Tag Archive for: chemotherapy

Advanced Small Cell Lung Cancer Treatment Options and Clinical Trials

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How is small cell lung cancer research evolving? Dr. Tejas Patil, a researcher and lung cancer specialist, discusses the recent advances in small cell lung cancer treatment, explains the impact of clinical trial participation, and shares why he is hopeful for the future of care. 

Dr. Tejas Patil is an Assistant Professor of Thoracic Oncology at the University of Colorado Cancer Center focused on targeted therapies and novel biomarkers in lung cancer. Learn more about Dr. Patil.

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Transcript:

Jamie: 

And are there emerging treatments that are showing promise for small cell lung cancer care? 

Dr. Tejas Patil: 

There are. So small cell lung cancer has some new treatments, specifically new immunotherapies that are called DLL3 T-cell engagers. The FDA has approved one of these called tarlatamab-dlle (Imdelltra), and there are several clinical trials underway looking at using these new treatments for small cell. We have been a participant in some of the clinical trials involving DLL3-targeted immunotherapy treatments, and the results have been remarkable.  

In general, I’m an advocate that patients with small cell lung cancer participate in clinical trials when possible. Our ability to develop new and groundbreaking treatments is really dependent on collective action.   

Jamie: 

Sure. I know some patients may be hesitant to join a trial. Sometimes that may be something scary. What do you tell patients that may be hesitant to participate?  

Dr. Tejas Patil: 

Clinical trials, in my view, offer the best opportunity for patients to receive cutting-edge treatment. A common question I get as a treating physician is whether I will receive a placebo if I’m on a clinical trial. The short answer is it is unethical to give patients placebo if there is a standard-of-care treatment option available. So, in most cases, patients will either receive the experimental drug, this is called an open-label clinical trial, where both the patient and the doctor know what they’re getting.

Or they might get a double-blind randomized clinical trial, in which case the doctor doesn’t know what the patient’s getting. But what we do know is that the patient will get either the standard of care, whatever that is for the disease state or the standard of care, plus some new treatment. And that is the only ethical way to design clinical trials in the first-line, second-line, or later-line setting. So clinical trials also allow us to advance the field because it allows us to offer treatments that wouldn’t otherwise be available commercially.  

Jamie: 

Dr. Patil, how’s the field of small cell lung cancer care progressing? Are you hopeful?  

Dr. Tejas Patil: 

I’m very hopeful for small cell lung cancer. I think in the last two years, I’ve seen some of the biggest therapeutic advances in this area that I’ve seen for almost 20 years. The DLL3 T-cell bispecifics, these are a new form of immunotherapy, have really been game-changers in small cell lung cancer. There’s a lot of exciting clinical trials in small cell lung cancer.   

It’s a disease that has been very difficult to treat for many years with traditional chemotherapies. And what I’m very excited about is that we are trying to think of newer ways to treat small cell lung cancer. We’re using new immunotherapies, there’s going to be radio ligand therapy in the future. There’s novel molecular profiling of small cell that’s helping us figure out which types of subsets of small cell might be better suited to different types of therapies. And I also want to emphasize that the other big advance in small cell lung cancer has been lung cancer screening. We are actually catching small cell at an earlier and earlier stage, which makes it even more likely for us to cure small cell lung cancer.  

Diagnosed With Small Cell Lung Cancer? Key Advice to Elevate Your Care

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When facing a small cell lung cancer diagnosis, how can you access the best care for you? Dr. Tejas Patil, a lung cancer specialist and researcher, shares key questions to ask you healthcare team following a diagnosis and emphasizes the importance of trust in the patient-doctor relationship.

Dr. Tejas Patil is an Assistant Professor of Thoracic Oncology at the University of Colorado Cancer Center focused on targeted therapies and novel biomarkers in lung cancer. Learn more about Dr. Patil.

Download Resource Guide

See More from ELEVATE Small Cell Lung Cancer

Related Resources:

What You Should Know | Small Cell Lung Cancer Treatment and Testing

What You Should Know | Small Cell Lung Cancer Treatment and Testing

 Advanced Small Cell Lung Cancer Treatment Options and Clinical Trials

Advanced Small Cell Lung Cancer Treatment Options and Clinical Trials

 Small Cell Lung Cancer Care: Striking a Balance With Urgency and Shared Decision-Making

Small Cell Lung Cancer Care: Striking a Balance With Urgency and Shared Decision-Making

Transcript:

Jamie: 

Dr. Patil, when a person is first diagnosed with small cell lung cancer, what sort of questions should they be asking their healthcare team?  

