SGO Annual Mtg 2023: Miscellaneous topics

This post completes my coverage of the 2023 SGO Annual Meeting. Below are some tweets on  miscellaneous topics from treatments to testing.

 Cryocompression

Prevention of neuropathy in gyn cancer patients. 

The data are in! Cryocompression therapy works during chemo and prevents subjective neuropathy in patients with gyn cancers. Congrats @MKMontesDeOca @LHavrilesky and @dukeobgyn team. #SGOMtg #PatientsPurposeProgress pic.twitter.com/VU6p3JYvMG

— Rebecca Previs (@BeccaPrevisMD) March 25, 2023

 Immune Biomarkers in Locally Advanced Cervical Cancer 

Combo of durvalumab concurrent with radiation produce more tumor-associated T-cells clones. 

Zamarin presenting LACC Evolution of peripheral and tumor immune parameters as biomarkers of differential sequencing of immune checkpoint blockade and chemoradiotherapy in locally advanced cervical cancer: An NRG Oncology/GOG Study #SGOMtg #gyncsm pic.twitter.com/ky1yWh3jjd

— Dee Sparacio (@womenofteal) March 25, 2023

Palliative Care  

Higher value and less aggressive care at end of life with early palliative care.

Impact of Timing of Palliative Care
Initiation on End-of-Life Quality Metrics
and Health Resource Utilization ,Mah #SGOmtg, #gyncsm Early palliative care is assoc w/ higher-value and less aggressive end-of-life care#palliativecare pic.twitter.com/mpPKFZY9ig

— Dee Sparacio (@womenofteal) March 28, 2023

Palliative care referral was impacted by diagnosis and insurance coverage. 

Palliative Care Utilization of Gynecology Oncology Patients with Advanced Cancer #SGOMtg #gyncsm Disparities in palliative care referral based on cancer
diagnosis/insurance were significant,No significant difference in referrals
based on age, race/ethnicity or preferred language pic.twitter.com/11D2SXbxqo

— Dee Sparacio (@womenofteal) March 28, 2023

Breast MRI 

Denials in women with hereditary BRCA1/2 mutations with gyn cancer diagnosis.

Barriers to early detection: Breast MRI denials in patients with
germline BRCA1/2 mutations Gordhandas, #SGOmtg #gyncsm #bcsm #patientspurposeprogress increase time to rec MRI, collaborate w/insurers pic.twitter.com/WfEhy7VwTX

— Dee Sparacio (@womenofteal) March 28, 2023

Funding gaps  

Significant gaps in funding for gyn cancers compared to other cancer types

Significant funding gaps exist for lethal gynecologic cancers compared to other malignancies. We all need to advocate with Congress for more funding! Highlighted by Dr Victor Dzau #NAM during Presidential Lecture at #sgomtg ⁦@uppals⁩ ⁦@SGO_org⁩ pic.twitter.com/gV4AiRB6wl

— Joshua Garrett Cohen (@JCohenMD) March 25, 2023

Obesity  

Japanese study showed obese women have higher risk of uterine cancer

The Consequence of Obesity on the Risk of Uterine Cancer Incidence in Younger vs. Older Adults Stewart #SGOMtg #gyncsm Taiwan data | Obese and overweight patients have a higher risk of uterine cancer pic.twitter.com/473v6Lpu6m

— Dee Sparacio (@womenofteal) March 28, 2023

HPV vaccination

Intervention helps uptake of HPV in clinic 

Every nudge counts: Impact of a clinical intervention bundle on the uptake of HPV vaccination in an under-resourced clinic
Byrne #SGOmtg #gyncsm pic.twitter.com/pkJ5RVWGqW

— Dee Sparacio (@womenofteal) March 28, 2023

 Tremelimumab, durvalumab, and radiotherapy

Patients with cervical or vaginal cancers had good overall response rates if high in PDL1

#SGOMtg #gyncsm
A phase I study of tremelimumab, durvalumab, and hypofractionated radiotherapy for metastatic gynecologic cancers
Lin , 18 patients cervical and vaginal, ORR in PDL1 high patients pic.twitter.com/IMqBpQZOFI

— Dee Sparacio (@womenofteal) March 27, 2023

In June I will report on  research of interest presented at the ASCO annual meeting which I will attend virtually. 

