Objectives. Disparities persist in the enrollment of racial/ethnic groups in clinical trials for ovarian cancers. We sought to analyze the enrollment rates of patients by race/ethnicity in phase II/III clinical trials involving poly (ADP-ribose) polymerase (PARP) inhibitors for ovarian cancers and compare these to the racial/ethnic prevalence of ovarian cancers in the United States. Methods. This study was a retrospective review of clinical trials registered with ClinicalTrials.gov. Studies included evaluated PARP inhibitors for the treatment of ovarian, fallopian tube, and primary peritoneal cancers. Enrollment rates for clinical trials were stratified by race/ethnicity and type of cancer. Enrollment fractions (EFs) were calculated using prevalence data from the Surveillance, Epidemiology, and End Results Program. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to compare racial/ethnic group enrollment rates to Non-Hispanic (NH) White enrollment rates. Results. Forty-eight trials were identified, 15 of which met inclusion criteria. The EFs for included trials, were 1.5% for NH-White, 0.47% for NH-Black, 0.33% for Hispanic, and 2.38% for Asian/Pacific Islander. Patients who identified as NH-Black and Hispanic were significantly underrepresented compared to those who identified as NH-White (OR 0.23, 95% CI [0.18-0.29] and OR 0.3, 95% CI [0.25-0.38] respectively, p < 0.001). Conclusions. NH-Black and Hispanic patients are significantly underrepresented in clinical trials evaluating PARP inhibitors for ovarian cancers compared to NH-White cohorts. Phase II/III trials assessing PARP inhibitors for ovarian cancers do not accurately represent the populations diagnosed with these malignancies. Enrollment strategies are needed to increase diversity in PARP inhibitor clinical trials for women's cancers. (C) 2022 Elsevier Inc. All rights reserved.

In 2022, for the first time, uterine cancer (UC) will not only be the most common gynecologic cancer in the United States, but it may also match ovarian cancer in gross mortality.1Siegel R.L. Miller K.D. Fuchs H.E. Jemal A. Cancer statistics, 2022.CA Cancer J Clin. 2022; 72: 7-33Crossref PubMed Scopus (5944) Google Scholar This is in part owing to a lack of treatment advances in UC.1Siegel R.L. Miller K.D. Fuchs H.E. Jemal A. Cancer statistics, 2022.CA Cancer J Clin. 2022; 72: 7-33Crossref PubMed Scopus (5944) Google Scholar Gynecologic cancer trials suffer from low accrual2del Carmen M.G. Annunziata C.M. Rice L.W. The clinical trials crisis in gynecologic oncology.Gynecol Oncol. 2017; 145: 481-482Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar and receive significantly less public funding relative to societal burden than most other cancers receive.3Spencer R.J. Rice L.W. Ye C. Woo K. Uppal S. Disparities in the allocation of research funding to gynecologic cancers by Funding to Lethality scores.Gynecol Oncol. 2019; 152: 106-111Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar Most studies that have investigated cancer funding patterns utilize the federal funding data. In this study, we identified the trends in the number of open public- and industry-funded endometrial cancer trials relative to UC’s disease burden. We queried ClinicalTrials.gov to obtain the number of open endometrial cancer clinical trials that utilized public and industry funds from 2007 to 2019 in the United States. Public funders include the National Cancer Institute and other federal agencies. Industry funders represent pharmaceutical and device companies. A study is considered open if the date of first enrollment in that year begins between January 1 and December 31. The disability-adjusted life year (DALY) number incorporates the years of potential life lost owing to premature mortality and the years of productive life lost because of disability. DALY has been shown to correlate better with funding decisions than other cancer burden metrics.4Gross C.P. Anderson G.F. Powe N.R. The relation between funding by the National Institutes of Health and the burden of disease.N Engl J Med. 1999; 340: 1881-1887Crossref PubMed Scopus (391) Google Scholar The DALY numbers for UC from 2007 to 2019 were retrieved from the Institute for Health Metrics and Evaluation database.5Institute for Health Metrics and EvaluationGBD compare.http://vizhub.healthdata.org/gbd-compareDate: 2015Google Scholar The ratios of the number of open trials to DALY number per 100,000 people were generated as studies funded by public (#P/DALY) and industry (#I/DALY). Linear regression analyzed the trend lines and rates of change. This study was considered exempt from institutional review board approval. The results are presented in the Figure. From 2007 to 2019, UC’s DALY increased significantly (R2=0.981; P≤.001). The number of public-funded trials did not change (R2=0.072; P=.375), but the number of industry-funded trials rose significantly (R2=0.604; P=.002). #P/DALY showed a negative trend over the study period (R2=0.317; P=.045), reflecting decreases in the number of public-funded studies relative to the rise in DALY. By #I/DALY, endometrial cancer experienced significant increases in industry-funded studies relative to DALY (R2=0.427; P=.015). The Society of Gynecologic Oncology declared a clinical trial crisis in gynecologic oncology in 2016.2del Carmen M.G. Annunziata C.M. Rice L.W. The clinical trials crisis in gynecologic oncology.Gynecol Oncol. 2017; 145: 481-482Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar The reasons were multifactorial, but a commonality was the paucity of gynecologic cancer trials. Our findings found that, whereas industry-funded clinical trials rose significantly, public-funded trials for endometrial cancer did not increase significantly to reflect the striking rise in UC's societal burden from 2007 to 2019. In fact, relative to DALY, the number of public-funded trials decreased. This suggests that public funding for UC has been disproportionately low, considering its escalating disease burden. The opposite was seen with industry-funded studies. For public funding agencies to continue to meaningfully contribute to UC advancements, greater efforts need to be made to secure funding for clinical trials that is proportionate to its high and worrisome disease burden. Future studies that will additionally evaluate the number of patients enrolled by each funding source and utilize different burden metrics are warranted to investigate this differential allocation of funding resources in gynecologic cancer clinical trials.

