SGO Issues Dec. 17, 2015
Sentinel Lymph Node mapping statement released
$20M slated for ovarian cancer research for FY2016
Practicing Wellness pre-conference session offered at Annual Meeting
SGO receives joint accreditation for continuing education
Gynecologic Oncology December 2015, Volume 139, Issue 3, p389-602
Allied Health Workshop draws more with new topics
SGO has released a clinical practice statement on The Role of Sentinel Lymph Node Mapping in Endometrial Cancer, stating that “Sentinel lymph node mapping has the potential to decrease morbidity and optimize the pathologic assessment of identified nodes in women with endometrial cancer.” Lead author Robert Holloway, MD, noted that the inclusion of SLN mapping into the NCCN guidelines as an alternative to traditional pelvic ± aortic lymphadenectomy for patients with endometrial cancer signaled a significant paradigm shift.
“The use of SLN biopsies for staging are is a natural progression away from ‘Halstedian’ surgical principles to a more targeted approach that identifies the highest risk draining lymph nodes, similar to current breast cancer, melanoma, and vulvar cancer surgeries,” said Dr. Holloway. “When the technique is mastered and the algorithm described in the NCCN guidelines is followed, patients can be surgically staged with pathology that assists in the determination of adjuvant therapy, while likely mitigating the morbidity associated with complete lymphadenectomy.”
Dr. Holloway noted that emerging data from several institutions suggests that the enhanced pathology methods used in the processing of SLN biopsies also detect more “low volume” metastasis, potentially increasing the sensitivity for detection of disease.
“The SLN technique is not known to reliably map the upper aorta above the inferior mesenteric artery, and therefore decisions about the performance of para-aortic lymphadenectomy should be determined by intra-operative analysis of the primary tumor and pelvic lymph nodes,” he said.
Regarding which patients might benefit from SLN mapping the most, Dr. Holloway said that it can be argued that GOG low risk (G1, < 50% invasion) patients may benefit the most, because many of these cases may not undergo lymphadenectomy based on their perceived low risk for metastasis. These low risk cases may have up to a 3% to 5% risk of metastasis depending on lesion size, exact depth of invasion, or presence of lymph vascular space involvement, the last factor often not diagnosed on frozen section analysis.
“Even patients with high-intermediate risk uterine pathology may benefit from avoidance of morbidity associated with lymphadenectomy, and increased sensitivity for detection of metastasis that can influence the choice of adjuvant therapy, i.e., use of whole pelvic radiation,” he said.
Dr. Holloway added that this opinion assumes adequate SLN training and experience, a success rate for detecting SLN of at least 80%, and a false negative rate of less than 5% as suggested in the Practice Statement.
“We encourage our SGO membership to review the statement and the references, seek assistance with training if needed from colleagues, and continue their institutional standard of care procedures while SLN mapping is introduced as an ‘add on,’” said Dr. Holloway. “Once proficiency is attained as described in the ASCO guidelines on breast SLN mapping referenced in the statement, it is reasonable to limit lymphadenectomy to cases requiring removal of suspicious lymph nodes and completion of side-specific mapping failures.”
Ovarian cancer research is expected to receive $20 million under the Dept. of Defense for FY 2016. The funding is contained in Omnibus Appropriations Legislation that U.S. House and Senate may vote on this week. President Barack Obama may sign the bill into law by Dec. 22. The SGO Legislative and Regulatory Affairs Taskforce and the SGO Congressional Ambassadors Program spent several months lobbying to preserve this critical source of research dollars.
As part of the Omnibus bill, the National Institutes of Health (NIH) is slated to receive a $2 billion increase for FY 2016. This 6.6 percent increase would be the largest uptick in funding since 2003. The NIH’s National Cancer Institute will receive $264.3 million for a total FY 2016 amount of over $5.2 billion, an increase of approximately 5.34 percent.
The Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program will receive a $3 million increase (1.6 percent) the Ovarian Cancer Control Program will receive a $500,000 increase (7.1 percent).
Next year there may be additional opportunities to request funding to research other gynecologic cancers through the Federal government’s Peer Reviewed Cancer Research Program, which has a budget of $50 million. The SGO taskforce and ambassadors will continue to monitor the votes and reach out to Members of Congress who may be undecided about supporting OCRP, as well as thank the Members of Congress who support these programs.
Exploring the role of coaching in professional development, experiencing mindfulness, and developing a work-life balance are the focus of “Practicing Wellness: Tools for Cultivating Resilience and Avoiding Burnout,” a pre-conference session March 18 at SGO’s Annual Meeting on Women’s Cancer in San Diego. Registration is $25 for this Special Session led by course director David Kushner, MD, from the University of Wisconsin, Madison, WI, and faculty Sarah Halley of The Napier Group.
Dr. Kushner noted that while provider burnout and wellness issues are not commonly discussed among most physicians, acknowledging these concerns is starting to become acceptable in our culture.
“The nature of the work environment has changed significantly over the last 20 years, and one driver has been changes in technology,” he said. “Email and cell phones have driven an expectation that physicians should be available 24/7, and not just for clinical issues, but for administrative tasks as well.
“Most professionals feel they need to log back on from home to respond to emails and complete work projects. This is especially true for work that requires uninterrupted thinking time,” said Dr. Kushner. “The rate of change in the health care system is also increasing regularly, increasing the demands on providers beyond the direct ‘patient-care’ responsibilities they were trained to perform.”
Following up on the “Gyn Onc Wellness Retreat: Reinvigorating the Joy and Compassion in Your Practice” session from the 2015 SGO Annual Meeting in Chicago, “Practicing Wellness: Tools for Cultivating Resilience and Avoiding Burnout” will build upon previously introduced mindfulness practices in the context of personal and professional development.
“The goal of work life balance will drive a person into a developmental path that requires them to be able to witness themselves objectively. In most cases the behaviors that drive a person out of balance are well-developed habits, largely unconscious and therefore very difficult to change,” said Halley. “As in everything, you cannot change what you cannot see. Developing the capacity to witness oneself is at the heart of mindfulness practice. This can take many forms and often does in the context of a coaching process.”
Halley added that while professional mentors are important for physicians for developing their careers, there are limitations to the kind of support mentors can provide.
“Executive or leadership coaching looks more broadly at a person’s overall development and supports a person to look at their life in a more holistic way,” she said. “To achieve work life balance. One needs to be clear about their big picture values and develop the capacity to prioritize the often competing demands of being successful in multiple domains.”
On Dec. 4, SGO received acceptance for a four-year Joint Accreditation for Interprofessional Continuing Education™ by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC). SGO is now one of only three medical associations to be simultaneously accredited to provide medical, pharmacy, and nursing continuing education through a single, unified application process, fee structure, and set of accreditation standards.
Launched in 2009, Joint Accreditation is a leading model for collaborative practice. It establishes the standards for education providers to deliver interprofessional continuing education (IPCE) planned by the health care team for the health care team. In this way, members from multiple professions can learn from each other to enable effective collaboration and improve health outcomes.
Achieving Joint Accreditation was an 18-month process for the SGO Education Committee. Committee Chair R. Wendel Naumann, MD, noted that the committee had put together many of SGO’s CME products prior to accreditation and these CME products and activities were reviewed as part of the application process.
“Joint Accreditation ensures that accredited continuing medical education can be delivered across our diverse membership with no increased cost to the Society,” said Dr. Naumann. “Our patients can be assured that our members are up to date on the latest medical advances in our specialty as part of our accredited education program.”
Joel Sorosky, MD, immediate past chair of the Education Committee’s Compliance Subcommittee, noted that this elevated standard of continuing education will have a positive impact on patients treated by SGO members.
