SGO Issues Sept. 8, 2016
FDA recommends against current ovarian cancer screening tests
SGO signs on to CMSS Code for Interactions with Companies
Fellows gain hands-on MIS experience at SGO workshop
Hurry, Scurry, Work and Worry | Jeffrey M. Fowler, MD
Cancer Moonshot Blue Ribbon Panel releases report recommendations
Sept. 19 deadline for SGO Annual Meeting abstract submissions
Yesterday the U.S. Food & Drug Administration (FDA) issued a safety communication which recommends against using tests that are currently marketed for ovarian cancer screening: According to the statement, “The Agency is especially concerned about delaying effective preventive treatments for women who show no symptoms, but who are still at increased risk for developing ovarian cancer. Based on currently available information, the FDA recommends against using currently offered tests to screen for ovarian cancer.”
As a summary of the current problem, the FDA noted that in recent years numerous companies have marketed tests that claim to screen for and detect ovarian cancer. “Despite extensive research and published studies, there are currently no screening tests for ovarian cancer that are sensitive enough to reliably screen for ovarian cancer without a high number of inaccurate results.”
The FDA is making the following recommendations regarding ovarian cancer screening tests:
For women, including those at increased risk of developing ovarian cancer:
- Be aware that there is currently no safe and effective ovarian cancer screening test.
- Do not rely on ovarian cancer screening test results to make health or treatment decisions.
- Talk to your doctor about ways to reduce your risk of developing ovarian cancer, especially if you have a family history of ovarian cancer, or have the BRCA1 or BRCA2 genetic mutations.
- Do not recommend or use tests that claim to screen for ovarian cancer in the general population of women. Be aware that testing higher risk asymptomatic patients for ovarian cancer has no proven benefit and is not a substitute for preventive actions that may reduce their risk.
- Consider referring women at high risk of developing ovarian cancer, including those with BRCA mutations, to a genetic counselor or gynecologic oncologist, or other appropriate health care provider for more specialized care.
The Council of Medical Specialty Societies (CMSS) has added SGO to their list of signers to the Code for Interactions with Companies, which ensures that participating medical societies meet high ethical standards in their dealings with companies that may provide charitable contributions, grants in support of programmatic activities, and a range of other business transactions. SGO is now one of 35 member medical specialty societies in addition to 17 non-member societies that have formerly signed on to the Code.
According to CMSS, “The purpose of the Code is to guide Societies in the development of policies and procedures that safeguard the independence of their programs, policies, and advocacy positions.”
The CMSS Code also states that “Societies that sign on to the Code should adopt policies and procedures to guide Society‐Company interactions in accordance with the Code. Societies will interpret and implement the Code in the context of their organizational structure and their policies and procedures.”
The CMSS Code covers the following “Principles for Interaction” for a medical society’s dealings with any “company,” which is defined as a “for-profit entity that develops, produces, markets, or distributes drugs, devices, services or therapies used to diagnose, treat, monitor, manage, and alleviate health conditions.”
- Accepting Charitable Contributions
- Accepting Corporate Sponsorships
- Society Meetings
- Society Educational and Informational Programs
- CME-Accredited Satellite Symposia
- Company Informational/Educational Programs
- Awarding of Research Grants
- Clinical Practice Guidelines
- Society Journals
- Standards for Advertising
- Standards for Licensing
The 43 medical society members of the CMSS represent more than 790,000 U.S. physician members.
Last month SGO hosted two sessions of the Minimally Invasive Surgery Academy: Hands on Workshop for Fellows—one in Sunnyvale, CA, the other in Atlanta, GA—for a total of 27 fellows and 10 attendings. This is the second year that SGO has offered this program; senior fellows and attendings were invited to apply for acceptance through their gynecologic oncology fellowship program directors.
Based on the need for more thorough and effective surgical education during gynecologic oncology fellowship programs, the SGO Education Committee determined that the unique structure of this workshop with its high ratio of faculty and cadaver/robotic surgical system to fellows would be ideal, particularly when paired with the free five-part webinar series SGO Robotics Academy on SGO ConnectEd®. Participation in the SGO Robotics Academy was a requirement of acceptance into the workshop.
Developed by University of Alabama at Birmingham Associate Fellowship Director and Director of Robotic Surgical Education and Training, Kenneth Kim, MD, FACOG, the workshop opened with a one-day introduction that included dry labs, surgical simulations, in depth didactic lectures on rarely addressed issues in MIS surgery. The intensely focused small group discussions addressed the real-life challenges gyn onc fellows face in learning the necessary skills for surgery in an environment that was repeatedly referred to by faculty and attendees alike as a “safe space.”
