SGO Issues June 2, 2016
Addressing the high cost of drugs for oncology patients
SGO endorses new ASCO cervical cancer clinical practice guideline
#ResearchNotRedTape tweetstorm to save DoD ovarian funding
Clinical commentaries on talc, platinum sensitive OVCA in June journal
Next Real Conversations panel discussion to be released on June 6
HVO teams with SGO for launch of new gynecologic oncology project in Nepal
In response to “skyrocketing drug prices” in the United States, today the Society of Gynecologic Oncology proposed five specific recommendations to improve the availability of drugs for cancer patients at a reasonable and fair cost. The proposals are contained in the article, “Addressing the High Cost of Drugs for Oncology Patients: A National Priority,” written by members of the SGO Legislative and Regulatory Affairs Taskforce.
SGO proposes the following:
- Allow Medicare to negotiate prices.
- Encourage transparency from pharmaceutical companies in setting prices.
- Improve access to lower cost chemotherapy agents through generics.
- Develop a federal working group at the Centers for Medicare and Medicaid Services (CMS) to study value-based pricing.
- Better align drug supply with dosing recommendations.
“The above recommendations have one aim: to ensure access by our patients to effective drugs at a reasonable cost,” the authors wrote. “This problem must be attacked from all angles in order to solve it. With the positive cooperation of the federal government, pharmaceutical industry, patients, advocacy groups and physicians, progress can be made and the SGO looks forward to engaging in the process.”
The following taskforce members served as authors of the paper: Matthew Carlson, MD, (lead author); Joe Casey, MD; Brittany Davidson, MD; Anne Shapter, MD; Bruce Patsner, MD; and Stephanie Wethington, MD.
On May 25, the American Society of Clinical Oncology (ASCO) issued its first clinical practice guideline on invasive cervical cancer. This resource-stratified guideline is the first of its kind from ASCO, offering treatment recommendations tailored to resource availability. SGO endorsed the guideline.
SGO member Linus Chuang, MD, MS, a gynecologic oncologist from the Icahn School of Medicine at Mount Sinai in New York, NY, was co-chair of the ASCO Expert Panel that developed the guideline, which takes into account how cervical cancer care varies throughout the world. Women in lower resource settings with limited or no cervical cancer screening programs often have advanced cervical cancer at diagnosis.
The guideline provides evidence-based recommendations for four resource tiers: basic, limited, enhanced and maximal. For each setting, and for each stage of cervical cancer, the guideline recommends optimal therapy and palliative care.
The key guideline recommendations include:
- In basic settings where patients cannot be treated with radiation therapy, extrafascial hysterectomy either alone or after neoadjuvant chemotherapy may be an option for women with stage IA1 to IVA cervical cancer.
- Concurrent radiotherapy and chemotherapy is standard in enhanced and maximal settings for women with stage IB to IVA disease. The panel stresses the addition of low-dose chemotherapy during radiotherapy, but not at the cost of delaying radiation therapy if chemotherapy is not available in limited settings.
- In limited resource settings where there is no brachytherapy, the ASCO Expert Panel recommends extrafascial hysterectomy or its modification for women who have residual tumor two to three months after concurrent chemoradiotherapy and additional boost.
- If the resources are available and the patient cannot receive treatment with curative intent, palliative radiotherapy should be used to relieve symptoms of pain and bleeding.
- Where resources are constrained, single- or short-course radiotherapy schemes can be used with re-treatments if feasible for persistent or recurrent symptoms.
- For patients with stage IV or recurrent cervical cancer, single-agent chemotherapy (carboplatin or cisplatin) is recommended in basic settings.
- Concurrent radiotherapy and chemotherapy followed by brachytherapy is standard in enhanced and maximal settings for women with stage IB to IVA disease.
“Even though cervical cancer is largely preventable, a quarter of a million women die of this disease every year globally. The vast majority of those deaths occur in less developed regions of the world, such as South-East Asia, the Western Pacific, India and Africa,” Dr. Chuang said. “In those regions, access to pathology services, skilled surgeons, radiation machines, brachytherapy, chemotherapy and palliative care may all be constrained.”
Senator Richard Durbin (D-IL) urges supporters of ovarian cancer research to join the #ResearchNotRedTape “tweetstorm” from noon to 2 p.m. Tuesday, June 7. The goal is to maintain funding for ovarian cancer research in the Department of Defense. The Senate will vote on proposed cuts early next week.
To participate in the tweetstorm, share on Facebook or retweet on Twitter the following posts from Senator Durbin’s office:
Or post your own social media messages. Be sure to include #ResearchNotRedTape, @SGO_org (Society of Gynecologic Oncology) @GYNCancer (Foundation for Women’s Cancer), and @SGNO (Society of Gynecologic Nurse Oncologists) in your tweets.
Two clinical commentaries on important issues in ovarian cancer have been published in the June 2016 issue of Gynecologic Oncology: “Moving beyond the platinum sensitive/resistant paradigm for patients with recurrent ovarian cancer,” by Ronald D. Alvarez, Ursula A. Matulonis, Thomas J. Herzog, Robert L. Coleman, Bradley J. Monk, and Maurie Markman; and “Talc and ovarian cancer,” by Steven A. Narod.
The next video panel discussion in SGO’s Real Conversations in Gynecologic Oncology series, “Optimal Management of Stage IIIc Endometrial Cancer,” will be released on SGO Connect Ed on June 6. Led by moderator Floor Backes, MD, from The Ohio State University in Columbus, OH, the panelists include Daniela Matei, MD, from Northwestern University in Chicago; Matthew Powell, MD, from the Washington University School of Medicine in St. Louis; Junzo Chino, MD, from Duke University Medical Center in Durham, NC; and Gini Fleming, MD, from the University of Chicago.
Health Volunteers Overseas (HVO) is seeking volunteers for a new gynecologic oncology project in Nepal at the Bhaktapur Cancer Hospital (BCH) in Kathmandu. Volunteers for the Nepal project must be board certified gynecologic oncologists with at least two years of post-fellowship experience. This project will accept volunteers beginning in February 2017. HVO’s oncology program is supported by the SGO and the American Society of Clinical Oncology, and HVO’s obstetrics and gynecology program is supported by the American College of Obstetricians and Gynecologists.
BCH is a national-level cancer center that has requested training for the physicians staffing its gynecologic oncology department. The three physicians currently handling all gynecologic oncology surgeries require specialized training. BCH treats approximately 80 gynecologic oncology patients per year, and the physicians at BCH also staff a busy clinic three days per week with a case load that ranges from 25 to 50 patients a day.
HVO’s new project in Nepal will bring expert volunteers to BCH to develop a gynecologic oncology curriculum for both didactic and clinical skills. HVO volunteers will also bring surgical and didactic training to BCH gynecologic oncologists, providing the required amount of supervised hours to qualify for local certification.
To learn more about volunteering for this project, contact Dinah Girma.