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ABSTRACT: To evaluate the efficacy and adverse events of thalidomide in previously-treated, measurable, persistent or recurrent carcinosarcoma of the uterus, and to explore associations between angiogenic markers with patient demographics and clinical outcome.
Eligible, consenting patients were treated until disease progression or toxicity intervened with daily starting dose of 200mg thalidomide/day that was increased by 200mg every 2weeks to a target dose of 1000mg/day. Endpoints included progression-free survival (PFS)≥6months (primary), toxicity, response, overall PFS and survival. Pre- and post-treatment plasma were evaluated for a panel of angiogenic biomarkers and assessed against clinical outcomes.
Of 55 enrolled patients, 45 were evaluable for toxicity and survival. Two patients (4%; 90% CI 1-13%) experienced a partial response, and 8 (18%; 90% CI 9-30%) had PFS≥6months. Median PFS was 1.9months and median survival was 5.9months. Grade 2-3 sensory neuropathy was noted in 6 patients, and 4, 3, and 3 patients experienced grade 3 sedation, fatigue, and constipation, respectively. Three patients had grade 4 adverse events (2 thromboembolic, 1 anemia). High pre-treatment VEGFA levels were associated with poorer PFS and survival.
Treatment with thalidomide met the protocol specified goal of prolonging PFS at 6months. However, based on results with newer agents, the activity was insufficient to support further investigation. Association between pre-treatment VEGFA and prognosis in this population supports further evaluation of anti-angiogenic therapies in uterine carcinosarcoma.
Gynecologic Oncology 07/2012; 127(2):356-61. · 3.89 Impact Factor
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ABSTRACT: The primary objective was to establish noninferiority of laparoscopy compared with laparotomy for recurrence after surgical staging of uterine cancer.
Patients with clinical stages I to IIA disease were randomly allocated (two to one) to laparoscopy (n = 1,696) versus laparotomy (n = 920) for hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The primary study end point was noninferiority of recurrence-free interval defined as no more than a 40% increase in the risk of recurrence with laparoscopy compared with laparotomy.
With a median follow-up time of 59 months for 2,181 patients still alive, there were 309 recurrences (210 laparoscopy; 99 laparotomy) and 350 deaths (229 laparoscopy; 121 laparotomy). The estimated hazard ratio for laparoscopy relative to laparotomy was 1.14 (90% lower bound, 0.92; 95% upper bound, 1.46), falling short of the protocol-specified definition of noninferiority. However, the actual recurrence rates were substantially lower than anticipated, resulting in an estimated 3-year recurrence rate of 11.4% with laparoscopy and 10.2% with laparotomy, or a difference of 1.14% (90% lower bound, -1.28; 95% upper bound, 4.0). The estimated 5-year overall survival was almost identical in both arms at 89.8%.
This study previously reported that laparoscopic surgical management of uterine cancer is superior for short-term safety and length-of-stay end points. The potential for increased risk of cancer recurrence with laparoscopy versus laparotomy was quantified and found to be small, providing accurate information for decision making for women with uterine cancer.
Journal of Clinical Oncology 03/2012; 30(7):695-700. · 18.37 Impact Factor
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Jean A Hurteau,
Mark F Brady,
Kathleen M Darcy,
William P McGuire,
Pamela Edmonds, Michael L Pearl,
Iouri Ivanov,
Krishnansu S Tewari,
Robert S Mannel,
Kristine Zanotti,
Doris M Benbrook
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ABSTRACT: To compare progression-free survival (PFS), overall survival (OS) and toxicities of thalidomide versus tamoxifen and to evaluate serum vascular endothelial growth factor (VEGF) in biochemical-recurrent epithelial ovarian cancer, primary peritoneal cancer or fallopian tube carcinoma (EOC/PPC/FTC).
Biochemical recurrence was defined as a rising CA-125 exceeding twice the upper limit of normal without evidence of disease as defined by RECIST 1.0 criteria. Women with FIGO stages III and IV, histologically confirmed EOC/PPC/FTC who were free of disease following first-line chemotherapy were randomized to oral thalidomide 200mg daily with escalation to a maximum of 400 mg or tamoxifen 20mg orally twice daily for up to 1 year, progression or adverse effect prohibited further treatment. VEGF was quantified by ELISA in pre and post-treatment serum.
