Tag Archive for: gynecologic cancer

Essential Genetic Testing for Personalized Gynecologic Cancer Treatment

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

[ACT]IVATION TIP

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

See More from [ACT]IVATED Ovarian Cancer

Related Resources:

Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

 PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects

PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects

 What Are Common Symptoms of Ovarian Cancer

What Are Common Symptoms of Ovarian Cancer?

Transcript:

Lisa Hatfield:

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

Dr. Ramez Eskander:

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

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

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

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

Lisa Hatfield:

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

Dr. Ramez Eskander:

That’s correct.

Lisa Hatfield:

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

Dr. Ramez Eskander:

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

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

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

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

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PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects

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

[ACT]IVATION TIP

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

See More from [ACT]IVATED Ovarian Cancer

Related Resources:

Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

 Essential Genetic Testing for Personalized Gynecologic Cancer Treatment

Essential Genetic Testing for Personalized Gynecologic Cancer Treatment

 What Are Common Symptoms of Ovarian Cancer

What Are Common Symptoms of Ovarian Cancer?

Transcript:

Lisa Hatfield:

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

Dr. Ramez Eskander:

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

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

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

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

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

Lisa Hatfield:

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

Dr. Ramez Eskander:

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

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

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

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Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches

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

[ACT]IVATION TIP

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

See More from [ACT]IVATED Ovarian Cancer

Related Resources:

PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects

PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects

 Essential Genetic Testing for Personalized Gynecologic Cancer Treatment

Essential Genetic Testing for Personalized Gynecologic Cancer Treatment

 What Should Ovarian Cancer Know About Immunotherapy and Targeted Therapies

What Should Ovarian Cancer Know About Immunotherapy and Targeted Therapies

Transcript:

Lisa Hatfield:

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

Dr. Ramez Eskander:

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

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

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

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

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

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

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How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

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What gynecologic cancer care questions should patients and families ask? Expert Dr. Ramez Eskander from UC San Diego Health discusses the value of patient education, second opinions, credible resources, and proactive patient advice to help optimize care. 

[ACT]IVATION TIP

“…be informed. Explore your options and opportunities. Again, there are strategies that are available to you both on the Internet, publicly available, but also through colleagues, through friends, and a network that you can build through support groups, even at your institutions. It’s never too early to ask about clinical trials so that you can make sure you’re educated and informed as you look to make decisions. Because if you try to take all of this into consideration and at one time point, it can be a little bit overwhelming.”

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See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Overcoming Gynecologic Cancer Challenges for Optimal Care

Overcoming Gynecologic Cancer Challenges for Optimal Care

 What Are the Barriers to Endometrial Cancer Care in Underserved Communities?

What Are the Barriers to Endometrial Cancer Care in Underserved Communities?

 How Can Gynecologic Oncology Racial Disparities Be Addressed

How Can Gynecologic Oncology Racial Disparities Be Addressed

Transcript:

Lisa Hatfield:

Dr. Eskander, as new treatments and strategies emerge, how can patients and their families stay activated and ensure they’re benefiting from the latest advancements? And what should they be asking their care team to make sure they’re up to speed with the latest in gynecologic cancer care?

Dr. Ramez Eskander:

This is so important to me for patients to feel like they’re empowered and educated. I believe that patients are their greatest advocates. This is where family and friends are also an important part of the care team. From my perspective, it’s very beneficial to have someone in the room with the patient as they’re having conversations about treatments and treatment strategies to take appropriate notes, to be informed, and to not feel bad about asking questions, to not feel bad about asking the relevance of a second opinion.

Any provider should never take offense to a patient asking for a second opinion. In fact, I would say, I encourage my patients. I say, listen, if you have questions and you…if you would like to get someone else’s perspective, please do so. I want that, and I want you to come back to me with potentially a different option or a question that my hope is to answer.

We have a shared goal of making sure our patients have the best possible clinical outcome. That is our north star. So as new treatments and strategies emerge, try to stay informed. There are multiple platforms available, of course, via the Internet, for example. I will just be cautious in saying not all of that information is accurate. So if you’re going to use a platform that’s publicly available, the web, make sure that you’re trying to go to areas where a resource is vetted and reliable.

The National Cancer Network, the NCCN, the National Cancer Institute, clinicaltrials.gov for clinical trials, vetted and established advocacy organizations, and then taking that information, using it as a foundation in which you can build upon when you have conversations with your providers. But again, this is where I think not just the patient alone, but patient, family, and friends can really work together to try to develop.

And all of our meetings, the cancer meetings that we have, for example, for gynecologic cancer as a Society of Gynecologic Oncology, there’s a foundation for women’s cancer. There are opportunities for education, the American Society of Clinical Oncology. These are publicly available resources, websites where you can go to and look for patient facing material to make informed decisions about the management of your cancers.  And, of course, when you’re asking to talk about clinical trials, how do I stay up to date? Again, it’s a dialogue. It’s never too early to ask. I worry sometimes that patients don’t want to bring up a clinical trial, because they fear that bringing that up means that they’ve exhausted all treatment strategies.

