Let's Define Value of Care June 2018 #gyncsm Chat

This month we discussed, for the first time, the topic Value of Care. We were pleased that Sarah Temkin, MD a gynecologic oncologist (VCU Massey Cancer Center) and co-author of the SGO article "The "Value" of value in gynecologic oncology practice in the United States: Society of Gynecologic Oncology evidence-based review and recommendations" joined us for this important discussion. 

We had a lively discussion with 46 participants and achieved 2.43 million impressions. You may find the complete transcript here and the analytics here. Resources mentioned during the chat may be found at the end of this post. 

Here is a sample of the responses we had to the questions we discussed. 

T1a: There been a lot of discussion in recent years about "value of care". Why is it important?

• T1a It’s important to remember that more expensive care does not always mean better care. Spending in the US which far exceeds that of other countries is not correlated with commensurate improvements in health outcomes (http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective)
• T1a #Healthcarevalue also means avoiding waste - estimated that 20% of healthcare spending is unnecessary care (eg. 2 doctors order the same test) Reducing waste could leave $ for better or more care elsewhere
• T1a. There’s a slow culture shift in cancer where it’s no longer just about “will drug X make me live longer” but “will drug X make me live better.” And how you the patient define “better” is your very own definition of “value” - how’s that for #PrecisionMedicine!

T1b: How do YOU define the "value of care" you give and/or receive as a patient, loved one, healthcare professional, etc?

• T1b the most “valuable care” to me personally is when the healthcare provider LISTENS
• And valuable care may mean eliminating therapy – #ASCO18 showed us that as many as 70% of patients with breast cancer don’t benefit (but do get toxicity) from chemotherapy
• My definition is improvement In Quality of life per cost of intervention
• T1b Net Health Benefit with clinical benefit, financial toxicity, long term survival, palliation of symptoms, Quality of life, treatment free interval
• "Value of care" has become increasingly significant as the rise of medical costs for treatments continue to rise. As a patient, I want the most effective treatment for the least cost.
• T1b. I value care in which the professional listens and does the best they can under the circumstances, even if things don't always work out.

T2: In addition to price, what other information would you need in order to make a judgment on the value of the care you receive (procedures/chemo/visits/etc.)? 

• T2 We often lose sight of toxicity and time away from family when prescribing care. If a chemotherapy regimen can be given monthly, but a weekly treatment is prescribed that is a lot of time spent traveling and getting care that could have been saved.
• T2 Opportunity costs. Effectivity. Side effects and medicines required to control them, months lost due to not using an effective drug. Quality of life. 
• A2: Value of care takes into consideration that patients will be treated well, with compassion and #empathy. Cost savings are irrelevant if I am not acknowledged as a human with goals for my life that may change how I want to pursue treatment
• Price wouldn’t be number one for me. It would be how can I make this easier on my loved ones.

T3: What are Quality-adjusted life years (QALY)? How do we measure outcomes? What elements are large medical organizations (incl. ASCO and SGO) including in their recommendations on value of care?

• QALY economic evaluation to assess the value for money of medical interventions. One QALY equates to one year in perfect health 
• Essentially years of life added due to cancer treatment but adjusted by functional status. Is it really worth extending life without living?
• just today I read an interesting review of QALY as a measure of healthcare outcome and cost...and the controversy over its use. recently published: https://jamanetwork.com/journals/jama/fullarticle/2682917
• @ASCO Value Framework assesses the relative value of cancer treatment regimens that have been studied in #clinicaltrials. This is a combination of clinical benefit, side effects, and improvement in patient symptoms or quality of life in the context of cost

T4: How are rising drug, immunotherapy and targeted therapy prices impacting the evaluation of which treatments are of value? How have rising drug costs impacted you?

• As a #healthcare provider, I spend more and more time on the phone with insurance companies trying to justify treatments that may be of benefit to an individual patient #NotValuable
• I cringe every time I read a study about maintenance immunotherapy or targeted therapy where the patient continues it every few weeks (for life) - none of those studies go into the out of pocket costs and consequences of indefinite treatment!
• The more recently approved deufs for Gyn cancers ar exorbitantly expensive as compared to older approves drugs. They may not me more effective.
• Sarah Kelly LCSW for CacerCare in NYC often hears from patients" I don't want to bankrupt my family" and "I can't afford to live "
• T4: for patients who I work with at a local county hospital, access to PARP inhibitors after ovarian cancer recurrence & the identification of an inherited BRCA mutation, can be challenging primarily due to cost when they are un/underinsured
• T4. For gyn #sarcoma patients, I think most get new treatments in clinical trials, but I'd love to hear more from them & the doctors who are treating them.
• T4 And oral chemotherapy drugs may have completely different out of pocket costs compared infused chemotherapy. They also don't always align with physician financial incentives. 

