The American Medical Association (AMA) annual House of Delegates (HOD) meeting took place June 10–14, in Chicago, IL. The agenda included 62 reports from the AMA board and councils and 186 resolutions from state medical associations, specialty societies, and AMA sections.

The uncertain mood of the HOD was shaped by congressional activity on the Affordable Care Act and a competitive election for AMA president-elect. At the start of the meeting’s final day, the HOD paused to remember the lives lost and changed one year earlier at the Pulse nightclub in Orlando, FL. The HOD also noted the value of American College of Surgeons (ACS) Stop the Bleed® training in response to the shooting June 14 at the Republican congressional baseball team practice in Alexandria, VA.

In the AMA House of Delegates, which is composed of 545 members, the College was represented by its six-member delegation.

The meeting has eight reference committees that focus on the following issues: bylaws and medical ethics, health care system, legislation, medical education, public health, medical science and technology, governance, and medical practice. John H. Armstrong, MD, FACS, co-author of this article, chaired Reference Committee A, which reviewed items pertaining to the health care system. This article provides an overview of several issues of relevance to ACS members.

Medical education

The priority issue for the ACS at this meeting was protecting the profession’s autonomy in defining the standards of lifelong learning through Maintenance of Certification (MOC). Five items related to MOC and Continuing Medical Education (CME) resulted in considerable debate. Internists and medical specialists were particularly frustrated by their experiences with their certifying boards. While acknowledging opportunities to improve MOC, the College delegation took the lead in collaborating with other specialty and state societies to argue against referring MOC to the state legislatures and in creating a new solely CME-based certification system.

• Council on Medical Education Report 2, Update on Maintenance of Certification and Osteopathic Continuous Certification, provided an overview of board-specific MOC innovations that increase relevance and reduce cost. The report was amended to have the AMA advocate that physicians who participate in programs related to quality improvement and/or patient safety should receive credit for MOC Part IV.

• Resolution 302, Comprehensive Review of CME Process, directed the AMA, in collaboration with the Accreditation Council for Continuing Medical Education, to conduct a comprehensive review of the CME process on a national level, with the goal of decreasing costs and simplifying the process of providing CME.

• Resolution 316, Action Steps Regarding Maintenance of Certification, sponsored by the largest state delegations in the HOD (Arizona, California, Florida, Georgia, New York, Pennsylvania, and Texas), sought to extend AMA model state legislation against MOC by barring hospitals, health care insurers, and state licensing boards from linking nonparticipation in the American Board of Medical Specialties (ABMS) MOC process to exclusion from credentialing. Further, it sought to create AMA policy that would replace MOC with high-quality CME under the purview of a physician’s specialty society solely as the demonstration of lifelong learning in hospital, insurance, and licensing credentialing. The HOD conversation shifted from restricting how hospitals, licensing boards, and insurers can use MOC, to redefining MOC.

To address this challenge to professional autonomy while emphasizing the need for responsiveness to concerns across boards, the ACS Delegation applied a strategy that involved prepared talking points; caucus presentations by ACS Executive Director David B. Hoyt, MD, FACS, and Dr. Armstrong; reference committee testimony from Dr. Hoyt and Vice-Chair of the ACS Board of Regents Leigh A. Neumayer, MD, FACS, and ACS Regent James Denneny, MD, FACS, executive director, American Academy of Otolaryngology-Head and Neck Surgery; as well as hallway conversations and HOD floor discussion. As a result, the AMA affirmed that lifelong learning is a fundamental obligation of the profession and recognizes that, for a physician, it is best achieved through ongoing participation in a program of high-quality CME appropriate to the physician’s medical practice as determined by the relevant specialty society. The concept of the AMA lobbying hospital associations, health care insurers, and state licensing boards to not use the ABMS-sponsored MOC process with lifelong interval high stakes testing for credentialing, in addition to the idea of the AMA partnering with state medical associations and specialty societies to undertake a study to establish a separate program of certification by 2020, were referred for further consideration. The ACS will continue to emphasize that a core element of professionalism is self-regulation of lifelong learning through standard-setting.

• Resolution 318, Oppose Direct-to-Consumer Advertising of the ABMS MOC Product, asked the AMA to oppose direct-to-consumer marketing of the ABMS MOC product in print media, social media, apps, and websites that specifically target patients and their families, including but not limited to the promotion of false or misleading claims linking MOC participation with improved patient health outcomes and experiences where limited evidence exists. This item was referred for further study.

• Resolution 319, Public Access to Initial Board Certification Status of Time-Limited ABMS Diplomates, was adopted. The AMA now advocates that the initial certification status of time-limited diplomates be listed and publicly available on all ABMS and ABMS member board websites and physician certification databases and that the names and initial certification status of time-limited diplomates remain on ABMS and ABMS member board websites or physician certification databases, even if the diplomate opts out of MOC participation.

Health system

• Council on Medical Service Report 6, Expansion of U.S. Veterans’ Health Care Choices, was adopted with an amendment offered by the ACS delegation. The AMA will encourage the Veterans Health Administration (VHA) to engage with VHA physicians to explore and develop solutions to improve the health care choices of veterans. The AMA also will continue to support efforts to improve the Veterans Choice Program (VCP) and make it permanent, advocate for new funding to support expansion of the VCP, and encourage the acceleration of interoperability of electronic personal and health records and the exchange of medical records between VHA and non-VHA physicians.

• Substitute Resolution 115, Out-of-Network Care, combined four resolutions on the subject of greatest interest in the Reference Committee A hearing—surprise (unanticipated) billing for out-of-network care. It was adopted with eight AMA principles regarding unanticipated out-of-network care and AMA development of model state legislation addressing the coverage of and payment for unexpected unanticipated out-of-network care.

Public health

• Resolution 419, Improving Physicians’ Ability to Discuss Firearm Safety, was adopted with minor amendments. As a result, the AMA is working with appropriate stakeholders to develop state-specific guidance for physicians on how to counsel patients to reduce their risk for firearm-related injury or death by suicide, including guidance on when and how to ask sensitive questions about firearm ownership, access, and use; and clarification on the circumstances under which physicians are permitted or may be required to disclose the content of such conversations to family members, law enforcement, or other third parties.

Medical practice

• Substitute Resolution 706, Concurrent and Overlapping Surgery, was adopted. The AMA will work with interested national medical specialty societies on issues related to concurrent and overlapping surgery.

AMA elections

The June meeting is when AMA officers, trustees, and councilors are elected. Barbara McAneny, MD, an oncologist from New Mexico, was elected AMA president-elect. Three ACS-endorsed candidates were successful in their bids to serve on the Council on Medical Education. Liana Puscas, MD, MHS, FACS, associate professor of surgery, Duke University School of Medicine, Durham, NC, and Luke Selby, MD, a general surgery resident, University of Colorado School of Medicine, Denver, were reelected; Krystal Tomei, MD, assistant professor of neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, was elected.

Surgical Caucus

The Surgical Caucus hosted a well-attended educational session, Cultivating and Protecting Your Digital Presence: Do’s and Don’ts of Social Media. Speakers included Deanna Attai, MD, FACS, a breast surgeon and assistant clinical professor of surgery, David Geffen School of Medicine, University of California, Los Angeles, and Ravi Goel, MD, an ophthalmologist in private practice in Cherry Hill, NJ, and delegate from the American Academy of Ophthalmology. Both presentations emphasized that surgeons need to manage their online reputation in practice reviews and other web content. Drs. Attai and Goel provided constructive ideas for personal and professional branding through social media, as well as practical ways for surgeons to build and protect their social media reputation. Both presentations are available on the Surgical Caucus web page at facs.org/advocacy/ama-house-of-delegates/surgical-caucus.

