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Article ; Online: Help wanted: low provider density is associated with advanced stage cervical cancer.

Calo, Corinne / Barrington, David Allen / Mclaughlin, Eric M / Bixel, Kristin

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2022

Abstract: Background: Patients in rural areas have a higher incidence of cervical cancer with increased rates of metastatic disease than their urban counterparts.: Objective: To evaluate whether medical provider density, acting as a surrogate for screening ... ...

Abstract	Background: Patients in rural areas have a higher incidence of cervical cancer with increased rates of metastatic disease than their urban counterparts. Objective: To evaluate whether medical provider density, acting as a surrogate for screening availability, is associated with the incidence of cervical cancer or proportion diagnosed with advanced stage disease. Methods: Cervical cancer cases by county from 2015 were retrieved from the SEER database. The numbers of primary obstetric-gynecologists (OB-GYN), family practice, and internal medicine providers were obtained from the Area Health Resource File, and population estimates for each county were used to calculate provider to resident ratios. Spearman rank correlations were used to compare the number of providers per 100 000 residents with the overall incidence of cervical cancer as well as the proportion diagnosed at an advanced stage. Multivariable logistic regression was performed to assess factors independently associated with advanced stage disease, accounting for county of residence. Mortality was compared across different OB-GYN provider density categories. Results: A total of 3505 cases of cervical cancer from 405 counties were included. Spearman correlation demonstrated a significant inverse association between the number of OB-GYN providers per 100 000 residents and the incidence of cervical cancer (p<0.0001) as well as the proportion diagnosed at an advanced stage (p=0.003). Compared with those living in counties with ≤5 OB-GYN providers per 100 000 residents, those living in counties with >10 providers had a 29% reduction in the odds of presenting with advanced stage disease (OR=0.71; 95% CI 0.55 to 0.91). An inverse association between cervical cancer-related mortality and OB-GYN provider density was also noted. Conclusion: A significant inverse correlation between provider density and incidence of cervical cancer, proportion with advanced stage disease, and cervical cancer-related mortality was observed. Increasing provider density in these underserved, high-risk areas may improve timely cancer detection.
Language	English
Publishing date	2022-09-28
Publishing country	England
Document type	Journal Article
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2022-003779
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Zs.A 3198: Show issues

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Article ; Online: The modified 5-item frailty index is a predictor of post-operative complications in vulvar cancer: a National Surgical Quality Improvement Program (NSQIP) analysis.

Levine, Monica D / Felix, Ashley S / Meade, Caitlin E / Bixel, Kristin L / Chambers, Laura M

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2023 Volume 33, Issue 4, Page(s) 465–472

Abstract: Objective: To determine whether frailty is associated with post-operative complications following surgery for vulvar cancer.: Methods: This retrospective study used a multi-institutional dataset from the National Surgical Quality Improvement Program ( ...

Abstract	Objective: To determine whether frailty is associated with post-operative complications following surgery for vulvar cancer. Methods: This retrospective study used a multi-institutional dataset from the National Surgical Quality Improvement Program (NSQIP) database (2014-2020) to analyze the relationship between frailty, procedure type, and post-operative complications. Frailty was determined using the modified frailty index-5 (mFI-5). Univariate and multivariable-adjusted logistic regression analyses were performed. Results: Of 886 women, 49.9% underwent radical vulvectomy alone, and 19.5% and 30.6% underwent concurrent unilateral or bilateral inguinofemoral lymphadenectomy, respectively; 24.5% had mFI ≥2 and were considered frail. Compared with non-frail women, those with an mFI ≥2 were more likely to have an unplanned readmission (12.9% vs 7.8%, p=0.02), wound disruption (8.3% vs 4.2%, p=0.02), and deep surgical site infection (3.7% vs 1.4%, p=0.04). On multivariable-adjusted models, frailty was a significant predictor for minor (OR 1.58, 95% CI 1.09 to 2.30) and any complications (OR 1.46, 95% CI 1.02 to 2.08). Specifically, for radical vulvectomy with bilateral inguinofemoral lymphadenectomy, frailty was significantly associated with major (OR 2.13, 95% CI 1.03 to 4.40) and any complications (OR 2.10, 95% CI 1.14 to 3.87). Conclusion: In this analysis of the NSQIP database, nearly 25% of women undergoing radical vulvectomy were considered frail. Frailty was associated with increased post-operative complications, especially in women concurrently undergoing bilateral inguinofemoral lymphadenectomy. Frailty screening prior to radical vulvectomy may assist in patient counseling and improve post-operative outcomes.
MeSH term(s)	Humans ; Female ; Frailty/diagnosis ; Frailty/etiology ; Retrospective Studies ; Vulvar Neoplasms/surgery ; Vulvar Neoplasms/complications ; Quality Improvement ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/diagnosis ; Risk Factors ; Risk Assessment
Language	English
Publishing date	2023-04-03
Publishing country	England
Document type	Journal Article
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2022-004175
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Article: The poor prognosis of sarcomatoid carcinoma arising from low grade serous ovarian cancer: A case report and review of the literature.

