Why Should Endometrial Cancer Patients Engage in Their Care?

What role do patients play in their endometrial cancer care and treatment decisions? Gynecological cancer expert Dr. Nita Karnik Lee explains the shared decision-making process and discusses the benefits of engaging in conversations with your healthcare team. 

Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.

 

Related Programs:

What Are Common Endometrial Cancer Health Disparities?

What Are Common Endometrial Cancer Health Disparities?

Tools for Improving Access to Quality Endometrial Cancer Care

Tools for Improving Access to Quality Endometrial Cancer Care

Advances in Endometrial Cancer Treatment and Research

Advances in Endometrial Cancer Screening and Detection


Transcript:

Katherine Banwell:  

Would you define shared decision-making, Dr. Lee? Tell us why it’s so important for patients to engage in their care.  

Dr. Nita Karnik Lee:  

Shared decision-making is sort of the idea model, right? It’s this idea that we want to, as physicians, know what values my patient has, and I want to be able to impart information that I think will be helpful for them to make a decision. Sometimes the decisions are do I want to do surgery or not? Sometimes the decision are do I want to do chemo or continue chemotherapy? Those are very different decisions, and shared decision-making is a way of saying we’re going to have some kind of communication back and forth where I’m like, hey, this is what I think is happening. These are the choices that you have.  

And you telling me, okay, these are the things that I’m worried about. These are the things that align with what I want to do. I think it’s really important, though, to not have physicians put it out as, oh, well, I just let the patient decide, right, because just like when my car breaks down or my lights don’t work at my house and I get an electrician to come and see, I have no idea what they’re talking about.  

I have no concept. I really rely on them to say, well, I don’t know what kind of wire for you to use in my house. I have no idea. So, we really want to be careful that shared decision-making doesn’t turn into a menu of choices that we, the physicians, are actually giving up their role in advising if that makes sense. A lot of shared decision-making is in that relationship of trust and saying I really get this. I get what you’re telling me.  

I have patients, for example, who are on chemotherapy for a recurring disease, either uterine or ovarian cancer, and a lot of times you’re making these decisions of, okay, quality of life, like, what are events that are coming up? Sometimes they don’t always align with what I think is best, but if somebody tells me, you know what, I’m going to do these three cycles, but my son’s wedding is coming up. And I really need a month off beforehand, that aligns for me because I think that’s important, but maybe it’s not the standard.  

And so, kind of really knowing your patient, from my perspective, and also, as patients, not being afraid to say these are my values, and this is what’s really important to me. People will hear it, and they’ll feel better equipped to be able to help you guide those decisions with the caveat that sometimes I’ll say, look, you know what, I’m pretty worried about you. Yes, let’s give you a month off before, but let’s scan right after the wedding and see what’s going on.  

And then we can decide what we’re going to do after that. Or holiday times are oftentimes where I really give people sometimes a break. If they’ve been on chronic chemotherapy, sometimes this is a time where I’d say I’m really worried. I don’t think we can give you a break. People will tell me I know you’re worried about me, but this is really important. And we work together on it. I think it’s knowing the medical background, and then making sure you know what your patient wants, from that perspective.  

Katherine Banwell:  

And having an open line of communication. 

Dr. Nita Karnik Lee:  

Yes. 

Katherine Banwell:  

That’s what you’re saying. 

Dr. Nita Karnik Lee:  

Exactly. I think you hit it on the nail. Having an open line of communication, and not feeling that you need to hold back from that. I think it’s much easier for our whole team. I work really closely with our nurses and PAs, and sometimes one of the nurses will be like, you know what, she really wants to talk to you about this. Sometimes it’ll be maybe not even talking to your doctor first, but talking to the person on your team you feel closest to, to say I’ve been really thinking about this. I know Dr. Lee wants to do this, but this doesn’t align with my kid’s graduation, or my grandkid’s something, and those things are really important to get that open.

Tools for Improving Access to Quality Endometrial Cancer Care

What proactive steps can endometrial patients take to access the best care? Gynecological cancer expert Dr. Nita Karnik Lee walks through self-advocacy steps that may encourage improved patient outcomes. 

Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.

 

Related Programs:

What Are Common Endometrial Cancer Health Disparities?

What Are Common Endometrial Cancer Health Disparities?

Why Should Endometrial Cancer Patients Engage in Their Care?

Why Should Endometrial Cancer Patients Engage in Their Care?

Advances in Endometrial Cancer Treatment and Research

Advances in Endometrial Cancer Screening and Detection


Transcript:

Katherine Banwell:  

How is the medical community dealing with these disparities? How are they handling them? 

Dr. Nita Karnik Lee:  

You know, I think a lot of it is, again, sort of educating. You have to think about you want patient education. You want provider education. Sometimes I have patients who come to me and say, you know what, I reported these symptoms to my doctor, and they said it was nothing, or they told me it was a UTI. So, we often think about, when we’re making an intervention, we want to make sure that providers who are seeing patients first-line are also hearing about this as in their differential diagnosis, and that patients have enough knowledge that they feel really comfortable advocating for themselves. Many of our patients who are cancer survivors will tell us. 

Or when they speak on their own in different ways or say listen to your body, make sure you’re advocating for yourself, and if somebody doesn’t listen, find another doctor. I hate to say it, but you just have to know that those are things that happen. I think structurally, as providers, we have to be really aware of our own biases that we bring to patients and their families and our own health system.  

How are we set up to help people more? I think a lot of it is quick access to care. And so, I think that’s where we try to make some differences in terms of both policy and policy within a health system, and then larger policy that’s kind of maybe more not just one hospital, but statewide or nationwide.  

Katherine Banwell:  

You mentioned advocating for oneself and how important that is. If a patient feels like they’re not receiving good care or they’re being treated unfairly, what steps should they take to access better overall care? 

