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Perceptions of risk and reward in BRCA1 and BRCA2 mutation carriers choosing salpingectomy for ovarian cancer prevention
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Abstracts / Gynecologic Oncology 145 (2017) 2–220
Results: Of the original 213 patients who answered the GCLQ survey, 10 patients (4.72%) had a diagnosis of LLL in the medical record. The respondents had a mean age of 67.8 years (SD ± 49.7) and BMI of 33.5 kg/m² (SD ± 23.5). The majority of patients underwent surgery (98.5%) and did not receive chemotherapy (70.6%) or radiation (60.1%). Seventy-eight patients (36.6% response rate) completed a follow-up survey 5 years later. The most common symptoms in the initial survey were tenderness (35.7%), stiffness (51.2%), and aching (55.1%). Five years later, stiffness (48.7%) and aching (53.9%) were still the most common symptoms reported along with limited movement in the knee (44.2%). There was a significant decrease in the swelling domain symptoms from 38.5% initially to 34.6% 5 years later (P b 0.001). There was a significant increase in infection domain symptoms from 35.9% to 44.9% (P = 0.008). By GCLQ criteria, 14.1% (n = 11) of patients who answered both surveys met the diagnosis of LLL. Five years later, 12.8% (n = 10) of patients met the diagnosis. Two patients had persistent LLL, while 8 patients developed LLL. Conclusions: Patient-reported outcomes by GCLQ define a greater symptom burden of LLL, which is underreported in the medical record. Almost 3 times as many uterine cancer patients are diagnosed with LLL by the GCLQ survey. These patients continue to develop symptoms even 5 years later. Improving capture of LLL with earlier identification and referral to lymphedema programs could decrease the symptom burden for uterine cancer survivors over an extended period of time.
doi:10.1016/j.ygyno.2017.03.473
446 - Poster Session Perceptions of risk and reward in BRCA1 and BRCA2 mutation carriers choosing salpingectomy for ovarian cancer prevention T. Ghezelayagha, L. Stewarta, V. Yub, K.J. Agnewc, B.M. Norquistd, K. Penningtonc, E.M. Swishera. aUniversity of Washington Medical Center, Seattle, WA, USA, bGeorgetown/Washington Hospital Center, Washington, DC, USA, cUniversity of Washington School of Medicine, Seattle, WA, USA, d University of Washington, Seattle, WA, USA Objective: Salpingectomy with delayed oophorectomy has gained traction as an ovarian cancer prevention strategy but is not currently recommended for high-risk women. Nevertheless, some women choose this procedure. We aimed to better understand BRCA1 or BRCA2 (BRCA) mutation carriers who chose bilateral salpingectomy for ovarian cancer prevention. Method: This was a longitudinal survey study of BRCA mutation carriers who had previous bilateral salpingectomy to reduce ovarian cancer risk. An initial written questionnaire and telephone interview were followed by annual follow-up phone interviews. Patients were divided into 2 groups, those pursuing salpingectomy before and those pursuing salpingectomy after the recommended age of oophorectomy (age 40 years for BRCA1 and 45 years for BRCA2 carriers). Results: Twenty-one women were enrolled, 11 with BRCA1 and 11 with BRCA2 (1 patient had both) with median follow-up of 1 year (range 0–2 years). Fourteen (66.7%) women had salpingectomy before and 7 (33.3%) after the recommended age of oophorectomy. The median age at salpingectomy was 40 years (range 27–49). The majority of patients were white (100%), had completed graduate education (66%), and were married/partnered (76%). Nearly half (42.9%) were nulliparous. Most (80%) expressed
decreased worry about developing ovarian cancer after salpingectomy. Seventy percent were getting regular pelvic ultrasounds and CA-125 for screening. There was no difference in levels of worry about ovarian cancer or in risk perception between women who had salpingectomy before or those who had it after the recommended age. Patients who had pursued salpingectomy after the recommended age of oophorectomy were less likely to plan for future oophorectomy (13% vs 87%, P = 0.006). All were satisfied with their decision to delay oophorectomy throughout the study time, with the most cited reasons including the low risk and repercussions of salpingectomy and the feeling that they reduced their risk while delaying menopause. There were no diagnoses of ovarian cancer during our limited study period. Conclusion: This exploratory study of BRCA mutation carriers demonstrates that most are satisfied with their decision, have decreased worry, and have lower risk perception after salpingectomy. Surprisingly, most older women undergoing salpingectomy did not plan on future oophorectomy, suggesting an important educational need.
