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Williams-Brown MY, Summey RM, Newtson A, Burke W, Turner T, Sabu P, Davidson BA, Glaser G. System-level recommendations for improved wellness for gynecologic oncologists: A Society of Gynecologic Oncology Review. Gynecol Oncol 2024; 183:85-92. [PMID: 38554478 DOI: 10.1016/j.ygyno.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/01/2024]
Abstract
Burnout and its negative sequelae are a persistent problem in gynecologic oncology, threatening the health of our physician workforce. Individual-level interventions such as stress management training, physical activity, and sleep hygiene only partially address this widespread, systemic crisis rooted in the extended work hours and stressful situations associated with gynecologic oncology practice. There is an urgent need for systematic, institution-level changes to allow gynecologic oncologists to continue the crucial work of caring for people with gynecologic cancer. We present recommendations for institution-level changes which are grounded in the framework presented by the National Plan for Health Workforce Well-Being by the National Academy of Medicine. These are aimed at facilitating gynecologic oncologists' well-being and reduction of burnout. Recommendations include efforts to create a more positive and inclusive work environment, decrease administrative barriers, promote mental health, optimize electronic medical record use, and support a diverse workforce. Implementation and regular evaluation of these interventions, with specific attention to at-risk groups, is an important next step.
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Affiliation(s)
- M Y Williams-Brown
- Department of Women's Health, Dell Medical School at The University of Texas at Austin, Austin, TX, United States of America.
| | - R M Summey
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - A Newtson
- Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - W Burke
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook University Cancer Center, Stony Brook, NY, United States of America
| | - T Turner
- St. Luke's Cancer Institute, Boise, ID, United States of America
| | - P Sabu
- Division of Gynecologic Oncology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - B A Davidson
- Division of Gynecologic Oncology, Duke University, Durham, NC, United States of America
| | - G Glaser
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
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Leiva S, Newtson A, Bi J, Devor E, Zhang Y, Thiel K, Leslie K. Phosphoproteomic response mapping to anti-angiogenic agents bevacizumab and cediranib in high-grade serous ovarian and endometrial cancer cell lines. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Russo D, Bosquet JG, Cardillo N, Newtson A, Reyes H, Nobre SP, McDonald M, Bender D, Goodheart M, Nobre SP. Prediction of chemo-response for serous ovarian cancer using DNA methylation patterns with deep machine learning (AI). Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01107-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Newtson A, Reyes H, Devor EJ, Goodheart MJ, Bosquet JG. Identification of Novel Fusion Transcripts in High Grade Serous Ovarian Cancer. Int J Mol Sci 2021; 22:ijms22094791. [PMID: 33946483 PMCID: PMC8125626 DOI: 10.3390/ijms22094791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/11/2022] Open
Abstract
Fusion genes are structural chromosomal rearrangements resulting in the exchange of DNA sequences between genes. This results in the formation of a new combined gene. They have been implicated in carcinogenesis in a number of different cancers, though they have been understudied in high grade serous ovarian cancer. This study used high throughput tools to compare the transcriptome of high grade serous ovarian cancer and normal fallopian tubes in the interest of identifying unique fusion transcripts within each group. Indeed, we found that there were significantly more fusion transcripts in the cancer samples relative to the normal fallopian tubes. Following this, the role of fusion transcripts in chemo-response and overall survival was investigated. This led to the identification of fusion transcripts significantly associated with overall survival. Validation was performed with different analytical platforms and different algorithms to find fusion transcripts.
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Affiliation(s)
- Andreea Newtson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (M.J.G.); (J.G.B.)
- Correspondence: ; Tel.: +1-319-356-2015
| | - Henry Reyes
- Department of Obstetrics and Gynecology, University of Buffalo, Buffalo, NY 14260, USA;
| | - Eric J. Devor
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Michael J. Goodheart
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (M.J.G.); (J.G.B.)
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
| | - Jesus Gonzalez Bosquet
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (M.J.G.); (J.G.B.)
