Laura Havrilesky

Overview:

I am interested in using health economic models to inform decisions related to gynecologic cancers. Specific models have addressed the decision to administer intraperitoneal chemotherapy for newly diagnosed advanced ovarian cancer following optimal cytoreduction, the choice of chemotherapy regimen for recurrent platinum-sensitive ovarian cancer, and the exploration of screening strategies for ovarian cancer. The ovarian cancer screening model examines the effects of test cost, sensitivity, specificity, and screen frequency on ovarian cancer mortality, the lifetime false positive rate of testing, the positive predictive value of the test, and its cost effectiveness. This type of model is potentially useful in informing the design trials of novel screening tests for ovarian cancer. I am also conducting a prospective study to quantify the effects of screening for, diagnosis of, and treatment for ovarian cancer on the quality of life of women.

Positions:

Professor of Obstetrics and Gynecology

Obstetrics and Gynecology, Gynecologic Oncology
School of Medicine

Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1995

Duke University

Residency, Obstetrics And Gynecology

Duke University

Gynecology Oncology Fellowship, Obstetrics And Gynecology

Duke University School of Medicine

Grants:

Tissue and Data Acquisition Activity for the Study of Gynecologic Disease

Administered By
Obstetrics and Gynecology, Gynecologic Oncology
Awarded By
United States Army Medical Research and Materiel Command
Role
Principal Investigator
Start Date
End Date

Tissue and Data Acquisition Activity for the Study of Gynecologic Disease

Administered By
Obstetrics and Gynecology, Gynecologic Oncology
Role
Principal Investigator
Start Date
End Date

Cancer Tx with a PARP Inhibitor VS Standard

Administered By
Duke Clinical Research Institute
Awarded By
TESARO
Role
Co Investigator
Start Date
End Date

Ovarian Cancer Patient-Centered Decision Aid

Administered By
Obstetrics and Gynecology, Gynecologic Oncology
Awarded By
University of California - Irvine
Role
Principal Investigator
Start Date
End Date

Tissue and Data Acquisition Activity for the Study of Gynecologic Disease

Administered By
Obstetrics and Gynecology, Gynecologic Oncology
Awarded By
Henry M. Jackson Foundation
Role
Principal Investigator
Start Date
End Date

Publications:

Opportunities to Advance the Delivery of High-Quality, Goal-Concordant End-of-Life Care in Ovarian Cancer.

MLA Citation
Davidson, Brittany A., et al. “Opportunities to Advance the Delivery of High-Quality, Goal-Concordant End-of-Life Care in Ovarian Cancer.Jco Oncol Pract, vol. 18, no. 3, Mar. 2022, pp. 161–63. Pubmed, doi:10.1200/OP.21.00699.
URI
https://scholars.duke.edu/individual/pub1500922
PMID
34748389
Source
pubmed
Published In
Jco Oncol Pract
Volume
18
Published Date
Start Page
161
End Page
163
DOI
10.1200/OP.21.00699

Distress screening in endometrial cancer leads to disparity in referral to support services.

OBJECTIVES: Racial disparities in survival from endometrial cancer (EC) are well known. Cancer distress has also been associated with worse clinical outcomes. We characterized the association between race/ethnicity, patient distress reported on the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), referral to support services, time to surgery, and acceptance of adjuvant therapy in patients with EC. METHODS: We included patients presenting at an academic gynecologic oncology practice from 1/2013-6/2020 who had not received prior EC-directed treatment. Demographics, NCCN DT scores, and treatment details were abstracted from the electronic medical record. Difference in initial DT scores by race/ethnicity and treatment type was tested using general linear modeling. The significance of interaction effects was tested using linear mixed models and logistic regression. RESULTS: 393 non-Hispanic White (NHW) and 134 non-Hispanic Black (NHB) patients were included. Median distress scores were higher in NHW patients compared to NHB patients (4 vs. 2, p < 0.001); 51% of NHW patients qualified for referral to support services compared to 40% of NHB patients (p = 0.03). Distress scores were highest at initial appointment and declined over time in NHW patients regardless of treatment, but were initially low and remained low over time in NHB patients. There was no association of initial distress score with time to surgery or acceptance of adjuvant treatment (p-values >0.25). CONCLUSIONS: An observed difference in NCCN DT leads to racial disparities in referral to support services. The NCCN DT may not adequately measure distress in NHB women with EC.
Authors
Reid, HW; Broadwater, G; Montes de Oca, MK; Selvan, B; Fayanju, O; Havrilesky, LJ; Davidson, BA
MLA Citation
Reid, Hadley W., et al. “Distress screening in endometrial cancer leads to disparity in referral to support services.Gynecol Oncol, vol. 164, no. 3, Mar. 2022, pp. 622–27. Pubmed, doi:10.1016/j.ygyno.2022.01.001.
URI
https://scholars.duke.edu/individual/pub1505939
PMID
35016785
Source
pubmed
Published In
Gynecol Oncol
Volume
164
Published Date
Start Page
622
End Page
627
DOI
10.1016/j.ygyno.2022.01.001

