their admission and 13% (n = 5) were not screened due to admis-sion over a weekend or holiday.Conclusion: Implementation of clinical triggers for PC consultationwas feasible in terms of investment from relevant stakeholders.Trigger implementation was not associated with increased rates ofPC consultation among patients meeting triggers. Process issues,including false negative screens and patients going unscreened mayhave contributed significantly to the lack of change in PC consulta-tion rates. Use of clinical triggers may still hold promise as a strategyfor standardizing PC consultation patterns and capturing subgroupsof patients with high needs. Our next steps include modifying bothour clinical triggers and our screening process and expanding ourproject into the outpatient setting.

doi:10.1016/j.ygyno.2014.07.028

Needs assessment of palliative care education in gynecologiconcology fellowship: We're not teaching what we think ismost importantC. Lefkowitsa, P. Sukumvanicha, R. Claxtonb, M. Courtney-Brooksa,J.L. Kelleya, M.A. McNeilc, A.K. Goodmand. aMagee Womens Hospitalof the University of Pittsburgh Medical Center (UPMC), Division ofGynecologic Oncology, Pittsburgh, PA, USA, bUPMC Department of InternalMedicine, Section of Palliative Care andMedical Ethics, Pittsburgh, PA, USA,cUPMC Department of Medicine, Division of General Internal Medicine,Pittsburgh, PA, USA, dMassachusetts General Hospital, Division of GynecologicOncology, Harvard Medical School, Boston, MA, USA.

Objectives: (1) Characterize coverage of palliative care (PC) topicsin current gynecologic oncology fellowship didactics, (2) identifyfellowship directors' (FD) perception of most important PC topics forfellows to learn, and (3) identify FDs' interest in utilizing PC curricularmaterials.Methods: An electronic survey was distributed to all gynecologiconcology FDs. The instrument assessed coverage of palliative care indidactic settings, explicit teaching of 16 PC topics meeting ABOG and/orASCO objectives, identification of PC topics most important for fellowsto learn and interest in utilizing new PC curricular materials by bothtopic and educational modality. Descriptive and correlative statisticswere used.Results: Response ratewas 63% (29/46). 100% of programs had coverageof some PC topic in didactics in the past year and 48% have either arequired (8/29) or elective (6/29) PC rotation. Only 14% (4/29) have awritten PC curriculum. Table 1 outlines PC topicswith the highest rates of(1) explicit teaching, (2) inclusion among most important topics forfellows to learn and (3) interest in utilization of PC curricular materials ifthey were to be made available. There was no correlation between therank of topics with the greatest teaching coverage and the rank of topicsconsidered most important for fellows to learn (rs = 0.108). 86% of FDsanticipate an increase in formal teaching of PC in the next five years and100% of FDs would consider using new PC curricular materials if they

were to be made available. Educational modalities of greatest interest fornew curricularmaterials were example teaching cases, PowerPoint slidesand online case-based modules.Conclusion: There is no correlation between which palliative caretopics are explicitly taught to gynecologic oncology fellows andwhich are considered most important for fellows to learn. BecauseFDs prioritize communication topics over symptom managementtopics as most important for fellows to learn, future efforts shouldaddress identification of optimal methods for teaching communica-tion to gynecologic oncology fellows. The rate of interest in novel PCcurricular materials meeting ABO/ASCO learning objectives is high,representing an opportunity for curricular development, testing andnational dissemination.

doi:10.1016/j.ygyno.2014.07.029

Ovarian cancer knowledge in Hispanic women: Bridging the gapM. Schlumbrechta, J. Dettlera, R. Yariana, C. Nivenb, K. Salmona, D. Singha.aBanner M.D. Anderson Cancer Center, Gilbert, AZ, USA, bMesa PublicSchools, Mesa, AZ, USA.