T5: What is being done to encourage including discussions around cost as part of the treatment plan? Are cost and financial toxicity discussions happening during office visits? Do payment models impact care?

• Creating a safe space with patients, and honest conversation is important: https://www.cancer.net/blog/2016-04/financial-toxicity-another-hurdle-cancer-treatment
• T5. It's not routine to focus on cost, but it isn't uncommon to discuss at some point. That doesn't come up immediately.
• in genetic counseling we actually (unfortunately) have a word for all the time we spend counseling patients on cost/insurance coverage/paperwork processes... Genesurance. Definitely cuts into our availability and limits working at the top of our scope
• As many of the newer drugs are oral, I often times hear from the pharmacist that the drug is too expensive and the patient can not afford it
• T5 Patients experiencing high out-of-pocket costs may reduce their spending on food and clothing, self-reduce their doses (stretch pills), avoid recommended procedures, and skip physician appointments to save money
• T5: $ discussions are so tough in onc bc we’re talking about cancer, a life-altering illness. How do you decide when a drug is not worth it? What I CAN do at this stage is make it ok to talk about co-pays & expenses in clinic - I ask my pts about their #financialtoxicity.

If you are a patient or caregiver you may continue this discussion on the Smart Patients Platform ( https://www.smartpatients.com/gyncsm ). 

We hope to see you next month on July 11, 2018 at 9pm ET when we discuss Hereditary versus Somatic Mutations.

Please continue to tag your tweets with #gyncsm with information and news important to our community. 

See you next month. 

Dee

Co-founder #gyncsm 

RESOURCES

Presidents Panel: Cancer costs and value
https://www.cancer.gov/news-events/cancer-currents-blog/2018/presidents-cancer-panel-drug-prices?cid=eb_govdel

@CancerDotNet :
Managing Care
https://www.cancer.net/navigating-cancer-care/managing-your-care/taking-charge-your-care
Making Decisions
https://www.cancer.net/navigating-cancer-care/how-cancer-treated/making-decisions-about-cancer-treatment
Financial Toxicity
https://www.cancer.net/blog/2016-04/financial-toxicity-another-hurdle-cancer-treatment
Understanding Cost related to Cancer Care
https://www.cancer.net/blog/podcasts/understanding-costs-related-cancer-care

ASCO Value Framework
https://www.asco.org/practice-guidelines/cancer-care-initiatives/value-cancer-care
http://ascopubs.org/doi/abs/10.1200/JCO.2016.68.2518

Value: The Next Frontier in Cancer Care
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912371/

QALYs in 2018
https://jamanetwork.com/journals/jama/fullarticle/2682917

@sloan_kettering Abacus a drug pricing lab/tool
https://drugpricinglab.org/tools/drug-abacus/

@FacingOurRisk
 http://www.facingourrisk.org/get-involved/HBOC-community/BRCA-HBOC-blogs/FORCE/general/nccn-summit-explores-patient-perspectives-of-value-in-cancer-care/

@ascopost clinical benefits/cost of Car-T cell therapy
http://www.ascopost.com/issues/may-25-2018/weighing-the-cost-and-value-of-car-t-cell-therapy/?email=865aa94a58f0b27b9edd2aa71d80e9a99b924971f7ce90316a0d742b2e9c9b1c

NCCN White Paper
https://www.nccn.org/jnccn/supplements/pdf/JN1407_2RePR_Nardi.pdf

What is value in healthcare? via #hcldr
https://www.nejm.org/doi/full/10.1056/NEJMp1011024?viewType=Print2010

Crowdfunding for Prostate Cancer and Breast Cancer
https://onlinelibrary.wiley.com/doi/abs/10.1111/bju.14408

How Should We Define Value in Cancer Care?
http://theoncologist.alphamedpress.org/content/15/suppl_1/1.long

Charges and costs aren’t the same thing
http://www.kevinmd.com/blog/2017/06/charges-costs-arent-thing.html

Spending on cancer drugs in the U.S. has doubled in the last five years, and will double again
https://www.statnews.com/pharmalot/2018/05/24/cancer-drugs-spending-prices/

