Should Some Gynecologic Cancer Patients Seek a Specialist?

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Should Some Gynecologic Cancer Patients Seek a Specialist? from Patient Empowerment Network on Vimeo.

Why might some gynecologic cancer patients want to see a specialist? Expert Dr. Charlotte Gamble from MedStar Health explains the reasoning of seeing a specialist and why a specialist may not be seen in some areas.

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Are Beauty Products a Risk Factor for Endometrial Cancer?

Transcript:

Lisa Hatfield:

A lot of people in our audience are going to community facilities for their care. Do you recommend for patients who are diagnosed with any type of gynecologic cancer to seek out a specialist or a subspecialist to get more information or do you feel confident that they can ask these questions if they’re a local oncologist, if they do not specialize, if they’re more of a general oncologist versus a specialist?

Dr. Charlotte Gamble:

This is such a nuanced question and is probably a little bit controversial within the oncology sphere. So endometrial cancer is a gynecologic cancer. And because of that, historically, the providers that have the most specific expertise in that area have traditionally been gynecologic oncologists. These are both surgeons as well as oncologists that do the surgery as well as the chemotherapy or the targeted therapy. We are now in a space where sometimes that care is a little bit fractioned, and there’s different ways of practicing within this realm of gynecologic oncology throughout the country.

And so some health systems have gynecologic oncologists, more of the surgeons that work very closely in partnership with medical oncologists that might treat specifically gynecologic cancers, or sometimes are more general medical oncologists that treat multiple different kinds of cancers. I would say that, and then there are some places where gynecologic oncologists do it all.

So I actually work in a hybrid system where I, in one hospital that I work at, I’m the gynecologic oncologist and do both the surgeries as well as the chemotherapy. And then at a community site that I work with, I do the surgeries and I work closely with general medical oncologists who are able to provide the chemotherapy or the targeted therapies.

I would say that for patients who are receiving care within a general medical oncology practice, a very good question to ask their medical oncologist would be, are you in contact or how closely do you work with gynecologic oncologists in terms of taking care of patients with gynecologic cancers? Because traditionally, medical oncologists might not receive the depth of education in gynecologic cancers that gynecological oncologists actually need to go through and that patients deserve.  And I have worked with several medical oncologists who are absolutely wonderful, but it is a close partnership that we are making these plans together and they understand the gynecological oncology literature and I’m able to guide those therapies for my patients. 

Lisa Hatfield:

That’s great clarification for patients who might be facing this disease and a great question they can pose to their local oncologist. So thank you for that.

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Advancements in Endometrial Cancer Trials | Insights and Opportunities

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Advancements in Endometrial Cancer Trials: Insights and Opportunities from Patient Empowerment Network on Vimeo.

What’s important for endometrial cancer patients to know about clinical trials? Expert Dr. Charlotte Gamble from MedStar Health discusses novel therapies under study, treatments that are showing promising results, and patient advice on clinical trials.

[ACT]IVATION TIP

“…be able to ask your doctor about if you’re eligible for clinical trials, what your cancer mutational or genetic code is that might make you eligible for certain clinical trials, and where those trials are offered, if it’s at the health system that you are seeking care, or if it’s at a nearby health system, if you’re able and willing to travel.”

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What Are Barriers to Endometrial Cancer Care Access?

 Should Some Gynecologic Cancer Patients Seek a Specialist?

Should Some Gynecologic Cancer Patients Seek a Specialist?

 Are Beauty Products a Risk Factor for Endometrial Cancer?

Are Beauty Products a Risk Factor for Endometrial Cancer?

Transcript:

Lisa Hatfield:

So, Dr. Gamble, this is kind of a three-part question about clinical trials. Can you talk a little bit about ongoing clinical trials that are investigating novel therapies for advanced endometrial cancer? And then maybe talk a little bit about some promising or encouraging results that you’re seeing with trials? And last part of the question is, what do you want people living with endometrial cancer to know about clinical trials?  

Dr. Charlotte Gamble

I’m so glad you asked this question. This is such a valuable question and an area of a lot of interest that has improved over the past several years, not only about clinical trials and the real need to make sure that patients are aware of them and to ensure that these clinical trials represent the populations that we intend to serve as healthcare providers in the United States, but also specifically in the world of endometrial cancer. Really exciting, promising results that we’ve had over the past year, year-and-a-half specifically that address the very desperate need for novel therapeutics to treat patients who have endometrial cancer.

