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Anastasia is a Clinical Nurse Specialist in Gynecologic Oncology at Cedars Sinai Medical Center in Los Angeles and CURE'S 2019 Heroes of Ovarian Cancer award ceremony at a March event in Honolulu, on the eve of the 50th Annual Meeting of the Society of Gynecologic Oncology (SGO) on Women's Cancers. During the annual meeting, Anastasia sat down to talk with Oncology Nursing News on the treatment of patients with the disease.
As an oncology nurse, what are the biggest challenges you face everyday for patients with ovarian cancer?
I think in the new era of health care, there is so much information on the Internet, and then their friends, who are not health professionals, say, "you should do this, this and that" , and then there are many myths about there. But also, with new research that is not yet ready for prime time – for example, with immunotherapy – patients say "I want immunotherapy!". But it's not approved by the FDA and it's not quite ready. But we have all these other treatments.
As for the cost [of treatments], the new term … is of course financial toxicity. Simply because it could be approved by the FDA, especially [in the cases of] some of these oral medications, [does not mean that] Medicare patients will be able to afford a drug. So, there are a lot of challenges, and I think [that includes communicating] … overwhelming [amounts of] information and try to spend enough time with the patients.
What are some of the challenges of treatment?
I think that [a big challenge is providing] education and awareness on how to diagnose ovarian cancer at an early stage, so that it is more curable, as opposed to diagnosis at stage 3 or 4. Overview cancer [ovarian] is not the most common, but it's unfortunately one of the deadliest because it is [typically] diagnosed in the later stages. The reason is that there is not enough information about the signs and symptoms. I think that the SGO, the national organization of physicians and experienced practitioners, is trying to educate practitioners who will see women more frequently, such as primary care physicians and gynecologists.
We must also treat the patient as a whole: not only the physical, but also the emotional. Ovarian cancer, unfortunately, is a chronic disease. These ladies will be diagnosed and go into remission, but unfortunately, most of these patients will reoffend. And then it repeats. There is a vulnerability and, for lack of a better term, post-traumatic stress, always waiting, even if they are in remission and feel good – wait [to see] when and if it will happen again. There is both emotional and physical [involvement] taking care of these incredible and brave ladies.
Can you discuss the current standard of care for ovarian cancer and the toxic effects that can result from it?
The standard treatment for ovarian cancer is going to be surgery and chemotherapy. Now, it will depend on the burden of disease if the gynecologist GYN will perform a surgical operation followed by chemotherapy, or give chemotherapy in the first place, will reduce the tumor, then after 3 or 4 cycles, will enter and surgically release. The goal is to eliminate all visible diseases at the time of surgery. That's why sometimes they will do neoadjuvant chemotherapy, followed by surgery, followed by additional chemotherapy.
But in standard treatment, regardless of the order, the result would be a remission or a complete response, evidenced by the normalization of the CA-125, clean CT scans and no evidence of disease in pelvic exams.
Standard chemotherapy is usually a platinum and a taxane. With these agents, nurses and doctors are worried about the decrease in the blood count. There is a risk of infection, but patients do not necessarily feel it. We educate them and monitor their blood counts. We talk to them about precautions to take against infections.
What matters most to patients is to lose their hair. Unfortunately, with a taxane, they will lose their hair. We now have new technologies that allow patients to keep their hair using cold protection devices. If they lose their hair, they begin to fall about 2 to 3 weeks after the start of chemotherapy, and they start to grow back about a month or two after finishing chemotherapy. Thus, it takes them about six months to finish chemotherapy before they can push back the lock of short, elegant hair.
Other side effects of the patients are: getting sick and vomiting. Not a lot of nausea is badociated with this diet, which is good. One of the reasons is that we have excellent antinausea medications. This is where the advanced practice nurses and nurses intervene because we are the ones who will handle this. I think we manage that very effectively. I let patients know that I can help them have a good day, but I also need them to tell me when they are not having a good day. I need them to call me or send me an email.
Patients will also be tired, especially if they receive chemotherapy immediately after surgery, approximately one month after surgery. Believe it or not, I remind patients that being active will actually help reduce fatigue. Obviously, they do not have to run marathons, but I want them and I move them. Even if they are undergoing surgery, I need them to walk around them, dilating the lungs so that they do not contract pneumonia, decreasing the weakness. muscular – that kind of thing. But also, they must calm down.
Peripheral neuropathy is another very common side effect that is manifested by numbness and tingling in the fingers and toes. It's something subjective, so we're going to monitor that, and there are medications we can advise patients on. Acupuncture works very well for that too.
Everyone will have symptoms, but it is very important that we collaborate with our patients and tell them to talk to us. We will educate them, we will give them recommendations. But sometimes it will not work, so I need patients to talk to me so that we can reevaluate and do another plan.
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