Publications by authors named "Ramey D Littell"
Background: Female cancer survivors often experience estrogen-deprivation symptoms, which may lead to decreases in sexual desire, vulvovaginal health (lubrication, dryness, discomfort), and sexual satisfaction. Interventions are needed to address these concerns.
Aim: The objective of this secondary analysis was to determine if women with higher (better) scores on the Female Sexual Function Index (FSFI) lubrication and pain subscales reported higher desire scores based on treatment with bupropion vs placebo.
Background And Objective: Several professional societies have recommended incorporating palliative care into routine oncology care, yet palliative care remains underutilized among women with gynecologic cancers. This narrative review highlights current evidence regarding utilization of palliative care in gynecologic oncology care. Additionally, the authors offer recommendations to increase early integration and utilization of palliative care services, improve education for current and future gynecologic oncology providers, and expand the palliative care workforce.
View Article and Find Full Text PDFPurpose: ATHENA (ClinicalTrials.gov identifier: NCT03522246) was designed to evaluate rucaparib first-line maintenance treatment in a broad patient population, including those without or (BRCA) mutations or other evidence of homologous recombination deficiency (HRD), or high-risk clinical characteristics such as residual disease. We report the results from the ATHENA-MONO comparison of rucaparib versus placebo.
View Article and Find Full Text PDFArticle Synopsis
- The study focuses on the outcomes of women with vaginal recurrences of endometrial cancer who underwent reirradiation, specifically using image-guided interstitial high-dose-rate (HDR) brachytherapy after previous treatments.
- Twenty-three women were analyzed, revealing a median time of 13.7 months since their initial radiation therapy, with various outcomes including an overall survival rate of 56% and local control rate of 87%.
- The findings suggest that while the reirradiation technique has a good local control rate and manageable toxicity, distant recurrences remain a significant challenge, indicating further research is necessary to optimize treatment strategies.
Article Synopsis
- Cervical cancer is the most prevalent gynecologic cancer globally, primarily linked to human papillomavirus exposure.
- Treatment options vary depending on the disease stage and can include surgery, radiation, chemotherapy, and immunotherapy, but these can lead to significant side effects and complications.
- Effective supportive care, both physical and emotional, is crucial for improving the quality of life for cervical cancer patients.
Objective: Referral to Genetics for pre-testing counseling may be inefficient for women with ovarian cancer. This study assesses feasibility of gynecologic oncologists directly offering genetic testing.
Methods: A prospective pilot study was conducted at two gynecologic oncology hubs in an integrated healthcare system from May 1 to November 6, 2019.
Objective: To assess the feasibility of a novel hysteroscopic catheter to collect fallopian tube cytologic samples and to correlate cytologic findings with histopathology.
Methods: This was a prospective, multicenter, single-arm pilot study. Women undergoing salpingo-oophorectomy for a pelvic mass suspicious for malignancy or for prevention of cancer for BRCA mutation carriers were recruited from 3 gynecologic oncology centers (October 2016-August 2017).
Background: Data are limited regarding the use of poly(adenosine diphosphate [ADP]-ribose) polymerase inhibitors, such as veliparib, in combination with chemotherapy followed by maintenance as initial treatment in patients with high-grade serous ovarian carcinoma.
Methods: In an international, phase 3, placebo-controlled trial, we assessed the efficacy of veliparib added to first-line induction chemotherapy with carboplatin and paclitaxel and continued as maintenance monotherapy in patients with previously untreated stage III or IV high-grade serous ovarian carcinoma. Patients were randomly assigned in a 1:1:1 ratio to receive chemotherapy plus placebo followed by placebo maintenance (control), chemotherapy plus veliparib followed by placebo maintenance (veliparib combination only), or chemotherapy plus veliparib followed by veliparib maintenance (veliparib throughout).
Effective communication between gynecologic oncology providers and patients is vital to patient-centered care. Skilled communication improves the patient's knowledge retention, builds trust in providers, enhances shared decision-making, and alleviates anxiety of both patients and caregivers. Effective communication is also associated with reduced provider burnout due to improved comfort from possessing the skills to handle emotionally charged situations.
View Article and Find Full Text PDFObjective: To estimate the rate of human papillomavirus (HPV) vaccine completion by race and ethnicity.
Methods: In this retrospective cohort study, we analyzed females aged 11-26 years who initiated HPV vaccination from 2008 through 2012 in a community-based health care system in California. Vaccine completion was defined as having received at least three injections.
Introduction: CC-002 is a prospective cooperative group study conducted by NRG Oncology to evaluate whether a pre-operative GA-GYN score derived from a predictive model utilizing components of an abbreviated geriatric assessment (GA) is associated with major post-operative complications in elderly women with suspected ovarian, fallopian tube, primary peritoneal or advanced stage papillary serous uterine (GYN) carcinoma undergoing primary open cytoreductive surgery.
Methods: Patients 70 years or older with suspected advanced gynecologic cancers undergoing evaluation for surgery were eligible. A GA-GYN score was derived from a model utilizing the GA as a pre-operative tool.
