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Davidson BA, Turner TB, Kim KH, Cass I, Calat L, McGwin G, Kushner DM. SGO and the elephant that is still in the room: Wellness, burnout and gynecologic oncology. Gynecol Oncol 2022; 167:354-359. [PMID: 36064677 DOI: 10.1016/j.ygyno.2022.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure wellness and burnout among gynecologic oncology clinicians and identify trends and at-risk populations to inform future interventions. METHODS Gynecologic oncologist (GO) and advanced practice provider (APP) responses to the 2020 Society of Gynecologic Oncology State of the Society survey were analyzed. The Maslach Burnout Inventory criteria for burnout was used. Work-life balance was scored on a 5-point Likert scale. Chi-square tests were used to compare mental health factors and the prevalence of burnout. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for associations between burnout and gender. RESULTS 543 survey responses were included for analysis. Most GO (54%) and all APP respondents were female. Female GOs were disproportionately affected by burnout particularly in the Northeast (female(F): 40.9% vs male(M): 19.1%, p = 0.007) and South (F: 42.5% vs M:22.9%, p = 0.01). Burnout in female GOs over 40 was 1.79 (CI: 1.13-2.83; p-value 0.01) times higher than similarly aged males. Females in non-private practice experienced burnout 1.66 times that of males in similar positions (CI: 1.18-2.94; p < 0.0001). Female GOs reported the worst work-life balance across all 5 domains. APPs and female GOs experienced more stress and feeling overwhelmed compared to men. GOs were more reluctant to see a mental health professional (p = 0.0003) or take medication (p = 0.009) than APPs. CONCLUSIONS Burnout in gynecologic oncology persists in both genders and is felt most acutely by female GOs. APPs are not immune and would benefit from inclusion in future research to mitigate burnout in healthcare clinicians.
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Affiliation(s)
- B A Davidson
- Division of Gynecologic Oncology, Duke University, Durham, NC, United States of America.
| | - T B Turner
- St. Luke's Cancer Institute, Boise, ID, United States of America
| | - K H Kim
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - I Cass
- Division of Gynecologic Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - L Calat
- Department of Obstetrics and Gynecology, NYU Langone Health, New York, NY, United States of America
| | - G McGwin
- School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - D M Kushner
- Division of Gynecologic Oncology, University of Wisconsin, Madison, WI, United States of America
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Schwartz Z, Li A, Walsh C, Rimel B, Alvarado M, Lentz S, Cass I. Patterns of care for risk reducing surgery in non-BRCA and Lynch ovarian cancer susceptibility mutation carriers. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.461] [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: 11/26/2022]
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John C, Amersi F, Fong A, Gillen J, Moore K, Walsh C, Li A, Rimel B, Cass I. Rethinking Breast Cancer Surveillance in Women with BRCA-associated Ovarian Cancer in the Post-SOLO Trial Era. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2019.11.087] [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: 10/24/2022]
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Ronen I, Wright KN, Cass I, Siedhoff MT. The Impact of Enhanced Recovery after Surgery on Outpatient Recovery after Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.604] [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: 11/30/2022]
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Schwartz Z, Zakhour M, Karlan B, Lester J, Rimel B, Walsh C, Li A, Cass I. Patterns of risk reducing surgery in germline homologous recombination deficiency/non-BRCA mutation carriers. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.188] [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: 10/26/2022]
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Walsh C, Kamrava M, Rogatko A, Li A, Cass I, Karlan B, Rimel B. Phase II trial of pembrolizumab with cisplatin and gemcitabine in women with recurrent platinum-resistant ovarian cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rowland M, Freeman A, Vesely S, Frey M, Liu A, Crim A, Lester J, Zantow E, Blank S, Powell B, Cass I, Moore K. Optimizing Second Line Chemotherapy in Germline BRCA Positive Patients with Platinum Sensitive Recurrent Ovarian Cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chang H, Kamara D, Lester J, Cass I. Short Term Impact of Surgically Induced Menopause on Cognitive Function and Well-Being in Women at High Risk for Ovarian Cancer following RRSO. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.016] [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: 10/18/2022]