So, for example, two major trials were published last year, presented at international meetings, looking at the real improvement in overall survival, really increasing the length of time patients can live with endometrial cancer that leverage the use of drugs called immunotherapy. So things like dostarlimab-gxly (Jemperli) or pembrolizumab (Keytruda), these are generic names for immunotherapy drugs that work very well in some subsets of patients with endometrial cancer.

This is something, some survival benefits that we have never seen before in the endometrial cancer space and rarely seen in the gynecologic oncology space and is a definite marker of huge success in terms of extending the lifespan of patients who suffer from this challenging to treat understudied, underfunded disease. Endometrial cancer is actually one of the lowest funded studies in the National Cancer Institute at NIH.

And so having major trials come out over the past couple of years that really look at survival opportunities with the leveraged use of immunotherapies is something that is both exciting and invigorating to the field and hopefully can potentiate further funding from the NCI to be able to study this disease type. In terms of your question for what patients should know about, about ongoing trials, I think this dovetails into several of the points that we’ll discuss during this interview of making sure that patients are their own advocate and having an advocate nearby and with them at all of their appointments.

 So it’s really important to ask their subspecialists, their oncologists or their gynecologic oncologists about if there are any clinical trials that the patients are eligible for. A lot of this comes down to, has the patient undergone genetic testing or molecular sequencing that looks at the specific mutations in the cancer tissue that sometimes will make patients eligible for certain clinical trials or others? And other times it’s just understanding that what opportunities are available within the health system and outside the healthcare system in which the patient is seeking care.

A lot of times when we see that these trials that are published might not represent a racially diverse group of patients. Oftentimes it’s because of two reasons. One, patients aren’t even offered clinical trials, even if they are eligible. Or two, patients might be getting care at a health facility that doesn’t have access or the infrastructure to enroll them on these clinical trials that could be available, perhaps at a regionally nearby cancer center.

I oftentimes suggest to patients, please ask me questions about your molecular subtyping. Ask me questions about what clinical trials you might be available for. There is a significant amount of trust that the health system needs to earn back from patients to allow them the headspace to trust the health system again, given historical, massive, ethical issues and trials in the past and patients and their loved ones feeling that clinical trials just means a big experiment and they don’t want to be experimented on. And what I often say to that is really, you have to understand the details of the trial and the science going into it and make sure that your doctor has your best interests at heart. But oftentimes these trials hold significant promise.

And the reason that you might be eligible for them is that the trial drugs might work better than standard of care, certainly for endometrial cancer we’ve seen that in the two major trials that came out this year. So I think my activation tip for this question is really to be able to ask your doctor about if you’re eligible for clinical trials, what your cancer mutational or genetic code is that might make you eligible for certain clinical trials, and where those trials are offered, if it’s at the health system that you are seeking care, or if it’s at a nearby health system, if you’re able and willing to travel.

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What Are Barriers to Endometrial Cancer Care Access?

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What Are Barriers to Endometrial Cancer Care Access? from Patient Empowerment Network on Vimeo.

How can endometrial cancer care access be obstructed by barriers? Expert Dr. Charlotte Gamble from MedStar Health discusses common barriers to care and patient advice to overcome some barriers.

[ACT]IVATION TIP

“…rely on the support that you have in your own lives to make sure that all the barriers that are in your control you can properly address and sometimes that takes a village and to really make sure that you have an advocate either a family friend, or a family member who could help get you and navigate you through this cumbersome process.”

Download Guide | Descargar Guía en Español

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Advancements in Endometrial Cancer Trials: Insights and Opportunities

Advancements in Endometrial Cancer Trials | Insights and Opportunities

 Should Some Gynecologic Cancer Patients Seek a Specialist?

Should Some Gynecologic Cancer Patients Seek a Specialist?

 Are Beauty Products a Risk Factor for Endometrial Cancer?

Are Beauty Products a Risk Factor for Endometrial Cancer?

Transcript:

Lisa Hatfield:

Dr. Gamble, can you speak to barriers to accessing care in endometrial cancer? 

Dr. Charlotte Gamble:

Absolutely. What I’ve seen from some of my research, both with myself as well as with Kemi Doll, when we talk to patients and speak to them about what are the issues they face into getting timely gynecologic oncology care, it’s a myriad of factors. So there are some barriers at different levels. So patients themselves face barriers in their own lives where they might not understand the symptoms of endometrial cancer, which oftentimes are a postmenopausal bleeding, or sometimes bloating, or pelvic fullness, and sometimes are really busy doing other things in their lives that they can’t prioritize their own health and kind of ignore some of the symptoms.

