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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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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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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Hereditary Ovarian Cancer: What’s Your Risk?

Hereditary Ovarian Cancer: What’s Your Risk? from Patient Empowerment Network on Vimeo.

What should patients know about ovarian cancer and hereditary risk? Expert Dr. Ebony Hoskins explains the incidence rate of hereditary ovarian cancer and shares advice about when it’s important to ensure you get genetic testing.

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

“…if you know someone who has ovarian cancer or if you’re affected yourself, make sure you have gotten genetics testing standard of care.”

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What Are the Subtypes of Ovarian Cancer

What Are the Subtypes of Ovarian Cancer?

Transcript:

Mikki:

Dr. Hoskins, can ovarian cancer be hereditary? Should patients suggest that their family members undergo genetic testing?

Dr. Ebony Hoskins:

So, yes, 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. I always recommend that an affected person, when I say affected person, I mean the person that have the cancer diagnosis get the genetics testing first. So sometimes I see patients where they’re…have several family members with, say, breast cancer, which could be indicative of a breast like a BRCA mutation, which is associated with an ovarian cancer. And come to find out they’ve had genetics testing, but they don’t have the gene for ovarian cancer. So again, it’s important that the affected person, meaning the person that have the cancer, get genetics testing. My activation tip for this is if you know someone who has ovarian cancer or if you’re affected yourself, make sure you have gotten genetics testing standard of care. 


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Ovarian Cancer Risk Factors: What Patients Should Know

Ovarian Cancer Risk Factors: What Patients Should Know from Patient Empowerment Network on Vimeo.

What ovarian cancer risk factors should patients know about? Expert Dr. Ebony Hoskins explains common risk factors and shares advice for 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.

[ACT]IVATION TIP

“…understanding the risk factors for ovarian cancer by also understanding the cancers that we know that we don’t have a screening for.”

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Transcript:

Mikki:

Dr. Hoskins, what are the risk factors for developing ovarian cancer?

Dr. Ebony Hoskins:

So, risk factors for developing ovarian cancer, I mentioned this, is genetics, could be genetics. So someone with a family history of breast and ovarian cancer, a BRCA mutation, Lynch syndrome. We also see it in women who are of later in age. Women who’ve had numerous ovulation cycles. Those are some of the risk factors. And I think the difference with, say, ovarian cancer is we don’t have a known precursor lesion to look for, to detect it early, if you will.

So it’s a little bit different than, say, some other cancers like a cervical cancer or colon cancer, where we can kind of find an early lesion and prevent it, with ovarian cancer we don’t. So these risk factors are kind of risk factors, but not necessarily diagnostic of it, if you will. So my activation tip would be understanding the risk factors for ovarian cancer by also understanding the cancers that where we know that we don’t have a screening for.


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What Are the Subtypes of Ovarian Cancer?

What Are the Subtypes of Ovarian Cancer? from Patient Empowerment Network on Vimeo.

What do ovarian cancer patients need to know about subtypes? Expert Dr. Ebony Hoskins explains ovarian cancer subtypes and shares questions to ask your doctor. 

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

“…understand the subtype, not only just the stage and also, kind of again, what will be the treatment options based off the subtype and stage.”

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Transcript:

Mikki:

Dr. Hoskins, what are the various subtypes of ovarian cancer?

Dr. Ebony Hoskins:

Well, you want to get complicated. I’ll try to make it really simple. [laughter] So when we typically you may hear people say, oh, such and such had ovarian cancer, they’re typically talking about someone who has an epithelial ovarian cancer. There are actually two other subtypes of ovarian cancer. There’s sex cord-stromal tumors, and there’s germ cell tumor. And these are all kind of tumors based off of the origin of the cancer, if you will, from the ovary. When we’re talking here today, I’m going to refer mainly to the epithelial type of ovarian cancer, because that’s the most common type. The most common type is a high-grade serous carcinoma. There’s low-grade serous carcinoma.

There’s endometrioid carcinoma, clear, serous carcinoma, carcinoma sarcoma. So there are different subtypes, and how we treat them sometimes are the same and sometimes they’re different. It all kind of depends on it.  So my activation tip for a patient would be understand the subtype, not only just the stage and also, kind of again, what will be the treatment options based off the subtype and stage. 


