Does Cervical Cancer Care Differ Between Academic and Non-Academic Centers?
What are key points about advanced cervical cancer treatment in academic versus non-academic settings? Expert Dr. Shannon MacLaughlan from University of Illinois discusses patient care at academic versus non-academic cancer centers, multidisciplinary care, support services, clinical trials, and the importance of second opinions.
[ACT]IVATION TIP
“…there’s always a role for a second opinion, and insurance providers are mandated to provide coverage for a second opinion. And that can be an important door for you to open to make sure that your case is reviewed at one of those academic centers.”
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Why Does Access to Care Matter in Cervical Cancer Treatment? |
Advancements in Cervical Cancer Treatment: Targeted Therapies and Immunotherapy |
Transcript:
Lisa Hatfield:
Dr. MacLaughlan, what role do academic centers play in the treatment of cervical cancer? And how might patients at these centers receive different care compared to those at non-academic centers?
Shannon MacLaughlan:
An academic cancer center, or a cancer center that has been designated as a comprehensive cancer center, or a National Cancer Institute cancer center, is going to have a certain, they’re required to provide multidisciplinary care that meets the highest standard of care. So an academic center or an NCI-designated center will, by definition, have the internal quality metrics, ensuring that they are doing the right thing, which you shouldn’t have to guess whether or not your team is doing the right thing.
But one of the biggest contributors to cervical cancer existing is and/or recurring and women dying from it is that we don’t always do the right thing. So, an academic center, number one is going to provide for you a multidisciplinary team. You need to make sure that that team includes a gynecologic oncologist.
You may need a radiation oncologist. The best multidisciplinary care of the patient with cervical cancer also includes a palliative care team that can manage pain control and other symptom management effectively. And these centers are required to screen patients for other needs than just treating the cancer. So if you go to an oncologist, wherever we are, we are going to be experts in the cancer and how to treat it.
And hopefully, we are keeping up with the latest and greatest and most effective treatment options. And if you go to a cancer center that has NCI designation or is an academic center, then that should come with it…the understanding that taking care of a patient with cancer is more than just killing the tumor.
It’s about taking care of the patient and taking care of that patient’s family and taking care of that patient and their family in the context of their community. We see often in patients with cervical cancer, the need for transportation services, for social work support, not only to cope with the diagnosis, but to cope and navigate with the treatment that we lay out for you and how to plug it into your life and deal with the financial toxicities that come along with it. And those academic centers are going to be equipped with the teams who can connect you with smoking cessation and assist with food security and other things that contribute to your wellness.
The other important thing about academic centers is access to clinical trials. And in the world of cancer care, access to clinical trials is a marker of quality and better outcomes for patients. We are also starting to see, now that we’re looking for it, we’re starting to see that we can, oftentimes we see survival outcomes diverge based on things that it shouldn’t. Diverges for Black women, not as effective as white women.
We can close those gaps when patients participate in clinical trials. It doesn’t necessarily mean that a clinical trial is available to a particular individual and that they may not be eligible for anything in that moment, but access to those clinical trials is a critical big picture for successful treatment of cervical cancer or any kind of cancer.
And then finally, I would say that academic centers have the mandate of educating the next generation of providers, and we need to do better. So, for several years, I ran a clinic specifically for patients with cervical cancer. And just doing that, spending a day seeing patients, only patients, dealing with cervical cancer, was such an important learning opportunity for the residents and the medical students because I hate to tell you, but we are often taught in medical school that cervical cancer isn’t a problem anymore and that we cured it with successful screening.
But we didn’t. We haven’t actually made any headway meaningful in incidence of cervical cancer in a couple decades. So, it is important that we educate our next generation of providers that cervical cancer is, in fact, a problem. The treatment that we provide for cervical cancer is in and of itself very tasking and somewhat traumatic thing for a patient to experience. And providers need to learn how to provide culturally-accessible, empathic care for patients coming to the table with this particular kind of cancer.
So, that’s more of an ask than a recommendation. I ask you to go to an academic center so that you can teach the next generation. That’s really important to me. Now, my [ACT]IVATION tip for this topic is that you always have an opportunity for a second opinion.
