Tag Archive for: Dr. Anna Pavlick

How a Skin Cancer Expert Empowers Patients

How a Skin Cancer Expert Empowers Patients from Patient Empowerment Network on Vimeo.

 

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here.

What are steps does skin cancer expert Dr. Anna Pavlick take to empower her patients? Dr. Pavlick explains how self-education and being comfortable with your healthcare team are key components of patient empowerment.

 

Katherine:

Yeah. Dr. Pavlik, how do you empower patients? 

Dr. Pavlick:

You know, when I talk to patients I really do try to number one: educate them. I am big believer in bad artwork, because I’m a bad artist. And so I really try to draw out schematics to help patients understand how they therapy that I’m proposing is going to work, so they understand the mechanism. Patients will also go home with printed handouts so that they can go back and read about what we talked about, because many times patients absorb maybe one-quarter of what’s been said in a consult. 

I encourage people to bring their family members or friends so that they can hear; two sets of ears is always better than one. And I fully support them; if they want to go get a second opinion, my answer is, “Absolutely.” I do not get offended. I feel that if – because a lot of times the patient’s going to say, “I don’t want a second opinion, but my family does.” You’ve got to live with your family. Go get the second opinion. 99 percent of the time, experts who do this for a living all have the same answers. And so it just is going to solidify for your family that the right thing is being done, and then you can also decide where do you feel most comfortable?  

If Dr. A and Dr. B tell you the same thing, what environment do you feel most comfortable in, so in the event that you had questions, or you didn’t feel well, where do you want to go? So, I strongly encourage that. And if somebody comes back and says, “You know, I really think that this place fits me better,” my answer is, “That’s absolutely fine; thank you for letting me know. If there’s anything I can do, please reach out.” Because, again, bottom line is I just want the best outcome for the patient.  

What Do Advanced Non-Melanoma Skin Cancer Patients Need to Know About Treatment and Research?

What Do Advanced Non-Melanoma Skin Cancer Patients Need to Know About Treatment and Research? from Patient Empowerment Network on Vimeo.

What therapies are emerging for advanced non-melanoma skin cancer (ANMSC)? Dr. Anna Pavlick shares the latest in ANMSC research news, including developments in targeted therapy and immunotherapy. 

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here

Katherine:

Are there developments in advanced non-melanoma skin cancer treatment and research that patients should know about?  

Dr. Pavlick:

Well, I think when it comes to non-melanoma skin cancers, the developments over the last five years have been groundbreaking. 

I think the first major advancement we made was to identify that the hedgehog pathway is a pathway that basal cell cancers follow in order to spread to other parts of the body. And we found out that if we can block that pathway, we can control basal cell cancer very easily because more than 90 percent of basal cell cancers use that pathway to spread. So it’s like a roadblock. If you’re doing construction and you come to point where you’ve got the detour, well, you can’t keep going straight ahead – you get stopped. And that’s what targeted therapies do, and we found that there are hedgehog inhibitors that are these roadblocks for basal cell cancer.  

Dr. Pavlick:

So what has been evolved since then is looking at immunotherapy as a way to control non-melanoma skin cancers because, as you know, melanoma was the first place that immunotherapy really became paramount as the key treatment that makes the hugest impact on patients. And because of what we learned in melanoma, finding out that the number of mutations that melanomas have make it very susceptible to immunotherapy. We then went and looked at, “Well, what does squamous cell cancer have, what does basal cell cancer have?” 

Well, we found out that basal cell, squamous cell and Merkel cell cancer have a very high mutational burden, and translating that, we said, “Well, we now know this: these are cancers that should now response to immunotherapy as well.” And they do. And they do very, very beautifully. Unfortunately, like every story, it’s not 100 percent of the tumors that will respond. It’s basically in the 50 percent range. So although it’s still a very high number, you need to know that going into it when you treat a patient with locally advanced squamous cell cancer, only 50 percent are going to have a response. So, if you don’t see that tumor getting better pretty darn quickly, you better start thinking, “This might be somebody who’s not going to respond to immunotherapy, and what’s going to be my Plan B?”  

Katherine:

Right.  

Dr. Pavlick:

Because squamous cell cancers in general respond very, very quickly to immunotherapy. 