doi:10.1016/j.ygyno.2017.03.474
447 - Poster Session Educational intervention to improve code status discussion skills and confidence for obstetrics and gynecology residents B.A. Margolisa, A. Buckley de Meritensb, C. Blindermana, S. Chatterjeec, A.I. Tergasa, W.M. Burked, J.Y. Houa, J.D. Wrightd. aNYP/ Columbia University Medical Center, New York, NY, USA, bUMDNJ-The Cancer Institute of New Jersey, New Brunswick, NJ, USA, cNYPH, Columbia University Medical Center and Weill Cornell Medical College, New York, NY, USA, dColumbia University College of Physicians and Surgeons, New York, NY, USA Objective: Obstetrics and gynecology (OBGYN) residents frequently care for patients with advanced gynecologic malignancy yet receive little formal training in conducting code status discussions (CSDs). We piloted an educational intervention to improve resident confidence and skills at conducting CSDs. Method: OBGYN residents at a single institution underwent consent and participated in an institutional review board-approved 3-part educational program: a journal article reading, an online module, and CSD simulations. The CSD simulations included an observed resident-to-resident mock patient encounter and a videotaped CSD with a standardized patient (SP). Pre- and postintervention surveys and performance evaluations were analyzed with descriptive methods. Results: Our cohort of 24 residents was 85% female, and the average age was 29 years. Postgraduate years 1–4 were represented. Half of the participants previously reported having received 1–3 hours of end-of-life care training and 15% received none. On average, 23% of respondents had never conducted a CSD, given bad news, or discussed prognosis or hospice. Residents initially felt most prepared to discuss treatment options (3.3/5 on Likert scale) and less prepared to discuss hospice, end-of-life care, and code status (2.2–2.3/5). Most (78%) disagreed that it is solely the attending’s responsibility to discuss goals of care with inpatients. Performance during the resident-to-resident CSD was variable with scores (percentage of skills achieved) from 27% to 93% (average 64%). Performance at the SP encounter was similar with scores from 40% to 73% (average 56%). Skills that few residents were proficient at included making a clear
Abstracts / Gynecologic Oncology 145 (2017) 2–220
Results: Of the original 213 patients who answered the GCLQ survey, 10 patients (4.72%) had a diagnosis of LLL in the medical record. The respondents had a mean age of 67.8 years (SD ± 49.7) and BMI of 33.5 kg/m² (SD ± 23.5). The majority of patients underwent surgery (98.5%) and did not receive chemotherapy (70.6%) or radiation (60.1%). Seventy-eight patients (36.6% response rate) completed a follow-up survey 5 years later. The most common symptoms in the initial survey were tenderness (35.7%), stiffness (51.2%), and aching (55.1%). Five years later, stiffness (48.7%) and aching (53.9%) were still the most common symptoms reported along with limited movement in the knee (44.2%). There was a significant decrease in the swelling domain symptoms from 38.5% initially to 34.6% 5 years later (P b 0.001). There was a significant increase in infection domain symptoms from 35.9% to 44.9% (P = 0.008). By GCLQ criteria, 14.1% (n = 11) of patients who answered both surveys met the diagnosis of LLL. Five years later, 12.8% (n = 10) of patients met the diagnosis. Two patients had persistent LLL, while 8 patients developed LLL. Conclusions: Patient-reported outcomes by GCLQ define a greater symptom burden of LLL, which is underreported in the medical record. Almost 3 times as many uterine cancer patients are diagnosed with LLL by the GCLQ survey. These patients continue to develop symptoms even 5 years later. Improving capture of LLL with earlier identification and referral to lymphedema programs could decrease the symptom burden for uterine cancer survivors over an extended period of time.
