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Mammen JR, Java JJ, Halterman J, Berliant MN, Crowley A, Frey SM, Reznik M, Feldman JM, Schoonmaker JD, Arcoleo K. Development and preliminary results of an Electronic Medical Record (EMR)-integrated smartphone telemedicine program to deliver asthma care remotely. J Telemed Telecare 2019; 27:217-230. [PMID: 31438761 DOI: 10.1177/1357633x19870025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Technology-based interventions that can function within real-world practice and improve outcomes without increasing provider burden are needed, yet few successfully cross the research-to-practice divide. This paper describes the process of developing a clinically integrated smartphone-telemedicine program for adults with asthma and results from proof-of-concept testing. METHODS We used a contextually grounded intervention development approach and May's implementation theory to design the intervention, with emphasis on systems capabilities and stakeholder needs. The intervention incorporated symptom monitoring by smartphone, smartphone telemedicine visits and self-management training with a nurse, and clinical decision-support software, which provided automated calculations of asthma severity, control and step-wise therapy. Seven adults (aged 18-40 y) engaged in a 3-month beta-test. Asthma outcomes (control, quality of life, FEV1) and healthcare utilisation patterns were measured at baseline and end-of-study. RESULTS Each participant averaged four telemedicine visits (94% patient satisfaction). All participants had uncontrolled asthma at baseline; end-of-study 5/7 classified as well-controlled. Mean asthma control improved 1.55 points (CI = 0.59-2.51); quality of life improved 1.91 points (CI = 0.50-3.31), FEV1 percent predicted increased 14.86% (CI = -3.09-32.80): effect sizes of d = 1.16, 1.09, and 0.96, respectively. Preventive healthcare utilisation increased significantly (1.86 visits/year vs. 0.28/year prior, CI 0.67-2.47) as did prescriptions for controller medications (9.29 prescriptions/year vs. 1.57 prescriptions/year, CI 4.85-10.58). DISCUSSION Smartphone telemedicine may be an effective means to improve outcomes and deliver asthma care remotely. However, careful attention to systems capabilities and stakeholder acceptability is needed to ensure successful integration with practice.Clinical Trials registration #: NCT03648203.
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Affiliation(s)
- Jennifer R Mammen
- University of Rhode Island, College of Nursing, Kingston, RI, USA.,University of Rochester School of Nursing, Rochester, NY, USA
| | - James J Java
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Jill Halterman
- University of Rochester School of Medicine, Department of Pediatrics, Rochester NY, USA
| | - Marc N Berliant
- University of Rochester School of Medicine, Department of Internal Medicine, Rochester NY, USA
| | - Amber Crowley
- University of Rochester School of Medicine, Department of Internal Medicine, Rochester NY, USA
| | - Sean M Frey
- University of Rochester School of Medicine, Department of Pediatrics, Rochester NY, USA
| | - Marina Reznik
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, Department of Pediatrics, Bronx, NY, USA
| | - Jonathan M Feldman
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, Department of Pediatrics, Bronx, NY, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | | | - Kimberly Arcoleo
- The Center for Innovation in Pediatric Practice, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH, USA
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Fuh KC, Java JJ, Chan JK, Kapp DS, Monk BJ, Burger RA, Young RC, Alberts DS, McGuire WP, Markman M, Bell J, Ozols RF, Armstrong DK, Aghajanian C, Bookman MA, Mannel RS. Differences in presentation and survival of Asians compared to Caucasians with ovarian cancer: An NRG Oncology/GOG Ancillary study of 7914 patients. Gynecol Oncol 2019; 154:420-425. [PMID: 31229298 DOI: 10.1016/j.ygyno.2019.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 01/17/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare patient/tumor characteristics and outcomes of Asians to Caucasian patients with epithelial ovarian cancer. METHODS Ancillary data were pooled and analyzed from ten prospective randomized front-line Gynecologic Oncology Group clinical trials from 1996 to 2011. Demographic, clinicopathologic features, disease-specific and all-cause survival were analyzed. RESULTS Of 7914 patients, 7641 were Caucasian and 273 Asian. When compared to Caucasians, Asians were younger at trial enrollment, had a better performance status, earlier-stage cancers (17.2% vs. 8.1% with stage I; p < 0.001), and were more likely to be of clear cell (15.8% vs. 6.2%, p < 0.001) and mucinous (3.3% vs. 1.9%, p < 0.001) histology. Asians had an improved 5-year disease-specific survival of 54.1% compared to 46.1% for Caucasians, p = 0.001. In multivariate analysis, the Asian race remained a significant prognostic factor for all-cause survival (HR: 0.84; 95% CI: 0.72-0.99; p = 0.04). Other factors predictive of improved survival included younger age, better performance status, optimal cytoreduction, earlier stage, non-clear cell histology, and lower grade tumors. CONCLUSION Asians enrolled into phase III ovarian cancer clinical trials were younger, with better performance status, earlier-stage of disease, and have a greater number of clear cell and mucinous tumors. After adjusting for these prognostic factors, Asians have a better survival compared to Caucasians.
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Affiliation(s)
- Katherine C Fuh
- Department of Gynecologic Oncology, Washington University, St Louis, MO 63110, USA.
| | - James J Java
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - John K Chan
- Department of Gynecologic Oncology, California Pacific Medical Center/Sutter Cancer Research Consortium/Palo Alto Medical Foundation, San Francisco, CA 94118, USA.
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA.
| | - Bradley J Monk
- Department of Gynecologic Oncology, Biltmore Cancer Center, Phoenix, AZ 85016, USA.
| | - Robert A Burger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Robert C Young
- RCY Consulting, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
| | | | - William P McGuire
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA 980037, USA.
| | - Maurie Markman
- Eastern Regional Medical Center, Meadowbrook, PA 19046, USA.
| | - Jeffrey Bell
- Ohio Riverside Methodist Hospital, Columbus, OH 43214, USA
| | | | - Deborah K Armstrong
- Department of Medical Oncology, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21287, USA.
| | | | | | - Robert S Mannel
- Department of Obstetrics and Gynecology, Peggy and Charles Stephenson Cancer Center - University of Oklahoma, Oklahoma City, OK 73104, USA.
