- Breast Health and Cancer Prevention
- Healthy Practices
- Breast Health
- In the Shower
- In Front of a Mirror
- Lying Down
- Johns Hopkins Kelly Gynecologic Oncology Service 5th Annual VIRTUAL Below the Belt – Stride and Thrive 5k and 1 Mile Walk
- 2019 Gynecologic Cancer Survivorship Conference: Thriving Through Education and Connection
- PARTNERS & RESOURCES – Ovarcome – Overcoming Cancer, Celebrating Life – Overcoming Cancer, Celebrating Life
- September is Ovarian Cancer Awareness Month
- Johns Hopkins University
- Title of the PCDC Project
- Description of the Project
- Resources for Sharing (e.g., description of cohorts, technologies)
- Opportunities for Collaboration
- Excessive use of skin cancer surgery curbed with awareness effort
- Medical Research and Beneficiaries
Breast Health and Cancer Prevention
October is National Breast Cancer Awareness Month. It’s a time for those who have personally been affected as well as those with loved ones affected by breast cancer to come together and share memories and stories of survival.
Awareness of others’ experiences is how we empathize with those impacted and how we encourage others who may be struggling. Breast Cancer Awareness Month is also a time to promote healthy practices, breast health, and self-inspection methods.
As we have learned over time, this information has the potential to save lives.
Breast Cancer is the most common cancer found in women. About one in eight U.S. women will develop invasive breast cancer over the course of her lifetime.
However, breast cancer death rates have been decreasing, especially among women under 50. This decrease can be attributed to increased awareness, treatment advances, and earlier detection through screening.
By continuing to raise awareness, we can work together to reduce the number of cancer victims every year.
The first thing you can do to reduce your own risk is the same measure you would take to prevent most other health problems; eat five or more servings of fruits and vegetables per day, engage in regular physical activity, limit your drinks, and don’t smoke, or quit if you do.
Although you may not to think about it, you should know your risk factors. You’re more ly to get breast cancer if:
- You are 40 years old
- Your mother, sister, or daughter has had breast cancer
- Your mother, sister, or daughter tested positive for gene mutations associated with higher risk
- You have been previously diagnosed with cancer
other cancers, many symptoms of breast cancer can go undetected without the help of a professional screening, which you should receive annually at your well woman exam. Some symptoms, however, are more noticeable.
Early detection leads to prompt treatment and could give you a greater chance of recovery. Pay attention to changes in your breasts.
If you experience one of the following symptoms, contact your gynecologist or primary care provider for a screening:
- A lump or thickening in or near the breast or in the underarm area
- A change in the size or shape of the breast
- Dimpling or puckering in the skin of the breast
- A nipple turned inward to the breast
- Discharge (fluid) from the nipple
- Scaly, red, or swollen skin on the breast, nipple, or areola
According to Johns Hopkins Medical Center, 40% of diagnosed breast cancers are detected by women who feel a lump.
At least once a month, women of all ages should perform a breast self-exam. The routine frequency keeps you updated and familiar with your breasts and makes it easier to notice slight changes you would otherwise miss.
There are three ways to perform a self-examination:
In the Shower
With an open hand, use your fingers to move around your breast in a spiral pattern gradually moving from the outside to the center. Check the armpit as well. You’re looking for any thickening, lumps, or knots.
In Front of a Mirror
Visually inspect your breasts with your arms at your sides. Next, raise your arms high overhead. Look for wrinkled skin, changes in shape, swelling, and changes to the nipples. Place your hands on your hips and press firmly to flex your chest muscles and look for the above signs once more.
Place a pillow under your shoulder and your arm behind your head. Use your left hand to feel around your right breast gently in small circles until you’ve covered the entire breast and armpit.
Use light, medium, and firm pressure. Squeeze the nipple; check for discharge and lumps. Repeat these steps with your right hand for your left breast.
Finally, and most importantly, contact your gynecologist or primary health provider if you have any questions about the health of your breasts.