And so knowledge gaps are a barrier. And the logistics sometimes of making it to a doctor’s office or their provider’s office can oftentimes be challenges that patients might face in their own lives. However, a lot of my concern also comes to the provider level barriers where sometimes when patients are legitimately concerned, rightfully so, with symptoms they might be having, oftentimes the health system might ignore their symptoms.

And so they might run into barriers when they actually try to call and schedule an appointment with their gynecologist or with their primary care doctor discussing symptoms, and they might be told that this doctor doesn’t have availability for the next three to four months, come and see us in August, which presents a whole set of delays that the patients face. And this might be somebody that’s an administrator for the office, the front desk staff that just might not have the insight to be able to escalate that concern upwards.

Additionally, what we see is that sometimes when patients come to their providers with these concerns, the providers themselves might not have the knowledge area or the level of concern to meet that need that patients have. And so sometimes can misdiagnose patients or not get a timely workup in place. And that’s something that the health community I think, needs to work on as well. And lastly, the health system is messy. We have a messy health system in the United States and lots of fragmentation and care.

And so the process, even when somebody appropriately raises a concern to their primary provider, gets the appropriate workup, gets a diagnosis, sometimes it’s actually very difficult for them to get that referral and make it to the oncologist or the subspecialist’s office in a timely fashion. And some of that, you know, some of my research right now goes into how can the health system be better about coordinating and helping patients navigate what is a very burdensome and cumbersome health system. So barriers are at several levels. They’re at the patient level, they’re at the organizational level, they’re at the health system level. Ranging all the way from, I didn’t know that this could be a problem, this symptom I’m experiencing, to, I don’t have the correct type of health insurance to be able to cover the subspecialty care that I now need.

 
And so all of these range and pose like challenges for us to address as health system advocates and patient advocates as we kind of try to address these barriers. My activation tip for this question is to really rely on the support that you have in your own lives to make sure that all the barriers that are in your control you can properly address and sometimes that takes a village and to really make sure that you have an advocate either a family friend, or a family member who could help get you and navigate you through this cumbersome process.

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Overcoming Barriers: Empowering Underrepresented Groups With Endometrial Cancer

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Overcoming Barriers: Empowering Underrepresented Groups with Endometrial Cancer from Patient Empowerment Network on Vimeo.

 How can endometrial cancer care barriers be overcome for underrepresented groups? Expert Dr. Emily Hinchcliff from Northwestern Medicine discusses racial and cultural barriers and advice to patients to be proactive toward receiving optimal care.

[ACT]IVATION TIP

“…know the genetic status of your tumor, specifically something called the mismatch repair status of your tumor. And then not only how does that status impact your own treatment, but also how that may impact your family members…understand what resources are out there for you as a patient, especially for women in underserved groups and minority populations.”

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Overcoming Geographical Barriers in Endometrial Cancer Care

Overcoming Geographical Barriers in Endometrial Cancer Care

 Innovative Approaches to Endometrial Cancer Care in Underrepresented Communities

Innovative Approaches to Endometrial Cancer Care in Underrepresented Communities

 Endometrial Cancer Care Disparities | The Impact of Rural Residence

Endometrial Cancer Care Disparities: The Impact of Rural Residence

Transcript:

Lisa:

Dr. Hinchcliff, in your research, you dive deeply into the significant disparities that exist within medically underserved and minority populations in the U.S. when it comes to awareness of, access to, and the use of genetic services in endometrial cancer. Can you speak to the research and provide tips to these patients and families?

Dr. Emily Hinchcliff: 

Yeah, so I think that there are sort of two different pieces that go on here. First is the relationship of endometrial cancer, that some of it can be, I guess, at random, and some of it can be genetic. So understanding, especially for those who have a strong family history, that there are hereditary forms of endometrial cancer. I think that’s a really important point for patients to take away. And then we, as a society, as a field, now recommend kind of routine screening for those tests to determine, Is an endometrial cancer hereditary or not? So make sure that you, as a patient, know your results and know if your family members should be tested in any way.

The second is regarding the significant disparities that exist. We know, as a field, as a kind of medical subspecialty, that there is a racial disparity in endometrial cancer mortality. While there is a lot of research going on to address the kind of potential biologic component there, is there something different about the cancers that are developed in different racial groups? I think there’s also really important research going on about the kind of systemic and cultural barriers and differences that women of different races experience that also can dramatically impact their cancer care.

Lisa:

And do you have an activation tip for this question?