Objectives: Disparities persist in the enrollment of diverse racial and ethnic groups in clinical trials for ovarian and breast cancers. We sought to analyze the enrollment of participants by race/ethnicity in phase II and III clinical trials involving poly ADP ribose polymerase (PARP) inhibitors for ovarian and breast cancers and compare these to the racial/ethnic prevalence of ovarian and breast cancer in the United States. Methods: This study was designed as a retrospective review of clinical trials registered with Clinicaltrials.gov. Studies included evaluated PARP inhibitors for the treatment of ovarian, fallopian tube, primary peritoneal, and breast cancers. Enrollment rates for clinical trials were stratified by race/ethnicity and type of cancer. Enrollment fractions (EF) were calculated using prevalence data from the Surveillance, Epidemiology, and End Results (SEER) Database. Odds ratios (OR) and 95% Confidence Intervals (CI) were calculated to compare minority enrollment rates to Non-Hispanic (NH) White enrollment rates. Results: Conclusions: NH-Black and Hispanic participants are significantly underrepresented in clinical trials evaluating PARP inhibitors for ovarian cancer compared to NH-White cohorts. Phase II and III trials assessing PARP inhibitors for ovarian and breast cancer do not accurately represent the populations diagnosed with these malignancies. Enrollment strategies are needed to increase diversity in PARP inhibitor clinical trials for women's cancers. Disparities persist in the enrollment of diverse racial and ethnic groups in clinical trials for ovarian and breast cancers. We sought to analyze the enrollment of participants by race/ethnicity in phase II and III clinical trials involving poly ADP ribose polymerase (PARP) inhibitors for ovarian and breast cancers and compare these to the racial/ethnic prevalence of ovarian and breast cancer in the United States. This study was designed as a retrospective review of clinical trials registered with Clinicaltrials.gov. Studies included evaluated PARP inhibitors for the treatment of ovarian, fallopian tube, primary peritoneal, and breast cancers. Enrollment rates for clinical trials were stratified by race/ethnicity and type of cancer. Enrollment fractions (EF) were calculated using prevalence data from the Surveillance, Epidemiology, and End Results (SEER) Database. Odds ratios (OR) and 95% Confidence Intervals (CI) were calculated to compare minority enrollment rates to Non-Hispanic (NH) White enrollment rates. NH-Black and Hispanic participants are significantly underrepresented in clinical trials evaluating PARP inhibitors for ovarian cancer compared to NH-White cohorts. Phase II and III trials assessing PARP inhibitors for ovarian and breast cancer do not accurately represent the populations diagnosed with these malignancies. Enrollment strategies are needed to increase diversity in PARP inhibitor clinical trials for women's cancers.

