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Genetic Counseling and Testing in Ovarian Cancer From the Patient Perspective
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Abstracts / Gynecologic Oncology 143 (2016) 194–223
may be a better indicator of treatment failure. This study sought to evaluate prognostic indicators for CXCA. Methods: A clinical database of stage IB-IVA CXCA patients treated during 1998-2011 (n = 505) was queried. We included patients treated with primary chemoradiation with curative intent who had thorough medical records and appropriate follow-up data available. The Kaplan-Meier method was used to estimate survival, and SAS version 9.3 was used for statistical analyses. Results: 195 patients met inclusion criteria. Age ≥ 60 (28%, n = 54) was associated with poorer Charlson score (median 6 vs 5, p = 0.0001), less tobacco (42% vs 62%, p b .01), and higher proportion of stage IB (33% vs 23%, p = 0.0232), but no differences in BMI, histology, or race were noted with age. Patients ≥60 years of age recurred less often (20% vs 44%, p b 0.010), but completion of chemotherapy (85% vs 86%, p = 0.95) and radiation within 56 days (45% vs 47%, p = 0.85) were similar. Sites of recurrence did not differ, and despite different recurrence rates, recurrence-free survival (RFS; 3.1 vs 4.0 years, p = 0.95) and overall survival (4.6 vs 5.2 years, p = 0.82) were similar. Conversely, patients with CrCl b60 mL/min (21% of total) experienced similar recurrence rates (44% vs 36%, p = 0.39) but were less likely to complete chemotherapy (76% vs 88%, p = 0.05) and radiation within 56 days (24% vs 50%, p = 0.04). RFS was clinically shorter in patients with CrCl b 60 (1.5 vs 4.8 years, p = 0.07). Overall survival was statistically and clinically shorter with CrCl b60 (2.2 vs 6.6 years, p = 0.03). Conclusion: Impaired CrCl appears to be a more significant prognostic factor than age alone with CXCA. Age alone should not bias treatment selection; CrCl and other indices may be more accurate for stratifying risk and identifying vulnerable patients for whom treatment modifications are justified with CXCA. doi:10.1016/j.ygyno.2016.08.305
The Predictive Value of Preoperative Thrombocytosis for Postoperative Infection in Ovarian Cancer Patients T. Longoria, J. Alldredge, B. Sawyer, R. Bristow, R. Eskander. University of California, Irvine, Irvine, CA Objectives: The objective of this study was to investigate an association between preoperative thrombocytosis and postoperative infection in patients with ovarian cancer and to identify the significant mediator variables. Methods: We performed a retrospective cohort study comparing the risk of postoperative infection in ovarian cancer patients with a normal preoperative platelet value (150,000/mm3 to 450,000/mm3) to ovarian cancer patients with preoperative thrombocytosis (N450,000/mm3). Patients who underwent surgery between January 2011 and December 2014 were identified from the American College of Surgeons National Surgical Quality Improvement Project. Infections captured by the database included superficial and deep wound infections, organ/space infections, pneumonia, urinary tract infections, sepsis, and septic shock. Only preoperative and intraoperative variables that were found to have a significant association with both the exposure and the outcome were included in the final multivariate logistic regression model. Results: Of 4,283 patients with ovarian cancer, 455 patients (11%) had preoperative thrombocytosis. Patients with thrombocytosis were 50% more likely to be diagnosed with a postoperative infection than patients with a normal platelet value (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1 – 2.1, p-value = .01). They were also more likely to have a longer hospital stay both before and after controlling for postoperative infectious morbidity. Thrombocytosis was significantly associated with higher preoperative white blood cell count, lower preoperative hemoglobin, lower preoperative albumin, presence of ascites, longer and more complex surgeries,
and receipt of a perioperative blood transfusion. Controlling for these variables in the final multivariate logistic regression model eliminated the significant association between thrombocytosis and postoperative infection (OR 1.1, 95% CI 0.8 – 1.5, p-value = .76). Conclusion: As compared to ovarian cancer patients with a normal preoperative platelet value, ovarian cancer patients with preoperative thrombocytosis present in a poorer state of health and face more complex surgeries, likely reflective of greater disease burden. These factors place them at significantly greater risk for a postoperative infectious complication.