Why does that matter? It matters because not everyone has access to an academic center for cervical cancer or any kind of cancer. You might not live near an academic center. You may not, even if you do live near one, you might not be able to get into one. But there’s always a role for a second opinion, and insurance providers are mandated to provide coverage for a second opinion. And that can be an important door for you to open to make sure that your case is reviewed at one of those academic centers.
Lisa Hatfield:
Okay, thank you. And I’m also a big advocate for getting an expert opinion, somebody who just sees those types of cancers. So, do you recommend if a patient is diagnosed with cervical cancer, they are not near an academic center, would you recommend that they do that at the time of diagnosis to try to seek out a second opinion or a consult at least once right at diagnosis? Is that the best time for that, do you think?
Shannon MacLaughlan:
Absolutely. The most effective time for a second opinion is before you start treatment. Once you initiate a treatment, there are very few certain…because you’ve started it, it’s almost always the best thing to continue doing it. Even if it’s not what I would have recommended to you to begin with. If you’ve already initiated it, you’re committed. So it’s tricky when you have a new diagnosis. It can be anxiety-provoking to have to wait for a second opinion or wait to get in for one or wait to start your treatment. But if at all possible, that’s the most effective time.
I would also add that many centers offer community doctors access to their tumor boards. I hate the term tumor board, but because it’s universal, I can’t change it. A tumor board is a multidisciplinary conference in which providers of each subtype gather and review cases. And so many academic and comprehensive cancer centers will offer that service to community physicians so that you may, if you can’t physically get to an academic center for a second opinion, then you may be able to have your case reviewed. There could be a telehealth option. Sometimes that’s an option when crossing state lines is necessary. And then finally, if all else fails, getting a second opinion on the pathology can be helpful.
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Advancements in Cervical Cancer Treatment: Targeted Therapies and Immunotherapy
Advancements in cervical cancer treatments have created a new landscape for patient care. Expert Dr. Shannon MacLaughlan from University of Illinois discusses immunotherapy, targeted therapies, antibody drug conjugates, and proactive advice for patient care.
[ACT]IVATION TIP
“…ask your team about clinical trial opportunities, because clinical trials are how we discover the next best treatment. And if you are eligible for a clinical trial, then that means you could gain access to that treatment early. So ask your provider about clinical trial opportunities.”
Related Programs:
Does Cervical Cancer Care Differ Between Academic and Non-Academic Centers? |
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Why Does Access to Care Matter in Cervical Cancer Treatment? |
Transcript:
Lisa Hatfield:
Dr. MacLaughlan, what exciting advancements in cervical cancer treatment are on the horizon? For example, how do targeted therapies like antibody drug conjugates fit into the broader future landscape of cervical cancer therapies?
Shannon MacLaughlan:
There are a lot of exciting developments in cervical cancer. And it’s exciting as a gynecologic oncologist because earlier in my career when I talked with someone diagnosed with stage IV cervical cancer or who had a recurrence, there were basically no treatment options that would work, and now we have so many options for patients, and I am starting to see complete responses in situations I’ve never seen before.
So some specific advances, I would say, one, would be in the surgical approach of cervical cancer. We are getting much better at taking care of patients who have surgeries and minimizing the impact of the surgery on their body. With regard to systemic treatment options, I would say the most, the biggest impact I’ve seen so far is the addition of immunotherapy for the treatment of cervical cancer such that I have seen patients with stage IV disease have complete responses to their treatment, and I’ve seen patients who have had recurrences in their spine get complete responses and get to another remission, and that’s exciting. That’s the lease on life that we could not talk about just a few years ago.
Targeted therapies are an important phenomenon and movement in all cancer care, because it represents thinking about cancers differently. If we think about cancers based on where they start, where in the body they are started so if we think of cervical cancers just as a cancer that starts in the cervix, then we can only lean on experience from other patients who have cervical cancer, and it puts our thinking into a very narrow box. Targeted therapy means that we’re looking at the cancer, not where it started, but what that tumor is doing under the microscope. What proteins is it producing, what mutations does it have? And those mutations are usually a clue to how the cancer is surviving. And if we can have that kind of a clue, then we can choose a treatment that can target that particular mutation, no matter where the cancer started in the body.