Dr. Nita Karnik Lee:  

Well, I mean, a little bit of it’s complicated, because so many of us are kind of limited by our insurance. We don’t always have the ability to do all the things. It can be scary, and it can be intimidating. I think one of the things that could be very helpful is to prepare yourself with a list of questions, to be like these are the questions. These are the things that I’m not feeling are being heard, and potentially even getting a second opinion. You can say this in a way that you can sort of feel like your doctor doesn’t need to feel bad. 

I even think second opinions, for me, I’m all for them. More information is better. That’s a way of positing it and saying, look, I know we’ve gone through these symptoms. These are my concerns. I don’t think they’re being addressed, and I would really like to get another opinion. Physicians are often like, yes, get another opinion. And so, those are ways that I think people can find the right fit for the physician that they want. 

What Are Common Endometrial Cancer Health Disparities?

How can a patient’s individual circumstances impact the quality of their endometrial cancer care? Gynecological cancer expert Dr. Nita Karnik Lee reviews common health disparities and their impact on patient outcomes. 

Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.

 

Related Programs:

Tools for Improving Access to Quality Endometrial Cancer Care

Tools for Improving Access to Quality Endometrial Cancer Care

Why Should Endometrial Cancer Patients Engage in Their Care?

Why Should Endometrial Cancer Patients Engage in Their Care?

Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches


Transcript:

Katherine Banwell:  

Dr. Lee, disparities in healthcare can impact a patient’s experiences and their outcomes. What are common health disparities that gynecological cancer patients can face? 

Dr. Nita Karnik Lee:  

Yeah, this is really – I always think about the cancer care continuum. This is the model that I think of. I think of what is risk reduction and prevention? What is early diagnosis and getting to the right person to take care of your cancer? Did you get the right treatment? And then did you get the right follow-up? 

Disparities can happen along those ways, and some of it can be related to access to care. Access, oftentimes, people just think it’s insurance, but it’s not. It is insurance. That’s a big part of it. We know that our states that don’t have as much insurance support for our patients who are poorer actually do worse. There’s worse survival. 

But I think it’s also does the person feel comfortable with the healthcare system? Are they connected with their doctor? Is it a language issue? Is it a bias issue that they’ve felt that they haven’t been comfortable in their health system before? All of those things can create these roadblocks along that whole cancer care continuum. Access really means more than just like it has to be acceptable. It has to be available. 

It has to be something that the person can feel comfortable with when they make a decision about treatment. That’s where we see things like people say, oh, that person declined surgery. I’m like, but did they really decline? Why did they decline? Did anyone get into what they were worried about, what their experience had been? So, we can’t just blame the patient and say, oh, they just didn’t want treatment. It’s really a complex area. The biggest disparity we see is in uterine cancer. 

So, Black women are much more likely to die of uterine cancer at any stage, especially older Black women. Some of this is access, but some of this is that there are actually differences in biology, and it’s kind of tricky because nobody thinks there is. Race is really a construct, right? It’s not really a biological difference, but there are differences in the types of more aggressive cancers that Black women get, and there are a lot of different reasons that people have started to look at that, both genetically, but also environmental influences, stress influences. 

So, the biggest disparity is probably in the uterine cancer, but unfortunately, we still see disparities by race in ovarian and cervical cancer. We also see disparities by income and insurance type. And so, I think those are kinds of things that are just the larger picture. 

What Questions Should You Ask About Endometrial Cancer Detection?

Gynecological cancer expert Dr. Nita Karnik Lee explains the importance of self-advocacy in endometrial cancer detection, including speaking up when you have concerns and seeking care early. 

Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.

See More from DETECT Ovarian Cancer

Related Resources:

Advances in Endometrial Cancer Detection

Advances in Endometrial Cancer Detection

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches


Transcript:

Katherine Banwell: 

What questions should patients be asking their doctor about detection? 

Dr. Nita Karnik Lee:  

For uterine cancer or endometrial cancer, detection is really based on symptoms. If there are any of those symptoms that are happening, they really should be asking, hey, I need to see a gynecologist. I need to do a biopsy. We do, unfortunately, see many patients who are sort of told, oh, it must be fibroids. But that shouldn’t happen in post-menopausal patients. I’ve heard everything. I’ve heard patients sort of self-reflect, and say, you know what, I was stressed that day, or I moved the couch that day. I’ve heard all the different things we think about, because none of us wants to feel like there could be something wrong. We often justify. It was probably nothing.  

But the patients who do the best are the patients who have a spotting episode, they have a bleeding episode, they seek care right away. And then 80 percent of uterine cancers need only surgery, so that’s a good statistic compared to some of the other GYN cancers. I would say advocating for your symptoms, not being afraid of a symptom being worked up, because I think there’s a lot of fear with, if you report something, maybe it will be something.  

And getting over that sensation of it may not be. It may be something completely different that’s benign. But I think the earlier that we can see a diagnosis and get people to treatment and/or hysterectomy, that tends to do the best in terms of survival and just getting over this episode. 

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

How does biomarker testing impact endometrial cancer screening? Gynecologic expert Dr. Nita Karnik Lee reviews genetic mutations related to endometrial cancer and outlines key considerations for women with a family history of the disease. 

Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.

See More from DETECT Ovarian Cancer

Related Resources:

Advances in Endometrial Cancer Detection

Advances in Endometrial Cancer Detection

What Questions Should You Ask About Endometrial Cancer Detection?

What Questions Should You Ask About Endometrial Cancer Detection?

Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches


Transcript:

Katherine Banwell:  

What is the role of genetic and biomarker testing as screening tools?  

Dr. Nita Karnik Lee:  

Those two things are different in certain ways, and it’s actually really important to think about that as well because for genetic testing if you do have a strong family history, there may be times where you are going to see a cancer genetics person. They may say, hey, your mom had uterine cancer. Maybe they are diagnosed with a certain syndrome. Lynch syndrome is the most common one, which is caused by a mutation in some of the repair proteins that normally repair DNA. That’s something that can get diagnosed and predispose people to many cancers, the most common of which is colon or uterine cancer.  

