For all members and friends of the Southwest Oncology Group, the SWOG Update will keep you informed of what's happening with the Group. News to report? Send it to communications@swog.org.
How should we spell success?
Questions of how we define success in cancer research and how costs should factor into that definition have been much in the news.
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S0702: Zoledronic acid and ONJ risk
Patients taking zoledronic acid seem to face an increased risk of osteonecrosis of the jaw, or ONJ. S0702 seeks answers.
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S0715: Does ALC prevent neuropathy?
Pain and numbness in hands and feet is a common side effect of taxane-based chemotherapy. Can the dietary supplement acetyl-L-carnitine prevent it?
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The War on Cancer: Raise the bar, or move the goal line?
Plenary Session SWOG Fall 2009 Group Meeting
Friday, October 23, 12:15 - 2:45 pm
Gold Level, Regency B - D
Hyatt Regency Chicago
SWOG Spotlight: Comparative effectiveness
NCI GO grant charts comparative effectiveness research course for SWOG
A $4 million National Cancer Institute (NCI) grant will help position the Southwest Oncology Group as a national leader in comparative effectiveness research on cancer.
The Grand Opportunities (GO) award supports the development of the Center for Comparative Effectiveness Research in Cancer Genomics, or CANCERGEN, under the direction of Scott Ramsey, MD, PhD, of the Fred Hutchinson Cancer Research Center in Seattle. Researchers at the University of Washington, Cancer Research And Biostatistics (CRAB) in Seattle, and the Center for Medical Technology Policy in Baltimore will co-lead the effort.
CANCERGEN will create a comprehensive evaluation, assessment, and design process to identify which emerging cancer genomics technologies are the best candidates for studies by SWOG's clinical trials network.
"CANCERGEN will provide us objective tools to determine which proposed trials are most likely to have a significant clinical benefit for patients," says SWOG Group Chair Laurence H. Baker, D.O., "and we will commit to doing only those trials that meet this new standard."
Comparative effectiveness research, or CER, has gained national attention and a surge of federal stimulus funding because it is seen as a means of slowing the growth of runaway health care costs in the U.S. by moving the system away from expensive but less effective treatments.
A recent Institute of Medicine report on comparative effectiveness research has influenced many of the health care reform packages now wending their way through the U.S Congress.
"Realizing [CANCERGEN's] vision will go a long way to help achieve the health care reform goal of making cancer treatment more effective and less expensive," says the Hutchinson's Ramsey.
The first SWOG clinical trial to be supported under CANCERGEN will assess whether a genetic test known as the Oncotype DX assay can predict which patients with node-positive breast cancer -- breast cancer that has spread to their lymph nodes -- will benefit from chemotherapy and which patients will not.
The study was one of five comparative effectiveness trial proposals NCI Director John Niederhuber, MD, submitted to the National Institutes of Health in January of 2009 as candidates for federal stimulus funding. It is expected to serve as a model for future comparative effectiveness studies of cancer genomics technologies.
S0930: CANCERGEN's first trial?
The Oncotype DX genetic assay is now routinely used to test the tumors of patients whose breast cancer has not spread to their lymph nodes -- node-negative breast cancer. By measuring the expression or activity level of 21 specific genes within the tumor, the assay helps oncologists decide on treatment options by predicting whether a patient is likely to benefit from a course of chemotherapy.
S0930 is a proposed nationwide phase III clinical trial to determine whether this genetic test has the same predictive value for patients with node-positive breast cancer -- those whose cancer has spread to their lymph nodes. In 2008 about one-third of the 184,000 women diagnosed with breast cancer in the U.S. had cancer that had spread to their lymph nodes.
The genetic assay is expensive, costing about $3,500 per test. Yet the chemotherapy treatment now routinely given to node-positive breast cancer patients costs on the order of $50,000 per year. If the Oncotype DX assay does prove to predict which patients with node-positive breast cancer will see no benefit from this chemotherapy, it could spare thousands of women the grisly effects of a course of chemotherapy that will not help lengthen their life, while at the same time saving hundreds of millions of dollars in health care costs each year.
Chair's Corner
How should we spell success?
Questions of how we define success in cancer research and how costs should factor into that definition have been much in the news.
In considering this debate (which will be engaged at the plenary session of this fall's Group Meeting), I was struck by a commentary in the August 5th Journal of the National Cancer Institute titled "How Much Is Life Worth."
