conditions ◽

Public Meetings ◽

Care Services ◽

Number Of Patients ◽

The Impact

AbstractBackgroundPolitical parties in Turkey execute political public meetings (PPMs) during their election campaign for members of the parliament (MoP). A great number of people attend these meetings. No guidelines exist regarding preparation and organization of health care services provided during these meetings. Furthermore, there is no study evaluating health care problems encountered in previous PPMs.ObjectivePolitical parties arranged PPMs in 2015 during the election campaign for general election of MoP. The present study aimed to investigate the context of health care services, the distribution of assigned health staff, as well as the number and the symptoms of patients admitted in health care tents in these PPMs.MethodsTwo general elections for MoP were done in Turkey on June 7, 2015 and November 1, 2015. Health care services were provided by the City Emergency Medical Services Department (CEMSD) in the cities. Demographic characteristics, symptoms, comorbid conditions, treatment, discharge, and hospital transfer of the patients were obtained from patient medical registration records. Information about the distribution and the number of the assigned staff was received from local CEMSDs. The impact of variables such as the number of attendees, heat index, humidity, and the day of the week on the number of patients and the patient presentation rate (PPR) were analyzed.ResultsA total of 97 PPMs were analyzed. The number of total attendees was 5,265,450 people. The number of patients seeking medical help was 1,991. The PPR was 0.5 (0.23-0.91) patients per 1,000 attendees. Mean age of the patients was 40 (SD=19) years old while 1,174 (58.9%) of the patients were female. A total of 1,579 patients were treated in the tents and returned to the PPM following treatment. Two-hundred and three patients were transferred to a hospital by ambulance. Transfer-to-hospital ratio (TTHR) was 0.05 (0.0-0.13) patients per 1,000 attendees. None of the patients suffered sudden cardiac death (SCD) or cardiac arrest. Medical conditions were the main cause for admission. The most common symptoms were dizziness, low blood pressure, fatigue, and hypertension, respectively. The most commonly used medical agents included pain killers and myorelaxants. The number of attendees, heat index, and weekend days were positively correlated with the number of the patients.Conclusion: The majority of medical conditions encountered in PPMs are easily treatable in health care tents settled in the meeting area. The number of attendees, heat index, and weekend days are factors associated with the number of patients.CeyhanMA, DemirGG, GülerGB. Evaluation of health care services provided in political public meetings in Turkey: a forgotten detail in politics. Prehosp Disaster Med. 2018;33(6):607–613.

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What Are The Determinants of Parametrial Invasion In Patients With Early Stage Cervical Cancer: A Cross Sectional Study

10.21203/rs.3.rs-1084890/v1 ◽

2021 ◽

Author(s):

Niloufar Hoorshad ◽

Narges Zamani ◽

Shahrzad Sheikh Hasani ◽

Amirhossein Poopak ◽

Amirsina Sharifi

Keyword(s):

Cervical Cancer ◽

Tumor Size ◽

Early Stage ◽

Univariate Analysis ◽

Surgical Margin ◽

P Value ◽

Positive Surgical Margin ◽

Stromal Invasion ◽

Number Of Patients ◽

Early Stage Cervical Cancer

Abstract Background: There was an increase in number of patients presented with early-stage cervical cancer (CC). Tumors with favorable pathological features might be candidates for less radical surgery.Methods: We retrospectively reviewed 700 patients with histologically confirmed CC between January 2011 and March 2020. Chi-square, Fisher's exact tests and multivariate logistic regression analysis were used to assess relations between parametrial involvement (PI) and clinic-pathological variables.Results: Total number of 132 patients with stage IA to IIA were eligible to participate. Squamous cell carcinoma was reported in 100 (75.8%) patients, adenocarcinoma and other tumor pathologies were found in 24(18.2%) and 8(6.1%), respectively. Considering the FIGO stage, 11 (8.4%) patients had IA, 111 (83%%) IB and 10 (7.6%) IIA. Nine patients (6.8%) had PI on permanent pathologic report. Univariate analysis demonstrated that following variables were statistically different between patients with and without PI: age ≥ 50, tumor size ≥ 3cm, lower segment involvement, poorly differentiated pathology, deep stromal invasion, pelvic lymph node, lympho-vascular involvement and positive surgical margin (all p values < 0.05). Among these variables only tumor size ≥ 3 cm (OR: 2.1, 95% CI: 1.11-4.16, p value: 0.02), deep stromal invasion (OR: 2.2, 95% CI: 1.9-7.43, p value: 0.02) and positive surgical margin (OR: 5.1, 95% CI: 3.97-11.15, p value: 0.008) were independent risk factor of PI in multivariate analysis.Conclusions: Early stage CC can be surgically approached in a more conservative manner if patients have tumor size < 3 cm and do not have deep stromal invasion in conization.

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