The ACS delegation successfully put forth the College’s priorities at the June AMA HOD meeting. The delegation is now working with the ACS Division of Advocacy and Health Policy, the Health Policy and Advocacy Group, and other committees to develop next steps in shaping AMA policy consistent with College principles.

The next AMA meeting is the Interim Meeting in Honolulu, HI, November 11–14. The College’s delegation welcomes input from Fellows regarding issues of importance to surgeons. Comments and questions should be directed to [email protected].

ACS delegation at the AMA HOD

John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Ocala, FL

Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH

Jacob Moalem, MD, FACS, general surgery, Rochester, NY

Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents

Naveen F. Sangji, MD, (also Resident and Fellow Section delegate), general surgery resident, Boston, MA

Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; Chair, AMA Council on Medical Education

Dr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member of the American College of Surgeons (ACS) Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).

Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy.

The American Medical Association (AMA) annual House of Delegates (HOD) meeting took place June 10–14, in Chicago, IL. The agenda included 62 reports from the AMA board and councils and 186 resolutions from state medical associations, specialty societies, and AMA sections.

The uncertain mood of the HOD was shaped by congressional activity on the Affordable Care Act and a competitive election for AMA president-elect. At the start of the meeting’s final day, the HOD paused to remember the lives lost and changed one year earlier at the Pulse nightclub in Orlando, FL. The HOD also noted the value of American College of Surgeons (ACS) Stop the Bleed® training in response to the shooting June 14 at the Republican congressional baseball team practice in Alexandria, VA.

In the AMA House of Delegates, which is composed of 545 members, the College was represented by its six-member delegation.

The meeting has eight reference committees that focus on the following issues: bylaws and medical ethics, health care system, legislation, medical education, public health, medical science and technology, governance, and medical practice. John H. Armstrong, MD, FACS, co-author of this article, chaired Reference Committee A, which reviewed items pertaining to the health care system. This article provides an overview of several issues of relevance to ACS members.

Medical education

The priority issue for the ACS at this meeting was protecting the profession’s autonomy in defining the standards of lifelong learning through Maintenance of Certification (MOC). Five items related to MOC and Continuing Medical Education (CME) resulted in considerable debate. Internists and medical specialists were particularly frustrated by their experiences with their certifying boards. While acknowledging opportunities to improve MOC, the College delegation took the lead in collaborating with other specialty and state societies to argue against referring MOC to the state legislatures and in creating a new solely CME-based certification system.

• Council on Medical Education Report 2, Update on Maintenance of Certification and Osteopathic Continuous Certification, provided an overview of board-specific MOC innovations that increase relevance and reduce cost. The report was amended to have the AMA advocate that physicians who participate in programs related to quality improvement and/or patient safety should receive credit for MOC Part IV.

• Resolution 302, Comprehensive Review of CME Process, directed the AMA, in collaboration with the Accreditation Council for Continuing Medical Education, to conduct a comprehensive review of the CME process on a national level, with the goal of decreasing costs and simplifying the process of providing CME.

• Resolution 316, Action Steps Regarding Maintenance of Certification, sponsored by the largest state delegations in the HOD (Arizona, California, Florida, Georgia, New York, Pennsylvania, and Texas), sought to extend AMA model state legislation against MOC by barring hospitals, health care insurers, and state licensing boards from linking nonparticipation in the American Board of Medical Specialties (ABMS) MOC process to exclusion from credentialing. Further, it sought to create AMA policy that would replace MOC with high-quality CME under the purview of a physician’s specialty society solely as the demonstration of lifelong learning in hospital, insurance, and licensing credentialing. The HOD conversation shifted from restricting how hospitals, licensing boards, and insurers can use MOC, to redefining MOC.

To address this challenge to professional autonomy while emphasizing the need for responsiveness to concerns across boards, the ACS Delegation applied a strategy that involved prepared talking points; caucus presentations by ACS Executive Director David B. Hoyt, MD, FACS, and Dr. Armstrong; reference committee testimony from Dr. Hoyt and Vice-Chair of the ACS Board of Regents Leigh A. Neumayer, MD, FACS, and ACS Regent James Denneny, MD, FACS, executive director, American Academy of Otolaryngology-Head and Neck Surgery; as well as hallway conversations and HOD floor discussion. As a result, the AMA affirmed that lifelong learning is a fundamental obligation of the profession and recognizes that, for a physician, it is best achieved through ongoing participation in a program of high-quality CME appropriate to the physician’s medical practice as determined by the relevant specialty society. The concept of the AMA lobbying hospital associations, health care insurers, and state licensing boards to not use the ABMS-sponsored MOC process with lifelong interval high stakes testing for credentialing, in addition to the idea of the AMA partnering with state medical associations and specialty societies to undertake a study to establish a separate program of certification by 2020, were referred for further consideration. The ACS will continue to emphasize that a core element of professionalism is self-regulation of lifelong learning through standard-setting.

• Resolution 318, Oppose Direct-to-Consumer Advertising of the ABMS MOC Product, asked the AMA to oppose direct-to-consumer marketing of the ABMS MOC product in print media, social media, apps, and websites that specifically target patients and their families, including but not limited to the promotion of false or misleading claims linking MOC participation with improved patient health outcomes and experiences where limited evidence exists. This item was referred for further study.

• Resolution 319, Public Access to Initial Board Certification Status of Time-Limited ABMS Diplomates, was adopted. The AMA now advocates that the initial certification status of time-limited diplomates be listed and publicly available on all ABMS and ABMS member board websites and physician certification databases and that the names and initial certification status of time-limited diplomates remain on ABMS and ABMS member board websites or physician certification databases, even if the diplomate opts out of MOC participation.

Health system

• Council on Medical Service Report 6, Expansion of U.S. Veterans’ Health Care Choices, was adopted with an amendment offered by the ACS delegation. The AMA will encourage the Veterans Health Administration (VHA) to engage with VHA physicians to explore and develop solutions to improve the health care choices of veterans. The AMA also will continue to support efforts to improve the Veterans Choice Program (VCP) and make it permanent, advocate for new funding to support expansion of the VCP, and encourage the acceleration of interoperability of electronic personal and health records and the exchange of medical records between VHA and non-VHA physicians.

• Substitute Resolution 115, Out-of-Network Care, combined four resolutions on the subject of greatest interest in the Reference Committee A hearing—surprise (unanticipated) billing for out-of-network care. It was adopted with eight AMA principles regarding unanticipated out-of-network care and AMA development of model state legislation addressing the coverage of and payment for unexpected unanticipated out-of-network care.

Public health

• Resolution 419, Improving Physicians’ Ability to Discuss Firearm Safety, was adopted with minor amendments. As a result, the AMA is working with appropriate stakeholders to develop state-specific guidance for physicians on how to counsel patients to reduce their risk for firearm-related injury or death by suicide, including guidance on when and how to ask sensitive questions about firearm ownership, access, and use; and clarification on the circumstances under which physicians are permitted or may be required to disclose the content of such conversations to family members, law enforcement, or other third parties.

Medical practice

• Substitute Resolution 706, Concurrent and Overlapping Surgery, was adopted. The AMA will work with interested national medical specialty societies on issues related to concurrent and overlapping surgery.

AMA elections

The June meeting is when AMA officers, trustees, and councilors are elected. Barbara McAneny, MD, an oncologist from New Mexico, was elected AMA president-elect. Three ACS-endorsed candidates were successful in their bids to serve on the Council on Medical Education. Liana Puscas, MD, MHS, FACS, associate professor of surgery, Duke University School of Medicine, Durham, NC, and Luke Selby, MD, a general surgery resident, University of Colorado School of Medicine, Denver, were reelected; Krystal Tomei, MD, assistant professor of neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, was elected.