If you haven't seen it, I suggest you read and consider.
Reflecting on these issues in light of the summary statement that came from the NCI committee reviewing our treatment grant raises two questions SWOG needs to tackle:
1. How do we avoid starting phase III studies that we can't complete or that are very slow to accrue?
2. How do we ensure that new ideas come forward from the laboratory that have the potential to change the care and improve the outcome of cancer patients?
When we discussed these questions at SWOG's Executive Summit in Seattle last month, we came to something of a consensus on two ideas.
First, our Statistical Center will routinely provide data for each proposed study that cites our prior experiences with that patient population. Some of our committees already have this information when making their decisions, but these data will soon be part of all SWOG concept submissions, which should help us more accurately estimate of the length of time needed to complete accrual for any proposed trial.
Second, we propose that all new phase III trial concepts have a statement within the primary objective that defines the target difference between the experimental and control arms as a clinically significant difference, not just a p value or hazard ratio.
We will leave it to each committee to determine what endpoint is clinically significant.
As you plan for the Chicago meeting, give thought to these proposals. We will discuss them further at the committee chairs meeting scheduled for Saturday, October 24, 2009.
I look forward to seeing you all at the plenary session to debate these issues!
Federal stimulus funding reaches SWOG trials
NCI grant to integrate patients with HIV into S0816
S0816 has received additional NCI funds to support the participation of cancer patients who are HIV-positive. The funding comes as part of an NCI initiative to integrate the HIV patient population into cancer clinical trials, where possible.
Sites can receive up to $4,000 in additional funding for each HIV-positive patient they enroll to S0816.
The Southwest Oncology Group has received its first awards from NIH grant programs set up to distribute funding from the American Recovery and Reinvestment Act of 2009 (ARRA), the federal government's economic stimulus program.
The NCI's ACTNOW (Accelerating Clinical Trials of Novel Oncologic Pathways) program awarded two $800,000 grants to support imaging components in two recently launched SWOG trials.
The first is S0816, a phase II advanced Hodgkin lymphoma study incorporating centralized review of PET scans to determine adaptation of treatment, which opened in July. S0816 is an intergroup study with CALGB and ECOG.
The second ACTNOW grant went to S0800, a neoadjuvant trial for breast cancer, activated in September, that incorporates a centralized review of diffusion MRI scans.
Study Update
S0702: Observational study of osteonecrosis of the jaw (ONJ) in patients with metastatic bone disease starting zoledronic acid
Patients whose cancer has spread to their bones often use bisphosphonates to reduce their risk of fracture. Some studies have shown that such patients have an increased risk of ONJ, in which areas of jawbone die.
ONJ can cause swelling of the jaw's soft tissues, pain, infection, loosening of the teeth, drainage, and exposed jawbone. It generally occurs after a tooth extraction or some other trauma to the jaw, and treatment is difficult and often unsuccessful.
Catherine Van Poznak, M.D., study coordinator of S0702
(Photo: UMHS)
SWOG study S0702 will measure this ONJ risk among patients with cancer getting the bisphosphonate drug most widely used in cancer treatment in the U.S. -- zoledronic acid, also known by the brand name Zometa.
"The overall risk of ONJ in patients with bone metastases treated with intravenous bisphosphonates appears to range between one and ten percent," says study coordinator Catherine Van Poznak, M.D., of the University of Michigan Medical School.
"S0702 will refine our understanding of the incidence, risk factors, clinical presentation, and natural history of ONJ in patients starting zoledronic acid treatment."
To do so, S0702 will recruit 7,000 patients who will be followed for three years, with dental and medical checkups every six months. Those who do develop ONJ will be examined every three months. S0702 is an observational study and does not dictate care of the study participants.
Patients with bone metastases of myeloma, solid tumor, or other malignancies who are just starting treatment with zoledronic acid may be eligible.
Those with a prior history of ONJ or who have had radiation therapy to the jaw are not eligible. Please review the detailed eligibility requirements .
Eligible patients can find the nearest participating institution online or by contacting the Southwest Oncology Group at (210) 614-8808 or at protocols@swog.org.
Sites are paid $1,250 per initial patient enrollment and $125 twice-yearly with submission of follow-up forms. Each form confirming a case of ONJ brings a site an additional $1,250 plus $250 for quarterly follow-up forms.
