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Introduction/BackgroundColposcopy has undeniable significance in women’s healthcare, however the entire process is frequently associated with high levels of stress and anxiety for patients. Colposcopy is a fairly unique circumstance due to the intimate nature of the examination and the association with cancer. It is associated with fear, stress and a loss of control. In comparison to other medical procedures, women experience a higher level of anxiety when attending colposcopy than when they are attending for cardiac surgery.There has been some impactful interventions to reduce anxiety for women, but more work is needed. One of the first steps is understanding the patients perception.MethodologyOn arrival to the outpatient department, all women who attend for colposcopy where invited to complete a questionnaire that contained the state trait anxiety index (STAI) score prior to any medical consultation taking place.Demographic data includes age range, previous attendances at colposcopy and if women understand what happens at a colposcopy appointment.ResultsPreliminary data suggests that women experience high levels of anxiety when attending for colposcopy.Data collection is ongoing and will be completed by January 2023 in a high volume tertiary centre. Aim n=100.Statisical analysis will be performed on data to determine if there are any statistical differences in the patient demographics.ConclusionPreliminary data confirms that women experience significantly high levels of anxiety when attending for colposcopy. As colposcopy is so important in prevention of cervical cancer, it is of utmost importance that we understand womens perception in order to develop meaningful interventions. Anxiety may vary with different demographics and clinicians can modify interventions to allow for individualistic care for patients.

Introduction/BackgroundThe SUCCOR study initially reported relevant findings in 2020 from a large European international study with a 5-year follow-up. Now, we offer an update, extending the analysis to a 10-year follow-up, addressing gaps in limited information about prolonged outcomes for this disease.MethodologyContacting SUCCOR database authors, we requested data updates for 1272 patients. We dispatched a Case Report Form (CRF) to researchers from 126 institutions across 29 European countries. Our focus included tracking late recurrences and monitoring relapsed patients‘ progression, leading to a meticulous update of the 10-year follow-up for all participants.ResultsThe long-term analysis of 556 patients demonstrated an 8.81% relapse rate over a median 102-month follow-up. The 10-year overall survival stood at 91%, a decrease from 97% at the 5-year mark. Similarly, disease-free survival reached 90%, slightly lower than the 93% observed at 5 years. The data indicated that 77% of relapses occurred within the initial five years, highlighting a 3.22 relative risk for relapsing pre-5 years compared to post-5 years.Regarding relapse locations, 55% occurred locally within five years, and after 5 years, 45.5% experienced local recurrences. No significant differences were found between the two groups. Patients with recurrences faced a 24-fold higher mortality risk (OR 23.7, 95%CI 11.4-47.8, p<0.001). The 2-year survival post-recurrence was 69% for those relapsing before 5 years and 80% after 5 years. However, during the last follow-up, 45% of patients with pre-5-year relapses were still alive, compared to 72% in the post-5-year relapse group over a median 34-month follow-up.ConclusionIn the Succor study, the 10-year overall survival and disease-free survival after radical hysterectomy for cervical cancer were 91% and 90%, respectively. Patients facing recurrence had a 24-fold higher risk of death. Notably, 77% of recurrences appeared within the initial 5 years, while 45% of relapsed patients remained alive after 34-months of follow-upDisclosuresNothing to disclose.

Introduction/BackgroundThough atypical endometriosis (AE) is hypothesized to be a precursor of endometriosis associated ovarian carcinoma (EAOC), its identification has no established clinical consequences and is therefore not structurally embedded in histopathological examination of endometriosis. The aim of this study was to determine whether AE is diagnosed more often when pathologists use a clear set of criteria for atypical features compared to common practice.MethodologyAll cases of ovarian endometriosis, collected at the Radboud University Medical Centre Nijmegen between 1985 and 2017, were identified using the PALGA database. Pathology reports were searched for of atypical features and the notion of AE by the pathologist. Using a set list of criteria for AE, a total of 293 samples were revised by two independent pathologists to assess atypical features in the samples.ResultsA total of 949 cases of ovarian endometriosis were included in the database. AE was documented in 105 cases . After revision of 266 endometriosis samples, the pathologist identified a total of 48 samples with AE. In contrast, in the original pathology report, only 31 cases of AE were identified, with 18 cases where AE was mentioned in the microscopy report, but not the concluding section. The agreement of the revising pathologist with the original report regarding AE occurrence was minimal.ConclusionThis study shows that AE is not properly identified in common practice. Furthermore, AE diagnosis may depend on the criteria used and the alertness of the pathologist and inter-observer variability may be a pitfall for proper identification. As AE has been identified in association with malignant transformation, it is of utmost importance to mark its occurrence. With this study we want to press the importance of adequate identification and documentation of atypical features in AE in order to move towards clinical implications for AE in order to aid EAOC prevention.

