Patient Empowerment | Advice From an Ovarian Cancer Expert

How can you feel empowered in your ovarian cancer care? Dr. Heidi Gray highlights the importance of allowing others, like your doctor, to help alleviate fear and regain a sense of control while navigating your journey with hope.

Dr. Heidi Gray is the Division Chief of Gynecologic Oncology and the Director of Gynecologic Oncology Clinical Trials at UW Medicine. Learn more about Dr. Gray.

See More from INSIST! Ovarian Cancer

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Essential Testing Following an Ovarian Cancer Diagnosis

Essential Testing Following an Ovarian Cancer Diagnosis

How Do Biomarkers Impact Ovarian Cancer Treatment and Care?

How Do Biomarkers Impact Ovarian Cancer Treatment and Care?

Understanding Your Role in Your Ovarian Cancer Care

Understanding Your Role in Your Ovarian Cancer Care 

Transcript:

Katherine Banwell:  

Dr. Gray, as a provider, how do you empower patients who have been diagnosed with ovarian cancer?  

Dr. Heidi Gray:  

That’s such an important question. I think that it’s incredibly important. My role is to help alleviate fear. I think when patients have a new diagnosis of cancer the rug’s been pulled out from under them. The patient describes it like being in a car crash.   

You’re numb. It’s hard to even know where to go next. There’s so much fear, because you don’t know what’s next and the loss of control. So, I really spent a lot of time trying to just address that and acknowledge but also help move people forward, because I think it’s always helpful to be able to have a plan or have a sense of what’s going to happen next or have some control around that.  

Of course, I also need to instill a lot of hope for patients. You never know what any one patient’s journey is going to be. The way information is, as I said, you can get all of these information and numbers, and it can be completely scary. Any one patient, their journey is different from the next one from the next one, and it’s very important to be hopeful and thoughtful about what that might look like or thinking about what that might look like. 

How Do Biomarkers Impact Ovarian Cancer Treatment and Care?

How do biomarkers impact ovarian cancer care? Dr. Heidi Gray discusses how genetic biomarkers like BRCA-1, BRCA-2, and HRD inform treatment options, affect prognosis, and guide therapies like PARP inhibitors. 

Dr. Heidi Gray is the Division Chief of Gynecologic Oncology and the Director of Gynecologic Oncology Clinical Trials at UW Medicine. Learn more about Dr. Gray.

See More from INSIST! Ovarian Cancer

Related Resources:

Essential Testing Following an Ovarian Cancer Diagnosis

Essential Testing Following an Ovarian Cancer Diagnosis

Patient Empowerment | Advice From an Ovarian Cancer Expert

Patient Empowerment | Advice From an Ovarian Cancer Expert

Understanding Your Role in Your Ovarian Cancer Care

Understanding Your Role in Your Ovarian Cancer Care 

Transcript:

Katherine Banwell:  

What are the most common biomarkers associated with ovarian cancer? 

Dr. Heidi Gray:  

So, the most common biomarkers, first of all, are the genetic mutations that are associated with higher risk. So, many folks are familiar with BRCA-1 and BRCA-2. There are a couple of lesser-known genetic mutations that fall into that family that also can put patients at an inherited risk. 

Other biomarker testing that we do is for something called HRD, which is a test to look at a profile of the cancer that is similar to having the BRCA-1 and BRCA-2 mutations. It is a spectrum of different testing that may make those cancers more susceptible to PARP inhibitor therapy.  

Katherine Banwell:  

Are there biomarkers associated with prognosis? 

Dr. Heidi Gray:  

Let me back up a little bit. So, the biomarkers associated with prognosis – yes. So, in patients who have BRCA-1 or BRCA-2 mutations, they actually tend to have better prognosis longer term and better responsiveness to chemotherapy and other therapies. 

Patients who also have HRD may also have a little improved responsiveness to some of the therapies as well.  

Katherine Banwell:  

How do these biomarkers impact ovarian cancer treatment options? 

Dr. Heidi Gray:  

Good question. So, the biomarker testing again, particularly for the BRCA-1, BRCA-2, and then the HRD spectrum, there have been several very large studies that have looked at using a variety of drugs that fall under this group called PARP inhibitors, P-A-R-P inhibitors.  

These drugs specifically target cancers that have these mutations – or more susceptible to these mutations and interestingly have found that when we use these PARP inhibitors in a maintenance therapy, so after patients have completed their primary treatment, surgery, chemotherapy, and then go on maintenance therapy to prevent recurrence, they have very, very long improvement in survival and pushing out recurrence very far, significantly so, more than we’ve seen for anything in ovarian cancer in recent years.   

So, it’s very, very exciting. 

Katherine Banwell:  

What question should patients ask about test results?  

Dr. Heidi Gray:  

It is interesting now because as many patients have experienced, they sometimes get their test results before their provider has had a chance to review them as part of the patient access program that has been in place. So, I find that many patients have had time to sit with their results or question or go on the Internet about them before they see me. So, some of it is helping direct, okay, where are you getting your information from and all of that, because I think that that is something newer now. 

But I think it’s important for patients to be asking do I qualify for genetic testing, what are those results, what are the implications for myself and/or my family members? Then the molecular testing, as I said, is a very important next step that we do recommend for all, certainly advanced ovarian cancers or recurrent ovarian cancers, to help better guide therapy. 

Essential Testing Following an Ovarian Cancer Diagnosis

 

What essential testing should follow an ovarian cancer diagnosis? Dr. Heidi Gray explains that patients should undergo both genetic testing, which identifies inherited risk factors, and molecular testing, which evaluates specific tumor mutations.