Dr. Tejas Patil: 

So small cell lung cancer accounts for about 25 percent of all cases of lung cancer, but it’s a very unique type of lung cancer, and it has a different treatment paradigm than traditional lung cancer. The kind of questions that patients would want to ask are first about the diagnosis, specifically what stage of small cell lung cancer they have, so is it limited stage or extensive stage?

And I’ll discuss what those mean. Where is the cancer located? Has it spread? And then asking the doctor to explain what the staging results are and what they mean. They should ask questions about the treatment plan, what are my treatment options, and what does the doctor recommend? What is the goal of treatment? How soon should treatment start? What are the potential side effects of treatment? And I think one important question that patients should always ask their providers are, are clinical trials available for me? 

Jamie: 

As a physician and a researcher, how do you empower patients and care partners to participate in their care and treatment decisions? Why is that so essential? 

Dr. Tejas Patil: 

It’s really important for patients to participate in their own clinical care because an informed patient really is a collaborator in their own cancer journey. I’m a big believer that patients need reliable sources of information regarding small cell lung cancer. With the current fractured state of the Internet and media, I’ve been increasingly concerned about where patients are getting their medical information, especially from algorithmically driven content such as social media.

In my opinion, this is not where you want to get key central information to make decisions for your own care. It’s also important that patients trust their doctor. I think trust is a very crucial ingredient to a therapeutic relationship. Patients who do trust their doctor, I think are often much better collaborators in their own care.  

ELEVATE Small Cell Lung Cancer Resource Guide

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ELEVATE SCLC Resource Guide

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Understanding Antibody Drug Conjugates (ADCs) in Cervical Cancer

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Dr. Abigail Zamorano of McGovern Medical School at UT Health Houston explains essential details about antibody drug conjugates (ADCs) for cervical cancer, including benefits, side effects, and their impact on quality of life. She discusses the importance of maintaining a strong patient-provider relationship, especially when navigating side effects like ocular issues and neuropathy, and emphasizes the role of regular eye exams.

[ACT]IVATION TIP

“…maintain close communication between provider and patient in order to share the experience of receiving an antibody drug conjugate.”

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Transcript:

Lisa Hatfield:

Dr. Zamorano, for patients and care partners learning about antibody drug conjugates for the first time, what key information should they know about the benefits, the potential side effects, and overall impact of these treatments on quality of life?

Dr. Abigail Zamorano:

So I think that you touched on something really important here, and that is quality of life. Antibody drug conjugates are really amazing. They’re a really great way of delivering really high doses of chemotherapy targeted to cancer cells. They do have side effects. One of the most significant side effects that we see with our ADCs in cervical cancer are ocular or eye side effects. So we work very closely with an ophthalmologist or an optometrist, some eye doctor, for very frequent exams during this treatment phase.

It’s really important for both the provider and the patient to understand how, what symptoms might result, when to bring up symptoms to the provider, the oncologist, or the eye doctor, and then what they can do to help prevent any symptoms from occurring. There’s a lot of eye drops involved. It can feel very tedious. But it’s important, because we want to both treat the cancer, but also maximize their quality of life.

There are other side effects that can come up, such as neuropathy, which is numbness and tingling of the hands or the feet. This can be very common with these ADCs. Again, it’s just important for a patient to know that this could be a possibility and then to bring it up with their provider so that they can talk about management strategies. Because ADCs are given in the recurrent disease setting, I do counsel patients that I have a lot of hope in ADCs and their ability to treat cancer, but this is still recurrent cancer, and I can’t take away that fact.

And so I am very hopeful that this treatment will work, and we will see that the cancer stabilizes or shrinks, goes away in the best scenario. But that might not happen. And I really want to maximize quality of life during this treatment process in the off chance that it’s not working and that these are the last, you know, months to years that this patient has.

I always keep that type of conversation open with my patients, because I want them to tell me really how they’re feeling in order to maximize quality of life. So my [ACT]IVATION tip for this question is to maintain close communication between provider and patient in order to share the experience of receiving an antibody drug conjugate. Both the experience of going through the various eye exams and using the eye drops to any symptoms that the patient is receiving and how the treatment is impacting their quality of life.

