Wednesday, 13 April 2016

Re-envisioning Ovarian Cancer Survivorship -April 2016 Chat

Tonight our guests were Massachusetts General Hospital and Harvard Medical School's Dr Don S Dizon (@drdonsdizon) and Dr Teresa Hagan (@TLHagan) . We discussed various aspects of ovarian cancer survivorship with our 43 participants. More chat analytics may be found here.

Below are our topic questions with a few responses. For the complete transcripts please visit this Symplur page.

T1a: What does survivorship mean to you? What is it to be an ovarian cancer survivor?
  • Survivorship in all cancers is defined as any time after diagnosis.
  • Learning to live one's best thru treatment & beyond despite uncertainty, loss of control that ovca dx brings
  • survivorship is defined by the individual. If they like the term
  • Survivorship seems so straightforward, yet it's so subjective and personal
  • Although "survivorship" is defined, everyone interprets differently

T1b: Do you use the term survivor? If not, what term do you prefer?
  • My wife prefers the terms "Experienced cancer" She's an 8 year CML survivor still in treatment. She doesn't like "survivor"
  • I use the term remission. After all I have researched it makes the most sense to me
  • While in tx for 1st recurrence questioned if I really was "survivor," Decided I am as long as I am breathing in & breathing out
  • I'm in search of JUST the RIGHT word to replace 'survivor', personally; I am a well person with a history of cancer.
  • think that "survivor" has baggage for many because it has been linked with NED, so some folks w/mets feel left out of term.
  • everyone should feel free to use whatever word fits best for them. Too much pressure to be positive, to fight & survive
* note: The October #gyncsm chat topic will be on the terms used by those diagnosed with cancer. 

T2: What needs and concerns did you have when you were first diagnosed and treated? How were they addressed? What was lacking?
  • I certainly hear from some of my clients that the mental health/emotional coping wasn't addressed as fully as they needed.
  • Things happened very quickly first-line. No major complications. Lots of concerns AFTER tx ended. Thank goodness 4 support grp!
  • I feel what is missing is more stories of women living with OC. When I was first diagnosed I was sure I would not survive
  • Just because many are still alive doesn't mean they're doing well. #QualityOfLife issues are minimized.
  • I think honesty is lacking in those up front days with regard to the spectrum of emotions: shock, grief, loss, fear, panic.
  • Women seem to seek first to know they are not alone and also practical concerns that come with treatment.
  • Most lacking was when treatment ended the first time. I was a rudderless ship. Looked for other women dx for support
  • palliative care needs to be integrated with the entire experience

    T3: How was the topic of recurrence addressed with you? Did you find it helpful or not helpful at the time - and now looking back?
    • Recurrence is such a hard topic, but I've read too many stories of women who felt slammed b/c it wasn't discussed at all
    • It was addressed but I was told the likelihood was considerable. When I wanted to remove my power port I was asked why.
    • so worried about trying to figure out how to avoid recurrence and survive, what we really need is help to focus on living
    • Discussion about weight is an opportunity to impact risk of other disease and length of life 
    • thinking of the experience as chronic is so important regardless of disease state

    T4a: What are your needs and concerns now? (After recurrence or As you live past diagnosis and initial treatment of ovarian cancer)
    • Now that third remission is 8+ years, distinguishing btn symptoms indicating another recurrence and normal aging process
    • 7 years from recurrence Still worry. Then there is  Chemobrain and neuropathy
    • Was far more afraid of recurrent ovca that I had, than new cancer that MIGHT show up 10 years down the road, fast approaching

    T4b: What issues - physical, emotional or other - currently give you the most difficulty?
    • Need clear guidelines 4 long-term remission after multiple recurrences follow-up-scans, CA-125. GynOnc & MedOnc opinions differ
    • Leg pain from carb/taxol still present. Issues with my sleep. 6 months post chemo. Told leg pain was a chemo gift and would stay
    • Knowing reporting ANY gyn symptom gets me a ride in a machine, concerned w/past rads exposure (25CTs 5PETs +rads for BreastCA)

    T5: What actions have you taken in living past your ovarian cancer diagnosis and treatment? Were you given a Survivorship Care Plan?
    • Serve ovarian cancer community as research advocate and provide peer support. I was not given ovarian cancer survivorship plan
    • Refuse to let ovarian cancer define who I am. Take frequent breaks from being all teal to being just me
    • Went back to running. Completed two 5ks in last two weeks. Working on my diet and trying to find ways to reduce stress
    • Don't always have to be a survivor. Sometimes its good to just be you
    • Lynch team at Dana Farber gave me a Lynch plan. No other plan given except come back every three months. I have to call and book

    We always end our chats by asking participants to complete the phrase "Today I learned..." (TIL). Here are a few from today's chat.

    TIL: Survivor is not necessarily the term of choice. Need to continue to work on the language around this for gyn cancer patients
    TIL there is still room for growth in making sure that all #gyncsm patients feel that their mental health & QOL are supported.
    TIL We still have work to do to improve gyn patient education on side effects emotional needs 
    TIL dismissal of pt needs, fears and lack of transparency in Communication impedes pts attainment of quality of life


    We appreciate the support and RT's by our followers especially OCRFA, NOCC and SGO.