Objectives: Given that K grant funding secured in early career correlates with success in achieving R funding, we aim to describe the state of K and R funding by cancer type through time, hypothesizing that those cancer sites receiving more K grant allocation also receive greater R grant allocation. Methods: We queried the National Cancer Institute (NCI) Research portfolio from 2007-2017 for K and R grant sums by year and 19 cancer sites. Yearly K grant amount means, medians and sums were summarized for each cancer site, and the sums trended over time, as were yearly K grant number of funded studies. R grant sums were similarly trended through time using linear regression with year as the independent variable. The relationship between K and R grant funding was assessed using a multivariable linear regression model with K grant yearly total by year interaction and adjusting for cancer site, after applying a Box-Cox transformation of R grant total amount to gain linearity. All statistical analyses were performed in R, version 4.0.2. Results: Median yearly number of funded K grants range from 0-85 and median total yearly dollar amounts range from $0-10.66 million. Breast, leukemia and lung (85, 47, 45 respectively) have the highest median number of K grants per year; and breast, lung, and brain ($10.66, 5.95, and 5.85 million) have the highest total yearly amount of K grant funding. Cervical, ovarian and uterine cancer sites ranked 11, 9, and 14 in median number of yearly funded K grants over the 19 cancer sites considered, and 14, 13, and 17 in yearly median K grant dollar amounts. By total yearly R grant medians, the highest funded three cancer sites were breast, lung, and colorectal, while cervix, ovary and uterus ranked 11, 10, and 16. The rates of change over time in K grant funding for cervix, ovarian, and uterine cancer were 0.008, 0.107, and -0.014, while the rates of change in R grant funding for these sites were -1.088, 0.987, and 0.186. They ranked thus 14, 7, and 15 in K grant growth across all sites, and 17, 7, and 12 in R grant growth across sites. K grant funding is significantly associated with growth in R grant funding (p=0.021) adjusting for all cancer sites. Conclusions: Gynecologic cancers are being funded at a lower rate and dollar amount than other cancer types at the K grant level, and this correlates as well with lower rates and dollar amounts at the R grant level. Given early career investigators typically foster innovation, it behooves us to advocate for and mentor more K grant funding recipients in gynecologic cancers. K and R grant funding also demonstrate stagnant growth in gynecologic cancers, also a potential arena for advocacy for allotment of funding. Given that K grant funding secured in early career correlates with success in achieving R funding, we aim to describe the state of K and R funding by cancer type through time, hypothesizing that those cancer sites receiving more K grant allocation also receive greater R grant allocation. We queried the National Cancer Institute (NCI) Research portfolio from 2007-2017 for K and R grant sums by year and 19 cancer sites. Yearly K grant amount means, medians and sums were summarized for each cancer site, and the sums trended over time, as were yearly K grant number of funded studies. R grant sums were similarly trended through time using linear regression with year as the independent variable. The relationship between K and R grant funding was assessed using a multivariable linear regression model with K grant yearly total by year interaction and adjusting for cancer site, after applying a Box-Cox transformation of R grant total amount to gain linearity. All statistical analyses were performed in R, version 4.0.2. Median yearly number of funded K grants range from 0-85 and median total yearly dollar amounts range from $0-10.66 million. Breast, leukemia and lung (85, 47, 45 respectively) have the highest median number of K grants per year; and breast, lung, and brain ($10.66, 5.95, and 5.85 million) have the highest total yearly amount of K grant funding. Cervical, ovarian and uterine cancer sites ranked 11, 9, and 14 in median number of yearly funded K grants over the 19 cancer sites considered, and 14, 13, and 17 in yearly median K grant dollar amounts. By total yearly R grant medians, the highest funded three cancer sites were breast, lung, and colorectal, while cervix, ovary and uterus ranked 11, 10, and 16. The rates of change over time in K grant funding for cervix, ovarian, and uterine cancer were 0.008, 0.107, and -0.014, while the rates of change in R grant funding for these sites were -1.088, 0.987, and 0.186. They ranked thus 14, 7, and 15 in K grant growth across all sites, and 17, 7, and 12 in R grant growth across sites. K grant funding is significantly associated with growth in R grant funding (p=0.021) adjusting for all cancer sites. Gynecologic cancers are being funded at a lower rate and dollar amount than other cancer types at the K grant level, and this correlates as well with lower rates and dollar amounts at the R grant level. Given early career investigators typically foster innovation, it behooves us to advocate for and mentor more K grant funding recipients in gynecologic cancers. K and R grant funding also demonstrate stagnant growth in gynecologic cancers, also a potential arena for advocacy for allotment of funding.

OBJECTIVE:To demonstrate discrepancies between operative times in the ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Project) and self-reported operative time from the American Medical Association's Relative Value Scale Update Committee (RUC) and their effect on relative value units (RVU) determination.METHODS:This is a cross-sectional review of registry data using the ACS NSQIP 2016 Participant User File and the Centers for Medicare & Medicaid Services physician procedure time file for 2018. We analyzed total RVUs for surgeries by operative time to calculate RVU per hour and stratified by specialty. Multivariate regression analysis adjusted for patient comorbidities, age, length of stay, and ACS NSQIP mortality and morbidity probabilities. The surgeon self-reported operative times from the Centers for Medicare & Medicaid Services physician were compared with operative times recorded in the ACS NSQIP, with excess time from RUC estimates termed "overreported time."RESULTS:Analysis of 901,917 surgeries revealed a wide variation in median RVU per hour between specialties. Orthopedics (14.3), neurosurgery (12.9), and general surgery (12.1) had the highest RVU per hour, whereas gynecology (10.2), plastic surgery (9.5), and otolaryngology (9) had the lowest (P<.001 for all comparisons). These results remained unchanged on multivariate regression analysis. General surgery had the highest median overreported operative time (+26 minutes) followed by neurosurgery (+23.5 minutes) and urology (+20 minutes). Overreporting of the operative time strongly correlated to higher RVU per hour (r=0.87, P=.002).CONCLUSION:Despite reliable electronic records, the AMA-RUC continues to use inaccurate self-reported RUC surveys for operative times. This results in discrepancies in RVU per hour (and subsequent reimbursement) across specialties and a persistent disparity for women-specific procedures in gynecology. Relative value unit levels should be based on the available objective data to eliminate these disparities.