Johns Hopkins Kelly Gynecologic Oncology Service 5th Annual VIRTUAL Below the Belt – Stride and Thrive 5k and 1 Mile Walk
The Kelly Gynecologic Oncology Service has been thoughtfully considering the upcoming 5th Annual Below the Belt – Stride and Thrive 5K and 1 mile Run/Walk and how to promote the safety of our incredible community while still celebrating our gynecologic cancer survivors, their caregivers, families and friends, and raising awareness for gynecologic cancers.
We are going to transform our in-person spirited day to a virtual celebration. We are inviting you to run, walk, skip, hop, or couch surf on Sunday, June 7th from 8:00 am to 2:00 pm (EDT). You can walk or run around your living room, on a treadmill in your basement, in your driveway or on a private path in your neighborhood, at a 6-foot distance from others. All registered participants who complete a 5K (~7500 steps) can submit their times via the runsignup.com results page. This will work on an honor system for reporting the steps of your own feet and not your child or pet.
Join us on (Johns Hopkins Kelly Gynecologic Oncology Service) on Sunday, June 7, from 8am to 2pm.
During this time, you will hear from Janet Weise and Kathy Drake (Race Co-Chairs), Amy Brown (Emcee), Jesse Grant (singing the National Anthem), Karyn Peluso (Survivor Speaker), our presenting sponsor NFM Lending, partner Sibley Memorial Hospital, and our amazing KGOS doctors.
The registration website is open, so please register if you have not already done so and continue to let your friends know (www.charmcityrun.com/hopkins)! It's a way to connect to others and continue to build community during this challenging time.
Prizes will be given to the best 5K time in the categories of female, male, and survivor. There will be recognition of the team with the greatest number of members and the team with the most fundraising.
We will also be awarding prizes to recognize the creativity of our participants and supporters, such as best photo, best costume, and best fundraising team name. Keep an eye on the race website www.charmcityrun.
com/hopkins for further details about prize categories! We will announce all awards winners at 2:00 pm (EDT) on race day.
All proceeds will support gynecologic cancer research and clinical trials, training for gynecologic oncology fellows, and gynecologic cancer survivors through the Susan L. Burgert, M.D. Gynecologic Oncology Survivorship Program. Last year, the race raised more than $240,000 and had 900 participants! We are aiming even higher this year and won’t be held back by a change in format. In 2020, we are striving to recruit more than 1,000 virtual participants and raise $250,000. We understand that these are financially challenging times for many in our race community. If you would a registration refund, please contact us via the information provided below.Many thanks to our sponsors who have been steadfast in their support!We truly appreciate your partnership in these challenging times. Whether you race from the treadmill, the streets, or your couch, we thank you for your continued support of all gynecologic cancer survivors.
If you have any questions, we are here for you! Please email email@example.com, or contact one of our race co-chairs: Kathy Drake at 443-253-0949 or Janet Weise at 443-535-3121. If you wish to stay up to date on our developing virtual race plans, please make firstname.lastname@example.org a trusted sender in your email account.
*Due to covid-19 health concerns, we will not be able to produce race t-shirts this year.
2019 Gynecologic Cancer Survivorship Conference: Thriving Through Education and Connection
Newswise — A premier educational event sponsored by the Johns Hopkins Kelly Gynecologic Oncology Service and the Division of Gynecologic Oncology at Sibley Memorial Hospital, this one-day conference gathers more than 25 experts to provide cancer survivors and their caregivers, family and friends an innovative daylong educational and supportive program that leaves them strengthened by their new knowledge, comforted by the connections they have made with fellow survivors and inspired to spread awareness in their local communities.
With more than 200 participants expected to attend, top experts will lead sessions focused on a broad range of topics including innovative clinical trials, the latest FDA-approved therapies, management of side effects, genetics of gynecologic cancers, nutrition and exercise, and the use of mistletoe in cancer care.
