Andreea I. Dinicu

Oncofertility Research: A Review of the Literature

Objective: To examine publication trends pertaining to fertility-sparing management in patients of reproductive age with gynecological malignancies. Methods: Ovid MEDLINE was used to aggregate all publications on gynecological cancers and fertility between 1946 and 2022. Original research, reviews, case series/reports, and editorials were included. Publication information was extracted from Ovid MEDLINE. Individual authors’ subspecialty credentials were individually reviewed and confirmed. Descriptive statistics were generated. Results: The initial query generated 2,057 publications. Of these, 1,057 (51.4%) publications met search criteria, with the first study being published in 1991 and with 16.6% published in the last 2 years. Only 34 (5.5%) studies were published with collaboration between reproductive endocrinology and infertility (REI) and gynecological oncology physicians in the United States. Gynecological oncologists comprised most senior authors (50.9%), followed by REI specialists (18.6%). Topics of the publications centered on fertility-sparing surgical management (43.1%), medical management of gynecological malignancies (11.3%), and oocyte/ovarian tissue preservation (6.0%). Most publications focused on ovarian malignancies (349, 33.3%), followed by cervical cancer (299, 28.5%), and uterine/endometrial cancer (258, 24.6%). While the number of publications regarding fertility-sparing management has increased over the last 30 years, the majority are retrospective studies and case reports/series. In the last 10 years, only five studies were randomized controlled trials. Conclusions: There is an urgent need for more prospective research in oncofertility. While fertility care in the setting of gynecological cancer is a collaborative effort between the specialties of gynecological oncology and REI, this partnership is not reflected in the authorship of current literature.

Region of origin and cervical cancer stage in multiethnic Hispanic/Latinx patients living in the United States

AbstractBackgroundHispanic/Latinx people have the second highest cervical cancer incidence rates in the U.S. However, there is a lack of disaggregated data on clinical outcomes for this diverse and populous group, which is critical to direct resources and funding where they are most needed. This study assessed differences in stage at diagnosis of cervical cancer among Hispanic/Latinx subpopulations and associated factors.MethodsWe analyzed patients with primary cervical cancer from 2004 to 2019 in the National Cancer Database. Hispanic/Latinx patients were further categorized into Mexican, Puerto Rican (PR), Cuban, Dominican, and Central/South American, as per standard NCDB categories, and evaluated based on stage at diagnosis and sociodemographic characteristics. Multinomial logistic regression quantified the odds of advanced stage at presentation. Regression models were adjusted for age, education, neighborhood income, insurance status, and additional factors.ResultsHispanic/Latinx cervical cancer patients were more likely to be uninsured (18.9% vs. 6.0%, p < 0.001) and more likely to live in low‐income neighborhoods (28.6% vs. 16.9%, p < 0.001) when compared to non‐Hispanic White populations. Uninsured Hispanic/Latinx patients had 37.0% higher odds of presenting with regional versus localized disease (OR 1.37; 95% CI, 1.19–1.58) and 47.0% higher odds of presenting with distant versus. Localized disease than insured patients (OR 1.47; 95% CI, 1.33–1.62). When adjusting for age, education, neighborhood income, and insurance status, PR patients were 48% more likely than Mexican patients to present with stage IV versus stage I disease (OR 1.48; 95% CI, 1.34–1.64).ConclusionDisaggregating health data revealed differences in stage at cervical cancer presentation among Hispanic/Latinx subpopulations, with insurance status as a major predictor. Further work targeting structural factors, such as insurance status, within specific Hispanic/Latinx subpopulations is needed.