Objective: To assess abortion-related attitudes, practices, and perceptions among physicians of all specialties at a Wisconsin academic medical center. Study design: We developed and disseminated a cross-sectional web and mail survey to physicians at our academic center using a list generated by Human Resources. We performed descriptive analyses and assessed bivariate relationships between measures of support for abortion, perceived climate of opinion, willingness to consult in abortion-related cases, and sociodemographic and professional characteristics. We used binary logistic regression to model willingness to consult. Results: We sent the survey to 1357 physicians and received 913 (67%) responses. Participants reported strong support for unrestricted access to abortion and the effort s of abortion providers but estimated relatively lower support among peers. Compared to 556 (62%) who reported "a lot" of support for abortion access, only 183 (21%) estimated the same level of support among peers. Similarly, 615 (69%) participants reported "a lot" of support for abortion providers, compared to only 227 (25%) who estimated the same level of support among peers. Participants most commonly estimated that peers "somewhat" support abortion access (381; 43%) and abortion providers (344; 39%). Across specialties, 799 (90%) physicians said they were at least "somewhat" willing to consult in abortion-related cases. Compared to obstetrician gynecologists and family physicians, other specialists were less likely to be willing to consult (aOR = 0.43, 95% CI 0.29-0.65), though majorities of both groups were willing. Physicians who perceived equal or higher support for abortion among peers were more likely to be willing to consult (aOR = 2.17, 95% CI 1.60-2.95). Conclusion: Most physicians at our center reported support for abortion; however, those who perceived less support among peers reported less willingness to consult in abortion-related care, regardless of specialty. Implications: Even among physicians who supported abortion, the perception that peers were less supportive deterred participation in abortion-related care at our institution. Where abortion care is isolated or stigmatized, physicians may be unaware of colleagues' true attitudes about abortion. Efforts to normalize communication about abortion care could improve access and quality. (c) 2021 Elsevier Inc. All rights reserved.

On June 29, 2020, the US Supreme Court issued an opinion in June Medical Services, L.L.C. v. Russo that ruled Louisiana's admitting privileges law unconstitutional, thereby blocking it from taking effect and allowing Louisiana abortion clinics to remain open. The Supreme Court reached this decision after it examined research showing that admitting privilege requirements have no medical benefit and instead place unnecessary burdens on clinics, preventing many people from accessing needed reproductive health care.1 (Am J Public Health. Published online ahead of print October 22, 2020: e1-e4. https://doi.org/10.2105/AJPH.2020.305997).

The primary goal was to convert 50% of all outpatient Gynecologic Oncology (GynOnc) encounters during the COVID-19 pandemic to telemedicine within one week. The secondary goal was to reach 100% documentation of telemedicine consent. The tertiary goal was to analyze patient satisfaction scores. An additional goal was to estimate CO2 emissions prevented from being produced. The period from 3/16/2020–4/15/2020 was targeted. The initial intervention involved transitioning surveillance visits. A second intervention, with nursing and advanced-practice-provider support, included transitioning additional visit types, and distributing a note template. The Telehealth Satisfaction Survey (TeSS) was administered to patients. Descriptive statistics and run charts were used to analyze and depict results. Within four weeks, there were 408 encounters; 217 were telemedicine (53.2%). Following the second intervention, 13 of 15 days (86.7%) reached the 50% telemedicine target and consent was documented in 96.6% of the telemedicine encounters. The TeSS had a 74.8% response-rate. Patients rated the following aspects of the telemedicine encounter as good or excellent: call quality (96.5%), personal comfort (92.9%), length-of-visit (94.7%), treatment explanation (93.8%), overall experience (88.5%). Moreover, 82.3% of patients would use telemedicine again. Additionally, 6.25 metric tons of CO2 emissions from travel were prevented from being produced. A GynOnc clinic can rapidly implement telemedicine systems. With multidisciplinary team planning and standardized note templates, transitioning 50% of encounters to telemedicine and achieving high rates of consent documentation were accomplished in four weeks. This increase in telemedicine represented a measurable decrease in the amount of CO2 emissions. Additionally, patients were overwhelmingly satisfied.

