- Email: [email protected]
Prospective correlation of multinational association for supportive care in cancer risk index score with outcomes in neutropenic fever
126
Abstracts / Gynecologic Oncology 137 (2015) 92–179
sexual activity increased from 46% (70/151) at visit 1 to 64% (91/ 142) at last visit. Conclusions: Promising trends with the use of vaginal health strategies were observed in women attending our female sexual medicine program, with improvement in confidence, sexual activity, and vaginal pH over time. Preliminary findings suggest that simple strategies, education, and support may improve vaginal/sexual health concerns in cancer survivorship. doi:10.1016/j.ygyno.2015.01.313
311 - Poster Session The effect of radical gynecologic surgery on urinary incontinence T.T. Ilhana, A.K. Kebapcilarb, B.B.B. Bakbakb, T.I. Ilhanc, S.A. Yilmazd, T.C. Cakirb, C. Celike. aSelcuk University Medicine Faculty, Konya, Turkey, b University of Selcuk, Konya, Turkey, cBeyhekim State Hospital, Konya, Turkey, dSelçuk University Medicine Faculty, Konya, Turkey, eSelçuk University, Konya, Turkey Objectives: The aim of the study was evaluate the effect of gynecologic cancer treatment on urinary incontinence symptoms. Methods: This study included 76 patients who underwent gynecologic radical surgery for endometrial cancer and ovarian cancer. Preoperatively, a urogynecologic examination and Urinary Incontinence Score for Females test were performed. Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory-6 (UDI-6) were performed before treatment and at the sixth week after surgery for all patients. Results: The mean age and parity of patients were 57.7 ± 10.5 years and 2.6 ± 1.2. A total of 44 patients (57%) were diagnosed with stress or urge incontinence by examination or Urinary Incontinence Score for Females' test. The percentages of patients with stress urinary incontinence and urge incontinence were 52.3% and 9%, respectively. The percentage of mixed incontinence was 38.7%. Twenty-four of 76 procedures (31%) were performed for ovarian cancer and 52 (69%) procedures were performed for endometrial cancer. There was no urinary tract injury during procedures. The percentage of urinary incontinence at the sixth postoperative week was 71% and the difference was significant (P b 0.05). The difference between preoperative and postoperative IIQ-7 and UDI-6 scores was significant (P b 0.05). There was no significant difference in a comparison of the items of physical activity and travel on the IIQ-7 test. Conclusions: Radical gynecologic surgery has serious adverse effects on urinary continence. Urinary symptoms could impair quality of life after surgery. Urinary incontinence is one of the important symptoms of pelvic organ prolapse. Neural injuries, muscle injuries, radiotherapy, or edema could be the source of pelvic organ prolapse and incontinence. Preventive approaches should be suggested to patients early after surgery. doi:10.1016/j.ygyno.2015.01.314
312 - Poster Session Prospective correlation of multinational association for supportive care in cancer risk index score with outcomes in neutropenic fever C.C. Gundersona, B.K. Ericksonb, I. Wilkinson-Ryanc, K.M. Dolld, B. Whitee, S. Veselya, C.A. Leath IIIb, L.S. Massadc, P.A. Gehrigd, K.N. Moorea. a The University of Oklahoma, Oklahoma City, OK, USA, bUniversity of Alabama at Birmingham, Birmingham, AL, USA, cWashington University School of Medicine, St. Louis, MO, USA, dUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA, eUniversity of North Carolina Hospitals, Chapel Hill, NC, USA
Objectives: Despite published guidelines outlining outpatient management strategies, neutropenic fever (NF) often results in hospital admission due to mortality risk. The Multinational Association for Supportive Care of Cancer (MASCC) risk index score has been validated as a stratification tool in a heterogeneous group of solid tumor patients. Recently, it has been deemed a suitable tool in gynecologic oncology patients in a retrospective study. In this prospective multi-institutional study, we sought to validate the MASCC score for stratifying NF morbidity in gynecologic oncology patients. Methods: Institutional review board approval was obtained at four institutions for prospective data collection of patients admitted with NF from 3/1/2013 to 9/1/2014. Participating institutions have a policy of inpatient management of NF patients receiving chemotherapy. Patients admitted for other indications who incidentally developed NF were excluded; only the first admission was included for patients with N1 admission for NF. De-identified data were compiled and processed at the leading institution. Low risk was considered ≥21. Results: During the study period, 17,394 cycles of chemotherapy were administered at the four sites and 31 patients met inclusion criteria. Most had advanced-stage disease (67%). Primary tumors were 57% ovary, 30% endometrium, and 10% cervix. 100% of patients were receiving chemotherapy (57% for primary, 43% for recurrent disease), and 52% had a positive culture. Median MASCC score was 21 (range, 10– 26); 58% of patients were considered low risk. Although not statistically significant, high-risk patients were more likely to have a severe complication (11% vs. 38%, P = 0.09), multiple severe complications (5.5% vs. 23.1%, P = 0.28), intensive care unit admission (0% vs. 15%, P = 0.17), and delay in receipt of next chemotherapy cycle (33% vs. 54%, P = 0.25). No patients died during the study period. Conclusions: Although not statistically significant, this prospective pilot data suggest that the MASCC score may be a promising tool for determining safety of outpatient management of NF in gynecology oncology patients. Larger studies are warranted to achieve statistically significant results, which may enable us to use this risk stratification tool effectively for cost containment and avoidance of nosocomial infections.