Breakout sessions will focus on each of the gynecologic cancers — ovarian, fallopian tube, primary peritoneal, uterine, cervical, vulvar and vaginal — their treatment paradigms today and what the current research might lead to in the future, with time for audience questions. Breakout sessions will also provide the opportunity to explore yoga, meditation, art therapy and journaling.
The event will conclude with a panel discussion by five gynecologic cancer survivors.
What: Full-day conference geared toward anyone with a gynecologic cancer and their caregivers, family and friends who want to learn more about innovative treatments for gynecologic cancers, management of cancer and treatment-related symptoms, healthy living, and approaches to managing the strains of a cancer diagnosis.
When: Sept. 14, 2019, 8 a.m.–4:30 p.m.
Where: Renaissance Baltimore Harborplace Hotel, 202 E Pratt St, Baltimore, MD 21202
Subject matter experts available for interview:
Amanda Fader, M.D., is director of the Johns Hopkins Kelly Gynecologic Oncology Service and the Center for Rare Gynecologic Cancers at Johns Hopkins Medicine. An internationally recognized expert in the management of gynecologic cancers, Fader will lead the breakout session on rare gynecologic cancers and present in the main session on new frontiers in cancer screenings.
Stephanie Wethington, M.D., is director of the Susan L. Burgert, M.D., Gynecologic Oncology Survivorship Program, one of the only cancer survivorship programs developed solely for gynecologic cancer survivors.
In this capacity, she organizes the survivorship conference, Kelly Gynecologic Oncology Service gynecologic cancer awareness month programming, and the ongoing support programs offered for survivors and their caregivers.
Stephanie Gaillard, M.D., is director of gynecologic cancer trials and an assistant professor of oncology at the Johns Hopkins University School of Medicine. Dr. Gaillard specializes in the development of clinical trials aimed at improving outcomes by incorporating promising new biologic, targeted and immune therapies into standard treatment regimens.
She will present on clinical trials in gynecologic cancers as well as lead the breakout session on ovarian malignancy.
Cornelia Trimble, M.D., professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine, specializes in HPV, cervical dysplasia and cutting edge treatments for HPV disease. Dr. Trimble is an international expert well recognized in the academic community and has translated this expertise into popular forums such as TED Talks.
At the conference, Dr. Trimble will discuss the role of vaccines in preventing and treating gynecologic cancers.
To interview one of the Johns Hopkins experts or to attend, please contact Waun’Shae Blount, email@example.com.
PARTNERS & RESOURCES – Ovarcome – Overcoming Cancer, Celebrating Life – Overcoming Cancer, Celebrating Life
Ovarcome partners with American Association of Cancer Research in standing up to cancer. The mission of the American Association for Cancer Research is to prevent and cure cancer through research, education, communication, and collaboration.
Through its programs and services, the AACR fosters research in cancer and related biomedical science; accelerates the dissemination of new research findings among scientists and others dedicated to the conquest of cancer; promotes science education and training; and advances the understanding of cancer etiology, prevention, diagnosis, and treatment throughout the world.
To learn more about AACR, please visit: www.aacr.org
Ovarcome partners with Foundation For Women’s Cancer in enhancing awareness, research, and education on ovarian cancer. FWC offers comprehensive information by gynecologic cancer type to help guide patients through diagnosis and treatment.
Ovarcome bestows OvarInnovate: Research Excellence Award every year to Young Investigators and Scientists, in partnership with Foundation For Women’s Cancer.
FWC’s programs are designed to raise public awareness of ways to prevent, detect and optimally treat gynecologic cancers; provide education about gynecologic cancers and the importance of seeking care first from a gynecologic oncologist if a gynecologic cancer is suspected or diagnosed; and support promising, innovative gynecologic cancer research and train a cadre of clinicians/scientists to participate in clinically relevant research. They also offer free Gynecologic Cancer Survivors Courses throughout the country.
For more information on Foundation For Women’s Cancer, please click here.
Ovarcome is proud to partner with NCCN Foundation in keeping Survivors updated and informed.
