The Society of Gynecologic Oncology (SGO) had over 2,500 attendees at their annual meeting in Honolulu, Hawaii on March 16-19. Doximity was fortunate enough to have the opportunity to speak with one of SGO’s experts, Dr. Shannon Maclaughlan, MD, about her insights and highlights from the conference. Shannon is the director of Gynecologic Oncology at the University of Illinois in Chicago.
Doximity: Thank you, Shannon, for taking the time to speak to me about the successful meeting SGO had last week. I heard the meeting had record-breaking attendance, why do you think that is?
Shannon Maclaughlan: Certainly. Yes, there were many attendees, probably because of a couple of exciting reasons. It was SGO’s 50th anniversary and the meeting was held in the beautiful destination city of Honolulu, Hawaii to attract a larger crowd. It was also an overall celebration of SGO and the subspecialty of Gynecologic Oncology as a whole. SGO has also expanded its membership beyond the United States and to Advanced Practice Providers (APPs). Abstracts are being translated into multiple languages and will be shared through video clips. SGO is definitely prioritizing and recognizing the valuable contributions of the international community of all clinicians practicing in Gynecologic Oncology.
Dox: That’s great news. What do you think was the most attended session?
SM: The opening plenary was well-attended because of the impactful abstracts that were presented. It was made evident that the “patient-centered approach” has not been translated into research until now. I have noticed that there has been a greater emphasis on prioritizing patient-reported outcomes.
Dox: What were some of the abstracts presented that used this new patient-centered approach?
SM: One of the major topics discussed in these abstracts was the use of poly (ADP-ribose) polymerase (PARP) inhibitors to treat ovarian cancer. They are the leading edge we have in practicing precision medicine in Gynecologic Oncology because of their efficacy in targeting specific genetic mutations. And not only are we looking at survival data but also patient-reported outcomes in trials — how a patient is feeling is important data and can be quantified. That was demonstrated in the TWiST (time without symptoms or toxicity) analysis of the ENGOT-OV16/NOVA trial. The PARP inhibitor, niraparib, was found to prolong TWiST versus placebo, regardless of BRCA gene status. Overall quality of life was also found to be enhanced. This is meaningful information to have because it allows clinicians to counsel patients better. There are papers looking further into how we can personalize dosing based on age, weight, and other factors. There is much to be done on how we can make cancer treatments more effective and individualized.
Dox: Were there any updates/findings regarding other cancers such as cervical cancer?
SM: Yes, an important finding regarding cervical cancer centered around the current treatment of brachytherapy. Current treatment for later-stage cervical cancer is radiation, chemotherapy, and brachytherapy within eight weeks. Realistically, clinicians know that getting that treatment within eight weeks can be difficult because of toxicity, delays, and access issues, however, it was found that it is better to receive brachytherapy later than eight weeks, than not at all. And it is to be highlighted that black women are less likely than white women to receive brachytherapy — an inequity we must work on reducing.
Dox: Regarding access issues, the concept of “financial toxicity” was brought up during the meeting. Could you please expand on that?
SM: Yes, financial toxicity is the financial distress that comes with undergoing cancer treatments and causes poor health outcomes. Treatments can be very expensive, causing patients to stay out of work, and burdening their family and interfering with other life responsibilities. There can be a lot of traveling and logistics to plan in order to receive regular treatments. These treatments can be so financially draining that healthy food access and other preventative health measures cannot be adequately sustained. This all affects quality of life and treatment outcomes. The overall cancer community has not been great about recognizing this. Too often we mischaracterize patients as having an “I’ll do whatever it takes” mentality to treating their cancer. We must realize the difference between what patients have to do versus what they should do. Cancer centers can help by providing more psychosocial, financial, and logistical support to patients.
Dox: What is to note regarding preventative measures like screenings and vaccines?
SM: HPV vaccine uptake in the U.S. has been subpar compared to other countries. We are always behind countries like the UK and Australia and even more underdeveloped nations. A paper was presented studying HPV vaccine uptake in Alabama and it was found that vaccination rates were higher in counties that had higher HPV prevalence. In those counties there’s more concerted efforts to spread awareness of the cancer, more teaching of the risk, and because the risk is more real, those residents are more likely to be vaccinated.
Dox: Do you think the recent FDA approval of the use of the HPV vaccine up to age 45 will improve vaccination rates?
SM: It takes time for an update/approval to translate into practice guidelines. More often, getting the HPV vaccine is an out-of-pocket expense and not always covered by insurance carriers. Only two states mandate HPV vaccination in schools. Anytime there is a barrier in communication between experts and the public, or people asserting themselves without being fully informed, there is a threat to public health. This includes misinformation, fake news, and health policies that make it easier to opt out of vaccination.
Dox: Dr. Agnes Binagwaho is a champion for cervical cancer prevention and women’s health globally and in her home country of Rwanda. How was her talk at SGO?
SM: It’s hard to describe how powerful of a speaker she is. She’s very motivated and I found it personally moving to hear her story and all the great work she’s done. She framed her discussion of the cervical cancer vaccination program in Rwanda in the context of a country healing from mass genocide. She shared what a hateful, ugly, and violent war has done to Rwanda and how a lot of social capital that was used in the response to cervical cancer there came from communities that were forced to heal and forgive each other. Dr. Binagwaho was able to teach communities what a cervix is and what it means for women have one and take care of their bodies- the amount of education and enlightenment that must have gone into those efforts, it’s impressive. She was able to garner the trust of the government and her people to advance the health of women.
Dox: What an inspiring talk. The world can learn a lot from her. Another topic of importance that I saw highlighted in the SGO agenda was Palliative Care. What more can be done around Palliative Care for women with gynecologic cancers?
SM: SGO is recognizing the importance of palliative care and how to incorporate it into clinical practice. There are leaders in the field developing curriculum for more clinician training. Up until now it has always been treated as a separate thing when palliative care should really be implemented from the start. That can be both ingrained in the interdisciplinary team and in the gynecologic oncologist specifically trained in Palliative Care. Palliative Care is so much more than end-of-life care. We need to reframe it and lift the shadow of death and dying around the subject. Palliative care definitely has a stigma which is a shame because patients with early access to Palliative Care live longer. Holistic care should be focused on more than just killing the cancer.
Dox: What are new developments regarding minimally invasive surgery (MIS)?
SM: Last year a controversial finding in laparoscopy for cervical cancer was shared. It was found that women with operative (early stage) cervical cancer who had laparoscopy had a higher risk of recurrence and lower overall survival rate. It was hard to believe and such a finding would cause an abrupt change of practice because it is widely accepted and being done. When you see people doing better shortly after MIS it’s hard to not believe it’s due to that procedure. The best evidence that drives patient care decision-making is randomized prospective clinical trials, greater than retrospective. Some clinicians are no longer performing MIS until more information demonstrates that it is safe. Cervical cancer trials are tricky because they are big and expensive. It might be difficult to design a study that an IRB agrees to due to the survival disadvantage for research participants. There would have to be a way to handle that ethically. So the question remains, is there room for another trial and should there be another trial?
Dox: Is there anything else clinicians should know about this year’s SGO meeting?
SM: It can be hard to make it out to the meeting every year and even when you do, you can’t always go to every session you want to. Over the next several months, abstracts and video presentations will be available on the SGO website. I definitely recommend taking advantage of these resources coming out of the meeting.
Dox: Thank you Shannon, and looking forward to next year’s SGO meeting!
This interview was conducted by Angelica Recierdo, Op-Med Editor.
Illustration by April Brust.