Of the 139 women randomized, 138 were eligible. Interim analysis showed that thalidomide did not reduce the recurrence rate relative to tamoxifen, and the trial was closed. Thalidomide versus tamoxifen was associated with a similar risk of progression (HR = 1.31, 95% confidence interval [CI] = 0.93-1.85), an increased risk of death (HR = 1.76, 95% CI = 1.16-2.68) and more grades 3 and 4 toxicities (55% versus 3%). The most common grades 3 and 4 toxicities were constitutional (12%), somnolence (12%), pulmonary (9%), venous thromboembolism (VTE) (6%) and peripheral neurologic (6%) for thalidomide, with VTE (1.4%) and gastrointestinal (1.4%) for tamoxifen. Serum VEGF was not associated with clinical characteristics, treatment, PFS or OS.
Thalidomide was not more effective than tamoxifen in delaying recurrence or death but was more toxic. VEGF was not prognostic in this cohort.
Gynecologic Oncology 12/2010; 119(3):444-50. · 3.89 Impact Factor
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ABSTRACT: The objective was to compare laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer.
Patients with clinical stage I to IIA uterine cancer were randomly assigned to laparoscopy (n = 1,696) or open laparotomy (n = 920), including hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The main study end points were 6-week morbidity and mortality, hospital length of stay, conversion from laparoscopy to laparotomy, recurrence-free survival, site of recurrence, and patient-reported quality-of-life outcomes.
Laparoscopy was initiated in 1,682 patients and completed without conversion in 1,248 patients (74.2%). Conversion from laparoscopy to laparotomy was secondary to poor visibility in 246 patients (14.6%), metastatic cancer in 69 patients (4.1%), bleeding in 49 patients (2.9%), and other cause in 70 patients (4.2%). Laparoscopy had fewer moderate to severe postoperative adverse events than laparotomy (14% v 21%, respectively; P < .0001) but similar rates of intraoperative complications, despite having a significantly longer operative time (median, 204 v 130 minutes, respectively; P < .001). Hospitalization of more than 2 days was significantly lower in laparoscopy versus laparotomy patients (52% v 94%, respectively; P < .0001). Pelvic and para-aortic nodes were not removed in 8% of laparoscopy patients and 4% of laparotomy patients (P < .0001). No difference in overall detection of advanced stage (stage IIIA, IIIC, or IVB) was seen (17% of laparoscopy patients v 17% of laparotomy patients; P = .841).
Laparoscopic surgical staging for uterine cancer is feasible and safe in terms of short-term outcomes and results in fewer complications and shorter hospital stay. Follow-up of these patients will determine whether surgical technique impacts pattern of recurrence or disease-free survival.
Journal of Clinical Oncology 10/2009; 27(32):5331-6. · 18.37 Impact Factor
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ABSTRACT: To estimate the antitumor activity of pemetrexed in patients with persistent or recurrent platinum-resistant epithelial ovarian or primary peritoneal cancer and to determine the nature and degree of toxicities.
A phase II trial was conducted by the Gynecologic Oncology Group. Patients must have had cancer that had progressed on platinum-based primary chemotherapy or recurred within 6 months. Pemetrexed at a dose of 900 mg/m(2) was to be administered as an intravenous infusion over 10 minutes every 21 days. Dose delay and adjustment was permitted for toxicity. Treatment was continued until disease progression or unacceptable adverse effects.
From July 6, 2004, to August 23, 2006, 51 patients were entered. A total of 259 cycles (median, four; range one to 19 cycles) of pemetrexed were administered, with 40% of patients receiving six or more cycles. Overall, the treatment was well tolerated. More serious toxicities (grade 3 and 4) included neutropenia in 42%, leukopenia in 25%, anemia in 15%, and constitutional in 15% of patients. No treatment-related deaths were reported. One patient (2%) had a complete and nine patients (19%) had partial responses, with a median duration response of 8.4 months. Seventeen patients (35%) had stable disease for a median of 4.1 months. Eighteen patients (38%) had increasing disease. Three patients (6%) were not assessable. Median progression-free survival was 2.9 months, and overall survival was 11.4 months.
Pemetrexed has sufficient activity in the treatment of recurrent platinum-resistant ovarian cancer at the dose and schedule tested to warrant further investigation.
Journal of Clinical Oncology 04/2009; 27(16):2686-91. · 18.37 Impact Factor
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ABSTRACT: Stages III and IV ovarian and peritoneal cancer patients are commonly treated with combination chemotherapy after surgical debulking. This phase II trial investigated the use of pegylated liposomal doxorubicin as consolidation chemotherapy for these patients.
