Gynecologic Oncology 131 (2013) 3–5

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Gynecologic Oncology

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Conference Report

Embracing change: The key to revolutionizing SGO’s future. The 2013 Society ofGynecologic Oncology Presidential Address. Sunday, March 10, 2013.By Ronald D. Alvarez, MD. 2012–2013 SGO President

“Can I sail through the changing ocean tides? Can I handle the seasons ofmy life?”

[Stevie Nicks, Landslide, 1975]

Stevie Nicks of Fleetwood Mac wrote the lyrics to this classic songwhile faced with a landslide of change going on in her life back in themid 1970s. I believe that the message in this song also resonates withthe landslide of changes that the Society of Gynecologic Oncology(SGO) has experienced, particularly during the past few years. In thisPresidential Address, I would like to talk about how I believe that em-bracing change is the key to revolutionizing SGO's future, part of themotto for the SGO's 2013 Annual Meeting on Women's Cancer.

Thoughts on change

Heraclitus noted in 500 B.C. that “Nothing is permanent, exceptchange.” And change is occurring at an ever more rapid pace. It took8000 years to move from the agricultural revolution to the industrialrevolution. It took 120 years from the start of the industrial revolutionto create the light bulb. In another 90 years, man landed on the moon.In the following 30 years, man created the World Wide Web and se-quenced the human genome. It challenges the imagination to think ofwhat changes lie ahead for us in the coming decades.

Yet change can be so threatening tomany.We all have our view of theworld, shaped by our beliefs, values and life experiences. Change is oftenmisaligned with and challenges our worldview. But transformationalchange, the type of change that creates a new and improved paradigm,is healthy for an individual or organization. Aristotle advocated for thetype of transformational change that takes something old, creates some-thing entirely new, yet in the end remains true to its core principles.

Rarely does this type of transformational change occur instantaneous-ly. Rather change is best implemented in small increments and with theengagement of all stakeholders. In the end, the aggregate of many smallchanges results in a new paradigm and worldview for stakeholders.

Recent SGO changes

SGO has indeed gone through many such transformational changesover thepast fewyears. Our founders named this organization as the So-ciety of Gynecologic Oncologists in an effort to establish our identity as asubspecialty and they should be proud of what they have accomplished.Former President Carolyn Runowicz was the first to have the greatwisdom and vision to see that, after having established our subspecialty,it was time for the title of our organization to change to the Society of

Gynecologic Oncology in order to focus more on the diseases we takecare of rather than the subspecialists alone.

Gynecologic oncologists formed the core of the SGO when it wasestablished and still do so today. Yet we have come to better appreciatethe value that others contribute in themanagement of gynecologic can-cers. Former President Tom Burke ushered in bylaw and policy changesthat allowed our Society towelcome in somany newmembers of differ-ent disciplines to our organization. This diversity and inclusiveness hasbrought a true richness to the SGO and is one of the key changes thatwill ensure SGO's sustainability.

Under former President Daniel Clarke-Pearson, the Society broad-ened our mission and vision and sharpened our strategic goals. This ef-fort created a clear roadmap for the SGOover the past fewyears andwasutilized in every transformational decision made by the SGO's leader-ship in the past few years.

The SGO continues to restructure in order to meet the needs of thesubspecialty, its members, and the patients we serve. The SGO wasestablished in 1969 as a 501(c)(3) organization focused on establishingthe subspecialty and providing continuing physician education. The Gy-necologic Cancer Foundation, a 501(c)(3) organization, was created in1991 to enhance patient advocacy and education and create a platformfor research funding. The Gynecologic Cancer Foundation, now knownas the Foundation for Women's Cancer, has been extraordinarily suc-cessful in raising the awareness of our subspecialty and the diseaseswe care for. In addition, translational research pilot projects supportedby this Foundation have been very successful in securing additional ex-tramural support.

In 2012, under the leadership of former President John Curtin andformer Vice-President Steve Rubin, the SGO created a new 501(c)(6)organization and named it the SGO and renamed our 501(c)(3) organi-zation as the Foundation for Gynecologic Oncology. SGO did this inorder to create an infrastructure that would allow it to strengthen ef-forts to create an endowment that would help support SGO programspreviously supported by pharmaceutical CME dollars, to better advocateat the business and political level for the practices of our members, andto provide a platform to validate the value of our members assubspecialists.