Objectives: To advocate for National Cancer Institute (NCI) funding more effectively, we quantified funding to lethality (F:L) ratios, tracked changes in those ratios over time, and compared F:L to other measures of funding allocation, including funding to incidence (F:I), funding to mortality (F:M) and funding to years of life lost (F:YLL) across 19 cancer sites. Methods: We used the NCI research portfolio database to assess funding allocated to 19 different cancer sites from the years 2007-2017. We collected incidence rates (I), mortality rates (M), and years of life lost (YLL) from the Surveillance, Epidemiology and End Results (SEER) database over the same 11 years. We defined lethality (L) by the formula (M/I x (YLLx100)). We calculated median yearly funding ratios and ranked them by cancer site. The correlations between funding ratios were accessed using Pearson correlation test. For each ratio, we calculated rate of change over time by cancer site using linear regression with year as the independent variable. To compare rates of change of each ratio by cancer site, we performed multivariable linear regression incorporating year, cancer site and their interaction as covariates, after applying a log10 transformation on the ratio to achieve linearity. The reference groups for comparison were the gynecologic cancer sites uterus, ovary and cervix. All analyses were completed in R, version 4.0.2. Results: The three cancer sites with the highest F:L ratio were breast, prostate and melanoma despite these being the 12th, 17th and 16th in terms of lethality. Ovary, uterus and cervix ranked 12th, 15th and 13th in F:L ratios, but were 5th, 13th and 6th in terms of lethality. The top three F:I were brain, leukemia, cervix; F:M were melanoma, Hodgkin's lymphoma, brain; and F:YLL were breast, prostate, lung. All three gynecologic cancer sites experienced negative rate of change of F:L over the 11 years. Ovary, cervix and uterus also experienced negative rate of change for F:I, F:M, and F:YLL with the only exception being ovary with positive change in F:M. F:L rates of change were significantly different for ovary, cervix and uterus compared to breast, melanoma, and prostate. F:L ratio was strongly positively correlated to F/YLL with Pearson correlation coefficient of 0.86 (p<0.001), weakly positively correlated to F:M (Pearson coefficient 0.14, p=0.04), and weakly negatively correlated to F:I (Pearson coefficient -0.14, p=0.042). Sensitivity analyses looking at last 5 years of reported funding largely confirm trends and continue to highlight inadequate attention to gynecologic cancers. Conclusions: F:L ratios correlate with other funding allocation measures, and highlight inadequate NCI funding to gynecologic cancers. Trends of the last 5 years (2013-2017) are consistent with trends of the last 11 years. This data should be used for advocacy to improve the disparities in funding to GYN cancers that affect laboratory science discoveries, clinical trial availability and survival outcomes. To advocate for National Cancer Institute (NCI) funding more effectively, we quantified funding to lethality (F:L) ratios, tracked changes in those ratios over time, and compared F:L to other measures of funding allocation, including funding to incidence (F:I), funding to mortality (F:M) and funding to years of life lost (F:YLL) across 19 cancer sites. We used the NCI research portfolio database to assess funding allocated to 19 different cancer sites from the years 2007-2017. We collected incidence rates (I), mortality rates (M), and years of life lost (YLL) from the Surveillance, Epidemiology and End Results (SEER) database over the same 11 years. We defined lethality (L) by the formula (M/I x (YLLx100)). We calculated median yearly funding ratios and ranked them by cancer site. The correlations between funding ratios were accessed using Pearson correlation test. For each ratio, we calculated rate of change over time by cancer site using linear regression with year as the independent variable. To compare rates of change of each ratio by cancer site, we performed multivariable linear regression incorporating year, cancer site and their interaction as covariates, after applying a log10 transformation on the ratio to achieve linearity. The reference groups for comparison were the gynecologic cancer sites uterus, ovary and cervix. All analyses were completed in R, version 4.0.2. The three cancer sites with the highest F:L ratio were breast, prostate and melanoma despite these being the 12th, 17th and 16th in terms of lethality. Ovary, uterus and cervix ranked 12th, 15th and 13th in F:L ratios, but were 5th, 13th and 6th in terms of lethality. The top three F:I were brain, leukemia, cervix; F:M were melanoma, Hodgkin's lymphoma, brain; and F:YLL were breast, prostate, lung. All three gynecologic cancer sites experienced negative rate of change of F:L over the 11 years. Ovary, cervix and uterus also experienced negative rate of change for F:I, F:M, and F:YLL with the only exception being ovary with positive change in F:M. F:L rates of change were significantly different for ovary, cervix and uterus compared to breast, melanoma, and prostate. F:L ratio was strongly positively correlated to F/YLL with Pearson correlation coefficient of 0.86 (p<0.001), weakly positively correlated to F:M (Pearson coefficient 0.14, p=0.04), and weakly negatively correlated to F:I (Pearson coefficient -0.14, p=0.042). Sensitivity analyses looking at last 5 years of reported funding largely confirm trends and continue to highlight inadequate attention to gynecologic cancers. F:L ratios correlate with other funding allocation measures, and highlight inadequate NCI funding to gynecologic cancers. Trends of the last 5 years (2013-2017) are consistent with trends of the last 11 years. This data should be used for advocacy to improve the disparities in funding to GYN cancers that affect laboratory science discoveries, clinical trial availability and survival outcomes.