So, in those patients, some of those patients will actually undergo endometrial biopsies starting at a young age, even if they don’t have any irregular bleeding. Biomarkers are something also really important for somebody who is diagnosed already with endometrial cancer. So, if you get diagnosed with endometrial cancer, we actually use the biomarkers, which are an example of proteins the tumor has on its cell surface that can be turned on and off. And that profile of which biomarkers are on and off gives us an idea, and now can really help guide a little bit of treatment for some patients. 

Katherine Banwell:  

Okay. Should women with a family history of endometrial cancer take extra precautions? 

Dr. Nita Karnik Lee:  

I think they need to be really aware about the symptoms, and they need to be really thinking about whether or not there’s any role for genetic testing. Some patients, they have a family history. They’ve done genetic testing. It’s negative. There’s not anything else that we would do. But in those patients, if there’s any vaginal bleeding, spotting, anything irregular, that might really jump on the symptom diagnosis, or the symptoms leading to diagnosis, or sometimes people have other issues. 

They have fibroids. They have other things going on, and maybe they need a surgery, and maybe having that family history in your background sways you a little bit more. Hey, maybe I will consider surgery. It’s probably not the only reason to do a hysterectomy, but it can contribute to the decision-making if that makes sense. 

Advances in Endometrial Cancer Detection

How are patients currently screened for endometrial cancer? Gynecological cancer expert Dr. Nita Karnik Lee discusses tools for detection and diagnosis of endometrial cancer and factors that may impact risk. 

Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.

See More from DETECT Ovarian Cancer

Related Resources:

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

What Questions Should You Ask About Endometrial Cancer Detection?

What Questions Should You Ask About Endometrial Cancer Detection?

Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches


Transcript:

Katherine Banwell:  

Dr. Lee, what are the screening tests for endometrial cancer? 

Dr. Nita Karnik Lee:  

That’s also a situation that we don’t actually have screening tests for uterine cancer. Again, PAP smears are usually normal in patients who have endometrial cancer because the PAP smear collects just the cells from the outside. Occasionally, sometimes cells that are in the endometrial lining can fall down into the cervix and get found on a PAP smear. 

But that’s actually, usually, the exception and not the norm. So, most women I operate on who have endometrial cancer will have had normal PAP smears. But it’s really important to know what symptoms would really trigger the first diagnosis. So, any type of vaginal bleeding after menopause, vaginal spotting, brownish discharge, or anything that seems unusual, really warrants a biopsy. That is not exactly a screening test because screening tests are usually for patients who don’t have any symptoms, but it is really a very important diagnostic test for someone who has any of those symptoms.  

Katherine Banwell:  

Have there been advances in screening or screening technology that patients should know about? 

Dr. Nita Karnik Lee:  

Yeah, people are talking about that. We know that there are certain risk factors for uterine cancer, so there has always been a discussion about, what about maybe we don’t screen everyone. Maybe we don’t biopsy everyone, but maybe we should be biopsying some people. So, the issue of patients who have obesity is one of the risk factors, not all of them, because some patients who have obesity don’t have this, and vice versa. 

Some patients are very thin and get endometrial cancer, because there are so many different types of endometrial cancer. But I think people have talked about the idea of people who have had a real cycle of irregular periods before menopause, and then may have some risk factors such as obesity, or metabolic syndrome, or diabetes, maybe they should get screened, but that has not been advocated at a public health level. Now, patients who do have a genetic mutation should get screening tests by the endometrial biopsy.  

Katherine Banwell:  

So, you mentioned some things to look for. How is endometrial cancer diagnosed? 

Dr. Nita Karnik Lee:  

It’s diagnosed when somebody usually comes in. Most of the people will be diagnosed because they have a symptom such as vaginal bleeding or vaginal discharge. Then they will have either an office-based biopsy, which is called an endometrial pipelle or endometrial biopsy. 

Or they can have something that people have heard of before, called a D&C. That stands for dilation and curettage. That means opening up or dilating the cervix just a little bit to allow an instrument to come in and do a small scraping of the lining of the uterus. So, one of those two ways is going to be the way this is diagnosed. 

Expert Perspective | Managing the Emotional Aspects of a Gynecologic Cancer Diagnosis

 

What emotional support and resource are available for gynecologic cancer patients? Dr. Hinchcliff discusses leveraging personal networks and highlights key resources like the Society for Gynecologic Oncology and ASCO.

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

 

Related Programs:

Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches

Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

Endometrial Cancer | What Is Personalized Medicine?

Endometrial Cancer | What Is Personalized Medicine?


Transcript:

Katherine Banwell:  

How do you counsel patients who might be having emotions around their gynecologic cancer? What advice and resources are available?  

Dr. Emily Hinchcliff:  

Yeah. So, I think that a cancer diagnosis is a life-changing experience. Even for patients who have early-stage cancers, hearing that word “cancer” on the phone, in the doctor’s office, and having to be the one to then tell family members and understand what that means for their life is truly a pivotal moment, and it does bring up all sorts of emotions and need for support. 

So, what I would say is, first and foremost, it can be really common that cancer patients sort of retreat into themselves and want to be more private. I think that I would encourage people to really use their support network that they have. Everyone’s different, and so, I definitely want them to do what feels right for them, but making sure that you leverage whatever support networks you have in your life is sort of the first foundation.  

Second, I think that there are just so many excellent resources out there for patients facing a cancer diagnosis. Certainly, in endometrial cancer, there are our big national groups of physicians. We put out a ton of information that is patient-focused, so, that is at a level that patients can understand.  