Quite contrary to that, the earlier you begin the conversation, the greater opportunity you’re going to have to potentially identify a clinical trial for which you may be eligible. And that will help you through your treatment paradigm. Because if you don’t, you may pass that up, because you’re no longer eligible, because you’ve had too many prior lines of treatment, for example. And having that conversation early will also help you prepare as you go through the treatment paradigm so that if you need to make a decision about potentially enrolling in a trial, you’re established, you’re ready to do so rather than trying to effectively push this forward quickly without making sure that you have the required information that you need.

So it’s a multi-pronged approach. It’s going to require support systems, undoubtedly, multiple resources are available, and then subsequently engaging those resources to use that information to guide your conversations.

My activation tip is be informed. Explore your options and opportunities. Again, there are strategies that are available to you both on the Internet, publicly available, but also through colleagues, through friends, and a network that you can build through support groups, even at your institutions. It’s never too early to ask about clinical trials so that you can make sure you’re educated and informed as you look to make decisions. Because if you try to take all of this into consideration and at one time point, it can be a little bit overwhelming.

Lisa Hatfield:

Okay. Thank you so much. And I really appreciate your comment about it’s okay to talk to your provider about getting a second opinion. I was terrified of that, because I really love my doctor. He is great. And I didn’t want to bring that up, but anybody who’s watching this, Dr. Eskander said it’s okay to talk to your provider about seeking out a second opinion.

And it may help in your care in making decisions too. So I appreciate that you said that. And also that you said to make sure you go to vetted sites for information. When I was diagnosed with blood cancer, the first place I went to that I wasn’t supposed to was Google, got all kinds of information that I didn’t want to read. So go to those vetted sites. I think that’s great advice. So thank you so much.

Dr. Ramez Eskander:

Thank you, Lisa.

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What Are the Barriers to Endometrial Cancer Care in Underserved Communities?

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What are common endometrial cancer care barriers? Expert Dr. Ramez Eskander from UC San Diego Health discusses common care barriers for underrepresented communities and how patients and healthcare professionals can help address these barriers to optimal care.

[ACT]IVATION TIP

“…we have to be committed to this. This is not just a patient issue. This is an issue that is shared, a responsibility that’s shared across institutions, clinicians. I would strongly suggest that patients advocate for themselves. Don’t be afraid to ask questions. Try to determine what resources might be available to assist if you are facing particular obstacles to help mitigate some of the barriers that may impact treatment in this era.”

Download Guide

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

Overcoming Gynecologic Cancer Challenges for Optimal Care

Overcoming Gynecologic Cancer Challenges for Optimal Care

 How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

 How Can Gynecologic Oncology Racial Disparities Be Addressed

How Can Gynecologic Oncology Racial Disparities Be Addressed

Transcript:

Lisa Hatfield:

Dr. Eskander, what are some common barriers that patients with endometrial cancers face in accessing care, especially in underrepresented communities?

Dr. Ramez Eskander:

The issue around access to care and disparities in care is an important one. And I will say that as we move to this world of more molecular testing, identifying changes in the tumor or in genetic findings that predispose patients to potentially responding to therapies, there’s concern that it may increase disparities in cancer outcome. And that’s because is everybody getting access to tumor testing? Is everybody getting access to genetic testing? Are they informed? Are they educated about the implications?

This is so complex, and I think, Lisa, we could talk for an hour just about the issues surrounding barriers to care disparities and outcome. I will say that the goal is to make sure that all patients have access to these important tests. The goal is to make sure that all patients are educated to the same capacity. Understanding that health literacy can vary quite substantially so that we can work to try to develop more equitable treatment approaches and improve clinical outcomes across the board.

Do we see barriers? Absolutely. It could be barriers related to language. It could be barriers related to travel that a patient may not be able to travel the distance needed to see the provider or the specialist that can provide them the treatment that they need, or the counseling. It could be copay costs, can be prohibitive, it could be concern, trust issues around, do I want to get genetic testing? I’m worried this information is going to be used against me rather than help inform my cancer treatment strategy.

So it’s layered. It’s multi-pronged. There are several initiatives that are being deployed at different centers to try to improve and break down these barriers so that we can help patients overcome. And these could be social workers, patient navigators, case managers that reach out to these patients, resources that are available to facilitate transfer transportation, and bridge gaps that some of these patients might be facing.

And this is just in standard of care, completely independent of the barriers that patients face when they look to enroll in a clinical trial, for example, for treatment of their cancers. My [ACT]IVATION tip is we have to be committed to this. This is not just a patient issue. This is an issue that is shared, a responsibility that’s shared across institutions, clinicians. I would strongly suggest that patients advocate for themselves. Don’t be afraid to ask questions. Try to determine what resources might be available to assist if you are facing particular obstacles to help mitigate some of the barriers that may impact treatment in this era.