The SGOhas substantially improved the governance of our organiza-tion. The SGOheard the voices of ourmembership regarding the need toimprove transparency and democracy in our organization and indeedhas responded. Under the leadership of Drs. Clarke-Pearson and Curtin,the SGO expanded the nominating committee and executed policiesthat have led to our first open elections. Under Vice-President RobertMannel's leadership, the SGO has further strengthened our conflict ofinterest policy. In this past year, the SGO established a Publications

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Committee to ensure that what we as an organization say in print hasthe highest credibility. Finally, additional cost accounting measureshave been put into place to ensure our members that the SGO remainsfiscally responsible with their entrusted resources.

Thomas Freidman authored the classic book entitled “The World isFlat” and, indeed, with increased connectivity the world is becomingeven flatter. In response to this reality, SGO established an InternationalCommittee to better coordinate our effort to reach out to the world.There is much we can learn from our international colleagues, andSGO must continue to work together with our international partner or-ganizations to address the global needs in gynecologic cancer educationand unmet health care needs.

Drivers of change

There are many drivers of change in our specialty. We have controlof some and limited control of others. Key among these drivers ofchange are those that occur as a result of scientific discovery and inno-vation. Past President Andrew Berchuck talked about progress throughinnovation and we have certainly experienced such in our field. Healthcare is in the midst of a genomic revolution. We have progressed fromthe discovery of the structure of DNA to sequencing the human genomeand more recently unraveling the genomic mysteries of cancer usingever-evolving high throughput technology.We have implemented clin-ical innovations in imaging, minimally invasive surgery, targeted thera-peutics and supportive care that have revolutionized how we practice.Undoubtedly we will continue to see new discoveries and innovationsthat will lead to improvements in cancer prevention and care. How asa Society are we going to rapidly integrate these innovations and howcan we do so in the most cost-effective manner?

The demographics of the U.S. (and the world for that matter) willdramatically change over the next couple of decades. The U.S. popu-lation will grow by 100 million in the next 30 years and there will beover 40 million more people over the age of 65, the peak age atwhich many of the cancers we care for occur. There will be over20,000 more women affected by gynecologic cancer in the next20 years. Will we as a subspecialty have the appropriate manpowerand skill sets to address the needs of the increasingly growing andaging population?

We are becoming an increasingly diverse country from a racial andethnic perspective and unfortunately becoming a more obese country.We know that gynecologic cancer outcomes are worse in certain affect-ed minorities, ethnic groups, and lower socioeconomic and obese pa-tients. Already we are faced with significant challenges in providingaccess to care and managing the perioperative and medical care ofthese patient groups. How arewe as a Society going to assistwith reduc-ing cancer based disparities and obesity in our nation and addressingthe unique survivorship issues in these patients?

We can no longer deny that we spend the most money on healthcare in theU.S.when compared to other nations and thatwe cannot sus-tain these levels of spending.We can also no longer deny thatwe lag be-hindmany other countries in leading health indicators. How as a Societyare we prepared to reverse these statistics? Over the past year the Pa-tient Protection and Affordable Care Act has been validated by the U.S.Supreme Court and the presidential election. How does SGO prepareits members to implement the changes in health care that are beingimplemented by themost significant health care legislation to be passedsince Medicare and Medicaid?

Lastly, there continues to be fewer and fewer resources to invest inresearch. National Cancer Institute funding has been largely flat since2000 and when corrected for inflation has in fact declined by over 20%in the last decade. Grant paylines are the lowest since the 1980s. Thenation's clinical trials program is being restructured and the Gynecolog-ic Oncology Group (GOG) that has been so woven into the fabric of theSGO will likely cease to exist as we have all known it. How does SGO

adjust to these new realities and ensure continued investment in gyne-cologic cancer research?

What change must SGO effect now?

Dr. Curtin emphasized last year the importance of education, one ofour key strategic goals. SGOmust continue to assist the American Boardof Obstetrics and Gynecology (ABOG) with enhancing the education ofour trainees and expanding their training in genomics, geriatric care,health care disparities, quality measures and health economics, andnovel clinical trial methodology. SGO must also continue to work withABOG to facilitate life-long learning in our established members. Inthis past year, that partnership wasmanifested in an ABOG grant desig-nated to support an endowed lecture at SGO's Annual Meeting.