Usually within a matter of four to six weeks, you’re already starting to see improvement. When it comes to basal cell cancer on the other hand, basal cell cancers – because they develop very, very slowly over years – it takes months of immunotherapy to get them to respond. So I tell patients with locally advanced basal cell, “You really have to be patient, because we expect this to take somewhere between three and 6 months for us to start seeing something get better.” It doesn’t mean that it’s not working, it’s just basal cells just respond much slower. I think when patients are prepared and knowing that this is not a quick eight weeks – we’re going to know for sure whether this helps or not – it helps patients to be able to understand that, “I’m in this for at least six months –maybe longer.” 

Expert Advice for Newly Diagnosed Advanced Non-Melanoma Skin Cancer Patients

Expert Advice for Newly Diagnosed Advanced Non-Melanoma Skin Cancer Patients from Patient Empowerment Network on Vimeo.

Dr. Anna Pavlick provides three key pieces of advice for newly diagnosed advanced non-melanoma skin cancer patients to help them feel empowered in their care and treatment decisions.

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here
 

Katherine:

What three key pieces of advice would you have for a patient who has just been diagnosed with advanced non-melanoma skin cancer?  

Dr. Pavlick:

I think the first one is number one: do your homework. Don’t just take anything for face value. You know, I tell my patients, “This is your life. If you go and do research about what appliance you’re going to put in your kitchen, I think you should also do a little bit of research about what doctor you’re going to allow care for you.” And so I always tell everybody, “Did you do your homework? Are you sure you’re in a place that is going to be able to provide you with the care that you need? Are the physicians that you’re seeing experienced in the disease that you have?” Because they may be brilliant physicians, but they may not have any expertise in that particular area. And so I think it really behooves people to – I tease my patients, I ask them if they go to “Google Medical School.”  

And really, find out a little bit about our backgrounds, find out about the institution that you’re going to, and learn a little bit about the disease. I’m certainly not saying come in and tell us what you want to have done, because I would hope that it takes many years of training and expertise to know how to make a good decision. But I think the more that patients know about the physicians that they’re seeing, and their level of expertise, and their interest, the better the outcome’s going to be. So that’s number one, number two is consider clinical trial. If you are a candidate for a clinical trial, consider it.   

Because we are taking promising agents and looking for ways to make patients have better outcomes. And so, many times when we talk about clinical trials, we know about the drugs, we know about their side effects, we know their efficacy, but we’re looking to find ways to make those drugs work even better. And sometimes it may be adding radiation to one of the standard drugs we have. It may be adding a different type of targeted therapy to the medicines that we have. Sometimes it’s actually taking a research medicine that looks really, really good and very promising, and adding that extra research drug to a standard drug to see if we can’t do better.  

So that I think is really – my second point of advice is really consider participating in a clinical trial if it’s applicable.  

Katherine:

Mm-hmm. 

Dr. Pavlick:

And so what’s my third one? My third one is to really make sure that you can communicate with your team, that you trust your team, and you feel comfortable with your team. You know, there are many of us who have the expertise, but we all have very different manners in which we communicate and talk to patients and speak with family members. If you’re not comfortable with the person that you’re seeing, there is absolutely nothing wrong with going to get a second opinion to find someone who has the same level of expertise who may just fit your personality better.  

You know, everybody’s different. You have to find the health care team that fits for you. And I think that’s so important, because you’re trusting us with your life. And if you don’t feel comfortable, then we shouldn’t be the ones taking care of you.  

Katherine:

Yeah. This is all about self-advocacy.  

Dr. Pavlick:

That’s right. 

Katherine:

The more you know, the better care you’re going to get, and the more comfortable I think you’ll feel with your treatment.  

Dr. Pavlick:

Correct. 

Katherine:

Yeah.  

Dr. Pavlick:

And again, I think treatment – yes, people come to us for our recommendations, but it really is a team effort. My feeling is the more that patients understand why we’re doing what we’re doing, and are part of that decision-making process, the smoother treatment goes.  

Katherine:

Sure.  

Dr. Pavlick:

I really think education is important – of the patient and the family.  

I think being able to ask your physician questions without feeling that you’re threatening – it’s something you should be able to do. And I think it just provides with better care.  