Lisa Hatfield:

So let’s say you have a patient that comes in, has recurrent cancer and is considering antibody drug conjugate. We might have a patient watching this who is going through this, trying to consider if they want to start this therapy. Can you explain from say day one, what that might look like?

They’re trying to organize their schedule with work and kids. What will that patient experience starting on the first day of that treatment and maybe the subsequent months of treatment? How often do they have to come in? How is that dose delivered? How much time will that take away from their work or their family? Can you explain that a little bit, what the course might look like?

Dr. Abigail Zamorano:

So this is delivered not unlike other more traditional chemotherapies. So it is delivered in an infusion suite with an infusion nurse with an oncologist available if there are any issues or questions. Similarly to when the patient has had chemotherapy for, they get labs beforehand to make sure that the chemotherapy is delivered at an appropriate dose and that they’re safe enough to receive the dose of chemotherapy. What is unique about receiving antibody drug conjugates is that the patient also does need a close relationship with an eye doctor. Either an optometrist or an ophthalmologist.

And so we and many other centers have developed very close relationships with local eye doctors to help facilitate this. It doesn’t need to be an ophthalmologist in the medical center. A lot of optometrists that could be local to the patient could see the patient, which are sometimes a little bit easier to get into. Also the company that provides the antibody drug conjugate has really great resources for providers that are, and also for patients that are just starting on this journey to help make it as easy, as seamless as possible. They provide a lot of literature, they are there to answer questions.

They have lists of eye doctors that other providers have worked with. So there, there are ways of making this a little bit easier for the patient. There are also start kits that the patient can receive that again help them navigate this a little bit better. In terms of the patient experience, it is an infusion every few weeks just like other chemotherapies. The typical feelings afterwards, there can be again some nausea, predominantly there’s fatigue afterwards. I do counsel patients that the first cycle is their learning experience.

They’re learning how, what symptoms to think about. They’re learning how the regimen of the eye drops, and then they’re learning how they’re going to feel on each day. The second cycle in my experience, working with patients is typically a little bit easier. And this is not unique to ADCs, this is any chemotherapy. Because they’ve already been through one cycle, they kind of know which days are going to be their low days and then which days are going to be their high days. Typically, they’re feeling kind of fatigued for about 10 days, and then they start to feel better.

So the second half of the treatment cycle, they’re more able to get back to their routine activities and can kind of reinsert themselves into their usual life. But every patient is different. Sometimes, they need a little bit of extra help, or sometimes patients are feeling really great. These ADCs are designed to be continued until toxicity or progression. And so patients are potentially on these for quite a long time depending on their response both cancer-wise and then other body side effect-wise. And so this could be something that someone is on for some time.

Exploring Antibody Drug Conjugates in Cervical Cancer Treatment

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Dr. Abigail Zamorano of McGovern Medical School at UT Health Houston explains how antibody drug conjugates (ADCs) are revolutionizing cervical cancer treatment. She discusses how these therapies deliver targeted chemotherapy to cancer cells, minimizing exposure to healthy tissue while maximizing effectiveness.

[ACT]IVATION TIP

…for patients to talk to their providers about what next steps might need to occur if their cancer were to recur.”

See More From [ACT]IVATED Cervical Cancer

Download Resource Guide Download Spanish Resource Guide

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Screening Saves Lives: Overcoming Barriers to Cervical Cancer Prevention

Screening Saves Lives: Overcoming Barriers to Cervical Cancer Prevention

 Understanding Antibody Drug Conjugates (ADCs) in Cervical Cancer

Understanding Antibody Drug Conjugates (ADCs) in Cervical Cancer

 Advancing Cervical Cancer Care: Breakthrough Treatments and the Power of Clinical Trials

Advancing Cervical Cancer Care: Breakthrough Treatments and the Power of Clinical Trials

Transcript:

Lisa Hatfield:

Dr. Zamorano, what is an antibody drug conjugate as it relates to cervical cancer? And how do you see antibody drug conjugates shaping the future of cervical cancer treatment?

Dr. Abigail Zamorano:

An antibody drug conjugate is this really fascinating new way of delivering essentially chemotherapy to cancer cells. It is essentially a chemotherapy backpack where it is a therapy delivered to the patient, usually through an IV, similar to the way that chemotherapy is delivered. But instead of giving a large dose across the entire body, as is is typical with traditional chemotherapy, it’s packaged in these little backpacks that go directly to cells that express certain proteins, specifically in certain types of cancers. Now, there are other cells in our body that also have these proteins. And so there are side effects to these therapies. But the really exciting thing is that it allows us to give a really high dose of chemotherapy directly to the cancer cell.

