SGO Issues January 9, 2014
New FIGO ovarian cancer staging guidelines
HPV vaccination a priority at federal, state levels
Board of Directors open election Jan. 21 – Feb. 21
Tour state-of-the-art simulation center during SGO Annual Meeting
Voices: Are We Measuring Correctly?
SGO issues position statement on morcellation
Important deadlines and reminders
The International Federation of Gynecologists and Obstetricians (FIGO) has revised the staging of ovarian cancer. The approved, new ovarian cancer staging went into effect on Jan. 1, 2014.
The revision by FIGO followed a series of meetings which were concluded in Italy at the end of 2012. Representatives of several international organizations including the SGO participated in these deliberations under the leadership of Professor Lynette Denny from South Africa, the Chair of FIGO committee on Gynecologic Oncology.
The proposed changes were subsequently approved by the FIGO Executive Board, The American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC). This new staging also applies to fallopian tube cancer and primary peritoneal cancer (where feasible). To keep the summary simple, we will just refer to ovary.
The new staging is summarized in this FIGO Ovarian Cancer Staging document with changes in italics. The guidelines will be published in the January 2014 issue of the International Journal of Gynecology and Obstetrics.
As the CDC makes HPV vaccination one of its priorities for 2014, Robert Holloway, MD, reports that the state of Florida will emphasize public education for parents, teachers, and health care providers on the benefits of the vaccine for girls and boys, including the prevention of oro-pharyngeal cancers in addition to cervical cancer.
As a member of the Florida Cancer Control & Research Advisory Council (CCRAB), Dr. Holloway addressed the organization in October about the importance of promoting HPV vaccination for the health of Floridians, as well as the reduction in costs of care in the long run.
Capitalizing on the highly publicized cancer diagnosis of actor Michael Douglas, who publicly discussed HPV’s link to oro-pharyngeal cancers, CCRAB’s educational materials sent to local Parent Teacher Associations and an upcoming webinar for the state’s health care providers stress the importance of preventing multiple cancers and a variety of pre-cancerous HPV-related diseases that can be quite symptomatic for patients.
“We hope this knowledge makes vaccination more acceptable to parents,” said Dr. Holloway. “CCRAB educates via newsletters to providers, various professional publications targeting primary providers, letters to local PTA groups, public school health nursing groups, and Florida’s Coordinated School Health Partnership.”
The message is also consistent with SGO’s position statement on HPV vaccination for girls and boys, which was updated last month to include emphasis on the safety of the vaccine.
“I encourage SGO members to send the SGO policy statement on HPV vaccination to local and state legislators and urge more public education on the importance of vaccinating girls and boys, and the demonstrated safety of the vaccine,” said Dr. Holloway.
Online voting for the 2014 SGO Board of Directors and Foundation for Gynecologic Oncology Council is open Jan. 21 through Feb. 21, 2014. Nominating Committee Chair Ronald D. Alvarez, MD, noted that SGO’s second open election reflects “a more transparent and democratic process” in selecting the Society’s leadership.
“This year’s Nominations Committee included more members to reflect the ever-increasing diversity in our Society,” said Dr. Alvarez. “SGO members will have the opportunity to choose from among an excellent group of well qualified nominees who have truly distinguished themselves in our Society. The most important thing for SGO members to do now to further ensure democracy in this election process is to make sure they vote.”
Voting Members will receive an email with a link to cast their votes on Jan. 21 and have 30 days to make their selection. Voting members include Senior and Full Members as well as International and Associate Members who joined the Society prior to 2010. Only Candidate and Fellow-in-Training Members are eligible to vote for their respective representatives.
Biographical information, personal statements and photographs of the candidates will be available for review prior to the election. The open positions and candidates for the 2014 SGO Board of Directors Election Ballot include:
President Elect II Candidates
- Eva Chalas, MD, FACOG, FACS – Winthrop University Hospital
- Jeffrey Fowler, MD – The Ohio State University
- Stephen Rubin, MD – University of Pennsylvania
Secretary-Treasurer Elect Candidates
- David Cohn, MD – The Ohio State University
- Susan Modesitt, MD – University of Virginia
- William R. (Rusty) Robinson, III, MD – Tulane University School of Medicine
Board Member Candidates (three seats open)
- Deborah Armstrong, MD – John Hopkins Kimmel Cancer Center
- Kian Behbakht, MD – University of Colorado
- Linus Chuang, MD, MPH, MS – Icahn School of Medicine at Mount Sinai
- D. Scott McMeekin, MD – University of Oklahoma
- Carolyn Muller, MD – University of New Mexico
- Adnan Munkarah, MD – Henry Ford Health System
- Matthew Powell, MD – Washington University in St. Louis
- Elizabeth Swisher, MD – University of Washington
- Vivian von Gruenigen, MD – Summa Health System, Northeast Ohio
Candidate Member Representative Candidates
- Rebecca Brooks, MD – University of California, San Francisco
- Jori Carter, MD, MS – Virginia Commonwealth University Medical Center
- Emily Ko, MD, MSCR – University of Pennsylvania
Fellow-in-Training Member Representative Candidates
- Elizabeth Dickson, MD – University of Minnesota
- Andrea Jewell, MD – University of Chicago
- Nina Shah, MD – University of California, San Diego
Attendees of the SGO Annual Meeting on Women’s Cancer in Tampa, FL, may register now for an exclusive tour of the largest simulation center in the United States—the Center for Advanced Medical Learning and Simulation (CAMLS).