Haight, Paulina / Savage, Johanna / Bixel, Kristin

Gynecologic oncology reports

2021 Volume 36, Page(s) 100735

Abstract: Sarcomatoid or anaplastic carcinomas arising within epithelial ovarian neoplasms are rare, particularly within serous tumors of the ovary, and carry a poor prognosis. Here we present the case of a patient initially diagnosed with low grade serous ovarian ...

Abstract	Sarcomatoid or anaplastic carcinomas arising within epithelial ovarian neoplasms are rare, particularly within serous tumors of the ovary, and carry a poor prognosis. Here we present the case of a patient initially diagnosed with low grade serous ovarian carcinoma arising within a serous borderline tumor (atypical proliferative serous tumor). She underwent rapid progression of disease and was found to have anaplastic/sarcomatoid carcinoma on biopsy of recurrence. These findings prompted pathologic re-review of the original neoplasm, which demonstrated a microscopic focus of sarcomatoid/anaplastic carcinoma.
Language	English
Publishing date	2021-02-23
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2818505-5
ISSN	2352-5789
ISSN	2352-5789
DOI	10.1016/j.gore.2021.100735
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Article ; Online: Fertility-sparing surgery for early-stage cervical cancer: does surgical approach have an impact on disease outcomes?

Bixel, Kristin L / Fowler, Jeffrey M

American journal of obstetrics and gynecology

2019 Volume 220, Issue 5, Page(s) 417–419

MeSH term(s)	Adult ; Aged ; Disease ; Female ; Humans ; Laparotomy ; Minimally Invasive Surgical Procedures ; Trachelectomy ; Uterine Cervical Neoplasms/surgery ; Women
Language	English
Publishing date	2019-05-10
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2019.03.012
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Article ; Online: Management of stage II endometrial cancer and subsequent oncologic outcomes: a National Cancer Database study.

Vetter, Monica Hagan / Bixel, Kristin / Felix, Ashley S

Journal of gynecologic oncology

2020 Volume 31, Issue 6, Page(s) e84

Abstract: Objective: The management of stage II endometrial cancer (EC) is challenging due to the wide variation in surgical practice and adjuvant treatment recommendations. We sought to describe the treatment patterns for patients with stage II EC and to ... ...