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Understanding Stages of Ovarian Cancer: What Should Patients Know?

Understanding Stages of Ovarian Cancer: What Should Patients Know? from Patient Empowerment Network on Vimeo.

What are the ovarian cancer stages, and what do patients need to know about them? Expert Dr. Ebony Hoskins provides an overview of the stages and explains why they are important in both diagnosis and treatment planning.

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

“…for patients with a stage of ovarian cancer, understanding what the stage is, what organs that were involved, and kind of the plan of attack.”

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What is Ovarian Cancer? An Expert Explains.

Transcript:

Mikki: 

Dr. Hoskins, what are the stages of ovarian cancer, and why is it important for treatment planning?

Dr. Ebony Hoskins:  

Well, stages of ovarian cancer, typically we stage cancers in four stages. Stage I, I would look at it very generally as a disease, confined to the ovary. Stage II is disease that’s in the pelvis, kind of below the pelvic bones in that area. Stage III can be disease in the lymph nodes or in the upper abdomen. And when I think stage IV for any disease, I think metastatic disease or distant metastases. So someone who may have an ovarian cancer and now we see liver lesions, that is a stage IV. Someone who may have an ovarian disease, ovarian cancer that is now in the lung, that’s stage IV. So those are the way 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. So my activation tip for patients with a stage of ovarian cancer is understanding what the stage is, what organs that were involved, and kind of the plan of attack.


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What Are Common Symptoms of Ovarian Cancer?

What Are Common Symptoms of Ovarian Cancer? from Patient Empowerment Network on Vimeo.

What should patients know about ovarian cancer symptoms? Expert Dr. Ebony Hoskins explains common symptoms that patients experience and patient types who are considered high-risk.

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

“…if you have any of these symptoms that are vague in nature, and you really can’t put your hand or on what it is, and it’s been going on for a week or two, pop into the doctor. There’s no, please don’t let it get to three months. Literally let it be no more than two weeks and then pop into the doctor.”

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Transcript:

Mikki:

What are some symptoms of ovarian cancer, and who is considered high risk?

Dr. Ebony Hoskins:

So the symptoms for ovarian cancer are vague, which makes it difficult to diagnose. So abdominal bloating, abdominal distinction, a pelvic pain, abdominal pain. Sometimes patients can feel a mass, difficulty in urination, difficulty with bowel movements. So these are some of the symptoms I typically tell someone, “Okay, well I felt bloated last night. I’m not talking about one night. Usually we’re talking over say, one or two weeks. Those are things that to prompt a visit either to the primary care doctor, GYN, or kind of whoever your provider is.

The persons who are at risk for are typically people who have a family history. So family history of ovarian cancer or breast cancer. Older women we tend to see it in women who are greater than 60. So you see that in an older age woman. But probably the biggest risk factor is genetics. Yeah.

So my activation tip, for patients would be, if you have any of these symptoms that are vague in nature, and you really can’t put your hand or on what it is, and it’s been going on for a week or two, pop into the doctor. There’s no, please don’t let it get to three months. Literally let it be no more than two weeks and then pop into the doctor. 


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What Is Ovarian Cancer? An Expert Explains

What Is Ovarian Cancer? An Expert Explains from Patient Empowerment Network on Vimeo.

How can ovarian cancer be explained to patients? Expert Dr. Ebony Hoskins shares how she explains the diagnosis to newly diagnosed 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

“…my activation tip for someone who is newly diagnosed or may want to know more about it is distinguishing, whether it’s from the ovary, fallopian tube, or a primary peritoneal cancer.”

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What Should Ovarian Cancer Know About Immunotherapy and Targeted Therapies?

Transcript:

Mikki:

Dr. Hoskins, what is ovarian cancer, and how do you explain it to your newly diagnosed patients?

