Artificial intelligence (AI) applications to medical care are currently under investigation. We aimed to evaluate and compare the quality and accuracy of physician and chatbot responses to common clinical questions in gynecologic oncology. In this cross-sectional pilot study, ten questions about the knowledge and management of gynecologic cancers were selected. Each question was answered by a recruited gynecologic oncologist, ChatGPT (Generative Pretreated Transformer) AI platform, and Bard by Google AI platform. Five recruited gynecologic oncologists who were blinded to the study design were allowed 15 min to respond to each of two questions. Chatbot responses were generated by inserting the question into a fresh session in September 2023. Qualifiers and language identifying the response source were removed. Three gynecologic oncology providers who were blinded to the response source independently reviewed and rated response quality using a 5-point Likert scale, evaluated each response for accuracy, and selected the best response for each question. Overall, physician responses were judged to be best in 76.7 % of evaluations versus ChatGPT (10.0 %) and Bard (13.3 %; p < 0.001). The average quality of responses was 4.2/5.0 for physicians, 3.0/5.0 for ChatGPT and 2.8/5.0 for Bard (t-test for both and ANOVA p < 0.001). Physicians provided a higher proportion of accurate responses (86.7 %) compared to ChatGPT (60 %) and Bard (43 %; p < 0.001 for both). Physicians provided higher quality responses to gynecologic oncology clinical questions compared to chatbots. Patients should be cautioned against non-validated AI platforms for medical advice; larger studies on the use of AI for medical advice are needed.

Objective. To describe and evaluate the effects of implementation of a venous thromboembolism (VTE) prophylaxis quality improvement (QI) initiative on a gynecologic oncology service at a single institution. Methods. Prior to 2018, no consensus gynecologic oncology VTE prophylaxis protocol existed at the authors' academic institution. Published, evidence-based guidelines were reviewed to create a standardized VTE risk stratification algorithm. Interventions to improve perioperative heparin administration and sequential compression device (SCD) compliance as well as provider/patient education efforts were introduced in January 2018. Initial efforts included nursing and patient SCD education, internal dissemination of VTE prophylaxis guidelines, and creation of a VTE 'dashboard' to track performance. During a second phase, VTE prophylaxis guidelines were reviewed and further refined, non-compliant operative cases reviewed weekly, and guidelines incorporated into the electronic medical record. Performance was measured using Tableau data software (www.tableau. com) and by separately evaluating adherence to the developed guidelines in three retrospective cancer enriched surgical cohorts (2016-2017, 2018, 2019). Results. Compared to the baseline period, we observed a reduction in VTE rate during the 2018-2019 VTE QI implementation period from 2.1% (19/905) to 1.0% (20/2015, p = 0.02) among gynecologic oncology inpatients. In the retrospective cancer-enriched cohorts, adherence to evidence based guidelines improved: 31.0% in 2016-2017, 69.1% in 2018, and 82.4% in 2019 (p < 0.001). There were no significant differences in rates of peri-operative blood transfusion, surgical site infections, hematomas, or vaginal cuff dehiscences. Conclusions. Implementation of a robust VTE prophylaxis QI initiative has resulted in improved VTE prophylaxis guideline adherence and higher rates of pre-operative heparin administration. (c) 2021 Published by Elsevier Inc.