Dee

Every Day is a Blessing!

News from #ASCO22 Part 5 - Case Studies of Endometrial Cancer

This session was a case based discussion titled Controversies and Considerations in Adjuvant Advanced Endoemterial Cancer. 

Cases were presented and questions asked of the panel which included a patient advocate, @AdrienneEcana.

#ASCO22 Endometrial Cancer session
First case
Women Presented late- Why?
Did she not know bleeding after menopause was abnormal?
Did change of guidelines ( Neg PAP, Neg HPV screen safe no need to go to gyn for 5 yrs) impact? Covid? pic.twitter.com/4S74Yk8ye0

— Dee Sparacio (@womenofteal) June 7, 2022

1/2 Case 1 #ASCO22 Endometrial cancer #gyncsm
When should EC patient be approached re:clinical trial? @AdrienneEcana "my goal is to destigmatize participation in a clinical trial"
There is time early in treatment to offer option.

— Dee Sparacio (@womenofteal) June 7, 2022

#ASCO22 Endometrial cancer #gyncsm
Obesity is num 1 cause of endometrial cancer.
Case 2
Not Defined menopause.
Her2 testing @ajhingran Radiation important option due to lymph involvement
MMR / Lynch testing should be done . Should POLE be tested? pic.twitter.com/MaFkA8b1qq

— Dee Sparacio (@womenofteal) June 7, 2022

#ASCO22 Endometrial cancer #gyncsm

Mortality in Black women for Endometrial cancer is rising. -Gaillard

"Many black women live in food deserts and improvements in diet is needed." @AdrienneEcana

Endometrial cancer is heading to a more personalized treatment!

— Dee Sparacio (@womenofteal) June 7, 2022

Loved watching advocate and friend @AdrienneEcana present during the Controversies & Considerations in Endometrial Cancer session at #ASCO22. So proud of this amazing advocate . Wish I could have been there in person. #gyncsm pic.twitter.com/rgkbeP2S2C

— Dee Sparacio (@womenofteal) June 7, 2022

Tomorrow catch my last post from ASCO. It included varied Tweets of studies from the meeting that were not necessarily a part of the sessions I viewed.

 

Dee

Every Day is a Blessing! 

Disparity Research - #ASCO20 Virtual Annual Meeting

For the past year, I have been a member of Community Action Board at the Rutgers Cancer Institute. The Board advises the Center of Health Equity and Engagement led by Dr. Anita Kinney. The Center's role is to improve patient engagement for underserved and underrepresented communities in NJ in order to improve screening, prevention and access to treatment and clinical trials.

With that role in mind I took some time during the ASCO annual meeting to review studies related to cancer disparities. Here are just a few of the studies I viewed.

Uterine Cancer
Abstract 6089

#6089 Uterine cancer histology and stage at presentation in black & white women:
A cohort study of 488,000
Compared to white women black women are more likely to be dx with serous, clear cell,carcinosarcoma, leiomyosarcomas at adv stages #gyncsm #ASCO20 #OVCA #cancerdisparity

— Dee Sparacio (@womenofteal) May 29, 2020

Impact of Obesity Ovarian Cancer
e18067

"Obese patients were more likely to experience carboplatin under dosing in the neoadjuvant and adjuvant setting. No association with survival was observed for dose reduction and BMI #gyncsm #ASCO20 #OVCA #cancerdisparity 2/2

— Dee Sparacio (@womenofteal) May 29, 2020

Opiod Access / End Of Life Care 
Abstract 7005

Fleishman: Health Services Research and Quality Improvement Highlights #ASCO20
Racial / ethnic disparities in Opiod Access at EOL

