SGO Issues Nov. 14, 2019
With gratitude and thanksgiving | Wellness Task Force
Gynecologic Oncology journals launch podcast series
Coding Corner: Radical surgery for benign disease | Andrew W. Menzin, MD, MBA, FACOG, FACS
Coding fellowship available for early career SGO members
FWC hosts 10th National Race to End Women’s Cancer
FWC award application deadline November 25
Clarification: National Academy of Medicine announcement
Ready or not, the holiday season is upon us. And while it is traditionally a time of giving thanks, many of us will be on call. Some of us will miss family dinner and holiday traditions, and undoubtedly all of us at some point in our career, have felt guilt over gratitude on Thanksgiving (or any) Day, as we ask our loved ones to sacrifice for the career we have chosen. Here’s the thing that is easy to forget – our loved ones are proud of us and the work we do.
In this special Thanksgiving edition of the SGO Wellness blog, we hear from three spouses and a mother of SGO members about life with a gynecologic oncologist in the family. We share these with you in gratitude this holiday season, in recognition of your dedication and in appreciation for you and your families. On behalf of the SGO Wellness Task Force, thank you for all that you do. The following are presented with the permission of both the author and the SGO member.
Bear Barnes, spouse of Ilana Cass, MD
My romance with Ilana began the week before her MCAT scores came back, underwhelming. A month into our relationship, a professor who she’d asked for a med school recommendation suggested that maybe law school would be a better fit. Her boat was definitely taking on water, but even in those early days, it was already abundantly clear to me that this beautiful, determined young woman was unsinkable. So sometime later when Ilana decided to pursue GYN Oncology, a field that seemed to attract the toughest of the tough, I wasn’t surprised. What has surprised me, though, over these thirty some-odd years, has been how she’s managed to be at once hard and soft; strong enough to survive the accumulated sadness inherent in her work, yet gentle enough to be there in every way for her patients.
It’s a calling, what Ilana and her peers do. And for the rest of us – who do perfectly valid things like sell shoes, or write ads, or teach math – I think it’s really easy to underestimate the day-in, day-out fortitude it must take. Imagine breaking the news to someone that they have cancer. I still can’t. Imagine going to a job where you cry with your customers on a weekly basis. All I can say is, wow. Ilana, what you do is such an inspiration to me, to the kids, and to our friends and family. It makes us proud. It makes us grateful for the good things we have. And boy are we pleased that you didn’t go to law school.
Matt Kilts, husband of Toni Kilts, MD
I met Toni in 2014 at the start of her journey and we have now been married for almost 3 years. Right away, I noticed there was a difference in her, a desire and drive, to improve the lives of every person she comes in contact with. While I knew my wife as this brave, kind, funny and compassionate person, I don’t think I fully grasped how important and impactful someone in her position could be until we ran into a patient at the local grocery store. This patient recognized my wife immediately, walked to the end of the aisle to give her a huge hug and introduced us to her grandchildren. The patient thanked my wife for taking such good care of her while she was hospitalized and “went through the most difficult period of her life.”
In that moment, it seemed to all make sense to me. The hours that she works, whether it’s operating for 14 hours straight, writing papers at home from the couch, falling asleep while reading or calling patients on Saturday, it is all worth it for her to be able to have such a profound impact on another human life. That moment in the grocery store, I realized how privileged I was to be accompanying her on this journey. I am so blessed to be spending my life with someone who is so kind, passionate, and caring. And while there are times her job limits the amount of time she is available to spend with family, the quality of our time together is just enhanced by the same qualities she exhibits when she cares for these unique patients on a daily basis. I am happy to share my wife with her patients, her profession, and in some ways, it seems this is how I can best make an impact for these same patients my wife works tirelessly to care for. I am grateful and proud to be part of her journey.
Giuliano Cristino, husband of Julie Cristino, MSN, APN, AGPCNP-BN, OCN
I met Julie a little over ten years ago on a blind date. Prior to us meeting I knew only that she was a nurse and based off the picture I had seen, she was beautiful. Seeing her in person quickly confirmed her attractive physical attributes, but I had no idea at the time those would be outshined by the qualities she possessed within.
I always knew nursing was a tough job, at least what I heard of it. Grueling hours, tough patients, and less pay than other medical professions. However seeing the person you love endure that on a daily basis, working in oncology no less, gave me such a heightened perspective on how nurses lives really are. The first year or so, Julie worked nights. Then she flipped to days, but started going to school part time with the goal of becoming a Nurse Practitioner at Memorial Sloan Kettering. It wasn’t easy for us. We would see each other at crazy times or go stretches relying on phone calls and texts. But I was always in awe of how she juggled the insane schedule and our relationship, never compromising her ability to be the best nurse to her patients and friend to her coworkers.