Dr. Heidi Gray is the Division Chief of Gynecologic Oncology and the Director of Gynecologic Oncology Clinical Trials at UW Medicine. Learn more about Dr. Gray.

See More from INSIST! Ovarian Cancer

Related Resources:

How Do Biomarkers Impact Ovarian Cancer Treatment and Care?

How Do Biomarkers Impact Ovarian Cancer Treatment and Care?

Patient Empowerment | Advice From an Ovarian Cancer Expert

Patient Empowerment | Advice From an Ovarian Cancer Expert

Understanding Your Role in Your Ovarian Cancer Care

Understanding Your Role in Your Ovarian Cancer Care 

Transcript:

Katherine Banwell:  

Dr. Gray, what essential testing should people with ovarian cancer have following diagnosis?  

Dr. Heidi Gray:  

That’s a great question. We’re learning more and more about this disease. Therefore, we also have a lot more variety of tools to look at to be able to match better therapies for patients. Historically, when patients were diagnosed with ovarian cancer, it was based on just the pathology at the time of surgery and some lab testing called the CA-125, which many patients with ovarian cancer are familiar with.  

The next level of testing that we are doing for ovarian cancer is really to look at how aspects of either the patient themselves or of the cancer themselves that might better match therapies. So, the first line of testing we recommend for all women for ovarian cancer is genetic testing. Genetic testing is blood-based testing.  

It is testing for if you have an inherited gene or a mutated gene, that’s being passed along through families that may have put you at risk of developing ovarian cancer and potentially breast cancer. That is recommended for all women and patients who have been diagnosed with ovarian cancer because we know about 15 percent to 20 percent of these cancers are due to a genetic cause. 

The other level of testing that we have incorporated is what we call molecular testing. Other terms for it are “tumor-based testing” – I think you use the term “biomarker testing.” Some people use the term “precision medicine,” and that is a little different. That is testing that is actually testing the tumor itself. It’s looking at a variety of different factors but particularly looking at mutations in the cancer itself, in the tumor itself, so different than the genetic, which is an inherited thing. This is in the tumor itself. There is some overlap of that.  

But it has an expanded profile of different targets that we can match therapies to. 

Katherine Banwell:  

Would you define biomarker testing for us? 

Dr. Heidi Gray:  

Yeah. So, biomarker testing is just that. It is more expanded testing, particularly tumor testing is one aspect of it. There can also be some blood testing, genetic testing. Then there is a new realm also of looking at cell-free DNA or ct or tumor DNA in the blood as well too that is gaining a lot of interest. 

Comprender su Papel en su Cuidado del Cáncer de Ovario Guía

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Comprender su Papel en su Cuidado del Cáncer de Ovario

 

¿Qué medidas pueden tomar los pacientes de cáncer de ovario para ser proactivos en su cuidado? Este vídeo animado comparte consejos para hablar, participar en decisiones y consejos para aprender más sobre el cáncer de ovario.

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Becoming Empowered and [ACT]IVATED After An Ovarian Cancer Diagnosis 

Understanding Your Role in Your Ovarian Cancer Care

Understanding Your Role in Your Ovarian Cancer Care

Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

Transcript:

Dra. Thompson:

¡Hola! Soy la Dra. Thompson, y me especializo en el tratamiento de los cánceres ginecológicos, que son un grupo de cánceres que afectan los órganos reproductivos de las mujeres.  

Hoy, estoy aquí con Sarah, quien vive con cáncer de ovario. 

Sarah:

¡Hola a todos! En este video, la Dra. Thompson y yo hablaremos sobre el importante papel que los pacientes desempeñan en su cuidado y compartiremos los pasos que pueden tomar para sentirse seguros al tomar decisiones CON su equipo médico.  

Dra. Thompson:

Sarah y yo sabemos de primera mano que esto comienza con encontrar un equipo médico que los apoye. Sentirse a gusto al hablar sobre sus pensamientos y preocupaciones es crucial, porque compartir su opinión puede influir en su atención general.  

Sarah:

Totalmente. Cuando me diagnosticaron por primera vez, me sentía ansiosa y abrumada, pero la Dra. Thompson me animó a hacer preguntas, lo que me ayudó a sentirme más en control.   

También descubrí que buscar atención con un especialista marcó una gran diferencia. Dra. Thompson, ¿puede hablar sobre por qué eso es tan importante? 

Dra. Thompson:

Claro, Sarah. Los especialistas, como los oncólogos ginecológicos, tienen la experiencia para ofrecer los tratamientos y recomendaciones más actualizadas para el cáncer de ovario. Pueden brindar un enfoque más personalizado a su cuidado, lo que puede ayudar a manejar la enfermedad de manera más efectiva. 

Sarah:

Exactamente—colaborar con un especialista aumentó mi confianza en las decisiones sobre mi tratamiento. También me hizo darme cuenta de la importancia de aprender sobre mi cáncer, para poder participar en las conversaciones sobre mi cuidado. 

Dra. Thompson:

Así es, Sarah. Educarse a uno mismo es otro paso clave para sentirse empoderado. Cuando comprende más sobre su enfermedad, su diagnóstico y las terapias disponibles, le ayuda a tomar las decisiones que son mejores para usted.  