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Rose PG, Java JJ, Salani R, Geller MA, Alvarez A, Tewari KS, Bender DP, Mutch DG, Friedlander ML, Van Le L, Method MW, Hamilton CA, Lee RB, Wenham RM, Guntupalli SR, Markman M, Muggia FM, Armstrong DK, Bookman MA, Burger RA, Copeland LJ. Nomogram for Predicting Individual Survival After Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma. Obstet Gynecol 2019; 133:245-254. [PMID: 30633128 PMCID: PMC6551603 DOI: 10.1097/aog.0000000000003086] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To analyze clinical prognostic factors for survival after recurrence of high-grade, advanced-stage ovarian-peritoneal-tubal carcinoma and to develop a nomogram to predict individual survival after recurrence. METHODS We retrospectively analyzed patients treated in multicenter Gynecologic Oncology Group protocols for stage III and IV ovarian-peritoneal-tubal carcinoma who underwent primary debulking surgery, received chemotherapy with paclitaxel and a platinum compound, and subsequently developed recurrence. Prognostic factors affecting survival were identified and used to develop a nomogram, which was both internally and externally validated. RESULTS There were 4,739 patients included in this analysis, of whom, 84% had stage III and 16% had stage IV ovarian carcinoma. At a median follow-up of 88.8 months (95% CI 86.2-92.0 months), the vast majority of patients (89.4%) had died. The median survival after recurrence was 21.4 months (95% CI 20.5-21.9 months). Time to recurrence after initial chemotherapy, clear cell or mucinous histology, performance status, stage IV disease, and age were significant variables used to develop a nomogram for survival after recurrence, which had a concordance index of 0.67. The time to recurrence alone accounted for 85% of the prognostic information. Similar results were found for patients who underwent second look laparotomy and had a complete pathologic response or received intraperitoneal chemotherapy. CONCLUSION For individuals with advanced-stage ovarian carcinoma who recur after standard first-line therapy, estimated survivals after recurrence are closely related to the time to recurrence after chemotherapy and prognostic variables can be used to predict subsequent survival. CLINICAL TRIAL REGISTRATION ClinialTrials.gov, NCT00002568, NCT00837993, NCT00002717, NCT01074398, and NCT00011986.
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Affiliation(s)
- Peter G Rose
- Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH;
| | - James J Java
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY;
| | | | | | | | | | | | - David G Mutch
- Washington University School of Medicine, St. Louis, MO;
| | | | | | - Michael W Method
- Community Health Network and Indiana University School of Medicine, Indianapolis, IN;
| | | | | | | | | | | | | | | | | | - Robert A Burger
- University of Pennsylvania Medical Center, Philadelphia, PA:
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Olawaiye AB, Java JJ, Krivak TC, Friedlander M, Mutch DG, Glaser G, Geller M, O'Malley DM, Wenham RM, Lee RB, Bodurka DC, Herzog TJ, Bookman MA. Corrigendum to "Does adjuvant chemotherapy dose modification have an impact on the outcome of patients diagnosed with advanced stage ovarian cancer? An NRG Oncology/Gynecologic Oncology Group study" [Gynecol. Oncol. 151 (2018) 18-23]. Gynecol Oncol 2018; 152:220. [PMID: 30360899 DOI: 10.1016/j.ygyno.2018.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Alexander B Olawaiye
- Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, United States of America.
| | - James J Java
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States of America
| | - Thomas C Krivak
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Western Pennsylvania Hospital, Pittsburgh, PA, United States of America
| | - Michael Friedlander
- Prince of Wales Clinical School UNSW, Department of Medical Oncology, The Prince of Wales Hospital, Sydney, Australia
| | - David G Mutch
- Dept. of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, MO 63110, United States of America
| | - Gretchen Glaser
- Gynecologic Oncology, Carilion Clinic Gynecological Oncology, Roanoke, VA 24016, United States of America
| | - Melissa Geller
- Dept. of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical Center-Fairview, Minneapolis, MN 55455, United States of America
| | - David M O'Malley
- Dept. of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, United States of America
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States of America
| | - Roger B Lee
- Tacoma General Hospital, Tacoma,WA, United States of America
| | - Diane C Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America
| | - Thomas J Herzog
- Dept. of Obstetrics & Gynecology, University of Cincinnati Cancer Institute, University of Cincinnati, Cincinnati, OH 45267, United States of America
| | - Michael A Bookman
- The Permanente Medical Group, Inc., 2350 Geary Blvd, Room 115, San Francisco, CA 94115, United States of America
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Mammen JR, Java JJ, Rhee H, Butz AM, Halterman JS, Arcoleo K. Mixed-methods content and sentiment analysis of adolescents' voice diaries describing daily experiences with asthma and self-management decision-making. Clin Exp Allergy 2018; 49:299-307. [PMID: 30113733 DOI: 10.1111/cea.13250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/18/2018] [Accepted: 07/31/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Accurate symptom assessment remains challenging in teen populations. Little is known of usual symptom/response patterns, and self-reported paper diaries have traditionally low compliance rates. Therefore, we used concurrent digital voice diaries to capture daily asthma experiences. OBJECTIVE (a) To qualitatively explore usual symptom patterns and self-management responses and (b) to quantitatively explore relationships between symptom severity and sentiment scores (a marker of emotional response to events). METHODS Fourteen minority and nonminority teenagers (age 13-17) with controlled (50%) and uncontrolled asthma used digital recorders to report about their asthma once daily over 14 days. Dairy entries were coded for symptom frequency, severity, type, and self-management responses, while sentiment analysis was used to evaluate the emotional valence of diary entries and to explore whether increased symptom levels correlated with greater negative sentiment. RESULTS Symptom frequency and severity recorded in voice diaries were much higher than teens indicated at baseline and were discordant with clinical assessments of asthma control. Of 175 entries, teens had symptoms 69.1% of days (121/175) and severe symptoms on one-third of these. Atypical symptoms (coughing, throat clearing) were reported twice as often as traditional symptoms (wheezing, chest tightness) and often not recognized as asthma, but rather attributed to being "sick" (25.6% of symptom days). Teens frequently minimized symptoms, used rescue and controller medication inconsistently, and resorted to alternative strategies to manage symptoms. Sentiment was not significantly correlated with assessed control (β = 0.14, P = 0.28), but for teens reporting severe symptoms, sentiment scores decreased by 0.31 relative to teens without symptoms (P = 0.006). CONCLUSIONS AND CLINICAL RELEVANCE Teens may minimize symptoms and have greater symptom frequency and severity than is recognized by themselves or providers. Screening for specific symptoms including coughing, throat clearing, and respiratory illness may be needed to identify those experiencing burden from asthma.