The two that I think of are the Society for Gynecologic Oncology is a big resource for patients with gynecologic cancers, and then, the overarching cancer society ASCO is another place that has a ton of cancer resources. I also think that patient support groups can be really helpful. There are many, many – so, my institution has one that is more specific to our institution as part of our institutional branch of the Woman to Woman program. 

There are also national, or city, or state cancer support groups, and I think that those can be really helpful to gain mentorship from someone who’s been through it and from someone who is a little bit further along in their journey than you might be as the patient that’s just getting a diagnosis, for example, and that can be really helpful so that you have that bird’s-eye view that sometimes, right after your own diagnosis, you just don’t have the perspective to understand. 

Expert Perspective | The Value of Empowering Endometrial Cancer Patients and Care Partners

 

How can patients feel empowered after an endometrial cancer diagnosis? Dr. Hinchcliff emphasizes seeing a GYN oncologist, asking questions, and bringing a care partner to appointments for support and understanding key decisions.

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

 

Related Programs:

What Questions Should Patients Ask About Endometrial Cancer Testing?

What Questions Should Patients Ask About Endometrial Cancer Testing?

Questions to Ask About Endometrial Cancer Clinical Trials

Questions to Ask About Endometrial Cancer Clinical Trials

Endometrial Cancer | What Is Personalized Medicine?

Endometrial Cancer | What Is Personalized Medicine?


Transcript:

Katherine Banwell:  

As a provider, Dr. Hinchcliff, how do you empower care partners and patients who have been diagnosed with endometrial cancer? 

Dr. Emily Hinchcliff:  

So, I think that one of the most important things about a diagnosis of cancer is to develop the relationship with your physician. I think that it is truly a partnership, and it is an incredibly important thing as you think about the next steps in your treatment. For someone who’s diagnosed with endometrial cancer – or, honestly, cancer in general – making sure that you’re seeing a cancer specialist in obstetrics and gynecology – it can actually be sometimes a little bit difficult. 

You might have gotten your diagnosis with a general OB/GYN, but it’s very important to see a GYN oncologist – a cancer-specific doctor – because we’ve actually shown that patients who see GYN oncologists are more likely to get guideline-appropriate care – so, care within what we think of as the right standard – and then they tend to do better with their cancer. So, that’s kind of the first step, is finding that doctor and developing the relationship with them.  

The second thing that I would say is that you should ask questions. Bringing people to your appointments to have an extra set of ears is always helpful. Taking notes and trying to keep track yourself of what was talked about in your appointment, I always encourage my patients to do, but really, asking questions. So, making sure that you know what those molecular tests are that your doctor is sending, making sure you know, once they’re sent, what your results were and how that might change what your treatment will be. 

Now, you don’t need to go and get a degree in biology or go to medical school. I think that that’s a lot to ask someone going through a cancer journey, but it is really important that you understand where those key decision points might be made because that allows you to feel not only like your own advocate, but that you have some ownership of those decisions and you understand why the decisions are being made in the way that they’re being made. 

Questions to Ask About Endometrial Cancer Clinical Trials

 

What questions should patients ask about endometrial cancer clinical trials? Dr. Hinchcliff outlines key inquiries regarding trial structure and eligibility and encourages patients to explore online resources and support groups for additional information.

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

 

Related Programs:

Current Endometrial Cancer Treatment Approaches
Advances in Endometrial Cancer Treatment and Research
Where Do Clinical Trials Fit Into an Endometrial Cancer Plan?

Where Do Clinical Trials Fit Into an Endometrial Cancer Plan?


Transcript:

Katherine Banwell:  

What questions should endometrial cancer patients ask their doctor about a potential trial? 

Dr. Emily Hinchcliff:  

I think the two important things to ask are what is the structure, what am I actually going to get, or what could I get, depending on how many of those arms exist on the trial. 

Katherine Banwell:  

Would the doctor know that specific information, though? 

Dr. Emily Hinchcliff:  

It’s a good question, actually. So, generally speaking, most of us as physicians, in order to offer a trial to you, we have an overarching structure of that clinical trial. There may be some nuances about what the exact enrollment is in terms of the majority of the patients get this treatment, whereas a small minority get this treatment, or because of this patient’s specific mutation profile, they must be enrolled on this subset of the trial. 

So, there are some nuances there that, generally speaking, if I as the physician don’t know, I will contact what’s called my clinical trial coordinator or my research nurse, and they can come spell out some of those nuances, but if your doctor’s recommending a trial to you, they generally know what is the overarching goal, and what is the overarching treatment being tested. 

Katherine Banwell:  

Okay. How can patients learn more about clinical trials? 

Dr. Emily Hinchcliff:  

So, there are a lot of resources online. To some extent, it can be really overwhelming for patients to try and tease out am I a candidate, would I be eligible for a trial, or this trial, is this trial available at my institution. So, what I would say – first and foremost, ask your physician. I think that your physician is your advocate in this and your partner in your cancer care, and I think that certainly I and all of us as physicians feel really strongly that we can help you weigh those different options as you see them and as we learn about them.  

So, I think that that’s where I would start. I think there are a lot of online resources. The FDA and the government have a cancer trials website that you can go to and search for your specific cancer type. 

Many institutions – my own included – will have their own institutional trials website, where, on my institution, you can look up and see what trials do we have open on my institution, because obviously, the government will speak nationally, but your particular treating physician might not have the availability to give you that particular trial. And then, I also will say I think patient support groups are an incredible opportunity to understand what others have been going through and what treatments have been offered, and that can be a really helpful resource as well to get hooked into as a patient is trying to tease all this out. 

Where Do Clinical Trials Fit Into an Endometrial Cancer Plan?

 

What role do clinical trials play in endometrial cancer treatment plans? Dr. Hinchcliff highlights that clinical trials can be crucial at every stage of the cancer journey, offering access to innovative therapies and alternatives to standard care. 