How do Patients Define Value in Cancer Care
https://www.huffingtonpost.com/kim-thiboldeaux/how-do-patients-define-va_b_7939662.html

June 13, 2018 Let's Define Value of Care

Over the past few years there have been many discussions and articles written on the value of different health care treatments, technologies and protocols. As we see amazing developments in targeted therapies, we see rising costs for those same cancer treatments. Spending on cancer treatments has doubled in five years. We talk in "QALY" Quality-adjusted life years. We hear of financial toxicity. How do we measure outcomes to determine which treatment is of value? We have had these type of discussions online and around our dining room tables. Other online communities such as the #hlcldr community have had this discussion (https://hcldr.wordpress.com/2016/01/03/value-in-healthcare/). Organizations such as NCCN, ASCO and SGO have presented their recommendations for finding value of cancer care.

This month we will be discussing Value of Care with special guest, Sarah Temkin, MD (@temkins). Dr Temkin is a co-author of the article "The "Value" of value in gynecologic oncology practice in the United States: Society of Gynecologic Oncology evidence-based review and recommendations". You may read the article at
https://www.sgo.org/wp-content/uploads/2012/09/Final-PDF_Value_Article.pdf

Our Chat will be guided by these questions:

T1a: There been a lot of discussion in recent years about "value of care". Why is it important?
T1b: How do YOU define the "value of care" you give and/or receive as a patient, loved one, healthcare professional, etc?

T2: In addition to price, what other information would you need in order to make a judgment on the value of the care you receive (procedures/chemo/visits/etc.)?

T3: What are Quality-adjusted life years (QALY)? How do we measure outcomes? What elements are large medical organizations (incl. ASCO and SGO) including in their recommendations on value of care?

T4: How are rising drug, immunotherapy and targeted therapy prices impacting the evaluation of which treatments are of value? How have rising drug costs impacted you?

T5: What is being done to encourage including discussions around cost as part of the treatment plan? Are cost and financial toxicity discussions happening during office visits? Do payment models impact care?


Dee
#gyncsm co-founder

Palliative Care- When and Why - May 2018

For this month's chat, Palliative Care - When and Why, we welcomed guest Christian Sinclair (@ctsinclair), a palliative care and hospice physician, editor of Pallimed and founder of the #hpm community on Twitter. Fifty-four participants made over 2.3 million impressions during the hour chat. You may find more analytics here and the transcript here.

Here is a sampling of responses. Please scroll down for Resources. 

What do you think of when you hear the term "palliative care"? What does it mean to you?

• PalliativeCare is symptom management offering emotional support, to patient and family. At any time during Cancer dx not just eol.
• Living life on your terms with the help of team of healthcare professionals who support the patient and family
• Palliative care-I think of a critical piece of overall care during serious illness, pain, and end of life.
•  I think of palliative care as an opportunity for someone to receive whatever support (pain management, counseling, home care, accessing info/resources, etc.) they may need when progressing through a health problem that may be life limiting #gyncsm
• Palliative care should be available at any age and any stage. The goal is support. 
• We #hpm docs spend quite a bit of time clarifying perceptions of the field (ie. its not just end of life care). Our #PalliativeCare thermometer highlights the domains of a person's care that may be of importance to them! #Palliative Care is whole person care!

This first question also began a discussion regarding the term "Palliative care". Some felt that the term may actually turn patients off from getting the care they need. Some centers use the term Supportive care. Sinclair responded "There are lots of debate inside and outside the palliative care community about finding the best name. Ultimately it comes down to organizational/community culture, and making sure the clinicians feel comfortable introducing the concept as concurrent, not either/or".

When do cancer patients tend to get referred to a palliative care specialist? Do you find this to be a tricky conversation? Patients - Did anyone on your care team discuss palliative care with you?

• ASCO recommends PalliativeCare is offered within 8 weeks after dx
• We are seeing more family and patient-initiated #pallaitive care referrals. As they realize they can have more support, they are starting to ask for it and our oncologists are open to collaborating with us. Caveat: I am in an academic med center in a metro area.
• Patients with advanced cancer should be referred to #pallativeCare early and it should be an integral part of treatment, not just something added on near the end of life
• I see them referred too late. Palliative care is still associated with end of life & have been told “they aren’t ready for that”. Who’s not ready for patient centered care that views the whole person not the illness & manages all symptoms physical, emotional, etc.?!