    Do you want to join in the conversation or continue to discuss this topic? Join us on Smart Patients at https://www.smartpatients.com/gyncsm

    Our next chat topic will be "Getting Social with Your Health". Join us will special guest @teaminspire on May 11 at 9pm E.

    See you then.

    Dee
    #gyncsm co-moderator

    Link shared during chat
    Living With Cancer: Coming to Terms by Susan Gubar
    http://well.blogs.nytimes.com/2015/01/22/living-with-cancer-coming-to-terms/?_r=1




    Friday, 8 April 2016

    April 13, 2016 Chat : Re-envisioning Ovarian Cancer Survivorship


    When Christina and I were talking about establishing the #gyncsm community and chat in 2013, we decided our inaugural chat would be in September (Gynecologic Cancer Awareness Month) and that our focus would be Ovarian Cancer. Since then we have covered many topics of interest to those diagnosed with gynecologic cancers - precision medicine, emotional issues, side effects, risks, hereditary links, nutrition, exercise and sexuality - just to name a few. We have also covered specific gynecologic cancers - vulvar, cervical, fallopian tube and vaginal. It has been over 2 years since we focused our chat topic discussion on ovarian cancer, where each of our personal advocacy work began. When Massachusetts General Hospital and Harvard Medical School’s Dr Don Dizon and Dr Teresa Hagan approached us a few months ago about joining us for a chat on re-envisioning ovarian cancer “survivorship", we jumped at the opportunity.

    What is it like to be... in the first few months of a new diagnosis of ovarian cancer? to undergo treatment? to have “No Evidence of Disease" (NED)? to hear you have recurred? These experiences must be different at every point, and for every woman, and in this chat we hope to hear from women at all stages of the experience.

    A number of our regular chat participants are researchers, gynecologic oncologists, medical oncologists and radiation oncologists. This is a perfect opportunity for women’s voices to be heard and to share needs, concerns and helpful tips.

    Our discussion on April 13, 2016 at 9pmET (8pmCT/6pmPT) will include these questions.


    T1a: What does survivorship mean to you? What is it to be an ovarian cancer survivor?
    T1b: Do you use the term survivor? If not, what term do you prefer?

    T2: What needs and concerns did you have when you were first diagnosed and treated? How were they addressed? What was lacking?

    T3: How was the topic of recurrence addressed with you? Did you find it helpful or not helpful at the time - and now looking back?

    T4a: What are your needs and concerns now? (After recurrence or As you live past diagnosis and initial treatment of ovarian cancer)
    T4b: What issues - physical, emotional or other - currently give you the most difficulty?

    T5: What actions have you taken in living past your ovarian cancer diagnosis and treatment? Were you given a Survivorship Care Plan?


    T6: Do you personally research new #ovca treatments and info online? Do you follow scientific meetings like SGO and ASCO?

    Here are some resources you may view prior to the chat:

    American Cancer Society: What Will Happen After Treatment for Ovarian Cancer?http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer-after-follow-up

    Cancer.Net (ASCO): Ovarian Cancer: Follow-Up Care
    http://www.cancer.net/cancer-types/ovarian-cancer/follow-care

    Associations between physical Activity and Quality of Life in Ovarian Cancer Survivors
    http://www.sciencedirect.com/science/article/pii/S0090825807002508 


    We look forward to having you join us on April 13th.

    New to tweetchats? Here's our tips:
    Tweetchat Etiquette
     

    Dee
    Co-Moderator #gyncsm chat

    Wednesday, 9 March 2016

    March Chat Genetic Counselors and Gynecologic Cancer Risk

    "Genetics is an integral part of cancer prevention. Know your genetics. Get to know a GC."
    -Mary Freivogel 

    For this month's chat, we were joined by the National Society of Genetic Counselors (@GeneticCouns) Past President Joy Larsen Haidle (@JoyLarsenHaidle) and NSGC President-elect Mary Freivogel (@MaryFreivogel) to discuss Genetic Counselors and Understanding Gynecologic Cancer Risk. We had 45 participants and achieved over 1.7 million impressions.  Additional analytics may be found here. 

    A small sample of the responses to each of our topic questions appear below. You may read the full transcript here.  (Please scroll down for a list of valuable resource shared during the chat. )

