In 2016, the American Cancer Society projected that the number of women dying worldwide from cancer was expected to rise to 5.5 million by 2030.1
In the realm of women’s cancers, ovarian cancer is prominent and serious. A woman is diagnosed with ovarian cancer every 23 minutes in the United States, and it is the number one cause of gynecological cancer deaths and the fifth cause of cancer-related deaths in women.2
September is Ovarian Cancer Awareness Month, an important time to acknowledge the impact and severity of this rare disease as well as the clinical advancements that have been developed to combat it. If treated in the earliest stages, the rate of ovarian cancer survival is very high. If regional cancer – cancer that has spread to nearby lymph nodes, tissues or organs – or localized cancer – cancer that is limited to the place where it started, with no sign that it has spread – is found within the first year, patients have a nearly 90 to 98 percent chance of surviving.3
This makes early detection absolutely key. Unfortunately, only about 20 percent of ovarian cancer cases are found early - women with ovarian cancer may be asymptomatic, and there is a need for more tests geared toward early detection.4
Fortunately, ovarian cancer diagnoses have been decreasing over the past 20 years.5
According to a study by the European Society for Medical Oncology, the use of oral contraceptives, the decline in hormone replacement therapy (HRT) to manage menopausal symptoms, and better diagnosis play a role in declining ovarian cancer rates. Ovarian cancer death rates in Europe decreased by 10 percent and in the U.S. by 16 percent between 2002 and 2012, according to the same study.6
Clinical advancements in screening tests, surgical procedures, chemotherapy, radiation, oral oncolytic and cell and gene therapies are also helping to control this rare disease. Poly (ADP-ribose) polymerase (PARP) inhibitors have been a major therapeutic advancement in managing ovarian cancer. Before PARP inhibitors, there weren’t many options to help maintain remission between chemotherapy cycles. Cancer cells use an enzyme, poly ADP-ribose polymerase, to repair DNA after chemotherapy. This oral therapy is targeted at women who have undergone chemotherapy treatment but are at risk for cancer relapse. PARP inhibitors seek to block this enzyme to delay cancer relapse. There are three PARP inhibitors now available on the market, and more progress in this space is eagerly anticipated.
Even with ovarian cancer rates declining and promising advancements in therapeutic options, more work needs to be done by stakeholders across the healthcare system to support women facing the many burdens associated with this rare disease. All of us supporting ovarian cancer patients should focus on three core areas: alleviating financial burdens, providing highly coordinated clinical care and lastly, understanding the patient holistically.
The fact remains that cancer continues to be one of the most expensive diseases to treat. According to the Agency for Health Care Research and Quality, cancer patients paid nearly $4 billion in out-of-pocket costs for cancer treatment in 2014.7
Ovarian cancer patients are not immune from costly treatments. As high-deductible health plans require more consumer cost-sharing, increasing out-of-pocket costs may prevent women from seeking or adhering to a treatment regimen.
I lead a specialty pharmacy, US Bioservices, and we understand the serious need for patient support while working with ovarian cancer patients who are prescribed oral therapies. A significant component of our patient support service offering includes knowledgeable benefit experts who help patients understand their coverage and assist with prior authorizations and appeals. Even with coverage approval, patients may struggle to afford their medication copay, so we identify and help secure all possible financial assistance resources. Reimbursement support is crucial in helping patients navigate the often complex healthcare landscape and ensuring financial barriers do not prevent access to appropriate care.
Another area that is essential in the treatment of ovarian cancer is clinical support, including collaboration between healthcare providers to optimize the patient’s response to treatment. As mentioned, oral therapies, such as PARP inhibitors, are a significant clinical advancement. The desired outcome is progression-free survival, indicating that the cancer is not growing and has not spread. Specialty pharmacies serve as a lifeline of information and assistance for caregivers and patients, in conjunction with their prescribing physician. 24/7 clinical support is important, particularly when dealing with seriously ill patients. The ability to access a clinical pharmacist or nurse anytime to answer questions, help with the prescribed dosing regimen, assist with side effect management, and address other disease or therapy-specific concerns is critical. Specialty pharmacies also connect patients to additional support resources, including local resources that may be available in their community or resources that are specifically there to aid these courageous women and their families.
Women are often caregivers within families, and it’s imperative that we understand our patients holistically. A patient’s treatment success is influenced by many factors that can vary depending on a woman’s individual situation. Our pharmacy has helped women across a range of circumstances: single mothers, women who are the primary caregiver for an elderly parent or spouse, working women, women who are lacking a sufficient support system, or women needing language translation support. Transportation, caregiver support, childcare, adequate nutrition and depression can all be hurdles to treatment that are just as significant as managing side effects or financial concerns. Specialty pharmacies are an important bridge, not only in connecting healthcare stakeholders that are involved in patients’ care, but also in connecting patients to additional resources offering a range of support options beyond the healthcare system.
Ovarian Cancer Awareness Month is the perfect time to become educated on the impact of this rare disease on women and their families. It is also a time to honor those who dedicate their lives to continued research in this important area. As treatment options evolve, stakeholders must find ways to truly clinically integrate our services to streamline the patient experience. Lastly, we must continue to help patients overcome both individual barriers and shared challenges, so they can ultimately realize the full benefit of their treatment options.
1. American Cancer Society. Global Burden of Cancer in Women. www.cancer.org/content/dam/burden
2. Ovarian Cancer Research Fund Alliance. ocrfa.org/
3. Healthline. The Outlook for Ovarian Cancer: Prognosis, Life Expectancy, and Survival Rates by Stage. www.healthline.com/health/cancer/ovarian
4. American Cancer Society. Can Ovarian Cancer Be Found Early? www.cancer.org/cancer/ovarian-cancer/detection
5. American Cancer Society. What Are the Key Statistics About Ovarian Cancer? www.cancer.org/cancer/ovarian-cancer
6. European Society for Medical Oncology (ESMO). Deaths from Ovarian Cancer Decline Worldwide Due to Oral Contraceptive Use. www.esmo.org/Oncology-News/Deaths
7. American Cancer Society Cancer Action Network. The Cost of Cancer. www.acscan.org/sites/default/files/Costs.pdf