Y para ayudarle a aprender más sobre su cáncer de ovario, aquí está mi consejo sobre por dónde empezar:  

  1. Conozca su diagnóstico específico: Pregúntele a su médico sobre el tipo y la etapa de su cáncer de ovario. Esta información guiará sus opciones de tratamiento. 
  2. Además, asegúrese de haber realizado pruebas de biomarcadores, incluidas pruebas genéticas: Los resultados de las pruebas ayudarán a usted y a su equipo médico a comprender mejor su diagnóstico y pueden afectar la terapia.  
  3. Priorice su salud mental: Manejar un diagnóstico de cáncer puede ser emocionalmente desafiante. Busque apoyo de profesionales de la salud mental o grupos de apoyo para ayudar a sobrellevar la ansiedad y el estrés. 

Sarah:

Estoy completamente de acuerdo, Dra. Thompson. También hay muchos recursos disponibles que proporcionan información valiosa. Aquí hay algunos recursos confiables en los que puede confiar:  

Dra. Thompson, ¿qué consejo tiene para aprovechar al máximo el tiempo con su médico?   

Dra. Thompson: Buena pregunta, Sarah. Aquí algunos consejos: 

  • Primero, esté preparada: Anote cualquier pregunta o inquietud que tenga antes de su visita.  
  • Luego, tome notas: Lleve un cuaderno o algo para registrar los detalles durante su cita. 
  • También, lleve a un amigo o familiar: Tener a alguien con usted puede brindarle apoyo emocional y ayudarle a recordar la información compartida. 
  • Finalmente, discuta sus objetivos: Sea clara acerca de sus necesidades de tratamiento y cualquier inquietud relacionada con su estilo de vida. No dude en hablar durante la visita y asegúrese de que todas sus preguntas hayan sido respondidas.  

Sarah:

Esos son consejos muy útiles. Tener a mi hermana conmigo durante las citas fue reconfortante, y a menudo pensaba en preguntas que yo no había considerado.  

Dra. Thompson:

Eso es un excelente punto, Sarah. Recuerde, usted es el centro de su equipo de atención. Manténgase involucrada y nunca dude en comunicarse si tiene preguntas o no entiende algo. 

No olvide descargar la guía que acompaña a este video. Y para obtener más información sobre el cáncer de ovario, visite powerfulpatients.org. 

Understanding Your Role in Your Ovarian Cancer Care Resource Guide

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Understanding Your Role in Your Ovarian Cancer Care

 

What steps can ovarian cancer patients take to be proactive in their care? This animated video shares tips and advice for speaking up, engaging in decisions and tips for learning more about ovarian cancer.

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Related Resources:

Becoming Empowered and [ACT]IVATED After An Ovarian Cancer Diagnosis 

Comprender su Papel en su Cuidado del Cáncer de Ovario

Comprender su Papel en su Cuidado del Cáncer de Ovario

Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

Transcript:

Dr. Thompson:

Hi! I’m Dr. Thompson, and I specialize in treating gynecologic cancers, which are a group of cancers that impact a woman’s reproductive organs.  

Today, I’m here with Sarah, who’s living with ovarian cancer. 

Sarah:

Hi everyone! In this video, Dr. Thompson and I will discuss the important role that patients play in their care and will share steps you can take to feel confident when making decisions WITH your healthcare team. 

Dr. Thompson:

And Sarah and I know firsthand that this starts with finding a healthcare team that supports you. Feeling at ease when discussing your thoughts and concerns is crucial, because sharing your input can impact your overall care.  

Sarah:

Absolutely. When I was first diagnosed, I felt anxious and overwhelmed, but Dr. Thompson encouraged me to ask questions, which helped me feel more in control.  

I also found that seeking care from a specialist made a big difference. Dr. Thompson, can you talk about why that’s so important? 

Dr. Thompson:

Of course, Sarah. Specialists, like gynecologic oncologists, have the expertise to provide the most up-to-date treatments and recommendations for ovarian cancer. They can offer a more personalized approach to your care, which can help manage the disease more effectively. 

Sarah:

Exactly—collaborating with a specialist boosted my confidence in my treatment choices. It also made me realize the importance of learning about my cancer, so I could participate in conversations about my care. 

Dr. Thompson:

Absolutely, Sarah. Educating yourself is another key step in feeling empowered. When you understand more about your disease, your diagnosis, and available therapies, it helps you make decisions that are best for you.  

And to help you learn more about your ovarian cancer, here’s my advice for where to start:  

  1. Learn about your specific diagnosis: Ask your doctor about the type and stage of your ovarian cancer. This information will guide your treatment options. 
  2. Additionally, ensure you have had biomarker testing, including genetic testing: The test results will help you and your care team better understand your diagnosis and may affect therapy.  
  3. Prioritize your mental health: Managing a cancer diagnosis can be emotionally challenging. Seek support from mental health professionals or support groups to help cope with anxiety and stress. 

Sarah: I completely agree, Dr. Thompson. And, there are also plenty of resources available which provide valuable information. Here are few reputable resources you can rely on: 

Dr. Thompson, what advice do you have for getting the most out of your time with your provider? 

Dr. Thompson: Great question, Sarah. Here are a few tips: 

  • First, be prepared: Write down any questions or concerns you have before your visit.  
  • Then, take notes: Bring a notebook or something to record details during your appointment. 
  • Also, bring a friend or family member: Having someone with you can provide emotional support and help you to remember the information shared. 
  • Finally, discuss your goals: Be clear about your treatment needs and any lifestyle concerns you may have. Don’t hesitate to speak up during the visit and to ensure all of your questions have been answered.  

Sarah:

Those are really helpful tips. Having my sister with me during appointments was comforting, and she often thought of questions I hadn’t considered. 

Dr. Thompson:

That’s a great point, Sarah. Remember, you are the center of your care team. Stay engaged and never hesitate to reach out if you have questions or don’t understand something. 