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Affiliation(s)
- Jennifer R Mammen
- University of Rhode Island College of Nursing, Kingston, Rhode Island.,University of Rochester School of Nursing, Rochester, New York
| | - James J Java
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
| | - Hyekyun Rhee
- University of Rochester School of Nursing, Rochester, New York
| | - Arlene M Butz
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
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Olawaiye AB, Java JJ, Krivak TC, Friedlander M, Mutch DG, Glaser G, Geller M, O'Malley DM, Wenham RM, Lee RB, Bodurka DC, Herzog TJ, Bookman MA. Does adjuvant chemotherapy dose modification have an impact on the outcome of patients diagnosed with advanced stage ovarian cancer? An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2018; 151:18-23. [PMID: 30135020 DOI: 10.1016/j.ygyno.2018.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/20/2018] [Revised: 07/24/2018] [Accepted: 07/29/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the relationship between chemotherapy dose modification (dose adjustment or treatment delay), overall survival (OS) and progression-free survival (PFS) for women with advanced-stage epithelial ovarian carcinoma (EOC) and primary peritoneal carcinoma (PPC) who receive carboplatin and paclitaxel. METHODS Women with stages III and IV EOC and PPC treated on the Gynecologic Oncology Group phase III trial, protocol 182, who completed eight cycles of carboplatin with paclitaxel were evaluated in this study. The patients were grouped per dose modification and use of granulocyte colony stimulating factor (G-CSF). The primary end point was OS; Hazard ratios (HR) for PFS and OS were calculated for patients who completed eight cycles of chemotherapy. Patients without dose modification were the referent group. All statistical analyses were performed using the R programming language and environment. RESULTS A total of 738 patients were included in this study; 229 (31%) required dose modification, 509 did not. The two groups were well-balanced for demographic and prognostic factors. The adjusted hazard ratios (HR) for disease progression and death among dose-modified patients were: 1.43 (95% CI, 1.19-1.72, P < 0.001) and 1.26 (95% CI, 1.04-1.54, P = 0.021), respectively. Use of G-CSF was more frequent in dose-modified patients with an odds ratio (OR) of 3.63 (95% CI: 2.51-5.26, P < 0.001) compared to dose-unmodified patients. CONCLUSION Dose-modified patients were at a higher risk of disease progression and death. The need for chemotherapy dose modification may identify patients at greater risk for adverse outcomes in advanced stage EOC and PPC.
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Affiliation(s)
- Alexander B Olawaiye
- Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, United States of America.
| | - James J Java
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States of America
| | - Thomas C Krivak
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Western Pennsylvania Hospital, Pittsburgh, PA, United States of America.
| | - Michael Friedlander
- Prince of Wales Clinical School UNSW, Department of Medical Oncology, The Prince of Wales Hospital, Sydney, Australia.
| | - David G Mutch
- Dept. of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, MO 63110, United States of America.
| | - Gretchen Glaser
- Gynecologic Oncology, Carilion Clinic Gynecological Oncology, Roanoke, VA 24016, United States of America.
| | - Melissa Geller
- Dept. of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical Center-Fairview, Minneapolis, MN 55455, United States of America.
| | - David M O'Malley
- Dept. of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, United States of America.
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States of America.
| | - Roger B Lee
- Tacoma General Hospital, Tacoma, WA, United States of America
| | - Diane C Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America.
| | - Thomas J Herzog
- Dept. of Obstetrics & Gynecology, University of Cincinnati Cancer Institute, University of Cincinnati, Cincinnati, OH 45267, United States of America.
| | - Michael A Bookman
- The Permanente Medical Group, Inc. 2350 Geary Blvd, Room 115 San Francisco, CA 94115, United States of America.
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Seamon LG, Java JJ, Monk BJ, Penson RT, Brown J, Mannel RS, Oaknin A, Leitao MM, Eisenhauer EL, Long HJ, Liao SY, Tewari KS. Impact of tumour histology on survival in advanced cervical carcinoma: an NRG Oncology/Gynaecologic Oncology Group Study. Br J Cancer 2017; 118:162-170. [PMID: 29182608 PMCID: PMC5785748 DOI: 10.1038/bjc.2017.400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 06/25/2017] [Revised: 10/01/2017] [Accepted: 10/12/2017] [Indexed: 12/11/2022] Open
Abstract
Background: Based primarily on studies concerning early-stage tumours (treated surgically), and locally advanced disease (treated with chemoradiation), the prognosis for women with adenocarcinoma (AC) or adenosquamous (AS) carcinoma has been reported to be poorer than those with squamous cell carcinoma (SCCA) of the cervix. It is unclear whether differences in prognosis also persist in the setting of recurrent or metastatic disease treated using chemotherapy doublets with or without bevacizumab. Methods: Cases were pooled from three Gynaecologic Oncology Group randomised phase III trials of chemotherapy doublets. Pearson’s test was used to evaluate response rate (RR) of AC/AS vs SCCA, Kaplan–Meier method to estimate progression-free survival (PFS) and overall survival (OS), and Cox proportional hazards model to estimate the impact of histology on PFS and OS. Results: Of 781 evaluable patients, 77% (N=599) had SCCA and 23% (N=182) AC/AS. There were no significant differences in RRs between histologic subgroups. The adjusted hazard ratio (HR) for death for SCCA vs AC/AS was 1.13 (95% CI 0.93, 1.38 P=0.23). When comparing SC/AS (N=661, 85%) to AC alone (N=120, 15%), the adjusted HR for death was 1.23 (95% CI 0.97, 1.57, P=0.09). Conclusions: AC/AS and SCCA have similar survival in recurrent or metastatic cervical carcinoma when treated with chemotherapy doublets.