Surgical Caucus

The Surgical Caucus hosted a well-attended educational session, Cultivating and Protecting Your Digital Presence: Do’s and Don’ts of Social Media. Speakers included Deanna Attai, MD, FACS, a breast surgeon and assistant clinical professor of surgery, David Geffen School of Medicine, University of California, Los Angeles, and Ravi Goel, MD, an ophthalmologist in private practice in Cherry Hill, NJ, and delegate from the American Academy of Ophthalmology. Both presentations emphasized that surgeons need to manage their online reputation in practice reviews and other web content. Drs. Attai and Goel provided constructive ideas for personal and professional branding through social media, as well as practical ways for surgeons to build and protect their social media reputation. Both presentations are available on the Surgical Caucus web page at facs.org/advocacy/ama-house-of-delegates/surgical-caucus.

The ACS delegation successfully put forth the College’s priorities at the June AMA HOD meeting. The delegation is now working with the ACS Division of Advocacy and Health Policy, the Health Policy and Advocacy Group, and other committees to develop next steps in shaping AMA policy consistent with College principles.

The next AMA meeting is the Interim Meeting in Honolulu, HI, November 11–14. The College’s delegation welcomes input from Fellows regarding issues of importance to surgeons. Comments and questions should be directed to [email protected].

ACS delegation at the AMA HOD

John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Ocala, FL

Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH

Jacob Moalem, MD, FACS, general surgery, Rochester, NY

Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents

Naveen F. Sangji, MD, (also Resident and Fellow Section delegate), general surgery resident, Boston, MA

Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; Chair, AMA Council on Medical Education

Dr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member of the American College of Surgeons (ACS) Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).

Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy.

The American Medical Association (AMA) annual House of Delegates (HOD) meeting took place June 10–14, in Chicago, IL. The agenda included 62 reports from the AMA board and councils and 186 resolutions from state medical associations, specialty societies, and AMA sections.

The uncertain mood of the HOD was shaped by congressional activity on the Affordable Care Act and a competitive election for AMA president-elect. At the start of the meeting’s final day, the HOD paused to remember the lives lost and changed one year earlier at the Pulse nightclub in Orlando, FL. The HOD also noted the value of American College of Surgeons (ACS) Stop the Bleed® training in response to the shooting June 14 at the Republican congressional baseball team practice in Alexandria, VA.

In the AMA House of Delegates, which is composed of 545 members, the College was represented by its six-member delegation.

The meeting has eight reference committees that focus on the following issues: bylaws and medical ethics, health care system, legislation, medical education, public health, medical science and technology, governance, and medical practice. John H. Armstrong, MD, FACS, co-author of this article, chaired Reference Committee A, which reviewed items pertaining to the health care system. This article provides an overview of several issues of relevance to ACS members.

Medical education

The priority issue for the ACS at this meeting was protecting the profession’s autonomy in defining the standards of lifelong learning through Maintenance of Certification (MOC). Five items related to MOC and Continuing Medical Education (CME) resulted in considerable debate. Internists and medical specialists were particularly frustrated by their experiences with their certifying boards. While acknowledging opportunities to improve MOC, the College delegation took the lead in collaborating with other specialty and state societies to argue against referring MOC to the state legislatures and in creating a new solely CME-based certification system.

• Council on Medical Education Report 2, Update on Maintenance of Certification and Osteopathic Continuous Certification, provided an overview of board-specific MOC innovations that increase relevance and reduce cost. The report was amended to have the AMA advocate that physicians who participate in programs related to quality improvement and/or patient safety should receive credit for MOC Part IV.

• Resolution 302, Comprehensive Review of CME Process, directed the AMA, in collaboration with the Accreditation Council for Continuing Medical Education, to conduct a comprehensive review of the CME process on a national level, with the goal of decreasing costs and simplifying the process of providing CME.

• Resolution 316, Action Steps Regarding Maintenance of Certification, sponsored by the largest state delegations in the HOD (Arizona, California, Florida, Georgia, New York, Pennsylvania, and Texas), sought to extend AMA model state legislation against MOC by barring hospitals, health care insurers, and state licensing boards from linking nonparticipation in the American Board of Medical Specialties (ABMS) MOC process to exclusion from credentialing. Further, it sought to create AMA policy that would replace MOC with high-quality CME under the purview of a physician’s specialty society solely as the demonstration of lifelong learning in hospital, insurance, and licensing credentialing. The HOD conversation shifted from restricting how hospitals, licensing boards, and insurers can use MOC, to redefining MOC.

To address this challenge to professional autonomy while emphasizing the need for responsiveness to concerns across boards, the ACS Delegation applied a strategy that involved prepared talking points; caucus presentations by ACS Executive Director David B. Hoyt, MD, FACS, and Dr. Armstrong; reference committee testimony from Dr. Hoyt and Vice-Chair of the ACS Board of Regents Leigh A. Neumayer, MD, FACS, and ACS Regent James Denneny, MD, FACS, executive director, American Academy of Otolaryngology-Head and Neck Surgery; as well as hallway conversations and HOD floor discussion. As a result, the AMA affirmed that lifelong learning is a fundamental obligation of the profession and recognizes that, for a physician, it is best achieved through ongoing participation in a program of high-quality CME appropriate to the physician’s medical practice as determined by the relevant specialty society. The concept of the AMA lobbying hospital associations, health care insurers, and state licensing boards to not use the ABMS-sponsored MOC process with lifelong interval high stakes testing for credentialing, in addition to the idea of the AMA partnering with state medical associations and specialty societies to undertake a study to establish a separate program of certification by 2020, were referred for further consideration. The ACS will continue to emphasize that a core element of professionalism is self-regulation of lifelong learning through standard-setting.

• Resolution 318, Oppose Direct-to-Consumer Advertising of the ABMS MOC Product, asked the AMA to oppose direct-to-consumer marketing of the ABMS MOC product in print media, social media, apps, and websites that specifically target patients and their families, including but not limited to the promotion of false or misleading claims linking MOC participation with improved patient health outcomes and experiences where limited evidence exists. This item was referred for further study.

• Resolution 319, Public Access to Initial Board Certification Status of Time-Limited ABMS Diplomates, was adopted. The AMA now advocates that the initial certification status of time-limited diplomates be listed and publicly available on all ABMS and ABMS member board websites and physician certification databases and that the names and initial certification status of time-limited diplomates remain on ABMS and ABMS member board websites or physician certification databases, even if the diplomate opts out of MOC participation.

Health system

• Council on Medical Service Report 6, Expansion of U.S. Veterans’ Health Care Choices, was adopted with an amendment offered by the ACS delegation. The AMA will encourage the Veterans Health Administration (VHA) to engage with VHA physicians to explore and develop solutions to improve the health care choices of veterans. The AMA also will continue to support efforts to improve the Veterans Choice Program (VCP) and make it permanent, advocate for new funding to support expansion of the VCP, and encourage the acceleration of interoperability of electronic personal and health records and the exchange of medical records between VHA and non-VHA physicians.

• Substitute Resolution 115, Out-of-Network Care, combined four resolutions on the subject of greatest interest in the Reference Committee A hearing—surprise (unanticipated) billing for out-of-network care. It was adopted with eight AMA principles regarding unanticipated out-of-network care and AMA development of model state legislation addressing the coverage of and payment for unexpected unanticipated out-of-network care.

Public health

• Resolution 419, Improving Physicians’ Ability to Discuss Firearm Safety, was adopted with minor amendments. As a result, the AMA is working with appropriate stakeholders to develop state-specific guidance for physicians on how to counsel patients to reduce their risk for firearm-related injury or death by suicide, including guidance on when and how to ask sensitive questions about firearm ownership, access, and use; and clarification on the circumstances under which physicians are permitted or may be required to disclose the content of such conversations to family members, law enforcement, or other third parties.

