SIR 2015: Interventional radiologists need to champion UFE

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Interventional radiologists need to be proactive with women, gynecologists, and family healthcare providers about uterine fibroid embolization (UFE) as a treatment option for uterine fibroids. Many women with severe symptoms do not know about the treatment and medical providers are not telling them about it.

This was the message of two presenters at the recent annual meeting in Atlanta of the Society for Interventional Radiology (SIR). Interventional radiologists have the ability to make a major impact in the quality of women’s lives.

An estimated 80% of adult women have uterine fibroids, according to the National Uterine Fibroid Foundation (NUFF) in Colorado Springs. One in four of these women have severe symptoms requiring treatment. Approximately 600,000 hysterectomies are performed annually in the United States, and the NUFF states that between 170,000 to 300,000 of them are because of uterine fibroids. For many cases, UFE offers a minimally invasive alternative without the removal of the uterus and with significantly less recovery time.

John Lipman, M.D. has spent his career as an interventional radiologist focused on this issue, and has performed more than 3,000 UFE procedures. He is director of the Atlanta Interventional Institute and is affiliated with the Center for Image-Guided Procedures at Emory-Adventist Hospital in Smyrna. He believes that over one million women in the U.S. suffer from symptoms including menorrhagia, pelvic pain, and increased urinary frequency because they are of childbearing age and do not want to undergo a hysterectomy.

To formally confirm this, Lipman conducted a survey of patients presenting with uterine fibroids over a 90 day time period in 2014. More than 75% of the 83 patients surveyed said that their gynecologist failed to mention UFE as a potential treatment option initially. “Gynecologists are not uninformed,” Lipman told Applied Radiology. “The ones that don’t inform their patients have a desire to operate which supersedes their obligation to the patient to inform them of all the fibroid treatment options. Unfortunately, I see women every day in my office who tell us that they never heard about UFE from their gynecologist. They say if they had known, they would have sought treatment much earlier.”

“Interventional radiologists must have a dedicated clinic to see, evaluate, and discuss treatment options with patients,” he emphasized.

The radiology department of Massachusetts General Hospital in Boston has done just that. In 2013, it established the MGH Integrated Program for Fibroids (IPF), with its first clinic patient seen in January 2014. The clinic is staffed by a multidisciplinary team of interventional radiologists, gynecologists, minimally invasive gynecologic surgeons, radiologists, and infertility specialists treat fibroid patients. The goal is to provide one point of access to a full spectrum of care management options and customized care.

Melissa Chittle, physician assistant in interventional radiology, reported about 356 patients who were referred to Massachusetts General Hospital for a consultation about “fibroids’ during a 13 month period commencing June 2014. The study group consisted of 205 patients who were referred after the program was implemented, and a matched control group of 151 patients was selected from those seen prior to the program implementation.

“There were no significant differences in demographics and fibroid procedure indications between the two groups. However, referral rates increased significantly once the program was established, from an average 22 women per month over a six month time period to 34 per month over a seven  month time period. Additionally, UFE procedures in the study group were significantly higher than the control group (9.27% of the study group total compared to 3.31% of the control group). Additionally the number of days from consultation to UFE procedure was reduced by more than half for women participating in the program,” Chittle said.

The majority of patients are referred to Mass General’s program by internal primary care physicians and gynecologists. Others are self-referrals who have seen the website or learned of the program from friends. Chittle said that a multi-media marketing campaign was conducted to promote the program. In addition to patient education materials including videos and brochures, a website was created as well as a Facebook site.

Chittle told Applied Radiology that “launching the program was meant to be a way for patients to be conveniently educated about the range of treatment options – not just UFE – and to provide them with the information and tools necessary for them to choose a treatment aligned with their values and treatment goals. The specialists in this multidisciplinary team have a collaborative, noncompetitive, trusting relationship. They work together to educate patients and empower them to be able to intelligently make decisions about treatment options that are recommended.”

Chittle also said that the IPF team is considering conducting targeted outreach to area primary care physicians and gynecologists and to potentially host a medical education talk about fibroid treatment options.

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SIR 2015: Interventional radiologists need to champion UFE.  Appl Radiol. 

March 19, 2015
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