Reducing implicit bias is still a challenge ; calls to pharmacy may help alleviate issue#cancerdisparity #Healthservices pic.twitter.com/Y5Kph11K5t

— Dee Sparacio (@womenofteal) May 31, 2020

Gender based disparities in clinical trials
Abstract # 2058

2/2
Of the trials lacking balance, the vast majority (80%) had under-representation of women.
Early phase > #disparity

future work: Why is there underrepresentation of women?
Is it time? child care issues? travel? Lots more to learn #ASCO20

— Dee Sparacio (@womenofteal) May 31, 2020

Survival outcomes by race minimally invasive versus open surgery
 Abstract #6029

Are outcomes better if open radical hysterectomy used?
Data from Nat Cancer Database-
Black women with open radical hysterectomy have lower survival than white women who had MIS . #ASCO20 #gyncsm #disparity 2/2

— Dee Sparacio (@womenofteal) May 31, 2020

Financial Toxicity
Abstract 6079

"The cohort of women with high #financialToxicity demonstrated higher mean scores on screening measures for depression and anxiety as well as persistently lower quality of life." #gyncsm #ASCO20 #ovariancancer https://t.co/J0EGQlyjRI pic.twitter.com/Yk8lq2DO4f

— Fumiko Ladd Chino, MD (@fumikochino) May 29, 2020

Geography and Cancer Care
Poster  1574
This study assessed overall survival (OS) of patients with all cancers, chronic myeloid leukemia (CML), and lung cancer while assessing distance from each county to the one (NCI-CC) in Georgia. Researchers conclude that disparity in cancer care exists between geographic conditions.

Black and white disparities in triple negative breast cancer ... Nurses’ Health Study
Poster 1655
This study examined disparities in triple negative breaset cancer by socioeconomic position, reporductive factors and diabete.  " observed racial differences in TNBC diagnoses may be at least partially mediated by differences in socioeconomic position and reproductive patterns, namely breastfeeding."

 
Breast and cervical cancer screening disparities among transgender patients
Poster 7024
About 1 million Americans identify as transgender. Limited primary care access and poor adherence to breast and cervical cancer screening are evident for transgender populations.

I look forward to next year's annual meeting whose theme was announce by incoming ASCO President , Dr Lori Pierce. 

I’ve been interested throughout my whole career in how to best create #equity in cancer care for all patients. So, I'm excited to introduce my @ASCO presidential theme, Equity: Every Patient. Every Day. Everywhere. pic.twitter.com/X8W3Qn8R9R

— Lori J. Pierce, MD, FASTRO, FASCO (@ASCOPres) June 1, 2020

We as advocates have a role to play to insure all patients receive appropriate and timely cancer care.

Dee
Every Day is a Blessing! 

Day 5: A Month of Teal - Ovarian Cancer Risk Factors

1 in 75 women develop ovarian cancer 

Risk factors for epithelial ovarian cancer ( the most common type) include: 

• Increased Age 
• Genetics :  BRCA 1 or 2 Mutation, Lynch Syndrome, Peutz-Jeghers syndrome, Nevoid basal cell carcinoma syndrome, Li-Fraumeni and Ataxia-Telangiectasia (http://www.cancer.net/cancer-types/ovarian-fallopian-tube-and-peritoneal-cancer/risk-factors-and-prevention )
• A family history of epithelial ovarian cancer, fallopian tube cancer, peritoneal cancer, premenopausal breast cancer and/or male breast cancer
• Endometriosis
• Being of Ashkenazi Jewish heritage
• Being post menopausal
• Infertility, never having children
• Obesity
• Using menopausal hormone therapy

For more information please see:
https://ocrfa.org/patients/about-ovarian-cancer/risk-factors/ 
http://www.cancer.net/cancer-types/ovarian-fallopian-tube-and-peritoneal-cancer/risk-factors-and-prevention


Dee
Every Day is a Blessing! 