Medical practice

• Substitute Resolution 706, Concurrent and Overlapping Surgery, was adopted. The AMA will work with interested national medical specialty societies on issues related to concurrent and overlapping surgery.

AMA elections

The June meeting is when AMA officers, trustees, and councilors are elected. Barbara McAneny, MD, an oncologist from New Mexico, was elected AMA president-elect. Three ACS-endorsed candidates were successful in their bids to serve on the Council on Medical Education. Liana Puscas, MD, MHS, FACS, associate professor of surgery, Duke University School of Medicine, Durham, NC, and Luke Selby, MD, a general surgery resident, University of Colorado School of Medicine, Denver, were reelected; Krystal Tomei, MD, assistant professor of neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, was elected.

Surgical Caucus

The Surgical Caucus hosted a well-attended educational session, Cultivating and Protecting Your Digital Presence: Do’s and Don’ts of Social Media. Speakers included Deanna Attai, MD, FACS, a breast surgeon and assistant clinical professor of surgery, David Geffen School of Medicine, University of California, Los Angeles, and Ravi Goel, MD, an ophthalmologist in private practice in Cherry Hill, NJ, and delegate from the American Academy of Ophthalmology. Both presentations emphasized that surgeons need to manage their online reputation in practice reviews and other web content. Drs. Attai and Goel provided constructive ideas for personal and professional branding through social media, as well as practical ways for surgeons to build and protect their social media reputation. Both presentations are available on the Surgical Caucus web page at facs.org/advocacy/ama-house-of-delegates/surgical-caucus.

The ACS delegation successfully put forth the College’s priorities at the June AMA HOD meeting. The delegation is now working with the ACS Division of Advocacy and Health Policy, the Health Policy and Advocacy Group, and other committees to develop next steps in shaping AMA policy consistent with College principles.

The next AMA meeting is the Interim Meeting in Honolulu, HI, November 11–14. The College’s delegation welcomes input from Fellows regarding issues of importance to surgeons. Comments and questions should be directed to [email protected].

ACS delegation at the AMA HOD

John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Ocala, FL

Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH

Jacob Moalem, MD, FACS, general surgery, Rochester, NY

Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents

Naveen F. Sangji, MD, (also Resident and Fellow Section delegate), general surgery resident, Boston, MA

Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; Chair, AMA Council on Medical Education

Dr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member of the American College of Surgeons (ACS) Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).

Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy.

The American College of Surgeons (ACS) presented the 2017 Jacobson Innovation Award to Timothy A. M. Chuter, MB, BS, DM, FACS, at a dinner in his honor June 9 in Chicago. Dr. Chuter is professor of surgery at the University of California, San Francisco (UCSF), where he practices vascular surgery with a focus on the endovascular reconstruction of aneurysms involving the aortic arch and thoracoabdominal aorta.

The Jacobson Innovation Award honors living surgeons who have developed innovative devices or techniques in any field of surgery and is made possible through a gift from Julius H. Jacobson II, MD, FACS, and his wife Joan. Dr. Jacobson is a general vascular surgeon known for his pioneering work in the development of microsurgery.

Leading the way in endovascular aneurysm repair, Dr. Chuter was recognized for his role in the development of endovascular aneurysm repair. He was the first individual to design and implant bifurcated stent grafts to treat abdominal aortic aneurysms, based on the idea that if an aneurysm has branches—at the aortic arch or the bifurcation of the common iliac artery, for example—the endovascular prosthesis also should have branches. Because the most common site for aortic aneurysm involves the distal abdominal aorta, bifurcated endovascular repair has become the most accepted method of aneurysm repair worldwide.

In the years between 1993 and 2000, the scope of endovascular repair rapidly expanded, with several firsts in the field, such as the first bifurcated stent grafts in 1993, the first endovascular repair of a ruptured aortic aneurysm in 1994, the first fenestrated stent grafts for aneurysms of the pararenal aorta in 1998, and the first branched stent grafts for the thoracoabdominal aorta in 2000. Dr. Chuter played a role in many of these developments, though none was the work of a single inventor. Dr. Chuter has said that he is proud to have contributed to several advances in endovascular aneurysm repair, not only by inventing new forms of repair, but also by mentoring surgical residents, fellows, and faculty.

The American College of Surgeons (ACS) presented the 2017 Jacobson Innovation Award to Timothy A. M. Chuter, MB, BS, DM, FACS, at a dinner in his honor June 9 in Chicago. Dr. Chuter is professor of surgery at the University of California, San Francisco (UCSF), where he practices vascular surgery with a focus on the endovascular reconstruction of aneurysms involving the aortic arch and thoracoabdominal aorta.

The Jacobson Innovation Award honors living surgeons who have developed innovative devices or techniques in any field of surgery and is made possible through a gift from Julius H. Jacobson II, MD, FACS, and his wife Joan. Dr. Jacobson is a general vascular surgeon known for his pioneering work in the development of microsurgery.

Leading the way in endovascular aneurysm repair, Dr. Chuter was recognized for his role in the development of endovascular aneurysm repair. He was the first individual to design and implant bifurcated stent grafts to treat abdominal aortic aneurysms, based on the idea that if an aneurysm has branches—at the aortic arch or the bifurcation of the common iliac artery, for example—the endovascular prosthesis also should have branches. Because the most common site for aortic aneurysm involves the distal abdominal aorta, bifurcated endovascular repair has become the most accepted method of aneurysm repair worldwide.

In the years between 1993 and 2000, the scope of endovascular repair rapidly expanded, with several firsts in the field, such as the first bifurcated stent grafts in 1993, the first endovascular repair of a ruptured aortic aneurysm in 1994, the first fenestrated stent grafts for aneurysms of the pararenal aorta in 1998, and the first branched stent grafts for the thoracoabdominal aorta in 2000. Dr. Chuter played a role in many of these developments, though none was the work of a single inventor. Dr. Chuter has said that he is proud to have contributed to several advances in endovascular aneurysm repair, not only by inventing new forms of repair, but also by mentoring surgical residents, fellows, and faculty.

The American College of Surgeons (ACS) presented the 2017 Jacobson Innovation Award to Timothy A. M. Chuter, MB, BS, DM, FACS, at a dinner in his honor June 9 in Chicago. Dr. Chuter is professor of surgery at the University of California, San Francisco (UCSF), where he practices vascular surgery with a focus on the endovascular reconstruction of aneurysms involving the aortic arch and thoracoabdominal aorta.

The Jacobson Innovation Award honors living surgeons who have developed innovative devices or techniques in any field of surgery and is made possible through a gift from Julius H. Jacobson II, MD, FACS, and his wife Joan. Dr. Jacobson is a general vascular surgeon known for his pioneering work in the development of microsurgery.

Leading the way in endovascular aneurysm repair, Dr. Chuter was recognized for his role in the development of endovascular aneurysm repair. He was the first individual to design and implant bifurcated stent grafts to treat abdominal aortic aneurysms, based on the idea that if an aneurysm has branches—at the aortic arch or the bifurcation of the common iliac artery, for example—the endovascular prosthesis also should have branches. Because the most common site for aortic aneurysm involves the distal abdominal aorta, bifurcated endovascular repair has become the most accepted method of aneurysm repair worldwide.

In the years between 1993 and 2000, the scope of endovascular repair rapidly expanded, with several firsts in the field, such as the first bifurcated stent grafts in 1993, the first endovascular repair of a ruptured aortic aneurysm in 1994, the first fenestrated stent grafts for aneurysms of the pararenal aorta in 1998, and the first branched stent grafts for the thoracoabdominal aorta in 2000. Dr. Chuter played a role in many of these developments, though none was the work of a single inventor. Dr. Chuter has said that he is proud to have contributed to several advances in endovascular aneurysm repair, not only by inventing new forms of repair, but also by mentoring surgical residents, fellows, and faculty.

