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Article ; Online: Healthcare utilization in women diagnosed with endometrial cancer: A survey-based study.

Desravines, Nerlyne / Hazimeh, Dana / Desjardins, Michael R / Wethington, Stephanie L

2024 Volume 186, Page(s) 1–8

Abstract: Objective: Despite similar incidence, non-Hispanic Black women are twice as likely to die of endometrial cancer as non-Hispanic White women. The social determinants of health may contribute to this disparity. We studied barriers to care and social needs ...

Abstract	Objective: Despite similar incidence, non-Hispanic Black women are twice as likely to die of endometrial cancer as non-Hispanic White women. The social determinants of health may contribute to this disparity. We studied barriers to care and social needs of endometrial cancer patients. Methods: In a cohort of patients with endometrial cancer from the All of Us study, participants self-reported demographics and completed validated surveys (access to medical care, transportation, caregiving, finances, medication, general care, specialty care, housing insecurity). Univariate and multivariate logistic regression models evaluated demographic and access factors associated with any need. Results: Of 568 participants, 77.7% identified as non-Hispanic White, 7.5% Black, and 8.8% Hispanic. 59% were > 65 years and 95.8% insured. Contributors to delays in care were paying out of pocket (9.9%), provider anxiety (7.6%), transportation (6.3%), cost of copay (6.2%), and insufficient leave from work (5.6%). To mitigate healthcare costs, 16.2% of participants inquired about lower-cost medications, 11.1% reported delaying filling prescriptions, 7.6% taking fewer prescribed medications, and 6.5% skipped doses. Regarding multivariate analysis, participants earning <$25,000 had a 7.3 (95% CI 1.7-31.7) higher adjusted odds of transportation needs and 3.6 (95% CI 1.4-9.7) higher difficulty accessing specialists. No racial/ethnic disparities were identified. Conclusions: Social needs and barriers to care are most pronounced among endometrial cancer survivors earning <$25,000. Unexpectedly, and possibly related to sample size or survey tool, race/ethnicity were not zassociated with barriers to care. Further studies on health-related social needs, optimal screening tools, and effective interventions are needed in order to achieve equity in cancer outcomes for endometrial cancer patients.
Language	English
Publishing date	2024-03-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	801461-9
ISSN	1095-6859 ; 0090-8258
ISSN (online)	1095-6859
ISSN	0090-8258
DOI	10.1016/j.ygyno.2024.03.015
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Article ; Online: Geographic Disparities in Potential Accessibility to Gynecologic Oncologists in the United States From 2001 to 2020.

Desjardins, Michael R / Desravines, Nerlyne / Fader, Amanda N / Wethington, Stephanie L / Curriero, Frank C

Obstetrics and gynecology

2023 Volume 142, Issue 3, Page(s) 688–697

Abstract: Objective: To use a spatial modeling approach to capture potential disparities of gynecologic oncologist accessibility in the United States at the county level between 2001 and 2020.: Methods: Physician registries identified the 2001-2020 gynecologic ...

Abstract	Objective: To use a spatial modeling approach to capture potential disparities of gynecologic oncologist accessibility in the United States at the county level between 2001 and 2020. Methods: Physician registries identified the 2001-2020 gynecologic oncology workforce and were aggregated to each county. The at-risk cohort (women aged 18 years or older) was stratified by race and ethnicity and rurality demographics. We computed the distance from at-risk women to physicians. Relative access scores were computed by a spatial model for each contiguous county. Access scores were compared across urban or rural status and racial and ethnic groups. Results: Between 2001 and 2020, the gynecologic oncologist workforce increased. By 2020, there were 1,178 active physicians and 98.3% practiced in urban areas (37.3% of all counties). Geographic disparities were identified, with 1.09 physicians per 100,000 women in urban areas compared with 0.1 physicians per 100,000 women in rural areas. In total, 2,862 counties (57.4 million at-risk women) lacked an active physician. Additionally, there was no increase in rural physicians, with only 1.7% practicing in rural areas in 2016-2020 relative to 2.2% in 2001-2005 ( P =.35). Women in racial and ethnic minority populations, such as American Indian or Alaska Native and Hispanic women, exhibited the lowest level of access to physicians across all time periods. For example, 23.7% of American Indian or Alaska Native women did not have access to a physician within 100 miles between 2016 and 2020, which did not improve over time. Non-Hispanic Black women experienced an increase in relative accessibility, with a 26.2% increase by 2016-2020. However, Asian or Pacific Islander women exhibited significantly better access than non-Hispanic White, non-Hispanic Black, Hispanic, and American Indian or Alaska Native women across all time periods. Conclusion: Although the U.S. gynecologic oncologist workforce increased steadily over 20 years, this has not translated into evidence of improved access for many women from rural and underrepresented areas. However, health care utilization and cancer outcomes may not be influenced only by distance and availability. Policies and pipeline programs are needed to address these inequities in gynecologic cancer care.
MeSH term(s)	Female ; Humans ; Asian ; Ethnicity ; Health Services Accessibility/statistics & numerical data ; Hispanic or Latino ; Minority Groups ; Oncologists ; United States/epidemiology ; Gynecology/statistics & numerical data ; Surgical Oncology/statistics & numerical data ; Healthcare Disparities/ethnology ; Healthcare Disparities/statistics & numerical data ; Adolescent ; Young Adult ; Adult ; White ; Black or African American ; Native Hawaiian or Other Pacific Islander ; American Indian or Alaska Native
Language	English
Publishing date	2023-08-03
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000005284
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Article ; Online: Frequency and characteristics associated with opportunistic salpingectomy at cesarean delivery: A retrospective chart review.