NCCN Guidelines for Patients, patient-friendly translations of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), are easy-to-understand resources the same clinical practice guidelines used by health care professionals around the world to determine the best way to treat a patient with cancer. Each resource features unbiased expert guidance from the nation’s leading cancer centers designed to help people living with cancer talk with their physicians about the best treatment options for their disease. These resources are available free of charge at NCCN.org/patientguidelines Print versions are available to order on Amazon.com. To learn more about NCCN Foundation, please visit: http://www.nccn.org/patients/guidelines/cancers.aspx
Partial List of Partnering Organizations:
- MD Anderson cancer center
- Memorial Hermann Hospital System
- CHI St. Luke’s
- Methodist Hospital
- Vanderbilt Ingram Cancer Center
- Susan Poorman Blackie Foundation
- Rice Graduate School of Business
- Saint Thomas Health
- Baylor College of Medicine
- Tata Medical Center, Kolkata
- Tata Memorial Hospital, Mumbai
- Christian Ministries of Africa
- IEDA Relief
We are proud to collaborate with all our partners in better serving the ovarian cancer community. If you’d to partner with Ovarcome and become our Community Collaborator, please contact us – we would love to hear from you!
We are grateful to all our Sponsors & Champions for supporting our work and our mission. If you’d to support us, we’d love to hear from you. Please reach us at firstname.lastname@example.org. Thank You!
September is Ovarian Cancer Awareness Month
September is Ovarian Cancer Awareness Month, and we are especially mindful of the sobering statics related to this disease: more than 20,000 women in the United States are diagnosed with ovarian cancer each year, and approximately 15,000 women die annually from the disease.
Later this month, JHU Press is very proud to be publishing the second edition of A Guide to Survivorship for Women Who Have Ovarian Cancer, edited by Robert E. Bristow, MD, MBA, FACOG, FACS, Terri L. Cornelison, MD, PhD, FACOG, and F. J. Montz, MD, KM, FACOG, FACS. Today on the Blog, we excerpt the book’s introduction by the late Dr.
Montz—a powerful, humane essay retained from the first edition, a lasting testament to his career and character.
Introduction: Essential Concepts
by F. J. Montz, MD, KM, FACOG, FACS
Numerous philosophers have spent numerous hours discussing the “life well lived.” Most of them would agree that the well-lived life is full of love, experiences, sharing, meaningful relationships, accomplishments, and giving to others.
As we all progress along this journey, our attempts to live the “well-lived life” are threatened by different forces, both internal (for example, disease) and external (for example, social pressures) to ourselves. Ovarian cancer is only one of many such threats to the life well lived.
The sense of betrayal by one’s own body, the strain on relationships, and the physical toll that the disease and its treatments may inflict are some of the challenges that ovarian cancer presents to living life well.
Yet it is the deliberate and conscious choice to live life well that allows us to truly survive as we navigate the uncertainties of human life. That is what this book is about: survivorship in the face of, in spite of, and through ovarian cancer.
What do we mean by survivorship? Of course, part of survivorship is just that: outliving the disease and being around long enough to live out one’s natural life expectancy and die of something else. Do you have to be totally free of ovarian cancer to be a survivor? Absolutely not. Does being totally free of any viable cancer cell constitute survivorship? An equally forceful “No.
” Many women die from their ovarian cancer within a relatively short span of years or months, but they survive the experience, being mentally, emotionally, and, within certain limits, physically intact. Similarly, we have had numerous patients who have survived the disease, strictly speaking, but whose lives have been in shambles in all other respects.
One woman, the one who actually dies from her cancer, is a survivor; the other, the one who lives many years or even decades “disease-free,” isn’t. What makes the difference? The difference is in being in control as much as possible; being as “well,” in all aspects of wellness, as is possible; and finding joy and pleasure in ever having had a life well lived.
Our mission, therefore, must be not to avoid death but to live life.
The Reality of Ovarian Cancer
Ovarian cancer can be viewed as three separate diseases.