doi:10.1016/j.ygyno.2016.08.306
Genetic Counseling and Testing in Ovarian Cancer From the Patient Perspective M. Lianga,b, C. Walshb, R. Farias-Eisnera, J. Cohena. aUCLA Medical Center, Los Angeles, CA, bCedars-Sinai Medical Center, Los Angeles, CA Objectives: We sought to assess the knowledge and attitudes of patients diagnosed with ovarian cancer regarding genetic counseling and testing. Methods: All patients diagnosed with epithelial ovarian, fallopian tube, or primary peritoneal cancer presenting for an outpatient gynecologic oncology visit at a single institution were offered participation in an anonymous 34-item written questionnaire between August 2015 and January 2016. The survey included questions regarding demographics, patient knowledge, and five-point Likert scales assessing patient attitudes. Descriptive statistics were performed. Results: Fifty-three patients completed the survey with a median age of 57 years. The group consisted of Caucasian (69%), Asian/Pacific Islander (19%), Hispanic (6%), and African-American (4%) patients. Of these, 14% identified themselves as Ashkenazi-Jewish. Of the respondents, 60% had a family history of cancer and 6% had a family member with a known heritable cancer gene mutation. Two-thirds (65%) had previously seen a genetic counselor or undergone genetic testing. Despite this, one third (32%) of patients had not heard of genetic counseling and nearly half (45%) did not know what a genetic counselor does. Of those who had heard of genetic counseling, patients reported that health care providers and the Internet were their top two sources of information. A third (30%) of patients underestimated the 15% risk of a hereditary link to their diagnosis of ovarian cancer. The majority (85-96%) of patients recognized that genetic counseling could help prevent a future cancer for themselves or their family members and even impact their future treatment options. The majority (84%) also wanted to know a genetic mutation even if the results were not currently actionable. Traditionally cited barriers to genetic counseling or testing were only reported by small percentages of respondents, such as concern regarding health care discrimination (25%), privacy of results (16%), the cost of testing (12%), or anxiety over the implications of positive test results (9%). Conclusion: In a cohort of ovarian cancer patients at a tertiary referral center, patients exhibited a strong desire to obtain genetic information. Providers may improve patient knowledge by educating patients on the role of genetic counselors. Fortunately, traditionally cited concerns do not appear to represent significant patient barriers to recommended genetic assessment in ovarian cancer patients. doi:10.1016/j.ygyno.2016.08.307
Sandwich therapy for the treatment of stage IIIC endometrial carcinoma: A community-based experience T. Pulvera, E. Dietrichb, A. Doorb, B. Dossb, C. Harrisonb, G. Downeyb. a University of Minnesota, Minneapolis, MN, bSpectrum Health, Grand Rapids, MI
Abstracts / Gynecologic Oncology 143 (2016) 194–223
may be a better indicator of treatment failure. This study sought to evaluate prognostic indicators for CXCA. Methods: A clinical database of stage IB-IVA CXCA patients treated during 1998-2011 (n = 505) was queried. We included patients treated with primary chemoradiation with curative intent who had thorough medical records and appropriate follow-up data available. The Kaplan-Meier method was used to estimate survival, and SAS version 9.3 was used for statistical analyses. Results: 195 patients met inclusion criteria. Age ≥ 60 (28%, n = 54) was associated with poorer Charlson score (median 6 vs 5, p = 0.0001), less tobacco (42% vs 62%, p b .01), and higher proportion of stage IB (33% vs 23%, p = 0.0232), but no differences in BMI, histology, or race were noted with age. Patients ≥60 years of age recurred less often (20% vs 44%, p b 0.010), but completion of chemotherapy (85% vs 86%, p = 0.95) and radiation within 56 days (45% vs 47%, p = 0.85) were similar. Sites of recurrence did not differ, and despite different recurrence rates, recurrence-free survival (RFS; 3.1 vs 4.0 years, p = 0.95) and overall survival (4.6 vs 5.2 years, p = 0.82) were similar. Conversely, patients with CrCl b60 mL/min (21% of total) experienced similar recurrence rates (44% vs 36%, p = 0.39) but were less likely to complete chemotherapy (76% vs 88%, p = 0.05) and radiation within 56 days (24% vs 50%, p = 0.04). RFS was clinically shorter in patients with CrCl b 60 (1.5 vs 4.8 years, p = 0.07). Overall survival was statistically and clinically shorter with CrCl b60 (2.2 vs 6.6 years, p = 0.03). Conclusion: Impaired CrCl appears to be a more significant prognostic factor than age alone with CXCA. Age alone should not bias treatment selection; CrCl and other indices may be more accurate for stratifying risk and identifying vulnerable patients for whom treatment modifications are justified with CXCA. doi:10.1016/j.ygyno.2016.08.305