This appreciation of how Julie truly embodies what it is to be a nurse came early in our relationship. Within the first year, my aunt who battled uterine leiomyosarcoma seven years earlier had a recurrence. Julie didn’t not know much about this GYN cancer as she worked on the head and neck floor at Sloan. Being the person that she is, though, she took a vested interest in my aunt’s care even though she barely knew her at the time. She would be sure to stop by my aunt’s floor after her long shift to help ease any fears she had. I could see firsthand how empathetic Julie was, and I loved her for that. It was this experience that inspired her to specialize as a Gynecology Oncology Nurse Practitioner, a role she has been dedicated to for the last five years.
Now that we’re together over ten years and married over five, I need no reminder that I’ve married a smart, compassionate, hardworking woman. Julie has shown those qualities countless times over the years and is always looking for ways to give back and help people. This year, for example, Julie has coordinated a campaign, raising over $11,000 so far for MSK’s Cycle for Survival. She’s ridden and fundraised three times in the past, but this year our family has extra motivation as we ride to eradicate rare cancers like the pancreatic cancer her mom is currently battling. I’m so thankful to have found someone who is endlessly motivated to make the lives of others better, any way she can. I’m a lucky guy.
Joyce Rash, mother of Joanne Rash, MPAS, PA-C
Since she was a little girl, Joanne has always had a big heart for helping others. When she was in elementary school, she helped take care of classmates who got hurt on the playground. During her college years she worked at a nursing home caring for elderly patients. For the last 13 years she has been treating cancer patients.
In 2002 Joanne’s brother became deathly ill and was diagnosed with type 1 diabetes. After my son and I were sent home from the doctor’s office, I called Joanne. Over the phone she talked me through the procedure for giving him an insulin shot and I continued to consult with Joanne throughout that scary night checking his blood sugar. Only with Joanne’s knowledge and expertise did he survive that awful night. When Joanne’s son was diagnosed with type 1 diabetes at age five, Joanne became very involved with the Juvenile Diabetes Research Foundation fundraising efforts to combat diabetes.
Two years ago when I had my knee replacement surgery, Joanne drove to our home several times after working a full day at the gynecologic oncologist clinic to help with my recovery. She even helped put on my compression stockings.
She cares for her cancer patients with knowledge, dedication, and kindness just as she cares for her family. She is an active participant in the “Sparkle of Hope” fundraiser event working to find a cure for cancer at the University of Wisconsin. Even with her busy schedule, she finds time to give presentations at SGO meetings. I love and admire her for her dedication to her cancer patients and her willingness to work long hours to provide the best care for them.
This week the editors of Gynecologic Oncology and Gynecologic Oncology Reports launched a Podcast Series that will be released monthly and feature journal content – such as the Editor’s Choice article and invited Editorial from each issue – as well as lively discussions of the latest hot topics, meeting report recaps, and more. Anyone who has an idea for a podcast topic can email the journal at GYN@elsevier.com or reach out to Editor-in-Chief Beth Karlan, MD or Deputy Editor Stephen Rubin, MD. The following podcasts are available online and will be coming soon to iTunes, Google Play and Spotify:
When to stop hCG surveillance following chemotherapy for gestational trophoblastic neoplasia, hosted by Beth Karlan, MD
- Michael Seckl, BSc, MBBS, FRCP, PhD, October 2019 Editor’s Choice Article: When to stop human chorionic gonadotrophin (hCG) surveillance after treatment with chemotherapy for gestational trophoblastic neoplasia (GTN): A national analysis on over 4,000 patients
- Ross Berkowitz, MD: Continued hCG surveillance following chemotherapy for gestational trophoblastic neoplasia: When is enough enough?
Survival of endometrial cancer patients following lymphadenectomy or sentinel node procedure, hosted by Stephen Rubin, MD
- Andrea Mariani, MD, MS, November 2019 Editor’s Choice Article: Role of lymphadenectomy in endometrial cancer with nonbulky lymph node metastasis: Comparison of comprehensive surgical staging and sentinel lymph node algorithm
- Amanda Nickles Fader, MD, Editorial: Enough already: Is this the end of comprehensive lymphadenectomy in endometrial cancer or are further trials needed?
Current practice patterns reflect a trend toward the increased performance of complex benign surgical procedures by gynecologic oncologists. The operative challenges faced often necessitate the use of advanced surgical techniques typically brought to bear during oncologic procedures, however the CPT codes appropriate in the setting of malignancy are not always applicable.