For some women, mainly those with early-stage disease and about 30 percent of women with advanced-stage disease, ovarian cancer is treated once and for all with an aggressive combination of surgery and chemotherapy.
The disease is diagnosed, is treated, goes away, and never comes back. Unfortunately, for a small but significant second group of women, the initial treatments fail, and the time from diagnosis to death is short—only months or little more than a year.
For most women, however, ovarian cancer is a chronic disease, one that is treated and goes into remission for a while and then returns, is retreated, goes back into remission, and so on.
Eventually, perhaps years or decades from the time of initial diagnosis, the patient will succumb to the disease or to complications of its treatment.
With this in mind, a greater emphasis is naturally placed on “what happens along the way,” and the decisions made during these years or decades are enormously important.
As we emphasize repeatedly in this book, we firmly believe that the patient must be informed, as much as possible and as much as she desires, about the disease and about the treatment options and their side effects and outcomes.
We are unshakably committed to patient self-determination. For a woman to determine what she wants, however, she must know what the choices are and what the results of such choices are.
It is our obligation, as health care providers, to meet our patients “where they are,” to help them to prioritize their wishes and desires, and to develop individualized goals and agendas, while presenting them with the information they need to make decisions about what they do or don’t want. Only after all these events have occurred can the well-informed patient have true self-determination.
Quality of Life
Another concept we repeatedly focus on in this book is that of quality of life, often abbreviated as QOL. Simply defined, quality of life is how well a person feels about everything she is and everything that makes up her universe.
It includes measurable factors such as the amount of pain or physical discomfort she is experiencing, but it is much, much more than that.
Emotional, psychological, sexual, spiritual factors—all of them difficult to measure—are part of QOL.
For many of our patients, the nausea, loss of hair, and pain cause less suffering than do certain fears about the future: what is going to happen to the patient’s three-year-old daughter, her frail life partner for whom she is the primary caregiver, or her own soul.
Issues of quality of life must be addressed daily, if not minute by minute, when making decisions regarding treatments and other interventions.
Many women are willing to trade a marked deterioration in their measurable QOL for a significant chance of a cure or a meaningful prolonging of life; few are willing to do the same for only a few additional months or weeks.
Unfortunately, patients often are not informed that they have choices or that QOL can play a role in decision making. We believe that quality-of-life issues are the most important issues our patients face in exercising self-determination. One of our primary goals in our medical practice and in this book is to empower women to wrestle with these issues.
Robert E. Bristow, MD, MBA, FACOG, FACS, is the director of Gynecologic Oncology Services, the Philip J.
DiSaia Chair of Gynecologic Oncology, Chief of the Division of Gynecologic Oncology, and a professor of obstetrics and gynecology at the University of California–Irvine. He is the coauthor of Surgery for Ovarian Cancer: Principles and Practice.Terri L.
Cornelison, MD, PhD, FACOG, is the associate director for clinical research in the Office of Research on Women’s Health at the National Institutes of Health and an assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine.
F. J. Montz, MD, KM, FACOG, FACS, was a professor of gynecology and obstetrics, surgery, and oncology at the Johns Hopkins Hospital and Medical Institutions.
Use promo code HDPD to receive a 30% discount when you place your pre-publication order for the new edition of A Guide to Survivorship for Women Who Have Ovarian Cancer.
Johns Hopkins University
Principal Investigator (contact): Michael G. Goggins, MD
Institution: Johns Hopkins University
Title of the PCDC Project
USING MARKERS TO IMPROVE PANCREATIC CANCER SCREENING AND SURVEILLANCE
Since most patients with pancreatic cancer present with advanced disease, pancreatic screening is needed to detect asymptomatic early-stage potentially curable lesions. In our CAncer of the Pancreas Screening (CAPS) clinical studies we have screened ~600 individuals at increased risk of developing pancreatic cancer using family history or gene mutation criteria.
Screening can identify precancerous lesions and pancreatic cancers, but better circulating and pancreatic juice markers are needed to aid in pancreatic evaluation.
