Kumar, Amanika

Abstract Background Several ovarian cancer studies have suggested that a body mass index (BMI) of 30 or higher is associated with lower compliance with National Comprehensive Cancer Network–recommended chemotherapy but primarily involved treatment before 2012, when dose capping was recommended for patients with higher body surface areas. Updated analyses in the contemporary treatment era are warranted. Methods In a retrospective cohort of patients with newly diagnosed ovarian cancer receiving curative-intent carboplatin plus paclitaxel in the Yale-Smilow Cancer Network (2012-2022), we evaluated BMI at diagnosis in relation to relative dose intensity (RDI)—the ratio of completed chemotherapy dose intensity to the National Comprehensive Cancer Network–recommended dose intensity—which reflects dose modification both before and during treatment. We also assessed starting RDI (which reflects modifications before treatment) and received RDI (which reflects modifications during treatment). Data on hospitalizations and hematological chemotoxicities were collected. We examined the association between BMI (<25, 25-30, ≥30) and chemotherapy completion, hospitalizations, and toxicities using multivariable linear and logistic regressions. Results Among 327 patients, the average RDI was 79.7%, and 44.3% had an RDI below 85%. Mean (SD) starting and received RDI were 97.9% (9.1%) and 81.8% (25.7%), respectively. Higher BMI was associated with higher RDI (Paggregate = .03) and received RDI (Paggregate = .04). Body mass index was not associated with starting RDI, dose reductions, delays, hospitalizations, or hematological toxicities. Conclusions Among patients with ovarian cancer treated since 2012, the overall RDI was low. Relative dose intensity was higher among patients with a BMI of 25 or higher compared with a BMI below 25. Most dose modifications occurred during treatment and not before initiation. Studies with body composition data and interventions that maximize chemotherapy completion during treatment are warranted.

Purpose: Palliative care focuses on providing relief from the stress and symptoms of serious illness. Obstetrician gynecologists (OBGYNs) manage a variety of complex clinical situations ranging from delivering a cancer diagnosis to caring for a neonatal demise to symptom management, all of which fall within the realm of palliative care. Palliative care is relevant to the practice of OBGYNs, yet residents rarely receive formal primary palliative care training. We sought to design, implement, and evaluate a dedicated curriculum on palliative care for OBGYN residents. Methods: We performed a needs assessment of an OBGYN residency at a single institution. This information was used to develop a multidisciplinary palliative care curriculum. Post-curriculum surveys were distributed and analyzed. Descriptive statistics were utilized. Results: Our needs assessment identified a lack of knowledge and competency in palliative care concepts and skills. Using this information, we created a multidisciplinary palliative care curriculum, including clinical experiences, chalk talks, and online didactics. Post-curriculum surveys revealed a marked improvement in both knowledge base and perceived competence. Feedback was overwhelmingly positive; residents indicated that the curriculum was both a valuable use of time and would impact their provision of care in the future. Conclusion: A dedicated palliative care curriculum is an impactful addition to OBGYN training.