Dr. Ebony Hoskins:

So, ovarian cancer sounds like it’s just cancer from the ovary, but really in a gynac world, it could be a couple of things. So ovaries are where a woman ovulates, and she has follicles and kind of where we have menses and hormones, but in terms of when we say ovarian cancer, this could also include a cancer of the ovary, the fallopian tube, or a cancer of the primary peritoneum. So sometimes we may say, oh, it’s ovarian cancer, and it could be a person who has fallopian tube cancer. We treat it the same, we stage it the same. And so that’s why we kind of use it interchangeably. So my activation tip for someone who is newly diagnosed or may want to know more about it is distinguishing, whether it’s from the ovary, fallopian tube, or a primary peritoneal cancer. 


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[ACT]IVATED Ovarian Cancer Resource Guide

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Ultrasound Pictures of Ovarian Cancer

During the process of diagnosing ovarian cancer, doctors will use several tests to learn more about the tumor. The first test that doctors usually recommend is an ultrasound. This painless imaging test helps doctors see what the inside of the abdomen looks like. Doctors can use ultrasounds to detect various problems with the ovaries and nearby organs.

How Do Ultrasounds Work?

An ultrasound machine uses a small handheld tool called a transducer to send sound waves into the body. These sound waves are painless and are so high-pitched that humans can’t hear them. Echoes of the sound waves bounce back to the transducer, and the machine converts the sound waves into an image. The result is a sonogram — a picture of the tissues and organs within a particular part of the body.

There are a couple of types of ultrasound. When diagnosing potential cases of ovarian cancer, doctors often use a transvaginal ultrasound, in which a probe is placed into the vagina. Doctors may also perform a pelvic ultrasound, in which the transducer is placed on the skin of the lower part of the abdomen. Both of these approaches can capture pictures of the ovaries and uterus.

What Does the Ovary Look Like on an Ultrasound?

Sonograms from an ultrasound test can show several features of the ovary. They allow doctors to see the size and shape of the ovary. A sonogram can also look at the texture of the outer surface of the ovary. Additionally, ultrasound imaging can detect abnormalities or masses on the ovary, which may or may not be cancerous.

The Normal Ovary on an Ultrasound

Ultrasound of the normal right ovary without an ovarian follicle.
This ultrasound image shows a normal right ovary that contains no ovarian follicles. (Medical Images)

In general, the ovaries appear as almond-shaped structures on either side of the uterus. In individuals who have given birth multiple times, the ovaries may have moved slightly from their original position. The ovaries also shrink after menopause, so an ultrasound may not be able to detect them in older people.

For individuals who have not yet gone through menopause and are still getting their period, their ovary will contain follicles. Ovarian follicles are small sacs. Each one contains an egg cell. Follicles develop and grow larger throughout the beginning phase of the menstrual cycle. Then, a single follicle will continue to grow until it releases an egg, called ovulation.

Ultrasound of the left ovary during follicular phase (seventh day) of the menstrual cycle, showing an 11 mm ovarian follicle (pink).
This ultrasound image shows a left ovary during the follicular phase (seventh day) of the menstrual cycle. The ovarian follicle (pink) measures 11 millimeters. (Medical Images)

On an ultrasound, the follicles may appear as small, dark, round shapes around the edge of the ovary. Follicles may be different sizes depending on where a person is within their menstrual cycle.

Cysts on an Ultrasound

Sometimes, an ultrasound may detect other more unusual features within an ovary. Most of these findings are not cancerous, and many are not harmful

An ultrasound showing ovarian cysts.
Ovarian cysts are visible in this ultrasound image. These types of cysts are usually noncancerous and appear round and black on an ultrasound. (Adobe Stock)

A common ultrasound finding is a cyst (a fluid-filled sac). About 8 percent to 18 percent of women have cysts on their ovaries. Occasionally, ovarian cancer may appear as a cyst. However, ovarian cysts are usually benign (noncancerous). Often, cysts develop when a follicle fails to release an egg or fails to disappear after ovulation. These cysts usually go away over time. Occasionally, cysts are caused when blood or tissue from the uterus attaches to the ovary, called endometriomas. Cysts can also be teratomas — masses that form when an egg cell begins growing within the follicle.

Like follicles, cysts usually appear round and black on an ultrasound. They often have thin walls and don’t look like they contain anything inside. However, they are often larger than normal follicles.