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
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Lyons YA, Reyes HD, McDonald ME, Newtson A, Devor E, Bender DP, Goodheart MJ, Gonzalez Bosquet J. Interval debulking surgery is not worth the wait: a National Cancer Database study comparing primary cytoreductive surgery versus neoadjuvant chemotherapy. Int J Gynecol Cancer 2020; 30:845-852. [PMID: 32341114 PMCID: PMC7362882 DOI: 10.1136/ijgc-2019-001124] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/12/2020] [Accepted: 03/10/2020] [Indexed: 12/19/2022] Open
Abstract
Objective In previous studies, neoadjuvant chemotherapy followed by interval debulking surgery was not inferior to primary cytoreductive surgery as initial treatment for advanced epithelial ovarian cancer. Our study aimed to compare surgical and survival outcomes between the two treatments in a large national database. Methods Data were extracted from the National Cancer Database from January 2004 to December 2015. Patients with FIGO (International Federation of Gynecologists and Obstetricians) stage III-IV epithelial ovarian cancer and known sequence of treatment were included: primary cytoreductive (surgery=26 717 and neoadjuvant chemotherapy=9885). Tubal and primary peritoneal cancer diagnostic codes were not included. Residual disease after treatment was defined based on recorded data: R0 defined as microscopic or no residual disease; R1 defined as macroscopic residual disease. Multivariate Cox proportional HR was used for survival analysis. Multivariate logistic regression analysis was utilized to compare mortality between groups. Outcomes were adjusted for significant covariates. Validation was performed using propensity score matching of significant covariates. Results A total of 36 602 patients were included in the analysis. Patients who underwent primary cytoreductive surgery had better survival than those treated with neoadjuvant chemotherapy followed by interval surgery, after adjusting for age, co-morbidities, stage, and residual disease (p<0.001). Primary cytoreductive surgery patients with R0 disease had best median survival (62.6 months, 95% CI 60.5–64.5). Neoadjuvant chemotherapy patients with R1 disease had worst median survival (29.5 months, 95% CI 28.4–31.9). There were small survival differences between primary cytoreductive surgery with R1 (38.9 months) and neoadjuvant chemotherapy with R0 (41.8 months) (HR 0.93, 95% CI 0.87 to 1.0), after adjusting for age, co-morbidities, grade, histology, and stage. Neoadjuvant chemotherapy had 3.5 times higher 30-day mortality after surgery than primary cytoreductive surgery (95% CI 2.46 to 5.64). The 90-day mortality was higher for neoadjuvant chemotherapy in multivariate analysis (HR 1.31, 95% CI 1.06 to 1.61) but similar to primary cytoreductive surgery after excluding high-risk patients. Conclusions Most patients with advanced epithelial ovarian cancer may benefit from primary cytoreductive surgery. Patients treated with neoadjuvant chemotherapy should be those with co-morbidities unfit for surgery.
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Affiliation(s)
- Yasmin A Lyons
- OBGYN, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Henry D Reyes
- University at Buffalo - The State University of New York, Buffalo, New York, USA
| | | | - Andreea Newtson
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Eric Devor
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - David P Bender
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Wagner V, Winn H, Newtson A, Bender D, McDonald M. hCG production by mucinous adenocarcinoma of the ovary in a reproductive aged woman. Gynecol Oncol Rep 2018; 26:102-104. [PMID: 30533474 PMCID: PMC6258238 DOI: 10.1016/j.gore.2018.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 12/22/2022] Open
Abstract
When elevated serum hCG is discovered during the work up of a gynecologic tumor, it is paramount to identify the source of hCG prior to initiation of treatment. Potential sources of hCG include viable intrauterine pregnancy, ectopic pregnancy, miscarriage, gestational trophoblastic disease, pituitary hCG production, phantom hCG (heterophilic antibody interference), and tumor production. Here, we present a case of elevated hCG in a young women with a large complex pelvic mass. Prior to treatment initiation, the patient underwent work up for hCG elevation, which was ultimately found to be from tumor production. Pathologic examination revealed the mass to be a mucinous adenocarcinoma of the ovary with aberrant expression of hCG, rather than the more typical hCG producing germ cell tumor. We detail the preoperative evaluation process of hCG elevation. Additionally, we discuss the role of hCG in ovarian cancer and influence on tumorigenesis and management. Evaluation of elevated hCG in a premenopausal patient is complex but necessary prior to surgical intervention. Abberant hCG production resulting in elevated serum hCG can be seen in mucinous adenocarcinomas of the ovary. hCG production in ovarian cancer may be a useful marker for surveillance.