Women with stage III or IV ovarian or primary peritoneal carcinoma demonstrating no clinical evidence of disease after primary therapy were eligible for enrollment. Patients received 4 cycles of 40 mg/m(2) IV of pegylated liposomal doxorubicin every 28 days.
Twelve patients were enrolled. There were 6 stage IIIC and 6 stage IV patients. Ten patients received 4 cycles. Two patients had dose limiting skin toxicity manifest as hand-foot syndrome and received only 3 cycles. Forty-six of a planned 48 cycles were administered. Median disease-free survival from registration is 10 months with a mean of 18 months. Median overall survival has not yet been reached. Four patients are disease-free, two have relapsed and six have died from disease progression.
Pegylated liposomal doxorubicin is a well-tolerated choice for consolidation chemotherapy in patients with ovarian or primary peritoneal carcinoma.
Gynecologic and Obstetric Investigation 02/2007; 63(1):1-6. · 1.28 Impact Factor
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ABSTRACT: A phase II study was conducted to assess the activity and toxicity of weekly docetaxel in patients with advanced or recurrent cancer of the cervix.
Eligible patients were required to have measurable disease with adequate performance status, bone marrow, renal and hepatic function. Patients were allowed to receive chemosensitization and not more than one prior chemotherapy regimen excluding taxanes. Docetaxel 35 mg/m2 was administered intravenously weekly for 3 weeks followed by 1 week off until disease progression or adverse effects prohibited further therapy.
Ten patients were entered into this study, all of who were evaluable for toxicity and response. A median of 2 cycles (range 2-6) were administered. The most frequent drug-related toxicities were anemia and fatigue. There were no objective responses. Three patients had stable disease up to 6 cycles. One patient died of exsanguination from a known vaginal metastasis after completing her second cycle. The median progression-free interval was 1.7 months (range 0.9-5.8) and overall survival was 6.9 months (1.6-23.7).
Docetaxel has limited activity in patients with recurrent cancer of the cervix at the dose and schedule tested.
Gynecologic and Obstetric Investigation 02/2007; 64(4):193-8. · 1.28 Impact Factor
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ABSTRACT: The Gynecologic Oncology Group (GOG) has studied a number of drugs to determine their activity in patients with previously treated squamous and nonsquamous cancer arising in the uterine cervix. A Phase II study with intravenous vinorelbine was initiated for this purpose in patients with Stage IVB, recurrent, or persistent nonsquamous carcinomas who had received one prior chemotherapy or were not eligible for other studies.
Eligible patients had to have measurable disease, GOG performance status of 0-2 and adequate bone marrow, liver, and renal function. The treatment consisted of vinorelbine 30 mg/m(2) on days 1 and 8, repeated every 21 days. Tumor measurements and toxicities were recorded every treatment cycle.
Thirty patients were enrolled with 28 patients deemed eligible and evaluable. Only two confirmed partial responses (7.1%) were noted. Neutropenia was the most common toxicity with 9 of 28 (32%) experiencing either grade 3 or 4 changes. Anemia was severe in seven. Neuropathy was more than mild in three patients. Severe events, such as fatigue, hypertension, or pulmonary changes attributed to drug administration, occurred only in one or two instances.
With the dose schedule and assessment criteria employed, vinorelbine had only minimal activity in nonsquamous cancer of the cervix.
Gynecologic Oncology 02/2005; 96(1):108-11. · 3.89 Impact Factor
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ABSTRACT: This review summarizes contemporary concepts of abdominal surgical incision creation and closure. The Ovid computerized database was searched for articles published in English from 1996 to 2003 using keywords pertaining to the specific topic of interest (e.g., suture, drain, surgical technique, fascia). Human prospective, randomized trials; meta-analyses; and evidence-based-focused reviews were assessed and data abstracted. Several earlier and animal-based studies on specific issues were included. The data indicate that: (1) the direction of the incision should be based upon obtaining adequate exposure; (2) hair should either be left in place or clipped at the time of surgery; (3) a single dose of prophylactic antibiotics should be given 30 minutes prior to surgery; (4) using a "deep" scalpel is unnecessary; (5) a scalpel and electrocautery are comparable for deepening the incision; (6) minimal peritoneal lavage with non-antibiotic containing solutions is adequate; (7) the peritoneum should not be routinely closed; (8) the fascia should be loosely approximated by a continuous mass closure using a slowly absorbable, monofilament suture with the smallest possible caliber and a suture:wound length ratio of at least 4:1; (9) retention sutures, subcutaenous sutures and drains do not appear to reduce the risk of wound complications; and (10) the skin may be closed in a variety of methods, but a semiocclusive dressing should be applied. As scientific evidence accumulates to refute traditional dogma, management of the surgical patient has undergone substantial changes. Surgeons should now be able to create and close an abdominal wound based upon sound scientific principles rather than simply "doing what I always do."
