Society of Gynecologic Oncology Releases List of Commonly Used Tests and Treatments to Question

Group aims to encourage physician and patient conversations by identifying five tests or procedures to question, highlighting potentially unnecessary—sometimes harmful—care in gynecologic oncology

Released: 1-Nov-2013 9:00 AM EDT
Source Newsroom: Society of Gynecologic Oncology
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Newswise — CHICAGO, IL – The Society of Gynecologic Oncology (SGO) today released a list of specific tests or procedures that are commonly ordered but not always necessary in gynecologic oncology as part of Choosing Wisely®, an initiative of the ABIM Foundation. 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 released today 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.

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About the Society of Gynecology Oncology
The Society of Gynecologic Oncology (SGO) is a 501(c) 6 national medical specialty organization of physicians and allied health care professionals who are trained in the comprehensive management of women with malignancies of the reproductive tract. The Society’s membership, totaling more than 1,600, is primarily comprised of gynecologic oncologists, as well as other related medical specialists including medical oncologists, radiation oncologists, nurses, social workers and pathologists. SGO members provide multidisciplinary cancer treatment including chemotherapy, radiation therapy, surgery and supportive care. www.sgo.org.

About the Foundation for Gynecologic Oncology
The Foundation for Gynecologic Oncology is a 501(c)3 organization that ensures that SGO meets the needs and provides the resources for members and the women’s cancer care community. www.sgo.org/foundation.

About the ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit www.abimfoundation.org, read our blog blog.abimfoundation.org, connect with us on Facebook or follow us on Twitter.

About Choosing Wisely®
First announced in December 2011, Choosing Wisely® is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at www.ChoosingWisely.org.


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