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7. Geographic disparities in the distribution of the U.S. gynecologic oncology workforce: A Society of Gynecologic Oncology study.

Author

Ricci, Stephanie, Tergas, Ana I, Long Roche, Kara, Fairbairn, Melissa Gerardi, Levinson, Kimberly L, Dowdy, Sean C, Bristow, Robert E, Lopez, Micael, Slaughter, Katrina, Moore, Kathleen, and Fader, Amanda N

Subjects
Geographic disparities, Gynecologic cancer care
Abstract

A recent ASCO workforce study projects a significant shortage of oncologists in the U.S. by 2020, especially in rural/underserved (R/US) areas. The current study aim was to determine the patterns of distribution of U.S. gynecologic oncologists (GO) and to identify provider-based attitudes and barriers that may prevent GOs from practicing in R/US regions. U.S. GOs (n = 743) were electronically solicited to participate in an on-line survey regarding geographic distribution and participation in outreach care. A total of 320 GOs (43%) responded; median age range was 35-45 years and 57% were male. Most practiced in an urban setting (72%) at a university hospital (43%). Only 13% of GOs practiced in an area with a population

Published
2017

8. Factors Predicting Use of Neoadjuvant Chemotherapy Compared With Primary Debulking Surgery in Advanced Stage Ovarian Cancer—A National Cancer Database Study

Author

Leiserowitz, Gary S, Lin, Jeff F, Tergas, Ana I, Cliby, William A, and Bristow, Robert E

Subjects
Biomedical and Clinical Sciences, Oncology and Carcinogenesis, Patient Safety, Cancer, Rare Diseases, Ovarian Cancer, Adolescent, Adult, Aged, Carcinoma, Ovarian Epithelial, Chemotherapy, Adjuvant, Cohort Studies, Cytoreduction Surgical Procedures, Databases, Factual, Disease-Free Survival, Female, Humans, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Neoplasms, Glandular and Epithelial, Ovarian Neoplasms, Practice Patterns, Physicians', Proportional Hazards Models, United States, Young Adult, Neoadjuvant chemotherapy, Ovarian cancer, Patterns of care, Oncology & Carcinogenesis, Clinical sciences, Oncology and carcinogenesis
Abstract

ObjectivesWe performed a patterns-of-care study to characterize the types of patients with epithelial ovarian cancer (EOC) who received neoadjuvant chemotherapy (NACT) versus primary debulking surgery (PDS) using the National Cancer Database (NCDB).MethodsWe identified patients with stages IIIC and IV EOC in the NCDB diagnosed from 2003 to 2011. Patients who received chemotherapy (CT) prior to surgery were classified as receiving NACT; if surgery preceded CT, then it was classified as PDS. Data collected from the NCDB included demographics, medical comorbidity index, cancer characteristics and treatment, and hospital characteristics. Univariate and multivariable analyses were performed using χ test, logistic regression, log-rank test, and Cox proportional hazards modeling as indicated. Statistical significance was set at P < 0.05.ResultsA total of 62,727 patients with stages IIIC and IV EOC were identified. The sequence of surgery and CT was identified, of which 6922 (11%) had NACT and 31,280 (50%) had PDS. Neoadjuvant CT was more frequently done in stage IV than stage IIIC (13% vs 9%), and its use markedly increased over time. Variables associated with increased likelihood of NACT use were as follows: age older than 50 years and those with higher comorbidities, stage IV, and higher-grade EOC. Neoadjuvant CT use was also associated with hospitals that were adherent to the National Comprehensive Cancer Network guidelines, high-volume facilities, those in the Midwest and West, and academic centers.ConclusionsEvidence suggests that patients with greater adverse risk factors are more likely to receive NACT instead of PDS. Use of NACT has significantly increased over the study period, especially in patients with stage IV ovarian cancer.

Published
2017

14. Phase I trial of daily subcutaneous SPL-108 injections in combination with paclitaxel in patients with platinum resistant CD44+ advanced ovarian epithelial cancer

Author

Girda, Eugenia, Hou, June, Nelson, David, Finlayson, Malcolm, de Meritens, Alexandre Buckley, Chekmareiva, Marina, Leiser, Aliza, Song, Mihae, Stephenson, Ruth, Chan, Nancy, Tergas, Ana I, Vattakalam, Reena, Wright, Jason D, Yu, Hua, Martincuks, Antons, Kohut, Adrian, Palmer, Joycelynne, and Rodriguez-Rodriguez, Lorna