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Affiliation(s)
- Vincent Wagner
- Division of General Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, United States
| | - Heather Winn
- Division of General Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, United States
| | - Andreea Newtson
- Division of Gynecologic Oncology, The University of Iowa Hospitals and Clinics, United States
| | - David Bender
- Division of Gynecologic Oncology, The University of Iowa Hospitals and Clinics, United States
| | - Megan McDonald
- Division of Gynecologic Oncology, The University of Iowa Hospitals and Clinics, United States
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Miller M, Salinas E, Sharma D, Keeney M, McDonald M, Newtson A, Goodheart M, Gonzalez-Bosquet J, Devor E. NOTCH2 Expression is Significantly Associated with FIGO Stage at Diagnosis in Endometrioid Endometrial Cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Miller M, Salinas E, Sharma D, Keeney M, McDonald M, Newtson A, Devor E, Goodheart M, Gonzalez-Bosquet J. A Clinical Prediction Model Stratifies Patients by Risk and Helps with Surgical Staging Decisions in Endometrioid Endometrial Cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Devor EJ, Gonzalez-Bosquet J, Warrier A, Reyes HD, Ibik NV, Schickling BM, Newtson A, Goodheart MJ, Leslie KK. p53 mutation status is a primary determinant of placenta-specific protein 1 expression in serous ovarian cancers. Int J Oncol 2017; 50:1721-1728. [PMID: 28339050 PMCID: PMC5403493 DOI: 10.3892/ijo.2017.3931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/16/2017] [Indexed: 12/04/2022] Open
Abstract
Placenta-specific protein 1 (PLAC1) expression is co-opted in numerous human cancers. As a consequence of PLAC1 expression, tumor cells exhibit enhanced proliferation and invasiveness. This characteristic is associated with increased aggressiveness and worse patient outcomes. Recently, the presence of the tumor suppressor p53 was shown in vitro to inhibit PLAC1 transcription by compromising the P1, or distal/cancer, promoter. We sought to determine if this phenomenon occurs in primary patient tumors as well. Furthermore, we wanted to know if p53 mutation influenced PLAC1 expression as compared with wild-type. We chose to study serous ovarian tumors as they are well known to have a high rate of p53 mutation. We report herein that the phenomenon of PLAC1 transcription repression does occur in serous ovarian carcinomas but only when TP53 is wild-type. We find that mutant or absent p53 protein de-represses PLAC1 transcription. We further propose that the inability of mutant p53 to repress PLAC1 transcription is due to the fact that the altered TP53 protein is unable to occupy a putative p53 binding site in the PLAC1 P1 promoter thus allowing transcription to occur. Finally, we show that PLAC1 transcript number is significantly negatively correlated with patient survival in our samples. Thus, we suggest that characterizing tumors for TP53 mutation status, p53 protein status and PLAC1 transcription could be used to predict likely prognosis and inform treatment options in patients diagnosed with serous ovarian cancer.
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Affiliation(s)
- Eric J Devor
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine and The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Jesus Gonzalez-Bosquet
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine and The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Akshaya Warrier
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine and The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Henry D Reyes
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine and The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Nonye V Ibik
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine and The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Brandon M Schickling
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Andreea Newtson
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine and The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Michael J Goodheart
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine and The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Kimberly K Leslie
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine and The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Salinas E, Dai D, Newtson A, McDonald M, Goodheart M, Leslie K, Gonzalez-Bosquet J. Pre-treatment Prediction Model in Endometrioid Adenocarcinoma of the Uterus Using Somatic Mutations. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Newtson A, Salinas E, Leslie K, Bosquet JG. Genetic predictors of chemotherapeutic response in ovarian cancer within a previously associated molecular signature. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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