Objectives: Prompted by the 2005 United States Congressional passageof Johanna's Law, the Centers for Disease Control (CDC) developed“Inside Knowledge”, a program to increase awareness of gynecologicmalignancies. Studies have noted that in disadvantaged populations,including Hispanics, there is a significant deficit in an understanding ofcancer risk factors, symptoms, prevention, and treatment. The objectiveof this study was to assess knowledge of ovarian cancer in a populationof Hispanic women in Arizona to further identify directed topics for aneducational curriculum.Methods: After IRB approval, a de novo questionnaire was distrib-uted in both English and Spanish to Hispanic women participatingin family literacy programs through the Mesa Public SchoolDistrict. The questionnaire surveyed participant demographics, andcontained true/false questions about ovarian cancer anatomy,screening, epidemiology, risk factors, symptoms, genetics, diagnosis,and treatment. All questions were written to specifically assess anunderstanding of topics emphasized by the “Inside Knowledge”

Table 1

Pre-triggers Post-triggers

n % seenby PC

n % seenby PC

p-value (comparingpre-trigg % seen topost-trigg % seen)

Admission meetingat least 1 trigger

62 63.3 58 60.4 0.77a

Stage IV 31 62.0 18 39.1 0.04a

Symptom admission 41 74.5 42 72.4 0.83a

Malignant bowelobstruction

5 55.6 8 66.7 0.67a

Exent 5 71.4 6 75.0 1.00a

a Fischer's exact test.

Table 1

Highest ratesexplicitlytaught

Highest rate inclusionamong most importanttopics to learn

Highest rate inclusionamong greatest interestin curricular materials

Topic %programsteachingtopic

Topic %programsincludingtopic intop 5

Topic %programsincludingtopic intop 5

1. Nausea 93% 1. Deliveringbad news

59% 1. Opioidrotation

52%

2. XRT for pain 75% 2. Discussingprognosis(tie)

55% 2. Discussingprognosis

48%

3. Delivering badnews (tie)

72% 2. Discussingstoppingchemo (tie)

55% 3. Deliveringbad news

44%

3. Managingconstipation(tie)

72% 4. Discussinggoals ofcare/codestatus

48% 4. Fatigue(tie)

41%

5. Discussing goalsof care/codestatus, discussingprognosis &managinganorexia/cachexia(tie)

69% 5. When torefer tohospice

45% 4. Depression(tie)

41%

Abstracts390

program. Summary statistics and the Kruskal–Wallis test were usedto analyze the data.Results: 173 questionnaires were completed. 82.6% of women ages 25–44. 95.8% were not originally from the United States, 67.5% had at least ahigh school education, and 83.2% had a household family incomeof b$25,000. Questions with the fewest number of correct responsesincluded those focused on risk factors for ovarian cancer (28.3%), cancerscreening (52.4%), and genetics (57.5%). The topics of basic anatomy(86.5%) and cancer treatment (79.8%) contained the most incorrectresponses. 75% of the respondents were not able to correctly identifyovarian cancer symptoms. The number of correct responses was notassociatedwith age (p= 0.88) or the highest level of education achieved(p= 0.61).Conclusion: An ovarian cancer knowledge deficit was identified in thissample of Hispanic women, suggesting a need for educational effortsemphasizing prevention, screening, symptoms, and genetics in this andsimilar minority populations. Anticipated increases in the number ofcancer diagnoses in the coming decades, coupled with demographicshifts and rising healthcare costs in the US, make it even more importantto increase community awareness of cancer detection and treatmentin order to use healthcare resources efficiently. A pilot instructionalprogram has been initiated in this cohort.

doi:10.1016/j.ygyno.2014.07.030

Prognostic factors associated with long-term survival inovarian cancerR. Cress, C. Morris, Y. Chen, G. Leiserowitz. UC Davis ComprehensiveCancer Center, Sacramento, CA 95817, USA.