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Liu A, Rowland M, Vesely S, Powell B, Freeman J, Blank S, Frey M, Gillen J, Moore K, Cass I. Impact of Intra-peritoneal Chemotherapy and Bevacizumab in Front Line Chemotherapy for Ovarian Cancer Among gBRCA and wtBRCA Patients: A Multi-Institutional, Frequency Matched, Case Control Study. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.060] [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: 11/26/2022]
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Hodeib M, McMillen K, Beavis A, Zakhour M, Walsh C, Rimel B, Li A, Karlan B, Cass I. Risk of Uterine Cancer in Women with Deleterious BRCA Mutations Who Undergo Risk Reducing Salpingo-oophorectomy (RRSO). Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.105] [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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Liu A, Lester J, Laury A, Cass I, Rimel B, Li A, Karlan B, Walsh C. PD-1 and PD-L1 Expression in Advanced Endometrial Adenocarcinoma. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.277] [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: 11/15/2022]
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Liang M, Prendergast E, Rimel B, Leuchter R, Walsh C, Cass I, Karlan B, Li A. Antibiotic Use Negatively Influences Survival in Epithelial Ovarian Cancer: A Case for Studying the Microbiome. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.265] [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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Hodeib M, Lester J, Laury A, Cass I, Rimel B, Li A, Karlan B, Walsh C. PD-1 and PD-L1 staining patterns in cervical squamous cell carcinoma. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.280] [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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Liang M, Holzapfel M, Chang H, Lester J, Li A, Cass I, Rimel B, Karlan B, Leuchter R, Walsh C. Glasgow Prognostic Score Associated with Lower Rates of R0 Cytoreduction in Women with Stage III Serous Ovarian Cancer. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Liang M, Prendergast E, Staples J, Holschneider C, Cass I. Complete Pathologic Response at Interval Debulking Surgery Following Neoadjuvant Chemotherapy Predicts Improved Survival in Women with Advanced Epithelial Ovarian Cancer in a Multi-institutional Cohort. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zakhour M, Laury A, Lester J, Rimel B, Walsh C, Li A, Karlan B, Leuchter R, Cass I. Serous tubal intraepithelial carcinoma lesions are common in primary peritoneal serous carcinomas. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.378] [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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Prendergast E, Liang M, Staples J, Lester J, Li A, Walsh C, Rimel B, Leuchter R, Karlan B, Cass I. Pathologic response at interval debulking surgery following neoadjuvant chemotherapy predicts improved survival in women with ovarian cancer. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.387] [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: 11/24/2022]
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Prendergast E, Green M, Zakhour M, Lester J, Li A, Walsh C, Rimel B, Leuchter R, Karlan B, Cass I. Gynecologic health surveillance and outcomes in BRCA mutation carriers following risk-reducing salpingo-oophorectomy. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.174] [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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Liang M, Prendergast E, Rimel B, Walsh C, Cass I, Karlan B, Li A. Antibiotics and the commensal microbiota: Impact on survival in women with epithelial ovarian cancer. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.180] [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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Martin S, Walsh C, Rimel B, Karlan B, Cass I, Li A. Serum interleukin-6 is a biomarker of outcome in women with advanced stage optimally resected ovarian cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.07.058] [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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Zakhour M, Lester J, Rimel B, Walsh C, Li A, Karlan B, Leuchter R, Cass I. Frequency of serous tubal intraepithelial carcinomas in primary peritoneal serous carcinomas. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.07.045] [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: 10/22/2022]
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Martin S, Karlan B, Walsh C, Cass I, Rimel B, Li A. Serum interleukin-6 is a biomarker of survival in women with advanced stage and optimally resected epithelial ovarian cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Park S, Amneus M, Axtell A, Hakimian B, Li A, Leuchter R, Karlan B, Rimel B, Walsh C, Holschneider C, Cass I. Morbidity of triple modality therapy in the management of early stage cervical cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.347] [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: 11/24/2022]
