Improving the Quality of Care for Ovarian Cancer Patients

The committee identified that ovarian cancer patients regularly cite the "little big things" as significant burdens. The little big things in question are scheduling, wait times, pharmacy transportation, parking, finances, insurance and discharge. The committee also cited limited time with physicians as a major hurdle in providing adequate care to patients, especially when many patients reported that human contact was a comfort to them throughout their treatment.

The additional effect of this limited physician time is that patients aren't able to ask and receive an answer to every question they have regarding the treatment, which is problematic when new, complex treatment options are involved and the patient has limited experience with them.

"The care for ovarian cancer patients is multidisciplinary and complex," Temkin said.

The committee asserted that all ovarian cancer patients should "receive education on ovarian cancer, staging, prognosis, possible treatment side effects, and response expectations before therapy initiation by a multidisciplinary cancer care team member."

Additionally, these patients should have access to a member of this multidisciplinary team who can answer questions and be allowed to participate in shared decision-making regarding their care plan.

Currently, routine screening for people at average or high risk of developing ovarian cancer is not recommended because the risks outweigh the benefits. A number of risk factors—including age, weight, hormone therapy and family history—are associated with ovarian cancer, yet the implementation of risk-reducing surgery is still a challenge for many healthcare systems.

"Cancer centers are not, historically, centered around gynecology," Temkin said. "Even though there are 110,000 patients a year diagnosed with a gynecologic cancer, ovarian cancer is still a relatively rare disease. Without special accommodations for the severity of this disease, some patients may slip through the cracks."

The initial therapy for ovarian cancer includes surgery and chemotherapy, Temkin said.

"Not every health system can accommodate that being done in a timely fashion," she said. "Especially for the women with ovarian cancer, who are mostly diagnosed at a late stage and are symptomatic by the time they're diagnosed, this is a huge issue."

Though Temkin acknowledged that over the past two decades several novel changes have greatly improved the survival odds of ovarian cancer patients, there are still two main factors that often delay diagnosis: the condition's rarity and the relatively low number of gynecologic oncologists. She estimated the number to be about 1,200 in the United States.

Additionally, Temkin said the recommendation from experts for the past decade has been for every patient diagnosed with ovarian cancer to receive genetic counseling, but only about a third of patients actually receive it. Partly, this has to do with system capacity, but the other factor is out-of-pocket cost.

"Genetic counseling typically involves a conversation with a genetic counselor who will go through your family history and look for patterns of disease," Temkin explained.

While there aren't any good screening tests, genetic counselors are able to identify certain patterns that may be indicators of a higher risk of ovarian cancer, as well as clues to which drugs might help a patient.

There are also disparities in treatment among groups of women. Though survival rates have improved for individuals diagnosed with ovarian cancer, this doesn't always apply to Black women.

As the committee's report suggested, the women who tend to receive the best treatment are white and Asian women with insurance. Uninsured women, women in lower socioeconomic groups, and Black, Hispanic and Indigenous women all receive lower-quality care, on average, than white women with insurance.

This issue largely stems from women in these underrepresented groups generally having limited access to healthcare and insurance, but as the article's authors noted, there is an element of racial bias among healthcare providers that continues to be a challenge in providing adequate care to all ovarian cancer patients.

In general, women and minority groups have been historically underrepresented in the world of medicine. While this has changed in recent years as femtech companies continue to research health technologies for women and social justice movements advocate for better social equality, there is still a long road ahead until women, minorities and members of the LGBTQIA+ community are afforded equal access.

Still, there are steps we can take today to work toward improving the healthcare system and developing a better understanding of issues specific to women. One of Temkin's main suggestions was opting to enroll in clinical trials.

"The reason we've had so many improvements in treatment for this disease is because women have enrolled in clinical trials, but women don't always ask about being enrolled in them," she said. "Asking your healthcare team about the possibility of clinical trials is a way to potentially find an alternate treatment; potentially, a treatment that might be better than the current standard. And it leads to knowledge for everyone else."

As our understanding of these issues develops, so, too, will the technology and further research around them. In essence, it's a snowball effect. Knowledge leads to questions, which lead to research, which leads to development and then to further knowledge, all of which result in better access and better treatment for all ovarian cancer patients.