Patients with ovarian cancer often experience recurrence which comes with its own challenges and treatments.
Scott D. Richard, MD
Scott D. Richard, MD
For women with ovarian cancer, recurrence can be common due to how often the disease is detected in the later stages. Understandably, many women fear recurrence, underscoring the need for more research into more effective treatments.
Oncology Nursing News recently spoke with Scott D. Richard, MD, associate professor at the Sidney Kimmel Medical College at Thomas Jefferson University, about ovarian cancer recurrence, what nurses should be aware of, and what more needs to be done in the field.
How common is ovarian cancer recurrence, and is there a certain population at higher risk?
Unfortunately, about 70% of all ovarian cancer patients are found at a very advance stage—stage III or IV—and the majority of those, about 80%, will recur. So, ovarian cancer recurrence is something that most women with ovarian cancer will face. Regarding risk, it is just the fact that we catch the majority of these cancers at a later stage.
Is this part of the discussion during patients’ initial diagnosis?
That's actually a very interesting question. When we [oncologists] first discuss the diagnosis, we focus on initial treatment and talk about the 5-year survival rates and how we're going to treat the cancer. Oftentimes we don't spend a lot of time talking about recurrence. But if someone asks, I, personally in my practice, will let them know that there is a high likelihood that this cancer will come back.
What kind of prognosis do these patients typically face?
Unfortunately, when we talk about a recurrence of cancer, no longer can we talk about curing the cancer. But the prognosis is actually pretty decent. Some of our current treatment regimens that we're doing with women who have a very good response upfront to surgery and chemotherapy, survival can be greater than 7, 8 years for these women. So even in the setting of recurrence, we can usually treat these women so they go into remission and keep them in remission for a period of time. So although we no longer talk about curing the disease, many still have a very good long-term prognosis with good quality of life.
What more needs to be done in this field?
What we really need to focus on with ovarian cancer is being able to treat these women a little bit better. We've been focusing a lot of efforts on developing a diagnostic tool, along the lines of a pap smear, a mammogram, or a colonoscopy, for ovarian cancer, because the majority of women with high-grade ovarian cancer can have normal test results and 3 or 6 months later have widespread cancer.
So, a lot of our efforts should be about doing better with treatment for ovarian cancer, both upfront and in the recurrent setting. I think part of that is coming up with targeted agents that will do better in treating those cancers.
In terms of treatment, what are the options when ovarian cancer recurs?
A lot of the medications patients receive can be similar to what they had the first time around if they are platinum-sensitive. Oftentimes, though, because they've been treated with chemotherapy before, their quality of life can be affected with that chemotherapy the second time around. There can be more side effects, and more problems in the recurrent stage. So a lot of our efforts as oncologists focus on questions like: What are the effects that the treatment is having on the patients? What can we do better as far as nausea or neuropathy and other side effects?
What barriers do women with recurrent ovarian cancer face, and how can nurses help them to overcome them?
The biggest barrier, particularly in recurrence, is that the worst-case scenario for these patients has come back. First they had a cancer diagnosis, and with all efforts to have that cancer cured, it still came back. So the biggest challenge definitely has an emotional aspect. Focusing on the patients’ social status, making sure she has a good support network, and asking the proper questions about how they're doing—really focusing on quality of life issues—is very important.
Ideally, what should be emphasized in treating this patient population?
In an ideal world, we'd be able to find the individual nature of each cancer that makes a cancer different from one woman to the other and be able to treat that cancer. Like treat Mrs. Smith or Mrs. Jones in the exact way Mrs. Smith or Mrs. Jones' cancer should be treated, thereby identifying the things that may make it more likely to recur and treating those upfront.
Unfortunately, when we have a diagnosis like ovarian cancer, we treat the majority of women the same upfront. What we're realizing is that ovarian cancer is not just ovarian cancer. It has a lot of different individual characteristics for each patient. When we can identify those factors upfront is when we're going to be able to get a higher cure rate.