SGO Issues July 14, 2016
SGO Moonshot recommendations include clinical trials, data sharing
Carol Brown covers Cancer Moonshot, disparities at White House
The importance of mindfulness | Kimberly Resnick, MD
Gynecologic Oncology, Volume 142, Issue 1, p1-208 (July 2016)
July 25 comment deadline for USPSTF recommendation
On June 30, SGO submitted seven recommendations to Vice President Joe Biden’s National Cancer Moonshot initiative, which seeks to accomplish in five years research and treatment gains that may otherwise take 10 or more years. SGO’s recommendations addressed clinical trials, data sharing, obesity, disparities, p53, germline genetic testing, and school-based HPV vaccination.
SGO members were invited to submit their ideas through an online survey and a live tweetchat conducted June 29. An SGO Task Force led by Carol L. Brown, MD, Chair of the SGO Health Policy and Socio Economic Committee, finalized the Society’s recommendations. Members of the Task Force were SGO President Jeffrey M. Fowler, MD; and Drs. Ronald D. Alvarez, Robert L. Coleman, Marcela G. del Carmen, Douglas A. Levine, Laurel W. Rice, B.J. Rimel, Anil K. Sood, and Elizabeth M. Swisher.
Carol L. Brown, MD, Chair of the SGO Health Policy and Socioeconomic Committee, was one of several high profile speakers at the United State of Women Summit held at the White House on June 14. Dr. Brown spoke about the National Cancer Moonshot Initiative and how it can help alleviate cancer disparities among women.
Dr. Brown emphasized the importance of increasing the enrollment of minority and underserved populations in clinical trials and the need for women to prevent cancer through a healthful lifestyle, screening, and getting the HPV vaccine.
“While disparities are seen in many types of cancer, some of the most upsetting examples are found in cancers that affect women,” said Dr. Brown. “For breast and cervical cancer, African-American women have lower survival rates than women from any other group. Hispanic Latina women have the highest rates of getting cervical cancer, while African-American women have the highest death rates—for a cancer that we can now prevent, with the HPV vaccine.
“As a surgeon for women with cancer at a leading center for over two decades, I have learned that one way to eliminate cancer disparities is to get more people with cancer to participate in clinical trials,” Dr. Brown continued. “By joining a clinical trial minority and underserved patients can get innovative treatments they wouldn’t otherwise have access to. It’s just as important for cancer researchers to include minority patients in their studies, so they can find out if these novel therapies work for the patients who need them most.”
Part of a larger #StateofWomen movement, the United State of Women Summit brought together thousands of people working on gender equality issues. Other featured speakers included President Barack Obama, First Lady Michelle Obama and Oprah Winfrey.
“… Not being lost in thought, not being distracted, not being overwhelmed by difficult emotions but instead learning how to be in the here and now; how to be mindful, how to be present. I think the present moment is so underrated. It sounds so ordinary and yet we spend so little time in the present moment that it’s anything but ordinary.” Andy Puddicome, TED Talk
On Monday morning our clinic in downtown Cleveland was abuzz. Less than 12 hours earlier the Cleveland Cavaliers had won the National Basketball Association title, ending the city’s half century major sport championship drought. LeBron James kissed the ground. Attending physicians looked weary after a late night. At the nurses station, medical assistants watched the final game moments on YouTube. Patients came and went—needing chemotherapy, radiation, and shoulders to cry on.
Mr. X was clearly agitated. He and Mrs. X had been in clinic for two hours already, patiently waiting for her lab results. He grew increasingly impatient as the morning wore on. “I don’t care that the Cavs won the championship,” he declared. “I want Mrs. X to get her chemo!”
Given this situation, what should a clinician do? In this circumstance, practicing “mindfulness” can be a benefit to the patient and her caregiver as well as the health care practitioners involved.
Mindfulness is defined as a “moment-to-moment, non-judgmental awareness or binging one’s complete attention to the present experience…” (1). Originally emerging out of the teaching of Guatama Siddhartha, mindfulness can be practiced free from “-ism” or religious beliefs (1). Jon Kabat-Zinn, at the University of Massachusetts Medical Center, has developed the mostly widely-used mindfulness program for patients who are without hope for treatment for chronic issues (2). There is strong evidence supporting that therapeutic gains made from this instruction persist long after the teaching. But those of us wearing the white coats can benefit from this principle as well.
It is apparent that a mindful clinician, one who is grounded in the present doctor-patient interaction will be more effective at communicating, coping, treating and healing. McGill University in Montreal has undertaken an eight week mindfulness training for health care professionals (2). Pilot data demonstrated that these participants all reported an improvement in psychological well-being and in their ability to disengage from distractive thoughts.
To practice mindfulness, clinicians need to dis-engage to engage, bringing their full attention to each and every patient interaction. On this particular Monday, my wonderful charge nurse was mindful of Mr. X’s needs. She disengaged from the background noise regarding the Cleveland Cavs celebration and allowed herself to interact with Mr. X free from judgment and clatter. Afterwards she spoke of his needs, his fears for his wife, and his need to connect with a provider.
My advice to my fellow physicians would be to start your day with focus–focus on your breath, on your body–focus on what you are “bringing to the table” on that particular clinic day. And try to let it go. Allow Mr. X a centered encounter. You too will feel at ease.
1. Baer RA. Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Prac 2003; 10:125-143.
2. Whitesman S. Mindfulness in Medicine – MBSR www.mbsr.co.za › Article
- Mindful Doctors, Happy Patients (University of California, Berkeley)
- Easing Doctor Burnout With Mindfulness (New York Times)
- Mindful Practice (JAMA)
Kimberly Resnick, MD, is the Division Director of Gynecologic Oncology at the MetroHealth Medical Center at Case Western Reserve University in Cleveland, OH.
Lead Article: Cited rationale for variance in the use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian carcinoma at a high intraperitoneal chemotherapy utilization center
Brooke A. Schlappe, Jennifer J. Mueller, Oliver Zivanovic, Ginger J. Gardner, Kara Long Roche, Yukio Sonoda, Dennis S. Chi, Roisin E. O’Cearbhaill
Editorial: Intraperitoneal chemotherapy for ovarian cancer Joan L. Walker
State of the Science: Immunotherapy for gynecologic cancers John B. Liao
The public comment period for the U.S. Preventive Services Task Force Draft Recommendation Statement on Gynecological Conditions: Screening with the Pelvic Examination expires on July 25, 2016, at 8:00 p.m. EST.
According to the draft statement, “The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, non-pregnant adult women.
“This statement does not apply to pelvic examinations performed for the purposes of screening for specific disorders for which the USPSTF has already issued a recommendation [i.e., cervical cancer, gonorrhea, and chlamydia].”
As a Draft Recommendation Statement, this draft is being distributed solely for the purpose of receiving public input. It has not been disseminated otherwise by the USPSTF. The final Recommendation Statement will be developed after careful consideration of the feedback received and will include both the Research Plan and Evidence Review as a basis.