Photo by Michelle Hruby
Ovarian cancer is often called a silent killer, a disease with vague symptoms that typically escapes detection until it reaches an advanced, often deadly, stage. It causes more deaths than any other reproductive cancer.
But clinical researchers at the Seattle Cancer Care Alliance's gynecologic oncology service, a component of the University of Washington Department of Obstetrics and Gynecology, and affiliate investigators at the Hutch reported last year that most women with ovarian cancer do display an often overlooked set of early-warning signals that warrants closer inspection by their physicians.
That study is but one of several novel research efforts conducted by this group of gynecologic oncologists, nurses and support staff who treat women afflicted with a variety of reproductive cancers, including those of the cervix, uterus, vagina, vulva and ovary.
In the United States each year, more than twice as many women are diagnosed with breast cancer than with gynecologic cancers. Because of that, there has been less emphasis on public education about reproductive malignancies, said Dr. Benjamin Greer, a UW professor of obstetrics and gynecology and director of the gynecologic oncology program.
"There are only about 80,000 new cases of gynecologic cancer a year as compared with breast or prostate cancers, of which there are close to 200,000," he said. "Consequently, we don't have the same public presence, although there are now some prominent ovarian-cancer groups. But it is important that women be aware of symptoms and available screening techniques for these diseases."
The Alliance gynecologic oncology clinic on the Hutch's Day Campus serves as the front door for any woman who is referred to a gynecologic oncologist for a diagnosed or suspected reproductive malignancy. Patients who require surgery are treated at UW, while outpatient services, such as chemotherapy and radiation, are offered at the Alliance facility.
The gynecologic oncology program at the Alliance, Greer said, is notable for its multidisciplinary nature.
"We are able to offer all aspects of care for our patients, including surgery, chemotherapy and radiation," he said. "Patients who require radiation therapy have joint consultations that include a gynecologic oncologist and a radiation oncologist who specializes in gynecologic cancers."
The group also stands out for its commitment to a continuing-care approach to patient care.
"When a patient is appointed to a physician by our patient care coordinator, Monica Dherin, that physician continues to see that patient whenever they return for treatment," Greer said.
"Our nurses are an important component of this continuity of care. During each new consultation, nurses sit in and provide information and advocacy. Patients are encouraged to call the nurses with questions about any aspect of their treatment."
More than 100 calls a day
Holly Tomashek, one of two nurse/case managers in the program, said she and colleague Heidi Heins routinely field more than 100 calls each day from patients with questions or needing added support. Barbara Silko, the program's nurse practitioner, provides medical services to the gynecologic oncology patients.
"Many callers are patients undergoing chemotherapy who have questions or concerns," Tomashek said. "We're called nurse/case managers because we help in the planning of the patient's care all the way through. We know all of our patients well. We meet them regularly, and we develop a relationship with them."
Continuity of care extends beyond the walls of the Alliance outpatient clinic, Tomashek said.
"We have constant contact with the inpatient nurses at UW Medical Center. It's important that neither side is left out of the loop on what's happening to a patient."
The program primarily sees patients who reside in the WWAMI area - Washington, Wyoming, Alaska, Montana and Idaho - although calls are received from patients all over the country. Since the formation of the Alliance, the number of patients receiving chemotherapy treatment at any given time has risen from about 45 to 65. More than 500 new patients are seen every year by the program and over 400 major surgeries are performed at the UW Medical Center.
In addition to patient care, the Alliance gynecologic oncology group has an active research program. The majority of patients cared for by the program participate in a clinical trial, Greer said.
"Every patient we see is evaluated for potential treatment with a research protocol," he said.
The group takes part in several research projects aimed at treating and detecting ovarian cancer.
Program member Dr. Barbara Goff, a UW associate professor of obstetrics and gynecology, reported results last year of a study showing that most women with ovarian cancer do have symptoms, but in many cases these warning signals are overlooked or cancer is not suspected.
"Women who ignored their symptoms were significantly more likely to be diagnosed with advanced disease," she said.
Greer said that the program has begun a related project that asks patients with a pelvic mass to participate in a study of symptoms by completing a questionnaire.
Dr. Pamela Paley, a UW assistant professor of obstetrics and gynecology and an affiliate investigator at the Hutch, and Hutch investigator Dr. Leona Holmberg direct a study to evaluate the safety and efficacy of a drug with cancer-fighting properties in ovarian-cancer patients.
The drug, IM862, is administered by nose drops and is combined with a standard chemotherapy regimen.
The program also is involved in several trials of chemotherapeutic agents for ovarian cancer, a combination of radiation and chemotherapy for cervical cancer and vaccine-based therapy for cervical cancer. A tissue bank is maintained for potential research use with patient consent.
Several trials are coordinated by the Gynecologic Oncology Group, an interdisciplinary, national trials group sponsored by the National Cancer Institute. Greer is the principal investigator of the local Gynecologic Oncology Group site, which includes investigators from UW and the Hutch.
Collaboration with Urban
The program also actively collaborates with the Ovarian Specialized Program of Research Excellence, an NCI-funded ovarian cancer research project directed by Hutch investigator Dr. Nicole Urban.
The success of these research efforts, as well as standard patient care, depends on a strong commitment to teamwork by all program members. The entire group - physicians, nurses and support staff - meets weekly to discuss the care of patients.
"We decided from the beginning that this would be a team effort," he said. "Everyone on our staff has input and feels a valued part of the team."