It’s a very new kind of drug called an ADC or an antibody drug conjugate. What that means is the antibody targets the mutation. All it does is bind to the cancer cell, but it’s got attached to it, a little molecule of chemo, and so it sneaks itself into the cancer cell and the chemo can kill the cancer cell from the inside, instead of the outside. And that can improve efficacy. It definitely changes the side effect profile and toxicity profile. And so that has opened up additional doors for patients with cervical cancer that weren’t previously available.
My [ACT]IVATION tip for this topic is to ask your team about clinical trial opportunities, because clinical trials are how we discover the next best treatment. And if you are eligible for a clinical trial, then that means you could gain access to that treatment early. So ask your provider about clinical trial opportunities.
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Understanding Your Role as a CAR T-Cell Therapy Care Partner
Why is a care partner essential during the CAR T-cell therapy process? This animated video explains the role of care partner when supporting someone undergoing CAR T-cell therapy and provides advice and tips for their own self-care.
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Transcript:
As a care partner, you play an essential role in supporting your loved one through the CAR T-cell therapy process. Your responsibilities will go beyond emotional support into active caregiving, medical monitoring, and close communication with the healthcare team.
It’s important to gather as much information as possible early on in the process.
Start with these questions:
- Who are the essential members of my loved one’s healthcare team?
- CAR-T therapy involves a multi-disciplinary team and you should know the members, who may include hematologists, oncologists, nurse practitioners, pharmacists, and social workers.
- What are my responsibilities as a care partner?
- Your role is an essential part of your loved one’s recovery and may include administering medication, monitoring for side effects, and keeping track of medical appointments.
- What can I expect during the CAR-T therapy process?
- Understanding how the process works and what your loved one will experience will help you prepare for CAR-T therapy and the recovery period.
- What can I expect when my loved one leaves the hospital?
- When your loved one comes home, you need to understand how to assist them, what side effects to watch for, and when to call for help.
- Who do I contact in case of an emergency?
- Know the 24/7 contact information for members of your healthcare team. Some side effects can escalate quickly, and fast action may be needed.
And while you’re busy supporting your loved one, it’s crucial to recognize your own needs. Care partner burnout is real, and to provide the best care, you must stay mentally and physically healthy.
So, what can you do?
First, recognize when you’re stressed. Signs of burnout can include fatigue, irritability, or feeling overwhelmed. Don’t try to handle everything on your own. Ask family members for help and talk with friends – sharing your challenges can reduce stress.
Remember to practice self-compassion – it can help you cope during stressful times and to manage unrealistic expectations that you may place on yourself.
- Next, arrange for help. If caring for your loved one becomes overwhelming, consider hiring professional in-home caregivers, even temporarily, to give yourself a break.
- Make self-care a priority. When time allows, take advantage of opportunities to recharge. Self-care is not selfish – it’s essential for your health AND for success in supporting your loved one.
- Finally, you don’t have to go through this alone. Ask about support. Many cancer centers offer resources and support groups specifically for care partners – you can start by talking to a social worker or a mental health professional about your needs.
And, advocacy organizations like The Leukemia & Lymphoma Society (LLS), American Cancer Society, and Caregiver Action Network provide assistance for care partners, including helplines, counseling, and community connections.
For more care partner tools and resources, visit powerfulpatients.org.
Why Should Endometrial Cancer Patients Engage in Their Care?
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.
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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
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.
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Why Should Endometrial Cancer Patients Engage in Their Care? |
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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?
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.
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Tools for Improving Access to Quality Endometrial Cancer Care |
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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?
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.
See More from DETECT Ovarian Cancer
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How Does Biomarker Testing Impact Ovarian Cancer Screening and Detection? |
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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?
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.
See More from DETECT Ovarian Cancer
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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.
Where Do Clinical Trials Fit Into an Endometrial Cancer Plan?