Pancreatic juice collected from the duodenum during routine endoscopic ultrasound reveals that this sample is a rich source of biomarkers of pancreatic neoplasia and the analysis of pancreatic juice could be a useful diagnostic test. Thus, GNAS mutations are highly specific for IPMNs are specifically detected in the juice samples of patients with IPMNs.
KRAS mutations are commonly found not only in the pancreatic juice of patients with pancreatic cancer, but in patients undergoing pancreatic screening even when they do not have evidence of pancreatic neoplasia by imaging.
Many of these mutations are thought to arise in PanIN, which are not detected by pancreatic imaging tests because these lesions are very small and do not form masses. Thus, pancreatic juice analysis has the potential to indicate the presence of PanIN.
More valuable would be a test that would indicate the grade of pancreatic neoplasia since in the absence of cancer, this is usually not possible to determine without analyzing the resected pancreas. We know that TP53 and SMAD4 mutations emerge in high-grade dysplasia and invasive pancreatic cancer tumors and can find TP53 and SMAD4 mutations in pancreatic juice samples in patients with pancreatic cancer and high-grade dysplasia, not in disease controls or those with low- grade dysplasia.
Description of the Project
Our project, which helps support the CAPS screening program, is a joint collaboration between Johns Hopkins University, University of Pittsburgh, University of Pennsylvania, Dana Farber Cancer Institute and Case Western Medical Reserve.
Our goals is to develop and follow our CAPS screening cohort, to evaluate biomarkers of pancreatic cancer, and to perform PROBE-based analysis of our best biomarkers of cases within our cohort that progress to pancreatic cancer or high-grade dysplasia during follow-up vs those who do not progress.
The main biomarkers we are evaluating are pancreatic juice mutations determined by digital next-generation sequencing and circulating biomarkers, primarily ctDNA.
Specifically, we propose: Aim #1: To determine the diagnostic accuracy of mutations detected in pancreatic fluid as markers of pancreatic cancer and precancerous lesions.
We will use novel nextgen sequencing methods to detect mutations in patients with pancreatic cancer, IPMNs, chronic pancreatitis, or normal pancreata. Aim #2: To evaluate circulating markers as diagnostic tests for the early detection of pancreatic cancer.
We will evaluate ctDNA and exosomal markers. Aim #3: To evaluate pancreatic fluid and serum markers as tests to detect PanIN-3 and/or pre-clinical pancreatic cancer among high-risk individuals undergoing pancreatic screening and surveillance.
We will develop a tissue repository of precious samples to aid in the evaluation of candidate pancreatic cancer markers, including samples from high-risk subjects and PanIN-3 lesions.
Resources for Sharing (e.g., description of cohorts, technologies)
The CAPS sites are primarily following high-risk individuals, but we are also enrolling patients with incidentally identified pancreatic cysts and patients who are undergoing pancreatic evaluation routinely for non-pancreatic indications (such as those who undergo endoscopic ultrasound for other upper GI indications). The Johns Hopkins group also has an extensive biobank of tissues and blood samples from patients who have undergone pancreatic reseection. Technologies such as digital next-generation sequencing developed in the Goggins lab will be used to detect low-abundance mutations.
Opportunities for Collaboration
There are a number of other CAPS sites who are ongoing collaborators with the CAPS program including Dr. James Farrell at Yale University and Dr. Fay Kastrinos at Columbia University.
Several other sites have approached us and are interested in collaborating as part of the CAPS program.
In addition, screening centers across the world have joined the International CAPS registry to share data and experience.
Excessive use of skin cancer surgery curbed with awareness effort
Sometimes a little gentle peer persuasion goes a long way toward correcting a large problem.
That's the message from researchers at Johns Hopkins Medicine and seven collaborating health care organizations which report that a “Dear Colleague” performance evaluation letter successively convinced physicians nationwide to reduce the amount of tissue they removed in a common surgical treatment for skin cancer to meet a professionally recognized benchmark of good practice.