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Park S, Axtell A, Hakimian B, Li A, Leuchter R, Karlan B, Rimel B, Walsh C, Cass I. Morbidity of triple-modality therapy in the management of early stage cervical cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.07.073] [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: 10/24/2022]
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Paik D, Amersi F, Bresee C, Gangi A, Karlan B, Li A, Walsh C, Rimel B, Leuchter R, Cass I. Risk of breast cancer following ovarian cancer and the impact on overall survival. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.388] [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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Tran A, Rimel B, Walsh C, Cass I, Karlan B, Li A. Impact of obesity on secondary cytoreductive surgery and overall survival in women with recurrent ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Zakhour M, Labrant L, Rimel B, Walsh C, Li A, Karlan B, Cass I. Too much, too late: Aggressive measures and the timing of end-of life care discussions in women with gynecologic malignancies. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.150] [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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Paik D, Amersi F, Bresee C, Dang C, Karlan B, Li A, Wals C, Rimel B, Leuchter R, Cass I. Breast cancer following ovarian cancer in BRCA mutation carriers: What is the cost of surveillance? Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.381] [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: 10/25/2022]
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Labrant L, Rimel B, Walsh C, Li A, Karlan B, Cass I. Too much, too late: Aggressive care in women with recurrent gynecologic malignancies and the ttiming of end-of life discussions. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Holzapfel M, Rimel B, Li A, Cass I, Karlan B, Walsh C. What drives the development of synchronous endometrioid endometrial and ovarian cancers? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.068] [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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Cohen J, Tran A, Rimel B, Cass I, Walsh C, Karlan B, Li A. Thrombocytosis at secondary cytoreduction for recurrent ovarian cancer predicts suboptimal resection and poor survival. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.062] [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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Zakhour M, Li A, Walsh C, Cass I, Karlan B, Rimel B. Post treatment surveillance of type II endometrial cancer survivors. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.092] [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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Cohen J, Zakhour M, Rimel B, Li A, Cass I, Karlan B, Walsh C. Identification of gynecologic oncology patients that can be fast-tracked for early discharge. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.054] [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: 11/26/2022]
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Diaz E, Baquing M, Li A, Walsh C, Leuchter R, Karlan B, Cass I. Predictors of residual disease at hysterectomy following cervical conizations with positive margins. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.058] [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: 10/27/2022]
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Cass I, Zakhour M, Walts A, Gross J, Karlan B. Occult cancers at risk-reducing salpingo-oophorectomies (RRSO) in BRCA mutation carriers. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.207] [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: 10/28/2022]
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Penner K, Cass I, Walsh C, Aoyama C, Rao J, Balzer B, Ostrzega N, Dorigo O, Holschneider C. Endometrial intraepithelial neoplasia vs. World Health Organization classification of endometrial hyperplasia does not improve reliability of diagnosis or prediction of outcome in premenopausal women with preinvasive endometrial pathology undergoing progestin treatment. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2011.07.042] [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: 11/26/2022]
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Diaz E, Chen I, Liburd N, Karlan B, Walsh C, Cass I, Li A. Elevated serum adiponectin levels correlate with survival in epithelial ovarian cancers. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.162] [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: 10/18/2022]
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Fleming N, Lentz S, Vasilev S, Ellison M, Cass I, Li A, Leuchter R, Karlan B, Walsh C. Is older age a poor prognostic factor in stage I and II endometrioid endometrial adenocarsinoma? Gynecol Oncol 2010. [DOI: 10.1016/j.ygyno.2009.10.011] [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: 10/19/2022]
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Ioffe Y, Delic L, Amneus M, Leuchter R, Karlan B, Li A, Walsh C, Lentz S, Farias-Eisner R, Cass I. Before and after GOG 99: Did our practice patterns for treatment of intermediate risk endometrial adenocarcinoma change? Gynecol Oncol 2010. [DOI: 10.1016/j.ygyno.2009.10.015] [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: 10/19/2022]
