Emily K. Hill

Assessing gynecologic and breast cancer survivors' sexual health care needs.

The objective of this study was to identify patterns of interest in receiving care for sexual concerns among women who were survivors of gynecologic and breast cancers.

Nomogram for predicting 5-year disease-specific mortality after primary surgery for epithelial ovarian cancer

OBJECTIVE To develop a nomogram based on established prognostic factors to predict the probability of 5-year disease-specific mortality after primary surgery for patients with all stages of epithelial ovarian cancer (EOC) and compare the predictive accuracy with the currently used International Federation of Gynecology and Obstetrics (FIGO) staging system. METHODS Using a prospectively kept database, we identified all patients with EOC who had their primary surgery at our institution between January 1996 and December 2004. Disease-specific mortality was estimated using the Kaplan-Meier method. Twenty-eight clinical and pathologic factors were analyzed. Significant factors on univariate analysis were included in the Cox proportional hazards regression model, which identified factors utilized in the nomogram. The concordance index (CI) was used as an accuracy measure, with bootstrapping to correct for optimistic bias. Calibration plots were constructed. RESULTS A total of 478 patients with EOC were included. The most predictive nomogram was constructed using seven variables: age, FIGO stage, residual disease status, preoperative albumin level, histology, family history suggestive of hereditary breast/ovarian cancer (HBOC) syndrome, and American Society of Anesthesiologists (ASA) status. This nomogram was internally validated using bootstrapping and shown to have excellent calibration with a bootstrap-corrected CI of 0.714. The CI for FIGO staging alone was significantly less at 0.62 (P=0.002). CONCLUSION We have developed an all-stage nomogram to predict 5-year disease-specific mortality after primary surgery for epithelial ovarian cancer. This tool is more accurate than FIGO staging and should be useful for patient counseling, clinical trial eligibility, postoperative management, and follow-up.

Medical Therapy of Endometrial Cancer

While early-stage endometrial cancer is often successfully treated with surgical intervention, treatment of advanced endometrial carcinoma can be difficult and prognosis poor, particularly in the context of metastatic or recurrent disease. Standard chemotherapy agents for both adjuvant first-line treatment (for selected patients deemed at high risk of relapse) and recurrent endometrial cancer include doxorubicin, platinum agents and paclitaxel. Investigational options currently being studied in phase II trials include both combined regimens of standard chemotherapeutic agents versus radiation as well as targeted treatments such as epothilones, mammalian target of rapamycin (mTOR) inhibitors and anti-angiogenic agents. Recent interest in the molecular pathways of carcinogenesis have lead to increased investigation of these novel agents and the hope that they will impact positively on the overall survival of women with endometrial cancer.

HE4 (WFDC2) gene overexpression promotes ovarian tumor growth

Selective overexpression of Human epididymal secretory protein E4 (HE4) points to a role in ovarian cancer tumorigenesis but little is known about the role the HE4 gene or the gene product plays. Here we show that elevated HE4 serum levels correlate with chemoresistance and decreased survival rates in EOC patients. HE4 overexpression promoted xenograft tumor growth and chemoresistance against cisplatin in an animal model resulting in reduced survival rates. HE4 displayed responses to tumor microenvironment constituents and presented increased expression as well as nuclear translocation upon EGF, VEGF and Insulin treatment and nucleolar localization with Insulin treatment. HE4 interacts with EGFR, IGF1R, and transcription factor HIF1α. Constructs of antisense phosphorothio-oligonucleotides targeting HE4 arrested tumor growth in nude mice. Collectively these findings implicate increased HE4 expression as a molecular factor in ovarian cancer tumorigenesis. Selective targeting directed towards the HE4 protein demonstrates therapeutic benefits for the treatment of ovarian cancer.

High Interest in Screening and Treatment for Mild Cognitive Impairment in Older Adults: A Pilot Study

OBJECTIVES: To assess interest of older adults in screening and treatment for mild cognitive impairment (MCI).