Don’t forget to download the guide that accompanies this video. And for more information about ovarian cancer, visit powerfulpatients.org. 

Essential Genetic Testing for Personalized Gynecologic Cancer Treatment

How important is genetic testing for gynecologic cancer? Expert Dr. Ramez Eskander from UC San Diego Health discusses the role of genetic testing in gynecologic cancer care – including molecular tumor testing, germline testing, HRD tests, and BRCA mutations – along with proactive patient advice. 

[ACT]IVATION TIP

“…every patient with ovarian cancer needs to know their BRCA status and needs to know their molecular tumor testing status. Feel empowered to ask these questions. It is data that you should have at hand as you make informed decisions.”

See More from [ACT]IVATED Ovarian Cancer

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Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects

PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects

What Are Common Symptoms of Ovarian Cancer

What Are Common Symptoms of Ovarian Cancer?

Transcript:

Lisa Hatfield:

Dr. Eskander, for patients newly diagnosed with a gynecologic cancer, how important is it to get genetic testing like HRD or homologous recombination deficiency, and how can understanding one’s genetic profile help them and their care team choose the best treatment?

Dr. Ramez Eskander:

This is an incredibly important question. It is pivotal that every newly diagnosed ovarian cancer patient have germline genetic testing and molecular tumor testing because of the impact it can have on their treatment strategy, independent of course, the importance of them being diagnosed. So that if they had a genetically inherited mutation, we call it germline mutation, their relatives can be informed and tested, so they can have risk reducing surgical interventions.

In the ovarian cancer setting, homologous recombination deficiency testing is crucial, because it helps inform the magnitude of benefit that we might see with treatment strategy, in this case, combination of PARP inhibitor plus bevacizumab (Avastin) or PARP inhibitor alone. So these treatment strategies have been proven to improve clinical outcomes. And knowing HRD test status and knowing whether you have a germline mutation is pivotal to putting context around a conversation surrounding maintenance treatment approaches. And understanding the profile is what drives your ability to make an informed decision about your maintenance treatment strategies.

And it can be quite nuanced. For example, if a patient is HRD test-negative, they would have to make a decision about what kind of maintenance therapy with their provider. Do I do maintenance treatment? Should I do bevacizumab alone? Should I do a PARP inhibitor alone? And what might I anticipate with either of these approaches, and what are the pros and the cons? And an HRD test-positive patient, there is clear data supporting the use of PARP inhibitors or PARP inhibitors plus bevacizumab in combination.

So you want to be informed of those data as you look to make a decision. And this to me is germane to the care of patients with ovarian cancer. Every patient should know their status and in a similar manner when we talk about endometrial cancer, I would just like to elaborate that it’s critical to know what is the finding of the testing on the tumor for the endometrial cancer? Is this a mismatch repair-deficient or mismatch repair-proficient endometrial cancer and testing that was done? 

Lisa Hatfield:

That’s a lot of information. So I just want to clarify a couple of comments that you made. So when you talk about the germline testing of germline mutations, that has to do with mutations that are present in a patient’s, all the cells in a patient’s body. Is that correct? So like the BRCA1 and 2 genes?

Dr. Ramez Eskander:

That’s correct.

Lisa Hatfield:

And then there are the other types of mutations, some people call them somatic mutations that are just have to do with the DNA sequencing of the actual tumor or cancer cells. So is HRD then, is that a germline mutation, or is that more of a somatic?

Dr. Ramez Eskander:

Perfect question. So HRD itself isn’t a mutation. HRD is looking at changes in the tumor DNA, but you bring up a perfect point. A germline mutation is inherited, meaning that it is in every cell, and it’s a predisposition and increase in cancer risk. Somatic mutations are not inherited. Somatic mutations are mutations in the tumor unique to that cancer. That’s why we talk about informing your family or relatives with a germline mutation, because that was inherited. And other people in the family may have the same inherited mutation. Somatic mutations are not inherited. They arise in the cancer, and they require tumor testing to inform.

Homologous recombination deficiency isn’t looking for a specific mutation, but it’s rather examining the tumor DNA to look for something we call genomic scarring. The analogy I gave is if I’m driving on the freeway and I’m stuck in traffic, I know that I’m stuck in traffic, but I don’t know exactly why. Is there construction on the freeway? Is there an accident? It’s unclear. So the HRD is looking at the genomic signature, and it needs tumor samples to do that, but it’s not honing in on a specific mutation.

I know it can get a little bit complicated. I’ll just add this, A patient who has a germline BRCA mutation, if you test their tumor, the near vast majority are going to have an HRD test-positive signature, because it drives that. So that’s like saying, I know the reason that there’s that genomic instability, it’s a BRCA mutation, but there are patients we call beyond BRCA. There are many things that may cause this independent of BRCA that we may not know of right now, but we can identify the genomic scar, and that qualifies patients as having a homologous recombination deficiency test-positive tumor. 

So my tip is every patient with ovarian cancer needs to know their BRCA status and needs to know their molecular tumor testing status. Feel empowered to ask these questions. It is data that you should have at hand as you make informed decisions.

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PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects

Ovarian cancer treatment may cause side effects, so what should patients be aware of? Expert Dr. Ramez Eskander from UC San Diego Health discusses common ovarian cancer treatment side effects, management of side effects, and proactive patient advice for optimal care. 

[ACT]IVATION TIP

“…make sure you’re asking appropriate questions, that you’re educated about treatment-related side effects as they relate to PARP inhibitors. And then lastly, to understand that dose interruptions or dose reductions are an expected part of treatment with really any anti-cancer directed therapy, including PARP inhibitors, with a goal to keep patients on therapy, because they’re benefiting from this treatment.”