Surgeons are well familiar with the statistic from the Centers for Disease Control and Prevention (CDC) identifying trauma as the leading cause of death for children and adults under age 44. More Americans lose their lives each year to trauma than to AIDS and stroke combined. Unfortunately, nearly 45 million Americans live in areas more than an hour away from either a Level I or II trauma center. Ensuring access to trauma care requires many crucial components including trauma centers and appropriately trained physicians and nurses, all of which must dedicate extensive resources around the clock so that seriously injured patients have the best possible chance for survival.

It has long been a top legislative priority of the ACS to establish and maintain adequate funding for high-quality trauma systems throughout the United States, including those systems operated by our armed forces.The ACS was a sponsor of the National Academy of Medicine (NAM) report entitled, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. This report, released in June of 2016, outlines the steps necessary to secure a national trauma system and sets the goal of achieving zero preventable traumatic deaths.

In an effort to facilitate the achievement of the goals laid out in the report, The Mission Zero Act (H.R. 880) was introduced in the House of Representatives by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Cathy Castor (D-FL), Gene Green (D-TX), and Richard Hudson (R-NC). Identical companion legislation was introduced in the Senate (S.1022) by Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL). The Mission Zero Act creates a grant program to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality of trauma care in times of peace and war, thus taking a step in the direction of the NAM report recommendations.

Specifically, the legislation provides for:

• $40 million in grants to fund military trauma teams and providers to embed into civilian trauma facilities.

o Trauma centers are eligible for a $1 million grant to host military trauma teams at eligible high-acuity level 1 trauma centers

o Trauma centers are also eligible for grants to host individual providers ($100,000 for physician or $50,000 for non-physician providers) at eligible level I, II, or III trauma centers

As of today, the House and Senate versions of the Mission Zero Act have 25co-sponsors and 2 co-sponsors respectively. The ACS would very much like to build some momentum for the Mission Zero Act going into the fall when it is expected that there will be several large “must pass” pieces of legislation working their way through Congress to which the Mission Zero Act could potentially be attached. Accordingly, I respectfully ask all Fellows to take a few moments to visit the SurgeonsVoice website at www.surgeonsvoice.org, click on the Take Action tab on the right side of the page and send a message to their individual representatives and senators seeking support for this important legislation.

Until next month …

Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.

Surgeons are well familiar with the statistic from the Centers for Disease Control and Prevention (CDC) identifying trauma as the leading cause of death for children and adults under age 44. More Americans lose their lives each year to trauma than to AIDS and stroke combined. Unfortunately, nearly 45 million Americans live in areas more than an hour away from either a Level I or II trauma center. Ensuring access to trauma care requires many crucial components including trauma centers and appropriately trained physicians and nurses, all of which must dedicate extensive resources around the clock so that seriously injured patients have the best possible chance for survival.

It has long been a top legislative priority of the ACS to establish and maintain adequate funding for high-quality trauma systems throughout the United States, including those systems operated by our armed forces.The ACS was a sponsor of the National Academy of Medicine (NAM) report entitled, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. This report, released in June of 2016, outlines the steps necessary to secure a national trauma system and sets the goal of achieving zero preventable traumatic deaths.

In an effort to facilitate the achievement of the goals laid out in the report, The Mission Zero Act (H.R. 880) was introduced in the House of Representatives by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Cathy Castor (D-FL), Gene Green (D-TX), and Richard Hudson (R-NC). Identical companion legislation was introduced in the Senate (S.1022) by Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL). The Mission Zero Act creates a grant program to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality of trauma care in times of peace and war, thus taking a step in the direction of the NAM report recommendations.

Specifically, the legislation provides for:

• $40 million in grants to fund military trauma teams and providers to embed into civilian trauma facilities.

o Trauma centers are eligible for a $1 million grant to host military trauma teams at eligible high-acuity level 1 trauma centers

o Trauma centers are also eligible for grants to host individual providers ($100,000 for physician or $50,000 for non-physician providers) at eligible level I, II, or III trauma centers

As of today, the House and Senate versions of the Mission Zero Act have 25co-sponsors and 2 co-sponsors respectively. The ACS would very much like to build some momentum for the Mission Zero Act going into the fall when it is expected that there will be several large “must pass” pieces of legislation working their way through Congress to which the Mission Zero Act could potentially be attached. Accordingly, I respectfully ask all Fellows to take a few moments to visit the SurgeonsVoice website at www.surgeonsvoice.org, click on the Take Action tab on the right side of the page and send a message to their individual representatives and senators seeking support for this important legislation.

Until next month …

Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.

Surgeons are well familiar with the statistic from the Centers for Disease Control and Prevention (CDC) identifying trauma as the leading cause of death for children and adults under age 44. More Americans lose their lives each year to trauma than to AIDS and stroke combined. Unfortunately, nearly 45 million Americans live in areas more than an hour away from either a Level I or II trauma center. Ensuring access to trauma care requires many crucial components including trauma centers and appropriately trained physicians and nurses, all of which must dedicate extensive resources around the clock so that seriously injured patients have the best possible chance for survival.

It has long been a top legislative priority of the ACS to establish and maintain adequate funding for high-quality trauma systems throughout the United States, including those systems operated by our armed forces.The ACS was a sponsor of the National Academy of Medicine (NAM) report entitled, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. This report, released in June of 2016, outlines the steps necessary to secure a national trauma system and sets the goal of achieving zero preventable traumatic deaths.

In an effort to facilitate the achievement of the goals laid out in the report, The Mission Zero Act (H.R. 880) was introduced in the House of Representatives by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Cathy Castor (D-FL), Gene Green (D-TX), and Richard Hudson (R-NC). Identical companion legislation was introduced in the Senate (S.1022) by Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL). The Mission Zero Act creates a grant program to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality of trauma care in times of peace and war, thus taking a step in the direction of the NAM report recommendations.

Specifically, the legislation provides for:

• $40 million in grants to fund military trauma teams and providers to embed into civilian trauma facilities.

o Trauma centers are eligible for a $1 million grant to host military trauma teams at eligible high-acuity level 1 trauma centers

o Trauma centers are also eligible for grants to host individual providers ($100,000 for physician or $50,000 for non-physician providers) at eligible level I, II, or III trauma centers

As of today, the House and Senate versions of the Mission Zero Act have 25co-sponsors and 2 co-sponsors respectively. The ACS would very much like to build some momentum for the Mission Zero Act going into the fall when it is expected that there will be several large “must pass” pieces of legislation working their way through Congress to which the Mission Zero Act could potentially be attached. Accordingly, I respectfully ask all Fellows to take a few moments to visit the SurgeonsVoice website at www.surgeonsvoice.org, click on the Take Action tab on the right side of the page and send a message to their individual representatives and senators seeking support for this important legislation.

Until next month …

Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.

Today in America, more people survive serious injury than any time in the past. Yet trauma remains the leading killer of young people and military service members during combat. Trauma has been characterized as the “neglected epidemic of our time.”

A 2016 report by the National Academies of Science, Engineering and Medicine (NASEM) has added new momentum to the effort to complete the nation’s trauma system. It found one in five trauma deaths could be prevented through stronger Federal leadership, greater research funding to improve outcomes, strengthening prehospital care, distributing trauma centers based on need and integrating military and civilian trauma care into one national trauma system.

In a five-part series of stories, “Putting the Pieces Together: A National Effort to Complete the U.S. Trauma System,” the American College of Surgeons Committee on Trauma will share steps being taken to complete the nation’s trauma system. Stories will look at the history of trauma care and the trauma system in America, partnerships with the military to translate battlefield lessons to the home front and back again, the challenges facing America’s trauma systems, and the steps leading experts are taking to fill the gaps in the system and achieve the goal of zero preventable deaths and disability from injury.