Dr. Emily Hinchcliff:  

I’ll give you two different activation tips. I think that the first is to know the genetic status of your tumor, specifically something called the mismatch repair status of your tumor. And then not only how does that status impact your own treatment, but also how that may impact your family members. And then I think the second is to understand what resources are out there for you as a patient, especially for women in underserved groups and minority populations. Simply obtaining support can often be a really important key first step to gaining access and understanding of your disease.

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Innovative Approaches to Endometrial Cancer Care in Underrepresented Communities

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Innovative Approaches to Endometrial Cancer Care in Underrepresented Communities from Patient Empowerment Network on Vimeo.

How can endometrial cancer care use innovative approaches in underrepresented communities? Expert Dr. Emily Hinchcliff from Northwestern Medicine discusses diagnostic testing tools and support in navigating clinical trials.

[ACT]IVATION TIP

“… doing your own research and your own reading is really important, being your own advocate. But I think that your physician can serve as an excellent, almost medical translator to understand what is right for you and which of the many, many novel things that we are discovering every day is applicable to you and which might be good for you and which don’t actually apply or which are not potentially your best option in that side.”

Download Guide | Descargar Guía en Español

See More from [ACT]IVATED Endometrial Cancer

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Overcoming Geographical Barriers in Endometrial Cancer Care

Overcoming Geographical Barriers in Endometrial Cancer Care

 Overcoming Barriers: Empowering Underrepresented Groups With Endometrial Cancer

Overcoming Barriers: Empowering Underrepresented Groups With Endometrial Cancer

 Endometrial Cancer Care Disparities | The Impact of Rural Residence

Endometrial Cancer Care Disparities: The Impact of Rural Residence

Transcript:

Lisa:

Dr. Hinchcliff, are there any innovative approaches or technologies that you and your team are exploring to improve endometrial detection, treatment, or support services, especially for your underrepresented communities with limited access to healthcare resources?

Dr. Emily Hinchcliff:  

Yeah, so there are many, many different things that we’re doing here that we’re very excited about. I think I’ll probably highlight two. So one of the ones that I have been working on closely is there is an ever-increasing number of diagnostic testing tools that we have within our kind of armamentarium. And so one particular test that patients may have read about or heard about is something called circulating tumor DNA. And this is a pretty novel test that I will be completely open and honest that we don’t totally know how to use or how to incorporate in our cancer surveillance, meaning so once someone is diagnosed,  is this a test that can help us to watch to see if treatments are working or watch to see if a cancer may have come back? Similarly, can it be used as a screening tool? We just don’t know that, and so that’s an area that I am actively working in.

The other thing that one of my colleagues here is working on is trying to really create access for women who have limited access to healthcare. So we have developed a clinical trial platform to allow the women, specifically of Chicago, to better understand their options for clinical trials across the institutions in Chicago. So we have at Northwestern multiple cutting-edge endometrial cancer trials trying to bring these novel therapeutics to the forefront and to patients and also to thoughtfully triage patients to kind of treatments that we think are going to maximize their effectiveness and minimize toxicity.

But similar to us, the other institutions around Chicago have a different panel of clinical trials. And so for patients, it can be really overwhelming to know which trial, which institution, how do I know, how do I access all of that? And so we’re working to create a platform for patients and to have clinical navigators associated to help them to understand their options.

Lisa:

And do you have an activation tip?

Dr. Emily Hinchcliff:  

So I think that when patients are thinking about innovation and how can they make sure that they are at the cutting edge, I think that your physician is really your access point. So obviously, doing your own research and your own reading is really important, being your own advocate. But I think that your physician can serve as an excellent, almost medical translator to understand what is right for you and which of the many, many novel things that we are discovering every day is applicable to you and which might be good for you and which don’t actually apply or which are not potentially your best option in that side.

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Overcoming Geographical Barriers in Endometrial Cancer Care

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Overcoming Geographical Barriers in Endometrial Cancer Care from Patient Empowerment Network on Vimeo.

How can endometrial cancer care barriers be overcome in regards to geographic location? Expert Dr. Emily Hinchcliff from Northwestern Medicine discusses geographic care barriers, solutions, and patient advice to be proactive in their care.

[ACT]IVATION TIP

“…understanding that post-menopausal bleeding is never normal and that you need to see a physician for that…regarding the fact that accessing care can be, as you mentioned, done in many, many different ways these days. And so understanding what your options are, whether that’s telehealth, whether that’s a consult visit and then receiving the majority of the subsequent care closer to home, you have a lot of options.”