Those skills were put to the test on the second day of the course, which consisted of an extended cadaver lab utilizing both the daVinci Si and Xi systems to learn techniques for variations in port placement. Participants had time to consider the benefits of these alternatives and docking in a low-stress setting. There was also instruction on advanced energy usage and surgeries like para-aortic lymph node dissection and splenectomies.
One fellow highlighted the unique opportunities this curriculum and format allowed for, emphasizing the importance of the “emergency shutdown drill, wrench use, etc. –we never practice this and many didn’t even know some of those features existed…It was as close to real life surgery and advance dissection as one can get. …. I feel so much more comfortable in my radical hysterectomy confidence and the anatomical approach to extensive lymphadenectomy.”
SGO President Jeffrey Fowler, MD, Director of the Division of Gynecologic Oncology and professor of gynecologic oncology at The Ohio State University Wexner Medical Center, attended the MIS Workshop for Fellows in Sunnyvale, CA on Aug. 19-20.
“The benefits of MIS surgery to the patient are clear, however the technology adds many additional layers of operational complexity to the conduct of surgery within the OR,” said Dr. Fowler. ”In an era of a massive amount of information available, there is no substitution for hands on surgical training with the opportunity for close interaction and mentoring from experienced surgeons. In my mind the SGO MIS course is an ideal advanced surgical skills training course that will take months off the initial learning curve for these procedures.”
“It was a joy to be a new faculty member at the SGO MIS Workshop” said Joshua Cohen, MD, from UCLA Medical Centers. “This surgical course is extremely high yield for gyn onc fellows, and, in my opinion, is one of the most important teaching experiences offered through SGO for trainees. The open dialogue among fellows, attendings, course faculty, and staff at the training centers allowed for a wonderful exchange of surgical techniques, troubleshooting, and teaching approaches.”
In their course evaluations, all of the participants stated that the MIS Academy: Hands on Workshop for Fellows offered new, relevant strategies to assist in improving professional practice and that there is value in continuing this course. In the future, SGO hopes to be able to accept more fellows into this program, to combine didactics and hands-on experience for minimally invasive surgical techniques.
SGO gratefully acknowledges and thanks Intuitive Surgical for their generous unrestricted grant in support of this course.
Maybe I do not have the capacity or wisdom to give any other important mentoring advice to my junior colleagues, but David Cohn, MD, told me that one of the most important words of advice I gave him when he started on faculty at The Ohio State University was, “Just make sure you get a hobby.” Hopefully, I was able to offer more than that in my capacity as his Division Director. Perhaps this was one of the most important pieces of advice young Dr. Cohn received as he was fresh out of fellowship and about to embark on a successful and demanding career in gynecologic oncology.
The practice of gynecologic oncology is extremely demanding, rewarding and complex. It consumes most of our physical and mental capacity. The overwhelming majority of gynecologic oncologists are satisfied with their career choice, but the demands of the job take their toll; One third of Gyn Oncs are burned out. Indicators of psychosocial distress and poor mental well-being are alarmingly high. The wrong mix of perfectionism, self-doubt, fear of failure, compassion, loss of sense of control and exhaustion without proper support and resources leads to burnout and other problems with personal and professional well-being. The recipe for disaster is complicated. Risk factors that contribute to burnout and low career satisfaction will vary amongst individual physicians.
Work-life balance is a difficult concept in our profession; mental and physical time and effort are definitely not a 50-50 proposition. Despite finding meaning in our work and career satisfaction, it is impossible to escape the demands of our professional lives. We cannot punch out on a time clock, and it’s virtually impossible to avoid leaving work behind you when you exit the hospital. “Good” work-life balance prevents the most severe fallout that may result from our demanding careers. Surgeons who incorporate a philosophy stressing work-life balance are less likely to suffer from burnout and have a better quality of life.
An important component of work-life balance is regularly taking the time to relax. Relaxation is defined as any restorative activity associated with the key elements of enjoyment and satisfaction. It should not be an activity where the usually negative personality traits of perfectionism, obsession and extreme competitiveness are dominant, which is ot to say I don’t enjoy beating some of my colleagues in a Ping Pong match!) There is no magic formula except that the activity should be enjoyable and recharge your emotional and physical batteries.
It’s interesting that we have invested so many years into rigorous and competitive education training but we are not very disciplined about self-care. While I’m not the greatest example of work-life balance, perhaps you should have a serious talk with yourself regarding professional versus personal goals. I have learned to take regular time for family, exercise, travel, golf (enjoyable as long as I don’t expect to break 90 every outing) and fishing. It takes discipline, commitment, and advocating for oneself. You have to accept that the unique demands and responsibilities of our job will create peaks and valleys in our self-care schedule.