Objectives: To evaluate implementation of a venous thromboembolism (VTE) prophylaxis algorithm on adherence to evidence-based guidelines including the rate of administration of preoperative heparin and the overall VTE rate on the gynecologic-oncology service at a single institution. Methods: Prior to 2018, no consensus VTE prophylaxis protocol existed on the gynecologic oncology service at the authors’ academic institution. ACOG and Chest guidelines were used to modify a published gynecology VTE risk algorithm. Interventions to improve preoperative heparin administration included: ID badge algorithm attachments, placards in operating rooms, integration of algorithm into the H&P template and order set in the electronic medical record. Surgical, anesthesia, and nursing teams were contacted to investigate cases in which pre-operative heparin was indicated but not administered. In 2020, three retrospective cohorts of 100 patients each (2016-2017, 2018, and 2019) spanning the pre-, intra- and post-QI implementation periods were consecutively identified using cancer and radical surgery-specific CPT codes to evaluate performance in these highest risk cases; cohorts were filled to 100 using randomly selected additional gynecologic oncology cases. Perioperative heparin administration and VTE rates were evaluated. Proportions were compared using chi-square tests; continuous factors were compared using ANOVA or Kruskal-Wallis tests. Results: Conclusions: Implementation of an individualized perioperative VTE prophylaxis algorithm has resulted in improved adherence to evidence-based prophylaxis guidelines and improvement in rates of preoperative heparin administration; observed trends in VTE rates have not achieved significance. To evaluate implementation of a venous thromboembolism (VTE) prophylaxis algorithm on adherence to evidence-based guidelines including the rate of administration of preoperative heparin and the overall VTE rate on the gynecologic-oncology service at a single institution. Prior to 2018, no consensus VTE prophylaxis protocol existed on the gynecologic oncology service at the authors’ academic institution. ACOG and Chest guidelines were used to modify a published gynecology VTE risk algorithm. Interventions to improve preoperative heparin administration included: ID badge algorithm attachments, placards in operating rooms, integration of algorithm into the H&P template and order set in the electronic medical record. Surgical, anesthesia, and nursing teams were contacted to investigate cases in which pre-operative heparin was indicated but not administered. In 2020, three retrospective cohorts of 100 patients each (2016-2017, 2018, and 2019) spanning the pre-, intra- and post-QI implementation periods were consecutively identified using cancer and radical surgery-specific CPT codes to evaluate performance in these highest risk cases; cohorts were filled to 100 using randomly selected additional gynecologic oncology cases. Perioperative heparin administration and VTE rates were evaluated. Proportions were compared using chi-square tests; continuous factors were compared using ANOVA or Kruskal-Wallis tests. Implementation of an individualized perioperative VTE prophylaxis algorithm has resulted in improved adherence to evidence-based prophylaxis guidelines and improvement in rates of preoperative heparin administration; observed trends in VTE rates have not achieved significance.

Objectives. FDA-approved treatments for platinum-sensitive recurrent ovarian cancer (PSROC) include bevacizumab and PARP inhibitors (PARPi); clinical decisions regarding therapy must be made prior to initiating chemotherapy. Using the American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology (ESMO) value frameworks, we assessed relative values of concurrent/maintenance biologic therapies in PSROC. Methods. Value scores were calculated for key maintenance therapies based on randomized controlled trials: bevacizumab (OCEANS, GOG 213); olaparib (Study 19, SOLO2); niraparib (NOVA); rucaparib (ARIEL3). Personalized value scorecards were constructed for patients with germline/somatic-BRCA mutations, homologous recombination deficiency (HRD), and wild-type BRCA (wBRCA). ASCO value scores assess clinical benefit, toxicity, long-term survival, symptom palliation, treatment-free interval, and quality of life (QOL). ESMO value scores assess clinical benefit, toxicity, and QOL. Results. ASCO scores were highest for maintenance PARPi in germline/somatic-BRCA mutation cohorts: olaparib (SOLO2) = 47, (Study 19) = 62; niraparib = 50; rucaparib = 54. HRD cohorts had slightly lower scores: niraparib = 46; rucaparib = 37. wBRCA cohorts had the lowest scores: niraparib = 26; rucaparib = 26; and olaparib (Study 19) = 32, as did patients receiving bevacizumab (OCEANS) = 35, (GOG 213) = 26. ESMO scores demonstrated high-value for maintenance PARPi in germline/somatic-BRCA mutation cohorts and low-value for bevacizumab and PARPi in wBRCA cohorts. Conclusions. The value of maintenance PARPi therapy depends heavily on BRCA status, with the highest value scores in germline/somatic-BRCA mutation cohorts. Personalized value scorecards provide a visual aid to assess the harm-benefit balance of maintenance PARPi for PSROC. (C) 2018 Elsevier Inc. All rights reserved.

Objectives. The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF) and Medicare Physician and Other Supplier National Provider Identifier (POS NPI) Aggregate Report are publicly available files from the Center for Medicare and Medicaid Services that include payments to providers who care for fee-for-service Medicare recipients. The aim of this study was to analyze variability in gynecologic oncologists' Medicare reimbursements, with attention to differences in provider gender and time in practice. Methods. The 2015 POSPUF and POS NPI were analyzed with respect to gynecologic oncologists. We searched external publicly available data sources to confirm subspecialty and to determine each provider's number of years in practice. Evaluation and management (E&M) and procedure/surgery codes were analyzed; drug delivery codes were excluded due to variability in billing by facility/hospital. Results. The POS NPI file included 733 gynecologic oncologist providers receiving $55,626,739 in total payments. Female providers comprised 39% of gynecologic oncologists and received 31% of reimbursements (30% of E&M reimbursements and 24% of surgical reimbursements). During the first ten years in practice, female providers comprised 58% of providers and accounted for 52% of reimbursed services, compared to 38% of providers/ 26% of reimbursed services (11-20 years), and 18% of providers/19% of reimbursed services (>20 years). Conclusion. Male gynecologic oncologists perform more Medicare services than their female counterparts. There is a comparable number of services performed between genders among both the most senior and the most junior providers, with a gender gap in services and reimbursements among mid-career providers. (C) 2019 Published by Elsevier Inc.