Though the way that these have been made possible is really through clinical trials. And so we always, we appreciate all of the patients and providers that have enrolled in clinical trials to make this happen. I think that this is the direction that a lot of cancer therapy will take in the future. Of course, as I said, there are side effects to these therapies, but we’ve learned how to manage these really well, and I think that these are really exciting options for our patients.

My [ACT]IVATION tip for this question is for patients to talk to their providers about what next steps might need to occur if their cancer were to recur. I think it’s helpful in some ways to have these conversations even before cervical cancer has come back, because it allows the patient to be thinking of what might be down the pipeline. It also helps the provider think what options they might have for this patient, whether they’re these new antibody drug conjugates or if there’s a new clinical trial that this patient could enroll in.

It kind of keeps the, it gets the ball rolling. I also encourage patients to think about their body holistically, think about their nutrition, think about their physical activity, because we could have a really good treatment option for recurrent cancer. But sometimes patients are not able to receive that therapy, because they have a poor performance status or their nutritional status isn’t good enough. And we worry about the toxicity of these therapies. So sometimes this is unavoidable, but I really encourage patients, when you’re feeling good, do lots, you know, eat well, stay active, try to keep your body as healthy as possible.

Lisa Hatfield:

Okay, thank you. Now, are there currently FDA-approved antibody drug conjugates, and is it just for recurrent cervical cancer, or can it be used for early stage cervical cancer or frontline therapy even in more advanced stage?

Dr. Abigail Zamorano:

There’s one antibody drug conjugate that is approved for cervical cancer, and it is just in the recurrent setting at this time. But this is a new frontier in the field of cancer therapy, and so I expect that there will be more within years.

Lisa Hatfield:

Okay, thank you. And then if a patient does have recurrent cancer and is interested in the antibody drug conjugate, but doesn’t live near, maybe doesn’t live near an academic center or in a big metropolitan area. Can these be delivered at a community hospital? Or where can they find these treatments?

Dr. Abigail Zamorano:

These should be available no matter where you live. We always encourage patients with gynecologic cancers to see a gynecologic oncologist. But we also recognize that not every patient lives next to a gynecologic oncologist. And so there are really wonderful medical oncologists that are very well-equipped to treat gynecologic malignancies, including cervical cancer, and they would be able to deliver these antibody drug conjugates.

How Does the Stage of Cervical Cancer Impact Treatment and Prognosis?

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Early stage versus advanced stage cervical cancer are different, but how does the stage impact treatment and prognosis? Expert Dr. Shannon MacLaughlan from University of Illinois discusses how the diagnosis changes treatment approaches and proactive advice for patient care. 

[ACT]IVATION TIP

“…understand with your provider how your stage influences your treatment…ask about if it’s pertinent to you are one, is there a role you are a candidate for surgery, ask what kind of surgery is best for you? Should it be a minimally invasive surgery, or should it be a traditional surgery with a larger incision?…depending on how old you are at the time of diagnosis and where you are in building a family, ask about fertility preservation options…in the case of early disease or early stage, there can be fertility preservation options that you may need to ask about, rather than wait for your oncologist to volunteer the information…if your doctors say that radiation is right for you, please ask them if the radiation doctors also do something called brachytherapy.”

See More From [ACT]IVATED Cervical Cancer
 

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Disparities in Cervical Cancer Treatment: The Role of Poverty and Systemic Barriers

Transcript:

Lisa Hatfield:

Dr. MacLaughlan, what does it mean to be diagnosed with cervical cancer at an early stage versus advanced cervical cancer?

Shannon MacLaughlan:

So any cancer will be assigned a stage at the time of diagnosis. And the stage construct is really for providers and researchers to put clinical scenarios into boxes. An oversimplification is that a stage I cancer is confined to the organ where it starts. In this case, the cervix is its own organ. Even though it’s technically part of the uterus, it is its own organ for purposes of staging. The highest, it’s always on a scale of I to IV. So stage IV cancer is a metastatic disease where it has spread to multiple locations. In general, a stage I cancer has a higher survival rate than a stage IV cancer. And that’s true for any cancer that you look at.