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

 
 

Related Programs:

Current Endometrial Cancer Treatment Approaches
Advances in Endometrial Cancer Treatment and Research
Questions to Ask About Endometrial Cancer Clinical Trials

Questions to Ask About Endometrial Cancer Clinical Trials


Transcript:

Katherine Banwell:  

Dr. Hinchcliff, where do clinical trials fit into a treatment plan for endometrial cancer? 

Dr. Emily Hinchcliff:  

So, I think clinical trials are an incredibly valuable part of a patient’s cancer journey. Every institution and every provider is going to have potentially different clinical trials available to the patients in their practice, and so, it’s important to understand what clinical trials might be available to a patient as they both start their cancer journey, but certainly as their cancer progresses or comes back. 

I think that there is – it should be something that is on the back of your mind at all phases of a cancer journey. It may not be right for a patient if they are first diagnosed and have a clear standard-of-care option, but there are certainly clinical trials that add to or investigate what we consider to be the current standard of care to try and move that forward. So, even in that first diagnosis phase, I think it’s worth asking your doctor, “What’s available to me?” 

And then, certainly, when a cancer comes back, especially when a cancer has developed resistance to some of the more standard options that we would use, then I think clinical trials are an incredibly – it’s an incredible opportunity to have access to a toolbox that you would not have access to otherwise. And so, I think that – when I think about clinical trials, I think that they fit into all phases of a cancer journey, but that there are certain times in every individual patient’s journey that I would say this clinical trial might be right for you at this particular time. 

Katherine Banwell: 

What would you say to patients who are hesitant about trial participation? 

Dr. Emily Hinchcliff:  

So, I think that that is very common, and what I would say is information is power. I think that if there is a trial that you are eligible for, it’s really important to understand what the actual structure of that trial is and also understand what the phase of that trial is. So, let me explain those two things, because I think they’re a little bit different. 

When I think about a trial structure, I think about what is the trial testing, what is it looking at, and what are the potential arms of therapy. When we say “arms,” that just means what is a patient going to actually receive. And so, some trials, there’s only one option. Anyone who’s enrolled on the trial gets a certain thing. Other trials have some comparison arms. So, some patients that are enrolled get a certain treatment; some patients that are enrolled get a different treatment. 

And so, as you think about the structure, it’s important to know what might I get? Am I always going to get the treatment arm – for example, the drug that’s being investigated – is there a placebo arm – an arm that says I might get something that’s standard, like chemotherapy, but I’m going to get chemotherapy plus a placebo, which means an inactive agent, as compared to chemotherapy plus an inactive drug. 

So, it’s really important to understand the structure of a trial. The second thing that I think is important to understand is the phase. So, clinical trials are grouped into phases. Phase I, Phase II, Phase III are the most common that you’ll hear about, and those are a description of how far along is that particular drug or treatment in development. 

So, Phase I, that treatment is very early. It does not mean that there’s not promising data around it, but it means that that drug doesn’t have data, for example, in lots and lots of patients with your particular cancer type, right? Instead, usually, a Phase I trial is looking at a drug in humans or in a particular group of tumors – or patients with a particular group of tumors – for the first time or early on. 

Phase II trials are looking at that drug maybe a little bit later, after they’ve gotten some good data, or trying to expand a drug that might have been used in a different cancer type to a new cancer type, for example. And then, Phase III is the bigger studies where you’re looking to enroll more patients in a specific cancer type for a specific reason to say, “Okay, we’ve had good evidence that this drug has some amount of efficacy, so now we’re really trying to look to see how does it compare to what we have out there, and could this help us move forward?” 

Advances in Endometrial Cancer Treatment and Research

What new developments in endometrial cancer treatment should patients know about? Dr. Hinchcliff highlights advancements in immunotherapy for newly diagnosed patients and ongoing clinical trials focusing on molecular pathways and drug combinations for more personalized care. 

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

 
 

Related Programs:

Current Endometrial Cancer Treatment Approaches
Where Do Clinical Trials Fit Into an Endometrial Cancer Plan?

Where Do Clinical Trials Fit Into an Endometrial Cancer Plan?

Questions to Ask About Endometrial Cancer Clinical Trials

Questions to Ask About Endometrial Cancer Clinical Trials


Transcript:

Katherine Banwell:  

Are there endometrial cancer treatment developments that patients should know about? 

Dr. Emily Hinchcliff:  

Yes. So, I think within literally the past year/two years, we’ve had some truly groundbreaking work that has changed the way all of us practice in GYN oncology, and that is specifically around this immunotherapy. So, it used to be that we would save immunotherapy for when someone’s cancer had returned. So, they would get their initial, for example, chemotherapy if they needed it, and then, when the cancer came back, that’s when we would start thinking about immunotherapy. 

There are now two big randomized controlled trials, which is sort of our best data, that tells us that adding immunotherapy in the first line, meaning when someone is first diagnosed, if their cancer has spread outside the uterus, that adding immunotherapy at that point can be really helpful for certain patients, and so, I would say that as an avenue of treatment – understanding is immunotherapy right for me, why or why not – is kind of my second takeaway for patients. 

Katherine Banwell:  

You mentioned trials. Are there ongoing trials that are showing promise? 

Dr. Emily Hinchcliff:  

Absolutely. I think it is an incredible time to be a GYN oncologist because the field is advancing so rapidly. 

I think that now, we are really focused on some of these molecular pathways to try and not only understand which patients should we be giving these therapies to, who are they most effective in, which patients can we actually be pulling back, who has a better prognosis, so we may not need to give them the toxicity level that comes with all of the standard chemotherapy options, and then, also, are there drug combinations that may work better for patients, and how do we choose which combination therapies we should use. And so, I think that there are a lot of really exciting clinical trials going on in endometrial cancer right now. 

Katherine Banwell:  

Dr. Hinchcliff, what areas of research are you focused on? 