ObjectiveTo investigate the predictive value of lymphovascular space invasion (LVSI) for nodal recurrence and overall survival (OS) in patients with stage I endometrioid endometrial cancer (EC) following surgical staging that included adequate lymph node sampling.MethodsRetrospective analyses of patients undergoing surgical staging for FIGO stage I endometrioid EC between 1998 and 2015 were performed using an institutional database and the National Cancer Database (NCDB). Using the institutional database, logistic regression modeling identified predictors of nodal recurrence; Cox proportional hazards modeling was used to predict progression-free survival (PFS). Utilizing NCDB, Cox proportional hazards modeling was used to predict OS. The Kaplan-Meier method was used to estimate hazard ratios (HR). Survival curves were compared using the log-rank test.ResultsAmong 275 institutional cases, LVSI was present in 48 (17.5%). There were 11 nodal recurrences: 18.8% (9/48) of cases with LVSI had a nodal recurrence compared to 0.88% (2/227) of those without LVSI. In multivariate analysis of institutional data, LVSI was the only significant predictor of nodal recurrence (p=0.002). Among 28,076 NCDB cases, LVSI was present in 3766 (13.5%). In multivariate analysis of NCDB, grade 3, LVSI, and depth of invasion (all p<0.001) were prognostic for OS after adjusting for adjuvant radiation.ConclusionLVSI is an independent prognostic factor for nodal recurrence in stage I endometrial cancer with lymph node assessment. LVSI is associated with lower OS in NCDB. Given these findings, adjuvant therapy could be considered in these patients.

e13621 Background: Although genetic testing is recommended for women with epithelial ovarian cancer (EOC), little is known about patient preferences for the various testing options. Our objective was to measure relative preferences for features of genetic testing in women with EOC referred for genetic counseling. Methods: 100 women with EOC and planned referral for genetic testing were recruited to participate in a survey to elicit their preferences for 5 attributes of single gene vs multigene genetic testing, each presented with 2-4 levels: out-of-pocket cost ($0, $100, $250, $1,000), probability of identifying a deleterious mutation (60%, 80%, 88%) or a variant of uncertain significance (VUS) (5%, 20%, 40%), sample requirements (blood or saliva) and turn-around time (1, 2 or 4 weeks). Subjects viewed an educational video and were then asked to choose between 2 unlabeled testing scenarios, each with variations in the levels displayed, with 13 iterations of this task. We used a mixed logit regression to model patients’ choices as a function of attribute levels and to obtain log-odds estimates indicating the preference weights for each attribute level. Results: 94 EOC patients were enrolled; 68 (76.4%) subsequently presented for a genetic counseling appointment. 46 (48.9%) had a family history of breast and/or ovarian cancer. Test cost was the most important attribute and assigned an importance weight of 10, followed by the ability of a test to detect deleterious mutations (importance weight 8.8) or VUS (4.9). Sample requirements (0.4) and turnaround time (0.1) did not significantly drive the choice of a genetic test. Subjects valued an improvement from 60 to 88% in the probability of detecting a deleterious mutation at $877 (CI: $583-$1226). Similarly, subjects valued an improvement in detecting a VUS from 5% to 40% at $492 (CI: $305-$718). At subsequent genetics consultation, 55/68 (80.9%) subjects chose multigene testing, 8/68 (11.8%) chose BRCA1/2 testing only and 5/68 (7.4%) declined testing. Conclusions: Low out of pocket cost of testing and a high detection rate for both informative/deleterious and uninformative/variant mutations are preferred by patients with EOC who are considering genetic testing.

Objective: Therapeutic options for women with PSROC who respond to reinduction platinum have expanded to include several treatment options. Clinical decisions regarding maintenance therapy need to be made prior to initiating chemotherapy. We assessed the clinical benefit of maintenance novel biologic therapies in the management of PSROC using the American Society of Clinical Oncology (ASCO) Net Health Benefit (NHB) and the European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale (MCBS).

