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  • 1
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    Online Resource
    Trends and survival outcomes of robotic, laparoscopic, and open surgery for stage II uterine cancer
    BMJ ; 2020
    In:  International Journal of Gynecologic Cancer Vol. 30, No. 9 ( 2020-09), p. 1347-1355
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 30, No. 9 ( 2020-09), p. 1347-1355
    Abstract: A recent randomized clinical trial showed that minimally invasive surgery led to poorer survival compared with open surgery in early stage cervical cancer. We determined the trends in adoption of minimally invasive surgery and 5-year overall survival outcomes after open, laparoscopic-assisted, and robotic-assisted hysterectomy for stage II uterine cancer with cervical stromal involvement. Methods Data for patients with stage II uterine cancer were acquired from the National Cancer Database from 2010 to 2015. χ 2 testing, Kaplan–Meier methods, and Cox models were used for statistical analyses. Results Of 2949 patients, 44.3% underwent open hysterectomy, 13.9% underwent laparoscopic hysterectomy, and 41.8% underwent robotic hysterectomy. The proportion of robotic cases increased from 26.8% in 2010 to 48.3% in 2015 (annual percent change 10.1%), with a decrease in open hysterectomy from 63.3% to 34.3% (annual percent change –12.5%). The overall 5-year survival was 77.6% in robotic, 76.8% in laparoscopic, and 72.5% in open hysterectomy (p=0.045); however, after adjusting for known prognostic factors, robotic (HR 1.00, 95% CI 0.82 to 1.21; p=0.97) and laparoscopic hysterectomy (HR 1.09, 95% CI 0.83 to 1.44; p=0.54) did not portend for improved survival compared with open hysterectomy. Black women (HR 1.59, 95% CI 1.25 to 2.02; p 〈 0.001) and individuals with co-morbidities (HR 1.45, 95% CI 1.21 to 1.75, p 〈 0.001) had worse adjusted survival and the highest rates of open hysterectomy. Conclusion The use of minimally invasive surgery for stage II uterine cancer has increased over time, with comparable adjusted 5-year survival after robotic or laparoscopic hysterectomy compared with open hysterectomy. Black women and those with co-morbidities had lowest rates of minimally invasive surgery and the poorest adjusted survival.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    URL: Article
    DOI: 10.1136/ijgc-2020-001646
    DOI: 10.1136/ijgc-2020-001646.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2009072-9
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  • 2
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    The Role of Diet Compared to Physical Activity on Women's Cancer Mortality: Results From the Third National Health and Nutrition Examination Survey
    Frontiers Media SA ; 2022
    In:  Frontiers in Public Health Vol. 10 ( 2022-8-1)
    Details
    In: Frontiers in Public Health, Frontiers Media SA, Vol. 10 ( 2022-8-1)
    Abstract: Among women in the United States, cancer is the second leading cause of death. Prior studies have examined how lifestyle factors, such as diet and physical activity, influence cancer mortality. However, few have evaluated if diet or physical activity has a stronger protective effect for cancer mortality. Therefore, this study aims to evaluate and compare the impacts of diet and physical activity on women's cancer mortality. Methods Prospective, cross-sectional data were abstracted from the Third US National Health and Nutrition Examination Survey (NHANES III) on female respondents from 1988 to 1994. Physical activity was derived from the CDC's metabolic equivalent (MET) intensity levels. Dietary classifications were derived from the USDA's healthy eating index (HEI). We utilized the National Death Index to obtain mortality follow-up information on our cohort until December 31, 2015. Chi-squared, multivariable Cox regression, and Kaplan–Meier estimates were employed for statistical analyses. Results Of 3,590 women (median age: 57, range: 40–89), 30% had an obese BMI (BMI≥30 kg/m 2 ). Additionally, 22% of participants self-reported a healthy diet, 69% needed dietary improvement, and 9% had a poor diet. Furthermore, 21% reported physical inactivity, 44% did not meet physical activity guidelines, and 35% met guidelines. On multivariate analysis, healthy diet (HR: 0.70; 95% CI: 0.51–0.98; p = 0.04), but not physical activity (HR: 0.87; 95% CI: 0.55–1.38; p = 0.55), independently predicted for lower cancer mortality. Participants with a healthy diet but low exercise had decreased cancer mortality compared to participants with an unhealthy diet but high exercise ( p = 0.01). Conclusions A healthful diet was associated with lower cancer mortality in women, even after adjusting for obesity, inflammation, and other covariates. In addition, diet may play a stronger role in reducing cancer mortality in women than physical activity.