Additional funding is available to assist in covering the cost of the dental exams and care for uninsured or underinsured participants.
The SWOG Clinical Trials Initiative (SWOG-CTI) supports this study.
Study Update
S0715 launched: Does the supplement ALC prevent neuropathy?
A common side effect of taxane-based chemotherapy is peripheral neuropathy, a feeling of pain or numbness in the patient's extremities. The newly activated S0715 is testing the effectiveness of a dietary supplement -- acetyl L-carnitine, or ALC -- in reducing this side effect in breast cancer patients. It is also looking at the usefulness of ALC in reducing fatigue caused by such chemotherapy.
Dawn Hershman, M.D., study coordinator of S0715
(Photo: The Hope Foundation)
The study, "Randomized placebo-controlled trial of acetyl L-carnitine for the prevention of taxane induced neuropathy," is being led by Dawn Hershman, M.D., of Columbia University, who is also co-chair of SWOG's Health Disparities & Outcomes Committee.
"The study is the first of its kind for SWOG," Hershman says, "because we are using a dietary supplement and are looking at both early and late toxicity from a therapy."
Neurotoxicity develops in more than half of all patients treated with taxanes, with about half of that number developing moderate to severe neurotoxicity. ALC is a naturally occurring compound that enhances neuronal response to nerve growth factor and has been shown to be effective in mice and rats treated with taxanes, reducing neuropathic side-effects without diminishing the taxanes' antitumor activity.
ALC also showed promise in cancer patients in an earlier phase II study and has been used to improve neuropathy caused by diabetes and HIV.
With an accrual goal of 380 patients, S0715 is open to women with primary invasive adenocarcinoma of the breast with no evidence of metastatic disease who have undergone surgery and are slated to receive one of five standard taxane-based chemotherapy regimens. Please review the detailed eligibility criteria.
Eligible institutions include SWOG members, affiliates, CCOPs, and medical oncology practices.
All patients will be offered the option of having their specimens banked for future translational medicine studies.
Eligible patients can find the nearest participating institution online or by contacting the Southwest Oncology Group at (210) 614-8808 or at protocols@swog.org.
Rick Bangs is new SWOG Patient Advocate for bladder cancer
Rick Bangs, new SWOG patient advocate for bladder cancer
Rick Bangs is replacing Diane Zipursky Quale as SWOG's bladder cancer advocate with the Genitourinary Committee. Rick is a bladder cancer and prostate cancer survivor and is a volunteer advocate with the Bladder Cancer Advocacy Network (BCAN). He also volunteers with the University of Michigan Bladder Cancer Support Group.
His stated interests in advocacy include making more effective use of information technology and the Internet in patient advocacy and patient care, and increasing bladder cancer research funding to be commensurate with its impact on the U.S. health care system.
He has 25 years of IT and marketing experience.
2009 Young Investigators convene in Seattle
Five talented young physicians attended the three-day SWOG Young Investigators Training Course last month in Seattle for intensive training in how to design and conduct cancer clinical trials.
"These are cancer researchers who have trained extensively in laboratory and clinical work," said Laurence H. Baker, D.O., SWOG group chair. "This workshop gives them the tools to bring all of that together to design, implement, and manage an effective clinical trial that may involve hundreds of patients at dozens of institutions throughout North America."
Experienced clinical investigators, statisticians, and research coordinators from SWOG worked with the Young Investigators, providing training in statistical principles, data collection and analysis, and critical decision-making. Many of the trials developed in previous workshops have since been launched as phase II or phase III studies with National Cancer Institute funding.
The 2009 SWOG Young Investigators are as follows:
Neeraj Agarwal, M.D., Huntsman Cancer Institute, University of Utah:
Agarwal proposed a phase II clinical trial to test the agent cediranib, a pan-VEGF inhibitor, in treating patients with metastatic prostate cancer whose disease has progressed on first-line therapy with docetaxel. Agarwal's trial would compare patients receiving mitoxantrone either with or without cediranib with the goal of significantly improving progression free survival in this setting.
"My research experience has convinced me that only an integration of bench research with clinical research can lead to the design of truly original clinical trials that will lead to a better understanding of disease patho-physiology and treatment," says Agarwal. "Achieving an ideal mix of this remains my ultimate goal."