Desravines, Nerlyne / Brenner, Tara / Venkatesh, Kartik / Stuart, Gretchen

Contraception

2020 Volume 103, Issue 3, Page(s) 203–207

Abstract: Objectives: To identify the frequency and characteristics associated with total salpingectomy (TS) versus occlusion or partial salpingectomy (PS) at the time of cesarean delivery.: Study design: We performed a retrospective chart review of cesarean ... ...

Abstract	Objectives: To identify the frequency and characteristics associated with total salpingectomy (TS) versus occlusion or partial salpingectomy (PS) at the time of cesarean delivery. Study design: We performed a retrospective chart review of cesarean deliveries with a concurrent permanent contraception procedure, from July 1, 2014 to June 30, 2019 at 2 hospitals (community hospital and tertiary care academic center) within a single healthcare system. We assessed the proportion of TS versus PS at cesarean, and secondarily compared operative times between the 2 procedures. Results: We identified 2110 procedures during the 5-year period. Surgeons performed TS in 302 (14%, 95% confidence interval [CI] 13%-16%) cases, and the annual rate varied from 14% to 18% over the study period (p = 0.14). Factors associated with increased likelihood of TS rather than PS included public insurance/self-pay (adjusted odds ratio, aOR 2.8, 95% CI 2.0-4.1), delivery at the community hospital (aOR 4.8, 95% CI 3.0-7.7), parity of 5 or more (aOR 2.2, 95% CI 1.1-4.4), and presence of an obstetrician/gynecologist for cesarean delivery (aOR 2.9, 95% CI 1.6-5.4). The total operative time for TS and PS differed at the academic center (90 vs 68 minutes, p < 0.001) but not at the community hospital (55 vs 54 minutes, p = 0.5). Conclusions: This study highlights provider and institutional characteristics associated with TS compared to PS at the time of cesarean delivery, which may inform future programs aimed at increasing utilization of TS at cesarean delivery. Implications: Access to TS at the time of cesarean delivery may provide pregnant women with a very effective permanent contraception method at a convenient time of concurrent cesarean. This study identifies patient factors that may influence access to TS as part of obstetrical care.
MeSH term(s)	Cesarean Section ; Female ; Humans ; Operative Time ; Pregnancy ; Retrospective Studies ; Salpingectomy ; Sterilization, Tubal
Language	English
Publishing date	2020-12-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80106-9
ISSN	1879-0518 ; 0010-7824
ISSN (online)	1879-0518
ISSN	0010-7824
DOI	10.1016/j.contraception.2020.12.001
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Article: Treatment patterns and outcomes for primary uterine leiomyosarcoma with synchronous isolated lung metastases: A National Cancer Database study of primary resection and metastasectomy.

Istl, Alexandra C / Desravines, Nerlyne / Nudotor, Richard / Stone, Rebecca / Greer, Jonathan B / Meyer, Christian F / Johnston, Fabian M

Gynecologic oncology reports

2023 Volume 51, Page(s) 101308

Abstract: Background: One third of patients with uterine leiomyosarcomas (uLMS) present with distant metastases. Current guidelines do not include recommendations around surgery for metastatic uLMS. Patients with distant metastases commonly receive primary tumor ... ...