The Journal of reproductive medicine 09/2004; 49(8):662-70. · 0.87 Impact Factor
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ABSTRACT: This multi-center phase II trial was conducted by the Gynecologic Oncology Group to evaluate the activity and toxicity of irofulven in patients with previously treated adenocarcinoma of the endometrium.
Eligible patients had documented recurrent or persistent endometrial carcinoma after receiving definitive locoregional therapy, and were required to have measurable disease, performance status of 0-2, and adequate bone marrow, hepatic and renal functions prior to study entry. Patients were allowed one prior chemotherapy regimen. The initial dose of irofulven was 11 mg/m(2)/day for four days administered intravenously. Cycles were repeated every 28 days. Doses were escalated or reduced based on previous cycle toxicity.
Twenty-five patients were enrolled onto the trial. There was one (4%) confirmed complete response. Seven (28%) patients had stable disease, with a median duration of 10.4 (range: 4.4-21.6) months. Patients received a median of one (range: 1-5) cycle of protocol treatment. There were three early treatment-related deaths due to renal failure and severe electrolyte disturbances. Two patients experienced grade 4 hematologic adverse effects.
Irofulven administered at the dose and schedule used in this trial was minimally active and resulted in significant toxicity.
Investigational New Drugs 09/2004; 22(3):343-9. · 3.36 Impact Factor
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ABSTRACT: This study was undertaken to compare the outcomes of patients with endometrial cancer who had primary surgery with gynecologic oncology involvement at university or community hospitals.
The study population consisted of all patients who had primary surgery for endometrial cancer with involvement of the attending physicians of the Division of Gynecologic Oncology. The patients were divided into two groups based on whether their surgery was performed at a university or community hospital. Demographic and clinical data were abstracted from the medical records.
There were no significant differences between the two groups with regard to Quetelet index (kg/m(2)); intervals between biopsy and consultation, consultation and surgery, and biopsy and surgery; estimated blood loss; incidence of operative or hospital complications; frequency of appropriate surgical staging; stage distribution; histology or grade; and hospital stay. Patients at a university hospital were significantly older, had a higher severity index, were more likely to have had a vaginal hysterectomy, and participate in a research protocol. Both the Quetelet index and the severity index were significantly higher for patients who had vaginal hysterectomy than for those who had either laparoscopically assisted vaginal hysterectomy or total abdominal hysterectomy. When analyzed by surgical approach, the frequencies of pelvic and paraaortic lymph node sampling were comparable between the groups. Both the Quetelet and severity indices were significantly higher for patients who did not have lymph node sampling.
Involvement of a gynecologic oncologist at the time of primary surgery for endometrial cancer was associated with comparable outcomes in both the university and community hospital setting.
Obstetrics and Gynecology 11/2002; 100(4):724-9. · 4.73 Impact Factor
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ABSTRACT: The objective of this study was to compare tolerance of treatment of ovarian cancer patients > or = 70 years to those < or =55.
A retrospective review of all data relevant to comparison of clinical course in 31 women > or =70 years (Study Group) and 44 women < or =55 (Control Group), who received primary therapy for ovarian cancer between 1996 and 2001 was performed. The tolerance of the entire treatment plan was then compared using SAS 8.1 (Gary, IN), chi(2) test with Yates correction or Fischer's exact test, and the Student t test as appropriate.
The mean age for the study group was 73, and for the control group 49. Statistically significant differences were as follows: the study group had a lower hemoglobin and serum albumin, higher performance status postoperatively, and received lower carboplatin dose and dose intensity. The groups were similar in stage at presentation, medical comorbidities, estimated blood loss, optimal cytoreduction rates, dose intensity of paclitaxel, completed number of chemotherapy cycles, time intervals from surgery to completion of therapy, and posttreatment performance status and nutritional status. The rate of grade 3 and 4 toxicities was low in both groups, and did not hinder delivery of therapeutic dose of chemotherapy.