Dr. Emily Hinchcliff:  

So, I have spent a lot of my research time working in immunotherapy. As you can tell, I’m pretty jazzed about it. I think it really has changed the game in terms of cancer care. And so, a lot of my work centers around the use of immunotherapy in gynecologic cancers. 

I also am very interested in looking at how we can better understand a cancer’s response to treatment. As we give treatment, often, endometrial cancer doesn’t have an easy blood test to say, “My cancer’s getting better,” so we kind of have to wait until we get a CT scan, which we usually do three months apart, and so, there are some newer blood tests out there that we’re trying to understand how to use and how to best leverage for our cancer patients, and that allows us to potentially switch treatments sooner if something isn’t working, or choose a better treatment up front, depending on which test we’re looking at. So, that’s really where my research centers. 

Katherine Banwell:  

Is there anything you’d like to add about the evolution of endometrial cancer care? What are you excited about? 

Dr. Emily Hinchcliff:  

I think I am really excited that our field has made this big switch to focusing on some of these molecular aspects. It has always been so hard to treat all endometrial cancer with one hammer-and-nail-type pairing, and now we’re able to be a little bit more nuanced with our tools, and that’s always a really exciting place to be. I also think that it’s really important to highlight some of the disparities that still exist in endometrial cancer, and honestly in cancer more generally, and I think that we as a field are starting to really highlight that and understand – or at least try to understand – how can we better provide care to every single patient who is diagnosed with an endometrial cancer. 

Current Endometrial Cancer Treatment Approaches

 

 

What are the common treatment approaches for endometrial cancer? Dr. Hinchcliff explains that options typically include surgery, radiation, and chemotherapy, or a combination.

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

 
 

Related Programs:

Where Do Clinical Trials Fit Into an Endometrial Cancer Plan?

Where Do Clinical Trials Fit Into an Endometrial Cancer Plan?

Endometrial Cancer | What Is Personalized Medicine?

Endometrial Cancer | What Is Personalized Medicine? 


Transcript:

Katherine Banwell:  

Dr. Hinchcliff, what are the common approaches for endometrial cancer? 

Dr. Emily Hinchcliff:  

So, endometrial cancer – when I think about any cancer treatment, there are sort of three big buckets of treatment. There’s surgical management, radiation, and then, chemotherapy or some form of systemic treatment, meaning treatment that goes into the vessels, that’s going to spread throughout your body, and endometrial cancer can be treated by, actually, all three of those, or combinations of the three of those, depending on that cancer stage and depending on that cancer subtype. 

And so, what I would say is for endometrial cancer that is confined to the uterus, generally speaking, surgery is your upfront first line of defense, and then, once you understand – after taking that uterus out – what the risk level is, your doctor may recommend chemotherapy after, they may recommend radiation after, and that sort of is dependent on what they see under the microscope. 

But for cancer that’s thought to be confined to the uterus, it’s surgery, and then maybe additional treatment afterwards. For endometrial cancer that has spread outside the uterus already to the lymph nodes, elsewhere in the abdomen, or more distant, then we start to think about that systemic therapy, and that can include chemotherapy, which works by killing rapidly dividing cells, as well as what I mentioned before, which is immunotherapy. 

Immunotherapy is medicine that kind of takes your own immune system and tries to rev up your immune system to better fight the cancer, because the immune system is predisposed to recognizing abnormal things, and cancer is inherently abnormal. But cancer is smart and develops ways to cloak itself, so the immunotherapy takes that cloak off and revs up the immune system to try and get an immune response. 

How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

What gynecologic cancer care questions should patients and families ask? Expert Dr. Ramez Eskander from UC San Diego Health discusses the value of patient education, second opinions, credible resources, and proactive patient advice to help optimize care. 

[ACT]IVATION TIP

“…be informed. Explore your options and opportunities. Again, there are strategies that are available to you both on the Internet, publicly available, but also through colleagues, through friends, and a network that you can build through support groups, even at your institutions. It’s never too early to ask about clinical trials so that you can make sure you’re educated and informed as you look to make decisions. Because if you try to take all of this into consideration and at one time point, it can be a little bit overwhelming.”

Download Guide

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Overcoming Gynecologic Cancer Challenges for Optimal Care

Overcoming Gynecologic Cancer Challenges for Optimal Care

What Are the Barriers to Endometrial Cancer Care in Underserved Communities?

What Are the Barriers to Endometrial Cancer Care in Underserved Communities?

How Can Gynecologic Oncology Racial Disparities Be Addressed

How Can Gynecologic Oncology Racial Disparities Be Addressed

Transcript:

Lisa Hatfield:

Dr. Eskander, as new treatments and strategies emerge, how can patients and their families stay activated and ensure they’re benefiting from the latest advancements? And what should they be asking their care team to make sure they’re up to speed with the latest in gynecologic cancer care?

Dr. Ramez Eskander:

This is so important to me for patients to feel like they’re empowered and educated. I believe that patients are their greatest advocates. This is where family and friends are also an important part of the care team. From my perspective, it’s very beneficial to have someone in the room with the patient as they’re having conversations about treatments and treatment strategies to take appropriate notes, to be informed, and to not feel bad about asking questions, to not feel bad about asking the relevance of a second opinion.

Any provider should never take offense to a patient asking for a second opinion. In fact, I would say, I encourage my patients. I say, listen, if you have questions and you…if you would like to get someone else’s perspective, please do so. I want that, and I want you to come back to me with potentially a different option or a question that my hope is to answer.

We have a shared goal of making sure our patients have the best possible clinical outcome. That is our north star. So as new treatments and strategies emerge, try to stay informed. There are multiple platforms available, of course, via the Internet, for example. I will just be cautious in saying not all of that information is accurate. So if you’re going to use a platform that’s publicly available, the web, make sure that you’re trying to go to areas where a resource is vetted and reliable.