Read the series online at www.facs.org/trauma or follow the ACS COT on Twitter @ACSTrauma.

Today in America, more people survive serious injury than any time in the past. Yet trauma remains the leading killer of young people and military service members during combat. Trauma has been characterized as the “neglected epidemic of our time.”

A 2016 report by the National Academies of Science, Engineering and Medicine (NASEM) has added new momentum to the effort to complete the nation’s trauma system. It found one in five trauma deaths could be prevented through stronger Federal leadership, greater research funding to improve outcomes, strengthening prehospital care, distributing trauma centers based on need and integrating military and civilian trauma care into one national trauma system.

In a five-part series of stories, “Putting the Pieces Together: A National Effort to Complete the U.S. Trauma System,” the American College of Surgeons Committee on Trauma will share steps being taken to complete the nation’s trauma system. Stories will look at the history of trauma care and the trauma system in America, partnerships with the military to translate battlefield lessons to the home front and back again, the challenges facing America’s trauma systems, and the steps leading experts are taking to fill the gaps in the system and achieve the goal of zero preventable deaths and disability from injury.

Read the series online at www.facs.org/trauma or follow the ACS COT on Twitter @ACSTrauma.

Today in America, more people survive serious injury than any time in the past. Yet trauma remains the leading killer of young people and military service members during combat. Trauma has been characterized as the “neglected epidemic of our time.”

A 2016 report by the National Academies of Science, Engineering and Medicine (NASEM) has added new momentum to the effort to complete the nation’s trauma system. It found one in five trauma deaths could be prevented through stronger Federal leadership, greater research funding to improve outcomes, strengthening prehospital care, distributing trauma centers based on need and integrating military and civilian trauma care into one national trauma system.

In a five-part series of stories, “Putting the Pieces Together: A National Effort to Complete the U.S. Trauma System,” the American College of Surgeons Committee on Trauma will share steps being taken to complete the nation’s trauma system. Stories will look at the history of trauma care and the trauma system in America, partnerships with the military to translate battlefield lessons to the home front and back again, the challenges facing America’s trauma systems, and the steps leading experts are taking to fill the gaps in the system and achieve the goal of zero preventable deaths and disability from injury.

Read the series online at www.facs.org/trauma or follow the ACS COT on Twitter @ACSTrauma.

Photo courtesy of the CDC

A study of residents in Ontario, Canada, showed that opioid prescription use was more common in cancer survivors than in individuals without a history of cancer.

This was true even among survivors who were 10 or more years past their cancer diagnosis.

Rinku Sutradhar, PhD, of the University of Toronto in Ontario, Canada, and her colleagues reported these findings in Cancer.

The researchers said little is known about prescribing opioids to relieve pain in individuals who have survived cancer.

To investigate, the team looked at opioid prescribing among residents of Ontario, Canada, with and without a history of cancer.

The study included 8601 adults who were at least 5 years past a cancer diagnosis. These subjects were were matched with 8601 individuals without a prior cancer diagnosis. The subjects were matched based on sex and calendar year of birth.

The researchers looked for opioid prescriptions filled at a pharmacy during the observation period. Follow-up was stopped at any indication of cancer recurrence, second malignancy, or new cancer diagnosis.

The rate of opioid prescribing was 1.22 times higher among cancer survivors than corresponding matched controls.

Over a 36-month period, the average number of opioid prescriptions filled by cancer survivors was 7.7, compared with 6.3 for controls.

This increased rate of opioid prescribing was also seen among survivors who were 10 or more years past their cancer diagnosis.

Individuals with lower income and those who were younger, from rural neighborhoods, and with more comorbidities had significantly higher prescribing rates. Sex was not associated with prescribing rates.

“Our research findings raise concerns about the diagnosis and management of chronic pain problems among survivors stemming from their cancer diagnosis or treatment,” Dr Sutradhar said. “Physicians providing primary care to cancer survivors should consider close examination of reasons for continued opioid use to differentiate chronic pain from dependency.”

Photo courtesy of the CDC

A study of residents in Ontario, Canada, showed that opioid prescription use was more common in cancer survivors than in individuals without a history of cancer.

This was true even among survivors who were 10 or more years past their cancer diagnosis.

Rinku Sutradhar, PhD, of the University of Toronto in Ontario, Canada, and her colleagues reported these findings in Cancer.

The researchers said little is known about prescribing opioids to relieve pain in individuals who have survived cancer.

To investigate, the team looked at opioid prescribing among residents of Ontario, Canada, with and without a history of cancer.

The study included 8601 adults who were at least 5 years past a cancer diagnosis. These subjects were were matched with 8601 individuals without a prior cancer diagnosis. The subjects were matched based on sex and calendar year of birth.

The researchers looked for opioid prescriptions filled at a pharmacy during the observation period. Follow-up was stopped at any indication of cancer recurrence, second malignancy, or new cancer diagnosis.

The rate of opioid prescribing was 1.22 times higher among cancer survivors than corresponding matched controls.

Over a 36-month period, the average number of opioid prescriptions filled by cancer survivors was 7.7, compared with 6.3 for controls.

This increased rate of opioid prescribing was also seen among survivors who were 10 or more years past their cancer diagnosis.

Individuals with lower income and those who were younger, from rural neighborhoods, and with more comorbidities had significantly higher prescribing rates. Sex was not associated with prescribing rates.

“Our research findings raise concerns about the diagnosis and management of chronic pain problems among survivors stemming from their cancer diagnosis or treatment,” Dr Sutradhar said. “Physicians providing primary care to cancer survivors should consider close examination of reasons for continued opioid use to differentiate chronic pain from dependency.”

Photo courtesy of the CDC

A study of residents in Ontario, Canada, showed that opioid prescription use was more common in cancer survivors than in individuals without a history of cancer.

This was true even among survivors who were 10 or more years past their cancer diagnosis.

Rinku Sutradhar, PhD, of the University of Toronto in Ontario, Canada, and her colleagues reported these findings in Cancer.

The researchers said little is known about prescribing opioids to relieve pain in individuals who have survived cancer.

To investigate, the team looked at opioid prescribing among residents of Ontario, Canada, with and without a history of cancer.

The study included 8601 adults who were at least 5 years past a cancer diagnosis. These subjects were were matched with 8601 individuals without a prior cancer diagnosis. The subjects were matched based on sex and calendar year of birth.

The researchers looked for opioid prescriptions filled at a pharmacy during the observation period. Follow-up was stopped at any indication of cancer recurrence, second malignancy, or new cancer diagnosis.

The rate of opioid prescribing was 1.22 times higher among cancer survivors than corresponding matched controls.

Over a 36-month period, the average number of opioid prescriptions filled by cancer survivors was 7.7, compared with 6.3 for controls.

This increased rate of opioid prescribing was also seen among survivors who were 10 or more years past their cancer diagnosis.

Individuals with lower income and those who were younger, from rural neighborhoods, and with more comorbidities had significantly higher prescribing rates. Sex was not associated with prescribing rates.

“Our research findings raise concerns about the diagnosis and management of chronic pain problems among survivors stemming from their cancer diagnosis or treatment,” Dr Sutradhar said. “Physicians providing primary care to cancer survivors should consider close examination of reasons for continued opioid use to differentiate chronic pain from dependency.”

Micrograph showing DLBCL

Results from the SCHOLAR-1 study revealed poor outcomes of salvage therapy in patients with refractory diffuse large B-cell lymphoma (DLBCL).

This retrospective study included data on patients enrolled in 2 randomized trials and 2 academic databases.

The patients had primary refractory disease, were refractory to second-line or later therapy, or had relapsed within 12 months of autologous stem cell transplant (ASCT).

Twenty-six percent of patients responded to salvage therapy, with 7% achieving a complete response (CR).