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Delic L, Cass I, Li A, Leuchter R, Karlan B, Walsh C. Brachytherapy versus external beam radiation therapy in high intermediate risk endometrial cancer patients. Gynecol Oncol 2008. [DOI: 10.1016/j.ygyno.2008.07.085] [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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Nouri-Kinney S, Silva E, Walsh C, Li A, Karlan B, Cass I. Distinguishing primary mucinous ovarian carcinomas from primary gastrointestinal carcinomas metastatic to the ovaries: Are we trying hard enough and does it matter? Gynecol Oncol 2008. [DOI: 10.1016/j.ygyno.2008.07.064] [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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Blumenthal EB, Baldwin RL, Karlan BY, Cass I. 151 MECHANISM OF BRCA1 AND BRCA2 SECOND ALLELE INACTIVATION IN OVARIAN CANCER PATIENTS WITH GERMLINE MUTATIONS. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-151] [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: 11/04/2022]
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Abstract
OBJECTIVE Papillary serous peritoneal carcinoma (PSPC) is histologically indistinguishable from papillary serous ovarian carcinoma (PSOC) with a similar clinical presentation, yet may differ in its carcinogenesis. The purpose of this study was to determine the incidence of allelic loss and the frequency of p53 mutation by p53 overexpression in PSPC compared to PSOC. METHODS An allelotype analysis of 26 patients with PSPC was performed using 39 microsatellite markers from 25 chromosomal arms. Thirty-seven previously studied patients with PSOC served as the comparison. P53 mutations were detected by immunohistochemical protein overexpression. RESULTS There was significantly less LOH in PSPC than PSOC. Both the number of chromosomes with LOH and the proportion of tumors with allelic loss were less frequent. Significant LOH, defined as >/=30% of informative tumors having loss at a chromosome locus, was seen on 4 chromosome arms in PSPC: 12p, 17p, 17q, and 18q, compared to 18 arms in PSOC: 4q, 5q, 6p, 6q, 9p, 9q, 12p, 12q, 13q, 15q, 16q, 17p, 17q, 18q, 19p, 19q, 22q, and Xq (P < 0.001). The median LOH frequency was higher in PSOC than PSPC, 43% versus 33%, respectively (P = 0.013), and more PSOC tumors had LOH than PSPC tumors, 91% versus 65% (P = 0.042). P53 overexpression was detected in 80% of PSPC tumors. CONCLUSIONS LOH occurs less frequently in PSPC compared to PSOC. Chromosomal regions with high frequencies of LOH common to PSPC and PSOC, such as 12p, 17p, 17q, and 18q, may harbor tumor suppressor genes important in the carcinogenesis of both malignancies and likely include p53.
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Affiliation(s)
- I Cass
- Cedars-Sinai Medical Center, Los Angeles, California, 90048, USA.
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Cass I, Li AJ, Runowicz CD, Fields AL, Goldberg GL, Leuchter RS, Lagasse LD, Karlan BY. Pattern of lymph node metastases in clinically unilateral stage I invasive epithelial ovarian carcinomas. Gynecol Oncol 2001; 80:56-61. [PMID: 11136570 DOI: 10.1006/gyno.2000.6027] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE There is controversy regarding the pattern of lymphatic spread in unilateral stage I invasive ovarian carcinomas. The purpose of this study is to describe the incidence and distribution of lymph node (LN) metastases in ovarian carcinomas clinically confined to one ovary. METHODS Ninety-six patients with disease visibly confined to one ovary were identified. Pathology reports were reviewed to identify metastatic LN involvement, number of involved nodes, and their locations. Patients with gross disease in the pelvis or abdomen or those who had grossly positive LNs removed for debulking were excluded from this review. RESULTS Fourteen of ninety-six patients (15%) had microscopically positive LNs on pathologic review. All of these 14 patients had grade 3 tumors. Grade 3 tumors were more commonly seen in LN-positive versus LN-negative patients (P < 0.001). Pelvic nodes were positive in 7 patients (50%), paraaortic nodes in 5 patients (36%), and both in 2 patients (14%). Forty-two patients had LN sampling only on the side ipsilateral to the neoplastic ovary, 4 of whom (10%) had LN metastases. Fifty-four patients had bilateral sampling performed, 10 of whom (19%) had LN metastases. Of these 10 patients, isolated ipsilateral LN metastases were seen in 5 (50%) cases. Isolated contralateral LN metastases were seen in 3 (30%) cases, and bilateral metastases were seen in 2 (20%). CONCLUSIONS In this cohort of patients with clinical stage I ovarian carcinoma with disease limited to one ovary, bilateral LN sampling increased the identification of nodal metastases. Ipsilateral sampling may result in the understaging of patients. Bilateral pelvic and paraaortic LN sampling is recommended to accurately stage ovarian carcinoma.
