Radical hysterectomy case volume and cervical cancer treatment in the era of COVID-19: A multi-site analysis of National Cancer Institute-designated Comprehensive Cancer Centers.

OBJECTIVE: To compare radical hysterectomy case volume, cancer stage, and biopsy-to-treatment time of invasive cervical cancer diagnosed before and after onset of the COVID-19 pandemic. METHODS: In a multi-institution retrospective cohort study conducted at 6 large, geographically diverse National Cancer Institute-designated cancer centers, patients treated for newly diagnosed invasive cervical cancer were classified into 2 temporal cohorts based on date of first gynecologic oncology encounter: (1) Pre-Pandemic: 3/1/2018-2/28/2020; (2) Pandemic & Recovery: 4/1/2020-12/31/2021. The primary outcome was total monthly radical hysterectomy case volume. Secondary outcomes were stage at diagnosis and diagnosis-to-treatment time. Statistical analyses used chi-squared and two sample t-tests. RESULTS: Between 3/1/2018-12/31/2021, 561 patients were diagnosed with cervical cancer. The Pre-Pandemic and Pandemic & Recovery cohorts had similar age, race, ethnicity, smoking status, and Body Mass Index (BMI). During Pandemic & Recovery, the mean monthly radical hysterectomy case volume decreased from 7[SD 2.8] to 5[SD 2.0] (p = 0.001), the proportion of patients diagnosed with Stage I disease dropped from 278/561 (49.5%) to 155/381 (40.7%), and diagnosis of stage II-IV disease increased from 281/561 (50.1%) to 224/381 (58.8%). Primary surgical management was less frequent (38.3% Pandemic & Recovery versus 46.7% Pre-Pandemic, p = 0.013) and fewer surgically-treated patients received surgery within 6 weeks of diagnosis (27.4% versus 38.9%; p = 0.025). CONCLUSIONS: Lower radical hysterectomy case volume, a shift to higher cervical cancer stage, and delay in surgical therapy were observed across the United States following the COVID-19 outbreak. Decreased surgical volume may result from lower detection of early-stage disease or other factors.

Efficacy and safety of a restrictive blood transfusion protocol in gynecologic surgical patients.

Objectives: This study sought to compare differences in blood transfusion and surgical complication rates before and after the implementation of a restrictive blood transfusion protocol. Methods: On July 1, 2018, our institution implemented a restrictive blood transfusion protocol utilizing a hemoglobin trigger of less than 7 g/dL. Retrospective chart review was completed to review patients undergoing major abdominal surgery by the gynecology and gynecologic oncology services 18 months before, and after initiation of the transfusion protocol. Outcomes included number of patients, units transfused and postoperative complication rates. Complications included reoperation on the day of admission, surgical site infections, wound disruptions, pulmonary, renal, central nervous system, and cardiovascular complications, as well as deep venous thromboses, readmissions, and 30-day mortality. Results: There were 290 people in the pre- and 449 patients in the post-protocol group. A similar number of patients received blood transfusions in both groups (9.3% versus 10.6% p = 0.57). However, significantly fewer units of blood were given post-protocol initiation. For every patient who received a transfusion pre-protocol, 2.66 units were administered compared to 1.2 units after the protocol was initiated (p = 0.003). All postoperative complications were not significantly different between groups (p > 0.05). Individual postoperative complications were combined and analyzed using a clustered approach to detect rates of complications more conservatively. Both the 7-system (5.1% versus 4.9%, p = 0.90) and 8-system (5.5% versus 4.9%, p = 0.72) clustered analyses were not significantly different before and after the initiation of the transfusion protocol. Conclusions: A restrictive transfusion protocol is effective in decreasing the number of units of blood transfused without affecting postoperative complication rates in gynecologic surgery patients.

The long game: Telemedicine patient satisfaction metrics and methods of recurrence detection for gynecologic cancer patients throughout the initial year of the COVID-19 pandemic.

Objective: The primary aim of this study was to evaluate gynecologic cancer patients' satisfaction with telemedicine visits over a one-year period during the COVID-19 pandemic. The secondary aim was to characterize how gynecologic cancer recurrence was detected with high telemedicine utilization. Methods: A survey study and a retrospective cohort study of patients participating in telemedicine visits between April 20, 2020 and March 30, 2021 in a gynecologic oncology clinic were undertaken. To assess patient satisfaction with telemedicine visits, the Telemedicine Satisfaction Survey (TeSS) was administered to patients by phone. Retrospective chart review was conducted to gather clinical data regarding diagnosis, treatment, and recurrence. Results: Three hundred and sixteen patients completed the TeSS for a response rate of 80.2%. Patients rated the following aspects of the telemedicine encounter as good or excellent: quality of technology (97.8%), personal comfort (90.8%), length-of-visit (95.2%), treatment explanation (93.7%), overall experience (92.7%). Moreover, 87.0% of patients would use telemedicine again. Retrospective data was collected for 394 patients, 312 of which had invasive cancer (79.2%). Twenty-nine (7.4%) patients experienced a recurrence during the study period. The most common method of detection was patient-reported symptoms (n = 17, 58.6%). The remaining recurrences were diagnosed by scheduled biomarkers (n = 7, 24.1%), scheduled imaging (n = 4, 13.8%) and asymptomatic exam (n = 1, 3.4%). Conclusions: After one year of the COVID-19 pandemic and the implementation of routine telehealth visits, gynecologic cancer patients were overwhelmingly satisfied with the use of telemedicine. During this period, recurrences were most often diagnosed by patient-reported symptoms.