Katherine:

Dr. Pavlik, how do you empower patients? 

Dr. Pavlick:

You know, when I talk to patients I really do try to number one: educate them. I am big believer in bad artwork, because I’m a bad artist. And so I really try to draw out schematics to help patients understand how they therapy that I’m proposing is going to work, so they understand the mechanism. Patients will also go home with printed handouts so that they can go back and read about what we talked about, because many times patients absorb maybe one-quarter of what’s been said in a consult. 

I encourage people to bring their family members or friends so that they can hear; two sets of ears is always better than one. And I fully support them; if they want to go get a second opinion, my answer is, “Absolutely.” I do not get offended. I feel that if – because a lot of times the patient’s going to say, “I don’t want a second opinion, but my family does.” You’ve got to live with your family. Go get the second opinion. 99 percent of the time, experts who do this for a living all have the same answers. And so it just is going to solidify for your family that the right thing is being done, and then you can also decide where do you feel most comfortable?   

If Dr. A and Dr. B tell you the same thing, what environment do you feel most comfortable in, so in the event that you had questions, or you didn’t feel well, where do you want to go? So, I strongly encourage that. And if somebody comes back and says, “You know, I really think that this place fits me better,” my answer is, “That’s absolutely fine; thank you for letting me know. If there’s anything I can do, please reach out.” Because, again, bottom line is I just want the best outcome for the patient.  

Where Do Clinical Trials Fit Into a Non-Melanoma Skin Cancer Treatment Plan?

Where Do Clinical Trials Fit Into a Non-Melanoma Skin Cancer Treatment Plan? from Patient Empowerment Network on Vimeo.

At what point should advanced non-melanoma skin cancer patients consider participating in a clinical trial? Dr. Anna Pavlick discusses the benefits of trial participation and how the eligibility process works.

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here

 

Katherine:

Where do clinical trials fit into the treatment plan? 

Dr. Pavlick:

You know, for me clinical trials are something that patients need to see as an opportunity. 

It should always be the first question that a patient should say, “Hey doc, what about a clinical trial?” Clinical trials provide patients with such great resources to either get a standard therapy with something extra, or to look at a novel way of using a known therapy. I think it’s something that every patient should ask their physicians about – and not everybody is eligible, or should go on a clinical trial – but it’s certainly worth asking, “Is there a clinical trial that I could participate in?”  

Katherine:

So, who might be eligible? What’s the criteria? 

Dr. Pavlick:

Well, each trial has different criteria. So, depending on the trials that are available at the institution where you’re being seen – for example, if you have, let’s say, basal cell cancer – the clinical trial may be looking at two immunotherapies as opposed to one immunotherapy. So when we do a clinical trial, there are what we call inclusion and exclusion criteria, and those are pre-determined criteria that you have to check those boxes to make sure those patients fit that particular study.  

So it’s not a random, “You can’t participate because you’re wearing a purple shirt today.” It is, “You have basal cell, but you have never had this drug that the study says you have to have been treated with this drug in order to go on to this study.” So you can’t jump from A to Z. You have to go from A to B to get to C. So, it really is just checking the boxes, making sure that patients fit whatever the deemed criteria are, and make sure they also don’t fall into the exclusion criteria. 

You know, trials will also say, “If you have an unstable medical condition –,” you know if I have a patient who’s telling me that they’re in and out of the E.R. with chest pain because the doc thinks that they have unstable angina and may need a stint – well, that’s not a patient that you want to put on a clinical trial at that point in time. Not to say that it can’t be re-explored at a different point, but people with active other medical issues just add to the complexity of being able to determine what are the side effects, and what are the not – what’s related to study drug, and what’s related to underlying problem?  

How Is Advanced Non-Melanoma Skin Cancer Treated?

How Is Advanced Non-Melanoma Skin Cancer Treated? from Patient Empowerment Network on Vimeo.

Developments in advanced non-melanoma skin cancer treatment and research continue to evolve. Dr. Anna Pavlick reviews important treatment considerations and discusses targeted therapy options.

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here

 

Katherine:

How is advanced non-melanoma skin cancer treated? 

Dr. Pavlick:

Everybody’s locally advanced non-melanoma skin cancer really has to be looked at as a personal type of management. 