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Overcoming Gynecologic Cancer Challenges for Optimal Care

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What are the goals and strides in gynecologic cancer treatment? Expert Dr. Ramez Eskander from UC San Diego Health discusses how endometrial cancer and ovarian cancer treatment has evolved, different approaches to care, and proactive patient advice for optimal care.

[ACT]IVATION TIP

“…be informed. Ask the right questions. Make sure that you understand your treatment options for every stage of your disease. It is never too early to talk to your clinician or provider about clinical trial opportunities. It is never too early to talk to your provider about what systemic or chemotherapeutic or targeted therapies are available to you if you do recur so that you can begin to make informed decisions and plan towards management of these cancers.”

Download Guide

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

What Are the Barriers to Endometrial Cancer Care in Underserved Communities?

What Are the Barriers to Endometrial Cancer Care in Underserved Communities?

 How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

 How Can Gynecologic Oncology Racial Disparities Be Addressed

How Can Gynecologic Oncology Racial Disparities Be Addressed

Transcript:

Lisa Hatfield:

Dr. Eskander, even with recent advancements, what are some of the biggest challenges still facing patients with gynecologic cancers? And how can patients face these challenges head-on in order to get the best possible care?

Dr. Ramez Eskander: T

he management of ovarian cancer and endometrial cancer has really dramatically changed over the last several years, principally because of discoveries of effective treatments. And that’s also motivated by our understanding of the molecular drivers of these cancers. We’re learning more and more about what abnormalities on a molecular or genetic level may exist in these cancers that can inform treatment. When we think about the challenges, despite these advancements, it’s really focused primarily on the fact that we still deal with patients whose disease recurs after treatment.

So, for example, with ovarian cancer, patients have surgery and chemotherapy at diagnosis. And sometimes you start with chemotherapy and do surgery, followed by additional chemotherapy. And sometimes you do surgery, followed by chemotherapy. And that’s a decision that’s made based on multiple factors. Patients receive treatment, as I alluded to in the front line. But unfortunately, despite the advances that we’ve made in molecular testing and in therapeutics, a large proportion of patients with advanced stage disease may develop disease recurrence.

And in the context of disease recurrence, it’s difficult to achieve prolonged remission. So what we deal with is disease that is in remission for a period of time after primary therapy. And if that ovarian cancer recurs, that subsequent remission may be shorter than the primary remission. Now we can go into a lot of detailed conversations about what drugs we’ve identified to be effective in different disease settings.

And as I alluded to, we’ve made significant strides, but we still need to do better and identify more effective treatments, both in the front-line and in the recurrent setting. And I am very passionate about clinical trials, which are essentially the foundation in which we’ve identified effective treatment strategies that are now FDA-approved. And so I really want to empower patients who are dealing with advanced stage ovarian cancer diagnosis, really understand what your options are, understand whether or not you’re eligible for clinical trials in the face of a disease recurrence. 

Some of these studies are limited to specific time intervals during therapy or limited based on the number of prior treatments. And you want to have options available for you. And those options are going to be available by asking questions at these different phases of your treatment so that you can make sure that you’re making the most informed decision. And it’s the same thing with endometrial cancer. A large proportion of our patients are diagnosed with early stage disease that is successfully managed with surgery. Sometimes radiation is required. There are patients with advanced stage disease who are needing chemotherapy.

And again, in those circumstances, in the face of disease recurrence, we need more effective treatment strategies. Recently, we’ve incorporated immunotherapy plus chemotherapy in the management of advanced stage or recurrent endometrial cancer patients. Progressing after that leaves us with more limited options for which there are many clinical trials that are active in accruing patients to offer more effective treatment opportunities.

So my [ACT]IVATION tip in the context of this question is be informed. Ask the right questions. Make sure that you understand your treatment options for every stage of your disease. It is never too early to talk to your clinician or provider about clinical trial opportunities. It is never too early to talk to your provider about what systemic or chemotherapeutic or targeted therapies are available to you if you do recur so that you can begin to make informed decisions and plan towards management of these cancers.

Lisa Hatfield:

And I have a quick follow-up question to that, because you mentioned clinical trials, and I know you’re an advocate for patients seeking a second opinion. So if a patient who lives in an area where maybe there are not a lot of clinical trials, would like more information on that. And I live in an area where we don’t have a lot of clinical trials, and I have a great local oncologist, and he does a great job. But if I wanted to reach out and ask a specialist like you, a one-time consult, maybe, what are my options for a clinical trial? Can a patient do that? Can they do like a one-time consult with a specialist?