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Affiliation(s)
- Leigh G Seamon
- Divisions of Gynecologic Oncology, Spectrum-Health Hospital Group and Michigan State University College of Human Medicine, Lemmen Holton Cancer Pavilion, 145 Michigan Street, NE; Suite 6300, Grand Rapids, MI 49503, USA
| | - James J Java
- NRG Oncology/Gynecologic Oncology Group Statistics and Data Center, Buffalo, NY 14263, USA
| | - Bradley J Monk
- University of Arizona Cancer Center, Phoenix Creighton University School of Medicine, Phoenix, AZ 85013, USA
| | | | | | - Robert S Mannel
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Anna Oaknin
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona 080350, Spain
| | - Mario M Leitao
- Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | | | | | - Shu Y Liao
- Department of Pathology (SL) and Department of Gynecologic Oncology (KT), Irvine Medical Center, University of California, Orange, CA 92868, USA
| | - Krishnansu S Tewari
- Department of Pathology (SL) and Department of Gynecologic Oncology (KT), Irvine Medical Center, University of California, Orange, CA 92868, USA
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Mammen JR, Elson MJ, Java JJ, Beck CA, Beran DB, Biglan KM, Boyd CM, Schmidt PN, Simone R, Willis AW, Dorsey ER. Patient and Physician Perceptions of Virtual Visits for Parkinson's Disease: A Qualitative Study. Telemed J E Health 2017; 24:255-267. [PMID: 28787250 DOI: 10.1089/tmj.2017.0119] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Introduction: Delivering care through telemedicine directly into the patient's home is increasingly feasible, valuable, and beneficial. However, qualitative data on how patients' and physicians' perceive these virtual house calls are lacking. We conducted a qualitative analysis of perceptions of these visits for Parkinson's disease to (1) determine how patients and physicians perceive virtual visits and (2) identify components contributing to positive and negative perceptions. MATERIALS AND METHODS Qualitative survey data were collected from patients and physicians during a 12-month randomized controlled trial of virtual house calls for Parkinson's disease. Data from 149 cases were analyzed using case-based qualitative content analysis and quantitative sentiment analysis techniques. RESULTS Positive and negative perceptions of virtual visits were driven by three themes: (1) personal benefits of the virtual visit, (2) perceived quality of care, and (3) perceived quality of interpersonal engagement. In general, participants who identified greater personal benefit, high quality of care, and good interpersonal engagement perceived visits positively. Technical problems with the software were commonly mentioned. The sentiment analysis for patients was strongly favorable (+2.5) and moderately favorable for physicians (+0.8). Physician scores were lowest (-0.3) for the ability to perform a detailed motor examination remotely. DISCUSSION Patients and providers generally view telemedicine favorably, but individual experiences are dependent on technical issues. CONCLUSIONS Satisfaction with and effectiveness of remote care will likely increase as common technical problems are resolved.
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Affiliation(s)
| | - Molly J Elson
- 2 The Center for Health and Technology, University of Rochester Medical Center , Rochester, New York
| | - James J Java
- 3 Department of Biostatistics and Computational Biology, University of Rochester , Rochester, New York
| | - Christopher A Beck
- 3 Department of Biostatistics and Computational Biology, University of Rochester , Rochester, New York
| | | | - Kevin M Biglan
- 5 Department of Neurology, University of Rochester Medical Center , Rochester, New York
| | - Cynthia M Boyd
- 6 Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | | | - Allison W Willis
- 8 Departments of Neurology and of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania
| | - E Ray Dorsey
- 2 The Center for Health and Technology, University of Rochester Medical Center , Rochester, New York.,5 Department of Neurology, University of Rochester Medical Center , Rochester, New York
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Rose PG, Java JJ, Morgan MA, Alvarez-Secord A, Kesterson JP, Stehman FB, Warshal DP, Creasman WT, Hanjani P, Morris RT, Copeland LJ. Disease extent at secondary cytoreductive surgery is predictive of progression-free and overall survival in advanced stage ovarian cancer: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2016; 143:511-515. [PMID: 27692669 PMCID: PMC5720165 DOI: 10.1016/j.ygyno.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/01/2016] [Accepted: 09/03/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE GOG 152 was a randomized trial of secondary cytoreductive surgery (SCS) in patients with suboptimal residual disease (residual tumor nodule >1cm in greatest diameter) following primary cytoreductive surgery for advanced stage ovarian cancer. The current analysis was undertaken to evaluate the impact of disease findings at SCS on progression-free survival (PFS) and overall survival (OS). METHODS Among the 550 patients enrolled on GOG-152, two-hundred-sixteen patients were randomly assigned following 3cycles of cisplatin and paclitaxel to receive SCS. In 15 patients (7%) surgery was declined or contraindicated. In the remaining 201 patients the operative and pathology reports were utilized to classify their disease status at the beginning of SCS as; no gross disease/microscopically negative N=40 (19.9%), no gross disease/microscopically positive N=8 (4.0%), and gross disease N=153 (76.1%). RESULTS The median PFS for patients with no gross disease/microscopically negative was 16.1months, no gross disease/microscopically positive was 13.5months and for gross disease was 11.7months, P=0.002. The median OS for patients with no gross disease/microscopically negative was 51.5months, no gross disease/microscopically positive was 42.6months and for gross disease was 34.9months, P=0.018. CONCLUSION Although as previously reported SCS did not change PFS or OS, for those who underwent the procedure, their operative and pathologic findings were predictive of PFS and OS. Surgical/pathological residual disease is a biomarker of response to chemotherapy and predictive of PFS and OS.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/surgery
- Chemotherapy, Adjuvant
- Cisplatin/administration & dosage
- Cytoreduction Surgical Procedures
- Disease-Free Survival
- Female
- Humans
- Kaplan-Meier Estimate
- Middle Aged
- Neoplasm Staging
- Neoplasm, Residual
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/surgery
- Paclitaxel/administration & dosage
- Prognosis
- Reoperation
- Survival Rate
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Affiliation(s)
- Peter G Rose
- Dept. of OB/GYN, Cleveland Clinic, Cleveland, OH 44109, United States.
| | - James J Java
- NRG Oncology Statistics & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Mark A Morgan
- Dept. of OB/GYN, University of Pennsylvania Hospital System, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Angeles Alvarez-Secord
- Division of Gynecologic Oncology, Dept. of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC 27710, United States.
| | - Joshua P Kesterson
- Dept. of GYN/Oncology, Hershey Medical Center, Hershey, PA 17033, United States.
| | - Frederick B Stehman
- Section of Gyn Onc, Simon Cancer Center, Indianapolis, IN 46202, United States.
| | - David P Warshal
- Division of Gynecologic Oncology, Cooper Health, Camden, NJ 08103, United States.
| | - William T Creasman
- Dept. of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC 29425, United States.
| | - Parviz Hanjani
- Hanjani Institute for Gynecologic Oncology, Abington Memorial Hospital, Abington, PA 19001, United States.
| | - Robert T Morris
- Dept. of Oncology, Wayne State University Medical Center, Detroit, MI 48201, United States.
| | - Larry J Copeland
- Dept. of Gynecologic Oncology, Ohio State University Medical Center, Columbus, OH 43210, United States.