Objective: The American Society of Clinical Oncology (ASCO) value snapshot is a visual representation of novel treatments that includes clinical benefit, toxicity, and costs. We assessed whether patients view the value snapshot as a helpful tool during counseling and queried the importance to patients of third-party-payer costs versus out-of-pocket costs when making a treatment decision.

Objective Predictive models are increasingly being used in clinical practice. The aim of the study was to develop a predictive model to identify patients with platinum-resistant ovarian cancer with a prognosis of less than 6 to 12 months who may benefit from immediate referral to hospice care. Methods A retrospective chart review identified patients with platinum-resistant epithelial ovarian cancer who were treated at our institution between 2000 and 2011. A predictive model for survival was constructed based on the time from development of platinum resistance to death. Multivariate logistic regression modeling was used to identify significant survival predictors and to develop a predictive model. The following variables were included: time from diagnosis to platinum resistance, initial stage, debulking status, number of relapses, comorbidity score, albumin, hemoglobin, CA-125 levels, liver/lung metastasis, and the presence of a significant clinical event (SCE). An SCE was defined as a malignant bowel obstruction, pleural effusion, or ascites occurring on or before the diagnosis of platinum resistance. Results One hundred sixty-four patients met inclusion criteria. In the regression analysis, only an SCE and the presence of liver or lung metastasis were associated with poorer short-term survival (P < 0.001). Nine percent of patients with an SCE or liver or lung metastasis survived 6 months or greater and 0% survived 12 months or greater, compared with 85% and 67% of patients without an SCE or liver or lung metastasis, respectively. Conclusions Patients with platinum-resistant ovarian cancer who have experienced an SCE or liver or lung metastasis have a high risk of death within 6 months and should be considered for immediate referral to hospice care.

5599 Background: The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF) for 2015 is a publicly available file from the CMS that includes all direct payments to providers who care for fee-for-service Medicare recipients. The objective of this study was to analyze variability in gynecologic oncologists’ Medicare utilization and reimbursements, with attention to differences based on provider gender and time spent in practice. Methods: The POSPUF 2015 was analyzed with respect to Gynecologic Oncology specialty providers. We used publicly available data to confirm gynecologic oncology subspecialty and to determine each provider’s total number of years in gynecologic oncology practice. Evaluation, management, and procedure/surgery codes were analyzed; drug delivery codes were excluded due to variability in billing these by facility/hospital. Results: The POSPUF file included 824 gynecologic oncologist providers receiving a total of $28,772,739 in payments. The majority of providers practiced in large metropolitan areas (66%) or mid-sized metro areas (27%). While females composed 38.5% of gynecologic oncologists, they accounted for only 28.1% of Medicare reimbursements. The median Medicare reimbursement to a Gynecologic Oncologist was $24,828 (IQR $11,564, $45,412), but this was significantly different by gender; female $19,394 (IQR $10,913, $34,894) compared to male $29,395 (IQR $13,903, $52,941). Overall, female providers receive 30.4% of evaluation and management reimbursements and 22.5% of surgical reimbursements. During the first ten years in practice, women composed 47.0% of providers and accounted for 52.3% of the services reimbursed, compared to 36.25% of providers/26.6% of the reimbursed services (11-20 years in practice), and 18.11% of providers/16.4% of services ( > 20 years in practice). Conclusions: While male gynecologic oncologists receive higher median reimbursements than females, there is a trend toward equal services and reimbursements between genders among younger providers, suggesting a trend toward gender equity over time.

•Physician payment reform has escalated over the last few decades. •Value-based care delivery is critical in maximizing quality and cost effectiveness. •Alternative payment models will be used for future physician reimbursement.