Women in the study group tolerated aggressive cytoreductive surgery and therapeutic doses of chemotherapy, despite poorer nutritional status and general health at time of diagnosis. Although older women are more likely to have chemotherapy dose reduction, the treatment remained within the recommended standard dosage.
Gynecologic Oncology 09/2002; 86(3):316-22. · 3.89 Impact Factor
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ABSTRACT: To prospectively evaluate the safety and efficacy of a regular diet as the first meal after intraabdominal surgery in gynecologic oncology patients.
During a 20-month period, 254 gynecologic oncology patients undergoing intraabdominal surgery were enrolled in a randomized controlled trial of a clear liquid diet compared with a regular diet as the first postoperative meal. All patients received their first meal on the first postoperative day in the absence of nausea, vomiting, or symptomatic abdominal distension. Standard criteria for discharge were used for all study patients.
The clear liquid and the regular diet groups were similar in age, disease, surgical procedure distribution, surgery length, and estimated blood loss. The incidence of nausea, vomiting, abdominal distention, frequency and duration of nasogastric tube use, passage of flatus before discharge, and percentage of patients who tolerated their diets on the first attempt were comparable for both groups. For those patients who were intolerant of the first attempt at either a clear liquid or regular diet, the time to tolerance was comparable for both groups. The time to development of bowel sounds, passage of flatus, and hospital stay were comparable for both groups. Febrile morbidity, pneumonia, wound complications, and atelectasis occurred equally in both groups. There were no known anastamotic complications or aspirations in either group. Postoperative changes in hematologic indices and electrolytes were comparable in both groups.
A regular diet as the first meal after intraabdominal surgery in gynecologic oncology patients is safe and efficacious.
Obstetrics and Gynecology 09/2002; 100(2):230-4. · 4.73 Impact Factor
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ABSTRACT: To evaluate the safety and efficacy of early oral analgesia after intra-abdominal surgery in gynecologic oncology patients.
Over a 2.5-year period, 227 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early oral versus traditional parenteral analgesia. All patients initially received parenteral morphine via a patient-controlled analgesia (PCA) pump with a basal dose of 0.5 mg/h and a PCA dose of 1 mg with a 10-minute lockout. On the first postoperative day, all patients began a clear liquid diet, which was advanced as tolerated. Patients allocated to early oral analgesia were switched from parenteral to oral morphine. They received a scheduled dose of 20 mg every 4 hours with an additional dose of 10 mg every 2 hours as needed for breakthrough pain. Patients allocated to traditional parenteral analgesia continued to receive parenteral morphine via a PCA pump with basal and PCA doses. On the second postoperative day, the scheduled oral and basal parenteral doses were discontinued. The oral and parenteral PCA doses were continued until 24 hours before discharge, at which time the patient was switched to oxycodone 5 mg/acetaminophen 325 mg.
There were no significant differences among the groups in any demographic or clinical indices, including age, case distribution, surgery length, blood loss, time to return of bowel function, length of hospital stay, pain, sedation, and satisfaction scores, and incidence of nausea, vomiting, or major postoperative complications.
Early oral analgesia in gynecologic oncology patients undergoing intra-abdominal surgery is safe and efficacious.
Obstetrics and Gynecology 06/2002; 99(5 Pt 1):704-8. · 4.73 Impact Factor
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ABSTRACT: Hypercalcemia is an oncologic emergency that is associated with a median life expectancy of approximately 30 days. Despite this, antihypercalcemic therapy is often indicated to reduce morbidity and improve quality of life. Although at least four mechanisms are operative in producing hypercalcemia of malignancy, the treatment is consistent regardless of the underlying mechanism. Initial management consists of vigorous rehydration, followed by administration of agents that enhance renal calcium excretion or inhibit bone resorption. The purpose of this review is to discuss the current management of hypercalcemia of malignancy.
Primary Care Update for OB/GYNS.
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ABSTRACT: Despite advances in therapy over the past several decades, most women with advanced stage cancer will relapse and die from their disease. In recent years, an increasing number of patients with gynecologic cancer have been treated with high-dose chemotherapy and hematopoietic progenitor cell support. Although the response rates are impressively high, the median survival remains low. Thus, the appropriate role and timing of this potentially advantageous, yet very expensive, therapy remain to be determined.