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10
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Chan JK, Java JJ, Fuh K, Monk BJ, Kapp DS, Herzog T, Bell J, Young R. The association between timing of initiation of adjuvant therapy and the survival of early stage ovarian cancer patients - An analysis of NRG Oncology/Gynecologic Oncology Group trials. Gynecol Oncol 2016; 143:490-495. [PMID: 27771168 DOI: 10.1016/j.ygyno.2016.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 05/12/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the association between timing of adjuvant therapy initiation and survival of early stage ovarian cancer patients. METHODS Data were obtained from women who underwent primary surgical staging followed by adjuvant therapy from two Gynecologic Oncology Group trials (protocols # 95 and 157). Kaplan-Meier estimates and Cox proportional hazards model adjusted for covariates were used for analyses. RESULTS Of 497 stage I-II epithelial ovarian cancer patients, the median time between surgery and initiation of adjuvant therapy was 23days (25th-75th%: 12-33days). The time interval from surgery to initiation of adjuvant therapy was categorized into three groups: <2weeks, 2-4weeks, and >4weeks. The corresponding 5-year recurrence-free survival rates were 72.8%, 73.9%, and 79.5% (p=0.62). The 5-year overall survival rates were 79.4%, 81.9%, and 82.8%, respectively (p=0.51; p=0.33 - global test). As compared to <2weeks, the hazard ratio for recurrence-free survival was 0.90 (95%CI=0.59-1.37) for 2-4weeks and 0.72 (95%CI=0.46-1.13) for >4weeks. Age, stage, grade, and cytology were important prognostic factors. CONCLUSIONS Timing of adjuvant therapy initiation was not associated with survival in early stage epithelial ovarian cancer patients.
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Affiliation(s)
- John K Chan
- Division of Gynecologic Oncology, California Pacific-Palo Alto Medical Foundation Sutter Research Institute, 3838 California Street #410, San Francisco, CA 94115, United States.
| | - James J Java
- NRG Oncology/Gynecologic Oncology Group Statistics & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Katherine Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, School of Medicine, St. Louis, MO 63108, United States.
| | - Bradley J Monk
- Division of Gynecologic Oncology, University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, suite 660, Phoenix, AZ 85013, United States.
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, United States.
| | - Thomas Herzog
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Cincinnati Cancer Institute, Health Professions Building Suite, 3255 Eden Avenue, Cincinnati, OH 45267-0662, United States.
| | - Jeffrey Bell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State University, Riverside Methodist Hospital, Columbus, OH 43210, United States.
| | - Robert Young
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, United States.
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11
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Garcia-Soto AE, Java JJ, Nieves Neira W, Pearson JM, Cohn DE, Lele SB, Tewari KS, Walker JL, Alvarez Secord A, Armstrong DK, Copeland LJ. Does time interval between surgery and intraperitoneal chemotherapy administration in advanced ovarian cancer carry a prognostic impact? An NRG Oncology/Gynecologic Oncology Group study ancillary study. Gynecol Oncol 2016; 143:484-489. [PMID: 27726923 DOI: 10.1016/j.ygyno.2016.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/02/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the relationship of the time from surgery to intraperitoneal (IP) chemotherapy (TSIC) initiation with survival of patients with stage III epithelial ovarian cancer (EOC) patients using ancillary data from cooperative group clinical trials. METHODS Data from 420 patients with stage III EOC treated with IP chemotherapy under GOG-0114 and 172 were reviewed. The Cox proportional hazards model was used to evaluate independent prognostic factors and estimate their covariate-adjusted effects on PFS and OS. RESULTS The median TSIC was 62.5days (interquartile range 28-83). The median TSIC was longer for patients in GOG-0114 vs those in GOG-172 (83 vs 26days, p<0.001). TSIC was significantly associated (p=0.049) with PFS: each 10% increase in TSIC (days) decreases the risk of progression by 3%. TSIC was not significantly associated with OS in this model. In a linear regression model, gross residual disease was significantly associated with shorter TSIC (R2 -0.141, 95%CI -0.217, -0.064, p<0.001). When only data from GOG-172 were considered, no statistical significant association was found between TSIC and PFS or OS. CONCLUSIONS In this ancillary data study, TSIC was not associated with improved OS in patients with stage III epithelial ovarian cancer. TSIC was significantly associated with PFS for the entire cohort, suggesting increase in PFS with longer TSIC. However, this was not found when only data from GOG 172 or GOG 114 were analyzed separately. Hence, the relationship between IP chemotherapy initiation and time from surgery needs to be studied further.
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Affiliation(s)
- Arlene E Garcia-Soto
- Division of Gynecology Oncology, Department of OB-GYN, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - James J Java
- NRG Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, United States.
| | - Wilberto Nieves Neira
- Division of Gynecology Oncology, Department of OB-GYN, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - J Matthew Pearson
- Division of Gynecology Oncology, Department of OB-GYN, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - David E Cohn
- The Ohio State University, Columbus, OH, United States.
| | - Shashikant B Lele
- Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, United States.
| | - Krishnansu S Tewari
- Obstetrics-Gynecology, University of California, Irvine, Orange, CA, United States.
| | - Joan L Walker
- Gynecologic Oncology, Peggy and Charles Stephenson Oklahoma Cancer Center, Oklahoma City, OK, United States.
| | | | - Deborah K Armstrong
- Gynecology and Obstetrics, Johns Hopkins Kimmel Cancer Center, Baltimore, MD, United States.
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12
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Moore KN, Java JJ, Slaughter KN, Rose PG, Lanciano R, DiSilvestro PA, Thigpen JT, Lee YC, Tewari KS, Chino J, Seward SM, Miller DS, Salani R, Moore DH, Stehman FB. Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis. Gynecol Oncol 2016; 143:294-301. [PMID: 27542967 DOI: 10.1016/j.ygyno.2016.08.317] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 06/03/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the effect of age on completion of and toxicities following treatment of local regionally advanced cervical cancer (LACC) on Gynecologic Oncology Group (GOG) Phase I-III trials. METHODS An ancillary data analysis of GOG protocols 113, 120, 165, 219 data was performed. Wilcoxon, Pearson, and Kruskal-Wallis tests were used for univariate and multivariate analysis. Log rank tests were used to compare survival lengths. RESULTS One-thousand-three-hundred-nineteen women were included; 60.7% were Caucasian, 15% were age 60-70years and an additional 5% were >70; 87% had squamous histology, 55% had stage IIB disease and 34% had IIIB disease. Performance status declined with age (p=0.006). Histology and tumor stage did not significantly differ. Number of cycles of chemotherapy received, radiation treatment time, nor dose modifications varied with age. Notably, radiation protocol deviations and failure to complete brachytherapy (BT) did increase with age (p=0.022 and p<0.001 respectively). Only all grade lymphatic (p=0.006) and grade≥3 cardiovascular toxicities (p=0.019) were found to vary with age. A 2% increase in the risk of death for every year increase >50 for all-cause mortality (HR 1.02; 95% CI, 1.01-1.04) was found, but no association between age and disease specific mortality was found. CONCLUSION This represents a large analysis of patients treated for LACC with chemo/radiation, approximately 20% of whom were >60years of age. Older patients, had higher rates of incomplete brachytherapy which is not explained by collected toxicity data. Age did not adversely impact completion of chemotherapy and radiation or toxicities.