5544 Background: The ASCO value framework allows assessment of novel cancer therapies based on NHB. We assessed novel biologic therapies in the management of PSROC. Methods: ASCO’s revised value framework NHBs were constructed for key therapies based on randomized clinical trials for PSROC. BRCA-germline and HRD status were included. Additionally, patient-centered NHB calculations were weighted based on results from a prospective patient preferences study (n=54) and compared to ASCO-based NHB. Results: ASCO-centered NHB calculations were: platinum + taxane-based chemotherapy (ICON4) = 35; carboplatin + liposomal doxorubicin (CALYPSO) = 22; platinum-based chemotherapy + bevacizumab (OCEANS = 35; GOG 213 = 26). NHB scores based on germline-BRCA alterations were maintenance niraparib (NOVA) = 50 and maintenance olaparib (Study 19) = 62; wild-type BRCA, maintenance niraparib = 36 and maintenance olaparib = 33; and HRD-positive status, maintenance niraparib = 42. Patients valued clinical benefit as the most important component of NHB. Patients valued OS as the most important component of clinical benefit, followed by response rate (RR), then PFS. Patient-weighted NHB were significantly lower than ASCO-weighted scores (mean NHB 37.8 versus 23.5; p=0.009) due to decreased preference for PFS compared to other clinical benefit measures (Table). Conclusions: NHB scores for treatment of PSROC were highest in women with germline-BRCA and HRD tumor alterations who were treated with maintenance PARPi. Our data suggest that a patient-centered NHBs can be used to inform treatment decisions. [Table: see text]

Purpose The ASCO value framework allows physicians and patients to compare the relative value of novel treatments. Our aim was to assess the value of three frontline ovarian cancer therapies by using this framework. Methods From phase III, randomized controlled clinical trial (RCT) data, the net health benefits (NHBs) for three frontline ovarian cancer treatment options-dose-dense paclitaxel (Japanese Gynecologic Oncology Group study JGOG 3016), intraperitoneal (IP)/intravenous (IV) chemotherapy (Gynecologic Oncology Group[GOG] study GOG 172), and concurrent plus maintenance bevacizumab (GOG 218 and the Seventh International Collaborative Ovarian Neoplasm study [ICON7])-were calculated. The ASCO value framework calculates the NHB by using six criteria: clinical benefit, toxicity, tail of the curve, symptom palliation, treatment-free interval, and quality of life. Clinical benefit calculation uses ASCO-assigned importance weights for overall survival and progression-free survival. The maximum possible NHB points is 180. NHBs were presented alongside the drug-acquisition cost (DAC) of each therapy. A benefit-cost ratio of NHB points per additional cost was calculated. Results The NHB of dose-dense paclitaxel was 38, at an additional cost of $16 per cycle. IP cisplatin/IV + IP paclitaxel received 29 NHB points, at an additional cost of $1,629 per cycle. Concurrent plus maintenance bevacizumab received 24 NHB points, at an additional cost of $7,581 per cycle (GOG 218) or six NHB points ($3,790 per cycle; ICON7). The ratios of NHB points-to-dollar were as follows: dose-dense paclitaxel, 2.4 (highest); IP chemotherapy, 0.018; and bevacizumab, 0.003 (lowest). Conclusion Using the ASCO value framework, we constructed value snapshots of three major frontline therapeutic options in ovarian cancer. Dose-dense paclitaxel provided the highest additional value when analysis accounted for NHB and cost. However, additional research is needed to include individual patient preferences and provide personalized value assessments.

Objective: Utilizing the National Cancer Data Base (NCDB), we explored prognostic indicators and optimal treatment modalities in vulvar melanoma.

PURPOSE:Prior studies have demonstrated the importance of treatment duration (TD) in radiation therapy (RT) for cervical cancer, with an 8-week goal based primarily on RT alone. This study uses a contemporary cohort to estimate the time point by which completion of chemoradiation therapy is most critical.PATIENTS AND METHODS:The National Cancer Database was queried for women with nonmetastatic cervical cancer diagnosed from 2004 to 2012 who underwent chemotherapy, external beam RT, and brachytherapy. Data-derived TD cut points for overall survival (OS) were computed by using recursive partitioning analysis with bootstrapped aggregation (bagging) and 10-fold cross-validation. Models were independently trained with 70% of the population and validated on 30% of the population by log-rank test with and without propensity matching. Multivariable Cox proportional hazards regression was performed for the entire cohort.RESULTS:In all, 7,355 women were identified with a median TD of 57 days. Bagged recursive partitioning analysis converged to a mean cut point of 66.6 days (median, 64.5 days; interquartile range, 63.5 to 68.5 days). Cross-validation yielded a cut point of 63.3 days. Both cut points differentiated OS in validation. Younger age, recent diagnosis, geographic region, nongovernment insurance, shorter distance to treatment facility, metropolitan location, lower comorbidity, squamous cell carcinoma, lower stage, negative lymph nodes, and shorter TD were independently associated with longer OS. With adjustment, TD within the mean cut point (64.9 days; hazard ratio, 0.79; 95% CI, 0.73 to 0.87) and 56 days (hazard ratio, 0.87; 95% CI, 0.80 to 0.95) were associated with longer OS. Exploratory stratification suggested increasing OS detriment beyond 64 days.CONCLUSION:Shorter chemoradiation TD in cervical cancer is associated with longer survival, and TD should be minimized as much as possible. The data-derived cut point was distributed around 64 days, with a continuous relationship between shorter TD and longer OS.