Eduardo Gharzouzi, M.D., Guatemalan Cancer Institute, Instituto de Cancerologia:
As an oncologist in a country where 80 percent of cancer patients are diagnosed when their disease is at an advanced stage, and in which almost all of those patients are without the resources to pay for a full course of cancer treatment, Gharzouzi has a longer-term goal of establishing a clinical research center at the Instituto de Cancerologia in his home country of Guatemala.
He has proposed a phase III trial testing the use of cetuximab to treat gastric cancer, one of the most common cancers in Latin America. The trial would compare outcomes in patients with advanced gastric cancer treated with a standard course of oxaliplatin, capecitabine, and radiotherapy either with or without cetuximab.
Gharzouzi writes that in addition to his interest in the new drugs, regimens, and modalities of treatment that grow from clinical trials, he is also excited about being able, as part of clinical trials, to offer his patients treatment they might otherwise never get.
Reshma Jagsi, M.D., D.Phil., University of Michigan:
Jagsi has proposed a prospective observational study looking at the outcomes of breast reconstruction in patients who receive post-mastectomy radiation therapy. "Federal law now mandates insurer coverage of breast reconstructive surgery, and with radiation now an established component of cancer care in a substantial proportion of mastectomy patients, the number of patients undergoing both treatments is likely to increase," Jagsi says. "Yet little high-quality evidence exists regarding the optimal sequencing of these treatments, with some women offered immediate reconstruction at the time of mastectomy and others counseled to wait until after radiation is complete." Jagsi's study will gather data on patient satisfaction with cosmetic outcomes and decision-making, as well as complication rates, among patients undergoing immediate versus delayed reconstruction procedures.
Dipen J. Parekh, M.D., University of Texas Health Science Center San Antonio:
As director of robotic surgery in the Department of Urology at his institution, Parekh has proposed a trial to compare the effectiveness of robot-assisted surgery with open surgery in performing radical cystectomy for invasive bladder cancer.
"Routine use of robotic surgery can only be justified if it leads to significant benefits in improving patient recovery," says Parekh, "with superior or at least equal oncologic outcomes."
His pilot study would assess and compare functional recovery and independence rates of robotic surgery patients to those of open surgery patients. It would also give researchers important data to use in establishing statistical benchmarks that would inform the design of a larger, more definitive trial.
Brian Till, M.D., University of Washington and Fred Hutchinson Cancer Research Center:
Mantle cell lymphoma (MCL) carries perhaps the worst prognosis among all subtypes of non-Hodgkin lymphoma, with the majority of cases presenting at an advanced stage and considered incurable. Citing studies that show a synergistic effect of the drugs bendamustine and rituximab, Till has proposed a phase II trial to test the impact of these two drugs combined with bortezomib on the progression-free survival of patients with relapsed MCL.
"Mantle cell lymphoma, unlike some types of lymphoma that can be cured with chemotherapy alone, is difficult to treat," says Till. "New therapies are clearly needed, and this is a challenge that appeals to me as an investigator."
Costs of the Young Investigator program are paid for with a gift from the Hope Foundation.
Megan Othus, PhD, joins SWOG as statistician for melanoma and leukemia
Megan Othus, Ph.D., new SWOG faculty statistician for melanoma and leukemia
SWOG welcomes a new faculty statistician, Megan Othus, PhD, who joined the Group via the Fred Hutchinson Cancer Research Center in Seattle in August.
Megan earned her PhD from Harvard and says she is excited to be returning to the Northwest, where she was raised.
She will be working with the Melanoma and Leukemia Committees. If you also work with one of those committees, please introduce yourself to Megan at the Chicago Group Meeting.
CRAs: The time to OPEN up is here!
As of October 1, 2009, all SWOG sites need to work with the Clinical Trials Support Unit's new Oncology Patient Enrollment Network, or OPEN, to register patients to new trials.
The initial set of trials relying on the OPEN system for all registrations includes SWOG 0777. All S0777 patient registrations must now be done via the OPEN system.
Q modifiers and the role of the Clinical Research Associate
-- by Aermonia Nazaretyan, BS, and Amy DeBlaise, BA, CCRP
As of January 1, 2008, the Centers for Medicare and Medicaid Services (CMS) have created two new modifiers to differentiate between routine and investigational clinical services.