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Affiliation(s)
- Kathleen N Moore
- Division of Gynecologic Oncology, Stephenson Oklahoma Cancer Center at the University of Oklahoma, 800 NE 10th Street, Oklahoma City, OK 73121, United States.
| | - James J Java
- NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Katrina N Slaughter
- Division of Gynecologic Oncology, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA 70121, United States.
| | - Peter G Rose
- Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH 44109, United States.
| | - Rachelle Lanciano
- Dept. of Radiation Oncology, Crozer Keystone Regional Cancer Center at Broomall, Crozer Keystone Health System, Broomall, PA 19008, United States.
| | - Paul A DiSilvestro
- Division of Gynecologic Oncology, Women & Infants Hospital, Providence, RI 02905, United States.
| | - J Tate Thigpen
- Division of Medical Oncology, University of Mississippi Medical Center, Jackson, MS 39216, United States.
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, State University of New York Downstate, Brooklyn, NY 11203, United States.
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California at Irvine, Orange, CA 92868, United States.
| | - Junzo Chino
- Radiation Oncology, Duke University Medical Center, Durham, NC 27710, United States.
| | - Shelly M Seward
- Division of Gynecologic Oncology, Wayne State University/Karmanos Cancer Center, Detroit, MI 48201, United States.
| | - David S Miller
- Division of Gynecologic Oncology, UT Southwestern Medical Center at Dallas, Dallas, TX 75390, United States.
| | - Ritu Salani
- Division of Gynecologic Oncology, Ohio State University Medical Center, Columbus, OH 43210, United States.
| | - David H Moore
- Division of Obstetrics & Gynecology, Franciscan St. Francis Health, Indianapolis, IN 46237, United States.
| | - Frederick B Stehman
- Division of Gynecologic Oncology, Indiana University School of Medicine, Mel and Bren Simon Cancer Center, Indianapolis, IN 46202, United States.
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13
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Tewari KS, Java JJ, Eskander RN, Monk BJ, Burger RA. Early initiation of chemotherapy following complete resection of advanced ovarian cancer associated with improved survival: NRG Oncology/Gynecologic Oncology Group study. Ann Oncol 2015; 27:114-21. [PMID: 26487588 DOI: 10.1093/annonc/mdv500] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/09/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To determine whether time from surgery to initiation of chemotherapy impacts survival in advanced ovarian carcinoma. PATIENTS AND METHODS This is a post-trial ad hoc analysis of Gynecologic Oncology Group protocol 218, a phase III randomized, double-blind, placebo-controlled trial designed to study the antiangiogenesis agent, bevacizumab, in primary and maintenance therapy for patients with newly diagnosed advanced ovarian carcinoma. Maximum attempt at debulking was an eligibility criterion. Stage III patients, not stage IV, were required to have gross macroscopic or palpable residual disease following surgery. The survival impact of time from surgery to initiation of chemotherapy was studied using Cox regression models and stratified by treatment arm, residual disease and other clinical and pathologic factors. RESULTS One thousand seven hundred eighteen assessable patients were randomized (stage III (n = 1237); stage IV (n = 477), including those with complete resection (stage IV only, n = 81), low-volume residual (≤1 cm, n = 701), and suboptimal (>1 cm, n = 932). On multivariate analysis, time to chemotherapy initiation was predictive of overall survival (P < 0.001), with the complete resection group (i.e. stage IV) encountering an increased risk of death when time to initiation of chemotherapy exceeded 25 days (95% confidence interval 16.6-49.9 days). CONCLUSION Survival for women with advanced ovarian cancer may be adversely affected when initiation of chemotherapy occurs >25 days following surgery. Our analysis applies to stage IV only as women with stage III who underwent complete resection were not eligible for this trial. These results, however, are consistent with Gompertzian first-order kinetics where patients with microscopic residual are most vulnerable. CLINICAL TRIALS IDENTIFIER NCT00262847.
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Affiliation(s)
- K S Tewari
- University of California, Irvine Medical Center, Orange, California
| | - J J Java
- NRG Oncology/Gynecologic Oncology Group Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo
| | - R N Eskander
- University of California, Irvine Medical Center, Orange, California
| | - B J Monk
- Creighton University School of Medicine, St Joseph's Hospital and Medical Center, Phoenix
| | - R A Burger
- Obstetrics and Gynecology, University of Pennsylvania, Pennsylvania, USA
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14
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Duska LR, Java JJ, Cohn DE, Burger RA. Risk factors for readmission in patients with ovarian, fallopian tube, and primary peritoneal carcinoma who are receiving front-line chemotherapy on a clinical trial (GOG 218): an NRG oncology/gynecologic oncology group study (ADS-1236). Gynecol Oncol 2015; 139:221-7. [PMID: 26335594 DOI: 10.1016/j.ygyno.2015.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Readmission within 30days is a measure of care quality. Ovarian cancer patients are at high risk for readmission, but specific risk factors are not defined. This study was designed to determine risk factors in patients with ovarian cancer receiving upfront surgery and chemotherapy. METHODS The study population was enrolled to GOG 0218. Factors predictive of admission within 30days of a previous admission or 40days of cytoreductive surgery were investigated. Categorical variables were compared by Pearson chi-square test, continuous variables by Wilcoxon-Mann-Whitney test. A logistic regression model was used to evaluate independent prognostic factors and to estimate covariate-adjusted odds. All tests were two-tailed, α=0.05. RESULTS Of 1873 patients, 197 (10.5%) were readmitted, with 59 experiencing >1 readmission. One-hundred-forty-four (73%) readmissions were post-operative (readmission rate 7.7%). Significant risk factors include: disease stage (stage 3 vs 4, p=0.008), suboptimal cytoreduction (36% vs 64%, p=0.001), ascites, (p=0.018), BMI (25.4 vs 27.6, p<0.001), poor PS (p<0.001), and higher baseline CA 125 (p=0.017). Patients readmitted within 40days of surgery had a significantly shorter interval from surgery to chemotherapy initiation (22 versus 32days, p<0.0001). Patients treated with bevacizumab had higher readmission rates in the case of patients with >1 readmission. On multivariate analysis, the odds of re-hospitalization increased with doubling of BMI (OR=1.81, 95% CI: 1.07-3.07) and PS of 2 (OR=2.05, 95% CI 1.21-3.48). CONCLUSION Significant risk factors for readmission in ovarian cancer patients undergoing primary surgery and chemotherapy include stage, residual disease, ascites, high BMI and poor PS. Readmissions are most likely after the initial surgical procedure, a discrete period to target with a prospective intervention.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Ascites/etiology
