Perception of risk, cancer worry, anxiety, and acceptability of screening among low-risk women undergoing ovarian cancer screening with the risk of ovarian cancer algorithm

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tion, only 13 [1.93%] reported grade 3 or 4 peripheral neuropathy so this toxicity was not further investigated. Fatigue was not specifically collected as a part of GOG 179, thus from the 401 patients that were enrolled on GOG 204, a worse PS was significantly associated with reporting moderate to severe fatigue (OR 2.78 95% CI 1.66–4.68). Exposure to prior radiation (p= .0007), treatment regimen (p b .0001), and FACT-CX score (p= .0104) were significantly associated with the reporting of grade 3 or 4 leukopenia. Exposure to prior radiation (p= .0007), treatment regimen (p= .0008), and a lower FACT-CX score (pb .0001) were related to the reporting of grade 3 or 4 anemia. PS (p b .0001) and treatment regimen (p = .0275) were significantly associated with the reporting of grade 3 or 4 thrombocytopenia. Age (p = .0172) and treatment regimen (p b .0001) were significantly associated with the reporting of grade 3 or 4 neutropenia. The FACTCX score (p= .0016) was significantly associated with the reporting of grade 3 or 4 GI toxicity. Conclusions: The development of fatigue, hematologic and GI toxicity might be predictable based on factors other than treatment assignment such as age, PS, and patient-reported QOL measurement. Fatigue does not correlate with baseline overall QOL measurement in this cohort of patients. doi:10.1016/j.ygyno.2011.12.278

278 A prospective evaluation of quality of life, sexual function, and depression in women referred to a sexuality clinic for female cancer survivors E. Hill1, C. Raker1, S. Carson1, D. Wiggins1, C. Granai1, J. Gass1, E. Spriggs2, D. Dizon1. 1Women & Infants Hospital Brown University, Providence, RI, 2Brown University, Providence, RI. Objective: To characterize quality of life, sexual function, and depressive symptoms in female cancer survivors evaluated in a specialized program for sexual health. We also describe the effect of follow-up visits on these parameters. Methods: Female cancer survivors seen in the Women & Infants' Women's Oncology Center for Sexuality, Intimacy and Fertility clinic from February 2006 to August 2011 were prospectively assessed at new and follow-up visits with three questionnaires: the Female Sexual Function Index (FSFI; score range 2–36), the European Organization for Research and Treatment of Cancer Quality of Life (QOL) Core Questionnaire (QLQ-C30; range 0–100) and the Beck Depression Inventory (BDI; range 0–63). Higher scores on the FSFI and BDI reflect greater dysfunction while on the QLQ-C30 global QOL and functional scales reflect less dysfunction. These data were then analyzed in conjunction with demographic and medical history data. Statistics were generated using Stata v10. Results: There were 66 unique cancer patients seen in 114 clinic visits (66 new, 48 follow-up). Median age was 49.4 years (range 26–64). The majority comprised breast (39.4%), uterine (24.2%) or ovarian/ fallopian tube/peritoneal (15.2%) cancer survivors. Prior cancer treatment included surgery (92%), chemotherapy (63%), and/or radiation (56%). Significant sexual dysfunction was present at baseline (mean FSFI = 10.5, range 1.2–26.3), but this was not associated with poor quality of life (mean global QOL = 70.7, range 0–100). Women did have evidence of mild to moderate depression at baseline (mean BDI = 11.4, range 0–33). Women who were seen in follow-up showed improvement in FSFI domains for arousal (P = 0.05), satisfaction (P = 0.002) and total FSFI score (P = 0.03). The BDI scores also improved on follow-up though changes were not significant (P = 0.1). Global QOL scores remained stable. Conclusions: Female cancer survivors referred to a sexual health clinic demonstrate significant sexual dysfunction at baseline with

evidence for at least mild depressive symptoms. However, these findings do not appear to affect global quality of life. Our study is the first to prospectively assess these domains in women with cancer who refer to a sexual health program and demonstrates improvement in sexual function on follow-up visits, supporting the utility and relevance of a specialized clinic to address sexual concerns among women with gynecologic and breast cancer. doi:10.1016/j.ygyno.2011.12.279

