SGO Issues October 31, 2013
SGO’s 5 tests/procedures to avoid
ASCO releases second list for ABIM’s Choosing Wisely
Voices: Negotiating the pelvic exam | B.J. Rimel, MD
NIH revises grant review schedule in light of shutdown
Gynecologic Oncology November 2013, 131 (2013) 287–288
Important deadlines and reminders
The list identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary.
SGO’s list identified the following five recommendations:
- Don’t screen low risk women with CA-125 or ultrasound for ovarian cancer.CA-125 and ultrasound in low risk, asymptomatic women have not led to diagnosis of ovarian cancer in earlier stages of disease or reduced ovarian cancer mortality. False positive results of either test can lead to unnecessary procedures which have risks of complication.
- Don’t perform Pap tests for surveillance of women with a history of endometrial cancer.Pap testing of the top of the vagina in women treated for endometrial cancer does not improve detection of local recurrence. False positive Pap smears in this group can lead to unnecessary procedures such as colposcopy and biopsy.
- Don’t perform colposcopy in patients treated for cervical cancer with Pap tests of low grade squamous intraepithelial lesion (LGSIL) or less.Colposcopy for low grade abnormalities in this group does not detect recurrence unless there is a visible lesion and is not cost effective.
- Avoid routine imaging for cancer surveillance in women with gynecologic cancer, specifically ovarian, endometrial, cervical, vulvar and vaginal cancer.Imaging in the absence of symptoms or rising tumor markers has shown low yield in detecting recurrence or impacting overall survival.
- Don’t delay basic level palliative care for women with advanced or relapsed gynecologic cancer, and when appropriate, refer to specialty level palliative medicine.There is now an evidenced based consensus among physicians who care for cancer patients that palliative care improves symptom burden and quality of life. Palliative care empowers patients and physicians to work together to set appropriate goals for care and outcomes. Palliative care can and should be delivered in parallel with cancer directed therapies in appropriate patients.
“It is essential that women uniformly receive early access to the health care providers who are best qualified to care for women with gynecologic cancer. The SGO has been in the forefront of setting measurable standards of high quality care for women diagnosed with gynecologic cancer,” said SGO President Barbara A. Goff, MD. “The Choosing Wisely recommendations for gynecologic oncology provide valuable information to help patients and physicians discuss treatment options that will impact survival and quality of life.”
SGO created a “Cost of Care” workgroup in response to the ABIM Foundation’s Choosing Wisely campaign. The workgroup is comprised of representatives from the society’s clinical practice committee that is made up of gynecologic oncologists, medical oncologists, nurse practitioners, pharmacists, and other allied health providers. A literature review was conducted to identify areas of overutilization or unproven clinical benefit and areas of underutilization in the presence of evidence-based guidelines. The workgroup then evaluated these data and presented a list of five topics to the membership of the clinical practice committee and then to the SGO Board of Directors for approval. The selected five interventions were agreed upon as the most important components for women with gynecologic malignancies and their providers to consider.
In addition to SGO, more than 30 other specialty society partners are releasing Choosing Wisely lists over the next several months. To date, over 80 national and state medical specialty societies, regional health collaboratives and consumer partners have joined the conversations about appropriate care. With the release of these new lists, the campaign will have covered more than 250 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss.
The campaign also continues to reach millions of consumers nationwide through a stable of consumer and advocacy partners, led by Consumer Reports—the world’s largest independent product-testing organization—which has worked with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians to engage in these important conversations.
To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit www.ChoosingWisely.org.
On Oct. 30, the American Society of Clinical Oncology released its second Choosing Wisely list of cancer tests, procedures and treatments that doctors and patients should question.
Lately, I’ve been hearing a great deal of negotiating in my office. Now that I’ve been in practice for two years, I’m getting to see some patients back for surveillance visits and unfortunately some for recurrence. Regardless of the reason for the visit the strategy is always the same: is there a way to avoid the pelvic exam portion of the visit?
In an attempt to discuss the reasons why we, as gynecologic oncologists, perform what is inevitably an uncomfortable examination, I will answer the top 5 things said in my office after I say, “I’m going to step out now so you can undress.” READ MORE
On Oct. 22, the National Institutes of Health (NIH) Deputy Director for Extramural Research Sally Rockey, PhD, announced that NIH is revising its schedule for peer review meetings that were cancelled due to the government shutdown earlier this month.
The cancelled review panel meetings had delayed decisions on grant applications, which in turn delayed pending research projects.
According to a post on Dr. Rockey’s “Rock Talk” blog, “Most review meetings originally scheduled during October will be quickly re-scheduled to enable applications to be considered at January council.” She added that it might be necessary to reassign a small number of applications to May council.
“It is unfortunate that the government shutdown has forced all of us to scramble in this way,” said Dr. Rockey. “I very much appreciate that NIH can pull together with the extramural community in difficult times to ensure that great science continues.”
The Revised Guidance on Resumption of NIH Extramural Activities Following the Recent Lapse in Appropriations can be found here.
Lead Article: Outcomes of ovarian preservation in a cohort of premenopausal women with early-stage endometrial cancer: A Korean Gynecologic Oncology Group study READ MORE
Editorial: Take ‘em or leave ‘em: Management of the ovaries in young women with endometrial cancer READ MORE