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Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

Essential Genetic Testing for Personalized Gynecologic Cancer Treatment

Essential Genetic Testing for Personalized Gynecologic Cancer Treatment

What Are Common Symptoms of Ovarian Cancer

What Are Common Symptoms of Ovarian Cancer?

Transcript:

Lisa Hatfield:

Dr. Eskander, what are some common side effects of ovarian cancer treatments, particularly with long-term use of PARP inhibitors, and how can patients manage these side effects and maintain their quality of life during treatment?

Dr. Ramez Eskander:

PARP inhibitors, Lisa, are a very important part of the management of patients with advanced stage ovarian cancer. They have become a commonly used treatment in the first line we call it therapy or when patients are initially diagnosed as a maintenance treatment strategy and those PARP inhibitors can be given alone or the PARP inhibitors can be given in combination with another drug called bevacizumab (Avastin) as maintenance therapy. PARP inhibitors is a class I like to say are drugs that can be well tolerated.

One of the most important things that we face as providers is we are responsible to make sure our patients are educated. When we are able to have a conversation with a patient and educate them about potential treatment-related side effects and they feel empowered in managing those side effects, we’re able to make sure that patients can stay on treatment, tolerate, and of course, most importantly, benefit from this study-directed therapy for management of their cancer. As a class, some of the more common side effects of PARP inhibitors are fatigue. It’s actually one of the most common side effects.

We can see gastrointestinal side effects. They can be varied, but it can be constipation or diarrhea or abdominal cramping. We can also see hematologic side effects, which means impact on the blood counts. It can cause anemia, lowering the red blood cell count, lowering the white blood cell count, and in some instances, lowering the platelet count. There are rare, when I say rare in the front line, if you look across trials, less than about 1-1/2 percent of patients can develop a secondary malignancy of the bone marrow that’s called myelodysplastic syndrome or acute myeloid leukemia. Those are very uncommon, but they have been described when we use PARP inhibitors as a maintenance strategy in the front line.

So in these circumstances, again, it’s about education. It’s about making sure that you’re asking your provider, what might I experience, and how are we going to be proactive about mitigating these side effects? And I would like to emphasize that it’s okay when needed, to have a dose interruption, meaning pause the medication for a period of time, or a dose reduction, reduce the dose.

Because by doing so, we can make sure that a patient can stay on a treatment that they tolerate. And so managing these side effects is multi-pronged. It’s your clinician, your treatment team, of course, because it goes beyond the clinician who’s caring for you. It’s about understanding that an interruption in treatment may be needed, or reduction in the dose may be required, because that helps us keep patients on treatment. 

Lisa Hatfield:

So if I understand correctly then, PARP inhibitors are something that a patient remains on until disease recurrence. That’s not a limited duration therapy, but it can be interrupted if needed a little bit of a break. So is that correct that it’s until disease recurrence?

Dr. Ramez Eskander:

In the front line when we’re talking about maintenance treatment strategy with PARP inhibitors, there’s actually a defined time period, but that defined time period is quite long on the order of two years. So you’re on a medication for a long period of time. Now, if you get to that two years, and thankfully there’s no evidence of cancer recurrence or active disease, you may be able to discontinue the PARP inhibitor.

The different trials had different durations of maintenance therapy. So you can imagine that there can be some fluctuation between trials two years or three years. But needless to say, it’s still a long period of time that you’re on an anti-cancer directed maintenance therapy. When you get to the end of that, however, you would be able to potentially discontinue treatment in conversation with your provider.

So here, in my opinion, the [ACT]IVATION tip is make sure you’re asking appropriate questions, that you’re educated about treatment-related side effects as they relate to PARP inhibitors. And then lastly, to understand that dose interruptions or dose reductions are an expected part of treatment with really any anti-cancer directed therapy, including PARP inhibitors, with a goal to keep patients on therapy, because they’re benefiting from this treatment.

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Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

What’s vital for ovarian cancer patients to know about treatment options and approaches? Expert Dr. Ramez Eskander from UC San Diego Health discusses chemotherapy, surgery, the importance of molecular testing, treatment approaches for optimal outcomes, and proactive patient advice. 

[ACT]IVATION TIP

“…ask the questions of your provider. Understand, did you have genetic testing? Did you have molecular tumor testing? And do the results of that genetic or molecular tumor testing impact the treatment recommendations for maintenance therapy? I want to make sure everybody feels empowered to ask those questions and have those answers.”

See More from [ACT]IVATED Ovarian Cancer

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PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects

PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects

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Essential Genetic Testing for Personalized Gynecologic Cancer Treatment

What Should Ovarian Cancer Know About Immunotherapy and Targeted Therapies

What Should Ovarian Cancer Know About Immunotherapy and Targeted Therapies

Transcript:

Lisa Hatfield:

Dr. Eskander, for someone who is newly diagnosed with ovarian cancer, what are the most common treatment options available, and how can patients know which treatment plan is best suited for their specific situation?

Dr. Ramez Eskander:

Newly diagnosed ovarian cancer is managed utilizing chemotherapy and surgery. The order can vary depending on the specific patient, how they present, their cancer burden, whether you receive chemotherapy, surgery, followed by chemotherapy, or surgery and chemotherapy. The drugs, the backbone of treatment, are very similar, that is, two chemotherapy drugs called carboplatin (Paraplatin) and paclitaxel (Taxol). I will say that there are other drugs used in the front line. Another drug that’s commonly used is a drug called bevacizumab or Avastin. This is called an anti-angiogenic drug.