Abstract	Background: One third of patients with uterine leiomyosarcomas (uLMS) present with distant metastases. Current guidelines do not include recommendations around surgery for metastatic uLMS. Patients with distant metastases commonly receive primary tumor resection for symptoms and so oncologic outcomes after surgery warrant exploration. We describe treatment patterns and outcomes for uLMS patients with synchronous isolated lung metastases (SILM). Methods: This retrospective analysis of the National Cancer Database identified patients with uLMS and SILM. Patients with non-pulmonary metastases were excluded. We collected demographic, disease, and treatment characteristics and assessed clinicopathologic factors associated with the receipt of surgery on multivariate regression. Median, 1-year, and 5-year overall survival (OS) across treatment approaches were compared using Kaplan-Meier curves and log-rank tests. Multivariate Cox proportional hazard regressions identified independent predictors of survival. Results: We identified 905 patients with uLMS and SILM between 2004 and 2017. 600 patients had primary tumor resection; 63 also had curative intent surgery with metastasectomy. Patients who did not receive chemotherapy were older (p<0.01) with a higher comorbidity index (p<0.05). Women with private health insurance were more likely to receive chemotherapy (p<0.01) and primary tumor resection (p<0.01). Patients who underwent curative intent surgery had 1-year OS of 71.2% and 5-year survival of 18% compared to 1-year survival of 35.6 % and 5-year survival of 5.16 % for patients who had no surgery. Black women had poorer survival on multivariate regression. Conclusions: Primary tumor resection and curative intent surgery are associated with improved OS in uLMS with SILM and may be a reasonable treatment option in appropriately selected patients.
Language	English
Publishing date	2023-11-25
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2818505-5
ISSN	2352-5789
ISSN	2352-5789
DOI	10.1016/j.gore.2023.101308
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Article: Topical therapies for the treatment of cervical intraepithelial neoplasia (CIN) 2-3: A narrative review.

Desravines, Nerlyne / Miele, Kate / Carlson, Rebecca / Chibwesha, Carla / Rahangdale, Lisa

Gynecologic oncology reports

2020 Volume 33, Page(s) 100608

Abstract: Current management of Cervical Intraepithelial Neoplasia (CIN), caused by high-risk human papillomavirus (hr-HPV), is based on surveillance and surgical therapy. Procedures carry potential risks such as preterm birth, and access remains limited ... ...

Abstract	Current management of Cervical Intraepithelial Neoplasia (CIN), caused by high-risk human papillomavirus (hr-HPV), is based on surveillance and surgical therapy. Procedures carry potential risks such as preterm birth, and access remains limited throughout the world. However, there are no medical therapies recommended to promote the clearance of hr-HPV infection or CIN. Ultimately, even if less efficacious than excision procedures, medical therapies have the potential to decrease cervical cancer by eliminating barriers to treatment, such as access to treatment, or serving as an adjunct to surgical treatment in both high- and low-resource settings. This review describes current research on topical therapies with the potential for self-application for the treatment of HPV or CIN. Therapies included are immune-modulators, anti-proliferative medications, antivirals, hormones, and herbal/alternative therapies. Randomized trials of immune-modulating (imiquimod), anti-proliferative (5-fluorouracil), and anti-viral (cidofovir) therapies have had the most promising results. However, no option has sufficient clinical trial evidence to be recommended as treatment for CIN 2-3 and surgery remains the standard of care. The research described in this review serves as a guide for the development of future trials in the burgeoning arena of topical therapies for CIN 2-3.
Language	English
Publishing date	2020-07-02
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2818505-5
ISSN	2352-5789
ISSN	2352-5789
DOI	10.1016/j.gore.2020.100608
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Article ; Online: Feasibility of 5-fluorouracil and imiquimod for the topical treatment of cervical intraepithelial neoplasias (CIN) 2/3.

Desravines, Nerlyne / Hsu, Chiu-Hsieh / Mohnot, Sopan / Sahasrabuddhe, Vikrant / House, Margaret / Sauter, Edward / O'Connor, Siobhan / Bauman, Julie E / Chow, H-H Sherry / Rahangdale, Lisa

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

2023 Volume 163, Issue 3, Page(s) 862–867

Abstract: Objectives: To determine the feasibility (as measured by tolerability and safety) and efficacy of topical 5-fluorouracil (5-FU) and imiquimod for the treatment of cervical intraepithelial neoplasia (CIN) 2/3.: Methods: This pilot prospective study ... ...