Dr. Ramez Eskander:

That is an excellent question. There are specific rules around what providers can do. And I will venture to say I’m not an expert in those rules. I’ll give you a pragmatic example. There are rules that will not allow a provider to have a clinic visit virtually with someone who’s outside of their state. So, it does set some boundaries. Now, what I will say, and you alluded to this already, Lisa, which is talk to your provider. That is a very great starting point.

If you feel like you’re not making as much progress, there are really amazing advocacy organizations that have capacity to help patients make these decisions, whether it’s organizations regionally or if it’s national organizations. I will just say also if you go to clinicaltrials.gov, it’s a website that’s available to us all and you type in a diagnosis like ovarian cancer or endometrial cancer, and you search for Phase III clinical trials, it will provide you with contact information for sites and you can look by sites in your state or regionally.

And I know it can feel daunting to do that. And that’s part of the reason that I’m such a big advocate for second opinions is because when patients are being treated for a cancer diagnosis, searching for your own clinical trial without any real guidance can feel like information overload. So it’s for me, reach out to your primary provider, utilize any advocacy groups that are in your region or national advocacy groups, such as the Ovarian Cancer Research Alliance or the Clearity Foundation. There are many others that can help patients kind of navigate for ovarian cancer diagnosis or second opinions. And then do your homework and try to identify whether or not there’s a provider who might be of greater assistance.

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Should Some Gynecologic Cancer Patients Seek a Specialist?

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

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

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See More from [ACT]IVATED Endometrial Cancer

Related Resources:

What Are Barriers to Endometrial Cancer Care Access?

What Are Barriers to Endometrial Cancer Care Access?

 Advancements in Endometrial Cancer Trials: Insights and Opportunities

Advancements in Endometrial Cancer Trials | Insights and Opportunities

 Are Beauty Products a Risk Factor for Endometrial Cancer?

Are Beauty Products a Risk Factor for Endometrial Cancer?

Transcript:

Lisa Hatfield:

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

Dr. Charlotte Gamble:

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

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

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

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

Lisa Hatfield:

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

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Evolve Endometrial Cancer Resource Guide

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What Do You Need to Know About Emerging Endometrial Cancer Research? Resource Guide

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How Can Endometrial Cancer Patients Advocate for Better Care?

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How Can Endometrial Cancer Patients Advocate for Better Care? from Patient Empowerment Network on Vimeo.

How can endometrial cancer patients empower themselves for better care? Dr. Ebony Hoskins shares advice for patients who feel dismissed or unheard when seeing their care provider.

Dr. Ebony 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.

[ACT]IVATION TIP

“…seek alternate care or another opinion. I think it’s very important that patients have a doctor that they trust and feel like they can ask questions for. I don’t, I really don’t think it’s okay to be dismissed.”

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What Treatment Options and Factors Should Be Considered for Endometrial Cancer?

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 What Treatment Options Are Available for Advanced Endometrial Cancer

What Treatment Options Are Available for Advanced Endometrial Cancer?

Transcript:

Mikki:

Dr. Hoskins, what is your message to women who speak up and their concerns are dismissed and aren’t taken seriously?

Dr. Ebony Hoskins:

Well, Mikki, do you want to know my real answer? I don’t think you do. But I’m going to tell you anyway. So anytime I hear a patient that say they did not feel heard, I always say, “You understand that you can get a different provider, right?” So that also means that if a patient does not have the trust anytime you don’t have trust, you don’t have a relationship, and that it’s okay to find a different provider, or a doctor to make sure that you’re heard. And I have seen women who don’t have any type of gynecologic cancer who have come to my office for a second opinion. And when it, and I say, well, “Why are you here?” And they said, “Well, I was really looking for someone that looked like me that I could trust to tell me, because when I asked these questions, I was dismissed.”

And so I was happy to give the opinion, but really sad that this particular patient had to travel to see someone that they really didn’t need to see, to get an answer that she was actually looking for, and not looking for the wrong answer. She just wasn’t, her question wasn’t being answered. And so I think if you don’t have the trust, there are other providers in our communities and getting those names from either a primary care provider you know, and I always hit or miss on the online thing from family members, friends about doctors that they like or that have a good reputation in terms of listening to their patients.

Mikki:

I also have one patient, I mean not a patient. I have a connect that dealt with this, this right here. And she went to several doctors before she got her diagnosis and which means time had spanned in between that time and her trying to look and saying, “Hey, this is what’s wrong. This is what I’m feeling. I know it can’t be this.” And she’s just going from doctor to doctor. And in between that time she missed some care that she had needed in that time. So what would be your activation tip for someone like that?

Dr. Ebony Hoskins: 

I think, just like I said before, seek alternate care or another opinion. I think it’s very important that patients have a doctor that they trust and feel like they can ask questions for. I don’t, I really don’t think it’s okay to be dismissed. 

Mikki:

Thank you so much.

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