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Causal effect of obesity on gynecologic malignancies

Griffiths, Courtney; Jimenez, Edward; Chalas, Eva
INTRODUCTION/BACKGROUND:Gynecologic malignancies are estimated to affect 110,070 women and will be the cause of death in approximately 32,120 in 2018. Endometrial cancer is among the most prevalent with 63,320 estimated new cases and approximately 11,350 deaths, followed by ovarian cancer with an estimate of 22,000 new cases and 14,000 deaths annually. Obesity is one of the most modifiable risk factors. Providers should engage in a multifaceted approach to patient education and healthcare to decrease the projected cases of obesity-related cancers. BACKGROUND:The literature demonstrates a significant link between obesity and the development of certain malignancies such as endometrial, pancreatic, and renal cancer. Specific mechanisms found to play a role in the development of these malignancies include alterations of the metabolic pathway attributed to lipid accumulation as well as a chronic inflammatory process. Obesity also predisposes patients to other medical comorbidities as well as a poorer prognosis once a diagnosis of cancer is established. Factors contributing to poorer prognosis include challenges with treatment planning, specifically pertaining to inappropriate chemotherapy dosing and delivery of radiation therapy. Surgical approach and perioperative management are similarly challenging in obese patients and are associated with increased risk of complications. CONCLUSION/CONCLUSIONS:Obesity is a modifiable factor which is associated with an increased risk of cancer and poorer outcomes. Providers should educate patients on all health hazards of obesity, including increased risk of cancer, and encourage them to participate in a structured weight loss plan.
PMID: 30497850
ISSN: 1535-6345
CID: 3783132

Occult Gynecologic Cancer in Women Undergoing Hysterectomy or Myomectomy for Benign Indications

Chalas, Eva; Clarke-Pearson, Daniel; Berek, Jonathan S
PMID: 30045197
ISSN: 1873-233x
CID: 3460272

Regarding "Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy with Morcellation" [Letter]

Parker, William H; Berek, Jonathan S; Pritts, Elizabeth A; Olive, David; Chalas, Eva; Clarke-Pearson, Daniel
PMID: 29679676
ISSN: 1553-4669
CID: 3460252

Routine HbA1c Testing in Women Undergoing Major Gynecologic Surgery to Detect Prevalence of Glucose Intolerance [Meeting Abstract]

Valant, Roseanna; Ahamed, Tarnima; Musa, Fernanda; Chan, Kent; Jimenez, Edward; Chalas, Eva
ISSN: 0029-7844
CID: 3431222

Evaluation of a Streamlined Oncologist-Led BRCA Mutation Testing and Counseling Model for Patients With Ovarian Cancer

Colombo, Nicoletta; Huang, Gloria; Scambia, Giovanni; Chalas, Eva; Pignata, Sandro; Fiorica, James; Van Le, Linda; Ghamande, Sharad; González-Santiago, Santiago; Bover, Isabel; Graña Suárez, Begoña; Green, Andrew; Huot-Marchand, Philippe; Bourhis, Yann; Karve, Sudeep; Blakeley, Christopher
Purpose There is a growing demand for BRCA1/ 2 mutation ( BRCAm) testing in patients with ovarian cancer; however, the limited number of genetic counselors presents a potential barrier. To facilitate more widespread BRCAm testing in ovarian cancer, pretest counseling by the oncology team could shorten testing turnaround times and ease the pressure on genetic counselors. Patients and Methods The prospective, observational Evaluating a Streamlined Onco-genetic BRCA Testing and Counseling Model Among Patients With Ovarian Cancer (ENGAGE) study evaluated a streamlined, oncologist-led BRCAm testing pathway. The analysis population comprised 700 patients with ovarian cancer at 26 sites in the United States, Italy, and Spain. The primary objectives were to assess turnaround time and, using questionnaires, to evaluate stakeholder satisfaction (patients, oncologists, and geneticists or genetic counselors) with the oncologist-led BRCAm testing pathway. Results The median overall turnaround time was 9.1 weeks (range, 0.9 to 37.1 weeks), with median turnaround times in the United States, Italy, and Spain of 4.1 weeks (range, 0.9 to 37.1 weeks), 20.4 weeks (range, 2.9 to 35.4 weeks), and 12.0 weeks (range, 2.0 to 36.7 weeks), respectively. Patient satisfaction with the oncologist-led BRCAm testing pathway was high, with > 99% of patients expressing satisfaction with pre- and post- BRCAm test counseling. Oncologist satisfaction with the BRCAm testing pathway was also high, with > 80% agreeing that the process for performing BRCAm testing worked well and that counseling patients on BRCAm testing was an efficient use of their time. Oncologists expressed higher levels of satisfaction with the BRCAm testing pathway than did geneticists or genetic counselors. Conclusion The results of the ENGAGE study demonstrate that an oncologist-led BRCAm testing process is feasible in ovarian cancer. Development of local BRCAm testing guidelines similar to the one used in this study could allow faster treatment decisions and better use of resources in the management of patients with ovarian cancer.
PMID: 29558274
ISSN: 1527-7755
CID: 3460242

Society of Gynecologic Oncology Future of Physician Payment Reform Task Force report: The Endometrial Cancer Alternative Payment Model (ECAP)