doi:10.1016/j.ygyno.2017.03.473
446 - Poster Session Perceptions of risk and reward in BRCA1 and BRCA2 mutation carriers choosing salpingectomy for ovarian cancer prevention T. Ghezelayagha, L. Stewarta, V. Yub, K.J. Agnewc, B.M. Norquistd, K. Penningtonc, E.M. Swishera. aUniversity of Washington Medical Center, Seattle, WA, USA, bGeorgetown/Washington Hospital Center, Washington, DC, USA, cUniversity of Washington School of Medicine, Seattle, WA, USA, d University of Washington, Seattle, WA, USA Objective: Salpingectomy with delayed oophorectomy has gained traction as an ovarian cancer prevention strategy but is not currently recommended for high-risk women. Nevertheless, some women choose this procedure. We aimed to better understand BRCA1 or BRCA2 (BRCA) mutation carriers who chose bilateral salpingectomy for ovarian cancer prevention. Method: This was a longitudinal survey study of BRCA mutation carriers who had previous bilateral salpingectomy to reduce ovarian cancer risk. An initial written questionnaire and telephone interview were followed by annual follow-up phone interviews. Patients were divided into 2 groups, those pursuing salpingectomy before and those pursuing salpingectomy after the recommended age of oophorectomy (age 40 years for BRCA1 and 45 years for BRCA2 carriers). Results: Twenty-one women were enrolled, 11 with BRCA1 and 11 with BRCA2 (1 patient had both) with median follow-up of 1 year (range 0–2 years). Fourteen (66.7%) women had salpingectomy before and 7 (33.3%) after the recommended age of oophorectomy. The median age at salpingectomy was 40 years (range 27–49). The majority of patients were white (100%), had completed graduate education (66%), and were married/partnered (76%). Nearly half (42.9%) were nulliparous. Most (80%) expressed
decreased worry about developing ovarian cancer after salpingectomy. Seventy percent were getting regular pelvic ultrasounds and CA-125 for screening. There was no difference in levels of worry about ovarian cancer or in risk perception between women who had salpingectomy before or those who had it after the recommended age. Patients who had pursued salpingectomy after the recommended age of oophorectomy were less likely to plan for future oophorectomy (13% vs 87%, P = 0.006). All were satisfied with their decision to delay oophorectomy throughout the study time, with the most cited reasons including the low risk and repercussions of salpingectomy and the feeling that they reduced their risk while delaying menopause. There were no diagnoses of ovarian cancer during our limited study period. Conclusion: This exploratory study of BRCA mutation carriers demonstrates that most are satisfied with their decision, have decreased worry, and have lower risk perception after salpingectomy. Surprisingly, most older women undergoing salpingectomy did not plan on future oophorectomy, suggesting an important educational need.
doi:10.1016/j.ygyno.2017.03.474
447 - Poster Session Educational intervention to improve code status discussion skills and confidence for obstetrics and gynecology residents B.A. Margolisa, A. Buckley de Meritensb, C. Blindermana, S. Chatterjeec, A.I. Tergasa, W.M. Burked, J.Y. Houa, J.D. Wrightd. aNYP/ Columbia University Medical Center, New York, NY, USA, bUMDNJ-The Cancer Institute of New Jersey, New Brunswick, NJ, USA, cNYPH, Columbia University Medical Center and Weill Cornell Medical College, New York, NY, USA, dColumbia University College of Physicians and Surgeons, New York, NY, USA Objective: Obstetrics and gynecology (OBGYN) residents frequently care for patients with advanced gynecologic malignancy yet receive little formal training in conducting code status discussions (CSDs). We piloted an educational intervention to improve resident confidence and skills at conducting CSDs. Method: OBGYN residents at a single institution underwent consent and participated in an institutional review board-approved 3-part educational program: a journal article reading, an online module, and CSD simulations. The CSD simulations included an observed resident-to-resident mock patient encounter and a videotaped CSD with a standardized patient (SP). Pre- and postintervention surveys and performance evaluations were analyzed with descriptive methods. Results: Our cohort of 24 residents was 85% female, and the average age was 29 years. Postgraduate years 1–4 were represented. Half of the participants previously reported having received 1–3 hours of end-of-life care training and 15% received none. On average, 23% of respondents had never conducted a CSD, given bad news, or discussed prognosis or hospice. Residents initially felt most prepared to discuss treatment options (3.3/5 on Likert scale) and less prepared to discuss hospice, end-of-life care, and code status (2.2–2.3/5). Most (78%) disagreed that it is solely the attending’s responsibility to discuss goals of care with inpatients. Performance during the resident-to-resident CSD was variable with scores (percentage of skills achieved) from 27% to 93% (average 64%). Performance at the SP encounter was similar with scores from 40% to 73% (average 56%). Skills that few residents were proficient at included making a clear