Consider the following scenario: A 43-year-old woman undergoes a planned hysterectomy for uterine fibroids. At the time of exploration, a right lower uterine segment myoma and extensive endometriosis of the left uterosacral ligament is encountered. Extensive pelvic dissection was required, including bilateral ureterolysis and resection of the medial parametria, and a bilateral salpingectomy performed with ovarian conservation.
The coding for this procedure includes 58150 [Total abdominal hysterectomy (corpus and cervix), with our without removal of the tube(s), with or without removal of the ovary(s)]. Due to the extensive nature of the dissection, it would be appropriate to append a -22 modifier to the primary CPT code. It is important for the operative documentation to reflect and describe the nature and extent of the technical aspects of the procedure to support the modifier’s use. Best practice is to quantify the increased time and/or effort required for the completion of the surgery above the typical procedure.
Use of the ureterolysis code [CPT 50715 (ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis)] is not advised, as it is bundled within 58150, according to the Correct Coding Initiative. CPT 50715 is meant to be utilized only for the surgical treatment of retroperitoneal fibrosis, a rare disease also known as “Ormond’s disease.” Additionally, it would not be appropriate to employ the CPT code for radical hysterectomy code (CPT 58210), even with a reduced services modifier.
Andrew W. Menzin, MD, MBA, FACOG, FACS, is the Chief of Gynecologic Oncology at Northwell Health Physician Partners, Vice Chairman for Academic Affairs at North Shore University Hospital and Professor of Obstetrics & Gynecology at Zucker School of Medicine at Hofstra/Northwell.
The Society of Gynecologic Oncology (SGO) and the Coding Taskforce are pleased to announce that applications are now open for the 2020 Coding Fellowship. The goal of this two-year program is to nurture and educate physicians on coding and health economics issues, providing the fellow with the tools necessary to advocate on the national level, develop educational tools for our membership, and take a leadership role in this vital area in the future. Early Career members (Fellows-in-Training) with an interest in coding, billing and practice management are encouraged to apply. Applications must be submitted by Nov. 27, 2019. The Fellowship recipient will be selected in December 2019 and will receive a complimentary registration to attend the SGO Coding Course on March 27, 2020 in Toronto.
At least 1,171 people—including local runners, gynecologic cancer survivors and their doctors, family members, friends and virtual supporters—came together on Nov. 3 for the 10th National Race to End Women’s Cancer on Freedom Plaza in Washington, DC, to support the Foundation for Women’s Cancer (FWC). The 73-member SGO & Friends Team has raised $5,600 in donations to date, and the event has raised $313,000 so far from sponsors, participating runners, race teams and online donors. The top three SGO member runners were as follows:
- Robert Giuntoli, MD, University of Pennsylvania Medical Center, Philadelphia, PA (#15 overall)
- Andrea Hagemann, MD, Washington University School of Medicine, St. Louis, MO (#18 overall)
- Stephanie Blank, MD, Mount Sinai Downtown at Chelsea, New York, NY (#55 overall)
The Race was the culmination of the End Women’s Cancer Weekend, which included a daylong Gynecologic Cancer Education Course on Nov. 2.
“The education course this weekend had an awesome agenda,” said session presenter Ebony Hoskins, MD, from MedStar Washington Hospital Center, Washington, DC. “We addressed patients and any symptoms and issues that they might have after the treatment, including sexuality, behavioral health, and coming up with survivorship plans.”
Several of the course participants also attended the National Race to End Women’s Cancer the next day. Course moderator Monica Jones, MD, MSc, FACOG, FACS, from Anne Arundel Medical Center in Annapolis, MD, described the atmosphere on Race day as “magical.”
“You see families of folks that have gone before us, you see survivors, you see people helping each other. You see young children running the race for their mom or their aunt or their grandma,” she said. “For those of us who take care of these patients and their families, it is a true inspiration to continue to do what we do in terms of fighting gynecologic cancers.”
The Foundation for Women’s Cancer (FWC) 2019-2020 Research Grants and Awards program is still accepting applications for two Fellow-in-Training awards and three research prizes. Full proposals are due by Monday, Nov. 25 at 11:59 p.m. CT.
Last month’s SGO Issues announcement on the election of Ernst Robert Lengyel, MD, PhD, to the National Academy of Medicine (NAM) referenced previous inductees who listed gynecologic oncology as their area of discipline and research interest, but should have included Arthur L. Herbst, MD, who is a senior SGO member. Dr. Herbst was elected to the NAM for Obstetrics/Gynecology in 1995.