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Affiliation(s)
- I Cass
- Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Baldwin RL, Nemeth E, Tran H, Shvartsman H, Cass I, Narod S, Karlan BY. BRCA1 promoter region hypermethylation in ovarian carcinoma: a population-based study. Cancer Res 2000; 60:5329-33. [PMID: 11034065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
There is a clear association between germ-line BRCA1 mutations and inherited ovarian cancer; however, the association between BRCA1 mutations and sporadic ovarian cancer remains ambiguous. The frequency of BRCA1 promoter hypermethylation as an epigenetic means of BRCA1 inactivation was determined for a large, population-based cohort of ovarian cancer patients. BRCA1 promoter hypermethylation was determined by methylation-specific restriction digestion of tumor DNA, followed by Southern blot analysis and confirmed by methylation-specific PCR. BRCA1 promoter hypermethylation was observed in 12 of 98 ovarian tumors. BRCA1 methylation status of the primary tumor was conserved in six recurrent tumors after interim chemotherapy. None of the 12 tumors with BRCA1 promoter hypermethylation demonstrated BRCA1 protein expression by immunohistochemistry. BRCA1 methylation was only seen in ovarian cancer patients without a family history suggestive of a breast/ ovarian cancer syndrome. Therefore, the 12 BRCA1 methylated tumors represented 15% (12 of 81) of the sporadic cancers analyzed in this study. Although the clinical significance of BRCA1 promoter hypermethylation is yet to be determined, promoter hypermethylation may be an alternative to mutation in causing the inactivation of the BRCA1 tumor suppressor gene in sporadic ovarian cancer.
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Affiliation(s)
- R L Baldwin
- Division of Gynecologic Oncology, The Burns and Allen Research Institute. Cedars-Sinai Medical Center, Los Angeles, California 90048 USA.
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Abstract
Cancer is a genetic disease, and inherited or acquired genetic defects contribute to the initiation and progression of cancer. Improved molecular techniques have lead to the identification of many of these genetic mutations in gynecologic malignancies. The molecular characterization of cancer has provided a better understanding of tumor formation and the clinical behavior of different tumor types, with important implications for developing screening tests and prognostic markers. Applications of these findings have led to novel targeted gene therapies that correct the critical genetic defects seen in gynecologic cancers. Future research will focus on the clinical translation of these genetic alterations as targets of cancer prevention, screening, and treatment.
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Affiliation(s)
- I Cass
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Abstract
An 86-year-old female presented with a necrotic cervical mass that was biopsy-proven squamous cell carcinoma. She had an elevated CA-125 and a pelvic mass. At surgery, this mass was found to be of adnexal origin and contiguous with the cervix. Histology showed a malignant Brenner tumor with abundant squamous differentiation eroding the cervix and simulating a primary cervical malignancy. We describe this case and review the literature on metastatic tumors to the cervix.
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Affiliation(s)
- S Badve
- Division of Surgical Pathology, Albert Einstein College of Medicine, Bronx, New York, 10467, USA
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Abstract
OBJECTIVE To report a case of fatal pulmonary embolism associated with the use of i.v. estrogen therapy for menometrorrhagia. DESIGN Case report. SETTING University hospital. PATIENT(S) A 52-year-old woman with fibroid uterus treated with GnRH analogues with add-back therapy who presented with excessive vaginal bleeding. INTERVENTION(S) Intravenous conjugated estrogens were administered for a total of six doses. MAIN OUTCOME MEASURE(S) Fatal thromboembolic event. RESULT(S) The day after i.v. conjugated estrogens were administered, the patient had only scant vaginal bleeding, but she experienced the sudden onset of respiratory distress, became comatose, and subsequently had ventricular fibrillation leading to asystole. All resuscitative efforts failed. Postmortem examination revealed bilateral pulmonary artery thromboembolism (saddle embolus). CONCLUSION(S) Intravenous conjugated estrogen therapy may be complicated by fatal thromboembolic events. This potential adverse effect must be considered in the use of such therapy for severe menometrorrhagia, especially when treating a patient at increased risk.
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Affiliation(s)
- T G Zreik
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
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Cass I, Kuo DY, Fields AL, Runowicz CD, Goldberg GL. Profound thrombocytopenia in previously treated patients with recurrent ovarian carcinoma receiving topotecan. Gynecol Oncol 1998; 69:175-8. [PMID: 9600828 DOI: 10.1006/gyno.1998.4966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cass I, Runowicz CD. Nonhormonal alternatives to treating menopausal symptoms. Am J Manag Care 1998; 4:732-8; quiz 739-40. [PMID: 10179926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- I Cass
- Montefiore Medical Center, Bronx, NY, USA
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