SGO Issues Oct. 18, 2018
Opioid education modules now available on SGO Connect Ed
Is there a ‘good’ time to start a family as a gynecologic oncologist?
Gynecologic Oncology: Volume 151, Issue 1 (October 2018)
Gynecologic Oncology Reports: Volume 26 (November 2018)
Race weekend is only two weeks away
International affiliate member Francisco Fuster, MD, dies
CDC Inside Knowledge campaign adds new resources
SGO’s Palliative Care Task Force has developed a four-part online educational module series addressing the use of opioids in gynecologic oncology. This free series is now available on SGO Connect Ed and is aimed at gynecologic oncology practitioners. The 15-minute modules review best practices and cases relevant to the use of opioids in women’s cancer care.
Part 1 of the series, “Clinical Uses of Opioids in Gynecologic Oncology,” hosted by Amanika Kumar, MD, offers an introduction to opioids and different times through the course of cancer care in which opioids are used. Part 2, “Opioid Conversion,” led by Alexis Hokenstad, MD, is a practical case-based primer on opioid conversion, escalation, and rotation. Module 2 was part of a grant funded by the SGO Gynecologic Oncology Fellows Research Network (GOFRN). Dr. Kumar is also the speaker for Part 3, “Opioid Toxicity,” which focuses on common toxicities of opioid use. Part 4, “Opioid Misuse” with Carolyn Lefkowits, MD, concludes the series with a review of the current landscape of the opioid epidemic and regulatory issues.
“Opioid prescribing have long been part of the profession of gynecologic oncology, but little to no training is traditionally given,” explained Dr. Kumar. “With the opioid crisis at the moment and the increased attention to safe and appropriate opioid use, we feel this type of training won’t only become more common, but is increasingly necessary for safe prescribing.”
“I think what is most unique about the scope of practice of gynecologic oncologists as it relates to opioid use is the range of clinical scenarios in which we might use opioids (post-op pain, disease-related pain, treatment-related pain, pain in survivors, pain at the end of life),” explained Dr. Lefkowits. “As a result of this breadth of practice, it is critical that gynecologic oncologists are comfortable using opioids in a wide variety of clinical scenarios and that we recognize the differences in appropriate opioid use in different scenarios.”
Dr. Lefkowits noted that new restrictions on opioid prescribing might make it harder for terminally ill patients to obtain medications for their pain.
“Even in scenarios where legislation may exempt cancer pain or end of life care from opioid restrictions, we are concerned that barriers to access may persist related to issues such as lack of availability of opioids at pharmacies and insurance limitations,” she said. “Such barriers have been reported anecdotally.”
Balancing effective pain control with concerns about opioid safety and opioid misuse is an important goal of the opioids in gynecologic oncology series.
“I think the biggest questions (from practitioners) are about how to screen patients for misuse and prevent harm from our prescribing, and how to distinguish appropriate and inappropriate use,” said Dr. Kumar.
I thought I never wanted children. I was determined to be a great gynecologic oncologist, and thought children would get in my way. I was 36, advanced maternal age, when I decided it was the “right time” to have children. My initial pregnancy ended in miscarriage, but later that year I delivered a healthy baby girl. Holding that baby for the first time was the best gift I have ever received.
Exactly two years later I was blessed with a second child. Life was busy, I was working furiously to get grants while maintaining a full clinical practice. I suddenly realized that I missed a lot of “firsts”-rolling over, crawling, their first snowfall. I had this nagging feeling that I had to have another child. At age 39 I thought there still had to be time. We tried for many years. Multiple miscarriages later I was sad and angry. Angry that in an attempt to advance my career my reproductive years vanished. Then, unexpectedly, in my forties, I got my miracle.
Coordinating work and family life is difficult for everyone, but for biologic and social reasons, is especially difficult for women. Thus, women with professional degrees are more likely to remain childless compared to their male colleagues with the same level of education and career1. Our survey of SGO members reflected this—51% of women compared to 19% of men desired to have more children than the number they had (presented at SGO 2018). These differences may be due to lifestyle choices, but infertility may also play a role.
