Rural patients' experiences with diagnosis and treatment of endometrial cancer.

Background: Rural endometrial cancer (EC) patients are less likely to receive lymph node evaluation, high-quality surgical care, and adjuvant therapy compared to urban patients. Developing interventions to effectively address barriers to quality care requires understanding patient experiences across the cancer care continuum. Our objective was to understand the diagnostic and treatment experiences of rural EC patients.

Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and -analysis.

Objective: We aimed to describe the discriminatory ability of the Silva pattern-based classification system for invasive endocervical adenocarcinoma (EAC) in predicting risks of lymph node (LN) metastasis, recurrence, and death.

Method: We systematically searched PubMed, Scopus, and Embase through 2024 for manuscripts describing patients with EAC by Silva pattern-based classification. We included studies reporting outcomes of LN metastasis, recurrence, or death by Silva pattern.

The Role of Rurality, Travel Time, and Neighborhood Socioeconomics on Patterns of Adjuvant Therapy Receipt among Patients with Endometrial Cancer.

Background: Rural patients with endometrial cancer are more likely to receive lower-quality treatment compared with their urban peers. We evaluated the role of contextual factors [rurality, distance to care, and community socioeconomics (SES)] on the receipt of adjuvant therapy (AT): vaginal brachytherapy (VBT), external beam radiation, and chemotherapy.

Methods: We analyzed Surveillance Epidemiology and End Results-Medicare and included stages IB grade 3 and stages II to IV.

"It really takes a village": perspectives on multi-level barriers to endometrial cancer care for rural patients.

Purpose: While it is established that rural cancer patients face multi-level barriers to high-quality treatment, the interconnections between these barriers and how they drive rural cancer disparities is not well-understood. Therefore, our objective was to better understand the interconnections between barriers to high-quality treatment faced by rural endometrial cancer (EC) patients.

Methods: We conducted semi-structured interviews with 32 clinicians and healthcare personnel from three large, geographically diverse, rural-serving, integrated healthcare systems in North Carolina.

Medicaid Expansion, Uninsurance Rates, and Catastrophic Costs at the Time of Emergency Gynecologic Surgery.

Objective: To estimate the effect of Medicaid expansion on uninsurance rates and catastrophic charges from emergency surgical management of ectopic pregnancy and ovarian torsion using difference-in-difference analysis and to evaluate for racial and ethnic disparities.

Methods: We conducted a retrospective cohort analysis using 2012-2018 State Inpatient Data and State Ambulatory Surgery and Services Databases in four states: Kentucky and Maryland (expansion) and Florida and North Carolina (nonexpansion). Patients undergoing surgical management of ovarian torsion or ectopic pregnancy were included.

Adjuvant therapy and recurrence risk in non-myoinvasive high-grade (stage IC) endometrial cancer: A systematic review and meta-analysis.

Objective: To summarize practice patterns and outcomes among patients with non-myoinvasive high-grade (formerly stage IA, now stage IC) endometrial cancer.

Methods: We conducted a systematic search using MEDLINE, Embase, Cochrane, Web of Science, and ClinicalTrials.gov databases from inception to May 8, 2024 to identify studies reporting on treatment and outcomes of non-myoinvasive high-grade endometrial cancer.

Geographic and racial disparities in the quality of surgical care among patients with nonmetastatic uterine cancer.

Background: Although the rates of minimally invasive surgery and sentinel lymph node biopsy have increased considerably over time in the surgical management of early-stage uterine cancer, practice varies significantly in the United States, and there are disparities among low-volume centers and patients of Black race. A significant number of counties in the United States are without a gynecologic oncologist, and almost half of the counties with the highest gynecologic cancer rates lack a local gynecologic oncologist.

Objective: This study aimed to evaluate the relationships of distance traveled and proximity to gynecologic oncologists with the receipt of and racial disparities in the quality of surgical care among patients who underwent a hysterectomy for nonmetastatic uterine cancer.

The doc versus the bot: A pilot study to assess the quality and accuracy of physician and chatbot responses to clinical questions in gynecologic oncology.

Artificial intelligence (AI) applications to medical care are currently under investigation. We aimed to evaluate and compare the quality and accuracy of physician and chatbot responses to common clinical questions in gynecologic oncology. In this cross-sectional pilot study, ten questions about the knowledge and management of gynecologic cancers were selected.

Scalp hypothermia to reduce chemotherapy-induced alopecia: A systematic review and meta-analysis.

Background: Chemotherapy-induced alopecia (CIA) is a common and emotionally-taxing side effect of chemotherapy, including taxane agents used frequently in treatment of gynecologic cancers. Scalp hypothermia, also known as "cold caps", is a possible method to prevent severe CIA, studied primarily in the breast cancer population.

Objectives: To compile existing data on scalp hypothermia in cancer patients receiving taxane chemotherapy in order to investigate its application to the gynecologic cancer population.

Catastrophic health expenditures, insurance churn, and non-employment among women with breast cancer.

Background: Breast cancer treatment and survivorship entails a complex and expensive continuum of subspecialty care. Our objectives were to assess catastrophic health expenditures, insurance churn, and non-employment among women younger than 65 years who reported a diagnosis of breast cancer. We also evaluated changes in these outcomes related to implementation of the Affordable Care Act.

Geographic variation in the rate and route of hysterectomy for benign disease in the USA: A retrospective cross-sectional study.

Objectives: To describe population rate of hysterectomy for benign disease in the USA, including geographic variation across states and Hospital Service Areas (HSAs; areas defined by common patient flows to healthcare facilities).

Design: Cross-sectional study.

Setting: Four US states including 322 HSAs.

Treatments and outcomes in high-risk gestational trophoblastic neoplasia: A systematic review and meta-analysis.