And we’ve also identified biomarkers that have really transformed front-line management. Any and every newly diagnosed ovarian cancer patient should have genetic testing because about 15 percent of ovarian cancers can have a genetic predisposition, meaning that you’ve inherited a gene that increased your risk of developing the cancer. And that’s critically important for the treatment of that patient, but also for any family members who would benefit from what we call cascade genetic testing, they would get tested. And if they were identified to have the gene, they could be followed and have risk-reducing surgery.

The reason this molecular testing of ovarian cancer and again, every patient should have genetic testing and molecular testing is critically important is it is informing maintenance treatment strategies. We’ve now conducted several clinical trials that show the utilization of a class of drug called PARP inhibitors. These are oral pills. When we use these medications in patients who have a BRCA mutation, there is a dramatic improvement in clinical outcome.

So every advanced stage ovarian cancer patient should be tested. And for those who have a BRCA mutation, every one of those patients should be treated with a maintenance PARP inhibitor. And maintenance meaning after you finish the chemotherapy drugs that I mentioned, you go on to that maintenance PARP inhibitor. And we’ve also had clinical trials that have expanded that opportunity, because not only are we looking at patients that have a BRCA mutation, but we’ve now expanded and incorporate into patients who are homologous recombination-deficient, or HRD test-positive.

Because studies have shown that when you give the PARP inhibitors in combination with bevacizumab, the drug that I alluded to a moment ago, you can again get a very significant improvement in clinical outcome including an improvement in overall survival. So biomarker testing, genetic testing, chemotherapy plus surgery is a backbone but importantly utilizing that molecular testing to inform maintenance treatment strategies which have clearly improved clinical outcomes, and these are all very critical conversations to have with the physician who’s taking care of you.

And for me, my [ACT]IVATION tip here is ask the questions of your provider. Understand, did you have genetic testing? Did you have molecular tumor testing? And do the results of that genetic or molecular tumor testing impact the treatment recommendations for maintenance therapy? I want to make sure everybody feels empowered to ask those questions and have those answers.

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Becoming Empowered and [ACT]IVATED After An Ovarian Cancer Diagnosis

Patient Empowerment Network (PEN) is committed to helping educate and empower patients and care partners in the ovarian cancer community. Ovarian cancer treatment options are ever-growing with new treatments, and it’s important for patients and families to educate themselves about testing, factors in treatment decisions, treatment types, and disparities in care. With this goal in mind, PEN kicked off the [ACT]IVATED Ovarian Cancer program, which aims to inform, empower, and engage patients to stay tuned in on the latest in ovarian cancer care.

Ovarian cancer can occur in an ovary, a fallopian tube, or the primary peritoneum – which is the thin tissue lining in the abdomen. Symptoms of ovarian cancer can vary widely and may include abdominal pain, pelvic pain, abdominal bloating, difficulty urinating, difficulty with bowel movements, or a growth or mass. PEN is proud to add information about ovarian cancer to serve more patients and their families. Cancer survivor and Empowerment Lead Mikki Goodwin interviewed expert Dr. Ebony Hoskins, a board-certified gynecologic oncologist at MedStar Washington Hospital Center and Assistant Professor of Clinical Obstetrics and Gynecology at Georgetown University Medical Center.

Factors in Ovarian Cancer Treatment Options

One essential part for ovarian cancer patients to ensure their best care is to receive genetic testing. Dr. Ebony Hoskins discussed the importance of genetic testing. “…ovarian cancer can be hereditary. Approximately 10 to 15 percent are associated with an increased risk with family history. It is now recommended that any patient with ovarian cancer get genetics testing period, even if there’s no family history that they should be offered genetics testing.”

Dr. Hoskins stressed the importance of ovarian cancer patients to know their ovarian cancer subtype, stage of disease, organs involved, and plan of attack for their specific cancer. Empowering patients with this information can help them as part of shared decision-making. “…I look at it I, II, III, IV. In terms of treatment planning, we look at that and there’s data that look and say, “What are the best options for treatment in someone?” It depends on their stage and the grade. And that’s all kind of important in terms of treatment, but as well as for prognosis.

Ovarian Cancer Disparities

Studies show that there are disparities in ovarian cancer care and clinical trial participation. While both Hispanic women and Black women experience more barriers to quality ovarian cancer care, a study found that Black women were 14 percent less likely than white women to receive all treatments recommended by the National Comprehensive Cancer Network (NCCN) guidelines. Another study on ovarian cancer clinical trial participation found that Hispanic/Latinx patients and patients on Medicaid were less likely to participate in ovarian cancer clinical trials. Ovarian cancer patients and patient advocates can help educate themselves and others about these disparities to aid in efforts to spread awareness and changes toward better care and clinical trial participation rates.

Solutions Toward Better Ovarian Cancer Care

Clinical  trial participation is vital to develop effective ovarian cancer treatment for all patients. Dr. Hoskins shared her perspective about the importance of clinical trials. “…I always tell patients, the reason we know what to give you now, treatment is based off a clinical trial. So we need these trials. We didn’t just create a new drug and just gave it. We need to know, is it going to improve survival? What are the side effects? Is it going to kill the cancer? And so it’s important to be on the cutting edge if you will, of advancement in the field. The only way I know what to give patients is based off a clinical trial.