The national average age at first childbirth is 26 years, but 29 years among female surgeons;1 in our survey of SGO members, approximately 1/3 reported having their first child after age 35 years. Our OB/GYN background makes us all too aware of the risks of infertility as we delay childbearing. While our background also gives us greater awareness of infertility treatment options, success with in vitro fertilization (if we can fit it into our busy schedules) also decreases with age, with 42% of transfers resulting in live birth for women <35 years of age, but only 23% in women 35-37 years of age, and success rates decrease from there.2 And that assumes viable oocytes can be stimulated and retrieved.
If you manage to have a child, the struggle changes to the constant conflict between being a “good gynecologic oncologist” and being a “good parent.” In the end, we often feel like we are NOT good enough at either.
Despite our work-family struggles, we do have a positive impact on our children. A New York Times article highlighted the benefits of having a working mother (working males are considered the “standard”). A study of 50,000 adults in 25 countries showed that, specifically in the United States, adult daughters of working mothers earned 23% more money, and sons spent 7.5 hours more on childcare and 25 minutes more on housework per week compared to children of stay-at home mothers3.
One of my favorite quotes is from astronaut Pam Melroy: “There is no work-life balance. It’s really more like a see-saw—sometimes you have to prioritize your career, sometimes you need to prioritize your personal life.”
I am at peace now with my family of five. Life is no less busy, but I am in a place where I cherish all the “firsts” and “lasts” despite the demands of my career. If I had my choice, would I have chosen to do it this way? No, probably not. As a gynecologic oncologist there is no “good” time to start a family. But time waits for no one.
Deanna Teoh, MD, MS, also contributed to this article. Dr. Gellar and Dr. Teoh are from the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis MN.
- Turner PL, Lumpkins K, Gabre J, Lin MJ, Liu X, Terrin M. Pregnancy among women surgeons: trends over time. Arch Surg. 2012;147(5):474-479.
- American College of O, Gynecologists Committee on Gynecologic P, Practice Committee of the American Society for Reproductive M. Female age-related fertility decline. Committee Opinion No. 589. Obstet Gynecol. 2014;123(3):719-721.
- Miller CC. Women at Work: Mounting Evidence of Advantages for Children of Working Mothers. New York Times. 5/16/15, 2015.
Editorial: Tumor-infiltrating T cells in epithelial ovarian cancer: predictors of prognosis and biological basis of immunotherapy Weimin Wang, Weiping Zou, J. Rebecca Liu
Clinical Commentary: Hyperthermic intraperitoneal chemotherapy (HIPEC) is cost-effective in the management of primary ovarian cancer Kian Behbakht, David E. Cohn, J. Michael Straughn Jr
Featured Article: Participation in global health delivery: Survey results from the Society of Gynecologic Oncology Michelle D. S. Lightfoot, Katharine M. Esselen, Miriam J. Haviland, John L. Dalrymple, Christopher S. Awtrey, Leslie A.Garrett, Michele R.Hacker, Fong W. Liu
The 2018 National Race to End Women’s Cancer is on Sunday, Nov. 4, at Freedom Plaza in Washington, DC. Proceeds from the race benefit the mission-based programs of the Foundation for Women’s Cancer (FWC), including research, education and public awareness of gynecologic cancers. For those who are unable to make the event, consider donating to the SGO & Friends team—formerly known as the Surgeons Team. SGO member support helps the FWC reach more patients, survivors, and advocates as they strive to #EndWomensCancer.
SGO regrets to announce the passing of SGO International Affiliate member Francisco Fuster, MD, of Calderon Guardia Hospital in San Jose, Costa Rica. Dr. Fuster passed away on July 17 at the age of 67. Dr. Fuster was considered to be a pioneer in the fight against gynecologic cancers in Central America. In addition to being an SGO member, Dr. Fuster was a leader in the Central American Caribbean Federation of Gynecology and Obstetrics.
The Centers for Disease Control and Prevention (CDC) has added several new videos and resources as part of its CDC’s Inside Knowledge: Get the Facts about Gynecologic Cancer (IK) awareness campaign for women at risk for or diagnosed with gynecologic cancers. The CDC created four animated videos (in English and Spanish) to help inform women about gynecologic cancers.
The IK campaign offers additional materials in both English and Spanish– such as fact sheets, brochures, symptoms diaries, posters, and broadcast PSAs. Inside Knowledge also has a new Family History and Cancer Fact Sheet available, as well as guidance for women on recently updated screening recommendations for cervical cancer. The CDC has developed a toolkit that includes links to the videos, shareable graphics, and sample language for clinicians to post on social media channels, websites, and eNewsletters.