Cysts don’t usually need any treatment and are often not a cause for concern. In some cases, doctors may recommend a follow-up ultrasound a few months later to see if the cyst has grown.

Ovarian Cancer on an Ultrasound

In rare cases, ovarian cysts or solid masses may be malignant (cancerous). The ultrasound doesn’t show for sure whether an abnormality is cancer, but it can provide clues. Malignant cysts and masses usually look a little different on an ultrasound. They may:

  • Be very large
  • Have papillary structures (bulges) on their outer or inner surface
  • Be divided into multiple segments called loculations
  • Contain blood or other material inside them, making them not look solid black all the way through
Ultrasound showing a large ovarian cancer mass, 17 cm in diameter.
This ultrasound image shows a large ovarian cancer mass, measuring 17 centimeters in diameter. Images alone don’t necessarily reveal whether these types of abnormalities are cancerous, but they can provide clues. (CAMAL/Medical Images)

Some cases of ovarian cancer begin in the fallopian tubes (the tubes that connect the ovaries to the uterus). Fallopian tubes are usually invisible on an ultrasound. However, if there is a problem with the fallopian tube, it may appear as a long, thin mass. This may happen when the fallopian tube grows larger or fills with fluid due to conditions like a blockage, pelvic inflammatory disease, or cancer.

Doctors consider other information when deciding how likely it is that a cyst or mass is malignant. Risk factors that help indicate whether an abnormality is malignant include:

  • Your age
  • Whether you have gone through menopause
  • Levels of CA-125 (a protein that can serve as a sign of ovarian cancer)
  • How big the mass is
  • How much solid tissue is inside of the mass, as opposed to fluid
  • How many bulges or projections a mass contains
  • How many masses are present
  • Whether you have ascites (fluid in your abdomen)

If these factors indicate that you may have a malignancy, your doctor may recommend additional diagnostic tests or surgery to get a better look.

What Don’t Ultrasounds Tell You?

Although ultrasounds have several very useful purposes, they also have limitations. Doctors rely on additional diagnostic tests to gather more information about problems with the ovaries.

Whether You Have Cancer

Ultrasounds can detect abnormalities, and they can provide a clue as to whether an ovarian mass or cyst might be cancerous. However, biopsies are the only way to tell for sure whether a mass contains cancer cells.

For people with ovarian cancer, a biopsy is usually taken during surgery. Biopsies of the ovary are not usually performed before surgery because a needle biopsy of the ovary might potentially release cancer cells that were otherwise contained. The surgeon will send pieces of the mass to a laboratory where the cells will be studied under a microscope to determine whether they are cancerous. Biopsies also help determine the type of ovarian cancer.

Whether Ovarian Cancer Has Spread

The later the ovarian cancer stage is, the farther cancer cells have metastasized (spread within the body). Determining cancer’s stage is important for determining the prognosis (outlook) and knowing which treatment plan may be best.

Doctors don’t use ultrasounds to tell how far ovarian cancer cells have spread. Ultrasounds can’t distinguish whether cells are cancerous or not, and they are only used to look at one part of the body at a time. In order to determine cancer stage and locate metastases, doctors use other imaging tests or procedures. These other tests, which are often better at detecting cancer cells and show larger areas of the body, include:

  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT) scan
  • Positron emission tomography (PET) scan
  • Surgery

Ultrasounds and Cancer Screening

Ultrasounds can be used to detect potential ovarian tumors. Does this mean that this test can help screen people for ovarian cancer?

Researchers have studied whether a transvaginal ultrasound helps detect ovarian cancer during its early stages. They have also studied whether adding blood tests to measure CA-125 levels helps improve ultrasound screening. However, the results were not promising. These tests often pick up benign, noncancerous conditions, which means that individuals who use these screening methods often undergo additional and sometimes unnecessary tests and surgeries. Additionally, ultrasound and CA-125 screenings don’t seem to reduce the overall number of people who die from ovarian cancer.

Experts say that individuals who have an average risk of developing ovarian cancer should not be screened using the currently available methods. However, some doctors recommend regular screening for those with a high risk of ovarian cancer. This includes women who have many family members who have had ovarian or breast cancer or women with genetic mutations in high-risk genes such as BRCA1 or BRCA2.