The Predictive Value of Preoperative Thrombocytosis for Postoperative Infection in Ovarian Cancer Patients T. Longoria, J. Alldredge, B. Sawyer, R. Bristow, R. Eskander. University of California, Irvine, Irvine, CA Objectives: The objective of this study was to investigate an association between preoperative thrombocytosis and postoperative infection in patients with ovarian cancer and to identify the significant mediator variables. Methods: We performed a retrospective cohort study comparing the risk of postoperative infection in ovarian cancer patients with a normal preoperative platelet value (150,000/mm3 to 450,000/mm3) to ovarian cancer patients with preoperative thrombocytosis (N450,000/mm3). Patients who underwent surgery between January 2011 and December 2014 were identified from the American College of Surgeons National Surgical Quality Improvement Project. Infections captured by the database included superficial and deep wound infections, organ/space infections, pneumonia, urinary tract infections, sepsis, and septic shock. Only preoperative and intraoperative variables that were found to have a significant association with both the exposure and the outcome were included in the final multivariate logistic regression model. Results: Of 4,283 patients with ovarian cancer, 455 patients (11%) had preoperative thrombocytosis. Patients with thrombocytosis were 50% more likely to be diagnosed with a postoperative infection than patients with a normal platelet value (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1 – 2.1, p-value = .01). They were also more likely to have a longer hospital stay both before and after controlling for postoperative infectious morbidity. Thrombocytosis was significantly associated with higher preoperative white blood cell count, lower preoperative hemoglobin, lower preoperative albumin, presence of ascites, longer and more complex surgeries,
and receipt of a perioperative blood transfusion. Controlling for these variables in the final multivariate logistic regression model eliminated the significant association between thrombocytosis and postoperative infection (OR 1.1, 95% CI 0.8 – 1.5, p-value = .76). Conclusion: As compared to ovarian cancer patients with a normal preoperative platelet value, ovarian cancer patients with preoperative thrombocytosis present in a poorer state of health and face more complex surgeries, likely reflective of greater disease burden. These factors place them at significantly greater risk for a postoperative infectious complication.
doi:10.1016/j.ygyno.2016.08.306
Genetic Counseling and Testing in Ovarian Cancer From the Patient Perspective M. Lianga,b, C. Walshb, R. Farias-Eisnera, J. Cohena. aUCLA Medical Center, Los Angeles, CA, bCedars-Sinai Medical Center, Los Angeles, CA Objectives: We sought to assess the knowledge and attitudes of patients diagnosed with ovarian cancer regarding genetic counseling and testing. Methods: All patients diagnosed with epithelial ovarian, fallopian tube, or primary peritoneal cancer presenting for an outpatient gynecologic oncology visit at a single institution were offered participation in an anonymous 34-item written questionnaire between August 2015 and January 2016. The survey included questions regarding demographics, patient knowledge, and five-point Likert scales assessing patient attitudes. Descriptive statistics were performed. Results: Fifty-three patients completed the survey with a median age of 57 years. The group consisted of Caucasian (69%), Asian/Pacific Islander (19%), Hispanic (6%), and African-American (4%) patients. Of these, 14% identified themselves as Ashkenazi-Jewish. Of the respondents, 60% had a family history of cancer and 6% had a family member with a known heritable cancer gene mutation. Two-thirds (65%) had previously seen a genetic counselor or undergone genetic testing. Despite this, one third (32%) of patients had not heard of genetic counseling and nearly half (45%) did not know what a genetic counselor does. Of those who had heard of genetic counseling, patients reported that health care providers and the Internet were their top two sources of information. A third (30%) of patients underestimated the 15% risk of a hereditary link to their diagnosis of ovarian cancer. The majority (85-96%) of patients recognized that genetic counseling could help prevent a future cancer for themselves or their family members and even impact their future treatment options. The majority (84%) also wanted to know a genetic mutation even if the results were not currently actionable. Traditionally cited barriers to genetic counseling or testing were only reported by small percentages of respondents, such as concern regarding health care discrimination (25%), privacy of results (16%), the cost of testing (12%), or anxiety over the implications of positive test results (9%). Conclusion: In a cohort of ovarian cancer patients at a tertiary referral center, patients exhibited a strong desire to obtain genetic information. Providers may improve patient knowledge by educating patients on the role of genetic counselors. Fortunately, traditionally cited concerns do not appear to represent significant patient barriers to recommended genetic assessment in ovarian cancer patients. doi:10.1016/j.ygyno.2016.08.307
Sandwich therapy for the treatment of stage IIIC endometrial carcinoma: A community-based experience T. Pulvera, E. Dietrichb, A. Doorb, B. Dossb, C. Harrisonb, G. Downeyb. a University of Minnesota, Minneapolis, MN, bSpectrum Health, Grand Rapids, MI