Gender Differences in Scholarly Productivity Within Academic Gynecologic Oncology Departments

OBJECTIVE: To estimate whether there is a gender difference in scholarly productivity among academic gynecologic oncologists. METHODS: In this cross-sectional study, the academic rank and gender of gynecologic oncology faculty in the United States were determined from online residency and fellowship directories and departmental web sites. Each individuals h-index and years of publication were determined from Scopus (a citation database of peer-reviewed literature). The h-index is a quantification of an authors scholarly productivity that combines the number of publications with the number of times the publications have been cited. We generated descriptive statistics and compared rank, gender, and productivity scores. RESULTS: Five hundred seven academic faculty within 137 U.S. teaching programs were identified. Of these, 215 (42%) were female and 292 (58%) were male. Men had significantly higher median h-indices than women, 16 compared with 8, respectively (P<.001). Women were more likely to be of junior academic rank with 63% of assistant professors being female compared with 20% of full professors. When stratifying h-indices by gender and academic rank, men had significantly higher h-indices at the assistant professor level (7 compared with 5, P<.001); however, this difference disappeared at the higher ranks. Stratifying by the years of active publication, there was no significant difference between genders. CONCLUSION: Female gynecologic oncologists at the assistant professor level had lower scholarly productivity than men; however, at higher academic ranks, they equaled their male counterparts. Women were more junior in rank, had published for fewer years, and were underrepresented in leadership positions. LEVEL OF EVIDENCE: III

Stress and burnout among gynecologic oncologists: A Society of Gynecologic Oncology Evidence-based Review and Recommendations

Burnout in physicians is a significant problem in all fields of medicine. A 2008 survey of members of the American College of Surgeons (ACS) and a 2014 survey of members of the Society of Gynecologic Oncology (SGO) reported that physician burnout occurs in 32% to 40% of gynecologic oncologists and surgeons This article describes the risk factors responsible for burnout in gynecologic oncologists and other physicians and the consequences of burnout and explores potential solutions. Data from the oncology, trauma, and surgical literature have shown that physicians treating themost acutely ill patients have 40% or greater prevalence of burnout. At the individual level, burnout is indicative of emotional exhaustion and stress, depersonalization in relationships with coworkers, detachment from patients, a sense of inadequacy or low personal accomplishment, mental illness, substance abuse, and risk of suicide. In the SGO survey, 33% of respondents screened positive for depression, 11% took medication for depression, and 14% experienced panic attacks. The ACS survey corroborated these findings, reporting that 30% of surgeons screened positive for symptoms of depression. Substance abuse was identified in 15% of gynecologic oncologists; there was a positive screen for alcohol abuse and suicidal ideation. The SGO survey reported that only 9% of respondents had sought psychiatric care in the previous 12months, and 45%were reluctant to seek psychiatric care. Suicide is a significant problem among all physicians who experience burnout; suicide rates are higher among female physicians. In both the SGO survey and the ACS survey, 13% to 14% of respondents reported suicidal ideation. At the professional level, physician burnout impacts patient care as shown by suboptimal patient outcomes, increased medical errors, increased liability claims, and inappropriate prescriptions. Because few studies have specifically assessed burnout in gynecologic oncologists, much of what is understood about burnout has been extrapolated from a variety of other physician specialties. Risk factors for burnout: Job stress is one of the most important factors associated with physician burnout. Gynecologic oncologists with a low perception of internal locus of control and increased anxiety with end-of-life care have greater work-related stress. Loss of a sense ofmeaning fromwork has been shown to increase the risk of physician burnout. Changing interests and career drift can develop over time. Gynecologic oncologists who devote most of their time and effort to patient care and surgery may find that they derive more job satisfaction and meaning in research and be unable to do so. The difficulty balancing career with family/personal life is a key factor contributing to burnout. In the AGS survey, worklife balance issues predicted burnout equally in both sexes, but the effect was more pronounced among female physicians. Modern home computer technology has a major affect on work-life balance in that physicians have 24-hour access to patient records, shared communication with colleagues, and on-demand educational resources. Risk factors for burnout in the AGS survey were having younger children between the ages of 5 and 21 years, income based on patient care billing, and working at least 60 hours per week. The SGO survey reported that independent risk factors associated with burnout were low mental quality of life, depression, being stressed and overwhelmed, suicidal ideation, alcohol abuse, and reluctance to seek care. The findings of a large study among US physicians assessing work-home conflict in dual-career relationships reported that female physicians were more likely to report signs or symptoms of burnout than male physicians. Copyright

Profound sensorineural hearing loss after one cycle of intraperitoneal cisplatin in treatment of advanced ovarian cancer