Abstract	Objective: The management of stage II endometrial cancer (EC) is challenging due to the wide variation in surgical practice and adjuvant treatment recommendations. We sought to describe the treatment patterns for patients with stage II EC and to evaluate the association between surgical management and adjuvant therapy on survival outcomes in a large cohort of patients with stage II EC. Methods: Using data from the National Cancer Database, we identified 9,690 women with stage II EC. We used logistic regression to identify association of sociodemographic and tumor characteristics with surgery type and receipt of adjuvant therapy. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between adjuvant therapy, hysterectomy type, and overall survival. Results: Almost 11% of the cohort underwent radical hysterectomy; however, there was no difference in survival between surgical types even when adjusted for adjuvant therapy (HR=0.94; 95% CI=0.82-1.07). Compared to no adjuvant treatment, radiation only (HR=0.66; 95% CI=0.61-0.73) and combination radiation and chemotherapy (HR=0.53; 95% CI=0.45-0.62) were associated with lower risk of death. There was no survival benefit of chemotherapy alone even when separated by histologic subtype (HR range, 0.55-1.46). Conclusions: Women with stage II EC do not appear to benefit from routine radical hysterectomy though all patients appear to benefit from receipt of radiation therapy (RT), regardless of modality. Additionally, there may be an added survival benefit with the combination of computed tomography and RT in patients with non-endometrioid, high-risk histologies.
MeSH term(s)	Aged ; Chemotherapy, Adjuvant ; Endometrial Neoplasms/pathology ; Female ; Humans ; Hysterectomy ; Medicare ; Middle Aged ; Neoplasm Staging ; Radiotherapy, Adjuvant ; United States
Language	English
Publishing date	2020-10-20
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2478405-9
ISSN	2005-0399 ; 2005-0380
ISSN (online)	2005-0399
ISSN	2005-0380
DOI	10.3802/jgo.2020.31.e84
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Zs.A 6484: Show issues

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Article ; Online: PARP Inhibitors in Gynecologic Cancers: What Is the Next Big Development?

Lightfoot, Michelle / Montemorano, Lauren / Bixel, Kristin

Current oncology reports

2020 Volume 22, Issue 3, Page(s) 29

Abstract: Purpose of review: Conventional and novel applications of Poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitors (PARPi) are reviewed in the context of recently published clinical trials and preclinical data supporting rapidly expanding ... ...

Abstract	Purpose of review: Conventional and novel applications of Poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitors (PARPi) are reviewed in the context of recently published clinical trials and preclinical data supporting rapidly expanding uses of this class of chemotherapy. Recent findings: PARPi block a pathway of DNA repair and target defects in homologous recombination repair (HRR), a pathway responsible for high-fidelity repair of double-strand breaks in DNA. BRCA1/2 proteins are essential to this pathway. Approximately 15-30% of women with ovarian cancer will have a germline or somatic BRCA mutation, and PARPi have shown promise in this population in a variety of settings. With growing understanding of the HRR pathway and its role in gynecologic malignancies, the potential applications of PARPi continue to expand. While the role of PARPi in gynecologic malignancies is most established in ovarian cancer, there are also promising applications in uterine and cervical cancer. We review current indications for PARPi use and promising applications of these medications in gynecologic malignancies.
MeSH term(s)	BRCA1 Protein/genetics ; BRCA2 Protein/genetics ; DNA Repair/drug effects ; Female ; Genital Neoplasms, Female/drug therapy ; Genital Neoplasms, Female/genetics ; Humans ; Ovarian Neoplasms/drug therapy ; Ovarian Neoplasms/genetics ; Poly(ADP-ribose) Polymerase Inhibitors/administration & dosage ; Poly(ADP-ribose) Polymerase Inhibitors/pharmacology ; Poly(ADP-ribose) Polymerase Inhibitors/therapeutic use ; Uterine Cervical Neoplasms/drug therapy ; Uterine Cervical Neoplasms/genetics ; Uterine Neoplasms/drug therapy ; Uterine Neoplasms/genetics
Chemical Substances	BRCA1 Protein ; BRCA2 Protein ; Poly(ADP-ribose) Polymerase Inhibitors
Language	English
Publishing date	2020-02-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057359-5
ISSN	1534-6269 ; 1523-3790
ISSN (online)	1534-6269
ISSN	1523-3790
DOI	10.1007/s11912-020-0873-4
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Zs.A 5521: Show issues

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Article: An investigation into human papillomavirus (HPV) vaccination for patients undergoing surgery for high-grade cervical or vulvar dysplasia.

Boyles, Glenn P / Baek, Jae / Pandit, Radhika / Cosgrove, Casey M / Bixel, Kristin L

Gynecologic oncology reports

2022 Volume 41, Page(s) 101001

Abstract: Introduction: Eligibility for the human papillomavirus (HPV) vaccine now includes adults 27 through 45 years. It has not been reported how providers are addressing HPV vaccination in patients with existing preinvasive disease. Our objectives were to ... ...

