Sharonne Holtzman

Surveillance Visits for Ovarian Cancer: Is It Time to Reconsider?

ABSTRACT Background and Objectives The objective of this study was to examine patterns of recurrence and presentation of ovarian cancer (OC) patients. Methods This was a retrospective review of all patients at a single academic institution diagnosed with OC between January 1, 2014, and December 31, 2022. Demographic and clinical characteristics were extracted. Cox proportional hazards models were utilized to compare these characteristics, while the Kaplan‐Meier method was employed to determine overall survival (OS). Results During our study, 437 patients were diagnosed with OC, and 173 (39.6%) were diagnosed with recurrence. For those diagnosed with recurrence, 68 (39.3%) were symptomatic. Forty‐eight (72.7%) symptomatic patients had abdominal pain or increased abdominal girth, 5 (7.6%) had shortness of breath, 1 (1.5%) had vaginal bleeding, and 12 (18.1%) had nonspecific symptoms. Among the 105 (60.7%) asymptomatic patients, 57 (54.3%) had increasing CA‐125 levels. Four (2.32%) patients with recurrence were diagnosed on a routine pelvic exam, and only one (0.5%) patient was asymptomatic and incidentally diagnosed. Conclusions The majority of patients were asymptomatic at the time of diagnosis, and the pelvic exam was not the primary means of detecting OC recurrence. Guidelines for surveillance visits for OC patients and the utility of a pelvic exam should be examined.

Missing a chance to prevent: disparities in completion of genetic evaluation in high-risk patients with endometrial cancer

The primary goal of this study is to examine disparities in high-risk endometrial cancer (EC) patients in relation to rates of genetic referrals (GR), testing (GT), and counseling (GC). This is a retrospective analysis of patients with newly diagnosed EC between January 1, 2014 and September 1, 2020 at a single institution. Patients were defined as high-risk EC patients when they were 1) diagnosed at 50 years or younger, 2) had a positive family history for cancer or 3) had evidence of loss of mismatch repair protein expression on tumor immunohistochemistry. Rates of GR, GT and GC were analyzed based on race, ethnicity, primary language and insurance status. During the study period, 674 patients were diagnosed with EC and 249 (36.9%) were considered high-risk EC patients. Among high-risk patients, 128 (51.2%) were referred to GT and GC. Of those referred, 103 (80.5%) underwent GT and 85 (66.4%) completed GC. Out of all high-risk patients, 20 (18.4%) were positive for LS on GT and 29 (28.2%) had VUS results. In multivariate analysis, the odds of GT and GC referral were lower among patients who identified as Hispanic (OR=0.40; 95% CI=0.19-0.87; p=0.020). Patients who identified as black were less likely to receive GC when compared to patients of other races (p=0.030). It is our hope that through this data we will increase awareness around existing disparities in genetic evaluation for patients with EC and ultimately create strategies to improve equitable access to care for all patients.