Download Guide | Descargar Guía en Español

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Related Resources:

Which Endometrial Cancer Clinical Trials Are Showing Promise

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 Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

 Endometrial Cancer Care Disparities | The Impact of Rural Residence

Endometrial Cancer Care Disparities: The Impact of Rural Residence

Transcript:

Lisa:

If a woman goes in and is diagnosed at her local cancer center and has endometrial cancer, should she see some type of subspecialist, would it be of benefit to that patient maybe to even do a consult, a telemedicine consult at least upon diagnosis? Or how can a person who is more remote geographically access a subspecialist care or expertise?

Dr. Emily Hinchcliff: 

Yeah, absolutely. So I think that telehealth has really changed medicine in general and provides some really great opportunities for access. There is a big kind of dichotomy in endometrial cancer where early stage disease is often caught because it has a symptom, vaginal bleeding is a symptom. And so early stage disease can often be treated with surgery alone.

And so that surgical management, again, can potentially be done by a GYN oncologist at a one single time point. The subsequent care, so I’ll just use myself as an example. I will often see women for sort of that initial visit, treatment decision, sometimes surgery, but then if they need additional adjuvant therapy, such as chemotherapy, they’ll go closer to home to receive some of those therapies. And then I will serve as a bit of a consultant to their providers closer to home to discuss what treatment options, what regimens and how to manage toxicities might be good in their case.

Lisa:

And do you have an activation tip for patients for that question?

Dr. Emily Hinchcliff:  

Yeah, so I think that my activation tip here regarding barriers to endometrial cancer care is first and foremost addressing the knowledge gap, understanding that post-menopausal bleeding is never normal and that you need to see a physician for that, I think is the first key tip. The second tip, I guess, if I could give a second activation tip, is regarding the fact that accessing care can be, as you mentioned, done in many, many different ways these days. And so understanding what your options are, whether that’s telehealth, whether that’s a consult visit and then receiving the majority of the subsequent care closer to home, you have a lot of options. And we as a field in GYN oncology are really collaborative. And I think most of us would feel very positively towards creating a team to help you get the care you need.

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Endometrial Cancer Care Disparities: The Impact of Rural Residence

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Endometrial Cancer Care Disparities: The Impact of Rural Residence from Patient Empowerment Network on Vimeo.

What kind of care disparities do endometrial cancer patients from rural areas face? Expert Dr. Emily Hinchcliff from Northwestern Medicine shares her perspective on obstacles for patient care in rural areas and patient advice to help ensure optimal care.

Download Guide | Descargar Guía en Español

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Which Endometrial Cancer Clinical Trials Are Showing Promise

Which Endometrial Cancer Clinical Trials Are Showing Promise?

 Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

 Overcoming Geographical Barriers in Endometrial Cancer Care

Overcoming Geographical Barriers in Endometrial Cancer Care

Transcript:

Lisa:

Dr. Hinchcliff, can you speak to barriers faced by rural endometrial cancer patients, those living in rural areas, and are there specific challenges that these women in rural areas face in accessing timely and quality healthcare services for endometrial cancer screening and treatment?

Dr. Emily Hinchcliff: 

Absolutely. So, when I think of barriers, I think that barriers can be broken into some really key steps along the kind of diagnosis continuum. So certainly, a patient needs to understand that the symptom that they’re having is a problem. Then they need to see that problem and seek care. Then once they have established care they need to obtain a diagnosis. And then once you have a diagnosis, you need to get treated. And so I would suspect that those living remote from major hospital centers or from subspecialty care probably experience delays at each single one of those time points.

First, I think a knowledge gap probably exists about what bleeding should be, especially for postmenopausal women. Postmenopausal bleeding is not normal. And so even a small episode of spotting should warrant a visit to your physician. And then I think for those who see their physician, who have a less kind of either geographic or less access for whatever reason, there’s probably a greater prolongation of the series of visits that are required before they get the necessary endometrial sampling and a transvaginal ultrasound, which are really core tests when it comes to diagnosis.

Once the diagnosis is obtained, I think that the further referral and potential delay to someone like myself, like a GYN oncologist, is also a key barrier for those who are rural. There’s actually a really good study in gynecologic specifically in the Midwest that showed that rural women were significantly less likely to receive care from a subspecialist like myself.  I think that particular study was in endometrial, sorry in ovarian cancer, but it showed that those who receive care by a specialist are more likely to get optimal surgery and to get guideline-inherent care. So getting yourself to that subspecialist, I think is really key, but can be difficult for women who live remote from subspecialty care.

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