What Are the Risk Factors For Ovarian Cancer

--> Before I list the risk factors for ovarian cancer it is important to know that having a risk factor does not mean you will get the disease. But there are some factors that have been found to increase the likelihood that a women will develop the epithelial ovarian cancer ( the most common type). 

-->

The average woman’s risk for ovarian cancer in her lifetime is 

1 in 75.

Risk Factors:

Age: The average age of women diagnosed with ovarian cancer is 63 years.

Obesity: Studies have shown a relationship between obesity and ovarian cancer (BMI  of 30)

Reproductive History: Never being pregnant

Estrogen Therapy: Studies show that taking estrogen 5-10 years have an increased risk

Male Hormones: Studies show that women who take male hormones are at a higher risk for Ovarian cancer.

Personal History: Women who have had breast , uterine, colon or rectal cancer have an increase risk for ovarian cancer.

Family History:A family history of breast, ovarian, colorectal cancer ( BRCA1and BRCA2 gene mutations, Lynch syndrome, hereditary nonpolyposis colorectal cancer)  

PTEN Syndrome: Women with the inherited mutation of the PTEN gene have an increased risk of ovarian cancer. Also known as Cowden disease .

-->

Fertility Drugs: Some studies showed that the use of fertility drug Clomid , increased a woman’s risk for ovarian cancer.

Talc: Women who use talcum powder in the genital area have an increase risk. Please note that since the 70’s talc powder products must be asbestos-free. 

For more information please check this NCI source : http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer-risk-factors

Dee
Every Day is a Blessing ! 

ASCO - Patient and Survivor Care

Part four in my ASCO report. 

I spent time chatting with researchers and reading many posters related to patient survivorship issues at ASCO. It pleased me that researchers were spending time looking at quality of life, anxiety , sexual function , support efforts, hope, obesity and improving side effects. 

Obesity

The researchers looked at obesity and survival in ovarian cancer patients. They compared 130 obese vs 240 non-obese women with the disease. The time to recurrence was identical at 15 months in both groups. They concluded that obesity does not impact time to recurrence. (Abstract 5049)

Quality of Life/ Hope 

This longitudinal study by researchers from the Cancer Treatment Centers of America studied whether changes in quality of life could predict survival in ovarian cancer patients treated in an integrated model. There were 137 patients in the study and included newly diagnosed and those with recurrences. Quality of Life questionnaires were completed at initial visits and at 3 months of treatment. Preliminary evidence showed that patients with improved quality of life at three months had significantly longer survival. (Abstract 5049)

Researchers from Germany used a questionnaire to study sexual function in ovarian cancer patients. The study included over 700 women. Half of the women reported they were not sexually active. Results showed that sexual activity was impaired in women with ovarian cancer but that it did not impact their quality of life. The researchers concluded that a shift in priorities regarding anxiety due to cancer survival may have impacted the results.(Abstract 5051)

A longitudinal study by MD Anderson researchers studied ovarian cancer patients at MD Anderson, an academic cancer center and a community hospital. Results showed that underserved patients in the community hospital setting had poorer quality of life and that the future depended on “luck” or “others”. than those at the cancer centers. ( Abstract 9134) This is the poster of the work Dr L Ranondetta described at the Grand Rounds at St Peters University Hospital in May.

The Lance Armstrong Foundation researchers fielded a LiveSTRONG Survey for People Affected by Cancer. The survey looked at post treatment concerns and treatment summaries. Results showed that only one third of the patients received a treamtnet summary. Those patients that did receive a summary had a variety of positive outcomes. ( Abstract 9136)

Therapy management/ Anxiety

A German Study surveyed 676 ovarian cancer patients  regarding their expectations and needs about their therapy and doctor /patient communications. They found there is a high need of patients to discuss all details of treatment options and clinical management. the three most important aspects were “More time for discussion”, “therapy should not lead to hair loss” ad “therapy should be more effective”. 