Objectives: Population-based cancer registries have prolongedfollow-up on ovarian cancer survivors. Our objective was to identifyprognostic factors associated with long-term survival (N10 years).Methods: The California Cancer Registry (CCR) contains demo-graphic, diagnostic, treatment, and outcome information of Californiacancer patients, with nearly 100% follow-up. We identified epithelialovarian cancer patients, diagnosed between 1994 and 2001, andfollowed through December 2011, with a minimum of 10 yearfollow-up for all surviving patients. Exclusions included: if diagnosedat autopsy or if missing information about their SES, race/ethnicity,stage, grade, treatment, or cause of death. Characteristics of long-term (LT) survivors (N10 years) were compared to short-term (ST)survivors (2 to 5 years). Multivariate logistic regression and Coxproportional hazard modeling were used to identify significantpredictors of LT survival.Results: 11,410 of women were diagnosed with epithelial ovariancancer during this period. We identified 4046 patients who were LTsurvivors, and compared this group to 2608 patients who were STsurvivors. Significant differences between LT and ST survival groupsincluded: age b 50 years (46% vs. 21%), non-Caucasian (33% versus24%), have grade 1 or 2 tumors (43% versus 21%), stage I cancer (53%versus 5%), and have mucinous, endometrioid, or clear cell histologies(7% vs. 2%, 23% vs. 8%, 10% vs. 2%, respectively). 1242womenwith stageIII/IV cancer were long-term survivors. In multivariate analysis, youngage remained a significant predictor of being a long-term survivor, withall age groups having two to nearly four times better probability ofsurviving than those in the 75+ group. Stage was the strongestpredictor, followed by non-serous histology, and then grade. Race, SES,insurance type, and hospital volumes were not independently signifi-cant. LT survival characteristics for stage IIIC cancers included: age b 65,low grade, and non-serous histology; for stage IA only age b 50 andgrade were significant.Conclusion: Almost a third of ovarian cancer patients survived morethan 10 years, and 1242 had advanced stage disease — these will be

the focus for future studies. Most of the prognostic factors are non-modifiable, but are important for counseling.

doi:10.1016/j.ygyno.2014.07.031

A common gene expression signature in uterine and ovarian tumorssuggests conserved biological pathways in the endometrioidsubtype independent of tissue of originJ.M. Stephan, T. Neff, H.D. Reyes, A. Dupuy, M.J. Goodheart. Universityof Iowa Hospitals and Clinics, Iowa City, IA, USA.

Objectives: Endometrioid adenocarcinoma of the ovary is the secondmost common histologic subtype behind papillary serous adenocarcino-ma; however, it is the most common histology found in uterine cancer.The identification of genes unique to each histology is valuable, and couldprovide potential new therapeutic targets. We sought to identify genesunique to endometrioid and serous adenocarcinomas of the ovary anduterus in an attempt to identify new pathways for future therapeuticintervention.Methods: The Cancer Genome Atlas (TCGA) was used to retrievetranscriptome data for both serous (n = 57) and endometrioid(n = 302) uterine cancers, as well as microarray analysis data onserous ovarian cancers (n = 570). Endometrioid ovarian cancergene expression data were obtained by running AffymetrixExon arrays on 32 samples from our own tumor bank. Two inde-pendent statistical comparisons were performed to identify differ-entially expressed genes between tumors of serous and endometrioidhistology fromeither the uterus or ovary (p≤ 0.01). These differentiallyexpressed genes were then compared to identify a set of genes that isuniformly overexpressed in both uterine and ovarian endometrioidtumors.Results: This analysis revealed 60 genes to be overexpressedconsistently in endometrioid cancers, independently of site of origin.This association was not identified for serous cancers. The STRINGdatabase was then queried to identify gene pathways of interest.This analysis identified 240 interactions between the proteinsencoded by the 60 genes in the endometrioid gene signature, withAURKA and NDC80 at the core. These genes are of particular interestas they play a major role in microtubule stability and have beenimplicated in other malignancies such as ovarian and breast cancers,and malignant mesothelioma, respectively.Conclusion: Patients with ovarian and uterine cancers of endometrioidhistology possess an overlapping gene expression signature. Specificpathways involving genes such as AURKA and NDC80 warrant furtherinvestigation, as they can represent potential therapeutic targets in thissubset of patients.

doi:10.1016/j.ygyno.2014.07.032

Progestin treatment decreases cd133+cancer stemcell populationsin endometrial cancerM. Guy, L. Qamar, K. Behbakht, M. Spillman. University of ColoradoSchool of Medicine, Aurora, CO, USA.

Objectives: When surgery is not an option, patients with endome-trial cancer are treated with high dose progestins. CD133 is a knownmarker of endometrial cancer stem cells, which contribute to tumorprogression and are resistant to traditional chemotherapies. Ourhypothesis is that high dose progestins will decrease the number ofCD133+ stem cells in endometrial cancer.Methods: Using flow cytometry we profiled the CD133 populations inthe authenticated Ishikawa and KLE endometrial cancer cell lines. Cells

Abstracts 391