In a study published in the journal JAMA Dermatology, the researchers reported an immediate positive change in surgical behavior — an improvement that was sustained for one year — for 83 percent of the physicians notified that they were excising more-than-necessary amounts of tissue on a regular basis during Mohs micrographic surgery (MMS). The surgery is considered the most effective technique for treating many basal cell and squamous cell carcinomas, the two most common types of skin cancer.
“This study demonstrates the tremendous power of physicians within a specialty to create peer-to-peer accountability and of using that accountability to reduce unnecessary treatment and lower health care costs,” says Martin A. Makary, M.D., Ph.D.
, senior author of the study, professor of surgery at the Johns Hopkins University School of Medicine and an authority on health care quality.
He also serves as principal investigator of Improving Wisely, a national project to lower medical costs in the United States by implementing measures of appropriateness in health care.
The new study, part of the Improving Wisely effort, was supported by a grant from the Robert Wood Johnson foundation.
MMS, developed by Frederic Mohs at the University of Wisconsin in the 1930s, is a specialized technique for the treatment of skin cancer, the most common malignancy in the United States at greater than 5.4 million cases annually.
Performed as an outpatient procedure, MMS is designed so that the surgeon can methodically remove cancerous tissue on the surface and all of its “roots” — extensions of the tumors that may exist under the skin or lie along blood vessels, nerves and cartilage.
The surgery is conducted in stages, with stage 1 involving the removal of the visible cancer and a thin layer of surrounding tissue.
The excised sample is then cut into sections, stained and examined microscopically while the patient waits.
If residual cancer is found, the surgeon can elect right then to remove more tissue in successive stages. The process is repeated as many times as necessary.
The American College of Mohs Surgery (ACMS) considers a surgeon's annual mean stages per MMS case to be the measure of quality and appropriateness for the technique. Using that metric, the organization defines physicians whose practices are two standard deviations or more beyond the overall average as outliers who are performing excessive stages in MMS procedures.
Because previous studies suggest that MMS practices vary widely among surgeons, the study by Makary, his team and the ACMS had two aims: evaluate outlier practice patterns using a big-data approach and then, test whether a peer-to-peer notification could change the behavior of surgeons not meeting the appropriateness standard.
“This was an important goal because overuse of stages per case burdens patients with unnecessary and time-consuming surgical resections, and taxes the health care system with avoidable costs,” says Christine Fahim, Ph.D., M.Sc.
, one of the study authors, a postdoctoral fellow at the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health, and implementation and intervention design lead for Improving Wisely.
In their paper, the researchers describe how they used Medicare Part B claims to choose their study population of 2,329 U.S. surgeons who each performed more than 10 MMS procedures between Jan. 1 and Dec. 31, 2014.
The claim forms included the number of stages done in each case, so individual and overall annual averages were easily calculated.
Outliers and inliers (surgeons whose MMS performance was within the accepted range of appropriateness defined by the ACMS) were identified by their performances before they became part of the study population (as measured between Jan. 1, 2016, and Jan. 31, 2017).
The study population was then divided into four groups: (1) 53 outliers, each of whom would receive an intervention letter indicating his or her performance, and urging an improvement in practice, (2) 87 outliers, each of whom would not receive an intervention, (3) 992 inliers who would receive a straightforward performance evaluation letter, and (4) 1,197 inliers who would not receive a letter.
The intervention groups received their letters in February 2017. Each surgeon's MMS performance, defined as annual mean stages per case, was measured pre-intervention (between Jan. 1, 2016, and Jan. 31, 2017) and post-intervention (between March 1, 2017, and March 31, 2018).
The notified outlier group demonstrated a pre- to post-intervention decrease in mean stages per case from 2.55 to 2.31, with 44 of the 53 surgeons (83 percent) improving their MMS behavior. The non-notified outliers dropped from 2.56 to 2.46, with 69 percent making positive changes.
The researchers attribute the drop by non-notified outliers to two factors: an awareness campaign by ACMS around the time the intervention letters went out and possible communications between surgeons who received the letters and their colleagues who did not.