- Bevacizumab/administration & dosage
- Body Mass Index
- CA-125 Antigen/blood
- Carboplatin/administration & dosage
- Carcinoma/blood
- Carcinoma/complications
- Carcinoma/drug therapy
- Carcinoma/pathology
- Chemotherapy, Adjuvant
- Cytoreduction Surgical Procedures
- Double-Blind Method
- Fallopian Tube Neoplasms/blood
- Fallopian Tube Neoplasms/complications
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/pathology
- Female
- Humans
- Middle Aged
- Multivariate Analysis
- Neoplasm Staging
- Neoplasm, Residual
- Neoplasms, Cystic, Mucinous, and Serous/blood
- Neoplasms, Cystic, Mucinous, and Serous/complications
- Neoplasms, Cystic, Mucinous, and Serous/drug therapy
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Obesity/complications
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/complications
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Paclitaxel/administration & dosage
- Patient Readmission/statistics & numerical data
- Peritoneal Neoplasms/blood
- Peritoneal Neoplasms/complications
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/pathology
- Risk Factors
- Time Factors
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Affiliation(s)
- Linda R Duska
- University of Virginia Health Systems, Division of Gynecology Oncology, P.O. Box 800712, Charlottesville, VA 22908, United States.
| | - James J Java
- NRG Oncology/Gynecologic Oncology Group, Statistics & Data Center, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, United States.
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, 320 West 10th Avenue, M210 Starling Loving Hall, Columbus OH 43210, United States.
| | - Robert A Burger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, SCTR 8-104 Philadelphia PA, United States.
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15
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Ferriss JS, Java JJ, Bookman MA, Fleming GF, Monk BJ, Walker JL, Homesley HD, Fowler J, Greer BE, Boente MP, Burger RA. Ascites predicts treatment benefit of bevacizumab in front-line therapy of advanced epithelial ovarian, fallopian tube and peritoneal cancers: an NRG Oncology/GOG study. Gynecol Oncol 2015. [PMID: 26216729 DOI: 10.1016/j.ygyno.2015.07.103] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Predictive factors for efficacy of bevacizumab in advanced ovarian cancer have remained elusive. We investigated ascites both as a prognostic factor and as a predictor of efficacy for bevacizumab. METHODS Using data from GOG 0218, patients receiving cytotoxic therapy plus concurrent and maintenance bevacizumab were compared to those receiving cytotoxic therapy plus placebo. The presence of ascites was determined prospectively. Chi-square and Wilcoxon-Mann-Whitney tests compared baseline variables between subgroups. Survival was estimated by Kaplan-Meier method, and Cox proportional hazard models were used to evaluate independent prognostic factors and estimate their covariate-adjusted effects on survival. RESULTS Treatment arms were balanced with respect to ascites and other prognostic factors. Overall, 886 (80%) women had ascites, 221 (20%) did not. Those with ascites were more likely to have: poorer performance status (p<0.001); serous histology (p=0.012); higher baseline CA125 (p<0.001); and suboptimal cytoreduction (p=0.004). In multivariate survival analysis, ascites was prognostic of poor OS (Adjusted HR 1.22, 95% CI 1.00-1.48, p=0.045), but not PFS. In predictive analysis, patients without ascites treated with bevacizumab had no significant improvement in either PFS (AHR 0.81, 95% CI 0.59-1.10, p=0.18) or OS (AHR 0.94, 95% CI 0.65-1.36, p=0.76). Patients with ascites treated with bevacizumab had significantly improved PFS (AHR 0.71, 95% CI 0.62-0.81, p<0.001) and OS (AHR 0.82, 95% CI 0.70-0.96, p=0.014). CONCLUSIONS Ascites in women with advanced ovarian cancer is prognostic of poor overall survival. Ascites may predict the population of women more likely to derive long-term benefit from bevacizumab.
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Affiliation(s)
- James S Ferriss
- Temple University School of Medicine & Fox Chase Cancer Center, Philadelphia, PA, United States
| | - James J Java
- Gynecologic Oncology Group Statistical & Data Center, Buffalo, NY, United States
| | | | - Gini F Fleming
- University of Chicago Medical Center, Chicago, IL, United States
| | - Bradley J Monk
- St Joseph's Hospital, Creighton School of Medicine, Phoenix, AZ, United States
| | - Joan L Walker
- University of Oklahoma, Oklahoma City, OK, United States
| | | | | | | | | | - Robert A Burger
- University of Pennsylvania, Philadelphia, PA, United States.
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16
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Tewari D, Java JJ, Salani R, Armstrong DK, Markman M, Herzog T, Monk BJ, Chan JK. Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: a gynecologic oncology group study. J Clin Oncol 2015; 33:1460-6. [PMID: 25800756 DOI: 10.1200/jco.2014.55.9898] [Citation(s) in RCA: 207] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To determine long-term survival and associated prognostic factors after intraperitoneal (IP) chemotherapy in patients with advanced ovarian cancer. PATIENTS AND METHODS Data from Gynecologic Oncology Group protocols 114 and 172 were retrospectively analyzed. Cox proportional hazards regression models were used for statistical analyses. RESULTS In 876 patients, median follow-up was 10.7 years. Median survival with IP therapy was 61.8 months (95% CI, 55.5 to 69.5), compared with 51.4 months (95% CI, 46.0 to 58.2) for intravenous therapy. IP therapy was associated with a 23% decreased risk of death (adjusted hazard ratio [AHR], 0.77; 95% CI, 0.65 to 0.90; P = .002). IP therapy improved survival of those with gross residual (≤ 1 cm) disease (AHR, 0.75; 95% CI, 0.62 to 0.92; P = .006). Risk of death decreased by 12% for each cycle of IP chemotherapy completed (AHR, 0.88; 95% CI, 0.83 to 0.94; P < .001). Factors associated with poorer survival included: clear/mucinous versus serous histology (AHR, 2.79; 95% CI, 1.83 to 4.24; P < .001), gross residual versus no visible disease (AHR, 1.89; 95% CI, 1.48 to 2.43; P < .001), and fewer versus more cycles of IP chemotherapy (AHR, 0.88; 95% CI, 0.83 to 0.94; P < .001). Younger patients were more likely to complete the IP regimen, with a 5% decrease in probability of completion with each year of age (odds ratio, 0.95; 95% CI, 0.93 to 0.96; P < .001). CONCLUSION The advantage of IP over intravenous chemotherapy extends beyond 10 years. IP therapy enhanced survival of those with gross residual disease. Survival improved with increasing number of IP cycles.