The National Cancer Network, the NCCN, the National Cancer Institute, clinicaltrials.gov for clinical trials, vetted and established advocacy organizations, and then taking that information, using it as a foundation in which you can build upon when you have conversations with your providers. But again, this is where I think not just the patient alone, but patient, family, and friends can really work together to try to develop.

And all of our meetings, the cancer meetings that we have, for example, for gynecologic cancer as a Society of Gynecologic Oncology, there’s a foundation for women’s cancer. There are opportunities for education, the American Society of Clinical Oncology. These are publicly available resources, websites where you can go to and look for patient facing material to make informed decisions about the management of your cancers.  And, of course, when you’re asking to talk about clinical trials, how do I stay up to date? Again, it’s a dialogue. It’s never too early to ask. I worry sometimes that patients don’t want to bring up a clinical trial, because they fear that bringing that up means that they’ve exhausted all treatment strategies.

Quite contrary to that, the earlier you begin the conversation, the greater opportunity you’re going to have to potentially identify a clinical trial for which you may be eligible. And that will help you through your treatment paradigm. Because if you don’t, you may pass that up, because you’re no longer eligible, because you’ve had too many prior lines of treatment, for example. And having that conversation early will also help you prepare as you go through the treatment paradigm so that if you need to make a decision about potentially enrolling in a trial, you’re established, you’re ready to do so rather than trying to effectively push this forward quickly without making sure that you have the required information that you need.

So it’s a multi-pronged approach. It’s going to require support systems, undoubtedly, multiple resources are available, and then subsequently engaging those resources to use that information to guide your conversations.

My activation tip is be informed. Explore your options and opportunities. Again, there are strategies that are available to you both on the Internet, publicly available, but also through colleagues, through friends, and a network that you can build through support groups, even at your institutions. It’s never too early to ask about clinical trials so that you can make sure you’re educated and informed as you look to make decisions. Because if you try to take all of this into consideration and at one time point, it can be a little bit overwhelming.

Lisa Hatfield:

Okay. Thank you so much. And I really appreciate your comment about it’s okay to talk to your provider about getting a second opinion. I was terrified of that, because I really love my doctor. He is great. And I didn’t want to bring that up, but anybody who’s watching this, Dr. Eskander said it’s okay to talk to your provider about seeking out a second opinion.

And it may help in your care in making decisions too. So I appreciate that you said that. And also that you said to make sure you go to vetted sites for information. When I was diagnosed with blood cancer, the first place I went to that I wasn’t supposed to was Google, got all kinds of information that I didn’t want to read. So go to those vetted sites. I think that’s great advice. So thank you so much.

Dr. Ramez Eskander:

Thank you, Lisa.

Share Your Feedback

What Are the Barriers to Endometrial Cancer Care in Underserved Communities?

 

What are common endometrial cancer care barriers? Expert Dr. Ramez Eskander from UC San Diego Health discusses common care barriers for underrepresented communities and how patients and healthcare professionals can help address these barriers to optimal care.

[ACT]IVATION TIP

“…we have to be committed to this. This is not just a patient issue. This is an issue that is shared, a responsibility that’s shared across institutions, clinicians. I would strongly suggest that patients advocate for themselves. Don’t be afraid to ask questions. Try to determine what resources might be available to assist if you are facing particular obstacles to help mitigate some of the barriers that may impact treatment in this era.”

Download Guide

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Overcoming Gynecologic Cancer Challenges for Optimal Care

Overcoming Gynecologic Cancer Challenges for Optimal Care

How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

How Can Gynecologic Oncology Racial Disparities Be Addressed

How Can Gynecologic Oncology Racial Disparities Be Addressed

Transcript:

Lisa Hatfield:

Dr. Eskander, what are some common barriers that patients with endometrial cancers face in accessing care, especially in underrepresented communities?

Dr. Ramez Eskander:

The issue around access to care and disparities in care is an important one. And I will say that as we move to this world of more molecular testing, identifying changes in the tumor or in genetic findings that predispose patients to potentially responding to therapies, there’s concern that it may increase disparities in cancer outcome. And that’s because is everybody getting access to tumor testing? Is everybody getting access to genetic testing? Are they informed? Are they educated about the implications?

This is so complex, and I think, Lisa, we could talk for an hour just about the issues surrounding barriers to care disparities and outcome. I will say that the goal is to make sure that all patients have access to these important tests. The goal is to make sure that all patients are educated to the same capacity. Understanding that health literacy can vary quite substantially so that we can work to try to develop more equitable treatment approaches and improve clinical outcomes across the board.

Do we see barriers? Absolutely. It could be barriers related to language. It could be barriers related to travel that a patient may not be able to travel the distance needed to see the provider or the specialist that can provide them the treatment that they need, or the counseling. It could be copay costs, can be prohibitive, it could be concern, trust issues around, do I want to get genetic testing? I’m worried this information is going to be used against me rather than help inform my cancer treatment strategy.

So it’s layered. It’s multi-pronged. There are several initiatives that are being deployed at different centers to try to improve and break down these barriers so that we can help patients overcome. And these could be social workers, patient navigators, case managers that reach out to these patients, resources that are available to facilitate transfer transportation, and bridge gaps that some of these patients might be facing.

And this is just in standard of care, completely independent of the barriers that patients face when they look to enroll in a clinical trial, for example, for treatment of their cancers. My [ACT]IVATION tip is we have to be committed to this. This is not just a patient issue. This is an issue that is shared, a responsibility that’s shared across institutions, clinicians. I would strongly suggest that patients advocate for themselves. Don’t be afraid to ask questions. Try to determine what resources might be available to assist if you are facing particular obstacles to help mitigate some of the barriers that may impact treatment in this era.

