SGO Issues November 21, 2013
SGO Addresses Clinical Trial Endpoints
SGO announces Annual Meeting distinguished guests and invited lecturers
The Role of Palliative Care in Gynecologic Oncology
SGO comments on proposal to repeal and replace Sustainable Growth Rate
Remember the Foundation on ‘Giving Tuesday,’ Dec. 3
Survey: Tell us how to contain costs
Important deadlines and reminders
Gynecologic Oncology has published a white paper by the Society of Gynecologic Oncology addressing the advantages and disadvantages of clinical trial endpoints, particularly overall survival and progression-free survival, in ovarian cancer.
SGO produced the paper, now available online, to collaborate with regulatory authorities to optimize ovarian cancer endpoint selection and better provide guidance for drug approval. The paper also is intended to inform the public that endpoints are important in shaping drug development and can potentially hinder novel drug development in ovarian cancer, a disease with unique features in considering clinical trial endpoints. Results of a survey, conducted in collaboration with the Ovarian Cancer National Alliance, to obtain endpoint preferences of ovarian cancer patients are included in the paper.
The paper was produced by an SGO workgroup comprised of Thomas J. Herzog, MD; Deborah K. Armstrong, MD; Mark F. Brady, MD; Robert L. Coleman, MD; Mark H. Einstein, MD; Bradley J. Monk, MD; Robert S. Mannel, MD; J. Tate Thigpen, MD; Sharee A. Umpierre, MD; Jeannine A. Villella, MD; and Ronald D. Alvarez, MD.
SGO has announced the lineup of distinguished guests and invited lecturers who will be presenting at the SGO Annual Meeting in Tampa, FL, March 22 – 25, 2014.
2014 Annual Meeting Distinguished Guests
Presidential Invited Guest Lecturer
10:15 a.m. Saturday, March 22
Introduction by Barbara A. Goff, MD, SGO President
Leroy Hood, MD, PhD
Chairman, P4 Medicine institute
President, Institute for Systems Biology
SGO Member Forum
11:15 a.m. Monday, March 24
Harold D. Miller
President and CEO
Center for Healthcare Quality and Payment Reform
2014 Annual Meeting Invited Lecturers
Hugh Barber Lectureship
5:15 p.m. Saturday, March 22
Surendra Srinivas Shastri, MD
Professor, Preventive Oncology
Tata Memorial Hospital
Farr Nezhat Lectureship
7:50 a.m. Sunday, March 23
Nadeem Abu-Rustum, MD
Vice Chair for Technology Development, Department of Surgery
Director, Minimally Invasive Surgery, Gynecology Service
Chair, Surgical Quality Assessment
Memorial Sloan-Kettering Cancer Center
New York, NY
SGO Presidential Address
9:15 a.m. Sunday, March 23
Barbara A. Goff, MD
2013 – 2014 SGO President
Professor of Obstetrics and Gynecology
Director, Division of Gynecologic Oncology
University of Washington
American Board of Obstetrics and Gynecology Guest Lecturer
9:45 a.m. Monday, March 24
Amit Sood, MD, MSc
Professor of Medicine
Chair, Mind Body Medicine Initiative
Mayo Clinic, Rochester, MN
By Fredric V. Price, MD
Among the most important advances in our specialty in the last five years has been the recognition of palliative care as an integral part of the practice of gynecologic oncology. The landmark 2010 article by Temel, et al. showed in a randomized trial that early consultation with palliative care specialists with standard oncologic care after the diagnosis of metastatic non-small cell lung cancer resulted in better patient outcomes. It might have been predicted that quality of life indices would be better, but few expected that survival was 25% longer in the palliative care group with statistical significance. The fact that patients lived longer in the palliative intervention group raises many questions about the indications for aggressive and futile treatment in patients near the end of life. Few would argue that an intervention with such a significant overall survival improvement does not represent better patient care.
Symptom management has always played an important role in the practice of gynecologic oncology. Our specialty has been at the forefront of managing complications of progressive disease and side effects of therapy. In the last several years, many gynecologic oncologists have begun to integrate principles of palliative care into more traditional disease-directed therapeutic programs for patients with life-limiting illnesses. Research in palliative care as it applies to gynecologic oncology has resulted in a better understanding of our responsibility to provide these alternatives to patients near the end of life.