Talk With Others Who Understand

MyOvarianCancerTeam is the social network for people with ovarian cancer. More than 3,000 members come together to ask questions, give advice, and share their stories with others who understand life with ovarian cancer.

Are you living with ovarian cancer? Have you had to get an ultrasound test? Start a conversation by posting on MyOvarianCancerTeam.

A Patient’s Perspective | Participating in a Clinical Trial

A Patient’s Perspective | Participating in a Clinical Trial from Patient Empowerment Network on Vimeo.

Colorectal cancer survivor Cindi Terwoord recounts her clinical trial experience and explains why she believes patients should consider trial participation.

Dr. Pauline Funchain is a medical oncologist at the Cleveland Clinic. Dr. Funchain serves as Director of the Melanoma Oncology Program, co-Director of the Comprehensive Melanoma Program, and is also Director of the Genomics Program at the Taussig Cancer Institute of the Cleveland Clinic. Learn more about Dr. Funchain, here.

Cindi Terwoord is a colorectal cancer survivor and patient advocate. Learn more about Cindi, here.

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Transcript:

Katherine Banwell:    

Cindi, you were diagnosed with stage IV colorectal cancer, and decided to participate in a clinic trial. Can you tell us about what it was like when you were diagnosed?

Cindi Terwoord:        

Yeah. That was in September of 2019, and I had had some problems; bloody diarrhea one evening, and then the next morning the same thing. So, I called my husband at work, I said, “Things aren’t looking right. I think I’d better go to the emergency room.”

And so, we went there, they took blood work – so I think they knew something was going on – and said, “We’re going to keep you for observation.” So, then I knew it must’ve been something bad. And so, two days later, then I had a colonoscopy, and that’s when they found the tumor, and so that was the beginning of my journey.

Katherine Banwell:    

Mm-hmm. Had you had a colonoscopy before, or was that your first one?

Cindi Terwoord:        

No, I had screenings, I would get screenings. I had heard a lot of bad things about colonoscopies, and complications and that, so I was always very leery of doing that. Shame on me. I go for my other screenings, but I didn’t like to do that one. I have those down pat now, I’m very good at those.

Katherine Banwell:    

Yeah, I’m sure you do. So, Cindi, what helped guide your decision to join a clinical trial?

Cindi Terwoord:        

Well, I have a friend – it was very interesting.

He was probably one of the first people we told, because he had all sorts of cancer, and he was, I believe, one of the first patients in the nation to take part in this trial. It’s nivolumab (Opdivo), and he’s been on it for about seven years. And he had had various cancers would crop up, but it was keeping him alive.

And so, frankly, I didn’t know I was going to have the option of a trial, but he told me run straight to Cleveland Clinic, it’s one of the best hospitals. So, I took his advice. And the first day the doctor walked in, and then all these people walked in, and I’m like, “Why do I have so many people in here?” Not just a doctor and a nurse. There was like a whole – this is interesting.

And so, then they said, “Well, we have something to offer you. And we have this immunotherapy trial, and you would be one of the first patients to try this.”

Now, when they said first patient, I’m not quite sure if they meant the first colon cancer patient, I’m not sure. But they told me the name of it, and I said, “I’m in. I’m in.” Because I knew my friend had survived all these years, and I thought, “Well, I’ve gotten the worst diagnosis I can have, what do I have to lose?” So, I said, “I’m on board, I’m on board.”

Katherine Banwell:    

Mm-hmm. Did you have any hesitations?

Cindi Terwoord:        

Nope. No, I’m an optimistic person, and what they assured me was that I could drop out at any time, which I liked that option.

Because I go, “Well, if I’m not feeling well, and it’s not working, I’ll get out.” So, I liked that part of it. I also liked, as Dr. Funchain had said, you go in for more visits. And I like being closely monitored, I felt that was very good.

I’ve always kept very good track of my health. I get my records, I get my office notes from my doctor. I’m one of those people. I probably know the results of blood tests before the doctor does because I’m looking them up. So, I felt very confident in their care. They watched me like a hawk. I kept a diary because they were asking me so many questions.

