Faculty Bibliography

OBJECTIVE:This study aimed to explore the demographic and clinical factors associated with delayed initiation of treatment for patients with cervical cancer treated with chemoradiation and brachytherapy and determine its impact on oncologic outcomes. METHODS:Patients with stage IB2 to IVA cervical cancer who were treated with definitive chemoradiation therapy and brachytherapy from 2009 to 2019 were included. Patients who initiated treatment within 8 weeks of diagnosis (early) were compared with those who initiated treatment after 8 weeks (delayed). Time intervals at each stage of care and reasons for delay were evaluated. Logistic regression was performed to identify factors associated with delayed treatment initiation. Cox regression analyzed factors associated with progression-free and overall survival. RESULTS:Of 122 patients, 76 (62%) initiated early treatment, with a median time to treatment of 35 days, and 46 (38%) underwent delayed treatment initiation, with 76 median days to treatment. Patients referred from the public hospital were more likely to experience delayed treatment than those referred from the private hospital (odds ratio 4.31, 95% confidence interval [CI] 1.31 to 14.07). Most delays were due to system factors (85%). Each 10-day increase in time to treatment initiation was associated with worsened overall survival (hazard ratio [HR] 1.07, 95% CI 1.01 to 1.13). Public hospital patients were more likely to experience delays but were less likely to present with advanced stage (29% vs 50%, p = .031) and had improved overall survival compared with patients referred from the private hospital (HR 0.37, 95% CI 0.16 to 0.87). CONCLUSIONS:Treatment initiation delays were associated with a decrement in survival. In this cohort, public hospital patients were more likely to have a favorable stage and improved survival than those from the private hospital but also were more likely to experience treatment initiation delays. Referral patterns and delays related to diagnostic workup were the most common factors contributing to delays in care establishment. Improving care coordination may ensure equitable access to timely staging and treatment. Further studies are needed to determine whether treatment initiation delays impact cancer outcomes.

OBJECTIVE:Mismatch repair deficiency (dMMR), high microsatellite instability (MSI-H), and high tumor mutation burden (TMB-H) are predictive and prognostic biomarkers in endometrial cancer. We aimed to characterize the racial/ethnic distribution of molecular markers and the clinical characteristics among endometrial cancer patients with TMB-H and MSI-H/dMMR. METHODS:The Endometrial Cancer Molecularly Targeted Therapy Consortium is a centrally verified clinical and molecular repository. Patients with endometrial cancer who underwent tumor profiling were included. TMB-H was defined as ≥10-12 mutations per megabase. MSI-H was determined by next-generation sequencing or polymerase chain reaction, and dMMR by loss of MLH1, MSH2, MSH6, or PMS2 on immunohistochemistry. Tumor biomarker positivity was defined as TMB-H and/or MSI-H/dMMR. Overall survival was assessed using Kaplan-Meier and Cox proportional hazard models. RESULTS:Among 742 patients, 22 % (n = 164) were biomarker positive: 12 % (n = 87) had both TMB-H and MSI-H/dMMR, 8 % (n = 63) had MSI-H/dMMR alone, and 2 % (n = 14) had 14 TMB-H alone. Only 9 % of non-Hispanic Black patients had biomarker positive tumors compared to 26 % of patients from other racial/ethnic groups. Pathogenic POLE mutations were rare (<1 %, n = 5). Patients with TMB-H had a higher proportion of high-risk histologies (43 %) than those with MSI-H/dMMR (24 %). Biomarker positive tumors were associated with a lower risk of death compared to biomarker negative tumors (aHR 0.63, 95 % CI: 0.46, 0.88). CONCLUSION/CONCLUSIONS:Less than 10 % of non-Hispanic Black patients with endometrial cancer had TMB-H and/or MSI-H/dMMR, and biomarker positivity was associated with improved survival. Prospective studies are necessary to elucidate how these molecular differences impact treatment and outcomes.

OBJECTIVES/UNASSIGNED:The primary study objective was to determine the proportion of oncology physicians treating gynecologic oncology patients screening for sexual health concerns among patients with gynecologic malignancies. The secondary objective was to describe these physicians' perspectives on their role in evaluating sexual health concerns and barriers to managing sexual health in a gynecologic oncology office, by training level and gender. METHODS/UNASSIGNED:This was a cross-sectional, quantitative, 23-item survey based on a previously validated questionnaire. It was administered across the United States to physicians (attendings and fellows) treating gynecologic oncology patients using the Society of Gynecologic Oncology database. RESULTS/UNASSIGNED:There was a 10.2 % response rate with 166/1621 physicians completing the survey. Thirty-four (23.1 %) were fellow trainees and 113 (77.0 %) were attendings. Most participants were gynecologic oncologists (155/166, 93.4 %), with radiation oncologists (1/166, 0.6 %), and other physicians (10/166, 6.0 %) also responding. The majority (137/166, 82.0 %) identified as female providers and (29/166, 17.4 %) identified as male. Just over half (99/166, 59.6 %) of providers routinely asked about sexual health concerns of their patients. Attendings more often discussed sexual health with patients when compared to fellows when controlling for academic setting and gender (OR 2.8, 95 % CI 1.6-4.1, p < 0.01). Most providers (117/166, 70.5 %) felt they needed to improve their knowledge on sexual function. CONCLUSIONS/UNASSIGNED:surveyed, almost all feel sexual health should be discussed with their patients. Only about 59% routinely ask about sex health concerns. Future studies should focus on effective ways to incorporate sexual health screenings into gynecologic oncology clinics.

OBJECTIVE/UNASSIGNED:Sentinel lymph node biopsy (SLNB) for endometrial cancer staging may identify isolated tumor cells (ITCs). Although guidelines do not classify nodes with ITCs as positive, earlier papers reported that a significant proportion of gynecologic oncologists treat ITCs as they would positive nodes. The objective of this study was to examine practice patterns and determine if the presence of ITCs in endometrial cancer affects adjuvant treatment decision-making. METHODS/UNASSIGNED:test, and logistic regression were used with significance set at p < 0.05. RESULTS/UNASSIGNED:Of seven hundred thirty-four patients included, ITCs were identified in 41 patients (5.6 %). Deep myometrial invasion (61.0 % vs 20.5 %, p < 0.001) and lymphovascular invasion (58.4 % vs 17.7 %, p < 0.001) were more common in patients with ITCs than in those with negative lymph nodes. Patients with ITCs were more likely to receive adjuvant treatment (30 of 41, 73.2 % vs 289 of 693, 41.7 %, p < 0.001). When controlling for age, stage, histology, grade, and lymphovascular space invasion, ITCs were not associated with an increased likelihood of adjuvant therapy receipt. CONCLUSIONS/UNASSIGNED:Although patients with ITCs were more likely to receive adjuvant treatment, this was accounted for by other clinical and histological factors. Clinicians were likely to make decisions based on established risk factors, and more data are needed on the role of ITCs in the landscape of molecularly based decision making.