Introduction/BackgroundTumor Treating Fields (TTFields) have shown efficacy in glioblastoma, non-small-cell lung cancer and pleural mesothelioma, with favorable safety. TTFields’ anti-mitotic effects are dose-dependent and may be affected by tissue conductivity changes. Preclinical data (unpublished) showed doxorubicin induces tumor fibrosis and changes tissue conductivity. This randomized phase 3 study investigated TTFields therapy with paclitaxel (TTFields+PTX) vs paclitaxel (PTX) in patients with platinum-resistant ovarian cancer (PROC).MethodologyENGOT-ov50/GOG-3029/INNOVATE-3 (NCT03940196) enrolled adults with PROC, ≤5 prior lines of therapy (LOT), ≤2 prior LOT following platinum-resistance, and ECOG 0-1. Patients received TTFields (200 kHz; ≥18 hours/day) + PTX (80 mg/m2) weekly or PTX. Primary endpoint was overall survival (OS).Results558 patients were randomized to receive TTFields+PTX (n=280) or PTX (n=278) March 2019 to November 2021. Baseline characteristics were well-balanced (median age, 62 [22-91] years; serous histology, 88.7%; ECOG 0, 60.2%; BRCA+, 15.6%). 24.4% of patients received 4+ prior LOT; 65.9% received prior bevacizumab. In the intention-to-treat population, TTFields therapy median duration was 15.9 (0.1–159.7) weeks. Median OS was 12.2 months with TTFields+PTX versus 11.9 months with PTX (HR, 1.01; 95% CI, 0.83-1.24; p=0.89). Grade ≥3 adverse events (AEs) occurred in 60% of patients with no TTFields-related increase in severe systemic toxicities; 83.6% of patients receiving TTFields had a device-related skin AE (all Grade 1/2). Post-hoc analysis in pegylated liposomal doxorubicin (PLD)-naïve patients showed extended survival with TTFields+PTX (n=113) vs PTX (n=88) (16 vs 11.7 months; HR, 0.67; 95% CI, 0.49–0.94; p=0.03). Multivariate Cox regression analyses to eliminate alternative covariates potentially leading to survival superiority in PLD-naïve patients showed that TTFields and prior PLD status were statistically significant covariates following stepwise narrowing (HR, 0.56; p=0.0006).ConclusionIn the overall cohort TTFields+PTX did not improve OS compared with PTX. Post-hoc analysis of PLD-naïve patients showed clinically and statistically significant survival improvement in patients receiving TTFields therapyDisclosuresMedical writing support was provided by Makaila Wallin, PharmD, of The Curry Rockefeller Group, LLC (Tarrytown, NY), and was funded by Novocure, Inc.

IntroductionThe optimization of perioperative fasting is a key step in increasingly established ERAS (extended recovery after surgery) concepts in (gynecologic) surgery. But only little data exists about actually observed fasting intervals before and after surgery in clinical routine. This prospective study of the JAGO (Young Academy of Gynecologic Oncology) and NOGGO e.V. investigates the length of perioperative fasting in a multicentric survey.MethodsIn 13 German gynecologic departments the length of pre- and postoperative fasting intervals were recorded by questionnaire. Furthermore, the patients‘ subjective condition, clinical history and experience and ideas about fasting were documented. Subgroup analyses were performed for benign and malignant indications, as well as for the extent of surgery.ResultsA total of 924 patients participated in the study. On average, patients did not eat for 17:02 h and did not drink for 9:21 h before surgery. The first postoperative meal was 9:42 h after surgery. Patients with malignant indications had significantly longer pre- (Δ=67 min) and postoperative (Δ=166 min) fasting intervals. Prolonged fasting intervals were also observed for patients with extensive surgery. In general patients felt well informed and the majority did not feel impaired by the adherence to fasting restrictions.ConclusionsPatients fast significantly longer than recommended. Even more prolonged fasting intervals are observed in patients with malignant indications and extensive surgeries, where optimized fasting could play the greatest role. Therefore, better protocols on optimized perioperative fasting need to be implemented in routine clinical practice.

