The American Society of Clinical Oncology recommends that all patients with advanced cancer, including metastatic or life-limiting disease with a prognosis of 6 to 24 months, receive early, dedicated palliative care (PC) within 8 weeks of diagnosis in parallel with oncologic treatment.¹ Benefits of PC in patients with cancer include improved patient and caregiver quality of life (QOL) and symptom management, prolonged survival, and enhanced quality of end-of-life (EOL) care.^1-3 With increasing recognition that futile and overly aggressive care at the EOL is costly to patients and the health care system,^3,4 studies in the general cancer population have reported that early specialist PC referral is associated with less-aggressive EOL care, including emergency department (ED) visits, hospital and intensive care unit (ICU) admissions, and inpatient death.^5,6

Objective Despite increased participation of women in academic medicine in recent decades, gender disparities persist. The gender gap in authorship and editorial boards in gynecologic oncology, and impact of the COVID-19 pandemic, have not been recently evaluated. We examined gender representation and the impact of COVID-19 on authorship and editorial boards of two major peer-reviewed gynecologic oncology journals. Methods We conducted a bibliometric analysis of original articles published in Gynecologic Oncology and the International Journal of Gynecological Cancer, comparing the most contemporary 5-year period (2016–2020) to single years in the two prior decades (1996, 2006). To assess the early impact of COVID-19, we compared publications from May 2020–April 2021 to 2019. Editorial boards were analyzed for gender composition. First names, pronouns, and institutional photographs were used to determine gender. Results There were 3022 original articles published between 2016 and 2020, 763 in 2006, and 203 in 1996. Gender was identified for 91.3% of first authors (3641 articles) and 95.6% of senior authors (3813 articles). Men comprised the majority of the editorial boards in 2021 at 57% and 61% for Gynecologic Oncology and the International Journal of Gynecological Cancer, respectively. Men were overrepresented as senior authors across all study periods: 93% in 1996, 77% in 2006, and 58% in 2016–2020. Over time, representation of women as first and senior authors increased (7% in 1996, 42% in 2016–2020, p<0.00001). There was no immediate impact of the early pandemic on gender distribution of authorship. Conclusions Despite greater representation of women over time as authors in gynecologic oncology journals, there remains gender disparity in senior authorship and editorial board representation. This presents an opportunity for the academic publishing community to advocate for deliberate strategies to achieve gender parity. Although no impact of the early COVID-19 pandemic was found, this requires ongoing surveillance.

• Cervical PEComas are rare neoplasms which present a diagnostic challenge. • Large tumour size is an important clinical prognosticator in cervical PEComa. • All reported cases of cervical PEComa classified as benign by Folpe criteria behaved in benign fashion clinically. • Tumours ≤ 4 cm may be assessed with cone biopsy, and simple hysterectomy considered if no adverse pathologic features. • Molecular characterization and linkage with coordinated rare tumour registries may identify novel treatments.