Katherine Banwell:    

Oh, good for you.

Cindi Terwoord:        

I’m a transcriptionist, so I just typed out all my notes, and I’d hand it to them.

Katherine Banwell:    

That’s a great idea.

Cindi Terwoord:        

Here’s how I’m feeling, here’s…And I was very lucky I didn’t have many side effects.

Katherine Banwell:    

In your conversations with your doctor, did you weigh the pros and cons about joining a trial? Or had you already made up your mind that yes, indeed, you were going for it?

Cindi Terwoord:        

Yeah, I already said, “I’m in, I’m in.” Like I said, it had kept my friend alive for these many years, he’s still on it, and I had no hesitation whatsoever.

I wish more people – I wanted to get out there and talk to every patient in the waiting room and say, “Do it, do it.”

I mean, you can’t start chemotherapy then get in the trial. And if I ever hear of someone that has cancer, I ask them, “Well, were you given the option to get into a trial?” Well, and then some of them had started the chemo before they even thought of that.

Katherine Banwell:    

Mm-hmm. So, how are you doing now, Cindi? How are you feeling?

Cindi Terwoord:        

Good, good, I’m doing fantastic, thank goodness, and staying healthy. I’m big into herbal supplements, always was, so I keep those up, and I’m exercising. I’m pretty much back to normal –

Katherine Banwell:

Cindi, what advice do you have for patients who may be considering participating in a trial? 

Cindi Terwoord:

Do it. Like I said, I don’t see any downside to it. You want to get better as quickly as possible, and this could help accelerate your recovery. And everything Dr. Funchain mentioned, as far as – I really never brought up any questions about whether it would be covered. 

And then somewhere along the line, one of the research people said, “Well, anything the trial research group needs done – like the blood draws – that’s not charged to your insurance.” So, that was nice, that was very encouraging, because I think everybody’s afraid your insurance is going to drop you or something.  

And then the first day I was in there for treatment, a social worker came in, and they talked to you. “Do you need financial help? We also have art therapy, music therapy,” so that was very helpful. I mean, she came in and said, “I’m a social worker,” and I’m like, “Oh, okay. I didn’t know somebody was coming in here to talk to me.” 

But that was all very helpful, and I did get free parking for a few weeks. I mean, sometimes I’d have to remind them. I’d say, “It’s costing me more to park than to get treated.” But, yeah, like I said, I’m a big advocate for it, because you hear so many positive outcomes from immunotherapy trials, and boy, I’d say if you’re a candidate, do it. 

Katherine Banwell:

Dr. Funchain, do you have any final thoughts that you’d like to leave the audience with? 

Dr. Pauline Funchain:

First, Cindi, I have to say thank you. I say thank you to every clinical trial participant, everybody who participates in the science. Because honestly, whether you give blood, or you try a new drug, I think people don’t understand how many other lives they touch when they do that.  

It’s really incredible. Coming into clinic day in and day out, we get to see – I mean, really, even within a year or two years, there are people that we’ve seen on clinical trial that we’re now treating normally, standardly, insurance is paying for it, it’s all standard of care. And those are even the people we can see, and there are so many people we can’t see in other centers all over the world, and people who will go on after us, right?  

 So, it’s an amazing – I wouldn’t even consider most of the time that it’s a personal sacrifice. There are a couple more visits and things like that, but it is an incredible gift that people do, in terms of getting trials. And then for some of those trials, people have some amazing results. 

And so, just the opportunity to have patients get an outcome that wouldn’t have existed without that trial, like Cindi, is incredible, incredible. 

What Are the Risks and Benefits of Joining a Clinical Trial?

What Are the Risks and Benefits of Joining a Clinical Trial? from Patient Empowerment Network on Vimeo.

Why should a cancer patient consider a clinical trial? Dr. Pauline Funchain of the Cleveland Clinic explains the advantages of clinical trial participation.

Dr. Pauline Funchain is a medical oncologist at the Cleveland Clinic. Dr. Funchain serves as Director of the Melanoma Oncology Program, co-Director of the Comprehensive Melanoma Program, and is also Director of the Genomics Program at the Taussig Cancer Institute of the Cleveland Clinic. Learn more about Dr. Funchain, here.