Objectives: To identify trends and discrepancies between the number of clinical trials funded by public, industry, and other (individuals, universities, and community-based) organizations and measures of individual- and population-level cancer burden. Methods: Clinicaltrials.gov was queried for US trials initiated from 2007-2017 in 18 cancer types. For each cancer, incidence and mortality rates were obtained from the CDC, and person years of life lost (YLL) was obtained from the SEER database. Trials were categorized by funding sources and analyzed by measures of cancer burden: incidence (I), mortality (M), YLL, and lethality (L, years of life lost per new diagnosis). Standardized ratios of the number of new studies each year to cancer burden metrics were generated. These ratios were labeled as studies funded by public sources (#P/I, #P/M, #P/YLL, #P/L), industry sources (#I/I, #I/M, #I/YLL, #I/L), and other sources (#O/I, #O/M, #O/YLL, #O/L). Mean annual ratios for GYN cancers were compared to other cancers using Wilcoxon rank-sum tests. Rates of change (ROC) for these ratios over the 11-year period for each funding source were analyzed by linear regression. Results: Breast cancer was the most studied cancer among public, industry, and other funded sources, averaging 71.3, 101.6, and 101.0 new studies per year. For new studies in GYN cancers, ovary ranks 7th, 7th, and 10th; cervix 13th, 16th, and 13th; uterus 12th, 14th, and 12th. While breast and prostate cancers rank 11th and 17th in Lethality, the mean ratios for breast (#P/L 22.12, #I/L 31.84, #O/L 31.68, Figure 1) and prostate (#P/L 22.61, #I/L 33.37, #O/L 27.21) are the two highest across all 3 funding sources. Ovarian cancer ranks 4th in Lethality with 11.14 years of life lost per new diagnosis, yet it ranks 12th in mean #P/L (2.086 - lower than 10 others at p<0.05), 10th in #I/L (2.886 - lower than 9 others at p<0.05), and 14th in #O/L (1.557 - lower than 13 others at p<0.05). Cervical cancer is the 7th most lethal, but its ratios rank 16th in all funding categories (#P/L 1.373, #I/L 0.886, #O/L 1.108). Uterine cancer is the 12th most lethal with ratios ranking 8th (#P/L 5.755) 11th (#I/L 3.387), and 12th (#O/L 4.246). Over the 11-year period, the mean #P/L ratios for 4 of 18 cancers (uterus, testicular, brain, esophagus) had a significant negative slope or rate of change (p<0.05). Bladder cancer had the only positive ROC. For #I/L over 11 years, 9 of 18 cancers, including ovarian, had a significant positive ROC. None had a negative ROC. In other funded studies, 7 cancers had a significant positive ROC, and 11 were stagnant. For GYN cancers across all four cancer burden parameters, uterine showed a significant negative slope in the number of public funded studies and ovarian cancer had a significant positive slope for industry funded studies. Conclusions: To identify trends and discrepancies between the number of clinical trials funded by public, industry, and other (individuals, universities, and community-based) organizations and measures of individual- and population-level cancer burden. Clinicaltrials.gov was queried for US trials initiated from 2007-2017 in 18 cancer types. For each cancer, incidence and mortality rates were obtained from the CDC, and person years of life lost (YLL) was obtained from the SEER database. Trials were categorized by funding sources and analyzed by measures of cancer burden: incidence (I), mortality (M), YLL, and lethality (L, years of life lost per new diagnosis). Standardized ratios of the number of new studies each year to cancer burden metrics were generated. These ratios were labeled as studies funded by public sources (#P/I, #P/M, #P/YLL, #P/L), industry sources (#I/I, #I/M, #I/YLL, #I/L), and other sources (#O/I, #O/M, #O/YLL, #O/L). Mean annual ratios for GYN cancers were compared to other cancers using Wilcoxon rank-sum tests. Rates of change (ROC) for these ratios over the 11-year period for each funding source were analyzed by linear regression. Breast cancer was the most studied cancer among public, industry, and other funded sources, averaging 71.3, 101.6, and 101.0 new studies per year. For new studies in GYN cancers, ovary ranks 7th, 7th, and 10th; cervix 13th, 16th, and 13th; uterus 12th, 14th, and 12th. While breast and prostate cancers rank 11th and 17th in Lethality, the mean ratios for breast (#P/L 22.12, #I/L 31.84, #O/L 31.68, Figure 1) and prostate (#P/L 22.61, #I/L 33.37, #O/L 27.21) are the two highest across all 3 funding sources. Ovarian cancer ranks 4th in Lethality with 11.14 years of life lost per new diagnosis, yet it ranks 12th in mean #P/L (2.086 - lower than 10 others at p<0.05), 10th in #I/L (2.886 - lower than 9 others at p<0.05), and 14th in #O/L (1.557 - lower than 13 others at p<0.05). Cervical cancer is the 7th most lethal, but its ratios rank 16th in all funding categories (#P/L 1.373, #I/L 0.886, #O/L 1.108). Uterine cancer is the 12th most lethal with ratios ranking 8th (#P/L 5.755) 11th (#I/L 3.387), and 12th (#O/L 4.246). Over the 11-year period, the mean #P/L ratios for 4 of 18 cancers (uterus, testicular, brain, esophagus) had a significant negative slope or rate of change (p<0.05). Bladder cancer had the only positive ROC. For #I/L over 11 years, 9 of 18 cancers, including ovarian, had a significant positive ROC. None had a negative ROC. In other funded studies, 7 cancers had a significant positive ROC, and 11 were stagnant. For GYN cancers across all four cancer burden parameters, uterine showed a significant negative slope in the number of public funded studies and ovarian cancer had a significant positive slope for industry funded studies.