(5044)

Side Effects/ Hair loss

This prospective study of chemo induced hair loss with and without scalp cooling was done by researchers in Canada. Researchers studied 130+ women with and without a scalp cooling device.  The study used  a survey and photos were taken before treatment,at 3 cycles and at the end of treatment. The result showed 49% of women who used the scalp cooling described their  “Success” as none or little hair loss . While 4% of women who did not use the scalp cooling had “Success”.   Hair stylists reported “success at 34% for those using the cooling device (Abstract 9138)

Dee

Every Day is a Blessing!

Cancer and Obesity

Yesterday, I attended the 2012 Annual Retreat on Cancer Research in NJ at the University of Medicine and Dentistry of NJ Medical School in Piscataway. The conference was presented  by the Cancer Institute of NJ (CINJ) and the NJ Commission on Cancer Research. This year's sessions for medical professionals focused on areas such as Cell Death, Genomic Instability,Tumor Progression, Cancer Pharmacology, Preclinical Therapeutics and Clinical Investigations.

I attended the Public Forum again this year.( Last year's event was on Survivorship.)  The forum was titled Kids and Cancer:  the Obesity Connection but it offered information about adult obesity too.

After welcoming the standing room only crowd Peter Gillies, Ph.D, NJ Institute for Food, Nutrition and Health shared these facts.

• 1 in 3 children are obese
• 2 in 3 adults are obese
• We spend 190 Billion dollars a year because of obesity
• NJ is one of the worst states in the US in terms of obesity

John Milner, Ph.D, Chief Nutritional Science Research Group at the NCI, was the keynote speaker. What an informative lecture ! He spoke about the myths of cancer and obesity with facts and studies. Here are a just few myths he mentioned:

• Risk of obesity has plateaued Not true- obesity in the US will continue to increase unless we do something now.
• All people are equally susceptible to obesity . Not true. African Americans are more prone to obesity than Hispanics who are more prone to obesity than Caucasians.
• We all respond identically to food items. Not true. In studies some people who used olive oil gained weight , some people lost weight.
• Food availability and not genetics makes me eat Not true. Sure having lots of sweets available in our environment may make us eat more of them but how our individual bodies break them down , use and stores them may be genetic.

There are many things that influence obesity. The amount of food we eat, the types of food we eat , the amount we exercise, our genetic make-up including hormone level are important so controlling our weight ( loss or gain ) should be approached in a more personalized manner. One diet does not fit all.

Dr Milner's talk was followed by these related topics.

• Elisa Bandera, M.D., Ph.D an epidemiologist from CINJ spoke about Childhood Obesity and Timing of Puberty :Implications for Future Health and her current study Jersey Girls. Jersey Girls hopes to answer the question whether or not girls with earlier puberty become obese? 
• Chung Yang, Ph.D ( Rutgers University) clarified  Does Vitamin E Prevent or Promote Cancer in his studies of Vitamin E (Tocopherols). He  found that Alpha molecules like those found in vitamin E tablets were good nutritionally but failed to prevent  cancer while the gamma and delta molecules showed preventative properties.  
• Tracy Anthony, Ph.D (Rutgers) introduced Dietary Macro nutrients and Their Influence on Appetite and Weight Control with how the USDA guidelines for good nutrition have changed from the food pyramid to MyPlate. She spoke about amino acids, which make up proteins like leucine,  and their role in good nutrition and the need to spread out our protein intake throughout the days meals not just at dinner. 

After the talks were complete, I spent time looking at posters on CD-44 and Vitamin D,  chronic care and health beliefs in older breast cancer survivors, and sun protection and exposure behaviors among Hispanics.

On my drive home I reflected on all the information I had heard from NJ's very own researchers. What a benefit it is to live in a state in which there is such a wonderful collaboration between CINJ cancer center researchers and academic researchers especially those at Rutgers University ( my alma mater).

Dee
Every Day is a Blessing!