Dr. Hoskins [ACT]IVATION Tip

[ACT]IVATION Tip:

Clinical trial participation can often diminish the financial burden of cancer care. Dr. Hoskins explained some of the financial benefits and advice for patients. “The financial toxicity and sometimes coming under their trial, the drugs are covered, so you’re getting cutting-edge care that comes as maybe it’s not as costly to you, so I think, again, my activation tip for a patient is inquire with your doctor, “Am I a candidate for a clinical trial? Do you offer a clinical trial, are there clinical trials that would fit my scenario that’s local that I could go to? Are there clinical trials that are available, say, out of state that you think I will be a good fit for?” And sometimes…again, not every patient is a clinical trial candidate for a number of reasons, but asking the question, I think is huge.

Cancer survivor Mikki Goodwin shared her patient experience and the importance of empowering yourself as a patient. “Live on purpose every day, be your best advocate, record doctor appointments, you’ll never remember everything, so it’s good to be able to play it back, take one day at a time, rest when you need to rest that is part of healing, and stay hydrated. Having cancer is not a sentence to die, but a call to live intentionally. More than anything, stay positive, more than half the battle starts in the mind.”

[ACT]IVATED Ovarian Cancer Program Resources

The [ACT]IVATED Ovarian Cancer program series takes a three-part approach to inform, empower, and engage both the overall ovarian cancer community and patient groups who experience health disparities. The series includes the following resources:

Though there are ovarian cancer disparities, patients and care partners can be proactive in educating themselves to help ensure optimal care. We hope you can take advantage of these valuable resources to aid in your ovarian cancer care for yourself or for your loved one.

[ACT]IVATION Tip:

By texting EMPOWER to +1-833-213-6657, you can receive personalized support from PENs Empowerment Leads. Whether you’re an ovarian cancer patient, or caring for someone who is, PEN’s Empowerment Leads will be here for you at every step of your journey.

Ovarian Cysts and Uterine Fibroids: Is There a Connection to Ovarian Cancer?

Ovarian Cysts and Uterine Fibroids: Is There a Connection to Ovarian Cancer? from Patient Empowerment Network on Vimeo.

Are ovarian cysts and fibroids a concern for ovarian cancer patients? Expert Dr. Ebony Hoskins shares her perspective about fibroids and cysts, what she looks for in patients, and her advice to patients to ensure their best care.

Dr. Hoskins is a board-certified gynecologic oncologist at MedStar Washington Hospital Center and assistant professor of Clinical Obstetrics and Gynecology at Georgetown University Medical Center. Hoskins sees women for gynecological malignancies, which include the treatment of endometrial, ovarian, vulva, vaginal and cervical cancers.

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Sexual Health After a Cancer Diagnosis: An Expert Weighs In

Sexual Health After a Cancer Diagnosis: An Expert Weighs In

What Are Common Symptoms of Ovarian Cancer

What Are Common Symptoms of Ovarian Cancer?

What Should Ovarian Cancer Know About Immunotherapy and Targeted Therapies

What Should Ovarian Cancer Know About Immunotherapy and Targeted Therapies

Transcript:

Mikki:

Okay, Dr. Hoskins, are fibroids or ovarian cysts related to ovarian cancer?

Dr. Ebony Hoskins:

So from a gynecologic oncology standpoint, when I see someone who has a documented uterine fibroid, I don’t think that it’s related to ovarian cancer. Certainly when I see a woman that has ovarian cysts, that’s something that potentially could be an ovarian cancer. But then I’m looking at whether it’s a cyst, whether there’s fluid. So there’s other characteristics in the imaging that I have obtained. So I think the question is, are fibroids and ovarian cysts related to ovarian cancer? Not really, but I think it’s important that we are basing this on some objective data, right? So I can press on someone’s belly and say, “Oh, that’s fibroids.” But asking my activation tip would say, “Hey can I get an ultrasound to look at my pelvic organs?” Not just randomly, but if you, if a patient feels like it’s fibroids, let’s prove it, let’s get an ultrasound. And that will look not only at the uterus, it looks at the adnexa, which is the fallopian tubes and the ovaries, and have an objective diagnosis for what’s going on in the GYN organs and pelvis.


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Sexual Health After a Cancer Diagnosis: An Expert Weighs In

Sexual Health After a Cancer Diagnosis: An Expert Weighs In from Patient Empowerment Network on Vimeo.

What can ovarian patients do if they have sexual health issues that arise during their patient journey? Expert Dr. Ebony Hoskins explains issues that may come up for some patients and patient advice on how to seek support. 

Dr. Hoskins is a board-certified gynecologic oncologist at MedStar Washington Hospital Center and assistant professor of Clinical Obstetrics and Gynecology at Georgetown University Medical Center. Hoskins sees women for gynecological malignancies, which include the treatment of endometrial, ovarian, vulva, vaginal and cervical cancers.

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Related Resources:

Ovarian Cancer and Clinical Trial Participation: What Patients Should Know

Ovarian Cancer and Clinical Trial Participation: What Patients Should Know

Understanding Stages of Ovarian Cancer: What Should Patients Know

Understanding Stages of Ovarian Cancer: What Should Patients Know

What Should Ovarian Cancer Know About Immunotherapy and Targeted Therapies

What Should Ovarian Cancer Know About Immunotherapy and Targeted Therapies

Transcript:

Mikki:

Dr. Hoskins, can you speak to the sexual health following a cancer diagnosis, and which healthcare team member should patients have a conversation with?