Forty-seven members of the Society of Gynecologic Oncology have been certified through the American Board of Obstetrics and Gynecology using the grandfather pathway in lieu of a one-year fellowship. Applicants were required to document 800 hours of experience in end-of-life care and 100 hours of hospice experience. They were recommended by a hospice medical director, and passed a rigorous written test. The test covered materials not otherwise part of the gynecologic oncology curriculum, including approaches to the grieving family, the spiritual needs of the dying, and religious rituals surrounding death. Preparation for board certification was a rewarding opportunity to reevaluate our approaches to the most challenging problems we face as clinicians. It also engendered new respect for our colleagues from other specialties, who are full-time palliative care specialists.
The number of hospitals in the US with palliative care programs has increased by more than 100% in the last few years. Growth in hospital-based programs can be attributed to a new understanding that palliative care reduces outlay of expensive resources on patients for whom aggressive treatment may be futile. The goals of relieving suffering, improving quality of life for patients and families, and reducing health care expenditures have become aligned. Palliative care programs emphasize not only symptom management, but also work to establish realistic goals for patients with serious illnesses.
Gynecologic oncology has made unprecedented progress as a specialty in the last decade. Patients now benefit from minimally invasive and robotic surgery, a new understanding of the pathogenesis of ovarian cancer, new treatment modalities based on genomic medicine and anti-angiogenesis, and intraperitoneal chemotherapy. None is more important than the new emphasis on palliative care for patients with advanced gynecologic malignancies.
Fredric V. Price, MD is an Associate Professor and Director of Gynecologic Oncology at West Penn Allegheny Health System in Pittsburgh, PA. In addition to ABOG certification for Gynecologic Oncology he also has ABOG certification for Hospice and Palliative Medicine.
The bipartisan, bicameral legislative framework would eliminate Medicare’s SGR formula and replace it with a new valued-based program, including alternative payment models.
Jointly drafted by the U.S. Senate Finance Committee and the U.S. House Ways and Means Committee, the SGR proposal would take advantage of this year’s reduced cost of repeal: $138 billion—less than half of last year’s cost. If not repealed, the SGR formula will require a 24 percent cut in physician payments effective Jan. 1, 2014.
In a letter dated Nov. 12, 2013, SGO President Barbara A. Goff, MD, offered a number of recommendations that will support members of a woman’s cancer care team in providing the best care for their patients. The SGO’s comment letter referenced the SGO White Paper that was released earlier this year: “Creating a New Paradigm in Gynecologic Cancer Care: Policy Proposals for Delivery, Quality and Reimbursement.”
In its formal comments regarding participation in clinical improvement activities, SGO recommended the following items be added in the legislation:
- Annual Maintenance of Certification for specialty
- Proof of annual CME requirements
- Participation in hospital-based Continued Performance Improvement Committees
- Participation in a registry sponsored or endorsed by the physician’s primary specialty society
- Participation in cooperative group clinical trials and offering trials to patients
- Participation in tumor boards and other ongoing training
- Participation in self-critical and other activities where practices are required to review their annual data and respond
- Surgical Steering Committee participation and maintenance of surgical credentials and privileges at hospitals through an annual review process.
- Documentation of adherence to clinical practice guidelines that are endorsed by the medical specialty society.
The SGO will continue to advocate for SGR repeal legislation that will support physicians in providing the best care for their patients.
The second annual #GivingTuesday is Dec. 3, 2013, and the Foundation for Gynecologic Oncology’s Annual Member Appeal is under way.The Foundation aims to achieve the participation of 25 percent of the SGO membership by the 2014 Annual Meeting on Women’s Cancer.
Propelled by the power of social media, the first #GivingTuesday was initiated last year by community management experts at New York City’s 92nd Street Y in partnership with the United Nations. The group reasoned that during the holidays there are days for receiving gifts, buying gifts and giving thanks, but no official day for giving back to the community. #GivingTuesday is an international movement that celebrates and encourages charitable activities that support non-profit organizations. Learn more about #GivingTuesday.
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