Presentations 2004 Abstracts Presenting Residents Gema

Presenting Residents Gema E. Fernandez, MD Contraception: knowledge, lifestyles, and behaviors. G.E. Fernandez, MD; M. Phipps, MD, MPH; R. Shackelton; F. Lozowski; A. Meers. Objective: Efforts to make ECP available over the counter have been unsuccessful to date for many reasons, including claims that ECP encourages irresponsible sexual behavior and will increase rates of sexually transmitted diseases. This study looks at whether there are differences between women seeking ECP and women seeking general family planning services in lifestyle and sexual behaviors as well as differences in knowledge about ECP and contraception in general. Methods: This cross-sectional study performed during August 2003 through March 2004 included a total of 245 women. A group of 128 women presenting to the Women & Infants Hospital Triage Unit seeking emergency contraception (ECP group) and 117 women presenting to the Women’s Primary Care Center Family Planning Unit for contraceptive counseling (WPCC group) were asked to complete a self-administered anonymous questionnaire which included demographic information, medical and sexual history, and questions regarding contraceptive knowledge. Comparisons between the groups included contraceptive use, history of STD’s, and number of sexual partners, as well as comparisons in knowledge about ECP and other contraceptives. Results: Comparing the ECP and WPCC groups, there were no significant differences in educational levels. Although there was no difference found between the two groups regarding the presence of STD’s in the past six months (2% ECP group vs. 6% WPCC group, p=0.38), the ECP group had a lower overall proportion of STD’s as compared with the WPCC group (17% vs. 44%, p<0.01). As for contraception, 78% of the WPCC group used some form of contraception with the last episode of intercourse, of which 73% used OCP’s. Only 56% of the ECP used contraception with the last episode of intercourse, of which 83% used condoms. There was a significantly higher number of sexual partners within the past 6 months in the ECP group (1.69 vs. 0.95, p<0.01); over the course of a lifetime the ECP group averaged 5.6 partners and the WPCC group averaged 4.2 partners (p=0.054). The groups did not differ in the number of episodes of unprotected intercourse. Overall knowledge for many questions about contraception was similar. For example, a question about tubal ligation offering STD protection was answered correctly (“false”) by 88% of the ECP group and 95% of the WPCC group, and a question about OCP’s causing ovarian cancer was answered as “unsure” by 49% of the ECP group and 50% of the WPCC group. In contrast, more women in the ECP group reported knowledge about the existence of emergency contraception as compared with the WPCC group (84% vs. 53%, p <0.01). As for knowledge about ECP availability in the subgroup of women who reported knowing about the existence of ECP, only 44% in each group knew it was available with a prescription. Conclusion: This study does not support the idea that women seeking ECP have significantly increased rates of sexually transmitted diseases or risky sexual behavior. Overall, women in our study had limited knowledge regarding contraception in general and emergency contraception specifically. This study underscores the need for effective contraceptive education including information about emergency contraception for all women. As practitioners, we need to be sensitive to the needs of our patients and move towards making ECP more widely available and accessible to all women. Evelyn L. Fleming, MD Does body mass index predict cutaneous reactions to pegylated liposomal doxorubicin? E.L. Fleming, MD; D.S. Dizon, MD; P.A. DiSilvestro, MD; R.G. Moore, MD; C. Granai, MD; M.E. Gordinier, MD. Objective: The dose limiting toxicity of pegylated liposomal doxorubicin (PLD) is palmarplantar erythrodysesthesia (PPE). Some physicians may have a bias against using this drug in overweight patients, postulating that larger size increases the likelihood of drug deposition that may predispose to PPE. The aim of this study was to determine whether the body mass index (BMI) predicted frequency or severity of cutaneous reactions in patients receiving PLD. Methods: The records of all patients receiving PLD for a gynecologic malignancy between 1996 and 2003 were reviewed. Chemotherapy history, BMI at the start of PLD treatment, dose, infusion time, and adverse effects were all collected. In addition, type and grade of skin reactions and treatment for them were extracted. Finally, history of potential predisposing factors was recorded, such as sun exposure, medical conditions, and allergies. The reason for drug discontinuation was also ascertained. Results: 103 patients were included in this analysis. 429 cycles of PLD were given with a median of 4 cycles per patient. The primary toxicity was skin reaction, with 36% experiencing PPE. Of those with PPE, 54% had Gr1 reactions, 32% had Gr2 reactions, and 14% had Gr3 reactions. There were no Gr4 reactions. The mean BMI in patients who had clinically significant skin reactions was identical to those who did not, 29 vs. 28.8, respectively. When patients were analyzed by subsets of weight, the incidence of skin reactions among patients of different weight groups was similar. Logistic regression revealed no relationship between BMI and grade of rash. None of the potential predisposing factors analyzed correlated with an increased incidence of cutaneous toxicity. Conclusion: Increased BMI is not associated with an increased risk of skin reactions or PPE. Among the patients treated with PLD, the rate of skin toxicity was 36% and was a major reason for discontinuing the drug. Further work is required to better define which of our patients are at risk for PPE.