IntroductionTreatment for vulvar intraepithelial neoplasia (VIN) may lead to anxiety concerning genital health, influence body image and sexual activity. Surgical treatment may be associated with vulvar scarring and psychosexual morbidity. Conservative medical treatments do not modify genital anatomy and may lead to better cosmetic outcome and less psychosexual distress.MethodsThis is a subsequent analysis of the multicentre, randomised, phase 3, non-inferiority trial ‘Topical imiquimod versus surgery for vulvar intraepithelial neoplasia’ published in The Lancet in April 2022. Patients were randomized to primary topical treatment or surgery and stratified by unifocal or multifocal disease. Cosmetic outcome was assessed by three investigators blinded to group allocation. Digital photos were scored with a modified version of the Global Aesthetic Improvement Scale (GAIS).The Cervical Dysplasia Distress Questionnaire (CDDQ), the Sexual Activity Questionnaire (SAQ) and the Client Satisfaction Questionnaire (CSQ) were used to examine psychosexual distress and treatment satisfaction.Results110 patients aged between 19 and 82 years were enrolled. Per-protocol analysis showed complete clinical response in 80% (37/46) using imiquimod, compared to 79% (41/52) after one surgical intervention. Photo-documentation at baseline and 6 months follow-up was available for 84 of these patients (44 imiquimod, 40 surgery). Inter-rater agreement was poor (below 0.5) for the GAIS score (100%) and moderate to good (0.5 to 0.9) for lesion severity of the VASS (75%). There were no significant differences in GAIS and VASS scores between treatment groups in patients with complete (n= 66) or partial clinical response (n=18). No significant associations between cosmetic outcome, psychosocial distress, treatment satisfaction and initial lesions size of VIN could be found.ConclusionsTopical imiquimod and surgery may have similar effects on cosmetic outcome, psychosexual distress and treatment satisfaction in patients with VIN.

Abstract We launched a Person-Centered Dementia Training in March 2023, focused on Four interactive modules were offered via an Online Learning Platform. Topics included: Introduction to Dementia, Communication Process and Approach, Environmental and Cultural Implications in Dementia Care, and Best Practices in Responding to Difficult Behaviors. Subtopics included: Introduction to Age-Friendly and Dementia-Friendly Care, High-risk Medications and Dementia Care, Dementia vs Delirium, and Reframing Aging—Understanding and Recognizing Ageism Specific to People Living with Dementia. BSN students were recruited via (3) email blasts and (1) in-person announcement of participation opportunity. A total of (n=33) participants were recruited from 4 nursing programs, Traditional BSN Junior (34%), Traditional BSN Senior (48%), Degree Completion LPN to BSN (3%) and Accelerated BSN (14%). Most participants were female (96%), between the ages of 18-24 (60%). 24 participants completed the pre-/post-test and Final Program Evaluation. Participants rated the course content and structure as 4.5/5 on 5pt-likert scale. Common themes from evaluations included: need for additional content, more interactive activities, and inclusion as a required course for all nursing students. Future steps to include revising course content based on participant feedback, offer revised course over the next 2 academic semesters, and expand reach by offering course to practicing nurses to improve care of people living with dementia (PLWD).