Promoting timely goals of care conversations between gynecologic cancer patients at high-risk of death and their providers.

<h4>Objective</h4>We designed a multi-faceted intervention to increase the rate of outpatient goals of care (GOC) conversations in women with gynecologic cancers who are at high-risk of death.<h4>Methods and materials</h4>A multidisciplinary team developed an educational program around GOC conversations at end-of-life and chose criteria to prospectively identify patients at high-risk of death who might benefit from timely GOC conversations: recurrent or metastatic endometrial, cervical or vulvar cancer or platinum-resistant ovarian cancer. Gynecologic oncology provider consensus was built regarding the need to improve the quality and timing of GOC conversations. Eligible outpatients were prospectively identified and providers alerted pre-encounter; timely GOC documentation within 3 visits of high-risk identification was tracked. Our institution concurrently and subsequently tracked GOC documentation during the last 6 months of life among all established oncology patients.<h4>Results</h4>Of 220 pilot period high-risk patients (96 pre- and 124 during pilot period 2017-2018), timely GOC discussion documentation increased from 30.2% to 88.7% (p < 0.001) and this increase was sustained over time. In the post-pilot period (2019-2020), among patients seen by oncologists during last 6 months of life, compared to other cancer types, gynecologic cancer patients had a higher rate of GOC documentation (81% versus 9%; p < 0.001), a lower rate of receiving chemotherapy during the last 14 days of life (2% vs 5%; p = 0.051), and no difference in end-of-life admissions (29% vs 31%; p = NS).<h4>Conclusions</h4>Implementation of systematic outpatient identification of high-risk gynecologic oncology patients is feasible, sustainable, and increases the timely conduct of GOC conversations.
Authors
Davidson, BA; Puechl, AM; Watson, CH; Lim, S; Gatta, L; Monuszko, K; Drury, K; Ryan, ES; Rice, S; Truong, T; Ma, J; Power, S; Jordan, W; Kurtovic, K; Havrilesky, LJ
MLA Citation
Davidson, Brittany A., et al. “Promoting timely goals of care conversations between gynecologic cancer patients at high-risk of death and their providers.Gynecologic Oncology, vol. 164, no. 2, Feb. 2022, pp. 288–94. Epmc, doi:10.1016/j.ygyno.2021.12.009.
URI
https://scholars.duke.edu/individual/pub1504677
PMID
34922770
Source
epmc
Published In
Gynecologic Oncology
Volume
164
Published Date
Start Page
288
End Page
294
DOI
10.1016/j.ygyno.2021.12.009

Standardization of caregiver and nursing perioperative care on gynecologic oncology wards in a resource-limited setting.