Q0 -- identifies investigational clinical services provided in a clinical research study
Q1 -- identifies routine clinical services provided in a clinical research study
Medicare contractors (hospital, lab, X-ray, physician) for Part A and Part B are required to submit data to CMS to help track the different clinical research services providers are billing to Medicare. Under the new modifier rule, CMS is emphasizing the importance of coordination among providers and study sites.
The Q modifiers will help CMS understand what investigational and routine services are being billed during specific research studies. They'll also help CMS compare different institutions' billing practices for the same research study. This can help hospital corporations build and manage study budgets by standardizing research policy and practice.
Patient scenarios Patient A comes in for an outpatient mammogram that is unrelated to the research study. Do not include modifiers on the line for mammograms. If the claim includes other charges that are part of the research study, identify those charges with the appropriate Q modifiers.
Patient B is in a cancer research study. The sponsor is paying for the drug, and all other charges are standard of care. You should not include the drug since the sponsor pays for it, but report all other charges with Q1 modifiers. (If it is necessary to report the drug in order to suppress system edits, then the drug should be reported with non-covered token charges with any appropriate non-covered modifiers.)
The most common service within cooperative group research is the use of Q1 modifiers for patients on clinical trials that use standard-of-care practice to develop protocol therapy.
Collaboration among providers and physicians Patient C is enrolled in a research study and the hospital identifies this patient as participating in a study. CMS can access this patient's claim form and check to see if the physician is billing accordingly by assigning the same modifiers.
In conclusion, in order to comply with the CMS regulations, providers should consider the following actions:
Develop a process to analyze each research study that sorts the protocol-required services as "investigational" or "routine" clinical service.
Adopt a process to appropriately place modifiers on claims.
Begin a clinical research billing compliance initiative to build safeguards for accurate billing.
Always consult with your organization's Medicare liaison.
Identify studies that are active with multiple sites and collaborate with those sites to organize a guide that identifies which services should be coded as Q0 or Q1. The Southwest Oncology Group should lead this process to develop these guidelines to help CRAs in the field.
News from the Genitourinary Committee
Uro-Oncology New Investigators Course to be held at fall Group Meeting
With the goal of recruiting and developing the next generation of senior investigators, the Genitourinary (GU) Committee has set into motion an aggressive plan to provide opportunities for young GU investigators to lead clinical trials, develop new concepts for trials, and participate in the analysis of completed studies. Toward this end, the GU Committee will conduct its fifth Uro-Oncology New Investigators Course in conjunction with SWOG's Fall Group Meeting in October.
The course is targeted to young clinicians with an interest in participating in Group clinical trials, either in institutional practices or as members of the Urologic Cancer Outreach Program (UCOP). Participation is limited and participants are selected by a review process.
Criteria for inclusion include the following:
faculty level appointment,
potential to participate in Group GU Cancer Committee activities, and/or
potential to open a new UCOP within or outside a Southwest Oncology Group institution.
Participants for this year's course will include the following physicians.
Konstantinos Arnaoutakis, Arkansas
Georg Bartesch, USC UCOP
C. Lance Cowley, Baylor
Atreya Dash, UC Irvine
Nivedita Dhar, Wayne State
Tanya Dorff, USC
Dragan Golijanin, Rochester
Oscar Goodman, Nevada
Julie Graff, Oregon
Christopher Ledbetter, Tennessee
Deva Mahalingam, UTHSCSA
Moben Mirza, Kansas
Sumanta Pal, City of Hope
Stephen Riggs, East Virginia
Michael Woods, Loyola
We welcome and encourage the involvement of these future leaders of the committee.
News from the Nursing Committee
The fall meeting
With the change in economy, we are increasingly being asked to do more with less. This is a problem at all investigative sites, and budgets are very tight.
This fall's Nursing Committee session will focus on these issues and on how to stay afloat in changing economic times. We will address clinical trials billing and the Medicare required coding, as well as budgeting and staffing issues. Siu-Fun Wong, PharmD, and chair of SWOG's Pharmaceutical Sciences Committee, will close the session with a presentation on drug accountability.
Wanted: A few good nurses
The Nursing Committee is looking for nurses interested in leadership positions. We currently have two openings on our Disease & Discipline subcommittee. You would oversee the subcommittee's work, assuring that it is aligned with and contributes to SWOG's mission. The subcommittee reviews protocols and provides nursing input during protocol development, and creates fast fact sheets for trials. It also focuses on cancer control and quality of life. If you are interested, you should have support from your institution to attend at least one Group Meeting a year.
