Cervical Cancer Screening and Follow-Up Practices in U.S. Prisons.

INTRODUCTION: The objective of this study is to better understand cervical cancer screening and follow-up practices in U.S. prisons. METHODS: A 29-question survey examining cervical cancer screening practices, education, and facility/patient characteristics was disseminated to state-prison medical directors. RESULTS: A total of 70% (35/50) of state medical directors completed the survey between August 2021 and January 2022. All prison systems provided cervical cancer screening both at intake and specified intervals. A total of 36% provided colposcopy on site, and 9% performed excisional procedures on site. A total of 11 states identified 1‒5 cases of cervical cancer within the last year. Frequently cited challenges included a perceived lack of patient interest, delays in community referral, and lack of follow-up of abnormal results after release. CONCLUSIONS: This study found relatively high rates of screening with a perceived lack of patient interest as the most reported barrier. Follow-up care was also often affected by reported lack of patient interest, delays in community referral for diagnostic procedures, and patient release before follow-up. There is room for further optimization of screening and surveillance among incarcerated women by understanding and addressing systems-based challenges. By understanding patient barriers to primary screening, expanding access to onsite testing and community referral for abnormal results, and streamlining post-release follow-up, disparities in care among incarcerated women can be reduced.

Acceptability of virtual prenatal care: thinking beyond the pandemic.

OBJECTIVE: Obstetrical providers have had to rapidly rethink how to provide comprehensive prenatal care during the SARS-CoV-2 pandemic. At our institution, we implemented a risk-stratified approach to incorporating telemedicine into our prenatal care. The objective of this study was to determine acceptability of virtual prenatal care and preferences for future pregnancies among our patient population. STUDY DESIGN: We sought feedback from a convenience sample of patients regarding the acceptability of virtual prenatal care and desires for future pregnancies. RESULTS: We found that virtual prenatal care is acceptable to patients, and the majority would like to incorporate it into future post-pandemic pregnancy care, although preferences differ by race. CONCLUSION: Virtual prenatal care should continue to be employed in post-pandemic obstetric practice. Obstetrical providers must determine how to incorporate this practice in a risk-stratified and equitable fashion.

Lymph node assessment at the time of hysterectomy has limited clinical utility for patients with pre-cancerous endometrial lesions.

OBJECTIVE: The objective of this study was to determine the proportion of patients with a pre-invasive endometrial lesion who meet Mayo criteria for lymph node dissection on final pathology to determine if the use of sentinel lymph node biopsy in patients with pre-invasive lesions would be warranted. METHODS: All women who underwent hysterectomy for a pre-invasive endometrial lesion (atypical hyperplasia or endometrial intra-epithelial neoplasia) between 2009 and 2019 were included for analysis. Relevant statistical tests were utilized to test the associations between patient, operative, and pathologic characteristics. RESULTS: 141 patients met inclusion criteria. 51 patients (36%) had a final diagnosis of cancer, the majority (96%) of which were Stage IA grade 1 endometrioid carcinomas. Seven patients (5%) met Mayo criteria on final pathology (one grade 3, seven size >2 cm, one >50% myoinvasive). Three of these seven patients had lymph nodes assessed of which 0% had metastases. Six of these patients had frozen section performed, and 2 met (33%) Mayo criteria intraoperatively. Of the seven patients in the overall cohort that had lymph node sampling, six had a final diagnosis of cancer and none had positive lymph nodes. Of the 51 patients with cancer, only 10 had cancer diagnosed using frozen section, and only two met intra-operative Mayo criteria. Age > 55 was predictive of meeting Mayo criteria on final pathology (p = 0.007). No patients experienced a cancer recurrence across a median follow up of 24.3 months. CONCLUSIONS: Atypical hyperplasia and endometrial intra-epithelial neoplasia portend low risk disease and universal nodal assessment is of limited value.

Neoadjuvant chemotherapy does not disproportionately influence post-operative complication rates or time to chemotherapy in obese patients with advanced-stage ovarian cancer.

OBJECTIVES: To determine whether neoadjuvant chemotherapy (NACT) disproportionately benefits obese patients. METHODS: Data were collected from stage IIIC-IV ovarian cancer patients treated between 01/2010-07/2015. We performed univariate/multivariate logistic regression analyses with post-operative infection, readmission, any postoperative complication, and time to chemotherapy as outcomes. An interaction term was included in models, to determine if the effect of NACT on post-operative complications was influenced by obesity status. RESULTS: Of 507 patients, 115 (22.6%) were obese and 392 (77.3%) were non-obese (obese defined as BMI ≥30). Among obese patients undergoing primary debulking surgery (PDS) vs. NACT, rates of postoperative infection were 42.9% vs. 30.8% (p = 0.12), 30-day readmission 30.2% vs. 11.5% (p < 0.02), and any post-operative complication were 44.4% vs 30.8% (p = 0.133). Among non-obese patients undergoing PDS vs. NACT, rates of post-operative infection were 20.0% vs. 12.9% (p = 0.057), 30-day readmission 16.9% vs. 9.2% (p = 0.02), and any post-operative complication were 19.4% vs 28% (p = 0.044). Obesity was associated with post-operative infection (OR 2.3; 95%CI 1.22-4.33), 30-day readmission/reoperation (OR 2.27; 95%CI 1.08-3.21) and the development of any post-operative complication (OR 2.1; CI 1.13-3.74). However, there was not a significant interaction between obesity and NACT in any of the models predicting post-operative complications. CONCLUSIONS: The decision to use NACT should not be predicated on obesity alone, as the reduction in post-operative complications in obese patients is similar to non-obese patients.

Incarcerated Individuals' Perspectives on Living with Serious Illness.

The object of this study was to elicit patient perspectives on the experience of living with serious illness while incarcerated. The study was conducted at the Rhode Island Adult Corrections Institutions (ACI) in both the men's medium security and women's (all levels) facilities in June of 2016. Semi-structured interviews were conducted with participants, who met study criteria for serious illness. Interviews were coded following the template organizing style. Eighteen participants were enrolled, 13 males and five females with majority Caucasian (n=11) and ages 40-59 (n=9). Incarcerated individuals with serious illness perceived diverse healthcare deficits, including access to care, quality of care, and accommodations for medical needs and physical disabilities. Deficits were somewhat mitigated through prison programs and support from community advocates. The findings of our study support a quantitative needs assessment of available physical accommodations in prisons, national standardization of what constitutes adequate care, and reevaluation of the prison co-pay system. [Full article available at http://rimed.org/rimedicaljournal-2019-03.asp].