Objective: To evaluate the utilization rate of salpingectomy for cesarean deliveries and postpartum and interval tubal sterilization procedures.
Methods: This is a retrospective cohort study using the electronic medical record to identify women older than 18 years of age undergoing surgical sterilization from June 2011 to May 2016 in an integrated health care system. The primary objective is to describe the change in utilization rate of salpingectomy for tubal sterilization procedures over time and after a systemwide practice recommendation was issued in 2013.
Purpose: To evaluate clinical outcomes for isolated vaginal recurrence of endometrial cancer without adjuvant therapy treated with salvage external beam radiation therapy (EBRT) and high-dose-rate CT-based inverse-planned brachytherapy.
Methods And Materials: Thirty women were included in this retrospective study. Median time to first recurrence was 16.
Objective: To assess recent trends of administering adjuvant gemcitabine-docetaxel (GD) chemotherapy for Stage I uterine leiomyosarcoma, and to compare disease-free and overall survival between women who received and did not receive adjuvant GD chemotherapy.
Methods: All patients diagnosed with Stage I uterine leiomyosarcoma in a California-Colorado population-based health plan inclusive of 2006-2013 were included in a retrospective cohort. Adjuvant GD chemotherapy rates, clinico-pathologic characteristics and survival estimates were assessed.
Study Objective: To determine the association between resident involvement and operative time for minimally invasive surgery (MIS) for endometrial cancer.
Design: A retrospective cohort study (Canadian Task Force classification II-2).
Setting: An integrated health care system in Northern California.
Study Objective: To compare intraoperative and postoperative surgical complications and outcomes between robotic-assisted and laparoscopic surgical management of endometrial cancer using a standardized classification system.
Design: A retrospective cohort study (Canadian Task Force classification II-2).
Setting: An integrated health care system in Northern California.
Objective: To evaluate the trend in uptake of salpingectomy at the time of hysterectomy and assess physicians' attitudes toward the practice.
Methods: This was a retrospective cohort study using the electronic medical record to identify women 18 years of age or older undergoing hysterectomy from June 2011 to May 2014 in a large integrated health care delivery system. The primary outcome was the change in rate of opportunistic salpingectomy over time and after a systemwide practice recommendation was issued in May 2013.
Objective: To determine the rate of venous thromboembolism (VTE) among women undergoing minimally invasive surgery (MIS) for endometrial cancer.
Methods: Women undergoing robotic or laparoscopic hysterectomy for endometrial carcinoma or complex hyperplasia with atypia were identified between January 2009 and 2014 in a community based health care system. Patient data including age, race, cancer stage, grade, procedure type, length of hospital stay, use of prophylaxis, and diagnosis of VTE were collected retrospectively.
Objective: To estimate the incidence of occult uterine sarcoma and leiomyosarcoma in hysterectomies for leiomyomas and the risk associated with their morcellation.
Methods: We conducted a population-based cohort study. All uterine sarcomas from 2006-2013 in an integrated health care system were identified.
Article Synopsis
- The study aimed to assess how osteoporosis risk is managed in women with BRCA mutations after undergoing surgery to reduce cancer risk.
- A review of medical records from 225 women revealed that only 44% had a bone density scan after surgery, with many showing signs of bone loss.
- The findings suggest that women at risk for osteoporosis are often not screened adequately, highlighting the need for better screening guidelines for this group.
Objective: The aim was to identify clinical parameters and immunohistochemical markers predictive of recurrence and overall survival (OS) in a community cohort of patients with primary uterine leiomyosarcoma (ULMS).
Methods/materials: All patients with new diagnosis of ULMS from 1999 to 2007 were identified from the Kaiser Permanente Northern California pathology database. A retrospective chart review was performed to gather demographic and clinical data.
Article Synopsis
- * A study of 69 women with variants of unknown significance showed that only 30% chose risk-reducing salpingo-oophorectomy and 11% opted for mastectomy, much lower than the 74% and 44% respectively in women with deleterious mutations.
- * The findings suggest that women with variants of unknown significance are less likely to pursue aggressive preventive measures, highlighting the need for personalized counseling and alternative strategies like surveillance and chemoprevention.
Article Synopsis
- - The study aimed to evaluate how well BRCA mutation carriers in Northern California followed recommended risk-reducing options for ovarian and breast cancer, focusing on surgeries and surveillance practices.
- - Out of 305 eligible women, a majority underwent risk-reducing salpingo-oophorectomy (RRSO) and mastectomy but only a small percentage did so by the recommended ages; follow-up screenings dropped significantly after the first year.
- - Despite high initial uptake of RRSO, compliance with ongoing surveillance and use of preventive medications was low, highlighting the need for better support and standardized care for BRCA mutation carriers.
Objective: This study aimed to characterize the 24-month risk of cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) and grade 3 or worse (CIN 3+) in women with low-risk cytological finding and CIN 1 on endocervical curettage (ECC).
Materials And Methods: Cervical screening tests and cervical biopsy results from Kaiser Permanente Northern California were reviewed for years 2004 to 2008. Women with index cytological result of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion who underwent excisional procedure within 24 months of CIN 1 diagnosis were grouped by ECC status.