Why is knowledge of and access to palliative care throughout cancer treatment important? Does Medicare/Insurance cover palliative care? Are there specialists in rural areas?

• For this chat I found this @ASCO Connection article : Telemedicine has been used for those in rural areas.https://connection.asco.org/blogs/telemedicine-palliative-and-supportive-care-continuing-conversation
• Looking at symptom management by a specialist in the field offers a complementary approach to managing the disease itself by treating the patient as a whole being. Services are covered but often require copay. Rural areas often lack service
• Medicare covers PalliativeCare for symptom management in some extent Improving Quality of Life and prolong survival.
• #Telehealth show great promise is rural settings, along w/ patients' willingness to engage. Telehealth reduce travel needs, removing physical and financial burdens associated with travel. Telehealth utilization for #pallativeCare is emerging rapidly

What are medical and advocacy organizations doing to promote palliative care for cancer patients? How can patients advocate for themselves?

• NCI, NHPCO. SWHPN. GetPalliativeCare. org Be more proactive
• I do appreciate the statement from @SGO_org on the importance of #palliative care in #gyncsm #openaccess https://www.sgo.org/wp-content/uploads/2015/05/Palliative-Care-published-May-2015-Gyn-Onc.pdf
• Random, but I tell patients to grab one of every brochure at their Onc office and look through to find the things you might need and then ask with the brochure. It’s crazy how many supports exist that I’ve only found out about that way. They always make a brochure!

What do you wish you knew about palliative care at the beginning of your experience with a cancer-related diagnosis? For those who have worked with a palliative care specialist, what was most helpful? most challenging?

• I think more and more patients appear to be more empowered to not just get the latest greatest cutting edge research treatment, but to make sure they get all their needs met. Aiming for whole person care. To be fair though, advocating for yourself is really hard work
• Considering how much time we have to spend talking through acute issues with my GynOnc since I’ve been terminal, it’s not surprising we don’t talk about palliative care. I’m focused on getting more Oncs to have this talk when cases aren’t as complicated.
• I wish I had known when my dad was diagnosed that pts in #palliativecare can still go to PT and OT to help them gain the strength to return home for EOL. It would have saved so much pain for him while he tried to get strong enough to return home.

If you are a caregiver or patient you may continue this discussion online on the Smart Patients platform at https://www.smartpatients.com/gyncsm .

Be sure to check our resources below.

Join us next month on June 9th for Let's Discuss Value of Care.

See you then.
 
Dee
#gyncsm Co-founder

Resources
Perceptions of #palliative care by people with adv cancer and their caregivers
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938707/

Association between a name change from palliative to supportive care and the timing of patient referrals at a comprehensive cancer center.
https://www.ncbi.nlm.nih.gov/pubmed/21212438

Predictors of high symptom burden in gynecologic oncology outpatients: who should be referred to outpatient palliative care?
https://www.ncbi.nlm.nih.gov/pubmed/24472408

Practice Patterns, Attitudes, and Barriers to Palliative Care Consultation by Gynecologic Oncologists. https://www.ncbi.nlm.nih.gov/pubmed/28783424

Economics of Palliative Care for Hospitalized Adults With Serious Illness https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2678833?utm_source=twitter&utm_campaign=content-shareicons&utm_content=article_engagement&utm_medium=social&utm_term=050818&redirect=true#.WvJSZ-FbZeU.twitter

Palliative Care in the Global Setting Resource-Stratified Guideline
https://www.asco.org/practice-guidelines/quality-guidelines/guidelines/supportive-care-and-treatment-related-issues?et_cid=40284775&et_rid=977394059&linkid=Palliative+Care+in+the+Global+Setting%3a+A+Resource-Stratified+Guideline_link#/31016

@theNCI Palliative Care in Cancer Care
https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet

@Cancerdotnet Caring for the symptoms of cancer and its treatment
https://www.cancer.net/navigating-cancer-care/how-cancer-treated/palliative-care/caring-symptoms-cancer-and-its-treatment

@SGO_org
https://www.sgo.org/newsroom/position-statements-2/delivery-of-palliative-care-services/

Dana Farber
How Does Palliative Care Help Cancer Patients? | Dana-Farber ...

