What steps can ovarian cancer patients take to advocate for better care? Expert Dr. Kevin Elias explains why it’s essential for patients to play an active role in decisions, highlights the most important questions to ask about available treatment options, and underscores the value of seeking a second opinion.
Dr. Kevin Elias is a gynecologic oncologist and serves as the Lilli and Seth Harris Endowed Chair for Ovarian Cancer Research at the Cleveland Clinic, where he holds academic appointments in Gynecologic Oncology, Obstetrics and Gynecology, and Biomedical Engineering. Learn more about Dr. Elias.
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Transcript
Katherine Banwell:
What are the key questions patients should ask their healthcare team about their treatment options?
Dr. Kevin Elias:
The first question they should ask is, are they a candidate for surgery? Surgery, I tell my patients, should always be at least discussed as an option. The second question is, are they a candidate for a clinical trial?
Again, regardless of where they are in the treatment, there’s a good chance of trials available. And they should ask if there’s a trial, not just at the site where they’re being treated, but perhaps at other sites that might be near them. Sometimes patients are surprised to learn that there might be another center within close proximity to where they live that offers a trial, but it might not be at the primary site where they’re receiving their care.
The third question that patients should always ask is, is there an option to reduce the toxicity of their treatment? We tend to focus a lot about the efficacy of treatments and sometimes not as much on the toxicity. And what we have found is that it’s more important for a patient to be able to get through all of her therapy, rather than to have an overly toxic therapy that the patient receives an incomplete dose of.
Katherine Banwell:
Why is it so important for patients to participate in their care and treatment care options?
Dr. Kevin Elias:
There are several reasons for that. Oftentimes, if a patient doesn’t express interest in something like a clinical trial, a clinician might be reluctant to bring it up. They might think that the patient is simply not willing to consider that as an option. The second is that sometimes, as clinicians, we are not always the most up to date when it comes to which trials are opening or closing at any given moment. So, we may not realize that something new has come down the pike. And so, if patients don’t mention it, then their physician might not be prompted to look at it.
Katherine Banwell:
Dr. Elias, what are some of the factors that maybe prevent patients from getting the care they need?
Dr. Kevin Elias:
One of the significant risk factors for ovarian cancer is having a genetic predisposition to the disease. And one of the challenges with getting genetic testing is that most insurers will only pay for genetic testing for women who have already had cancer, or they have a family member who not only has had cancer themselves but has been diagnosed with a genetic alteration.
So, what that means is that the majority of women who have a genetic predisposition to ovarian cancer are actually unable to get that genetic testing ahead of time in a way that would allow us to perform preventative surgery to prevent the cancer being diagnosed in the first place, or to raise our suspicion that they might have cancer very early when their symptoms start to develop. So, it’s very important that women share their family health history with their providers and advocate for genetic testing if there is any cancer history whatsoever.
The second thing that delays treatment is the importance of seeing a gynecologic oncologist. There are very few gynecologic oncologists spread geographically around the country. In fact, about 90 percent of counties in the United States do not have a gynecologic oncologist. And so, it’s important to ask, whether it’s a primary care physician or a general OB-GYN, about a consultation with a gynecologic oncologist, particularly when it comes to opinions about candidacy for surgical management, as well as for selection of chemotherapy.
Katherine Banwell:
Why should patients consider getting a second opinion with another specialist?
Dr. Kevin Elias:
Sometimes when we look at a patient’s care with a fresh set of eyes, we recognize things that might not have been appreciated the first time. Sometimes there can be differences in opinion when we look at the tissue under the microscope.
Sometimes we can have differences in the radiographic interpretation. Sometimes it’s just a matter of experience. I might have had a patient with a very similar circumstance who responded to a combination of therapy that wouldn’t be inherently obvious to someone who had not seen that same scenario. Particularly whenever someone has a condition which is relatively uncommon or rare, a second opinion is certainly worth doing. But even patients with relatively common conditions, it can be worth it to have a second opinion, simply to make sure there’s consistency among different providers.