Disparities in the Rates of HPV Vaccine Series Completion for Cervical Cancer Prevention

Disparities in the Rates of HPV Vaccine Series Completion for Cervical Cancer Prevention

Abstracts / Gynecologic Oncology 147 (2017) 190–236 191 WB compared to capped dosing, although this study may be underpowered to detect meaningful O...

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Abstracts / Gynecologic Oncology 147 (2017) 190–236

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WB compared to capped dosing, although this study may be underpowered to detect meaningful OS differences. Interestingly, the WB chemotherapy dosing appears to be more beneficial to obese patients with a BSA N2. Larger studies may show a survival advantage in this cohort of patients.

The use of direct oral anticoagulants for the treatment of venous thromboembolism in patients with gynecologic malignancies V. Perkins, M. Buechel, C. Toal, C.C. Gunderson, D. Zhao, K.N. Moore, L.L. Holman. University of Oklahoma Health Sciences Center

Learning objectives: Determine progression free, recurrence specific and overall survival in obese patients receiving weight based chemotherapy. Determine the effect of obesity on complications and overall survival in patients with gynecologic malignancies.

Objectives: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in cancer patients. The current standard of care is low molecular weight heparin (LMWH), which is costly and inconvenient for patients. Direct oral anticoagulants (DOACs) inhibit either factor Xa or thrombin directly, and provide an opportunity for treatment of VTE without need for frequent monitoring or injections. However, these oral medications have not been well studied in cancer populations. This study aims to investigate the safety and efficacy of DOACs in patients with gynecologic malignancies.

Results: A total of 47 patients met inclusion criteria. Of these, 55% had ovarian cancer, 19% had uterine cancer, and 15% had cervix cancer. VTE was diagnosed during primary treatment in 62% of patients, while 30% were diagnosed during a recurrence. Though 91% received LMWH as initial VTE therapy, 40% of these patients changed to DOACs. Cited reasons for change included drug cost or patient/ provider preference. There was no difference in the rate of VTE progression or recurrence between the LMWH and DOAC groups (26.9% vs 26.3%, p N0.99). There was also no statistical difference in rates of bleeding between the two groups (25.9% vs 15%, p =0.48).

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Objectives: Vaccination against the human papillomavirus (HPV) is recommended for the prevention of HPV-related diseases, including cervical, vulvar, vaginal, and anal cancers. The HPV vaccine is administered in a series of three injections over a 6-month period. Several cultural barriers to the initiation and completion of vaccination have been suggested. The objective of this study was to determine the rate of HPV vaccination completion and disparities by race/ethnicity as well as age.

Methods: A retrospective, IRB-approved, review of patients with gynecologic malignancies treated with DOACs or LMWH for a known or presumed VTE between 2010 and 2017 was performed. Patients without adequate data in the medical record or those who received warfarin for treatment of their VTE were excluded. Rates of recurrence or progression of VTE and rates of bleeding between LMWH and DOAC were compared using the Fisher’s exact test. Time to recurrence or progression of VTE was tested between LMWH and DOACs using the log-rank test.

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Disparities in the Rates of HPV Vaccine Series Completion for Cervical Cancer Prevention A.H. Freemana, C. Gamboab, J. Darbinianc, S. Torrentea. aKaiser Permanente San Francisco Obstetrics & Gynecology, CA, bSalud Para La Gente, Watsonville, CA, cKaiser Permanente Northern California, Division of Research, Oakland, CA

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doi:10.1016/j.ygyno.2017.07.013

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Methods: We conducted a retrospective analysis of women ages 11 to 26 years who received at least one HPV-4 Gardisil vaccine from 2008 through 2012 in a community based health care system in Northern California. Vaccine completion was defined as having received three total doses after vaccine initiation during the study period. Demographic data including age, race/ethnicity, and language preferences were obtained. Among Hispanic women, acculturation was categorized as low or high using written and spoken Spanish versus English language as a proxy. Age groups were defined as: younger adolescents (ages 11 – 14 years), teens (ages 15 – 17 years), and young adults (ages 18-26 years). Bivariate analyses using Chisquare tests and age-adjusted logistic regression was performed. Results: Among all women who initiated the HPV vaccine (N= 102,052) during the study period, a total of 4,941 (41%) completed the series. Younger adolescents had the highest prevalence of series completion (43.4%, pb0.001) while teens and young adults had a similar completion rates (37.4% vs 38.0%, respectively). By race/ ethnicity, Asians had the highest prevalence of series completion (49.5%, 95% CI, 48.7-50.2) and African Americans had the lowest (28.7%; 95% CI, 27.8-29.6). Among Hispanics, the prevalence of vaccine completion was 38.9% (95% CI 38.3-39.5) and the low acculturated group was 1.2 times more likely to complete the series compared to the high acculturated group (AOR 1.23 [95% CI 1.16-1.31]). Conclusions: In this diverse Northern California population, the majority of those who initiated vaccination did not complete the series. The rate of HPV vaccine completion for cancer prevention varied by age and race/ethnicity among young women. Within the Hispanic population, the highest acculturated group had the lowest rate of vaccination series completion. Community health efforts should focus on improving health care compliance with culturally sensitive education for diverse populations.

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Conclusions: There is significant interest in the utility of DOACs for treatment of VTE in gynecologic cancer patients as they are convenient to use. However, these drugs have not been well studied in patients with active malignancy. Though the current study is small, it suggests that DOACs are effective and safe in the gynecologic cancer population. Larger studies are warranted to validate these findings.

Learning objectives: To identify the rate of HPV vaccination completion for cancer prevention among adolescents and young women within and between ethnicity groups. doi:10.1016/j.ygyno.2017.07.014

Learning objective: Learners will be able to assess potential utility and safety of DOACs in the treatment of VTEs in gynecologic cancer patients. doi:10.1016/j.ygyno.2017.07.015

Short Term Impact of Surgically Induced Menopause on Cognitive Function and Well-Being in Women at High Risk for Ovarian Cancer following RRSO H. Chang, D. Kamara, J. Lester, I. Cass. Cedars-Sinai Medical Center, Los Angeles, CA Objectives: To assess the short term impact of surgically induced menopause on cognitive function, sleep disruption, and depression in pre-menopausal women at high risk of ovarian cancer following risk reducing bilateral salpingo-oophorectomy (RRSO), and to determine if hormone replacement therapy (HRT) mitigates these conditions. Methods: Cognitive function was assessed using Functional Assessment of Cancer Therapy Scale Cognitive (FACT-Cog), a self-report measure of cognitive complaints to include total cognition and domains of cognition. FACT-Cog and well-being questionnaires were collected at 4 time points: pre-operatively, 6, 12 and 18 months post-