“This affirms the SGO concept of team management,” said Dr. Sorosky. “It objectively demonstrates that education and patient care will be coordinated by providing educational standards for all SGO members regardless of their specialty or interest.”
Susan Zweizig, MD, current compliance chair for the Education Committee, noted that more health care professionals who attend the SGO meetings will be able to get educational credit from their professional accrediting organizations.
“The SGO’s inclusion in Joint Accreditation will mean that nursing and pharmacy colleagues as well as other allied attendees will be able to receive their continuing education credits for their participation,” said Dr. Zweizig. “This will facilitate their collaboration in interprofessional education at SGO events. Prior to joint accreditation, over 25 percent of our activities were interprofessional in nature and these numbers will increase in the future.”
Dr. Zweizig added that there is significant data demonstrating that better patient outcomes are associated with providers who access accredited continuing medical education.
“The improved level of support for other members of the care team in SGO education will mean that allied health professionals will be more likely to attend meetings,” she said. “Inclusion of our allied health colleagues will foster an exchange of ideas, creativity and better communication amongst health care professionals who care for patients with gynecologic cancer.”
The SGO accreditation workgroup was led by Kelly Hecklinger, SGO Director of Professional Education, who laid out a comprehensive timeline and task list for the members of the SGO compliance committee.
“The application process took 13 months from the time we applied to their final decision and involved extensive documentation including a comprehensive self-study of the SGO that Kelly wrote,” said Dr. Zweizig. “This was supplemented by the work of committee members who reviewed 18 months of continuing education activity files.”
Lead Article: Suboptimal cytoreduction in ovarian carcinoma is associated with molecular pathways characteristic of increased stromal activation Zhenqiu Liu, Jessica A. Beach, Hasmik Agadjanian, Dongyu Jia, Paul-Joseph Aspuria, Beth Y. Karlan, Sandra Orsulic
Meeting Report: American College of Surgeons clinical congress 2015 Joel I. Sorosky, Colleen Rivard, Mitchell I. Edelson
With even more registrants than in previous years—73 compared to 55 in 2014—the SGO Allied Health Professionals Workshop on Dec. 5-6 in Chicago gave physician assistants, nurse practitioners and registered nurses who treat patients with gynecologic cancers an opportunity to expand their knowledge about different aspects of treating women with these malignancies.
Course directors Katie Elliott, MS, RN, WHNP-BC; Kayla Bowser, PA-C; and Jeff Lin, MD, worked with invited experts to address some of the most pressing issues for allied health practitioners, and included inpatient/outpatient breakout sessions as a new feature for this meeting.
“I found both outpatient breakout lectures, Oncologic Emergencies and Surveillance Guidelines, to be informative and well presented,” said Alicia Slifer, MSN, CNP, of the Miami Valley Hospital in Dayton, OH. “The information was broken down in such a way that it was easily understood and the notes are concise and relevant and can be referenced easily. Both presenters seemed very experienced and offered knowledgeable answers to audience members’ questions.”
Jennifer Cacciatore, RN, BSN, OCN, of Abington Hospital-Jefferson Health, Hanjani Institute for Gynecologic Oncology in Abington, PA, noted that the “Assessing Sexual Function” presentation by Lauren Streicher, MD, was a highlight of the meeting.
“Dr. Streicher’s presentation was quite entertaining,” said Cacciatore. “She offered a great deal of useful, pertinent information in a fun, lighthearted manner. Her presentation style lends to sustained interest of the audience during the presentation.”
Both Slifer and Cacciatore also added that the radiation oncology review presented by Yasmin Hasan, MD, from University of Chicago Medicine was very informative. They expressed an interest in returning to the next Allied Workshop.
“I have recommended the conference to my nurse colleagues,” said Cacciatore. “I believe that gyn-onc RNs—not just PAs and NPs—could also benefit from the workshop, just as I did this year. I found the program to be a great review for topics I am already comfortable with, as well as a great way to get information on updates to practice.”