    Type of Medium: Online Resource
    ISSN: 2296-2565
    URL: Article
    DOI: 10.3389/fpubh.2022.853636
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2711781-9
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  • 3
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    Applying Artificial Intelligence to Gynecologic Oncology: A Review
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Obstetrical & Gynecological Survey Vol. 76, No. 5 ( 2021-5), p. 292-301
    Details
    In: Obstetrical & Gynecological Survey, Ovid Technologies (Wolters Kluwer Health), Vol. 76, No. 5 ( 2021-5), p. 292-301
    Abstract: Artificial intelligence (AI) will play an increasing role in health care. In gynecologic oncology, it can advance tailored screening, precision surgery, and personalized targeted therapies. Objective The aim of this study was to review the role of AI in gynecologic oncology. Evidence Acquisition Artificial intelligence publications in gynecologic oncology were identified by searching “gynecologic oncology AND artificial intelligence” in the PubMed database. A review of the literature was performed on the history of AI, its fundamentals, and current applications as related to diagnosis and treatment of cervical, uterine, and ovarian cancers. Results A PubMed literature search since the year 2000 showed a significant increase in oncology publications related to AI and oncology. Early studies focused on using AI to interrogate electronic health records in order to improve clinical outcome and facilitate clinical research. In cervical cancer, AI algorithms can enhance image analysis of cytology and visual inspection with acetic acid or colposcopy. In uterine cancers, AI can improve the diagnostic accuracies of radiologic imaging and predictive/prognostic capabilities of clinicopathologic characteristics. Artificial intelligence has also been used to better detect early-stage ovarian cancer and predict surgical outcomes and treatment response. Conclusions and Relevance Artificial intelligence has been shown to enhance diagnosis, refine clinical decision making, and advance personalized therapies in gynecologic cancers. The rapid adoption of AI in gynecologic oncology will depend on overcoming the challenges related to data transparency, quality, and interpretation. Artificial intelligence is rapidly transforming health care. However, many physicians are unaware that this technology is being used in their practices and could benefit from a better understanding of the statistics and computer science behind these algorithms. This review provides a summary of AI, its applicability, and its limitations in gynecologic oncology. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing this CME activity, physicians should be better able to describe the basic functions of AI algorithms; explain the potential applications of machine learning in diagnosis, treatment, and prognostication of cervical, endometrial, and ovarian cancers; and identify the ethical concerns and limitations of the use of AI in the management of gynecologic cancer patients.