Objectives The objective of this study was to evaluate patterns of care and the survival impact of primary radiation and preoperative radiation therapy with surgery in women with locally advanced vulvar cancer using a large national cohort. Methods and Materials Women with vulvar cancer, diagnosed from 2004 to 2012, who received primary or preoperative radiation therapy were identified in the National Cancer Database. Patient characteristics, such as age, race, American Joint Committee on Cancer stage, and comorbidity score, were compared between those that received primary radiation only and those that received preoperative radiation with surgery using the χ 2 , Fisher exact, and Mann-Whitney tests as appropriate. Overall survival (OS) by treatment approaches was estimated via the Kaplan-Meier method and compared using the log-rank test. Factors associated with OS were determined using univariate and multivariate Cox proportional hazards regression models. Results A total of 2046 women were identified; 1407 of these women (69%) received primary radiation therapy (RT; n = 421) or chemoradiation therapy (CRT; n = 986) (RT/CRT), and 639 women (31%) received preoperative RT (n = 92) or CRT (n = 547) followed by surgery (RT/CRT + S). The American Joint Committee on Cancer staging distributions were as follows: T1 (n = 152), T2 (n = 1436), T3 (n = 405), N0 (n = 899), N1 (n = 480), N2 (n = 445), and N3 (n = 40). Median follow-up was 21.9 months. Primary RT/CRT was associated with compromised OS, compared with preoperative RT/CRT + S (41.7% vs 57.1% at 3 years, respectively; P < 0.001). On multivariate analysis, OS associated with primary RT/CRT with doses more than 55 Gy was not significantly different from RT/CRT + S (hazards ratio, 1.139; 95% confidence interval, 0.969–1.338; P = 0.116). Use of concurrent chemotherapy improved OS of primary RT with doses more than 55 Gy compared with CRT + S (hazards ratio, 1.107; 95% confidence interval, 0.919–1.334; P = 0.234). Conclusions In a large nationwide analysis, primary nonsurgical management of vulvar cancer with RT was associated with compromised survival compared with preoperative RT with surgery. However, with doses more than 55 Gy and concurrent chemotherapy, nonoperative approaches had comparable survival compared with preoperative CRT + S.

Objective The aim of the study was to assess interaction of lymph node dissection (LND), adjuvant chemotherapy (CT), and radiotherapy (RT) in stage I uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCC).Methods/Materials The National Cancer Data Base was queried for women diagnosed with International Federation of Gynecology and Obstetrics stage I UPSC and UCC from 1998 to 2012. Overall survival (OS) was estimated for combinations of RT and CT by the Kaplan-Meier method stratified by histology and LND. Multivariate Cox proportional hazard models were generated.Results Uterine papillary serous carcinoma: 5432 women with UPSC were identified. Uterine papillary serous carcinoma had the highest 5-year OS with CT + RT with (83%) or without LND (76%). On multivariate analyses, CT [hazard ratio (HR), 0.77; P = 0.01] and vaginal cuff brachytherapy (HR, 0.68; P = 0.003) with LND were independently associated with OS. Without LND, vaginal cuff brachytherapy (HR, 0.53; P = 0.03), but not CT (HR, 1.21; P = 0.92), was associated with OS. Uterine clear cell carcinoma: 2516 women with UCC were identified. Uterine clear cell carcinoma with and without LND had comparable 5-year OS for all combinations of CT and RT on univariate and multivariate analyses.Conclusions In stage I papillary serous uterine cancer, brachytherapy and CT were associated with increased survival; however, the benefit of chemotherapy was limited to those with surgical staging. In contrast, no adjuvant therapy was associated with survival in stage I uterine clear cell carcinoma, and further investigation to identify more effective therapies is warranted.

Objective: The American Society of Clinical Oncology (ASCO) value framework assesses novel cancer therapies based on net health benefit (NHB) and cost. Using patient preferences and patient-reported out-of-pocket costs, we assessed the relative value of 3 standard regimens in the primary treatment of ovarian cancer: dose-dense paclitaxel, intraperitoneal (IP)/intravenous (IV) chemotherapy, and concurrent plus maintenance bevacizumab.