Share Your Feedback

Overcoming Gynecologic Cancer Challenges for Optimal Care

What are the goals and strides in gynecologic cancer treatment? Expert Dr. Ramez Eskander from UC San Diego Health discusses how endometrial cancer and ovarian cancer treatment has evolved, different approaches to care, and proactive patient advice for optimal care.

[ACT]IVATION TIP

“…be informed. Ask the right questions. Make sure that you understand your treatment options for every stage of your disease. It is never too early to talk to your clinician or provider about clinical trial opportunities. It is never too early to talk to your provider about what systemic or chemotherapeutic or targeted therapies are available to you if you do recur so that you can begin to make informed decisions and plan towards management of these cancers.”

Download Guide

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

What Are the Barriers to Endometrial Cancer Care in Underserved Communities?

What Are the Barriers to Endometrial Cancer Care in Underserved Communities?

How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

How Can Gynecologic Oncology Racial Disparities Be Addressed

How Can Gynecologic Oncology Racial Disparities Be Addressed

Transcript:

Lisa Hatfield:

Dr. Eskander, even with recent advancements, what are some of the biggest challenges still facing patients with gynecologic cancers? And how can patients face these challenges head-on in order to get the best possible care?

Dr. Ramez Eskander: T

he management of ovarian cancer and endometrial cancer has really dramatically changed over the last several years, principally because of discoveries of effective treatments. And that’s also motivated by our understanding of the molecular drivers of these cancers. We’re learning more and more about what abnormalities on a molecular or genetic level may exist in these cancers that can inform treatment. When we think about the challenges, despite these advancements, it’s really focused primarily on the fact that we still deal with patients whose disease recurs after treatment.

So, for example, with ovarian cancer, patients have surgery and chemotherapy at diagnosis. And sometimes you start with chemotherapy and do surgery, followed by additional chemotherapy. And sometimes you do surgery, followed by chemotherapy. And that’s a decision that’s made based on multiple factors. Patients receive treatment, as I alluded to in the front line. But unfortunately, despite the advances that we’ve made in molecular testing and in therapeutics, a large proportion of patients with advanced stage disease may develop disease recurrence.

And in the context of disease recurrence, it’s difficult to achieve prolonged remission. So what we deal with is disease that is in remission for a period of time after primary therapy. And if that ovarian cancer recurs, that subsequent remission may be shorter than the primary remission. Now we can go into a lot of detailed conversations about what drugs we’ve identified to be effective in different disease settings.

And as I alluded to, we’ve made significant strides, but we still need to do better and identify more effective treatments, both in the front-line and in the recurrent setting. And I am very passionate about clinical trials, which are essentially the foundation in which we’ve identified effective treatment strategies that are now FDA-approved. And so I really want to empower patients who are dealing with advanced stage ovarian cancer diagnosis, really understand what your options are, understand whether or not you’re eligible for clinical trials in the face of a disease recurrence. 

Some of these studies are limited to specific time intervals during therapy or limited based on the number of prior treatments. And you want to have options available for you. And those options are going to be available by asking questions at these different phases of your treatment so that you can make sure that you’re making the most informed decision. And it’s the same thing with endometrial cancer. A large proportion of our patients are diagnosed with early stage disease that is successfully managed with surgery. Sometimes radiation is required. There are patients with advanced stage disease who are needing chemotherapy.

And again, in those circumstances, in the face of disease recurrence, we need more effective treatment strategies. Recently, we’ve incorporated immunotherapy plus chemotherapy in the management of advanced stage or recurrent endometrial cancer patients. Progressing after that leaves us with more limited options for which there are many clinical trials that are active in accruing patients to offer more effective treatment opportunities.

So my [ACT]IVATION tip in the context of this question is be informed. Ask the right questions. Make sure that you understand your treatment options for every stage of your disease. It is never too early to talk to your clinician or provider about clinical trial opportunities. It is never too early to talk to your provider about what systemic or chemotherapeutic or targeted therapies are available to you if you do recur so that you can begin to make informed decisions and plan towards management of these cancers.

Lisa Hatfield:

And I have a quick follow-up question to that, because you mentioned clinical trials, and I know you’re an advocate for patients seeking a second opinion. So if a patient who lives in an area where maybe there are not a lot of clinical trials, would like more information on that. And I live in an area where we don’t have a lot of clinical trials, and I have a great local oncologist, and he does a great job. But if I wanted to reach out and ask a specialist like you, a one-time consult, maybe, what are my options for a clinical trial? Can a patient do that? Can they do like a one-time consult with a specialist?

Dr. Ramez Eskander:

That is an excellent question. There are specific rules around what providers can do. And I will venture to say I’m not an expert in those rules. I’ll give you a pragmatic example. There are rules that will not allow a provider to have a clinic visit virtually with someone who’s outside of their state. So, it does set some boundaries. Now, what I will say, and you alluded to this already, Lisa, which is talk to your provider. That is a very great starting point.

If you feel like you’re not making as much progress, there are really amazing advocacy organizations that have capacity to help patients make these decisions, whether it’s organizations regionally or if it’s national organizations. I will just say also if you go to clinicaltrials.gov, it’s a website that’s available to us all and you type in a diagnosis like ovarian cancer or endometrial cancer, and you search for Phase III clinical trials, it will provide you with contact information for sites and you can look by sites in your state or regionally.

And I know it can feel daunting to do that. And that’s part of the reason that I’m such a big advocate for second opinions is because when patients are being treated for a cancer diagnosis, searching for your own clinical trial without any real guidance can feel like information overload. So it’s for me, reach out to your primary provider, utilize any advocacy groups that are in your region or national advocacy groups, such as the Ovarian Cancer Research Alliance or the Clearity Foundation. There are many others that can help patients kind of navigate for ovarian cancer diagnosis or second opinions. And then do your homework and try to identify whether or not there’s a provider who might be of greater assistance.

Share Your Feedback