    Type of Medium: Online Resource
    ISSN: 1533-9866 , 0029-7828
    URL: Article
    DOI: 10.1097/OGX.0000000000000902
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2043471-6
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  • 4
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    Ovarian, uterine, and cervical cancer patients with distant metastases at diagnosis: most common locations and outcomes
    Springer Science and Business Media LLC ; 2020
    In:  Clinical & Experimental Metastasis Vol. 37, No. 1 ( 2020-02), p. 107-113
    Details
    In: Clinical & Experimental Metastasis, Springer Science and Business Media LLC, Vol. 37, No. 1 ( 2020-02), p. 107-113
    Type of Medium: Online Resource
    ISSN: 0262-0898 , 1573-7276
    URL: Article
    DOI: 10.1007/s10585-019-10007-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 1496876-9
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  • 5
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    Relationship status and other demographic influences on survival in patients with ovarian cancer
    BMJ ; 2020
    In:  International Journal of Gynecologic Cancer Vol. 30, No. 12 ( 2020-12), p. 1922-1927
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 30, No. 12 ( 2020-12), p. 1922-1927
    Abstract: To evaluate the influence of marital status and other demographic factors on survival of patients with ovarian cancer. Study design Data were obtained from the Surveillance, Epidemiology, and End Results database from 2010 to 2015. Analyses were performed using Kaplan–Meier and multivariate Cox proportional hazard methods. Results Of 19 643 patients with ovarian cancer (median age 60 years, range 18–99), 16 278 (83%), 1381 (7%), 1856 (9%), and 128 (1%) were White, Black, Asian, and Native American, respectively. The majority of patients (10 769, 55%) were married while 4155 (21%) were single, 2278 (12%) were divorced, and 2441 (12%) were widowed. Patients were more likely to be married if they were Asian (65%) or White (56%) than if they were Black (31%) or Native American (39%) (p 〈 0.001). Most married patients were insured (n=9760 (91%), non-Medicaid) compared with 3002 (72%) of single, 1777 (78%) divorced, and 2102 (86%) of widowed patients (p 〈 0.001). Married patients were more likely to receive chemotherapy than single, divorced, and widowed patients (8515 (79%) vs 3000 (72%), 1747 (77%), and 1650 (68%), respectively; p 〈 0.001). The 5-year disease-specific survival of the overall group was 58%. Married patients had improved survival of 60% compared with divorced (52%) and widowed (44%) patients (p 〈 0.001). On multivariate analysis, older age (HR 1.02, 95% CI 1.016 to 1.021, p 〈 0.001), Black race (HR 1.24, 95% CI 1.11 to 1.38, p 〈 0.001), and Medicaid (HR 1.19, 95% CI 1.09 to 1.30, p 〈 0.001) or uninsured status (HR 1.23, 95% CI 1.05 to 1.44, p 〈 0.01) carried a worse prognosis. Single (HR 1.17, 95% CI 1.08 to 1.26, p 〈 0.001), divorced (HR 1.14, 95% CI 1.04 to 1.25, p 〈 0.01), and widowed (HR 1.16, 95% CI 1.06 to 1.26, p 〈 0.001) patients had decreased survival. Conclusion Married patients with ovarian cancer were more likely to undergo chemotherapy with better survival rates. Black, uninsured, or patients with Medicaid insurance had poorer outcomes.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    DOI: 10.1136/ijgc-2020-001512
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2009072-9
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  • 6
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    Hospital-acquired conditions after surgery for gynecologic cancer — An analysis of 82,304 patients
    Elsevier BV ; 2018
    In:  Gynecologic Oncology Vol. 150, No. 3 ( 2018-09), p. 515-520
    Details
    In: Gynecologic Oncology, Elsevier BV, Vol. 150, No. 3 ( 2018-09), p. 515-520
    Type of Medium: Online Resource
    ISSN: 0090-8258
    URL: Article
    DOI: 10.1016/j.ygyno.2018.07.009
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 1467974-7
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  • 7
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    Racial disparities in high-risk uterine cancer histologic subtypes: A United States Cancer Statistics study
    Elsevier BV ; 2021
    In:  Gynecologic Oncology Vol. 161, No. 2 ( 2021-05), p. 470-476
    Details
    In: Gynecologic Oncology, Elsevier BV, Vol. 161, No. 2 ( 2021-05), p. 470-476
    Type of Medium: Online Resource
    ISSN: 0090-8258
    URL: Article
    DOI: 10.1016/j.ygyno.2021.02.037
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 1467974-7
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  • 8
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    Chemotherapy alone for patients 75 years and older with epithelial ovarian cancer—is interval cytoreductive surgery still needed?
    Elsevier BV ; 2020
    In:  American Journal of Obstetrics and Gynecology Vol. 222, No. 2 ( 2020-02), p. 170.e1-170.e11
    Details
    In: American Journal of Obstetrics and Gynecology, Elsevier BV, Vol. 222, No. 2 ( 2020-02), p. 170.e1-170.e11
    Type of Medium: Online Resource
    ISSN: 0002-9378
    URL: Article
    DOI: 10.1016/j.ajog.2019.07.050
    RVK:
    XA 19400
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2003357-6
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  • 9
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    Human Papillomavirus Vaccination Trends and Disparities in the United States: Who Is Getting Left Behind?