Dr. Ebony Hoskins:

I think this is a great question. I think sexual health is something that goes undiscussed unless we ask it, and I think sometimes it’s uncomfortable for the patient, it’s uncomfortable for the provider. But I do talk to a lot of women that have decreased libido or pain, or there’s a lot of dysfunction sometimes after surgery or chemotherapy, and some of it is related to the actual treatment itself. Physiologic meaning how the body functions after treatment, and some could be the fact that there is shame associated with that, sometimes the cancer is involving a sexual organ in that area, and so I think bringing discussion up to your…whether the provider is a gynecologic oncologist and is the person who did the surgery, or the who person gave the chemo or the radiation oncologist. Also, there are mid-level providers who do survivorship, and it just kind of depends on who’s taking care of you after completion of treatment, butI know there are survivorships, and these are times to bring it up. Bring it up to your provider, number one, and they may have resources to refer you to in terms of getting through these difficult times, because I think ultimately you can get your sexual life back. 


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Ovarian Cancer and Clinical Trial Participation: What Patients Should Know

Ovarian Cancer and Clinical Trial Participation: What Patients Should Know from Patient Empowerment Network on Vimeo.

What do ovarian cancer patients need to know about clinical trial participation? Expert Dr. Ebony Hoskins explains the importance of clinical trial participation and key advice for patients who are considering participation in a clinical trial.

Dr. Hoskins is a board-certified gynecologic oncologist at MedStar Washington Hospital Center and assistant professor of Clinical Obstetrics and Gynecology at Georgetown University Medical Center. Hoskins sees women for gynecological malignancies, which include the treatment of endometrial, ovarian, vulva, vaginal and cervical cancers.

[ACT]IVATION TIP

“…inquire with your doctor, ‘Am I a candidate for a clinical trial? Do you offer a clinical trial, are there clinical trials that would fit my scenario that’s local that I could go to? Are there clinical trials that are available, say, out of state that you think I will be a good fit for?’”

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Related Resources:

Hereditary Ovarian Cancer: What's Your Risk

Hereditary Ovarian Cancer: What’s Your Risk?

Understanding Stages of Ovarian Cancer: What Should Patients Know

Understanding Stages of Ovarian Cancer: What Should Patients Know

What is Ovarian Cancer

What is Ovarian Cancer? An Expert Explains.

Transcript:

Mikki:

Dr. Hoskins, why is clinical trial participation so important in ovarian cancer, and what advice do you have for patients considering a clinical trial?

Dr. Ebony Hoskins:  

One, I always tell patients is the reason we know what to give you now, treatment is based off a clinical trial. So we need these trials. We didn’t just create a new drug and just gave it. We need to know, is it going to improve survival? What are the side effects? Is it going to kill the cancer? And so it’s important to be on the cutting edge if you will, of advancement in the field. The only way I know what to give patients is based off a clinical trial.

Right, so that’s number one. The advice for patients I have is, I think understanding what the options are for treatment, whether they come off of trial. So knowing if I’m not on trial, what am I going to get? If I am on trial, what am I going to get? What are the side effects? Side effects is an important thing. What are the safety issues? Because not only are there side effects, there can be a safety issue. I think one thing that we don’t really talk about that could be there, is some of the clinical trials depends on who’s sponsoring it, provide the drugs, and some of the drugs are quite costly, so that’s something that we’re not talking about.

The financial toxicity and sometimes coming under their trial, the drugs are covered, so you’re getting cutting-edge care that comes as maybe it’s not as costly to you, so I think, again, my activation tip for a patient is inquire with your doctor, “Am I a candidate for a clinical trial? Do you offer a clinical trial, are there clinical trials that would fit my scenario that’s local that I could go to? Are there clinical trials that are available, say, out of state that you think I will be a good fit for?” And sometimes…again, not every patient is a clinical trial candidate for a number of reasons, but asking the question, I think is huge.


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What Should Ovarian Cancer Patients Know About Immunotherapy and Targeted Therapies?

What Should Ovarian Cancer Patients Know About Immunotherapy and Targeted Therapies? from Patient Empowerment Network on Vimeo.

What do ovarian cancer patients need to know about immunotherapy and targeted therapy? Expert Dr. Ebony Hoskins explains how immunotherapy and targeted therapy are used, research about them, and advice to patients.

Dr. Hoskins is a board-certified gynecologic oncologist at MedStar Washington Hospital Center and assistant professor of Clinical Obstetrics and Gynecology at Georgetown University Medical Center. Hoskins sees women for gynecological malignancies, which include the treatment of endometrial, ovarian, vulva, vaginal and cervical cancers.

[ACT]IVATION TIP

“…asking ‘Has my tumor been studied, or has there been any sequencing to determine if they are a candidate for targeted therapy?’”

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See More from [ACT]IVATED Ovarian Cancer

Related Resources:

Ovarian Cysts and Uterine Fibroids: Is There a Connection to Ovarian Cancer

Ovarian Cysts and Uterine Fibroids: Is There a Connection to Ovarian Cancer

Ovarian Cancer Risk Factors: What Patients Should Know

Ovarian Cancer Risk Factors: What Patients Should Know

What Are the Subtypes of Ovarian Cancer

What Are the Subtypes of Ovarian Cancer?

Transcript:

Mikki:

Dr. Hoskins, what is the role of immunotherapy or targeted therapy in ovarian cancer care?

Dr. Ebony Hoskins:

So the role of immunotherapy, I think is still kind of ongoing. We’ve seen some improvements with endometrial cancer, not so much the same with ovarian cancer. In terms of targeted therapy, there are new drugs that are coming out that are targeting a different molecular markers in the actual tumor that are now offered for patients with ovarian cancer. And that’s been shown to be proven to work and improve the response and survival. My activation tip, particularly for patients who are affected by ovarian cancer, is asking, “Has my tumor been studied, or has there been any sequencing to determine if they are a candidate for targeted therapy?”

Mikki:

Thank you.


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