This article aims to describe contemporary parental leave among obstetrics and gynecology trainees and early-career faculty. Here, we present results of a survey that collected information about parental leave policies and contemporary practice, as well as beliefs about surgical and clinical experience for those who take leave. Faculty and trainees were equally well represented among respondents, with half of each group self-identifying as a parent. Most reported that childbearing trainees currently take 6 weeks or less of parental leave and believed that childbearing and nonchildbearing residents should be able to take 12 weeks of leave without extending training.
OBJECTIVE: To characterize whether enrollment patterns in precision oncology clinical trials for gynecologic cancers reflect the racial and ethnic diversity of patients with gynecologic cancers in the United States. METHODS: ClinicalTrials.gov was queried to perform this cross-sectional review. We included precision oncology trials —defined as trials using molecular profiling of a tumor or the patient genome to identify targetable alterations to guide treatment—of ovarian, uterine, cervical, and vulvar cancers in the United States. National Cancer Institute Surveillance, Epidemiology, and End Results and United States Census Bureau data were used to estimate cancer burden and the expected number of trial participants by race and ethnicity for each gynecologic cancer. The ratio of actual-to-expected participants was calculated. A ratio greater than 1 signified overenrollment. A random effects meta-analysis was performed to assess the relative weights of individual trials. RESULTS: We identified 493 trials, 61 of which met inclusion criteria. There were 2,573 patients enrolled in ovarian cancer trials, 1,197 in uterine cancer trials and 162 in cervical cancer trials. Non-Hispanic White women were overrepresented overall (enrollment ratio 1.26, 95% CI 1.20–1.32) and across all cancer types on subgroup analysis. Asian women, non-Hispanic Black women, and Hispanic women were underrepresented overall (enrollment ratios 0.63, 95% CI 0.41–0.86; 0.51, 95% CI 0.36–0.66 and 0.30, 95% CI 0.23–0.36, respectively). In subgroup analyses, Asian women and non-Hispanic Black women were underrepresented in ovarian and uterine cancer trials and Hispanic women were underrepresented across all cancer types. CONCLUSION: Non-Hispanic Black women, Asian women, and Hispanic women with gynecologic cancers are underrepresented in precision oncology trials. Few U.S.-based precision oncology trials exist for uterine and cervical cancers, which have a high burden of morbidity and mortality among racial and ethnic minority groups. Failure to equitably enroll patients who belong to racial and ethnic minority groups may perpetuate existing disparities in gynecologic cancer outcomes.
5595 Background: The majority of studies of uterine cancer combine high and low-grade histologies and do not sample a diverse cohort of patients. In many studies race is treated as biologic construct, when it may be better thought of as a proxy for socioeconomic inequity and deprivation. Socioeconomic (SE) deprivation may play a significant role in the disease trajectory of women with uterine cancer. Methods: Data were drawn from the Metropolitan Detroit Cancer Surveillance System which covers a tri-county area of approximately 4 million people. We included non-Hispanic Black (NHB) and White (NHW) women diagnosed with uterine cancer between 2010 and 2018. Poorly differentiated and undifferentiated endometrioid, serous, clear cell, mixed, carcinosarcoma and mucinous histologies were considered high grade. Patients diagnosed by death certificate, or with unknown stage or histology were excluded. Socioeconomic status was assessed using the Yost Score, an area-level composite measure of socioeconomic deprivation derived from census-tract data at cancer diagnosis. Lower Yost quintile indicates higher deprivation. Competing risk analysis was used to determine risk of uterine cancer specific mortality (reported as subdistribution hazard ratio [SHR]) and to assess statistical interaction between race and Yost score. Results: A total of 4,840 patients were identified. Race conferred significant increased risk of cancer-specific mortality (SHR 2.11, p < 0.0001). Race and Yost score interacted to increase risk of cancer-specific mortality in NHB women in the lowest Yost quintile (SHR 2.23, p < 0.0001) compared to NHW and NHB women in the highest quintiles. The interaction between race and Yost score persisted only among women with low grade cancers (SHR 1.7, p = 0.04). Time from diagnosis to surgery increased as Yost score decreased. Women in the lowest Yost quintile had lower likelihood of receiving surgery within 6 weeks of diagnosis (OR 0.74, p = 0.001). This effect persisted among women with low grade cancer (NHB OR 0.75, p = 0.014; lowest Yost quintile OR 0.68, p < 0.0001). An association between race, Yost score and delays in time to surgery was not seen among women with high grade cancers. Conclusions: Race and Yost score, an area-based measure of socioeconomic deprivation, are associated with increased cancer-specific mortality risk among women with low grade cancer. NHB race and high socioeconomic deprivation are associated with delayed primary surgery. The interaction between race and socioeconomic deprivation may underlie known disparities in uterine cancer survival, particularly in low grade disease where there is the greatest opportunity for timely curative surgery.
Since 2017, the number of women enrolled in medical schools in the United States has increased steadily. For the average female graduate, residency training will coincide with peak childbearing years. Despite increasingly well-defined parental leave policies in other industries, there is no standardized approach across graduate medical education programs. Physician mothers, particularly those in surgical specialties, have also been shown to be at increased risk for major pregnancy complications and postpartum depression. In addition, despite excellent initiation rates, the majority of breastfeeding trainees struggle with low milk supply, and as few as 7% of physician mothers continue to breastfeed for 1 year. Although the medical field routinely advocates for the benefits of parental leave and breastfeeding for our patients, significant and comprehensive change is needed to ensure that graduate medical education trainees can follow physician-recommended postpartum guidelines without meaningful implications for their careers. In February 2020, the American Board of Obstetrics and Gynecology changed its leave policy, allowing residents to take up to 12 weeks of paid or unpaid leave in a single year for vacation, parenting, or medical issues without extending their training. This change represents an important first step, and, as comprehensive women's health care professionals, our specialty should be leaders in normalizing family building for physicians-in-training. A culture change toward an environment of support for pregnant and parenting trainees and access to affordable, extended-hour childcare are also critical to enabling physicians at all levels to be successful in their careers.
e24185 Background: High-quality, patient-centered communication is not experienced equitably across patient populations, likely contributing to healthcare disparities. Question Prompt Lists (QPL) improve patient active participation and other aspects of patient-physician communication in diverse populations and settings. This descriptive, single-arm study assessed the implementation and patient perceptions of a previously-developed, evidence-based QPL, the ASQ brochure, across a network of oncology clinics providing care in a diverse population across Michigan. Methods: The QPL was revised in collaboration with community and physician stakeholders. Implementation was assessed through the reach, adoption, and efficacy domains of the RE-AIM framework. Eligible patients had a cancer diagnosis and were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before their appointment, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and univariable and multivariable linear mixed-effects models. Results: Reach: A total of 81 patients participated with a consent rate of 68.3%. Self-identified racial/ethnic groups were representative of the population served by the clinic network (72.4% white, 21.0% black, 3.7% American Indian/Native Alaskan, and 1.2% Mexican/Hispanic). Adoption: All eight invited clinics participated and recruited patients. Efficacy: All outcomes improved significantly, with no significant differences by clinic site or patient race. Patient perceptions of the ASQ brochure were overwhelmingly positive. Conclusions: The implementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population. Findings suggest this simple, evidence-based communication intervention should be implemented widely in similar clinical contexts.