See More from Clinical Trials 101

Related Resources:

You’ve Chosen to Participate In a Clinical Trial: What Are Next Steps?

Understanding Common Clinical Trial Terminology

How to Find A Clinical Trial That’s Right for You


Transcript:

Katherine Banwell:

Why would a cancer patient consider participating in a clinical trial? What are the benefits? 

Dr. Pauline Funchain:

So, I mean, the number one benefit, I think, for everyone, including the cancer patient, is really clinical trials help us help the patient, and help us help future patients, really.  

We learn more about what good practices are in the future, what better drugs there are for us, what better regimens there are for us, by doing these trials. And ideally, everyone would participate in a trial, but it’s a very personal decision, so we weigh all the risks and benefits. I think that is the main reason.  

I think a couple of other good reasons to consider a trial would be the chance to see a drug that a person might not otherwise have access to. So, a lot of the drugs in clinical trials are brand new, or the way they’re sequenced are brand new. And so, this is a chance to be able to have a body, or a cancer, see something else that wouldn’t otherwise be available.  

And I think the last thing – and this is sort of the thing we don’t talk about as much – but really, because clinical trials are designed to be as safe as possible, and because they are new procedures, there’s a lot of safety protocols that are involved with them, which means a lot of eyes are on somebody going through a clinical trial.  

Which actually to me means a little bit sort of more love and care from a lot more people. It’s not that the standard of care – there’s plenty of love and care and plenty of people, but this doubles or triples the amount of eyes on a person going through a trial. 

Katherine Banwell:

Yeah. When it comes to having a conversation with their doctor, how can a patient best weigh the risks and benefits to determine whether a trial is right for them? 

Dr. Pauline Funchain:

Right. So, I think that’s a very personal decision, and that’s something that a person with cancer would be talking to their physician about very carefully to really understand what the risks are for them, what the benefits are for them. Because for everybody, risks and benefits are totally different. So, I think it’s really important to sort of understand the general concept. It’s a new drug, we don’t always know whether it will or will not work. And there tend to be more visits, just because people are under more surveillance in a trial.  

So, sort of getting all the subtleties of what those risks and benefits are, I think, are really important. 

Katherine Banwell:

Mm-hmm. What are some key questions that patients should ask? 

Dr. Pauline Funchain:

Well, I think the first question that any patient should ask is, “Is there a trial for me?” I think that every patient needs to know is that an option. It isn’t an option for everyone. And if it is, I think it’s – everybody wants that Plan A, B, and C, right? You want to know what your Plan A, B, and C are. If one of them includes a trial, and what the order might be for the particular person, in terms of whether a trial is Plan A, B, or C. 

Participating in a Clinical Trial: What You Need to Know Resource Guide

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How Can Clinical Trials Be Accessed?

How Can Clinical Trials Be Accessed?  from Patient Empowerment Network on Vimeo.

Clinical researcher Dr. Seth Pollack and patient advocate Sujata Dutta explain the benefits of participating in a clinical trial. They review important questions to ask your doctor and share advice for finding a trial.

Dr. Seth Pollack is Medical Director of the Sarcoma Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University and is the Steven T. Rosen, MD, Professor of Cancer Biology and associate professor of Medicine in the Division of Hematology and Oncology at the Feinberg School of Medicine. Learn more about Dr. Pollack, here.

Sujuta Dutta is a myeloma survivor and empowered patient advocate, and serves a Patient Empowerment Network (PEN) board member. Learn more about Sujuta, here.

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Related Resources:

What Is a Clinical Trial and What Are the Phases? 

Are Clinical Trials Safe?

A Patient Shares Her Clinical Trial Experience


Transcript:

Katherine Banwell:    

Sujata, there’s clearly a lot of hesitation and misconceptions out there. What would you say to someone who’s considering a trial but is hesitant?