doi:10.1016/j.ygyno.2015.01.315
313 - Poster Session Ultrasound-guided intranodal lymphangiography with embolization: A novel technique to treat chylous ascites after retroperitoneal lymphadenectomy in gynecologic cancer T.W. Konga, J. Kimb, J.H. Sona, S.W. Kangb, S.J. Changa, J.H. Wonb, H.S. Ryub. aAjou University Hospital, Suwon, South Korea, bAjou University School of Medicine, Suwon, South Korea Objectives: Chylous ascites is a rare postoperative complication after retroperitoneal lymphadenectomy in gynecologic cancer. Its treatment includes use of a low-fat diet, increased medium-chain triglyceride uptake, and somatostatins. Resistant cases can be managed by invasive procedures. The aim of this study was to demonstrate the feasibility of ultrasonographic (US)-guided lymphangiography (LAG) with embolization for managing chylous ascites following retroperitoneal lymphadenectomy in gynecologic cancer. Methods: We report three cases of chylous ascites following systematic pelvic and paraaortic lymphadenectomy for gynecologic cancer. Conservative treatment failed, and the patients underwent LAG. Under US guidance, one groin lymph node was accessed with a spinal needle, and ethiodized oil was directly injected into the node to demonstrate opacification of the lymph nodes and efferent lymphatics. After visualization of lymphatic leakage, the leakage sites were embolized using n-butyl cyanoacrylate glue.
Abstracts / Gynecologic Oncology 137 (2015) 92–179
sexual activity increased from 46% (70/151) at visit 1 to 64% (91/ 142) at last visit. Conclusions: Promising trends with the use of vaginal health strategies were observed in women attending our female sexual medicine program, with improvement in confidence, sexual activity, and vaginal pH over time. Preliminary findings suggest that simple strategies, education, and support may improve vaginal/sexual health concerns in cancer survivorship. doi:10.1016/j.ygyno.2015.01.313
311 - Poster Session The effect of radical gynecologic surgery on urinary incontinence T.T. Ilhana, A.K. Kebapcilarb, B.B.B. Bakbakb, T.I. Ilhanc, S.A. Yilmazd, T.C. Cakirb, C. Celike. aSelcuk University Medicine Faculty, Konya, Turkey, b University of Selcuk, Konya, Turkey, cBeyhekim State Hospital, Konya, Turkey, dSelçuk University Medicine Faculty, Konya, Turkey, eSelçuk University, Konya, Turkey Objectives: The aim of the study was evaluate the effect of gynecologic cancer treatment on urinary incontinence symptoms. Methods: This study included 76 patients who underwent gynecologic radical surgery for endometrial cancer and ovarian cancer. Preoperatively, a urogynecologic examination and Urinary Incontinence Score for Females test were performed. Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory-6 (UDI-6) were performed before treatment and at the sixth week after surgery for all patients. Results: The mean age and parity of patients were 57.7 ± 10.5 years and 2.6 ± 1.2. A total of 44 patients (57%) were diagnosed with stress or urge incontinence by examination or Urinary Incontinence Score for Females' test. The percentages of patients with stress urinary incontinence and urge incontinence were 52.3% and 9%, respectively. The percentage of mixed incontinence was 38.7%. Twenty-four of 76 procedures (31%) were performed for ovarian cancer and 52 (69%) procedures were performed for endometrial cancer. There was no urinary tract injury during procedures. The percentage of urinary incontinence at the sixth postoperative week was 71% and the difference was significant (P b 0.05). The difference between preoperative and postoperative IIQ-7 and UDI-6 scores was significant (P b 0.05). There was no significant difference in a comparison of the items of physical activity and travel on the IIQ-7 test. Conclusions: Radical gynecologic surgery has serious adverse effects on urinary continence. Urinary symptoms could impair quality of life after surgery. Urinary incontinence is one of the important symptoms of pelvic organ prolapse. Neural injuries, muscle injuries, radiotherapy, or edema could be the source of pelvic organ prolapse and incontinence. Preventive approaches should be suggested to patients early after surgery. doi:10.1016/j.ygyno.2015.01.314
