Achieving High-Quality Care for Patients With Ovarian Cancer

Premal Thaker, MD

Ovarian cancer is a serious disease with a high mortality rate, and early diagnosis and proper treatment are crucial for better outcomes. However, gynecologic oncologists are a small specialty, and medical oncologists may not be as familiar with ovarian cancer as they are with other, more common cancer types.

The Association of Cancer Care Center’s (ACCC) Ovarian Quality of Care Project aims to bridge this gap to improve ovarian cancer care for patients in the US. The multiphase initiative was launched in 2019, beginning with a project called “Barriers to Quality Care in Ovarian Cancer.” The current focus is creating and consolidating resources for health care providers to access the latest information on ovarian cancer.

In an interview with Targeted Oncology^TM, Premal Thaker, MD, David & Lynn Mutch Distinguished Professor of Obstetrics & Gynecology; Chief of Gynecologic Oncology, Interim; Director of Gynecologic Oncology Clinical Research; and Professor in Gynecologic Oncology at Washington University School of Medicine, discusses this initiative.

Targeted Oncology: What would you consider to be some of the biggest barriers to care or unmet needs among patients with ovarian cancer?

Thaker: I think [one of] the biggest unmet needs are for patients to have equal access across the country, to GYN oncology specialists as well as access to clinical trials. Because as we know, a lot of GYN oncologists are located in urban areas, so not in rural America or in smaller centers.Having that opportunity to have a joint decision making with a GYN oncologist and a medical oncologist sometimes does not occur just because there is an inability to access that sort of expertise.

Additionally, women's cancers in general…except for breast cancer…are underfunded. Even breast cancer [is underfunded] as compared with a lot of the other cancers. Our medical oncology colleagues have so much that they must take care of that they may not realize the newest standard-of-care treatments, but also what trials patients may be eligible for. As we all know, clinical trials really need more diversity in ethnicities [and also in] social determinants of health. What are those barriers that make it harder for patients to access? And if we are not getting them to our systems, it is hard for us to learn about that. So how do we mitigate that maybe with more telemedicine or opportunities of networking, which is hopefully what this initiative is really to try to do, bridging medical oncologists, GYN oncologist, as well as our advocacy partners. 

Advocacy also varies as well as to what's available, depending where [a patient] may live. But the nice thing about the internet is that there [are] a lot of virtual forums where people can share their ideas, as well as maybe learn of something that is local, even though they may not have that exact chapter in their location. I think the main purpose of this is really trying to bridge gaps, which I think everyone is trying to do in oncology.

Can you give an overview of what initiatives the ovarian quality of care project is working on right now?

Some overall initiatives are trying to provide resources in a consolidated area because the [ACCC] is a great opportunity for all types of providers in oncology, so our extenders, physician assistants, nurse coordinators, nurse practitioners, in additions to physicians, to have that one place to reference. I think that is also where it makes it easier access and trying to say, do I have to go to a specific ovarian cancer site, and which one is the best one? 

Also, the website has, what does good practice of ovarian cancer look like? Because as I said, if [an oncologist is] not treating it often, and you only see maybe 2 or 3 patients in a year, you may forget some basic things like you need genetic testing to be done on all patients who are diagnosed with ovarian cancer so that we can hopefully prevent future cancers. So, it reminds us about our genetics or reminds us about somatic mutations that can lead to better treatments.

And then that same website has education about those newer treatments, so you learn about [adverse] effects. I think the main initiative is to try to consolidate and then hopefully, learn from that. Can we not only put our what partners already know about, but people can hopefully expand on it. Just because we have a group of experts does not mean we know everything. There are other opportunities that other people can provide that we can add to our library that could benefit all of us.

What are your recommendations for how to best stay informed as a medical or community oncologist?

As a GYN oncologist, we are a small subset of oncology. We know about our society of GYN oncology, and we are trying to get more medical oncologists and allied professionals to join. But I think they do not want to join our organization, because we only treat GYN cancers, and there are very few centers that do. I think the American Society of Clinical Oncology does a great job. But I would say ACCC has really been more of a leader with our sort of pharma[ceutical] sponsorship as well to help us develop these initiatives. We have available podcasts and printed literature, so everyone can access education the way they like. We know many people love, if they are commuting between clinic sites or exercising, to listen to a podcast. 

The key is to make people aware, because they use ACCC for their other cancers, which have been more focused on, and now we are trying to make more of a prevalence on their website to hopefully be a one-stop shop. What all of us want is convenience. We have limited hours in our day; you can't be like, go to that site, go to that site. You will be forever trying to search many sites and get no information. [We are] trying to consolidate it and bring it to the forefront.

Beyond treatment recommendations, what would be your takeaways for a community oncologist that sees a patient with ovarian cancer?

Like all oncology care, it is a multidisciplinary approach, right? Like one person cannot make that patient's journey amazing. It takes a whole score of people. I feel like the medical oncologist, their role [has] mainly been recommendations and things, but having that sort of support team to talk about nutrition, [etc]. Really, for a lot of these women, they are the family core, so talking about the psychological piece of it and coping because a lot of times I find these women are more centered and focused on their family and how it is going to affect them as opposed to realizing how it affects themselves, both physically and mentally. So, trying to have somebody who can do that psychological piece, as well as social determinants of health that might be barriers to getting the treatment [is important].

It is challenging because I face that in my clinic. It is hard enough to ask all the medical questions, then you want me to ask about housing and transportation, and do you have social workers to assist with that?I think that is just generalized oncologic care. But I feel like sometimes we forget about that, because we are so focused on treating the cancer that we forget that there are so many other aspects to that treatment. Do you have a support team who can bring you to your appointments? Or if you get sick, who is going to be there with the [adverse] effects. Who else needs to be educated to understand the [adverse] effects you are going through? I think that is also the most important, but sometimes I feel like it's a bit overlooked. A lot of it[the patient is] not understanding, probably no more than 1 word for every 10 that has been said, because it is such an overwhelming feeling. And of course, the first feeling is, I am going to fight it, and I am going to get through it, but [the patient does not] realize steps it takes to get there.

The initiative is the first time that we have been able to bring different types of experts together. They're different communities, which I think is important, because often, every institution or community has their own unique circumstances. It is just nice to hear diverse opinions, because I have always been in academia, and I think a lot of traditional guidebooks have been in academia. How you really bridge it is by hearing what people are from so many different aspects, the business side, the social work side, as well as the medical, the psychological [professionals], geneticists. That is probably the nicest thing about this initiative is that it is very multidisciplinary. It is encompassing as many people as we can to try to get that more comprehensive approach.