ASCO Connection: Telemedicine in Palliative and Supportive Care: A Continuing Conversation
https://connection.asco.org/blogs/telemedicine-palliative-and-supportive-care-continuing-conversation

Links to Palliative Care Graphics Shared:
https://twitter.com/skochb/status/994387131161366528
https://twitter.com/IshwariaMD/status/994387821770297344
https://twitter.com/IshwariaMD/status/994388792747360256

https://twitter.com/skochb/status/994387131161366528
https://twitter.com/skochb/status/994387131161366528
httpwitter.com/skochb/status/994387131161366528

May 9th Chat: Palliative Care - When and Why

This month we will return to a topic we last covered in 2015 - Palliative Care. We will once again be joined by Christian Sinclair (@ctsinclair), a palliative and hospice medical care physician, editor of Pallimed and founder of the #hpm community on Twitter.

More people are familiar with palliative care now, although there is still confusion as to what palliative care is versus hospice. Did you know that some are providing palliative care through Telemedicine? Did you know that ASCO issued a guideline on the Integration of Palliative Care on Standard Oncology Care? Join us as we discuss these topics.

T1: What do you think of when you hear the term "palliative care"? What does it mean to you?

T2: What is the technical definition of "palliative care"? How is it related to yet different from hospice care? Is there still a lot of confusion between the two?

T3: When do cancer patients tend to get referred to a palliative care specialist? Do you find this to be a tricky conversation? Patients - Did anyone on your care team discuss palliative care with you?

T4: Why is knowledge of and access to palliative care throughout cancer treatment important? Does Medicare/Insurance cover palliative care? Are there specialists in rural areas?

T5: What are medical and advocacy organizations doing to promote palliative care for cancer patients? How can patients advocate for themselves?

T6: What do you wish you knew about palliative care at the beginning of your experience with a cancer-related diagnosis? For those who have worked with a palliative care specialist, what was most helpful? most challenging?

You can learn more about palliative care by checking these resources:

• NCI https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet
• Cancer.net https://www.cancer.net/navigating-cancer-care/how-cancer-treated/palliative-care/caring-symptoms-cancer-and-its-treatment

See you at 9pm ET ( 8pm CT, 6pm PT)  on May 9, 2018!

Dee
#gyncsm co-founder

SGO Annual Meeting Research Review and Ask the Doc April 2018

Twenty-four participants shared what they had learned at the SGO Annual Meeting or asked questions about research presented at the meeting during this month's #gyncsm chat. You may find more analytics here. You may find a transcript from the chat here.

We covered a number of different research areas from treatments to survivorship to funding for research.

T1: What were the results of the study comparing minimally invasive surgery (MIS) w/ radical hysterectomy in early cervical cancer. Will the results change practice?

• "Disease-free survival following minimally invasive procedures significantly lagged behind radical hysterectomies done by open laparotomy," -Pedro T. Ramirez, MD. I found this fascinating.
• some suggested uterine manipulator use (not assessed in the study), also discussed immature data, early stopping.
• Any reasons would be speculation. But I think we get bigger tissue margins with open surgery
• data safety monitoring committee (filled with GYN ONCS) said the study should be stopped

T2: Several studies used targeted therapies to treat #ovariancancer - Which results stood out for you? Were side effects critical in any of the studies?

• The #PARPi combinations are very exciting - responses and improved outcomes regardless of #BRCA status are encouraging
• From our Scientific Director, Dr. Deb Zajchowski, “Exciting preliminary results for PARP inhibitors combined with immune checkpoint inhibitors — particularly in platinum-resistant patients.” (@ClearityFnd) 

T3: Which studies presented at the meeting will impact treatment of women with #endometrialcancer #uterinecancer #sarcoma?

• The combo of everolimus & letrozole was quite successful in #endometrialcancer - this is the 2nd study to demonstrate this
• Excited re our study (in rodents) of everolimus-eluting IUD pres by @JDottinoMD - could allow pts to avoid surgery in endo ca
• 
  

Dr. Marcus Randall discussing GOG 249 results: pelvic RT vs chemo/brachy similar RFS and OS; more acute toxicity in chemo arm, similar late tox #SGOMtg #gyncsm #endometrialcancer pic.twitter.com/cT4zbjoUbc

— Jolyn Taylor (@TaylorJolyn) March 25, 2018

• My friend Matt Anderson, MD, PhD, presented on the genomic profiling of #uterine #leiomyosarcoma from The Cancer Genome Atlas as well as his own lab in Baylor. Data from @ALazarMDPhD was included. This is bigly important for us
• This data confirmed gyn #leiomyosarcoma differs from LMS elsewhere
• I was not at SGO but results from the phase 2 trial looking at carbo/taxol vs carbo/tax + trastuzimab (herceptin) in uterine serous CA with Her2/neu overexpression were presented. Improved PFS w/addition of herceptin.
• Agree... exciting abstract. Several pre-analytical issues that can affect Her2 testing results which will be important to consider for the future

T4: What research on palliative care and survivorship do you think will impact patients lives the most - or that survivors should ask their gyn/onc's about?

