SGO Issues June 7, 2018
SGO reviews opioids in gyn oncology
Presidential address, Annual Meeting report in June Gynecologic Oncology
HVO seeking gynecologic oncology volunteers for project in Uganda
ACS HPV Cancer Free campaign offers resources for clinicians
Save the dates for SGO Allied and Winter Meetings
As the only oncologists who provide both medical and surgical care, gynecologic oncologists encounter a broad range of indications for prescribing opioids, from management of acute post-operative pain to chronic cancer-related pain to end-of-life care. In the May 2018 edition of Gynecologic Oncology, the authors explore these issues in a two-part review on “Opioid use in gynecologic oncology in the age of the opioid epidemic.”
In Part I – Effective opioid use across clinical settings: A Society of Gynecologic Oncology evidence-based review, the authors reviewed the appropriate use of opioids across the range of clinical settings encountered in gynecologic oncology. The risk-benefit equation for opioid misuse must be differentially evaluated in each clinical setting. “Opioid misuse” refers to any use of opioids for a purpose not consistent with legal or medical guidelines, such as recreational opioid use and diversion or sale of prescribed opioids for recreational use.
“The fact that we care for women throughout the course of their disease challenges us to simultaneously hold several different frameworks for pain management, particularly with respect to appropriate use of opioids, as opposed to non-opioid strategies,” said Carolyn Lefkowits, MD, one of the lead authors of the papers. “While opioids remain first line therapy for cancer-related pain in patients with active disease, pain management in disease-free periods should ideally focus more on non-opioid-based strategies.”
Dr. Lefkowits noted that the American Society of Clinical Oncology (ASCO) recently released a clinical practice guideline on chronic pain in post-treatment survivorship, which highlights the importance, in patients who are disease-free, of focusing on function and reserving use of opioids for patients who have not responded to more conservative management.
Part II – Balancing safety & accessibility addresses both the clinical and regulatory aspects of balancing opioid safety and accessibility for patients with gynecologic cancer. Due to the explosive growth of opioid prescriptions and opioid-related overdoses and deaths in recent years, there has been a concerted effort to prevent and treat opioid misuse through legislation and education. While opioid-related legislation commonly exempts patients undergoing cancer treatment or those receiving end–of-life care, patients with prolonged disease courses or multiple remissions and re-occurrences might not be considered to have “active cancer.” Such patients—like those with advanced ovarian cancer—may be subject to most, if not all, regulations.
Currently there are no oncology-specific screening instruments for opioid misuse. Larger studies are needed to determine the most effective way to screen for and triage gynecologic oncology patients who are at risk for opioid misuse.
“Because rigorous instrument development and validation is so resource and time intensive, I think we are unlikely to have instruments that are specific to oncology any time soon,” said Dr. Lefkowits. “Rather than aiming to develop completely new instruments, a better strategy might be to try to validate existing instruments in an oncology population. The clinical impact of routine screening for opioid misuse prior to prescribing or for active opioid misuse in patients on chronic opioids has not been well established, so that is another area in need of additional investigation.
“Given that effective pain management is integral to the care of women with gynecologic cancers, explicit instruction on pain management, including appropriate use of opioids in a variety of clinical settings, should be part of the training of our fellows,” she said. “Depending on locally available resources, instruction may come from faculty in gynecologic oncology, possibly supplemented by instruction from faculty in anesthesia, pain management or palliative care.”
Dr. Lefkowits added that several short instructional modules on opioid use in gynecologic oncology will soon be available through the SGO ConnectEd website will provide a centralized place for learners and practicing clinicians to go to for opioid education. Opioid rotation specifically, which refers to switching a patient from one opioid to another, is among the topics included in those modules.
Highlights from SGO’s 49th Annual Meeting on Women’s Cancer in New Orleans are in the June 2018 issue of Gynecologic Oncology, including Expanding the pipeline: The 2018 Society of Gynecologic Oncology Presidential Address by Laurel W. Rice, MD, and Society of Gynecologic Oncology 2018 Annual Meeting on Women’s Cancer: Meeting report by J. Alejandro Rauh-Hain, MD, MPH; Wendy R. Brewster, MD, PhD; and Kian Behbakht, MD.
Health Volunteers Overseas (HVO) is launching a new oncology project at the Uganda Cancer Institute (UCI) in Kampala, Uganda. HVO has partnered with UCI to develop and implement a structured gynecologic oncology training program, promote sustainability and acceleration of gynecologic cancer care training for Ob-Gyn physicians and residents, and facilitate multidisciplinary care and collaboration among clinical oncology, radiation oncology and pathology.
HVO will recruit qualified gynecologic oncologists, pathologists, radiation oncologists, and oncology nurses to assist in the training of UCI’s gynecologic oncology fellows. Volunteers may provide clinical and didactic training through participation in clinical rounds, surgeries, cervical cancer screenings, and colposcopy training. They may also participate in multidisciplinary tumor boards and lectures on other topics as requested by the host institution. Volunteers will collaborate with UCI faculty on the development and implementation of the gynecologic oncology curriculum and provide mentorship and training to UCI gynecologic oncology fellowship faculty.
Volunteers must be physicians or nurses specialized in oncology, pathology and/or radiation; board-certified or in active practice for at least five years. Assignments are a minimum of two weeks. Begin the volunteer process by contacting Andrea Moody or visiting the HVO website.
The American Cancer Society’s (ACS) Mission: HPV Cancer Free campaign to eliminate vaccine-preventable HPV cancers, starting with cervical cancer, is now officially underway. The goal is to increase HPV vaccination rates for pre-teen boys and girls to 80% by 2026, 20 years after approval of the first HPV vaccine.
The HPV VAC Roundtable Resources include these learning tools for health care professionals:
- Counter Myths with Facts
- CDC: Talking to Parents About HPV Vaccine
- Just Another Shot-Reframing the HPV Vaccine
- Don’t Wait to Vaccinate
- ACS Recommendations for HPV Vaccine Use
- Steps Action Guides for Increasing HPV Vaccination in Practice
- HPV Roundtable Action Guides
SGO Allied Health Professionals Workshop: Sept. 22-23, 2018, Chicago, IL, , with a pre-conference workshop on pharmacology on Sept. 21. Registration opens June 11.
SGO Winter Meeting: Jan. 17-19, 2019, Olympic Valley, CA