Abstract The metabolic and inflammatory cytokine growth-differentiation factor 15 (GDF15) increases with age and negatively associates with physical and cognitive function in older adults. We hypothesized GDF15 also negatively associates with resilient outcomes after surgery. This hypothesis was tested in the SPRING study of physical resiliency after total knee replacement by assessing relationships between pre-operative plasma GDF15 levels and postoperative resilience measures including short physical performance battery (SPPB) scores, fatigability, and grip strength. GDF15 analyses and physical resilience were assessed in 127 SPRING participants (age 70±6 yrs, n=83 women). Baseline GDF15 levels correlated with age (r=0.263, P< 0.05); age-adjusted analyses were applied. In total, pre-operative GDF15 levels did not significantly correlate with functional measures at any timepoint. However, in men (n=44), GDF15 levels correlated with age (r=0.408, P< 0.05) and significant age-adjusted correlations were observed in fatigue (r=0.368, P< 0.05), gait speed (r=-0.428, P< 0.05), and SPPB score (r=-0.329, P< 0.05). Additionally, GDF15 levels correlated with chair stands at six months (r=-0.398, P< 0.05), SPPB score at six months (r=-0.384, P< 0.05), and gait speed after one year (r=-0.487, P< 0.05). GDF15 did not significantly correlate with changes in SPPB score (P>0.05). There were no significant correlations between GDF15 and any of these functional measures in women (r-value range: -0.259 to 0.107; p-value range: 0.112 to 0.969). Elevated pre-operative GDF15 appears to correlate with worsening physical function following knee replacement in men, but not women. Further investigation is necessary to understand the relationship between GDF15 and the biology of physical resiliency.

Abstract There is significant loss of dendritic complexity with age, which may account for synaptic loss and cognitive decline in mammals. However, molecular mechanisms underlying these changes are unclear. Key molecular players in dendritic morphogenesis include the guidance cue semaphorin 3A (Sema3A). In developing cortical neurons, Sema3A signals through the Plexin-A4 receptor to induce basal dendritic arborization, while another closely related member, Sema3F, induces apical dendritic spine pruning. Interestingly, both ligands are expressed in adulthood, but their roles in age-associated dendritic remodeling are unknown. To address this, we established a model of aging mouse primary cortical neurons: 5, 15, and 30 days-in-vitro (DIV) representing young, mature, and aged timepoints. Treating with either ligand increases branching at 5-15DIV, but not 30DIV, suggesting age-associated changes in cellular responses to Sema3A/3F. Next, we examined mouse cortices in vivo and found both Plexin-A4 expression and dendritic elaboration decrease with age, suggesting a need for Plexin-A4 to maintain dendritic complexity at older ages. In 6-month-olds, mutant Plexin-A4 mice have less branching than wildtypes, but we found no further decline in 18-month-olds, likely because there can be no age-associated downregulation of Plexin-A4 signaling if the receptor is not present. Finally, we found increased levels of active-RhoA GTPase (a downstream cytoskeleton regulator) in Plexin-A4-/- 6-month-old cortices versus controls. Additionally, our preliminary data trends towards increased active-RhoA in 18-month-olds versus 6-month-olds. Collectively, our study provides novel insights into the diverse cellular functions of semaphorin-plexin, a signaling pathway important for nervous system development, in age-associated dendritic loss and cognitive decline.

Abstract The vast majority (88%) of adults wish to age in place. An aesthetically pleasing environment has been found to be associated with better physical functioning and reduced disability, however specific land cover features (i.e. blue, green, urban spaces) and their relation to mobility have not been fully investigated. Data come from the National Health and Aging Trends Study (NHATS, 2021), a nationally representative sample of Medicare beneficiaries, and the National Neighborhood Data Archive (NaNDA), a data repository with census-tract measures of land cover. Mobility was assessed using the objective Short Physical Performance Battery (SPPB) and subjective physical capacity (PC) (range = 0-3 for both measures). Higher categories for both measures indicate better mobility. The analytic sample included 2,939 individuals (58.3% women) with mean age 81.8 years (SD = 6.4) from 2,071 census tracts. In fully-adjusted ordinal logistic regression models, compared to those in the lowest SPPB category, each percentage increase of blue space was associated with a 3.6 greater odds of being in the next highest category of SPPB (aOR= 3.61, 95% CI = 1.20-10.84 ). In contrast, each percentage increase of urban space was associated with a 18% decreased odds of being in the next highest category of SPPB (aOR= 0.82, 95% CI = 0.67-0.99). Similar associations were observed with PC, although were not statistically significant. Since decreased mobility is associated with numerous negative health outcomes, results from this study highlight the need to consider land cover as a potential policy lever to promote mobility among older adults.