The Psychosocial Impact of Ovarian Cancer - Episode 1

Reacting to a Diagnosis of Ovarian Cancer


Shubham Pant, M.D.: Hello, and thank you for joining this “CURE Connections®” program titled “The Psychosocial Impact of Ovarian Cancer.” There are many important aspects of cancer care, and one very important factor is ensuring mental and emotional well-being. Today, we will discuss the various stages of a patient’s journey with ovarian cancer and provide insight on what steps might be taken to improve their care.

Hi, I’m Dr. Shubham Pant, an oncologist at The University of Texas MD Anderson Cancer Cancer in Houston, Texas. With me today is Doña Harman, as well as her physician, Dr. Ramez Eskander, who is an assistant clinical professor of gynecological oncology at the University of California San Diego Health Moores Cancer Center. Lastly, I’d like to welcome Dr. Jeremy Hirst, an associate director of patient and family support services at the University of California San Diego Moores Cancer Center. Thank you so much for joining us. Let’s begin.

Doña, I’m going to start with you. You were diagnosed with ovarian cancer approximately about three years back. Walk us through your diagnosis. How was it diagnosed, and what were the next steps that you took after the diagnosis?

Doña Harman: The summer before I was diagnosed, I started noticing swelling in my abdomen and some irregularity. I remember being in the ocean with my granddaughter and she was kicking her legs, and I was having this sense that I don’t want her to kick me here, and that was unusual. I’m pretty athletic. So I went to the doctor and got an exam and she said, I think you’re fine. Maybe you could lose a little weight, maybe exercise some more and drink more water. And then I remembered that my dad died of cancer. And before he died, he said to me to watch for cancer in my 50s.

Shubham Pant, M.D.: What age was he when he was diagnosed with cancer?

Doña Harman: He was in his 60s, but he had been going to a doctor for a number of years and told them to watch for cancer. There’s cancer everywhere in my family. And they didn’t diagnose it until it was everywhere. And so he passed in his late 60s. But I heard his voice all those years later. I thought, “Oh, I’m in my late 50s. I’d better go back to that doctor.” So I went back, and she was on it. She just said, let’s get an ultrasound, and it was diagnosed pretty quickly after that.

Shubham Pant, M.D.: So that’s good. You advocated for your own care. You went back; you were proactive. And your dad’s voice, that helped you and guided you through that. That’s just amazing.

Doña Harman: Yes.

Shubham Pant, M.D.: Did you get an ultrasound?

Doña Harman: Yes.

Shubham Pant, M.D.: And they said that this is cancer?

Doña Harman: An ultrasound, and then followed by an MRI [magnetic resonance imaging].

Shubham Pant, M.D.: And they said this is cancer. And then what was your reaction to discovering you had cancer? Did everything freeze and stop? What was your reaction to getting this diagnosis?

Doña Harman: It’s a fog. It was three years ago, so I think in some ways the body makes things a little unclear. I can’t remember exactly how I felt. Certainly it was a bummer, but I had so much support around me. There were all kinds of little things that came together, one of which was that my daughter’s dearest friend was in her fellowship, her final year as a gynecologic oncologist. And when she found out I had cancer, she called my daughter and she said, “I have the perfect doctor for you.”

Shubham Pant, M.D.: And that’s the one hopefully sitting right next to you.

Doña Harman: Well, it’s this doctor right here, yes. She said he’s an excellent surgeon and your personalities will mesh. And that was so important, because you’re traveling a long road with somebody, and you need to have that trust to put your head down, do the work, be a good patient, show up, and just work through it day by day. That was a huge difference. I was really fortunate to find Dr. Eskander.

Shubham Pant, M.D.: Your friends and family really helped you find the right direction. Do you remember, did you start googling it the first day trying to figure out where things are? You googled Dr. Eskander, saw his good-looking photograph, and said, “This guy looks like somebody who could take me through my diagnosis.” Did you already research him before you went and saw him, or did you just go by people telling you that this would be a good doctor to go to?

Doña Harman: I really trusted her. I’ve known her since she was 3 years old, and there’s a special thing about Dr. Teresa Codini Longoria. So I felt really good. It’s a very confusing world. You need surgery yesterday, so you don’t have a lot of time to research. And I had seen another doctor and their approach was, I remember being told in the waiting room that this was going to be a cakewalk. She said to me, “If I was a dentist, this would be like filling a cavity. If I was a pilot, this would be like flying a commuter flight.” And I just remember that didn’t resonate with me.

Shubham Pant, M.D.: And did you have any previous knowledge of ovarian cancer? I know you had cancer in the family, but did you have previous knowledge of ovarian cancer? Did a friend or somebody have it? Did you have any understanding of what this was and what the journey would be?

Doña Harman: A distant friend I knew had had it, but I really had no experience with it. It was quite the shock. I didn’t see it coming.

Shubham Pant, M.D.: Dr. Eskander, tell me, when patients show up the first time, how do you reassure them that it’s going to be fine? Or is this more serious? I’m sure you see patients in different stages. Some could be surgical candidates; some are not surgical candidates. What is your reaction? What kind of steps do you take when you see a patient for the first time?

Ramez N. Eskander, M.D.: I think, just like my conversation with Doña when I saw her in the office with her family, the priority in the initial visits is to make sure you’re listening to the patient’s concerns and questions but also giving them a foundation and an understanding of the plan and the steps moving ahead. It’s a long process, and there are pieces of information that we gather along the way that are independent from what the initial presentation may be or what the initial scans may show. So I emphasize in the beginning that this is the information we have. There’s some more information gathering that we need to do. Regardless of what we find, we’re going to synthesize a plan that’s going to be appropriate for your care. And many times, it is obviously an overwhelming conversation. There are a lot of questions, so I encourage families and patients to reach out and ask me any questions they have in the first weeks, as well as throughout the entire process, but certainly as they’re digesting this information and learning more about their diagnosis.

Shubham Pant, M.D.: Dr. Hirst, what is your thought about patients who are first diagnosed with cancer and what are the reactions you see in your practice?

Jeremy Hirst, M.D.: It’s often a reaction of extreme stress. People describe it as if they’ve been hit by a truck all of a sudden. Those folks are swimming in the ocean like Doña was, totally fine, and then all of a sudden start feeling something wrong and get this life-altering diagnosis. People react in a variety of ways, but frequently, it’s initially with terror and a desperate search for some answers and trying to get control back. That idea of losing control is quite common. “Oh my gosh, everything was laid out in order in my life. I was a grandma, I was working, I was whatever.” Then all of a sudden we got this cancer diagnosis that really shakes everything up.

I think, as Dr. Eskander says, the doctor’s office is the first place where they’re able to get some control back. And hearing that information, even though there are still some unknowns, allows us to say, “OK, now there’s a road map,” and starts letting some of that terror go and feeling like, “OK, now we’ve got some steps to take moving forward.” That’s a very typical way. Other people are very practical. “OK, I wasn’t an expert on cancer, but over the past 24 hours, I’ve read everything there is to know about it, and I know what we’re going to do,” in a calm and collected manner. For others, it’s like a feeling of denial, “No, this can’t be happening to me. I’m going to put off getting care. I’m going to put off treatment.”

Shubham Pant, M.D.: It’s a whole spectrum.

Jeremy Hirst, M.D.: Exactly, the whole spectrum.

Transcript Edited for Clarity