Abstract	Objectives: To determine the feasibility (as measured by tolerability and safety) and efficacy of topical 5-fluorouracil (5-FU) and imiquimod for the treatment of cervical intraepithelial neoplasia (CIN) 2/3. Methods: This pilot prospective study was conducted in women aged 18-45 years with p16+ CIN 2/3. Participants underwent an 8-week alternating regimen of self-applied 5% 5-FU on weeks 1, 3, 5, and 7 and physician-applied imiquimod on weeks 2, 4, 6, and 8. Adverse events (AEs) were collected by symptom diary and clinical exam. Feasibility was measured by tolerability and safety (AEs) of the study intervention. Tolerability was assessed as the number of participants able to apply 50% or more of the treatment doses. The safety outcome was calculated as the number of participants who experienced "specified AEs" defined as possibly, probably, or definitely related grade 2 or worse AE or grade 1 genital AEs (blisters, ulcerations, or pustules) lasting more than 5 days. The efficacy of the intervention was determined by histology and high-risk human papillomavirus (hrHPV) testing was done after treatment. Results: The median age of the 13 participants was 27 ± 2.9 years. Eleven (84.61%) participants applied 50% or more of the treatment. All participants reported grade 1 AEs; 6 (46.15%) reported grade 2 AEs; and 0 reported grade 3/4 AEs. Three (23.08%) participants had specified AEs. Histologic regression to normal or CIN 1 among those completing 50% or more of the treatment doses was observed in 10 (90.91%) participants, and 7 (63.63%) tested negative for hr-HPV at the end of the study. Conclusions: Topical treatment for CIN 2/3 with 5-FU/imiquimod is feasible, with preliminary evidence of efficacy. Topical therapies need further investigation as adjuncts or alternatives to surgical therapy for CIN 2/3.
MeSH term(s)	Female ; Humans ; Young Adult ; Adult ; Imiquimod/adverse effects ; Fluorouracil/adverse effects ; Uterine Cervical Neoplasms/pathology ; Prospective Studies ; Feasibility Studies ; Uterine Cervical Dysplasia/pathology ; Papillomavirus Infections/drug therapy ; Papillomaviridae
Chemical Substances	Imiquimod (P1QW714R7M) ; Fluorouracil (U3P01618RT)
Language	English
Publishing date	2023-07-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	80149-5
ISSN	1879-3479 ; 0020-7292
ISSN (online)	1879-3479
ISSN	0020-7292
DOI	10.1002/ijgo.14983
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Article: Capnocytophaga

Hopkins, Austin M / Desravines, Nerlyne / Stringer, Elizabeth M / Zahn, Katelin / Webster, Carolyn M / Krajick, Kayla / Vora, Neeta L

Infectious disease reports

2019 Volume 11, Issue 3, Page(s) 8272

Abstract: ... ...

Abstract	Capnocytophaga
Language	English
Publishing date	2019-12-05
Publishing country	Switzerland
Document type	Journal Article
ISSN	2036-7430
ISSN	2036-7430
DOI	10.4081/idr.2019.8272
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Article: Intrapartum Group B

Desravines, Nerlyne / Venkatesh, Kartik K / Hopkins, Austin / Waldron, Jamie / Grant, Megan / McGuire, Colleen / Boggess, Kim A

AJP reports

2019 Volume 9, Issue 3, Page(s) e238–e243

Abstract: ... ...

Abstract	Objectives
Language	English
Publishing date	2019-07-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2628074-7
ISSN	2157-7005 ; 2157-6998
ISSN (online)	2157-7005
ISSN	2157-6998
DOI	10.1055/s-0039-1694031
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Article ; Online: Outpatient Penicillin Allergy Testing in Pregnant Women Who Report an Allergy.

Desravines, Nerlyne / Waldron, Jamie / Venkatesh, Kartik K / Kwan, Mildred / Boggess, Kim A

Obstetrics and gynecology

2020 Volume 137, Issue 1, Page(s) 56–61

Abstract: Objective: To estimate the feasibility, acceptability, and safety of outpatient penicillin allergy testing among pregnant women.: Methods: We conducted a prospective cohort study at a large academic hospital from March 2019 to March 2020. We ... ...