Abstract	Introduction: Eligibility for the human papillomavirus (HPV) vaccine now includes adults 27 through 45 years. It has not been reported how providers are addressing HPV vaccination in patients with existing preinvasive disease. Our objectives were to determine the rates at which vaccination is offered to and received by patients undergoing surgery for high-grade cervical or vulvar dysplasia. Materials and methods: This was a single-institution retrospective cohort study including patients ages 18 through 45 years undergoing surgery for high-grade cervical or vulvar dysplasia from 10/2018 to 2/2020. Our primary outcome was the rate at which HPV vaccination was discussed at the pre- and/or post-operative visits. The secondary outcome was the rate of vaccine uptake in these individuals. Characteristics of those offered HPV vaccination were compared to those not offered vaccination. Results: Of the 115 patients included, 36 (31.3%) had HPV vaccination addressed in the perioperative setting. Thirty-two of these patients had never been vaccinated, and 21 of these (65.6%) went on to receive partial or complete HPV vaccination. Those in whom HPV vaccination was addressed were more likely to be under 27 years (RR 3.2; 95% CI 2.1-4.8) and less likely to be smokers (RR 0.5; 95% CI 0.2-0.9) or have prior excisional procedures (RR 0.3; 95% CI 0.1-0.9). The absolute rate of discussing HPV vaccination with patients improved from 26.0% within six months of vaccine age eligibility expansion, to 35.4% after six months ( Conclusions: Providers did not consistently address HPV vaccination among patients being treated for high-grade cervical or vulvar dysplasia despite the potential benefits. However, a high proportion of these patients are amenable to vaccination. Quality improvement initiatives are warranted to increase the rate of HPV vaccine counseling in this context.
Language	English
Publishing date	2022-05-15
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2818505-5
ISSN	2352-5789
ISSN	2352-5789
DOI	10.1016/j.gore.2022.101001
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Article ; Online: "More than a song and dance": Exploration of patient perspectives and educational quality of gynecologic cancer content on TikTok.

Morton, Molly / Haight, Paulina J / Khadraoui, Wafa / Backes, Floor / Bixel, Kristin / O'Malley, David M / Nagel, Christa / Chambers, Laura M

Gynecologic oncology

2023 Volume 175, Page(s) 81–87

Abstract: Objective: To investigate themes, quality, and reliability of gynecologic cancer-related content on the social media application TikTok.: Methods: TikTok was systematically searched for the 100 most popular posts for ovarian cancer (OC), endometrial ... ...

Abstract	Objective: To investigate themes, quality, and reliability of gynecologic cancer-related content on the social media application TikTok. Methods: TikTok was systematically searched for the 100 most popular posts for ovarian cancer (OC), endometrial cancer (EC), cervical cancer (CC), vulvar cancer (VC), and gestational trophoblastic disease (GTD) in August 2022. Data was collected for demographics, tone, and themes. Educational videos were rated for quality and reliability utilizing the modified DISCERN scale. Relationships between content demographics, disease sites, and themes were assessed. Results: As of August 2022, the top five hashtags for each gynecologic cancer on TikTok had 466.7 million views. 430 of the top 500 posts were eligible for inclusion (OC: n = 86, CC: n = 93, EC: n = 98, GTD: n = 63, VC: n = 90). The majority of creators (n = 323, 75.1%) were White, 33 (7.7%) were Black, 20 (4.6%) were Asian/Pacific Islander (API), 10 (2.3%) were South Asian, 20 (4.7%) were Hispanic/Latino/a, 24 (5.5%) were unable to determine. Eleven central themes were identified, with significant differences when analyzed by disease site and race. The median DISCERN score for all posts was 1.0, indicating poor educational quality and reliability. When compared by race, South Asian/API posters received the highest scores (3, IQR 2.5) versus Black (2: IQR 3), Hispanic/Latino/a (2: IQR 0), and White posters (1, IQR 2) (p = 0.0013). Conclusion(s): Gynecologic cancer-related content on TikTok is of poor educational quality, and racial disparities in gynecologic cancer extend to social media. Opportunities exist to create more diverse content to support racial and cultural experiences in gynecologic cancer treatment.
MeSH term(s)	Female ; Humans ; Pregnancy ; Educational Status ; Endometrial Neoplasms ; Genital Neoplasms, Female/therapy ; Gestational Trophoblastic Disease ; Ovarian Neoplasms ; Reproducibility of Results ; Social Media ; Uterine Cervical Neoplasms ; Vulvar Neoplasms
Language	English
Publishing date	2023-06-15
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	801461-9
ISSN	1095-6859 ; 0090-8258
ISSN (online)	1095-6859
ISSN	0090-8258
DOI	10.1016/j.ygyno.2023.06.004
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Zs.A 885: Show issues

