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The Society of Gynecologic Oncology recommends opportunistic salpingectomy during benign hysterectomy to reduce the risk of epithelial ovarian cancers. A previous study indicated racial discrepancies in the adoption rates of risk-reducing salpingectomies at time of hysterectomy from 2011-2018. We performed an updated analysis to determine if these differences persist. Retrospective cohort study. Over 700 academic and community hospitals in the American College of Surgeons National Surgical Quality Improvement Program. Patients 18-50 years old undergoing minimally invasive benign hysterectomy from 2016-2021. Billing codes were used to identify patients who underwent total laparoscopic hysterectomy (TLH), total vaginal hysterectomy (TVH), or laparoscopic-assisted vaginal hysterectomy (LAVH), with or without bilateral salpingectomy. Patients were identified in the dataset as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), or Hispanic. Log-binomial regression was used to calculate risk ratio (RR) and 95% confidence intervals (CI) of salpingectomy for NHB, and Hispanic patients compared to NHW patients. Of 117,587 patients, 65% were NHW, 17.1% NHB, and 17.8% Hispanic. Of these patients, 70.6% underwent TLH, 12.8% TVH, and 16.6% LAVH. 86.9% of all patients underwent salpingectomy. When compared to NHW patients undergoing TLH, NHB and Hispanic patients were as likely to undergo salpingectomy [NHB RR 0.98 (CI 0.97-0.98); Hispanic RR 0.99 (CI 0.99-0.999)]. The same was true for patients undergoing TVH [NHB RR 1.04 (CI 0.997-1.1); Hispanic RR 1.1 (CI 1.1-1.2)] and LAVH [NHB RR 0.95 (CI 0.93-0.97); Hispanic 0.997 (CI 0.98-1.01)]. RRs remained similar after adjusting for age, diabetes, smoking, hypertension, American Society of Anesthesiologists class, and year of operation. These findings suggest minimal differences in salpingectomy rates among racial and ethnic groups between 2016-2021. This is a change from prior studies and may indicate national improvements in reducing health disparities associated with opportunistic salpingectomy. [ABSTRACT FROM AUTHOR]

Our study evaluates outcomes of Stage III endometrial cancer patients treated with upfront chemotherapy with or without subsequent radiation ("upfront" cohort) compared to radiation with concurrent sensitizing cisplatin with or without subsequent chemotherapy ("concurrent" cohort). Our objective was to assess differences in 1) recurrence free survival (RFS) and overall survival (OS); 2) initial recurrence site; and 3) acute and long-term toxicities. All stage III endometrial cancer patients treated at our institution from 2010-2021 were included in chart review. Univariate analyses were performed using Mann-Whitney U, Fisher's exact, and log rank tests. Multivariate analysis was done using Cox proportional hazards and binomial regression models. Our sample included 156 patients; 107 received upfront and 49 received concurrent treatment. Groups were balanced in age, race, BMI, and comorbidities. More patients in the upfront cohort had stage IIIC2 disease (28% vs 14%, p = 0.04), and high-grade histology (54% vs 6%, p<0.01). Median RFS for all patients was 35 months, and median OS was 48 months. In the upfront vs concurrent groups, median RFS was 26 vs 50 months (p<0.01) while median OS was 42 vs 56 months (p<0.01). When adjusting for stage and histology, the upfront group had a trend towards shortened RFS (p = 0.09), and significantly shortened OS with a hazard ratio of 4.2 (95% CI = 1.1 to 15.9). There was no significant difference in site of initial recurrence between groups. For patients with endometrioid histology, 49 patients received upfront and 44 received concurrent treatment. After adjusting for stage and histology, in the upfront group, there was a trend towards shortened RFS (p = 0.05), and significantly shortened OS with a hazard ratio of 9.2 (95% CI = 1.4 to 61.1). Patients in the upfront group were more likely to have initial pelvic or paraaortic nodal recurrence (p = 0.04). More patients in the concurrent group discontinued one agent during subsequent chemotherapy due to toxicity (p<0.05), but no difference was seen in chemotherapy delays, dose reductions or early discontinuation. Upfront patients had more vulvar/anal pain (q = 0.01) and urinary frequency (q = 0.01), but there were no differences between groups in grade 3 or higher toxicities. Stage III endometrial cancer patients undergoing concurrent treatment trended toward improved RFS and had significantly longer median OS as compared to patients receiving upfront treatment, particularly among patients with endometrioid histology. For endometrioid patients, the upfront group had increased risk of nodal recurrence, but no difference was observed in local or distant recurrence. These findings suggest that there may be some stage III endometrial cancer patients who benefit from concurrent chemoradiation, which should be considered in future clinical trial design. [ABSTRACT FROM AUTHOR]