Published
2022
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19. The prognostic significance of pre- and post-treatment CA-125 in grade 1 serous ovarian carcinoma: A Gynecologic Oncology Group study

Author

Fader, Amanda Nickles, Java, James, Krivak, Thomas C, Bristow, Robert E, Tergas, Ana I, Bookman, Michael A, Armstrong, Deborah K, Tanner, Edward J, and Gershenson, David M

Subjects
Ovarian Cancer, Prevention, Cancer, Rare Diseases, Clinical Research, Aged, Antineoplastic Combined Chemotherapy Protocols, CA-125 Antigen, Carboplatin, Cystadenocarcinoma, Serous, Female, Humans, Membrane Proteins, Middle Aged, Neoplasm Grading, Ovarian Neoplasms, Paclitaxel, Ovarian cancer, Low grade serous carcinoma, CA-125, Oncology and Carcinogenesis, Paediatrics and Reproductive Medicine, Oncology & Carcinogenesis
Abstract

ObjectivesThe study objective was to determine the prognostic significance of serum CA-125 levels in patients with grade 1 serous ovarian carcinoma (SOC) enrolled in a Phase III study.MethodsAn ancillary analysis of a phase III study of women with advanced epithelial ovarian cancer treated with carboplatin/paclitaxel versus triplet or sequential doublet regimens. Grade 1 SOC was used as a surrogate for low-grade serous carcinoma.ResultsAmong 3686 enrolled patients, 184 (5%) had grade 1 disease and CA-125 levels available. For those with grade 1 SOC, the median patient age was 56.5; 87.3% had Stage III disease. Median follow-up was 102 months and there was no difference in pre-chemotherapy CA-125 by treatment arm (P=0.91). Median pretreatment CA-125 for those with grade 1 SOC was lower (119.1) than for patients with grade 2-3 SOC (246.7; P

Published
2014

33. Human Connection: Oncologist Characteristics and Behaviors Associated With Therapeutic Bonding With Latino Patients With Advanced Cancer.

Author

Tergas, Ana I., Prigerson, Holly G., Penedo, Frank J., and Maciejewski, Paul K.

Subjects
TUMOR treatment, CANCER patient psychology, HISPANIC Americans, PHYSICIAN-patient relations, TRANSCULTURAL medical care, RACE, TUMOR classification, SPANISH language, FAMILY-centered care, SELF-disclosure, RESEARCH funding, COMMUNICATION, DESCRIPTIVE statistics, DATA analysis software, ONCOLOGISTS, THERAPEUTIC alliance, SECONDARY analysis
Abstract

Purpose Therapeutic alliances (TAs) between oncologists and patients are bonds characterized by mutual caring, trust, and respect. We here relate oncologist characteristics and behaviors to TA among Latino and non-Latino patients with advanced cancer. Methods Participants included non-Latino oncologists (n = 41) and their Latino (n = 67) and non-Latino White (n = 90) patients with advanced cancer who participated in Coping with Cancer III, a multisite, US-based prospective cohort study of Latino/non-Latino disparities in end-of-life cancer care, conducted 2015-2019. Oncologist characteristics included age, sex, race, institution type, Spanish language proficiency, familismo practice style (emphasis on family) and clinical etiquette behaviors. Patient-reported TA was assessed using the average score of six items from The Human Connection scale. Hierarchical linear modeling (HLM) estimated effects of oncologist characteristics on TA. Results Of 157 patients, a majority were female (n = 92, 58.6%) and age younger than 65 years (n = 95, 60.5%). Most oncologists were male (n = 24, 58.5%), non-Latino White (n = 25, 61%), and age 40 years and older (n = 25, 61%). An adjusted HLM in the full sample showed that Latino patient ethnicity was associated with significantly lower TA (β = −.25; P < .001). In an adjusted stratified HLM for TA, among Latino patients, oncologist familismo practice style (β = .19; P = .012), preference using first names (β = .25; P = .023), and greater Spanish fluency (β = .11; P < .001) were positively associated with TA. In contrast, familismo practice style had no impact on TA for non-Latino White patients. Conclusion Latino patients with advanced cancer had worse TAs with their oncologists versus non-Latino patients. Modifiable oncologist behaviors may be targeted in an intervention designed to improve the patient-physician relationship between oncologists and their Latino patients with advanced cancer. [ABSTRACT FROM AUTHOR]

Published
2024
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42. Critical Care

Author

Buckley, Alexandre, Tergas, Ana I., Eskander, Ramez N., editor, and Bristow, Robert E., editor

Published
2015
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