The one-hour tour begins at 6:30 a.m. Sunday, March 23. It will focus on two areas:
- The Surgical and Interventional Training Center (SITC), which features large-scale facilities for tissue and animate exercises and is an ACS-Accredited Education Institute.
- The Virtual Patient Care Center (VPCC), which leverages simulation technology that assists health professionals to improve their clinical skills in a risk-free environment, and is accredited by The Society for Simulation in Healthcare.
Additional CAMLS features of interest to the SGO tour participants:
- As the largest simulation center in the United States, the 90,000-square-foot facility is dedicated to all levels of health care training and every specialty.
- It is the only simulation center in the world that incorporates all elements of health care training under one roof.
- It has 39 fully functional, clinical grade surgical skills stations. This includes the first-ever hybrid operating room dedicated to training. CAMLS also features a trauma OR with the ability to manipulate sights, sounds, and temperature to place the learners in a stressful environment
- There is a virtual hospital with the ability to replicate any area of a doctor’s office, hospital or homecare.
- The State of Florida’s first-ever Anatomage table—an 8-foot–long, tablet-based table—offers 3-D images of patients to allow clinicians to perform complex procedures virtually prior to surgery with the actual patient.
By Erin Stevens, MD
Metrics are becoming very important in the treatment of cancer. As physicians, we want to know that all patients are being given the correct treatments for their disease. We can measure this by using databases and codes. Nationwide, we use these metrics as a way to tell us how far we have to go get all patients to receive the standard of care. We also have metrics on end-of-life care and things we should avoid with our cancer patients, including hospital admissions and chemotherapy in the last two weeks of life. But sometimes numbers do not tell the whole story.
I met Maggie* at the beginning of December. She had been diagnosed with a recurrent uterine leiomyosarcoma and her admission to the hospital was prompted by a newly diagnosed pulmonary embolism. She had not yet started treatment when I entered her room. She was with one of her two sons and his wife. She didn’t look “sick” per se – she didn’t particularly look “well” either – and I thought it would be an appropriate time to sit and have a conversation.
Over the course of about an hour, my PA and I sat with Maggie and we listened to her tell us what she understood about her cancer and her prognosis. We discussed the treatment options and the risks and benefits of each of these options. She understood her cancer was not curable. She was given the information about Five Wishes and we visited about what things she would want at the end of her life. And then I asked her the question I always try to ask my patients when I’m faced with a cancer that I know is not curable.
“What are the things that you’ve always wanted to do but haven’t yet? Is there a trip you’d like to take, a place you’d like to see, a person you want to make amends with?”
Unbeknownst to me, before I had entered the room, her son and daughter-in-law were helping her make a bucket list. At the top of the list was Germany. Turns out, Maggie had always wanted to go to Germany. And she loved Christmastime. Unbeknownst to Maggie, the two loving people sitting at her bedside had already finagled a passport for her that had just arrived earlier that week. They looked at me and asked permission to take her to Germany. I looked at them and told them to go – and to go now – while she was “well.” Maggie was concerned about her other son who lived farther away and wanted her to get started immediately on the treatment. I spoke with him, explained that her cancer was not curable, and highly recommended letting her going to Germany if that was what her mother wanted. Ultimately, the other son wanted to do whatever his mom wanted, but he really wanted her to try chemotherapy if it could possibly help, regardless of how slim that chance was.
So Maggie went to Germany the following week. She showed up in my office a few days after she returned with pictures of her trip, ready to start chemotherapy. It was already obvious that she had weakened immensely. She required help with her activities of daily living and was using a walker in her house, two things that were bothering her immensely. We revisited whether or not she should go forward with chemotherapy at all.
You could tell she wanted to treat both of her sons equally. She had gone to Germany with one; the other wanted her to try chemotherapy. She loved both of them, differently but equally, and you could tell she was determined to start treatment. She got her first cycle of Day 1 gemcitabine and by the end of the week, was admitted to the hospital with severe anemia, renal failure and poorly controlled pain.
If she does die in the next week, I have failed as a physician, according to the “metrics” of giving a patient chemotherapy in the last two weeks of life. Yet I look at this woman who took a trip of a lifetime with one son she loved and showed her other son how much she loved him by trying treatment. I don’t see a failure here, I see a success. She had done what was best to balance the love of her two children and I think she did everything right, even if that’s not the story the statistics ultimately show.
Sometimes the numbers don’t tell the whole story.
Maggie passed away on Jan. 4, 2014, with her family at her side.
* Names changed for privacy
On Dec. 30, 2013, SGO issued a position statement on morcellation in response to national media coverage of a campaign to ban the procedure. SGO has been working closely with the American Congress of Obstetricians and Gynecologists to coordinate communications to the public.
Register for SGO Winter Meeting
Annual Meeting early bird deadline Jan. 20
Renew SGO member dues: Dec. 31 was the dues renewal deadline so please renew promptly to continue receiving SGO membership benefits in 2014.