Ovarian Cancer: Considering the Experience of Caregivers



Shubham Pant, M.D.: One of the things we talk about is care for the caregiver. Doña, do you ever have a discussion now that everything is over, with your daughter or husband, about what they went through? Do they ever share back?

Doña Harman: I was asking my daughter what her experience was just before I came here, because I never really had. She said I was grumpy. Then I asked another friend — I was getting ready because I thought you would ask me this —“What was your experience of me?” And she said, “You were in denial a lot.” That’s what she says.

Shubham Pant, M.D.: Were those the answers you were expecting?

Doña Harman: I wasn’t judging. I know I was grouchy. I’m sure I was.

Shubham Pant, M.D.: Hey, it’s completely understandable. Dr. Eskander, what do you think? For the caregiver, what are your thoughts on that?

Ramez N. Eskander, M.D.: I think it can be hard on the caregiver. I’ve seen caregivers where sometimes the visit will be done, and the caregiver will want to sit down and talk to me after the visit, because they’re struggling, and they don’t know how to deal with some of the issues that come up in the conversations they have with their family member. A lot of times it will be after the visit is over and they say, “Oh, can I speak to you outside of the room for a few minutes?” And I have to talk to the patient to see if it’s OK.

Shubham Pant, M.D.: That’s challenging always.

Ramez N. Eskander, M.D.: But it’s tough. I mean, they’re scared. They’re just as scared if not more scared than the patients. They don’t have control. Sometimes they worry if they’re helping or hurting with the things that they’re recommending, or how to answer questions that are posted. And so it’s really tough. And sometimes the caregiver can get overlooked because the focus is on the patient. But hopefully, as they navigate the process, it’s a happy equilibrium until we get through treatment.

Shubham Pant, M.D.: Dr. Hirst, what do you think? Care for the caregiver — how does one address the psychological aspect of that?

Jeremy Hirst, M.D.: It’s very important. We find that if family members are well cared for, they’re better able to help our patient and the patient will do better. It can be extremely stressful for a patient’s loved one, because I think they see the person as having this crisis go on and feel unable to do much about it. They’re not the ones prescribing the drugs. They’re not the ones infusing chemotherapy. They’re not going through the surgery. Often I hear a sense of somewhat helplessness and, “What can I do?” Being there for the caregiver and hearing these thoughts and normalizing them is often all that is needed. But if they need more, making sure that they get their own psychotherapy or their psychiatric help is critical.

And allow for some open dialogue. I think a lot of times in relationships, the relationship is seen as changing. One thing we haven’t talked about is issues with intimacy and feeling that sexuality or femininity can change. And that can be hard for partners to know how to navigate and talk about and normalize. That is a concern that has come up to be discussed, and we can make it a little easier.

Shubham Pant, M.D.: I think that’s very, very important. Doña, I don’t want to put you on the spot on that, but did you have those discussions with your family, with your husband and everything, about what you guys were going through?

Doña Harman: Yes. I’m just kind of learning now how they process it. I think they kept a lot of that to themselves, and so it’s more of a dialogue we go through now. But I think in general they’re very happy. Things were returning to…

Shubham Pant, M.D.: Normal?

Doña Harman: Normal, yes.

Shubham Pant, M.D.: Seeing those movies again. Although you never stopped seeing the movies.

Doña Harman: We never stop seeing the movies.

Shubham Pant, M.D.: That’s actually an amazing thing to have, that you guys can go and spend time in the movie hall. Dr. Eskander, I’ll end with you. Where do you think the field of ovarian cancer is going? Where is it right now, and what is your projection? Back to the future? In the future when you look at 10 years, a decade later—there’s so much that has happened in the past decade — where do you see that field going?

Ramez N. Eskander, M.D.: I would say it’s the most dynamic time compared with what it’s been historically. We have several clinical trials that are active in running. We’ve had multiple FDA approvals for a drug that we hadn’t had an approval for since 2006, I believe it was. From 2014 to 2019 we’ve had, if I remember correctly, 10 FDA drug approvals in ovarian cancer. So it’s been a really exciting time. Because with each approval there’s an opportunity, and that opportunity could benefit a patient and could prolong their life with this disease.

We have several studies that are looking at novel combinations of drugs, PARP inhibitors, plus other drugs to try to improve on outcome. We’re at a really amazing time because not only are we moving this therapeutic needle forward, we’re also understanding more about the molecular aspects of these cancers and combining both the molecular data with the therapeutic data to try to match and help our patients live longer, if not cure some of them. We haven’t used the word cure in ovarian cancer as far back as I can remember. And now with the data that came out with SOLO-1 and BRCA mutation, for patients with these novel combinations, we’re looking to see can we get rid of chemotherapy altogether in a subset of patients? And that’s something we would have never discussed a few years back. But it’s really an unbelievable time. And our goal is to be able to cure more of our patients and to be able help patients who are suffering with the disease live a much longer life span with a good quality of life.

Shubham Pant, M.D.: That’s amazing. I think there are some exciting times ahead. Doña, Dr. Eskander, and Dr. Hirst, thank you so much for this great discussion on this program. We really appreciate it. Thank you.

Transcript Edited for Clarity

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