What role do clinical trials play in endometrial cancer treatment plans? Dr. Hinchcliff highlights that clinical trials can be crucial at every stage of the cancer journey, offering access to innovative therapies and alternatives to standard care.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
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Transcript:
Katherine Banwell:
Dr. Hinchcliff, where do clinical trials fit into a treatment plan for endometrial cancer?
Dr. Emily Hinchcliff:
So, I think clinical trials are an incredibly valuable part of a patient’s cancer journey. Every institution and every provider is going to have potentially different clinical trials available to the patients in their practice, and so, it’s important to understand what clinical trials might be available to a patient as they both start their cancer journey, but certainly as their cancer progresses or comes back.
I think that there is – it should be something that is on the back of your mind at all phases of a cancer journey. It may not be right for a patient if they are first diagnosed and have a clear standard-of-care option, but there are certainly clinical trials that add to or investigate what we consider to be the current standard of care to try and move that forward. So, even in that first diagnosis phase, I think it’s worth asking your doctor, “What’s available to me?”
And then, certainly, when a cancer comes back, especially when a cancer has developed resistance to some of the more standard options that we would use, then I think clinical trials are an incredibly – it’s an incredible opportunity to have access to a toolbox that you would not have access to otherwise. And so, I think that – when I think about clinical trials, I think that they fit into all phases of a cancer journey, but that there are certain times in every individual patient’s journey that I would say this clinical trial might be right for you at this particular time.
Katherine Banwell:
What would you say to patients who are hesitant about trial participation?
Dr. Emily Hinchcliff:
So, I think that that is very common, and what I would say is information is power. I think that if there is a trial that you are eligible for, it’s really important to understand what the actual structure of that trial is and also understand what the phase of that trial is. So, let me explain those two things, because I think they’re a little bit different.
When I think about a trial structure, I think about what is the trial testing, what is it looking at, and what are the potential arms of therapy. When we say “arms,” that just means what is a patient going to actually receive. And so, some trials, there’s only one option. Anyone who’s enrolled on the trial gets a certain thing. Other trials have some comparison arms. So, some patients that are enrolled get a certain treatment; some patients that are enrolled get a different treatment.
And so, as you think about the structure, it’s important to know what might I get? Am I always going to get the treatment arm – for example, the drug that’s being investigated – is there a placebo arm – an arm that says I might get something that’s standard, like chemotherapy, but I’m going to get chemotherapy plus a placebo, which means an inactive agent, as compared to chemotherapy plus an inactive drug.
So, it’s really important to understand the structure of a trial. The second thing that I think is important to understand is the phase. So, clinical trials are grouped into phases. Phase I, Phase II, Phase III are the most common that you’ll hear about, and those are a description of how far along is that particular drug or treatment in development.
So, Phase I, that treatment is very early. It does not mean that there’s not promising data around it, but it means that that drug doesn’t have data, for example, in lots and lots of patients with your particular cancer type, right? Instead, usually, a Phase I trial is looking at a drug in humans or in a particular group of tumors – or patients with a particular group of tumors – for the first time or early on.
Phase II trials are looking at that drug maybe a little bit later, after they’ve gotten some good data, or trying to expand a drug that might have been used in a different cancer type to a new cancer type, for example. And then, Phase III is the bigger studies where you’re looking to enroll more patients in a specific cancer type for a specific reason to say, “Okay, we’ve had good evidence that this drug has some amount of efficacy, so now we’re really trying to look to see how does it compare to what we have out there, and could this help us move forward?”
Advances in Endometrial Cancer Treatment and Research
What new developments in endometrial cancer treatment should patients know about? Dr. Hinchcliff highlights advancements in immunotherapy for newly diagnosed patients and ongoing clinical trials focusing on molecular pathways and drug combinations for more personalized care.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
Related Programs:
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Where Do Clinical Trials Fit Into an Endometrial Cancer Plan? |
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Transcript:
Katherine Banwell:
Are there endometrial cancer treatment developments that patients should know about?