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Sexually Transmitted Diseases Vol. 48, No. 10 ( 2021-10), p. 714-719
    Details
    In: Sexually Transmitted Diseases, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 10 ( 2021-10), p. 714-719
    Abstract: United States guidelines recommend human papillomavirus (HPV) vaccination for males and females up to 26, with more recent extended coverage for those 27 to 45 years based on discussion with patients' clinician. This study seeks to assess trends and disparities of vaccination in the United States based on demographic characteristics. Methods Data were obtained from the National Health and Nutrition Examination Survey between 2007 and 2016. χ 2 Analyses were used for statistical methods. Results Of 12,844 participants (median age, 22 years; range, 9–36 years), 2711 (21.3%) initiated HPV vaccination, of which 1358 (56.3%) completed the 3-dose vaccination series. Vaccination rates were higher in females compared with males (24.6% vs 13.0%; P 〈 0.001) and in Whites compared to Mexican Americans (22.6% vs 19.4%; P = 0.02). The uninsured had lower vaccination rates than private insurance and Medicaid (12.5% vs 22.4% vs 28.5%; P 〈 0.001). We divided the 10 year study into five separate periods (2007–2008, 2009–2010, 2011–2012, 2013–2014, and 2015–2016) to analyze trends. Vaccine initiation increased from 19.6% to 49.6% for 14–19-year olds ( P 〈 0.001), 10.4% to 35.5% for females ( P 〈 0.001), and 8.5% to 32.9% for Blacks ( P 〈 0.001). Although on trend analyses, the vaccination rates with the highest proportional increase were found in those: older than 25 to 29 years (4.56-fold), Mexican Americans (4.56 fold), below high school education (2.32 fold), and low income group (2.90 fold) over time. Conclusions The HPV vaccination rates in Mexican Americans increased nearly 5-fold over the last 10 years. However, their vaccination rates continue to lag behind Whites and Blacks.
    Type of Medium: Online Resource
    ISSN: 1537-4521 , 0148-5717
    URL: Article
    DOI: 10.1097/OLQ.0000000000001410
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2055170-8
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  • 10
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    Prevalence of Oral Human Papillomavirus Infection by Number of Vaccine Doses Among US Adults
    Oxford University Press (OUP) ; 2021
    In:  JNCI Cancer Spectrum Vol. 5, No. 6 ( 2021-11-03)
    Details
    In: JNCI Cancer Spectrum, Oxford University Press (OUP), Vol. 5, No. 6 ( 2021-11-03)
    Abstract: The human papillomavirus (HPV) vaccine is effective at reducing the incidence of cervical cancer caused by HPV. Studies have shown that 1 dose of the HPV vaccine offers comparable protection against genital HPV infection as additional doses; however, it is unknown whether oral HPV prevalence also differs by number of vaccine doses. We examined differences in prevalence of oral HPV by number of doses using the National Health and Nutrition Examination Survey from 2009 to 2016. The prevalence of HPV 6, 11, 16, and 18 infections was statistically significantly lower in individuals who received 1 dose (0.3%, 95% confidence interval [CI] = 0.0% to 0.9%) or 2-3 doses (0.4%, 95% CI = 0.0% to 1.2%) compared with unvaccinated individuals (1.2%, 95% CI = 0.9% to 1.6%). Smokers, individuals who initiated oral sex at age 17 years or younger, and those with more than 2 oral sexual partners had higher rates of oral HPV infection. Ongoing prospective studies are essential to further evaluate the efficacy of a single-dose regimen for prevention of oral HPV.
    Type of Medium: Online Resource
    ISSN: 2515-5091
    URL: Article
    DOI: 10.1093/jncics/pkab086
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2975772-1
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