312 - Poster Session Prospective correlation of multinational association for supportive care in cancer risk index score with outcomes in neutropenic fever C.C. Gundersona, B.K. Ericksonb, I. Wilkinson-Ryanc, K.M. Dolld, B. Whitee, S. Veselya, C.A. Leath IIIb, L.S. Massadc, P.A. Gehrigd, K.N. Moorea. a The University of Oklahoma, Oklahoma City, OK, USA, bUniversity of Alabama at Birmingham, Birmingham, AL, USA, cWashington University School of Medicine, St. Louis, MO, USA, dUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA, eUniversity of North Carolina Hospitals, Chapel Hill, NC, USA
Objectives: Despite published guidelines outlining outpatient management strategies, neutropenic fever (NF) often results in hospital admission due to mortality risk. The Multinational Association for Supportive Care of Cancer (MASCC) risk index score has been validated as a stratification tool in a heterogeneous group of solid tumor patients. Recently, it has been deemed a suitable tool in gynecologic oncology patients in a retrospective study. In this prospective multi-institutional study, we sought to validate the MASCC score for stratifying NF morbidity in gynecologic oncology patients. Methods: Institutional review board approval was obtained at four institutions for prospective data collection of patients admitted with NF from 3/1/2013 to 9/1/2014. Participating institutions have a policy of inpatient management of NF patients receiving chemotherapy. Patients admitted for other indications who incidentally developed NF were excluded; only the first admission was included for patients with N1 admission for NF. De-identified data were compiled and processed at the leading institution. Low risk was considered ≥21. Results: During the study period, 17,394 cycles of chemotherapy were administered at the four sites and 31 patients met inclusion criteria. Most had advanced-stage disease (67%). Primary tumors were 57% ovary, 30% endometrium, and 10% cervix. 100% of patients were receiving chemotherapy (57% for primary, 43% for recurrent disease), and 52% had a positive culture. Median MASCC score was 21 (range, 10– 26); 58% of patients were considered low risk. Although not statistically significant, high-risk patients were more likely to have a severe complication (11% vs. 38%, P = 0.09), multiple severe complications (5.5% vs. 23.1%, P = 0.28), intensive care unit admission (0% vs. 15%, P = 0.17), and delay in receipt of next chemotherapy cycle (33% vs. 54%, P = 0.25). No patients died during the study period. Conclusions: Although not statistically significant, this prospective pilot data suggest that the MASCC score may be a promising tool for determining safety of outpatient management of NF in gynecology oncology patients. Larger studies are warranted to achieve statistically significant results, which may enable us to use this risk stratification tool effectively for cost containment and avoidance of nosocomial infections.
doi:10.1016/j.ygyno.2015.01.315
313 - Poster Session Ultrasound-guided intranodal lymphangiography with embolization: A novel technique to treat chylous ascites after retroperitoneal lymphadenectomy in gynecologic cancer T.W. Konga, J. Kimb, J.H. Sona, S.W. Kangb, S.J. Changa, J.H. Wonb, H.S. Ryub. aAjou University Hospital, Suwon, South Korea, bAjou University School of Medicine, Suwon, South Korea Objectives: Chylous ascites is a rare postoperative complication after retroperitoneal lymphadenectomy in gynecologic cancer. Its treatment includes use of a low-fat diet, increased medium-chain triglyceride uptake, and somatostatins. Resistant cases can be managed by invasive procedures. The aim of this study was to demonstrate the feasibility of ultrasonographic (US)-guided lymphangiography (LAG) with embolization for managing chylous ascites following retroperitoneal lymphadenectomy in gynecologic cancer. Methods: We report three cases of chylous ascites following systematic pelvic and paraaortic lymphadenectomy for gynecologic cancer. Conservative treatment failed, and the patients underwent LAG. Under US guidance, one groin lymph node was accessed with a spinal needle, and ethiodized oil was directly injected into the node to demonstrate opacification of the lymph nodes and efferent lymphatics. After visualization of lymphatic leakage, the leakage sites were embolized using n-butyl cyanoacrylate glue.