Primary Care Update for OB/GYNS.
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ABSTRACT: Endometrial adenocarcinoma is the most common gynecologic malignancy occurring in the United States. Evidence is accumulating that links peptide growth factors with malignant proliferation. Epidermal growth factor (EGF) and insulin-like growth factor I (IGF-I) are known mitogens for endometrial adenocarcinoma in vitro. However, the biological activity of other growth factors in this malignancy is unclear. This study was undertaken to determine the influence of growth factors on the mitogenic activity of the human endometrial adenocarcinoma cell lines HEC-1-A and KLE. Incubation with EGF, IGF-I, insulin-like growth factor II (IGF-II), or insulin stimulated a time-dependent mitogenic response in both cell lines, with the peak response occurring at 24 hr for HEC-1-A and 48 hr for KLE. After two doubling intervals, the number of HEC-1-A cells was increased 3.5-fold by EGF (100 ng/ml), 2.7-fold by IGF-I (100 ng/ml), 2.3-fold by IGF-II (100 ng/ml), and 2.2-fold by insulin (1000 ng/ml) when compared to untreated controls (P P < 0.05). Similar results were obtained when DNA content was measured. PDGF failed to stimulate any mitogenic response in either cell line at all concentrations tested (0.1-100 ng/ml). These findings suggest that EGF, IGF-I, IGF-II, and insulin may play a regulatory role in the proliferation of endometrial adenocarcinoma. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/30772/1/0000423.pdf
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ABSTRACT: The role of EGF in the proliferation of the poorly differentiated endometrial adenocarcinoma cell line (KLE) was examined. EGF (10 ng/ml) and the tumor promoter, protein kinase C agonist, phorbol 12-myristate 13-acetate (PMA) were potent stimulators (P 3H]thymidine incorporation into DNA. Staurosporine, a protein kinase C inhibitor, partially blocked the EGF effects on [3H]thymidine incorporation. Similarly, downregulation of protein kinase C also failed to completely abolish EGF effect on DNA synthesis and cell division. These results suggest that in the KLE cell line EGF stimulation of cell growth is exerted through both protein kinase C-dependent and -independent pathways. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/31609/3/0000538.pdf
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ABSTRACT: Superior vena cava syndrome (SVCS) affects approximately 15,000 people annually in the United States. Currently, mediastinal malignancies, primarily small cell lung cancer, account for the majority of cases of SVCS. Iatrogenic causes, predominantly long-term central venous catheters, account for approximately 7% of cases of SVCS, and the incidence is increasing. Historically, SVCS was considered an oncologic emergency that required urgent treatment. It is now evident that SVCS is rarely a true emergency and that treatment may be safely provided in a deliberate fashion to the majority of patients. This article provides an overview of the etiology, presentation, diagnosis, and management of SVCS.
Primary Care Update for OB/GYNS.
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ABSTRACT: We sought to document the incorporation of primary care education in the training of obstetrics and gynecology residents on the gynecologic oncology service at a university hospital in a tertiary care center. We conducted a prospective study of 177 consecutive admissions to the gynecologic oncology service at the University Hospital at Stony Brook during the 3 months from June to August 1996. Admissions were categorized into two groups: medical and surgical. Medical admissions were further categorized by diagnostic groups. For each admission, the medical history of each patient was recorded, as were any new diagnoses identified during that admission. Routine medications and newly initiated therapies were also recorded for each patient. All results were categorically summarized as frequencies and percentages. Of the 177 patients seen by the two residents staffing the gynecologic oncology service during the study period, 100 (56%) were admitted for medical conditions and 77 (44%) for surgical procedures. The patients’ ages ranged from 24 to 87 years, with the mean age being 59.1 years. One hundred thirty-two patients (74%) were admitted with comorbid medical conditions, and more than one quarter of them had a history of psychiatric illness. Moreover, 127 (72%) patients had a positive history of medications used for the chronic management of nongynecologic medical diseases. In addition, 150 (85%) patients were diagnosed with multiple new medical conditions, and the residents initiated new medical therapy for 128 (72%) patients. As flexibility training is introduced in obstetrics/gynecology, residents will gain a wealth of exposure to primary care on services with a high volume of patients who have medical comorbidities.
Primary Care Update for OB/GYNS.