Sujata Dutta:  

I would say speak to your provider, speak to your doctor, and get all these myths kind of busted to say, “it’s going to be expensive” or whatever those questions are. And then, through that process also try and understand what is it that the study is trying to achieve? How is that going to be beneficial to you? So, in my instance, it wasn’t the last line of defense, it was just one of the processes or combos that would help me. And so, that was important for me to understand and then a little bit of education as well. So, I was asking, I have questions on my phone every time I meet my provider, and I did the same thing. So, I think that one of the good practices is keep your note of your questions and have those questions ready. And no question is silly, all questions are important. So, ask as many questions as you can and use that opportunity to educate yourself about it.

And maybe you realize, “No. I don’t think it’s working for me” or “I don’t think this trial is good for me.” But it’s good, important, to have that conversation with your provider, that’s what I would recommend highly.

Katherine Banwell:    

Excellent. Thank you, Dr. Pollack, if someone is interested in participating, how can they find out about what trials are even available for them?

Dr. Seth Pollack:       

Yeah. I mean, the best thing to do is to start just by asking your doctor if they know about any clinical trials. And a lot of the times the clinical trials are run at the big medical centers that may be closer to you, so you could ask your doctor if there’s any clinical trials at the big medical center even. Or I always think it’s good to get a second opinion, you could go get a second opinion at the big medical center that’s close to you and ask them what clinical trials are at your center.

And sometimes they’ll be conscious about some of the clinical trials that may be even run around the country. And you can ask about that as well.

Katherine Banwell:    

Would specialists have more information about clinical trials than say a general practitioner?

Dr. Seth Pollack:       

So, I specialize in rare cancers, so a lot of the times the general practitioners they’ve got my cell phone number, and they text me, and they say, “Hey, do you have a clinical trial going on right now?” And that happens all the time, but yeah, the specialists will usually because frankly there’s so much to know. And the general practitioners really have a lot to keep track of with all the different types of diseases that are out there. Whereas at the big centers, the specialists, part of their job is really to keep their tabs on what’s going on with the clinical trials.

So, they’re good people to ask, either your local doctor could reach out to them, or you could go get a second opinion and ask.

Sujata Dutta:  

There’s also a lot of information, Katherine, on sites such as LLS, or PEN, or American Cancer Society that they also publish a lot of information. Of course, I would recommend once you have that information then vet it by your specialist, or whatever. But if you’re interested in knowing more about clinical trials in general and some that would work for you, then those are also some places to get information from.

Katherine Banwell:    

That’s great information. Thank you, I was going to ask you about that Sujata. Well, before we end the program, Dr. Pollack, I’d like to get your final thoughts. What message do you want to leave the audience with related to clinical trial participation?

Dr. Seth Pollack:       

Yeah. I think clinical trials it can be a very rewarding thing for a lot of patients to do, I think patients really like learning about the new treatments. And I think a lot of patients really like being a part of pushing the therapies forward in addition to feeling like sometimes they’re getting a little bit of an extra layer of scrutiny, because there’s a whole extra team of research coordinators that are going through everything.

And getting access to something that isn’t available yet to the general population. So, I think there’s a whole host of advantages of going on clinical trials, but you need to figure out whether or not a clinical trial is right for you.

Katherine Banwell:    

Yeah. Sujata, what would you like to add?

Sujata Dutta:  

Absolutely, I second everything that Dr. Pollack is saying. And in my personal experience I wouldn’t say everything is hunky-dory, everything is fine. I’m going through treatment, I have chemo every four weeks, I started with chemo every week. That’s when the logistics pace was really difficult because going to Mayo every week was not easy. But anyways, as the trial progress itself every four weeks, but as I said the benefits are huge because I have labs every four weeks. I meet my provider every four weeks.

So, we go through the labs and anything amiss, I’ve had some changes to my dosage because I’ve had some changes in the labs. And so, there’s a lot of scrutiny which I like, but the flip side, for maybe some maybe like, “I have to have chemo every four weeks. Do I want to do that or not?” Or whatever. In my case, I knew it, and I signed up for it, and I’m committed to doing that for two years. And so, I’m fine with that. So, I would say all in all, I’d see more benefits of being in a clinical trial. One, you’re motivated to give back to the community. Two, you are being monitored and so your health is important to your provider just as it is to you. And so, I highly recommend being part of a trial if it works for you and if you’re eligible for one.