So in the case of cervical cancer, someone in an early stage, which typically when we’re talking about early stage cervical cancer, it’s usually stage I. We might clump I and II together, but in simpler terms, in simpler normal language, that means that the tumor is small and it’s confined to a specific location, which makes it easier to deal with, frankly. So the difference between being diagnosed at early stage and late stage means one, the chances of cure are higher, and two, how you and your clinical team move forward with treatment is going to be different.

There’s broadly speaking, there are three different tools that we use in cancer care. One is surgery, radiation, chemotherapy, or I shouldn’t say chemotherapy, I should say systemic therapy or treatment that treats the whole body. And there can be a role for any of those things or a combination of those things in treatment. A very small, early stage I cervical cancer may be cured with surgery alone, whereas an advanced cervical cancer is not, that patient is not likely to receive surgical excision as part of their treatment for curative intent.

My [ACT]IVATION tip is to understand with your provider how your stage influences your treatment. The specific things I want you to ask about if it’s pertinent to you are one, is there a role you are a candidate for surgery, ask what kind of surgery is best for you? Should it be a minimally invasive surgery, or should it be a traditional surgery with a larger incision? Related to that, depending on how old you are at the time of diagnosis and where you are in building a family, ask about fertility preservation options. There aren’t options for everyone.

But in the case of early disease or early stage, there can be fertility preservation options that you may need to ask about, rather than wait for your oncologist to volunteer the information. And then the third piece, the third specific question is if your doctors say that radiation is right for you, please ask them if the radiation doctors also do something called brachytherapy. Brachytherapy is a specific kind of radiation that it’s an integral part of successful treatment for cervical cancer.

Lisa Hatfield:

Okay, thank you. So just to follow up on that point that you made about possibly needing systemic therapy, maybe surgery, maybe radiation, for patients watching this, does that mean that a patient could possibly have a medical oncologist, a radiation oncologist, and a surgeon? Could it…is it possible to have a team of doctors working with them on their cervical cancer treatment?

Shannon MacLaughlan:

Not only is it possible, it’s important. A gynecologic oncologist like myself is someone who is trained…we train in obstetrics and gynecology first, and then we do subspecialty fellowship training in gynecologic oncology so that a gynecologic oncologist who is board-certified is trained and capable of doing the surgeries for gynecologic malignancies as well as the chemotherapy or systemic treatment.

Now, oftentimes we partner with a medical oncologist to give the systemic therapy, but the most important piece is that a gynecologic oncologist evaluates you at some point early in your diagnosis before treatment begins. The second part of your question is that radiation oncology is its own subspecialty. And so, oftentimes gynecologic oncologists and radiation oncologists work together. Unfortunately, sometimes that means going to multiple different locations to get the different kinds of doctors, but we do know that a multidisciplinary approach is an important approach for success.

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Why Should Endometrial Cancer Patients Engage in Their Care?

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

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

See More from Evolve Endometrial Cancer
 

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Transcript:

Katherine Banwell:  

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

Dr. Nita Karnik Lee:  

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

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

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

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

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

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

Katherine Banwell:  

And having an open line of communication. 

Dr. Nita Karnik Lee:  

Yes. 

Katherine Banwell:  

That’s what you’re saying. 

Dr. Nita Karnik Lee:  

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

Tools for Improving Access to Quality Endometrial Cancer Care

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

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

See More from Evolve Endometrial Cancer
 

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What Are Common Endometrial Cancer Health Disparities?

What Are Common Endometrial Cancer Health Disparities?

 Why Should Endometrial Cancer Patients Engage in Their Care?

Why Should Endometrial Cancer Patients Engage in Their Care?

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Advances in Endometrial Cancer Screening and Detection

Transcript:

Katherine Banwell:  

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

Dr. Nita Karnik Lee:  

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

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

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

Katherine Banwell:  

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

Dr. Nita Karnik Lee:  

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

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

What Are Common Endometrial Cancer Health Disparities?

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

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

See More from Evolve Endometrial Cancer
 

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Tools for Improving Access to Quality Endometrial Cancer Care

Tools for Improving Access to Quality Endometrial Cancer Care

 Why Should Endometrial Cancer Patients Engage in Their Care?

Why Should Endometrial Cancer Patients Engage in Their Care?

 Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches

Transcript:

Katherine Banwell:  

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

Dr. Nita Karnik Lee:  

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

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

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

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

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

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

What Are the Symptoms of Ovarian Cancer?

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What should women know about ovarian cancer symptoms? Gynecological cancer expert Dr. Nita Karnik Lee reviews potential symptoms of ovarian cancer and emphasizes the importance of regular communication with the healthcare team. 

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

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Transcript:

Katherine Banwell: 

What symptoms should people look for? 

Dr. Nita Karnik Lee:  

So, this is a very important point. I think the symptoms that people should look for are symptoms that are in the bowel and bladder function area that are different or new to them. This can be changes in urinary frequency, or urgency, or sense of pressure, or not having as much bladder capacity, like having to run to the bathroom more frequently.   

Sometimes it can be changes in bowel movements, such as constipation, or not feeling like they’re emptying, or it can be changes in appetite, where people feel full really quickly, where they eat a small amount, and all of the sudden, they just feel like they can’t eat anymore. Obviously, worsening symptoms such as nausea or even throwing up, that’s a little more extreme, but that can happen.  

Again, if you’ve had these symptoms for years every time you eat a certain food or something like that, those are probably not new, and that probably is not going to be something cancerous. But if there’s something that’s new or different, the symptom seems to stick out to you that this isn’t your usual routine, and it seems persistent over two or three weeks, and it’s happening almost daily, or at least more frequently than you would expect, then I think that warrants telling your doctor about it, and really advocating, and knowing that not everyone is going to have ovarian cancer, which is good, but knowing that they should do the workup for this just to rule it out.  

Katherine Banwell:  

How reliable are PAP smears in detecting ovarian cancer? 

Dr. Nita Karnik Lee:  

PAP smears do not detect ovarian cancer at all. So, people with ovarian cancer have normal PAP smears. It would be very unusual to have an abnormal PAP smear due to ovarian cancer. A lot of the misconception is that patients have said, “Well, I had my annual exam last year. I got my PAP smear every three to five years. That seems negative. So, why did I get this cancer?” But the two are completely unrelated. 

How Does Biomarker Testing Impact Ovarian Cancer Screening and Detection?

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What role does biomarker testing play in ovarian cancer detection? Dr. Nita Karnik Lee reviews genetic mutations related to ovarian cancer and discusses key steps women with a family history of the disease should consider. 

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

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Transcript:

Katherine Banwell:  

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

Dr. Nita Karnik Lee:  

Genetic testing is very important. When we get, for example, and I’ll kind of back up a little bit to say if somebody gets diagnosed with ovarian cancer, that is actually everyone who has a diagnosis of ovarian, fallopian tube, or peritoneal, because those are all sort of the same cancer, should get genetic testing to see if there’s a hereditary predisposition in their genetics that are passed on.  

That’s called germline testing. And those patients, and 20 percent of them, may actually have a hereditary condition that could be passed on. Then that’s where you can see how important it is. If I have somebody, and her children now know that the person has the BRCA gene, for example, then it’s really important for her children, men and women, to get screened, because then they may be able to do preventive measures, such as preventive surgery, preventive medications, or more frequent screening, to be able to prevent cancer from happening. 

Katherine Banwell:  

Okay. What genetic mutations are associated with ovarian cancer? 

Dr. Nita Karnik Lee:  

The ones that are most common that you hear about are something called BRCA, or B-R-C-A, 1 and 2. Those make up the majority of those mutations. There are some other less common ones such as Lynch syndrome, which is more associated with colon and endometrial cancer but can have about 10 percent to 12 percent of patients related to ovarian cancer as well.   

Nowadays, when we do genetic testing, we do a panel, so there are like 35 genes that are tested. There are a whole lot of different genes that can have an association with ovarian cancer, but the BRCA genes are the ones that most people hear about.   

Katherine Banwell:  

Should women with a family history of ovarian cancer take extra precautions? 

Dr. Nita Karnik Lee:  

That’s a very good question. So, if you have a family history, it’s probably important to talk to your doctor and to maybe even see somebody in cancer genetics who can draw out a family tree for you to see how high is this risk? If people have an ovarian cancer patient, one – or a breast cancer patient – some of it also matters what was the age that that patient got diagnosed. Some genetic mutation syndromes, actually the patient gets diagnosed much younger than average.  