    T1: What is genetic counseling and why it is recommended prior to genetic testing?
    • @GeneticCouns help estimate #cancer risk, discuss test options & explain how test results might be used in your medical care 
    • We (Genetic Counselors) help to make sure genetic testing is the right choice for you and your family! 
    • Not everyone would benefit from a genetic test. Talk to a #geneticcounselor to learn if testing is useful for you.
    • Genetic counselors help people understand & adapt to med,psych & familial implications of genetic contributions to disease… 
    T2a: Who should consider genetic testing? How does it help those already diagnosed w/ a GYN cancer? Does it impact treatment plans?
    • T2A @SGO_org recommends genetic testing: https://t.co/Q3rMU66Qey
    • Cancer diagnosis before age 50 or strong family history of cancer often warrants genetic testing.
    T2b: Have you had genetic testing? What influenced your decision? If yes, did you have a genetic counselor?
    • T2 #Gyncsm: Family history of #ColonCancer, brother tested positive for #Lynchsyndrome. Having a child influenced decision, and yes! 
    • T2 My gyn onc spoke to me about genetic testing. I then talked to a genetic counselor re: my "pedigree" and she recommended the test
    • T2 yes had genetic testing. Breast & ovarian cancer in family. #brca mutation 3 generations 
    T3: Which genetic mutations are known to increase risk for gyn cancers? Do these mutations also impact risks for other cancers?
    • T3 At least 24 genes are associated with ovarian cancer risk. Several have uterine cancer risk.
    • T3 A genetic counselor can help determine the best test based on your personal and family history. #gyncsm @GeneticCouns 
    • Many more than BRCA1/2! Lynch syndrome is colon, uterine, ovarian, stomach cancer, etc... Talk to a GC if you are concerned! #gyncsm 
    • T3 Many mutations associated with Gyn Cancers: BRCA 1/2, Lynch Syndrome, Cowdens' Syndrome. Li Fraumeni . Often other cancers too.
    • T3: Many people, even PJS patients, don't know that Peutz-Jeghers Syndrome adds risk for gyn or breast cancer
    T4a: How can people access genetic counseling? What prep work is needed? Are referrals required?
    T4b: Does insurance cover genetic counseling? Are there protections against discrimination based on genetic test results?
    • Most but not all insurance covers both the genetics consultation and the testing 
    • GC for BRCA1/2 testing is often covered as preventive service as per the Affordable Care Act. Check your policy for details. 
    • Talk to your GC/MD about testing options--if cost is a barrier, there may be financial assistance available to help! 
    • Risk of genetic discrimination is very low. Often far outweighed by info gained from genetic testing. Talk to a GC!
    •  Life insurance is a HUGE problem , not protected under #GINA. Seek coverage PRIOR to genetic counseling/testing. 
    T5a: Let's talk about the term "risk". If mutations are found that increase my cancer risk, what does that really mean for me?
    • Everyone has a chance of developing cancer. Having a mutation raises the chance above the general population.
    • #Cancer risk is not the same with all genes. Some genes confer low, medium or high risk.
    • An average woman has a 1.5% chance of developing ovarian cancer. BRCA1 mutation raises chance to 45%. Lynch 4-24%. 
    • Some women will consider surgery to decrease their cancer #risk. Speak to a @GeneticCouns to discuss your cancer
    T6: Where can those with a genetic mutation find the latest info and get help weighing options for preventative action or treatment?
    • @GeneticCouns has resources. Talk to a genetic counselor to help gather current info tailored to you. https://t.co/6DC5QzpmDQ
    • We recommend people see only CGC Certified Genetic Counselor
    • Where can you find the latest info and get help w options for prevention or treatment? A genetics counselor!
    T7: How and when to share test results with family can be tough. What are some tips?

    If you would like to continue this discussion, feel free to join us on Smart Patients at https://www.smartpatients.com/gyncsm.

    Be sure to mark your calendar for our next chat on Wednesday, April 10  at 9pm ET as we discuss Re-envisioning Ovarian Cancer Survivorship. Our guests will be Dr. Don S. Dizon (@drdonsdizon) and Dr. Teresa Hagan ( @TLHagan). We hope to see you then.

    Dee
    #gyncsm co-moderator

    RESOURCES:
    Find a Genetic Counselor near you at https://t.co/JHZReh6ReE

    @GeneticCouns blog will help you prepare for a genetic counseling visit. https://t.co/murxf0ekQH


    @BeBrightPink Collect Family History  https://t.co/S8JvCebcpE

    SGO position statements on genetic testing https://www.sgo.org/newsroom/position-statements-2/genetic-testing-for-gynecologic-cancer/

    Surgeon General's Family Health History Initiative https://t.co/0ynYRl339L

    Genetic Discrimination information https://t.co/xJhGNF7VnZ 

    GENETIC TESTING, PRIVACY AND DISCRIMINATION https://t.co/x2Z1aTACg1

    https://t.co/o8hs49pDGn genetic discrimination laws and protections

    OCS:Development of the Risk of Ovarian Cancer Algorithm and RoOCA Screening Trials http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572791/

    Hereditary cancer risk resources: @FacingOurRisk @BeBrightPink @Sharsheret @Hc_chat @BRCAinfo @BRCAresponder 

    Communicating genetic test results: https://t.co/waFU48JsXi

    After receiving +test results https://t.co/ROLi0rlFbc via Cancer Communication Research University of South Florida 

    Oct 9,2013 Genetics and Personalized Medicine Chat https://t.co/T0ZjaCI4Bg

    Genetic Testing and Ovarian Cancer  #gyncsm Community: https://t.co/uMVhorzjFa 

    Genetic Counseling - Understanding Genetics - NCBI Bookshelf  https://t.co/Zi3UwQpRoE

    Genetic Counseling Infographic  https://t.co/SZKjfF1caj 

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