INTRODUCTION: In Kampala, Uganda, there is a strong cultural practice for patients to have designated caregivers for the duration of hospitalization. At the same time, nursing support is limited. This quality improvement project aimed to standardize caregiver and nursing perioperative care on the gynecologic oncology wards at the Uganda Cancer Institute and Mulago Specialised Women and Neonatal Hospital. METHODS: We developed, implemented, and evaluated a multidisciplinary intervention involving standardization of nursing care, patient education, and family member integration from October 2019 - July 2020. Data were abstracted from medical records and patient interviews pertaining to the following outcomes: 1) pain control; 2) post-operative surgical site infections, urinary tract infections, and pneumonia; 3) nursing documentation of medication administration, pain quality, and vital sign assessments, and 4) patient and caregiver education. Descriptive statistics, Fisher's exact test, and independent samples t-test were applied. RESULTS: Data were collected from 25 patients undergoing major gynecologic procedures. Pre- (N = 14) and post- (N = 11) intervention comparison demonstrated significant increases in preoperative patient education (0% to 80%, p = 0.001) and utilization of a comprehensive postoperative order form (0% to 45.5%, p = 0.009). Increased frequency in nursing documentation of patient checks (3 to 8, p = 0.266) and intraoperative antibiotic administration (9 to 10, p = 0.180) in patient charts did not reach significance. There was no change in infection rate, pain score utilization, caregiver documentation, or preoperative medication acquisition. CONCLUSION: Our findings suggest that patient- and family-centered perioperative care can be improved through standardization of nursing care, improved education, and integration of caregivers in a nursing-limited setting.
Authors
Wong, J; Mulamira, P; Arizu, J; Nabwire, M; Mugabi, D; Nabulime, S; Driwaru, D; Nankya, E; Batumba, R; Hagara, A; Okoth, A; Lindan Namugga, J; Ajeani, J; Nakisige, C; Ueda, SM; Havrilesky, LJ; Lee, PS
MLA Citation
Wong, Janice, et al. “Standardization of caregiver and nursing perioperative care on gynecologic oncology wards in a resource-limited setting.Gynecol Oncol Rep, vol. 39, Feb. 2022, p. 100915. Pubmed, doi:10.1016/j.gore.2021.100915.
URI
https://scholars.duke.edu/individual/pub1505940
PMID
35005159
Source
pubmed
Published In
Gynecologic Oncology Reports
Volume
39
Published Date
Start Page
100915
DOI
10.1016/j.gore.2021.100915

Adjuvant treatment and outcomes for patients with stage IIIA grade 1 endometrioid endometrial cancer.

OBJECTIVE: The role and type of adjuvant therapy for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIA grade 1 endometrioid endometrial adenocarcinoma are controversial. This retrospective cohort study aimed to determine associations between adjuvant therapy use and survival among patients with stage IIIA grade 1 endometrial cancer. METHODS: Patients who underwent primary surgery for stage IIIA (FIGO 2009 staging) grade 1 endometrial cancer between January 2004 and December 2016 were identified in the National Cancer Database. Demographics and receipt of adjuvant therapy were compared. Overall survival was analyzed using Kaplan-Meier curves, log-rank test, and multivariable Cox proportional hazard models. RESULTS: Of 1120 patients, 248 (22.1%) received no adjuvant treatment, 286 (25.5%) received chemotherapy alone, 201 (18.0%) radiation alone, and 385 (34.4%) chemotherapy and radiation. Five-year overall survival rate was 83.0% (95% CI 80.1% to 85.6%). Older age, increasing comorbidity count, and lymphovascular space invasion status were significant negative predictors of survival. Over time, there was an increasing rate of chemotherapy (45.4% in 2004-2009 vs 69.2% in 2010-2016; p<0.001). In the multivariable analysis, chemotherapy was associated with significantly improved overall survival compared with no adjuvant therapy (HR 0.49 (95% CI 0.31 to 0.79); p=0.003). There was no survival association when comparing radiation alone with no treatment, and none when adding radiation to chemotherapy compared with chemotherapy alone. Those with lymphovascular space invasion (n=124/507) had improved overall survival with chemotherapy and radiation (5-year overall survival 91.2% vs 76.7% for chemotherapy alone and 27.3% for radiation alone, log-rank p<0.001), but there was no survival difference after adjusting for age and comorbidity (HR 0.25 (95% CI 0.05 to 1.41); p=0.12). CONCLUSIONS: The use of adjuvant chemotherapy for the treatment of stage IIIA grade 1 endometrial cancer increased over time and was associated with improved overall survival compared with radiation alone or chemoradiation. Patients with lymphovascular space invasion may benefit from combination therapy.
Authors
Montes de Oca, MK; Albright, BB; Secord, AA; Havrilesky, LJ; Moss, HA
MLA Citation
Montes de Oca, Mary Katherine, et al. “Adjuvant treatment and outcomes for patients with stage IIIA grade 1 endometrioid endometrial cancer.Int J Gynecol Cancer, vol. 31, no. 12, Dec. 2021, pp. 1549–56. Pubmed, doi:10.1136/ijgc-2021-002884.
URI
https://scholars.duke.edu/individual/pub1500852
PMID
34725205
Source
pubmed
Published In
Int J Gynecol Cancer
Volume
31
Published Date
Start Page
1549
End Page
1556
DOI
10.1136/ijgc-2021-002884