The Nursing Committee welcomes fresh ideas, so consider sharing your time and talent with other SWOG members. Together we can make a difference. For more information, contact Rose Ermete, RN, BSN, at ermeter@trinity-health.org or Marge Good, RN, MPH, at Marge_Good@via-christi.org.
SWOG investigational drug training video a valuable resource
A Pharmaceutical Sciences Committee-produced training video on the proper handling of investigational drugs has become a widely used resource in the field.
The tutorial reviews guidelines from the Manual of Good Clinical Practice, the FDA Code of Federal Regulations, and the NCI-CTEP Requisition and Management of Agents rules.
Since its posting to the SWOG Web site in early June, the 23-minute video has been viewed more than 1,300 times.
Many of those visitors were likely referred to the resource by pointers on other Web sites.
The Pharmaceutical Management Branch of the NCI links to the video as an alternative to its own training module on the subject.
And the Hematology/Oncology Pharmacy Association made the video available as a take-home resource as part of its "Best Practices in Investigational Oncology Pharmacy" session at the organization's 2009 Annual Meeting.
SWOG is also making the video available for use by the other cancer clinical trial cooperative groups, extending its leadership in this area.
"Investigational drug accountability remains one of the most common audit errors," says Pharmaceutical Sciences Committee chair Siu-Fun Wong, PharmD, who oversaw production of the video. "I'm now working with the SWOG Ops Office to see if we can incorporate the tutorial as part of SWOG's quality control program."
... because answers to cancer come from clinical trials ...
The Hope Foundation appreciates your support in realizing our common goal of eradicating cancer.
Through a tailor-made Planned Giving Programs, your gift of Hope can provide income to you and your family, assist with your estate planning, and create a family legacy of supporting cancer research - all the while supporting SWOG programs. Please contact The Hope Foundation if you would like more information on Planned Giving.
At the Fall Group Meeting, all investors in Hope will be entered to win outstanding prizes.
Invest in Hope at this level…
Get a chance at a flexible travel voucher worth …
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$10,000
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Remember, 93% of your contribution is directly invested in SWOG programs.
In this decade alone, over $7 million from The Hope Foundation has been channeled to Southwest Oncology Group clinical research projects, Group meetings, and ongoing professional development.
Donations are being accepted now. The Hope Foundation accepts checks and major credit cards. You can contribute online, by mail, or by phone. Click the button at right to donate online.
Deadline for Coltman Fellowships extended to Oct. 15
The Southwest Oncology Group and the Hope Foundation have extended the application deadlines for the Coltman Fellowship and the Coltman Fellowship in Translational Medicine.
The new application deadline for both is October 15, 2009.
Both fellowships provide $100,000 in support over two years to outstanding young investigators.
Both fund investigators from a current SWOG member institution who have accepted a faculty position.
For each fellowship, the candidate must work with a SWOG mentor who has proven experience in clinical trial recruitment and management.
A member institution may nominate up to two candidates for each fellowship.
SWOG Ops Office to move: New phone and address, same great service
Although the SWOG Operations Office won't move to its new digs until January 1, 2010, you can travel to the future by using their new phone numbers, which are already active.
The old phone numbers will forward to the new until mid-2010.
New Ops Office phone numbers:
210-614-8808
210-614-0006 -- fax
Here's the new Ops Office address as of January 1, 2010:
4201 Medical Drive, Suite 250
San Antonio, TX 78229
E-mail addresses at the Operations Office will not change.
Did you know . . . ?
SWOG's total budget for fiscal year 2008 exceeded $45 million.
SWOG Update going monthly
To make it easier to get time sensitive news to SWOG members and to strengthen the lines of communication within the Group, the SWOG Update newsletter will now be issued monthly.
An issue will go out at the start of each month. The deadline for submissions for each issue will be the 23rd of the previous month.
Questions of how we define success in cancer research and how costs should factor into that definition have been much in the news.
[
Questions of how we define success in cancer research and how costs should factor into that definition have been much in the news.
Although the SWOG Operations Office won't move to its new digs until January 1, 2010, you can travel to the future by using their new phone numbers, which are already active.
SWOG's total budget for fiscal year 2008 exceeded $45 million.
To make it easier to get time sensitive news to SWOG members and to strengthen the lines of communication within the Group, the SWOG Update newsletter will now be issued monthly.