Background: High-risk gestational trophoblastic neoplasia (GTN) is rare and treated with diverse approaches. Limited published institutional data has yet to be systematically reviewed.

Objectives: To compile global high-risk GTN (prognostic score ≥7) cohorts to summarise treatments and outcomes by disease characteristics and primary chemotherapy.

Telemedicine and gynecologic oncology: caring for patients remotely during a global pandemic.

Background: Telemedicine uses technology to deliver medical care remotely and has been shown to provide similar patient satisfaction and care outcomes compared with in-person visits.

Objective: This study aimed to assess the gynecologic oncology patient telehealth experience.

Study Design: All patients receiving telehealth care between March 23, 2020, to May 14, 2020, from a single institution's gynecologic oncology division were offered postvisit surveys to assess satisfaction.

BAP1 Tumor Predisposition Syndrome Presenting as a Recurrent Ovarian Sex Cord-Stromal Tumor.

The BRCA1-associated protein 1 ( BAP1 ) gene encodes a tumor suppressor that functions as a ubiquitin hydrolase involved in DNA damage repair. BAP1 germline mutations are associated with increased risk of multiple solid malignancies, including mesothelioma, uveal melanoma, renal cell carcinoma, and high-grade rhabdoid meningiomas. Here, we describe the case of a 52-yr-old woman who experienced multiple abdominal recurrences of an ovarian sex cord-stromal tumor that was originally diagnosed at age 25 and who was found to have a germline mutation in BAP1 and a family history consistent with BAP1 tumor predisposition syndrome.

Catastrophic Health Expenditures With Pregnancy and Delivery in the United States.

Objective: To describe prevalence, trends, and risk factors for catastrophic health expenditures in the year of delivery among birth parents (delivering people).

Methods: We conducted a retrospective, cross-sectional study of the Medical Expenditure Panel Survey from 2008-2016. We identified newborn birth parents and a 2:1 nearest-neighbor propensity-matched control cohort of nonpregnant reproductive-aged individuals, then assessed for catastrophic health expenditures (spending greater than 10% of family income) in the delivery year.

Employment outcomes among cancer patients in the United States.

Background: Cancer diagnosis and treatment can lead to disruptions in employment, which can, in turn, lead to financial problems and uninsurance. We used a nationally representative survey to describe predictors of non-employment among cancer patients compared to a matched cohort of individuals without cancer.

Methods: This was a retrospective study of the 2005-2018 nationally representative Medical Expenditure Panel Survey.

Neoadjuvant chemotherapy for advanced stage endometrial cancer: A systematic review.

Objective: While primary cytoreductive surgery (PCS) is considered the standard of care for women who present with stage IV endometrial cancer, neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery (ICS) has emerged as an alternative treatment strategy. We summarized the literature and compared outcomes of PCS compared to NACT and ICS.

Methods: We conducted a systematic search on PubMed, Embase, Web of Science, and Scopus for articles published from January 1, 1990 to December 31, 2020.

Out-of-network bills among privately insured patients undergoing hysterectomy.

Background: In recent years, the issue of out-of-network billing for privately insured patients has been highlighted as a source of unexpected out-of-pocket charges for patients, even in the setting of an in-network primary surgeon. The Congress recently passed the No Surprises Act to curtail these practices. However, the new law contains exceptions, and its regulatory system has yet to be established.

Adjuvant treatment and outcomes for patients with stage IIIA grade 1 endometrioid endometrial cancer.

Objective: The role and type of adjuvant therapy for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIA grade 1 endometrioid endometrial adenocarcinoma are controversial. This retrospective cohort study aimed to determine associations between adjuvant therapy use and survival among patients with stage IIIA grade 1 endometrial cancer.

Methods: Patients who underwent primary surgery for stage IIIA (FIGO 2009 staging) grade 1 endometrial cancer between January 2004 and December 2016 were identified in the National Cancer Database.

Catastrophic health expenditures, insurance churn, and nonemployment among gynecologic cancer patients in the United States.

Background: In recent years, there has been growing recognition of the financial burden of severe illness, including associations with higher rates of nonemployment, uninsurance, and catastrophic out-of-pocket health spending. Patients with gynecologic cancer often require expensive and prolonged treatments, potentially disrupting employment and insurance coverage access, and putting patients and their families at risk for catastrophic health expenditures.

Objective: This study aimed to describe the prevalence of insurance churn, nonemployment, and catastrophic health expenditures among nonelderly patients with gynecologic cancer in the United States, to compare within subgroups and to other populations and assess for changes associated with the Affordable Care Act.

Evaluation of the clinical Index of Stable febrile neutropenia risk stratification system for management of febrile neutropenia in gynecologic oncology patients.

Objective: Scoring systems have been developed to identify low risk patients with febrile neutropenia (FN) who may be candidates for outpatient management. We sought to validate the predictive accuracy of the Clinical Index of Stable Febrile Neutropenia (CISNE) score alone and in conjunction with alternative scoring systems for risk of complications among gynecologic oncology patients.

Methods: We conducted a single institution retrospective cohort study of patients admitted to an academic gynecologic oncology service for FN.

Associations of Insurance Churn and Catastrophic Health Expenditures With Implementation of the Affordable Care Act Among Nonelderly Patients With Cancer in the United States.

Importance: Health insurance coverage is dynamic in the United States, potentially changing from month to month. The Patient Protection and Affordable Care Act (ACA) aimed to stabilize markets and reduce financial burden, particularly among those with preexisting conditions.

Objective: To describe the risks of insurance churn (ie, gain, loss, or change in coverage) and catastrophic health expenditures among nonelderly patients with cancer in the United States, assessing for changes associated with ACA implementation.