The median overall survival (OS) was 6.3 months, and 20% of patients were still alive at 2 years’ follow-up.

Christian Gisselbrecht, MD, of Saint Louis Hospital in Paris, France, and his colleagues reported these findings in Blood. SCHOLAR-1 was funded through an unrestricted grant from Kite Pharma.

“SCHOLAR-1 demonstrates the uniformly poor treatment outcomes for patients with aggressive non-Hodgkin lymphoma and emphasizes the need for breakthrough therapies for these refractory patients,” Dr Gisselbrecht said.

Patient characteristics

The study included pooled, patient-level data from 2 phase 3 trials and 2 databases:

• The Canadian Cancer Trials Group study LY.12 (n=219)
• The Lymphoma Academic Research Organization’s CORAL study  (n=170)
• A cohort from MD Anderson Cancer Center (n=165)
• A cohort from the Molecular Epidemiology Resource of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (n=82).

There were a total of 636 patients who met criteria for refractory DLBCL, which included primary mediastinal B-cell lymphoma and transformed follicular lymphoma.

Twenty-eight percent of patients were primary refractory, 50% were refractory to second-line or later therapy, and 22% had relapsed within 12 months of transplant.

The patients’ median age was 55 (range, 19-81), and 64% were male. Seventy-three percent had an ECOG performance status of 0-1, 14% had a status of 2-4, and 13% were missing this data. Seventy-two percent of patients had stage III-IV disease, 27% had stage I-II disease, and less than 1% were missing this data.

Treatments

The MD Anderson cohort included patients who were relapsed/refractory to initial rituximab-containing chemotherapy, had failed salvage platinum-containing chemotherapy, and received a second salvage therapy at MD Anderson.

The University of Iowa/Mayo Clinic cohort included unselected, newly diagnosed patients with lymphoma who entered prospective documentation of primary and subsequent treatments and outcomes.

In the LY.12 study, patients were enrolled upon relapse after anthracycline-containing therapy and randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

The CORAL study enrolled patients in their first relapse or whose lymphoma was refractory to first-line therapy. They were randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

In the LY.12 and CORAL studies, eligible patients with CD20+ lymphoma were randomized to rituximab maintenance or observation post-ASCT.

Response

In all, 523 patients were evaluated for response. The overall response rate (ORR) was 26%, with a 7% CR rate and an 18% partial response rate.

Among patients with primary refractory disease, the ORR was 20%, and the CR rate was 3%.

Among patients who were refractory to second-line or later therapy, the ORR was 26%, and the CR rate was 10%.

Among patients who relapsed after transplant, the ORR was 34%, and the CR rate was 15%.

Survival

A total of 603 patients were evaluated for survival.

The median OS from the start of salvage therapy was 6.3 months (range, 5.9-7.0). The 1-year OS rate was 28%, and the 2-year OS was 20%.

Among primary refractory patients, the median OS was 7.1 months (range, 6.0-8.1), 1-year OS was 29%, and 2-year OS was 24%.

Among patient who were refractory to second-line or later therapy, the median OS was 6.1 months (range, 5.2-7.0), 1-year OS was 26%, and 2-year OS was 17%.

Among patients who relapsed after transplant, the median OS was 6.2 months (range, 5.2-7.6), 1-year OS was 32%, and 2-year OS was 19%.

“Although 60% to 70% of non-Hodgkin lymphoma patients survive 5 years after rituximab-based chemotherapy and autologous stem cell transplant, nearly half of them either do not respond or relapse shortly after transplant,” Dr Gisselbrecht noted.

“SCHOLAR-1 provides a rigorous measure of outcomes for these patients who do not benefit from currently available therapies, and this landmark study will serve as an important historical control for evaluating new therapeutic candidates in the field of non-Hodgkin lymphoma.”

Micrograph showing DLBCL

Results from the SCHOLAR-1 study revealed poor outcomes of salvage therapy in patients with refractory diffuse large B-cell lymphoma (DLBCL).

This retrospective study included data on patients enrolled in 2 randomized trials and 2 academic databases.

The patients had primary refractory disease, were refractory to second-line or later therapy, or had relapsed within 12 months of autologous stem cell transplant (ASCT).

Twenty-six percent of patients responded to salvage therapy, with 7% achieving a complete response (CR).

The median overall survival (OS) was 6.3 months, and 20% of patients were still alive at 2 years’ follow-up.

Christian Gisselbrecht, MD, of Saint Louis Hospital in Paris, France, and his colleagues reported these findings in Blood. SCHOLAR-1 was funded through an unrestricted grant from Kite Pharma.

“SCHOLAR-1 demonstrates the uniformly poor treatment outcomes for patients with aggressive non-Hodgkin lymphoma and emphasizes the need for breakthrough therapies for these refractory patients,” Dr Gisselbrecht said.

Patient characteristics

The study included pooled, patient-level data from 2 phase 3 trials and 2 databases:

• The Canadian Cancer Trials Group study LY.12 (n=219)
• The Lymphoma Academic Research Organization’s CORAL study  (n=170)
• A cohort from MD Anderson Cancer Center (n=165)
• A cohort from the Molecular Epidemiology Resource of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (n=82).

There were a total of 636 patients who met criteria for refractory DLBCL, which included primary mediastinal B-cell lymphoma and transformed follicular lymphoma.

Twenty-eight percent of patients were primary refractory, 50% were refractory to second-line or later therapy, and 22% had relapsed within 12 months of transplant.

The patients’ median age was 55 (range, 19-81), and 64% were male. Seventy-three percent had an ECOG performance status of 0-1, 14% had a status of 2-4, and 13% were missing this data. Seventy-two percent of patients had stage III-IV disease, 27% had stage I-II disease, and less than 1% were missing this data.

Treatments

The MD Anderson cohort included patients who were relapsed/refractory to initial rituximab-containing chemotherapy, had failed salvage platinum-containing chemotherapy, and received a second salvage therapy at MD Anderson.

The University of Iowa/Mayo Clinic cohort included unselected, newly diagnosed patients with lymphoma who entered prospective documentation of primary and subsequent treatments and outcomes.

In the LY.12 study, patients were enrolled upon relapse after anthracycline-containing therapy and randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

The CORAL study enrolled patients in their first relapse or whose lymphoma was refractory to first-line therapy. They were randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

In the LY.12 and CORAL studies, eligible patients with CD20+ lymphoma were randomized to rituximab maintenance or observation post-ASCT.

Response

In all, 523 patients were evaluated for response. The overall response rate (ORR) was 26%, with a 7% CR rate and an 18% partial response rate.

Among patients with primary refractory disease, the ORR was 20%, and the CR rate was 3%.

Among patients who were refractory to second-line or later therapy, the ORR was 26%, and the CR rate was 10%.

Among patients who relapsed after transplant, the ORR was 34%, and the CR rate was 15%.

Survival

A total of 603 patients were evaluated for survival.

The median OS from the start of salvage therapy was 6.3 months (range, 5.9-7.0). The 1-year OS rate was 28%, and the 2-year OS was 20%.

Among primary refractory patients, the median OS was 7.1 months (range, 6.0-8.1), 1-year OS was 29%, and 2-year OS was 24%.

Among patient who were refractory to second-line or later therapy, the median OS was 6.1 months (range, 5.2-7.0), 1-year OS was 26%, and 2-year OS was 17%.

Among patients who relapsed after transplant, the median OS was 6.2 months (range, 5.2-7.6), 1-year OS was 32%, and 2-year OS was 19%.

“Although 60% to 70% of non-Hodgkin lymphoma patients survive 5 years after rituximab-based chemotherapy and autologous stem cell transplant, nearly half of them either do not respond or relapse shortly after transplant,” Dr Gisselbrecht noted.