Dr. Emily Hinchcliff:
Yes. So, I think within literally the past year/two years, we’ve had some truly groundbreaking work that has changed the way all of us practice in GYN oncology, and that is specifically around this immunotherapy. So, it used to be that we would save immunotherapy for when someone’s cancer had returned. So, they would get their initial, for example, chemotherapy if they needed it, and then, when the cancer came back, that’s when we would start thinking about immunotherapy.
There are now two big randomized controlled trials, which is sort of our best data, that tells us that adding immunotherapy in the first line, meaning when someone is first diagnosed, if their cancer has spread outside the uterus, that adding immunotherapy at that point can be really helpful for certain patients, and so, I would say that as an avenue of treatment – understanding is immunotherapy right for me, why or why not – is kind of my second takeaway for patients.
Katherine Banwell:
You mentioned trials. Are there ongoing trials that are showing promise?
Dr. Emily Hinchcliff:
Absolutely. I think it is an incredible time to be a GYN oncologist because the field is advancing so rapidly.
I think that now, we are really focused on some of these molecular pathways to try and not only understand which patients should we be giving these therapies to, who are they most effective in, which patients can we actually be pulling back, who has a better prognosis, so we may not need to give them the toxicity level that comes with all of the standard chemotherapy options, and then, also, are there drug combinations that may work better for patients, and how do we choose which combination therapies we should use. And so, I think that there are a lot of really exciting clinical trials going on in endometrial cancer right now.
Katherine Banwell:
Dr. Hinchcliff, what areas of research are you focused on?
Dr. Emily Hinchcliff:
So, I have spent a lot of my research time working in immunotherapy. As you can tell, I’m pretty jazzed about it. I think it really has changed the game in terms of cancer care. And so, a lot of my work centers around the use of immunotherapy in gynecologic cancers.
I also am very interested in looking at how we can better understand a cancer’s response to treatment. As we give treatment, often, endometrial cancer doesn’t have an easy blood test to say, “My cancer’s getting better,” so we kind of have to wait until we get a CT scan, which we usually do three months apart, and so, there are some newer blood tests out there that we’re trying to understand how to use and how to best leverage for our cancer patients, and that allows us to potentially switch treatments sooner if something isn’t working, or choose a better treatment up front, depending on which test we’re looking at. So, that’s really where my research centers.
Katherine Banwell:
Is there anything you’d like to add about the evolution of endometrial cancer care? What are you excited about?
Dr. Emily Hinchcliff:
I think I am really excited that our field has made this big switch to focusing on some of these molecular aspects. It has always been so hard to treat all endometrial cancer with one hammer-and-nail-type pairing, and now we’re able to be a little bit more nuanced with our tools, and that’s always a really exciting place to be. I also think that it’s really important to highlight some of the disparities that still exist in endometrial cancer, and honestly in cancer more generally, and I think that we as a field are starting to really highlight that and understand – or at least try to understand – how can we better provide care to every single patient who is diagnosed with an endometrial cancer.
Current Endometrial Cancer Treatment Approaches
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.
Related Programs:
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Where Do Clinical Trials Fit Into an Endometrial Cancer Plan? |
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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?
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.
See More from INSIST! Endometrial Cancer
Related Resources:
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 What Questions Should Patients Ask About Endometrial Cancer Testing? |
Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment |
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.
Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment
What are endometrial cancer biomarkers? Dr. Hinchcliff discusses how prognostic biomarkers, namely mismatch repair status and HER2, influence treatment, leading to more tailored strategies for patients.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
See More from INSIST! Endometrial Cancer
Related Resources:
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What Questions Should Patients Ask About Endometrial Cancer Testing? |
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Transcript:
Katherine Banwell:
Are there prognostic biomarkers that help determine how the cancer may behave?
Dr. Emily Hinchcliff:
Yeah. So, endometrial cancer, we now know that the molecular mechanism – so, what I’ve been talking about, these things that are happening inside the cancer cell – we now know that that can drive prognosis, and so, it used to be that we kind of had two big buckets of cancer.