The National Institutes of Health funding for reproductive sciences research, specifically in academic departments of obstetrics and gynecology, is disproportionately low. Research is one of the most important pillars in advancing healthcare. Despite US Congress' vision in providing increased funding to the National Institutes of Health as a whole, underfunding for research in the departments of obstetrics and gynecology remains one of the several critical drivers in the decline in reproductive health and healthcare for women in the United States.

INTRODUCTION: Reproductive justice (RJ) is a framework that promotes universal reproductive rights by addressing underlying economic, social, and political inequities. Although increasingly integrated into reproductive health specialties, broader physicians’ attitudes toward RJ have been unexamined – even though knowing and promoting RJ principles could improve patient care and public and social health. METHODS: Using mail and online recruitment methods, we surveyed clinical faculty at the largest academic medical center in one Midwestern state. On a five-point Likert-type scale (“strongly disagree” to “strongly agree”), physicians responded to five principles adapted directly from widely held RJ tenets. RESULTS: 913 physicians representing 20 specialties responded (67% response rate). Majorities somewhat or strongly agreed that every woman has the right to parent or not parent a child if she chooses (89%); health systems should ensure that every woman has access to the full range of contraceptives (93%) and abortion (87%); health systems should ensure everyone achieves full autonomy over reproductive decisions (90%) and raises children in safe and healthy environments (96%). Given high reliability (Cronbach alpha=.85), we collapsed items into a bivariate outcome of support for all five principles vs any opposition. A majority (88%) supported all five principles. Chi-square tests of independence (P CONCLUSION: Physician support for RJ was high but not unanimous. We join the call to incorporate RJ principles into medical curricula and healthcare policy.

Cancer treatment-induced bone loss is a known side effect of cancer therapy that increases the risk of osteoporosis and bone fracture. Women with gynecologic cancer are at increased risk of bone loss secondary to the combined effect of oophorectomy and adjuvant therapies. Data regarding bone loss in women with gynecologic cancers are overall lacking compared to other cancer populations. Consequently, guidelines for osteoporosis screening in women with cancer are largely based on data generated among non-gynecologic cancer survivors. This article reviews current available data of bone health in women with gynecologic cancer, summarizes best-available guidelines for screening for osteoporosis in women with cancer, and provides guidance for osteoporosis screening in women with gynecologic cancers based on best available evidence.

ABSTRACTBackgroundAlmost every medical professional organization supports abortion access. Meanwhile, federal and state-level policies continue to erode abortion-related healthcare. Physicians are instrumental to abortion access, and their evidence-based attitudes could significantly influence public understanding. However, most studies of physician attitudes about abortion focus on specific subgroups. A study of abortion attitudes among a broader population of clinicians is important for at least three reasons. First, results could provide insights and strategies to improve access and reduce stigma at academic medical centers and beyond. Second, findings could explain discrepancies between expressions of support for abortion by the medical community and the inability or unwillingness of the same community to provide sufficient access to abortion services. Third, gauging the climate of opinion among physicians in a politically contested state is likely to be informative given that most abortion-related judicial decisions will occur in state-versus federal-level courts, and physician attitudes could potentially influence public policy.ObjectiveTo use leading survey methodologies to assess abortion-related attitudes among all physicians at the largest academic medical center in a politically contested Midwestern state.Study DesignInvestigators developed a cross-sectional survey to gauge abortion-related knowledge, attitudes, and practices. The university’s survey research center disseminated the survey to all 1,357 physician faculty members of the school of medicine and public health using a web and mail mixed-mode methodology (67% response rate). Analyses included chi-squared tests and binary logistic regression models of support for abortion procedures and willingness to consult in abortion care.ResultsAcross more than 20 specialties and all sociodemographic categories, physicians reported strong support for abortion. Majorities expressed support for medication (81%) and surgical abortion (80%), that abortion should be legal in all or most cases (88%), and that a state law banning abortion would make women’s health worse (91%). While nearly all physicians (94%) care for women of reproductive age, most (69%) reported no opportunity to participate in abortion care and fewer than half (44%) knew whom to contact to refer a patient for abortion care. Female physicians and those who considered their expertise relevant to abortion were more supportive, while physicians of color and highly religious physicians were less supportive. Few physicians reported participating in any aspect of abortion care (14%), though nearly two-thirds were willing to consult in such care (65%). Those with relevant expertise were more willing to consult, while physicians of color and highly religious physicians were less willing. While most physicians said they support unrestricted access to abortion (63%) and the efforts of abortion providers (70%) “a lot,” a majority perceived relatively less support among their professional peers, revealing a climate of pluralistic ignorance.ConclusionsDespite overwhelming support for abortion among this population, participation in any aspect of abortion care is remarkably low. Physicians across all disciplines need clear training and guidelines on how to refer patients for abortion care, and abortion should be normalized and integrated into mainstream medicine. Given professional organizations’ support of abortion and physicians’ cultural influence, these results can be used to inform public policy regarding abortion access.