The average age for ovarian cancer is about 60. Some patients will get it. For some genetic mutations, it’s still about that range. So, I think it’s important because even if you don’t have a genetic mutation, having a family member with ovarian cancer slightly increases your risk. 

Knowing those symptoms, knowing that your history will help your doctor dictate how quickly are they thinking about something else is really important, ultrasound, but we know that ultrasound is not perfect. 

Current Endometrial Cancer Treatment Approaches

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

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

 
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Transcript:

Katherine Banwell:  

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

Dr. Emily Hinchcliff:  

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

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

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

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

Endometrial Cancer | What Is Personalized Medicine?

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

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

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Transcript: 

Katherine Banwell:  

How would you define personalized medicine?  

Dr. Emily Hinchcliff:  

So, personalized medicine I think is a big umbrella term that is sort of a buzzword in cancer right now – in a good way – but I think that it is important to understand how it affects each different cancer type. So, personalized medicine, what we mean as physicians when we say that is we are trying to better tailor treatments to the individual patient and the individual cancer.  

So, whether that is the cancer subtype, treating endometrial cancer with endometrial-cancer-specific drugs rather than drugs that have been used to treat ovarian cancer, and kidney cancer, and prostate cancer, so, using drugs that are potentially really good for your tumor type, but also using medicines that might best treat your individual tumor based on the genetics and the molecular features inside your tumor. 

One of the ways that I’ll explain it to patients is that your tumor is sort of like base camp, and it depends on certain supply chains for oxygen and nutrients to grow, and some supply chains are common to all cancer types, so if we block that supply chain, that drug might work on any different kind of cancer. But some supply chains are really specific to a particular patient and a particular tumor, and so, if we have a drug that blocks that supply chain, it might work in that particular patient, but might not work in a patient that has a very, very similar cancer type, and that’s really where personalized medicine can be a huge win. It allows us to say, “This drug would work really well for you when it might not work really well for the patient next door.”  

Katherine Banwell:  

Yeah. So, I think what used to happen is everyone with a specific cancer was painted with a broad brush. 

Dr. Emily Hinchcliff:  

Correct. 

Katherine Banwell:  

And now, we’re able to hone in on what might work for one person.  

Dr. Emily Hinchcliff:  

Yeah. I think that certainly, those broad brushes, they worked for a reason, and they still are in our arsenal and our toolbox, and so, it doesn’t mean those brushes are bad, but it does mean that now, hopefully, we can paint a little bit more within the lines. We can be a little bit more nuanced with our approach. 

What Questions Should Patients Ask About Endometrial Cancer Testing?

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What questions should patients ask about endometrial cancer testing? Dr. Hinchcliff highlights key questions, while stressing the importance of understanding both germline and somatic tests and their impact on treatment. She emphasizes the value of open, ongoing communication with doctors.  

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

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Transcript: 

Katherine Banwell:  

Right. And so, what questions should patients ask about their test results? 

Dr. Emily Hinchcliff:  

Yeah, so, I think first and foremost, just getting an understanding of what tests your doctor is sending is really important. This should be an open conversation, and it’s a conversation that you should actually have as you are going throughout your cancer journey. It’s not just a conversation at your diagnosis, it’s something that, if your cancer comes back, it should be reassessed. Are there additional markers that we should send that we didn’t send in the upfront setting? Do we have a complete picture of my cancer? 

And so, I think that is definitely a question to ask, is what tests are you sending, and what is the outcome of those tests, right? How would that test change your potential management or change the options that you have for me in terms of my cancer treatment? The other thing that I will say that I think can be confusing for patients as we think about the genomics and genetics of a cancer is that it’s really important to understand the difference between something called germline and something called somatic testing, and so, I’m going to explain that, because I think it can be confusing. 

The first, germline, is a test that is testing the genetics of the whole body – so, of a person – to see if there’s anything that’s hereditary that might have predisposed them to getting cancer. And so, that is something that, if it is abnormal, it may mean that family members need to get tested, and there are things that we can do to try and prevent cancers for other people in your family that might be at risk. So, that is germline testing. 

That’s different than somatic testing. Somatic testing is when we test the tumor itself to understand what about this tumor allowed it to become abnormal, allowed it to grow abnormally and keep growing the way cancer does? And both of those are really important. So, I think as you ask your doctor, “What tests are you sending?”, it’s important to ask about tests in both of those categories. 

Elevate | AML Resource Guide

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