Ko, Emily M; Havrilesky, Laura J; Alvarez, Ronald D; Zivanovic, Oliver; Boyd, Leslie R; Jewell, Elizabeth L; Timmins, Patrick F; Gibb, Randall S; Jhingran, Anuja; Cohn, David E; Dowdy, Sean C; Powell, Matthew A; Chalas, Eva; Huang, Yongmei; Rathbun, Jill; Wright, Jason D
Health care in the United States is in the midst of a significant transformation from a "fee for service" to a "fee for value" based model. The Medicare Access and CHIP Reauthorization Act of 2015 has only accelerated this transition. Anticipating these reforms, the Society of Gynecologic Oncology developed the Future of Physician Payment Reform Task Force (PPRTF) in 2015 to develop strategies to ensure fair value based reimbursement policies for gynecologic cancer care. The PPRTF elected as a first task to develop an Alternative Payment Model for thesurgical management of low risk endometrial cancer. The history, rationale, and conceptual framework for the development of an Endometrial Cancer Alternative Payment Model are described in this white paper, as well as directions forfuture efforts.
PMID: 29544708
ISSN: 1095-6859
CID: 2994282

Using advanced wound care and hyperbaric oxygen to manage wound complications following treatment of vulvovaginal carcinoma

Griffiths, C; Howell, R S; Boinpally, H; Jimenez, E; Chalas, E; Musa, F; Gorenstein, S
Postoperative management of patients with vulvar cancer is associated with a high incidence of poor wound healing and radiation -induced late tissue necrosis. This case series demonstrates the impact on wound healing with the use of hyperbaric oxygen therapy and advanced wound care following radical vulvectomy and/or radiation therapy. A retrospective case series was performed of all patients from 2016 to 2017 with lower genital cancer who underwent radical surgery with or without chemoradiation treatment, experienced wound dehiscence or late tissue radionecrosis, and were treated with advanced wound care, including hyperbaric oxygen therapy (HBO). Five patients were included with a mean age of 63; four had squamous cell carcinoma and one patient had vaginal adenocarcinoma secondary to prior diethylstilbestrol exposure. Three patients underwent radical vulvectomy. All received pelvic radiation therapy, subsequently experienced wound complications, and were managed with advanced wound care and HBO. The mean reduction in wound area at the final wound follow up visit after completion of HBO therapy was found to be 76%, ranging 42-95%, with an average follow up of five months. The mean number of HBO sessions per patient was 58. Complete tissue granulation or significant improvement in tissue radionecrosis was present in all patients. Advanced wound care and hyperbaric oxygen therapy are beneficial in the management of postoperative wound complications. Prospective studies are needed to identify the optimal use of perioperative hyperbaric oxygen and appropriate wound care for patients with gynecologic malignancies.
PMID: 29915804
ISSN: 2352-5789
CID: 3460262

Morcellation in gynecologic oncology

Chalas, Eva
PURPOSE OF REVIEW/OBJECTIVE:Morcellation of uteri with unsuspected malignancies has been the focus of reports for decades. More intensive evaluation of clinical outcomes and evaluation of impact of changes in practice has occurred since the release of FDA statement advising against the use of power morcellators. The review summarizes some of the most relevant publications on this topic. RECENT FINDINGS/RESULTS:The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists concur that symptomatic women should undergo appropriate evaluation, morcellation should not be performed whenever malignancy is suspected or diagnosed, and acknowledge the limitations of diagnostic testing currently available to detect leiomyosarcoma. Accurate incidence of occult leiomyosarcoma in women undergoing hysterectomy for symptomatic myomas is not known because of poor quality of data. Increased complication rates, including death, with abdominal procedures and increased societal costs have been reported. The FDA safety communication has resulted in decreased laparoscopic hysterectomy rates. SUMMARY/CONCLUSIONS:Clinical judgement and practice in accordance to clinical guidelines, based on best current scientific evidence, is recommended. Women should be aware of the limitation of current data regarding the incidence of occult leiomyosarcoma or other malignancies whenever consenting to any form of therapy for symptomatic myomas, including surgical, medical and expectant management. If surgical treatment is selected, morcellation should not be performed if a malignancy diagnosis is known or suspected. A minimally invasive surgical approach is associated with a decreased complication rate and an increased quality of life years. Research efforts should focus on improving diagnostic accuracy and efficacy of therapeutic interventions.
PMID: 29251679
ISSN: 1473-656x
CID: 3460232

Regarding "Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy with Morcellation" [Letter]

Parker, William H; Berek, Jonathan S; Pritts, Elizabeth A; Olive, David; Chalas, Eva; Clarke-Pearson, Dan
PMID: 28826956
ISSN: 1553-4669
CID: 3460222

ENGAGE: Evaluation of a streamlined oncologist-led BRCA mutation (BRCAm) testing and counselling model for patients with ovarian cancer. [Meeting Abstract]

Colombo, Nicoletta; Scambia, Giovanni; Chalas, Eva; Huang, Gloria S.; Pignata, Sandro; Fiorica, James; Van Le, Linda; Ghamande, Sharad A.; Santiago, Gonzalez Santiago; Bover, Isabel; Suarez, Begona Grana; Green, Andrew Emmons; Huot-Marchand, Philippe; Bourhis, Yann; Karve, Sudeep; Blakeley, Christopher
ISSN: 0732-183x
CID: 3460652