Racial and ethnic enrollment disparities in clinical trials of poly(ADP-ribose) polymerase inhibitors for gynecologic cancers.

OBJECTIVES: Disparities persist in the enrollment of racial/ethnic groups in clinical trials for ovarian cancers. We sought to analyze the enrollment rates of patients by race/ethnicity in phase II/III clinical trials involving poly(ADP-ribose) polymerase (PARP) inhibitors for ovarian cancers and compare these to the racial/ethnic prevalence of ovarian cancers in the United States. METHODS: This study was a retrospective review of clinical trials registered with ClinicalTrials.gov. Studies included evaluated PARP inhibitors for the treatment of ovarian, fallopian tube, and primary peritoneal cancers. Enrollment rates for clinical trials were stratified by race/ethnicity and type of cancer. Enrollment fractions (EFs) were calculated using prevalence data from the Surveillance, Epidemiology, and End Results Program. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to compare racial/ethnic group enrollment rates to Non-Hispanic (NH) White enrollment rates. RESULTS: Forty-eight trials were identified, 15 of which met inclusion criteria. The EFs for included trials, were 1.5% for NH-White, 0.47% for NH-Black, 0.33% for Hispanic, and 2.38% for Asian/Pacific Islander. Patients who identified as NH-Black and Hispanic were significantly underrepresented compared to those who identified as NH-White (OR 0.23, 95% CI [0.18-0.29] and OR 0.3, 95% CI [0.25-0.38] respectively, p < 0.001). CONCLUSIONS: NH-Black and Hispanic patients are significantly underrepresented in clinical trials evaluating PARP inhibitors for ovarian cancers compared to NH-White cohorts. Phase II/III trials assessing PARP inhibitors for ovarian cancers do not accurately represent the populations diagnosed with these malignancies. Enrollment strategies are needed to increase diversity in PARP inhibitor clinical trials for women's cancers.

A quality improvement pathway to rapidly increase telemedicine services in a gynecologic oncology clinic during the COVID-19 pandemic with patient satisfaction scores and environmental impact.

The primary goal was to convert 50% of all outpatient Gynecologic Oncology (GynOnc) encounters during the COVID-19 pandemic to telemedicine within one week. The secondary goal was to reach 100% documentation of telemedicine consent. The tertiary goal was to analyze patient satisfaction scores. An additional goal was to estimate CO2 emissions prevented from being produced. The period from 3/16/2020-4/15/2020 was targeted. The initial intervention involved transitioning surveillance visits. A second intervention, with nursing and advanced-practice-provider support, included transitioning additional visit types, and distributing a note template. The Telehealth Satisfaction Survey (TeSS) was administered to patients. Descriptive statistics and run charts were used to analyze and depict results. Within four weeks, there were 408 encounters; 217 were telemedicine (53.2%). Following the second intervention, 13 of 15 days (86.7%) reached the 50% telemedicine target and consent was documented in 96.6% of the telemedicine encounters. The TeSS had a 74.8% response-rate. Patients rated the following aspects of the telemedicine encounter as good or excellent: call quality (96.5%), personal comfort (92.9%), length-of-visit (94.7%), treatment explanation (93.8%), overall experience (88.5%). Moreover, 82.3% of patients would use telemedicine again. Additionally, 6.25 metric tons of CO2 emissions from travel were prevented from being produced. A GynOnc clinic can rapidly implement telemedicine systems. With multidisciplinary team planning and standardized note templates, transitioning 50% of encounters to telemedicine and achieving high rates of consent documentation were accomplished in four weeks. This increase in telemedicine represented a measurable decrease in the amount of CO2 emissions. Additionally, patients were overwhelmingly satisfied.

Stressing the person: legal and everyday person attributions under stress.

When determining the cause of a person's behavior, perceivers often overweigh dispositional explanations and underweigh situational explanations, an error known as the Fundamental Attribution Error (FAE). The FAE occurs in part because dispositional explanations are relatively automatic, whereas considering the situation requires additional cognitive effort. Stress is known to impair the prefrontal cortex and executive functions important for the attribution process. We investigated if stress increases dispositional attributions in common place and legal situations. Experiencing a physiological stressor increased participants' cortisol, dispositional attributions of common everyday behaviors, and negative evaluations. When determining whether a crime was due to the defendant's disposition or the mitigating situation, self-reported stress correlated with increased dispositional judgments of defendant's behavior. These findings indicate that stress may make people more likely to commit the FAE and less favorable in their evaluations of others both in daily life and when making socially consequential judicial decisions.

Neural mechanisms underlying the integration of situational information into attribution outcomes.

When forming impressions and trying to figure out why other people behave the way they do, we should take into account not only dispositional factors (i.e., personality traits) but also situational constraints as potential causes for a behavior. However, in their attributions, people often ignore the importance of situational factors. To investigate the neural mechanisms underlying the integration of situational information into attributions, we decomposed the attribution process by separately presenting information about behaviors and about the situational circumstances in which they occur. After reading the information, participants judged whether dispositional or situational causes explained the behavior (attribution), and how much they liked the person described in the scenario (affective evaluation). The dorsolateral prefrontal cortex showed increased blood oxygenation-level-dependent activation during the encoding of situational information when the resulting attribution was situational, relative to when the attribution was dispositional, potentially reflecting a controlled process that integrates situational information into attributions. Interestingly, attributions were strongly linked to subsequent affective evaluations, with the dorsomedial prefrontal cortex emerging as potential substrate of the integration of attributions and affective evaluations. Our findings demonstrate how top-down control processes regulate impression formation when situational information is taken into account to understand others.