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Affiliation(s)
- Devansu Tewari
- Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ
| | - James J Java
- Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ
| | - Ritu Salani
- Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ
| | - Deborah K Armstrong
- Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ
| | - Maurie Markman
- Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ
| | - Thomas Herzog
- Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ
| | - Bradley J Monk
- Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ
| | - John K Chan
- Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ.
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17
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Rose PG, Java JJ, Whitney CW, Stehman FB, Lanciano R, Thomas GM. Locally advanced adenocarcinoma and adenosquamous carcinomas of the cervix compared to squamous cell carcinomas of the cervix in gynecologic oncology group trials of cisplatin-based chemoradiation. Gynecol Oncol 2014; 135:208-12. [PMID: 25152438 DOI: 10.1016/j.ygyno.2014.08.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [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: 04/17/2014] [Revised: 08/14/2014] [Accepted: 08/15/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Conflicting results have been reported for adeno- and adenosquamous carcinomas of the cervix with respect to their response to therapy and prognosis. The current study sought to evaluate impact of adeno- and adenosquamous histology in the randomized trials of primary cisplatin-based chemoradiation for locally advanced cervical cancer. METHODS Patients with adeno- and adenosquamous cervical carcinomas were retrospectively studied and compared to squamous cell carcinomas in GOG trials of chemoradiation. RESULTS Among 1671 enrolled in clinical trials of chemoradiation, 182 adeno- and adenosquamous carcinomas were identified (10.9%). A higher percentage of adeno- and adenosquamous carcinomas were stage IB2 (27.5% versus 20.0%) and fewer had stage IIIB (21.4% versus 28.6%). The mean tumor size was larger for squamous than adeno- and adenosquamous. Adeno- and adenosquamous carcinomas were more often poorly differentiated (46.2% versus 26.8%). When treated with radiation therapy alone, the 70 patients with adeno- and adenosquamous carcinoma of the cervix showed a statistically poorer overall survival (p=0.0499) compared to the 647 patients with squamous cell carcinoma of the cervix. However, when treated with radiation therapy with concurrent cisplatin-based chemotherapy, the 112 patients with adeno- and adenosquamous carcinomas had a similar overall survival (p=0.459) compared the 842 patients with squamous cell carcinoma. Adverse effects to treatment were similar across histologies. CONCLUSION Adeno- and adenosquamous carcinomas of the cervix are associated with worse overall survival when treated with radiation alone but with similar progression-free and overall survival compared to squamous cell carcinomas of the cervix when treated with cisplatin based chemoradiation.
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Affiliation(s)
- Peter G Rose
- Gynecologic Oncology, Department of Obstetrics & Gynecology, Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH 44195, United States.
| | - James J Java
- Gynecologic Oncology Group Statistical & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States
| | - Charles W Whitney
- Christiana Gynecologic Oncology, LLC, Apex Medical Center, Newark DE 19713, United States
| | - Frederick B Stehman
- Gynecologic Oncology, Indiana University School of Medicine, Mel and Bren Simon Cancer Center, Indianapolis, IN 46202, United States
| | - Rachelle Lanciano
- Radiation Oncology, Delaware County Regional Cancer Center, Drexel Hill, PA 19026, United States
| | - Gillian M Thomas
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3 M5 Canada
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18
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Tewari KS, Java JJ, Gatcliffe TA, Bookman MA, Monk BJ. Chemotherapy-induced neutropenia as a biomarker of survival in advanced ovarian carcinoma: an exploratory study of the gynecologic oncology group. Gynecol Oncol 2014; 133:439-45. [PMID: 24657300 DOI: 10.1016/j.ygyno.2014.03.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 01/14/2014] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether chemotherapy-induced neutropenia (C-iN) is associated with improved survival in a population of primary advanced ovarian cancer and peritoneal carcinoma patients treated with a carboplatin plus paclitaxel chemotherapy backbone. METHODS A post-hoc exploratory analysis of Gynecologic Oncology Group (GOG) protocol 182 was performed. Landmark analysis was conducted on all patients with progression-free survival >18weeks from the time of study entry. Neutropenia was defined as the absolute neutrophil count <1000mm(3). The occurrence of C-iN was analyzed according to demographic, clinicopathologic, and therapeutic intent, including age, body surface area, and treatment arm. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate independent prognostic factors and to estimate their effects on PFS and OS. RESULTS Neutropenic data was available for 3447 patients. Neutropenic (n=3196) and non-neutropenic groups (n=251) were similar in demographic and clinicopathologic characteristics. Neutropenic patients experienced significantly improved survival compared to non-neutropenic patients with the adjusted hazard ratio (HR) for death being 0.86 (95% confidence interval 0.74-0.99; p=0.041). There was no survival benefit associated with any of the treatment arms among patients with C-iN. CONCLUSION These data suggest that C-iN may represent a clinical biomarker associated with a survival advantage for patients with untreated advanced ovarian cancer. The absence of C-iN may indicate under-dosing and ultimately attenuated anti-neoplastic effect in vulnerable populations.
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Affiliation(s)
- Krishnansu S Tewari
- Dept. of Obstetrics & Gynecology, University of California, Irvine Medical Center, Orange, CA 92868, USA.
| | - James J Java
- Gynecologic Oncology Group Statistical & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | - Troy A Gatcliffe
- Dept. of Obstetrics & Gynecology, GYN Oncology of Miami, Miami, FL 33176, USA
| | - Michael A Bookman
- Division of Hematology-Oncology, University of Arizona Cancer Center, Tucson, AZ 85724, USA
| | - Bradley J Monk
- Dept. of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Arizona Cancer Center, Creighton University School of Medicine, St. Joseph's Hospital & Medical Center, Phoenix, AZ 85013, USA
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