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Article: Role of Olaparib as Maintenance Treatment for Ovarian Cancer: The Evidence to Date.

Montemorano, Lauren / Lightfoot, Michelle Ds / Bixel, Kristin

OncoTargets and therapy

2019 Volume 12, Page(s) 11497–11506

Abstract: PARP inhibitors have shown significant promise in the treatment of ovarian cancer. Olaparib is a PARP inhibitor that has been approved for maintenance for BRCA-mutated ovarian cancer in the recurrent and front-line setting as well as for treatment of ... ...

Abstract	PARP inhibitors have shown significant promise in the treatment of ovarian cancer. Olaparib is a PARP inhibitor that has been approved for maintenance for BRCA-mutated ovarian cancer in the recurrent and front-line setting as well as for treatment of BRCA-mutated ovarian cancer in patients who have received multiple prior lines of chemotherapy. In this review, we focus on the use of olaparib in the maintenance setting including the evidence to date, ongoing research, and future directions.
Language	English
Publishing date	2019-12-27
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2495130-4
ISSN	1178-6930
ISSN	1178-6930
DOI	10.2147/OTT.S195552
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Article ; Online: Changes in prospectively collected patient-reported outcomes among women with incident endometrial cancer.

Sinnott, Jennifer A / Torkashvand, Elaheh / Meade, Caitlin E / Salani, Ritu / Vetter, Monica Hagan / Hall, Bobbie / Skolnick, Rebecca / Bixel, Kristin L / Cohn, David E / Cosgrove, Casey M / Copeland, Larry J / Hebert, Courtney / Felix, Ashley S

Journal of cancer survivorship : research and practice

2024

Abstract: Purpose: We examined associations between patient and treatment characteristics with longitudinally collected patient-reported outcome (PRO) measures to provide a data-informed description of the experiences of women undergoing treatment for endometrial ...

Abstract	Purpose: We examined associations between patient and treatment characteristics with longitudinally collected patient-reported outcome (PRO) measures to provide a data-informed description of the experiences of women undergoing treatment for endometrial cancer. Methods: We administered National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) questionnaires at the preoperative visit and at 6 and 12 months after surgery. Anxiety, depression, fatigue, sleep disturbance, pain, physical function, and ability to participate in social roles were assessed. Analysis of variance (ANOVA) and linear mixed models were used to examine associations between patient characteristics and PRO measures at baseline and through time. Results: Of 187 women enrolled, 174 (93%) and 103 (69%) completed the 6- and 12-month questionnaires, respectively. Anxiety was substantially elevated at baseline (half of one population-level standard deviation) and returned to general population mean levels at 6 and 12 months. Younger age, Medicaid/None/Self-pay insurance, prevalent diabetes, and current smoking were associated with higher symptom burden on multiple PRO measures across the three time points. Women with aggressive histology, higher disease stage, or those with adjuvant treatment had worse fatigue at 6 months, which normalized by 12 months. Conclusions: We observed a high symptom burden at endometrial cancer diagnosis, with most PRO measures returning to general population means by 1 year. Information on risk factor-PRO associations can be used during the clinical visit to inform supportive service referral. Implications for cancer survivors: These findings can inform clinicians' discussions with endometrial cancer survivors regarding expected symptom trajectory following diagnosis and treatment.
Language	English
Publishing date	2024-01-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2388888-X
ISSN	1932-2267 ; 1932-2259
ISSN (online)	1932-2267
ISSN	1932-2259
DOI	10.1007/s11764-024-01536-z
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