Our study examines clinical outcomes of stage III serous endometrial cancer patients treated with adjuvant chemotherapy vs combined chemotherapy and radiation. We assessed differences in recurrence free survival (RFS), overall survival (OS), and initial recurrence site. A retrospective cohort study was conducted including all stage III serous endometrial cancer patients treated at our institution from 2010-2021. Data was abstracted from the medical record and from chart review. Outcomes were compared between patients who received chemotherapy alone ("chemotherapy" group) vs any sequence combining chemotherapy and radiation ("sequential" group). Patients in the chemotherapy group received up to six cycles of carboplatin and paclitaxel. Patients in the sequential group received external beam radiation (EBRT) and/or vaginal brachytherapy (VBT) with or without sensitizing cisplatin and with or without up to 4 cycles of outback carboplatin and paclitaxel, or sandwich adjuvant therapy with three cycles of carboplatin and paclitaxel followed by radiation followed by up to 3 additional cycles of carboplatin and paclitaxel. Univariate analyses were performed using fisher's exact, Wilcoxon rank-sum, and log rank tests. A total of 53 patients were included in the study. Among them, 11 patients received chemotherapy and 42 received sequential treatment. Both groups were similar with regards to age, race, stage and comorbidities. In the sequential group, 26 patients received both EBRT and VBT, 11 received only EBRT, and 5 received only VBT. RFS was significantly improved for the sequential group compared to the chemotherapy group (24.5 months vs 10.3 months, p = 0.04). Although there was a large absolute difference in OS between groups (24.5 vs 46.9 months), this was not statistically significant (p = 0.25). Local recurrence was significantly more likely in the chemotherapy group (45.5% vs 11.9%, p = 0.02). There was no difference in nodal (p>0.99) or distant (p = 0.59) recurrence. Stage III serous endometrial cancer patients treated with a combination of adjuvant radiation and chemotherapy had improved RFS when compared to patients treated with adjuvant chemotherapy alone. OS was not significantly different between groups. Patients treated with a combination of radiation and chemotherapy were less likely to recur locally with no significantly increased risk in distant or nodal recurrence. These findings suggest that adjuvant treatment combining chemotherapy and radiation may increase recurrence free survival in this patient population and should be further evaluated in future clinical trials. [ABSTRACT FROM AUTHOR]

Background: "Financial Toxicity" (FT) is the financial burden imposed on patients due to disease and its treatment. Approximately 50% of gynecologic oncology patients experience FT. This study describes the implementation and outcomes of a novel financial navigation program (FNP) in gynecologic oncology., Methods: Patients presenting for initial consultation with a gynecologic oncologist from July 2022 to September 2023 were included. A FNP was launched inclusive of hiring a financial navigator (FN) in July 2022, and implementing FT screening in October 2022. We prospectively captured patient referrals to the FN, collecting clinical, demographic, financial and social needs information, along with FN interventions and institutional support service referrals. Referrals to the FN and support services were quantified before and after screening implementation., Results: There were 1029 patients with 21.6% seen before and 78.4% after screening initiation. Median age was 58 (IQR 46-68). The majority were non-Hispanic white (60%) with private insurance (61%). A total of 10.5% patients were referred to the FN. Transportation (32%), financial assistance (20.5%) and emotional support (15.4%) were the most common needs identified. A higher proportion of patients referred to the FN identified as Black, had government-funded insurance or diagnoses of uterine or cervical cancers (p < 0.05). Post-screening referrals to FN increased (5% vs. 12.9%, p < 0.001), while referrals to other support services decreased (9.5% vs. 2.9%, p < 0.001)., Conclusions: Implementation of the FNP was feasible, though presence of both a FN and FT screening maximized its effectiveness. Further investigation is needed to understand screening barriers and evaluate longer-term impact., Competing Interests: Declaration of competing interest There are no conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To understand facilitators, barriers, and perceptions of the Every Second Matters uterine balloon tamponade (ESM-UBT) package implemented across 10 medical colleges in India, 3 years after the program was introduced., Methods: Semi-structured interviews were conducted until thematic saturation in March 2020. Multiple provider cadres, including nurses, Obstetrics/Gynecology residents, professors, and program leads, were eligible. Interviews were transcribed and thematically coded using an inductive method., Results: Sixty-two obstetric providers were interviewed. Facilitators of implementation included recurrent training, improved teamwork and communication, strong program leadership, and involvement of lower-level facilities. Barriers to implementation included administrative hurdles, high staff turnover, language barriers, and resources required to reach and train lower-level facilities. Overall, the majority of clinicians viewed the ESM-UBT package as a useful intervention in aiding efforts to reduce maternal deaths from postpartum hemorrhage., Conclusions: Among 10 medical colleges in India the ESM-UBT package is seen as a beneficial intervention for managing refractory atonic postpartum hemorrhage, and for reducing maternal morbidity and mortality. Identified facilitators of and barriers to implementation of the ESM-UBT package in India should be used to guide future implementation efforts., (© 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Problem: The COVID-19 pandemic has presented a unique set of challenges to medical education globally. Low- and middle-income countries (LMICs) have faced unique barriers in transitioning to virtual modalities, and many medical students in LMICs experienced dramatically reduced educational time. The authors created the Global Medical Education Collaborative (GMEC) to address this problem by providing free, online, case-based tutorials to medical students in LMICs during the pandemic., Approach: The authors developed a needs assessment to gauge students' educational requirements, which informed GMEC's 2 primary goals: to provide free access to interactive online tutorials for students in LMICs and to bridge the physical distance between educators and learners via an online platform. A pilot program in Nigeria (April 26-May 26, 2020) helped inform the current strategy and logistics. Tutors and students were recruited via social media and medical education networks at the authors' home institutions., Outcomes: Within the first 2 months (April 26-June 26, 2020), 324 students representing 12 countries and 20+ medical schools joined GMEC. Additionally, 95 physicians and trainees joined as tutors and, collectively, delivered 52 tutorials. Students responded to a needs assessment querying confidence in various clinical domains, interest in covering clinical topics, barriers to virtual learning, and the effect of the pandemic on their education. Tutors held 1-hour, interactive tutorials over Zoom covering a variety of clinical topics. According to surveys, 91% of students (71 of 78) felt more confident in the material related to the tutorial's topic after participating., Next Steps: GMEC will continue to engage students, tutors, and collaborators to facilitate the delivery of innovative, high-quality tutorials to students affected by COVID-19 in LMICs. To ensure that the platform is sustainable and aligned with GMEC's mission to promote equity in global medical education, the collaborative will need to be agile and responsive., (Copyright © 2021 by the Association of American Medical Colleges.)