The performance of the inlier groups, as expected, remained statistically about the same.
The researchers also estimated that the relatively inexpensive ($150,000 or about $144 per surgeon) peer-to-peer intervention saved $11 million in Medicare costs during the study period.
“We observed an immediate and sustained improvement in quality with a simple intervention the spirit of physicians helping one another,” Makary says.
“The low cost to implement the program relative to the significant savings achievable suggests that this model could be applied to other areas of medicine with broad financial implications.
More importantly, we found that even small improvements in a physician's performance can positively impact the many patients he or she treats.”
Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.
Medical Research and Beneficiaries
In 2009, T.E.A.L.® gave OCRF $50,000 to fund research by Dr. Tsz-Lun Yeung at the University of Texas MD Anderson Cancer Center to research the role of ELF3, a protein that is not properly regulated in ovarian cancer cells.
In 2010, T.E.A.L.® gave OCRF $55,000 to fund research by Dr. Lin Zhang at the University of Pennsylvania School of Medicine to study a microRNA called let-7, which has been shown to be a promising therapeutic target.
In 2011, T.E.A.L.® gave OCRF $75,000 to fund research by Dr. See-Hyong Park at the Stanford University School of Medicine to research the combination of Bepridil, a small molecule drug, with Olaparib, a PARP inhibitor, to treat ovarian cancer that remains unresponsive to PARP inhibitors.
In 2012, T.E.A.L.® donated $55,000 to support an OCRF research grant at John Hopkins University School of Medicine guided by Bin Guan to study the function of the tumor suppressor ARID1A and its role in tumor suppression.
In 2013, T.E.A.L.® donated $25,000 to support an OCRF research grant at the Dana-Farber Cancer Institute for Dr.
Joyce Liu’s research to investigate the molecule ErbB3 as a novel therapeutic target, search for markers that can identify specific types of ovarian cancer that are most vulnerable to blocking ErbB3 activity, and explore other molecules that may work alongside ErRB3 to support ovarian cancer growth and survival.
In 2014, T.E.A.L.® donated $30,000 to help fund a study at Weill Medical College of Cornell University led by Juan Cubillos-Ruiz to study ER Stress Sensor XBP1 as a key regulator of ovarian cancer immunity, with the goal of helping to uncover new immune-based treatments against this disease.
In 2015, T.E.A.L.® gave OCRF $20,000 to fund research by Dr. Jessica Chacon at the University of Pennsylvania. This study investigates the inhibitory properties of CD137+TIL, a subset of tumor-infiltrating lymphocytes (TIL), which contain properties that can destroy cancer cells.
Following the merger between OCRF and OCNA in 2016, T.E.A.L.® gave OCRFA $7,500 to continue partially funding the research study by Dr. Jessica Chacon at the University of Pennsylvania that T.E.A.L.® previously funded in 2015.
In 2017, T.E.A.L.® awarded OCRFA $20,000 to fund research by Dr. Venkatesh Krishnan of Stanford University. This project, called Role of CCL15/CCR1 Axis in Ovarian Cancer Colonization of Omentum, investigates how the omental microenvironment contributes to the development of high-grade serous carcinoma (HGSC).
In 2018, since T.E.A.L.® is a Community Partner of OCRA, T.E.A.L.® became a Collaborative Partner in Science in collaboration with other organizations to fund a research study by Dr. Kristin Anderson at Fred Hutchinson Cancer Center with the goal of boosting antitumor immune reponses by overcoming tumor properties that prevent antitumor T cell efficacy.
In 2019, as a continued Community Partner of OCRA, T.E.A.L.® contributed $5,000 to be a Collaborative Partner in Science to collaborate with other organizations to fund a research study by Dr.
David Chapel at Brigham and Women’s Hospital in Boston, MA, with the goal of studying the hypothesis that pre-cancerous cells may also travel from the endometrium to the abdominal cavity, where they may then develop into high grade serous ovarian cancer.