Abstract	Objective: To estimate the feasibility, acceptability, and safety of outpatient penicillin allergy testing among pregnant women. Methods: We conducted a prospective cohort study at a large academic hospital from March 2019 to March 2020. We recruited pregnant women with a self-reported penicillin allergy who underwent allergy testing between 14 0/7 and 36 6/7 weeks of gestation. Results: Of 127 eligible women pregnant women, 74 (58%, 95% CI 4-67%) accepted allergy testing. Fifty completed or intended to complete allergy testing, yielding a feasibility rate of 68% (95% CI 56-78%). Among the 46 women actually tested (who ranged in age from 18 to 42), 93% (95% CI 68-100%) had a negative test result. A systemic reaction (symptoms consistent with anaphylaxis) occurred in only 2 women (4%, 95% CI 0.5-15%) despite 20 (43%) reporting a severe allergy. No woman suffered an adverse event as a result of allergy testing. In multivariate analysis adjusting for age and parity, women with public insurance had decreased odds of undergoing penicillin allergy testing (adjusted odds ratio 0.24, 95% CI 0.08-0.69). Conclusion: Outpatient penicillin allergy testing is acceptable and feasible in pregnancy.
MeSH term(s)	Adolescent ; Adult ; Drug Hypersensitivity/diagnosis ; Feasibility Studies ; Female ; Humans ; Penicillins/immunology ; Pregnancy ; Prenatal Care ; Skin Tests/statistics & numerical data ; Young Adult
Chemical Substances	Penicillins
Language	English
Publishing date	2020-12-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000004213
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Article ; Online: Contemporary Incidence of Medical Inoperability in Clinical Stage I Endometrial Cancer.

Ertel, Michelle / Staley, S Allison / Nguyen, Tam / Johnson, Austin / Hopkins, Austin / Desravines, Nerlyne / Recknagel, Johnathon / Zhang, Xinyi / Tan, Xianming / Clark, Leslie H

Annals of surgical oncology

2021 Volume 28, Issue 13, Page(s) 8987–8995

Abstract: Background: Minimally invasive surgical (MIS) staging is the standard treatment approach for clinical stage I endometrial cancer. Historical rates of inoperability in endometrial cancer are approximately 10%. Given surgical and medical advancements ... ...

Abstract	Background: Minimally invasive surgical (MIS) staging is the standard treatment approach for clinical stage I endometrial cancer. Historical rates of inoperability in endometrial cancer are approximately 10%. Given surgical and medical advancements against increasing population obesity, we aimed to describe a contemporary incidence of medical inoperability in clinical stage I endometrial cancer. Patients and methods: Patients diagnosed with clinical stage I endometrial cancer of any histology from April 2014 to December 2018 were included in this retrospective cohort study. The primary outcome, medical inoperability, was defined as (1) patients deemed inoperable by a gynecologic oncologist at initial consultation, (2) patients deemed inoperable during preoperative clearance, or (3) an aborted hysterectomy. Fisher's exact or χ Results: Overall, 767 patients were included, of which 4.6% (35/767) were determined to be inoperable. The inoperable group had a higher body mass index (52.7 vs. 33.9, p < 0.001), and increased rates of diabetes (62.8%, 22/35 vs. 27.1%, 199/732, p < 0.001), coronary artery disease (31.4%, 11/35 vs. 7.1%, 52/732, p < 0.001), and hypertension (94.3%, 33/35 vs. 70.2%, 514/732, p < 0.001). Of those with attempted surgical staging, hysterectomy was aborted intraoperatively in 0.68% (5/737). The overall complication rate was 11.6% (86/737). Conclusions: With maximal surgical effort and MIS, hysterectomy is possible in > 95% of patients with newly diagnosed endometrial cancer treated at a high-volume center. Complication rates were comparable to other trials evaluating the safety of MIS staging for endometrial cancer.
MeSH term(s)	Endometrial Neoplasms/epidemiology ; Endometrial Neoplasms/pathology ; Endometrial Neoplasms/surgery ; Female ; Humans ; Hysterectomy ; Incidence ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Neoplasm Staging ; Retrospective Studies
Language	English
Publishing date	2021-06-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-021-10313-6
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