• @Stigetta reported this from the meeting:

Fantastic sunrise seminar on survivorship! Survivors need to be empowered with information after front line treatment. Reduce risk and screen for secondary cancers. #sgomtg #gyncsm pic.twitter.com/OLyOW0E4lL

— Annie Ellis (@Stigetta) March 26, 2018

• There was a study that finally measured and estimated rates of post op lymphedema which were much higher than anticipated. If we can measure it we can look for ways to reduce it. 
•  Overall, I think it has been great to see an increase each year in survivorship studies and talk of long-term care planning and navigators/coordinators. Patients living longer and more emphasis on support.

T5: Once again studies showed less gyn cancer clinical trials and lower funding for gyn cancer research. What suggestions were made to increase enrollment and funding?

• We MUST advocate for gynecologic cancer funding - write your Congressman and tell them that this funding must be INCREASED!!
• the photo in this tweet shows how great the need is via @ShannonWestin

Research for #ovariancancer #endometrialcancer and #cervicalcancer is grossly underfunded compared to #ProstateCancer - this is a disturbing trend for our patients. #SGOMtg #gyncsm pic.twitter.com/NfqGNF1h1w

— Shannon Westin (@ShannonWestin) March 24, 2018

• Outcomes are better for minorities who have access to #clinicaltrials - we need funding to ensure these trials are available 
• I thought this was an important study. #clinicaltrials are an important part of cancer care. Many in general population still think trials are last resort and consider them "experimental" in a very negative risky way.
• From our Scientific Director, Dr. Deb Zajchowski, “We need more funding. We also need to get the word out to enroll in the many clinical trials that are already available. There are more than 300 #clinicaltrials that #ovariancancer patients can enter.”

We have several questions/thoughts out there - feel free to now add any additional tweets re: the latest gynecologic cancer research.

• Here is a link to a study reported at SGO on a vaccine to prevent recurrence in OC https://t.co/phQx2osDcN
• Can you please tell us a little more about check point inhibitors and what that they’re used for in regards to #Lynchsyndrome cancers
• Right now - they are FDA approved for any tumor that has MSI (microsatellite instability) - that includes Lynch Syndrome assoc tumors
• Essentially the MMR in LS makes the cells more susceptible to attack by the immune cells. The checkpoint inhibitors allow the immune system to be more effective.
• Still on #uterine #leiomyosarcoma: I'm glad the #sarcoma med oncs talked about the many lines of chemo -- I can think of at least 6 -- they might give. Some gyn oncs offer fewer
• I was very surprised that chemo for early stage endometrial Cancer didn’t improve outcomes. Especially after last years ASCO when it was discussed that it may replace radiation.
• Great video to share (from SGO) on clinical trial basics! https://t.co/UWjBqxQ584
• There was a study that finally measured and estimated rates of post op lymphedema which were much higher than anticipate…

Additional resources mentioned during the chat may be found below. 

Patients and caregivers are invited to continue our discussion on the Smart Patients platform at  https://www.smartpatients.com/partners/gyncsm

Join us next month on Wednesday May 9,2018 at 9pm ET for our chat on Palliative Care - When and Why? with guest Christian Sinclair @ctsinclair (#hpm). 

See you then, 

Dee

#gyncsm Co-founder

Resources:

Links to @SGO_org #SGOMtg Abstracts: https://www.sgo.org/wp-content/uploads/2018/03/Abstracts-2018-SGO-Annual-Meeting-on-Womens-Cancer-1.pdf and Late Breaking Abstracts https://www.sgo.org/wp-content/uploads/2018/03/Late-Breaking-Abstracts-2018-SGO-Annual-Meeting-on-Womens-Cancer.pdf

#SGOmtg Coverage and Videos https://www.sgo.org/education/annual-meeting-on-womens-cancer/annual-meeting-media-coverage-3/ compiled by @SGO_org

For #ovariancancer, see advocate summaries via @ocrfa https://ocrfa.org/wp-content/uploads/2018/04/2018-SGO-Highlights.pdf and also @womenofteal blog http://womenofteal.blogspot.com/