There is no cookie-cutter answer to say, “Well you just cut it out, or you just radiate it.” Again, it’s going to be contingent upon where is this located, how extensive is it, what is the patient’s preference, what is the patient’s performance status? You know, when you talk about offering radiation, although it’s a very good therapeutic option for many of these tumors, there are some patients who can’t travel hours to get to a radiation facility, and radiation is given every day for several weeks. So that’s an option – though it’s a treatment option, it may not be a feasible option. And so I think there are multiple factors. If you cut it out, is the patient going to be left with a disfiguring outcome? 

I know many times I get sent older patients because this is a disease many times of older patients, where they have these very large lesions and the thought of doing a surgery – not that you can’t – but can the patient withstand such an extensive procedure? What are they going to look like and what kind of functional deficits are you going to leave them with? You know, all of this really has to come into play, and then again, is the patient well enough tolerate a medical therapy that I have to offer? So this is why when you deal with these cancers, it really is a group effort. We all know the patient. We all get to see the patient. 

And then we all get together and say, “Okay, what are the pros and cons, and really what is the optimal way for us to best serve this patient to get rid of their cancer but also preserve their quality of life?”  

Katherine:

So other than surgery what other options are available to patients? 

Dr. Pavlick:

So surgery’s obviously the first and foremost because if you can take it out, it’s a one-and-done, patient can heal, patient can move on. 

But again, depending on location, depending on extent of the disease, sometimes we consider radiation therapy, sometimes we consider medical therapy, which would mean using different types of systemic therapies, whether it be pills – depending upon the type of cancer it is – or even intravenous immunotherapy to help either control this disease and shrink it up, then allowing the surgeon to go in and remove it. Or, best case scenario is that the immunotherapy will completely eradicate the tumor and spare the patient from having to undergo any type of procedure.  

Why Do Advanced Non-Melanoma Skin Cancer Patients Need a Multidisciplinary Care Team?

Why Do Advanced Non-Melanoma Skin Cancer Patients Need a Multidisciplinary Care Team? from Patient Empowerment Network on Vimeo.

Skin cancer expert Dr. Anna Pavlick explains what it means to have advanced non-melanoma skin cancer and discusses why patients should seek a multidisciplinary care team.

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here.

 

Katherine:

Let’s start with some basic information for patients. What is advanced non-melanoma skin cancer? 

Dr. Pavlick:

That’s actually a really good question, because many people think skin cancer is just skin cancer is just skin cancer. But when it comes to non-melanoma skin cancers, those are the types of cancers that are really much more common than melanoma. So we’re talking about your basal cell cancer, your squamous cell cancer, and even a more rare type of cancer called Merkel cell. Locally advanced non-melanoma skin cancers mean that these are lesions that are not easily removed by the dermatologist. So, it’s not a tiny little thing where you go in, you usually have a Mohs procedure for most of these types of cutaneous malignancies.  

And a Mohs procedure is where a dermatologic surgeon will go and take thin layers – layer by layer – and look at it with a pathologist in order to determine if they’ve successfully cleared out the cancer. It allows for us to be very meticulous in how we take things out, but it also allows us to have a nice, clean, smaller resection area, so healing is also much nicer than if you had to cut out a big chunk of tissue.  

But when you have locally advanced disease, sometimes that includes having such extensive disease that maybe cutting the lesion out is going to cause disfigurement, or they may be involved lymph nodes, and so we’re afraid that maybe this cancer can now go to other parts of the body. You know, it is just not a simple cut it out and you’re done kind of cancer. 

It’s a kind of cancer that really requires a multidisciplinary team to really think about what are the best ways to manage this for the patient that’s going to provide the patient with the best cosmetic outcome, and long-term outcome control as well.  

Katherine:

Who’s on that team?   

Dr. Pavlick:

So in our academic center that team, or even in a community setting, that team should include a dermatologist, a medical oncologist, a surgeon – depending on where that cancer is located – many times it’s on the head and neck, so it would be a head and neck surgeon. If it’s an extremity or a trunk lesion, then it may be an oncologic general surgeon. Radiation oncology is also important to include because sometimes these are very radiation-sensitive tumors, and radiation may be a part of the whole treatment plan.