“SCHOLAR-1 provides a rigorous measure of outcomes for these patients who do not benefit from currently available therapies, and this landmark study will serve as an important historical control for evaluating new therapeutic candidates in the field of non-Hodgkin lymphoma.”

Micrograph showing DLBCL

Results from the SCHOLAR-1 study revealed poor outcomes of salvage therapy in patients with refractory diffuse large B-cell lymphoma (DLBCL).

This retrospective study included data on patients enrolled in 2 randomized trials and 2 academic databases.

The patients had primary refractory disease, were refractory to second-line or later therapy, or had relapsed within 12 months of autologous stem cell transplant (ASCT).

Twenty-six percent of patients responded to salvage therapy, with 7% achieving a complete response (CR).

The median overall survival (OS) was 6.3 months, and 20% of patients were still alive at 2 years’ follow-up.

Christian Gisselbrecht, MD, of Saint Louis Hospital in Paris, France, and his colleagues reported these findings in Blood. SCHOLAR-1 was funded through an unrestricted grant from Kite Pharma.

“SCHOLAR-1 demonstrates the uniformly poor treatment outcomes for patients with aggressive non-Hodgkin lymphoma and emphasizes the need for breakthrough therapies for these refractory patients,” Dr Gisselbrecht said.

Patient characteristics

The study included pooled, patient-level data from 2 phase 3 trials and 2 databases:

• The Canadian Cancer Trials Group study LY.12 (n=219)
• The Lymphoma Academic Research Organization’s CORAL study  (n=170)
• A cohort from MD Anderson Cancer Center (n=165)
• A cohort from the Molecular Epidemiology Resource of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (n=82).

There were a total of 636 patients who met criteria for refractory DLBCL, which included primary mediastinal B-cell lymphoma and transformed follicular lymphoma.

Twenty-eight percent of patients were primary refractory, 50% were refractory to second-line or later therapy, and 22% had relapsed within 12 months of transplant.

The patients’ median age was 55 (range, 19-81), and 64% were male. Seventy-three percent had an ECOG performance status of 0-1, 14% had a status of 2-4, and 13% were missing this data. Seventy-two percent of patients had stage III-IV disease, 27% had stage I-II disease, and less than 1% were missing this data.

Treatments

The MD Anderson cohort included patients who were relapsed/refractory to initial rituximab-containing chemotherapy, had failed salvage platinum-containing chemotherapy, and received a second salvage therapy at MD Anderson.

The University of Iowa/Mayo Clinic cohort included unselected, newly diagnosed patients with lymphoma who entered prospective documentation of primary and subsequent treatments and outcomes.

In the LY.12 study, patients were enrolled upon relapse after anthracycline-containing therapy and randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

The CORAL study enrolled patients in their first relapse or whose lymphoma was refractory to first-line therapy. They were randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

In the LY.12 and CORAL studies, eligible patients with CD20+ lymphoma were randomized to rituximab maintenance or observation post-ASCT.

Response

In all, 523 patients were evaluated for response. The overall response rate (ORR) was 26%, with a 7% CR rate and an 18% partial response rate.

Among patients with primary refractory disease, the ORR was 20%, and the CR rate was 3%.

Among patients who were refractory to second-line or later therapy, the ORR was 26%, and the CR rate was 10%.

Among patients who relapsed after transplant, the ORR was 34%, and the CR rate was 15%.

Survival

A total of 603 patients were evaluated for survival.

The median OS from the start of salvage therapy was 6.3 months (range, 5.9-7.0). The 1-year OS rate was 28%, and the 2-year OS was 20%.

Among primary refractory patients, the median OS was 7.1 months (range, 6.0-8.1), 1-year OS was 29%, and 2-year OS was 24%.

Among patient who were refractory to second-line or later therapy, the median OS was 6.1 months (range, 5.2-7.0), 1-year OS was 26%, and 2-year OS was 17%.

Among patients who relapsed after transplant, the median OS was 6.2 months (range, 5.2-7.6), 1-year OS was 32%, and 2-year OS was 19%.

“Although 60% to 70% of non-Hodgkin lymphoma patients survive 5 years after rituximab-based chemotherapy and autologous stem cell transplant, nearly half of them either do not respond or relapse shortly after transplant,” Dr Gisselbrecht noted.

“SCHOLAR-1 provides a rigorous measure of outcomes for these patients who do not benefit from currently available therapies, and this landmark study will serve as an important historical control for evaluating new therapeutic candidates in the field of non-Hodgkin lymphoma.”

More than a quarter of the patients in palliative care have a primary diagnosis of cancer, according to the Center to Advance Palliative Care.

A survey of 351 palliative care programs showed that 27% of their patients had been diagnosed with cancer in 2016, more than twice as many patients who had a cardiac (13%) or pulmonary (12%) diagnosis. The next most common primary diagnosis category in 2016 was neurologic at 8%, with a tie at 6% between diagnoses classified as infectious or complex chronic, followed by patients with dementia at 5%, Maggie Rogers and Tamara Dumanovsky, PhD, of the CAPC reported.

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More than a quarter of the patients in palliative care have a primary diagnosis of cancer, according to the Center to Advance Palliative Care.

A survey of 351 palliative care programs showed that 27% of their patients had been diagnosed with cancer in 2016, more than twice as many patients who had a cardiac (13%) or pulmonary (12%) diagnosis. The next most common primary diagnosis category in 2016 was neurologic at 8%, with a tie at 6% between diagnoses classified as infectious or complex chronic, followed by patients with dementia at 5%, Maggie Rogers and Tamara Dumanovsky, PhD, of the CAPC reported.

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More than a quarter of the patients in palliative care have a primary diagnosis of cancer, according to the Center to Advance Palliative Care.

A survey of 351 palliative care programs showed that 27% of their patients had been diagnosed with cancer in 2016, more than twice as many patients who had a cardiac (13%) or pulmonary (12%) diagnosis. The next most common primary diagnosis category in 2016 was neurologic at 8%, with a tie at 6% between diagnoses classified as infectious or complex chronic, followed by patients with dementia at 5%, Maggie Rogers and Tamara Dumanovsky, PhD, of the CAPC reported.

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The Food and Drug Administration announced a safety alert on Aug. 10, 2017, for liquid-filled intragastric balloon systems, as they have caused five reports of unanticipated deaths that occurred from 2016 to present in patients.

The cause or incidence of patient death is still unknown, and the FDA has not been able to definitively attribute the deaths to the devices or the insertion procedures for these devices. All five reports show that patient deaths occurred within a month or less of balloon placement. In three of the reports, death occurred as soon as 1-3 days after balloon placement. The FDA has also received two additional reports of deaths in the same time period related to potential complications associated with balloon treatment.

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The Food and Drug Administration announced a safety alert on Aug. 10, 2017, for liquid-filled intragastric balloon systems, as they have caused five reports of unanticipated deaths that occurred from 2016 to present in patients.

The cause or incidence of patient death is still unknown, and the FDA has not been able to definitively attribute the deaths to the devices or the insertion procedures for these devices. All five reports show that patient deaths occurred within a month or less of balloon placement. In three of the reports, death occurred as soon as 1-3 days after balloon placement. The FDA has also received two additional reports of deaths in the same time period related to potential complications associated with balloon treatment.

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The Food and Drug Administration announced a safety alert on Aug. 10, 2017, for liquid-filled intragastric balloon systems, as they have caused five reports of unanticipated deaths that occurred from 2016 to present in patients.

The cause or incidence of patient death is still unknown, and the FDA has not been able to definitively attribute the deaths to the devices or the insertion procedures for these devices. All five reports show that patient deaths occurred within a month or less of balloon placement. In three of the reports, death occurred as soon as 1-3 days after balloon placement. The FDA has also received two additional reports of deaths in the same time period related to potential complications associated with balloon treatment.

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