279 Lower limb lymphedema after systematic lymphadenectomy for ovarian cancer G. Baiocchi, J. Timm, E. Fukazawa, C. Faloppa, L. Kumagai, R. Oliveira, L. Badiglian-Filho. AC Camargo Cancer Hospital, Sao Paulo, Brazil. Objective: Few studies have evaluated lymphedema after lymphadenectomy in ovarian cancer. The aims of our study were to evaluate the prevalence of lower limb lymphedema (LLL) in patients treated for ovarian cancer and correlate its presence to clinicopathological features. Methods: We reviewed a series of 36 patients with ovarian cancer who underwent systematic pelvic and retroperitoneal lymphadenectomy from June 2007 to June 2009. Medical records were reviewed for age, race, body mass index, FIGO stage, tumor histologic type and grade, number of resected lymph nodes and number of positive lymph nodes. Presence of lymphedema was identified through medical records. Results: All patients underwent optimal cytoreduction. Twenty-two (61.1%) patients were stage IIIC. Ten patients (27.8%) developed LLL. Mean time for lymphedema diagnosis was 4.59 months (range: 0.53– 8.7). Median resected lymph nodes were 48.5 (range: 13–140). Fourteen (38.9%) patients had lymph node involvement with median of 3.5 metastatic lymph nodes (range: 1–22). LLL development was not related to age (p = 0.11), obesity (p = 0.43), number of resected lymph nodes (p = 0.71), and number of metastatic lymph nodes. LLL prevalence was higher in patients with lymph node metastasis, but did not achieve statistical difference (p = 0.054). Conclusions: We found a prevalence of LLL in 27.8% of patients who underwent systematic lymphadenectomy for ovarian cancer. LLL prevalence was higher in patients with lymph node metastasis. doi:10.1016/j.ygyno.2011.12.280

280 Perception of risk, cancer worry, anxiety, and acceptability of screening among low-risk women undergoing ovarian cancer screening with the risk of ovarian cancer algorithm L. Holman1, K. Lu1, M. Hernandez1, R. Bast1, D. Bodurka1, S. Skates2, D. Gershenson1, C. Sun1. 1The University of Texas, MD Anderson Cancer Center, Houston, TX, 2Massachusetts General Hospital/Harvard University, Boston, MA. Objective: We evaluated baseline knowledge of ovarian cancer risk and perceptions toward ovarian cancer screening (OCS) in low-risk women initiating an OCS trial with the risk of ovarian cancer algorithm (ROCA). Methods: Low-risk, postmenopausal women were enrolled prospectively between 2001 and 2011, and concurrently enrolled in a large, multi-center, prospective OCS study utilizing the ROCA. A survey of risk perception, ovarian cancer worry (Cancer Worry Scale or CWS), anxiety (State-Trait Anxiety Inventory or STAI), health and well-being

Abstracts / Gynecologic Oncology 125 (2012) S3–S167

(SF-36), and acceptability of OCS was administered at enrollment. Survey results were analyzed with Statistical Package for the Social Sciences (SPSS) software. Results: To date, 1192 patients are enrolled and 848 (71.1%) have completed surveys. Of these, median age is 60 years, 87% are white, and 26.1% have a history of breast cancer (BC). The population's mean estimated lifetime risk of ovarian cancer was 29.96%, much higher than the actual risk of 1.4% for women in the U.S. Only 2.9% of patients correctly estimated their risk, while 35.5% reported their lifetime risk to be ≥50%. Although women with BC had an actual risk of ovarian cancer of approximately 3%, they reported a mean estimation of risk of 34.05%, significantly higher than other respondents (p b 0.001). Overall, cancer worry was low, with a mean CWS score of 7.61. Anxiety was comparable to published norms for women in this age group, with mean STAI-S and STAI-T scores of 32.04 and 31.30, respectively. In general, women reported good physical and mental well-being; however, those without a history of BC noted better physical health than women with BC history (p b 0.001). In terms of OCS acceptability, 97.2% of respondents agreed, or strongly agreed, that “the benefits of screening outweigh the difficulties.” Very few women were reluctant to undergo OCS due to time constraints (1.1%), pain (2.0%), or embarrassment (1.9%). The most common reason cited for reluctance to undergo OCS was fear of insurance not covering the tests, with 21.9% of women agreeing or strongly agreeing with this. Conclusions: Among low-risk, postmenopausal women undergoing OCS, risk of ovarian cancer is highly overestimated. Despite this, patients reported low cancer worry and anxiety. The discrepancy between patients' knowledge of and attitudes toward ovarian cancer risk highlights the need for educational efforts in this area. Importantly, OCS was acceptable to our population, with few expressing reluctance to undergo testing. doi:10.1016/j.ygyno.2011.12.281