Harry S. Truman, may have had the most difficult combination of challenges faced by any American president in modern history. As he emerged from the shadow of Franklin Delano Roosevelt in the closing months of World War II, Truman was forced to consider these daunting issues: the use of nuclear weapons against Japan, the reconstruction of Europe (Truman Doctrine, Marshall Plan), the Berlin Airlift,a Cold War with the Soviet Union, the Korean War, and use of nuclear weapons relating to General MacArthur and McCarthyism. In spite of all this, President Truman still understood the importance of rest and diversions from work. One of his favorite quotes was from a plumbing contractor who worked at the White House.
“Every man’s a would be sportsman, in the dreams of his intent,
A potential out-of-doors man when his thoughts are pleasure bent.
But he mostly puts the idea off, for the things that must be done,
And doesn’t get his outing till his outing days are gone.
So in a hurry, scurry, worry, work, his living days are spent,
And he does his final camping in a low green tent.”
And what about Dr. Cohn? I created a monster! He went back to playing the guitar, took up the mandolin, and he is a Cross-fit training triathlete who also loves to fish. As one of my mentors would say, “Just do something!” Go get a hobby….before it’s too late.
- Rath, K. S., et al. (2015). “Burnout and associated factors among members of the Society of Gynecologic Oncology.” Am J Obstet Gynecol 213(6): 824 e821-829.
- Shanafelt, T., et al. (2006). “Shaping your career to maximize personal satisfaction in the practice of oncology.” J Clin Oncol 24(24): 4020-4026.
- Shanafelt, T. D., et al. (2012). “Avoiding burnout: the personal health habits and wellness practices of US surgeons.” Ann Surg 255(4): 625-633.
- Balch, C.M, et al. (2010). “Combating Stress and Burnout in Surgical Practice: A Review.” Advance in Surgery 44: 29-47.
Jeffrey M. Fowler, MD, is the 2016-2017 SGO President and Director of the Division of Gynecologic Oncology and professor of gynecologic oncology at The Ohio State University Wexner Medical Center.
On Sept. 7, the Cancer Moonshot’s Blue Ribbon Panel presented its report to the National Cancer Advisory Board. The report describes ten recommendations for achieving the Cancer Moonshot’s ambitious goal of making a decade’s worth of cancer research progress in just five years. In June, SGO submitted seven recommendations to the Cancer Moonshot Initiative and two of those main concepts–clinical trials and data sharing—made the top ten list.
The “10 Years of Progress in 5” Blue Ribbon Panel Recommendations are as follows:
- Establish a network for direct patient involvement: Engage patients to contribute their comprehensive tumor profile data to expand knowledge about what therapies work, in whom, and in which types of cancer.
- Create a clinical trials network devoted exclusively to immunotherapy: Establish a cancer immunotherapy clinical trials network devoted exclusively to discovering and evaluating immunotherapy approaches.
- Develop ways to overcome cancer’s resistance to therapy: Identify therapeutic targets to overcome drug resistance through studies that determine the mechanisms that lead cancer cells to become resistant to previously effective treatments.
- Build a national cancer data ecosystem: Create a national ecosystem for sharing and analyzing cancer data so that researchers, clinicians and patients will be able to contribute data, which will facilitate efficient data analysis.
- Intensify research on the major drivers of childhood cancers: Improve our understanding of fusion oncoproteins in pediatric cancer and use new preclinical models to develop inhibitors that target them.
- Minimize cancer treatment’s debilitating side effects: Accelerate the development of guidelines for routine monitoring and management of patient-reported symptoms to minimize debilitating side effects of cancer and its treatment.
- Expand use of proven cancer prevention and early detection strategies: Reduce cancer risk and cancer health disparities through approaches in development, testing and broad adoption of proven prevention strategies.
- Mine past patient data to predict future patient outcomes: Predict response to standard treatments through retrospective analysis of patient specimens.
- Develop a 3-D cancer atlas: Create dynamic 3-D maps of human tumor evolution to document the genetic lesions and cellular interactions of each tumor as it evolves from a precancerous lesion to advanced cancer.
- Develop new cancer technologies: Develop new enabling cancer technologies to characterize tumors and test therapies.
According to the Blue Ribbon Panel report, “…These recommendations will help advance science that will benefit patients most quickly, whether by making it easier to find the most relevant clinical trials, by allowing researchers to see patterns across data that will help them rapidly zero in on key processes in cancer, or by speeding advances in technology that will enable acceleration overall.”
The deadline for abstract and surgical film submissions is Monday, Sept. 19, at 11:59 p.m. Central Time for the 2017 SGO Annual Meeting, to be held March 12-15, 2017, in National Harbor, MD (near Washington, DC). The deadline for global session submissions is Saturday, Dec. 31.