How people learn is likewise evolving and SGO has implemented in-novative changes in our Annual Meeting and specialized educationalmeetings. The one-price charge for SGO's Annual Meeting allows at-tendees to have access to all its educational content. SGO has enhancedour e-learning platform and social networkingwithin the Annual Meet-ing and through mySGO and SGO Connect Ed. These innovations willcontinue to evolve and help make SGO become an even more criticalcomponent of its members' continuing education.

SGO must lead the effort to create a new paradigm in gynecologiccancer care. We are all frustrated by the fact that the current healthcare system promotes fragmentation of care, which in turn leads topoorer quality and higher cost. In this past year, SGO sponsored thePractice Summit, an interactive workshop summarized in a workingdocument, to ask how should gynecologic cancer care be best delivered;how shouldwe definewhat high quality, cost effective gynecologic can-cer care is; and how should our members be fairly compensated to de-liver this type of care. (https://www.sgo.org/wp-content/uploads/2012/09/Practice_Summit_Report_FINAL.pdf)

In the Practice Summit, SGO advocated for a medical home led bya team captain for those womenwith a suspected or diagnosed gyne-cologic cancer. In most instances, the team captain would be a gyne-cologic oncologist who would help to coordinate care with a team ofother health care providers critically required to meet the needs ofan individual patient. SGO should always advocate that gynecologiccancer patients be provided care by those with the best trainingand most experience to do so!

If we as the leading professional society in gynecologic cancer aregoing to advocate that we should be the team captain in this gynecolog-ic cancermedical homemodel, wemust also hold ourselves accountableto delivering only the highest quality of care. Former President DavidMutch had the foresight to develop SGO's Quality and Outcomes Com-mittee to help SGO develop and implement quality measures in oursubspecialty. It is well established that outcomes in gynecologic cancerare better in the setting where evidence-based guidelines are adheredto and minimum volume metrics are met. Yet in the context of ovariancancer we know even today that a substantial number of patients don'tget what would be considered even minimum standard of care.

Health care reimbursement is clearly moving from a fee-for-serviceenvironment to a value-based payment system. The SGO must helpdefine cost-effective care and advocate for innovative reimbursementsystems that reward quality in both gynecologic cancer and the compli-cated gynecologic and obstetric caseswe are so often asked to become in-volved with.

Our subspecialty needs infrastructure that complements what theGOG and others are doing to better definewhat constitutes high quality,cost effective gynecologic cancer care. Our subspecialty needs the toolsto help ourmembers determine if the care they provide measures up tostandard benchmarks and to that of their peers. The SGO's OutcomesResearch Institute and registry-based projects can provide that infra-structure and will help our subspecialty demonstrate our value in thecare of gynecologic cancer patients. SGO also needs to work with CMSand private insurers via demonstration projects to validate these

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innovative approaches to delivering, defining and compensating forhigh quality gynecologic cancer care.

There must be investment in scientific discovery in gynecologic can-cer. SGO defined research priorities in gynecologic cancer through theResearch Summit held under the leadership of Dr. Clarke-Pearson. Inthis past year, the SGO received a generous grant from the GOG tofund pilot research projects in our Outcomes Research Institute and tosponsor seminars on novel clinical trial designs at our Annual Meeting.The SGOmust advocate for more access to clinical trials across the spec-trum of practices in our Society to address the research priorities in gy-necologic cancer. The SGO must ensure the success of NRG Oncology,one of the anticipated new NCTN Operation Centers that will align theGOG together with NSABP and RTOG. The SGO should continue towork with the FDA to rethink the pathways to regulatory approval ingynecologic cancer in an effort to continue to foster investment in thedevelopment of new and more effective treatments for our patients.

Closing comment

Benjamin Franklin once stated, “If youfinished changing, you are fin-ished.” The SGO I know is not finished. I know our Society will continueto adapt to the internal and external drivers of change and make thechanges needed to address the needs of our specialty, our members,and, most importantly, our patients. SGOworks best when its membersare invested not only in our profession but also in our professional soci-ety and foundations. Our strategic goals are important and wemust notwait for others to determine our path forward. Embracing transforma-tional change, both as an organization and as individual members, isthe key to revolutionizing SGO's future and that of our belovedsubspecialty.

It has been an honor to serve as the 44th President of the Societyof Gynecologic Oncology and I will remain forever grateful for thisprivilege.