We used to say there’s Type 1 endometrial cancer and Type 2 endometrial cancer, and now, we’ve actually broken it down into molecular categories – so, into categories much more based on certainly what the cell looks like under the microscope, but also what’s going on inside the cell, not only to impact treatment, but also to give a patient a better look at what their prognosis is expected to potentially be, and we actually have changed our staging system pretty recently to incorporate some of those molecular characteristics that we now know to check for.
Katherine Banwell:
Talking about the biomarkers, how do biomarkers impact endometrial cancer treatment options?
Dr. Emily Hinchcliff:
Yeah, so I think specifically the two that I mentioned, the mismatch repair status and the HER2 status, have really robust data that tells us that we can better tailor our treatment strategy based on a patient’s status. So, for mismatch repair, for example, if someone is mismatch repair deficient, that tumor is going to respond very well, incredibly well, to immunotherapy. So, we now actually use immunotherapy in combination with chemotherapy to treat those cancers, especially for the cancers that have spread outside the uterus or the cancers that have gone through initial treatment and then come back.
So, I think that is a really great option. Similarly, that HER2 receptor, there is a medicine that targets that receptor, which is that cell surface molecule, that thing that’s sitting on the cancer surface, and can treat that cancer better if that marker is expressed.
Essential Endometrial Cancer Testing
What testing should endometrial cancer patients undergo after diagnosis? Dr. Hinchcliff explains the importance of determining cancer stage, histology, and performing biomarker testing, as these factors can guide more targeted treatments.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
See More from INSIST! Endometrial Cancer
Related Resources:
| What Questions Should Patients Ask About Endometrial Cancer Testing? |
Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment |
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Transcript:
Katherine Banwell:
Dr. Hinchcliff, what testing should people with endometrial cancer undergo after diagnosis?
Dr. Emily Hinchcliff:
So, when I think about a cancer diagnosis, there are first two big buckets of things that are important to understand. One is the cancer stage, meaning where did the cancer start, and then, where has it potentially spread to. The other is the cancer histology, or what do the cells look like under the microscope. And in endometrial cancer, there are actually a variety of different subtypes of endometrial cancer that can be differentiated based on what they look like under the microscope. Once you have those as your framework, I think the next step is to better understand what’s called biomarker testing, or the genetics of your cancer.
Katherine Banwell:
Would you define biomarker testing? What does that mean?
Dr. Emily Hinchcliff:
Yeah. So, biomarker testing – while, under the microscope, we can determine what kind of cancer something is, we can’t tell what’s going on inside the cancer cells itself, and so, biomarker testing is an umbrella term for a variety of different tests that really try and assess what’s going on inside the cancer, what are the genetics making the cancer cells divide and grow abnormally, and also, what are the things that might be expressed or on the cancer cell surface that are potentially targets for us to leverage to treat the cancer better. So, what is unique to that cancer, either the patient’s own cancer individually or that cancer type in general, that we can use to our benefit to treat the cancer better.
Katherine Banwell:
What are the most common biomarkers associated with gynecologic cancers?
Dr. Emily Hinchcliff:
So, in endometrial cancer specifically, I think if there are a couple take-homes that I can emphasize to patients in this talk today, the first is it is essential to know your what’s called mismatch repair status. So, mismatch repair is one of the things that can happen inside a cancer cell, and when that goes awry, when that becomes abnormal, it means that the cancer has particular features that we can use to treat it better.
And so, the two categories of mismatch repair are you can be mismatch repair deficient, meaning there’s something abnormal in that machinery inside the cancer cell, or mismatch repair proficient, meaning that that machinery is still intact, and the reason for that being so important is that in endometrial cancer, if someone’s cancer is mismatch repair deficient, we can use a whole class of drugs called immunotherapy, or leveraging your own immune system using medicines to try and treat that cancer better.
So, I think knowing that about your cancer type is really essential in endometrial cancer. I think the other thing that is important to know is in endometrial cancer, some subsets will express a receptor – so basically, something on the cancer surface – called HER2, and if you are HER2-positive, that also can be a target for potential drugs. So, those are two really important biomarkers in endometrial cancer that I think it’s important that patients know that they have been tested, and then know what their results are.
