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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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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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