Few advances in the treatment of advanced epithelial ovarian cancer have improved patient overall survival. However, the incorporation of intraperitoneal administration of platinum based chemotherapy to standard treatment was one such advancement. It is understood that the intraperitoneal regimen is associated with increased toxicity when compared to intravenous administration alone; however, information regarding the specific risk of ototoxicity is lacking in the literature. We report a case of almost complete sensorineural hearing loss after one cycle of intraperitoneal cisplatin. Three days after receiving an intravenous 24 h paclitaxel at 135 mg/m2 and subsequent intraperitoneal infusion of cisplatin at 75 mg/m2, the patient presented with profound bilateral sensorineural hearing loss. The patient experienced no recovery of hearing despite an aggressive systemic steroid taper and change in chemotherapy regimen to alternative agents. She is currently under consideration for cochlear device implantation. Generally, cisplatin related ototoxicity during treatment of epithelial ovarian cancer is gradual, limited to high-frequency ranges and dose-related; however, the toxicity with only one standard dose can be profound and irreversible. This risk should be addressed when counseling patients prior to initiation of treatment.

A change in the balance between personal and professional life among female gynecologic oncologists

Background: Female representation in gynecologic oncology has increased over the last two decades. Our objective was to compare work-life balance issues faced by female gynecologic oncologists between 1998 and 2015. Material/Methods: We conducted a cross-sectional survey of physician members of the Society of Gynecologic Oncology. A survey sent to female gynecologic oncologists in 1998 was expanded, piloted with 10 volunteers, and administered in electronic format (DatStat Illume) in February 2015. There were 75 fixed response questions regarding 4 domains: demographics, mentoring issues, work-life balance, and caregiving responsibilities. We compared 2015 responses to the 1998 aggregate survey data. Data were analyzed using Stata 10 (Statacorp, College Station TX) with Chi-square/Fisher’s exact tests using aggregate data functions. Results: 172 of 643 female gynecologic oncologists (26.7% response rate) completed the 2015 survey. The historical comparison group included 82 females (56.2% response rate). While more women in 2015 versus 1998 reported starting a family during residency or fellowship (57.7% vs. 36.0%, p<0.009), 42% still waited until after training. More than half (55.9%) of respondents in 2015 said the timing of becoming a parent led to some or a great deal of relationship stress compared to only 20% in 1998 (p<0.0001). The majority of divorces were in fellowship for both groups with 8 (50.0%) in 2015 compared to 5 (45.5%) in 1998 (p=0.8). In 2015, 5 (83.4%) women divorced after fellowship and felt their career had a moderate to great influence on their divorce. Conclusions: Despite changes in work-life balance and caregiving responsibilities in female gynecologic oncologists between 1998 and 2015, challenges still exist today. Correspondence to: Ashley R Stuckey, Women and Infants Hospital, 101 Dudley St, Providence, RI 02905, USA, Tel: (401) 453-7520; Fax: (401) 453-7529; E-mail: astuckey@wihri.org

Current Mentorship Practices in Gynecologic Oncology [20P]

INTRODUCTION: Our objective was to describe mentoring practices among gynecologic oncologists. METHODS: We conducted a cross-sectional survey of gynecologic oncology physician members of the Society of Gynecologic Oncology. A survey sent to female gynecologic oncologists in 1998 was expanded, piloted, and administered electronically (DataStat Illume). Our 2015 instrument contained 75 fixed response questions in 4 domains: Demographics; Mentoring issues; Work-life Balance; Caregiving Responsibilities. Data was analyzed using Chi-square/Fishers exact test (Stata 10). RESULTS: We had a 22% response rate (268 of 1246), comprised of 64% women and 36% men. Fifty percent were between the ages of 30–40. 54% were in academic practice and 21% in fellowship. The majority (50%) reported currently having a mentor. Most (54%) had a male mentor, but 25% had both a male and female mentor. 41% of women had only a male mentor, while only 8% of men had only a female mentor. Most classified their mentor as academic (86%), but 29% reported a personal mentor. More women than men felt that it was somewhat important, important or very important that a mentor be the same gender (68.6% vs 41.7%, P<.001). Whether it was important that a mentor have children also differed between genders (37.5% of men vs 64.5% of women, P<.001). Formal mentoring programs were uncommon (28%). The majority (58%) also served as mentors themselves. CONCLUSION: The majority of gynecologic oncologists both receive and provide mentorship, despite few formal programs. Women placed greater value on having a mentor of the same gender and with children.