11539 Background: To compare end-of-life (EOL) care intensity across multiple cancer sites and its impact on the cost of care during the last 30-days of life. Methods: Cross-sectional retrospective study using Surveillance, Epidemiology, and End Results Program (SEER)-Medicare linked database from 2008-2013. Utilization of the following in the EOL period (last 30 days of life prior to death) was examined: 2 or more visits to the Emergency Department (ED), hospitalizations, receipt of any life-extending procedures, admission to intensive care unit, any hospice use, hospice used ≤3 days, death in hospital, or receipt of chemotherapy (last 14 days). We tallied the claims made during the EOL period for each patient. Median expenditures during the EOL period were tabulated by cancer site and stratified by receipt of hospice care. Results: EOL care utilization varied widely between cancer sites. The rates of any hospice utilization were the highest for breast cancer (48.2%) compared to ovarian (17.4%) (p < 0.001). Chemotherapy during the last two weeks of life was the highest for ovarian cancer (1.7%) and the lowest for colorectal cancer (0.5%). The median cost of care during the EOL period for patients who received hospice care was $7,547.84 (Interquartile range [IQR] $5,422-$17,293) compared to $17,179 (IQR $10,323 - $30,824) for those never received hospice care (p < .0001). There was no significant variation in median cost by cancer site for those who received hospice services (range $7,317 - $9,816). However, the cost of care varied for those who did not receive hospice care. Median costs for this subgroup was the lowest for pancreatic cancer ($14,635) and the highest for colorectal cancer ($24,324) (p < 0.001). Conclusions: Despite increasing acceptance of palliative care services and hospice in cancer care, there continues to be intensive and costly care administered during the EOL period. These costs vary considerably across cancer sites when patients do not receive hospice care, but costs are relatively similar when patient are enrolled in hospice Further research to investigate the causes of this variation should be undertaken to design interventions aimed at improving timely hospice enrollment at the EOL and reducing costly care in the EOL period.

Universal access to contraception benefits society: unintended pregnancies, maternal mortality, preterm birth, abortions, and obesity would be reduced by increasing access to affordable contraception. Women should be able to choose when and whether to use contraception, choose which method to use, and have ready access to their chosen method. State and national government should support unrestricted access to all contraceptives. As obstetrician-gynecologists, we have a critical mandate, based on principle and mission, to step up with leadership on this vital medical and public health issue, to improve the lives of women, their families, and society. The field of Obstetrics and Gynecology must provide the leadership for moving forward. The American Gynecological and Obstetrical Society (AGOS), representing academic and public policy leaders from across all disciplines of Obstetrics and Gynecology, is well positioned to serve as a unifying organization, focused on developing a strong unified advocacy voice to fight for accessible contraception for all in the United States.

The American Gynecological and Obstetrical Society (AGOS) has the potential to serve as a unifying organization to advocate for women's reproductive health care, education, and research. This report reviews a strategic plan designed to reinvigorate AGOS to address, together with our partner organizations, the ever more pressing issues and challenges in women's reproductive health.

OBJECTIVE:Identify the major factors that drive standardized cost in providing surgical care for women with ovarian cancer, characterize the magnitude of variation in resource utilization between centers, and to investigate the relationship between resource utilization and quality of care provided. METHODS:Retrospective cohort study of hospitals across the United States reporting to the Premier Database who cared for patients with ovarian cancer diagnosed between 2007 and 2014. The primary outcome was standardized total cost of the index hospitalization. To assess the relationship between hospital standardized costs and patient outcomes, we identified four measures of quality: 1) complications, 2) re-operation, 3) length of stay > 15 days, and 4) unplanned readmission. RESULTS:The study population included 15,857 patients treated at 226 hospitals. The median standardized cost for hospitalizations was $13,267 (IQR = $3342). Reoperation was associated with 49% increase (95% CI = 43%-56%), and having minor complication was associated with 10% (95% CI = 8%-12%) increase in standardized cost, a moderate complication was associated with 36% (95% CI = 33%-38%) increase, and a major complication was associated with 83% (95% CI = 76%-89%) increase. The average risk-adjusted hospital standardized costs for hospitals in the highest resource use quartiles was 56% higher than the average hospital costs for hospitals in the lowest quartile ($10,826 vs. $16,933). The largest variation was in operating room standardized cost (45.5% of the total variation in operating room cost is explained by differences in hospital practices) and supplies (41.7%). CONCLUSIONS:We identified significant variation in standardized costs among women who underwent surgery for ovarian cancer, operating room and supply costs are the largest drivers of variation.