281 Differences in the use of palliative medicine consultation in gynecologic malignancies in an urban hospital system N. Nevadunsky1, Z. Brodt1, S. Eti2, B. Rapkin1, E. Rivera1, P. Selwyn1, G. Goldberg1. 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 2Beth Israel Hospital and Medical Center, New York, NY. Objective: There is limited information regarding the role of a palliative care consultation for ethnically and racially diverse women with gynecologic malignancies. The purpose of this study was to determine the characteristics, clinical findings and outcomes of patients with gynecologic malignancies who were referred for hospital inpatient palliative medicine consultation. Methods: After IRB approval, patients with gynecologic malignancies who were referred for a Palliative Medicine consultation from January 1, 2007 to June 1, 2010 were identified at a single large urban teaching hospital. Abstracted data were demographics, consultation reason, clinical findings, and outcomes. Results were described and comparisons made using chi-square. Results: 84 patients were identified that met criteria. The average age was 63 years (range 22–96). Primary cancer sites were: uterus (44%), ovary (29%), cervix (18%), and vulva (6%). Self-described ethnic/racial distribution was, Black (37%), White (39%), Hispanic (16%) and other (8%). Reasons for consultation included pain (45%), nausea/vomiting (1%), bowel obstruction (3%) and dyspnea (4%). Another primary reason for consultation was “goals of care” (46%) which includes establishment of health care proxy, do-not-resuscitate/do-notintubate orders, hospice enrollment and discussion regarding avoidance of non-meaningful interventions. Mean number of days from consultation until death, a proxy metric for timely consultation

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was 75 days. There was a significant difference in time from consultation until death between White women and Hispanic women, where White women were more likely to have consultation earlier, 88 days versus 30 days (p = 0.03). Younger patients (b60) were less likely to be DNR (p = 0.03, 11% versus 37%) and referred to hospice (p=0.02, 9% versus 33%). There were differences in consultation reasons and dispositions depending on who referred the patient: Gynecologic Oncologists or medical sub-specialists. “Goals of care” was identified as reason for consultation in 61% of patients of medical sub-specialists (med onc and other) vs. 26% of Gynecologic Oncologists (p = 0.003). Conclusions: These data suggest that there may be barriers to implementation of palliative medicine for ethnic and racial minority women with gynecologic malignancies. Providers may be influenced by patient age as well as their training and knowledge of disease process when invoking consultation. Barriers to access and consultation in these women should be further explored. doi:10.1016/j.ygyno.2011.12.282

282 A pilot randomized control trial to evaluate pelvic floor muscle training for urinary incontinence among gynecologic cancer survivors T. Rutledge, S. Lee, R. Rogers, C. Muller. University of New Mexico, Albuquerque, NM. Objective: We previously reported high rates of urinary incontinence among gynecologic cancer survivors and aimed to evaluate the effectiveness of a simple intervention for treatment of urinary incontinence among gynecologic cancer survivors. Methods: We recruited 40 gynecologic cancer survivors (N1 year from completion of cancer therapy) who reported urinary incontinence on a validated screening questionnaire. Women were randomized to either pelvic floor muscle training/behavioral therapy (treatment group) or usual care (no treatment group). The treatment group underwent a 15 minute training session with instruction on the appropriate performance of pelvic floor exercises, a therapy program to follow at home during the 3 month study period and a handout describing behavioral management tips for urinary incontinence. The primary outcome measure, assessed at 12 weeks post intervention, was a 40% difference in the validated Patient Global Impression of Improvement (PGI-I) score. Secondary outcomes included change in pelvic floor muscle strength (Brink's score) and the bother and impact of urinary incontinence on quality of life as measured by the Urinary Distress Inventory (UDI-6). Fisher's exact test was used to identify differences between groups for frequency data; two-sample t-test was conducted for continuous measurements. Results: Mean age of this cohort was 57 years (range: 37–79). The majority of the survivors had uterine cancer (60%), 18% had received radiation therapy, 95% had received surgical therapy, and 35% had received chemotherapy. At three months, 80% of the treatment group and 40% of the no treatment group reported that their urinary incontinence was "much better" or "very much better" as evaluated by the Patient Global Impression of Improvement scale (p = 0.02), however, UDI-6 scores did not vary between groups (12.7 treatment group vs. 9.0 no treatment group). Brink's scores were significantly improved in the treatment group as compared to the no treatment group (p b 0.0001). Treatment group adherence was high; the treatment group performed exercises an average of 22 days in the last month prior to their 3 month follow-up. Conclusions: Urinary incontinence negatively affects quality of life, and despite a high prevalence among gynecologic cancer survivors, it is often under-assessed and undertreated. We found that pelvic floor