Collaborations Across Specialties
Robust Research Heighten Gynecologic Oncology Care
Collaborative care, with support from multiple specialties, together with a determination to improve the quality of life (QoL) experienced by its patients are defining features of the gynecologic oncology care practiced at NewYork-Presbyterian Hospital. The Hospital is comprised of 2 cancer centers - the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia University Medical Center, which is a National Cancer Institute (NCI)-designated comprehensive cancer center, and the Weill Cornell Cancer Center at NewYork-Presbyterian/Weill Cornell Medical Center. In addition, a distinctive hallmark of the Hospital is its extensive involvement in clinical drug trials in pursuit of improved care.
"We provide care throughout the entire course of the patient's disease, from screening and diagnosis to surgical management and adjuvant therapy," said Jason D. Wright, MD, gynecologic oncologist at Herbert Irving Comprehensive Cancer Center. "For patients with gynecologic cancer, it is very important that they be seen by a specialist in gynecologic oncology - that has been shown to improve survival.
"A major focus of our group has been to improve the quality of care for women with gynecologic cancers and develop programs to help them through the difficult time of being diagnosed with cancer," said Dr. Wright, who is also Levine Family Assistant Professor of Women's Health and Florence Irving Assistant Professor of Obstetrics and Gynecology at Columbia University College of Physicians and Surgeons.
"In the past 2 to 3 years, we have dramatically increased the number of support services that are available for our patients from nutrition services, psychosocial support, and peer-support groups, to access to new drugs through clinical trials and palliative care. For example, my partner, Sharyn N. Lewin, MD, has developed a 'Woman-to-Woman' program to pair up patients who have been recently diagnosed with cancer with survivors of gynecologic cancer to help them navigate through the process of diagnosis and treatment, and to help them deal with the side effects of treatment. Those are resources that patients treated at smaller centers often don't have access to," he said.
Evidence-based medical and surgical interventions can provide patients with better outcomes in the short term, reduced recurrences over the long term, and improved QoL. "One of the benefits of a place like the Herbert Irving Comprehensive Cancer Center is that our patients have access to a range of chemotherapeutic drugs and a number of different clinical trial options," said Dr. Wright.
Access to a network of surgeons and other experts in gynecologic oncology ensures that patients receive superior clinical care as they progress through treatment and management of their conditions. "At the Center, patients have access to many other medical specialists and collaborators, including medical, radiation, and surgical oncologists who can assist with their care," said Dr. Wright. "For instance, in the OR we sometimes perform collaborative procedures with hepatobiliary and colorectal surgeons and urologists if the cancer is encroaching on another organ. Certainly, the availability of those specialists is important."
Active Involvement in Clinical Trials
Patients at the Center, as well as those at Weill Cornell Cancer Center, regularly participate in studies encompassing all areas of cancer diagnosis and treatment. A recent study into the novel serum biomarker human epididymis protein 4 (HE4) performed at NewYork-Presbyterian/Weill Cornell demonstrated that it had a superior ability to differentiate between benign and malignant adnexal masses in premenopausal women compared with the commonly used carbohydrate antigen 125 (CA-125) biomarker. Assisted by Robert C. Knapp, MD, Visiting Scholar at Weill Cornell Medical College and developer of CA-125, researchers now are evaluating the utility of HE4 in detection of recurrent ovarian cancer.
Other treatment-related clinical trials have included investigations into the safety and feasibility of surgical debulking with heated intraperitoneal chemotherapy combined with intraperitoneal chemotherapy for ovarian cancer and the use of aurora kinase inhibitors in conjunction with paclitaxel for recurrent ovarian cancer, both of which are ongoing. "We're members of the NCI's Gynecologic Oncology Group and participate in open chemotherapy trials and radiation trials, such as examining the effectiveness of positron emission tomography scanning to detect lymph nodes metastasis," said Kevin Holcomb, MD, Associate Attending in Obstetrics and Gynecology at Weill Cornell Cancer Center, where he is a member of the Gynecologic Oncology Clinical Program, and Associate Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medical College.
In addition to conducting trials centered on medical treatment options, researchers at both the Herbert Irving Comprehensive Cancer Center and the Weill Cornell Cancer Center have focused on determining the benefits of minimally invasive, and particularly robotic-assisted laparoscopic surgery for gynecologic cancers. Dr. Holcomb, who also is Director of Minimally Invasive Surgery for the Department of Obstetrics and Gynecology, noted that the benefit of offering advanced robotics technology is to improve patient QoL while providing similar survival outcomes.
"A major focus for us at Weill Cornell Cancer Center is working to improve the quality of our patients' lives, leaving them with less morbidity from our treatments so they go on to live fruitful lives without any long-standing detriment. I think in that regard, robotics plays a major role," Dr. Holcomb said. He added that his team is studying robotic-assisted surgery, which involves the use of the da Vinci Surgical System, in gynecologic cancers other than those for which it has already demonstrated benefit, such as in endometrial cancer. "We've been performing many robotic surgeries for recurrent ovarian cancer, and really pioneering this," said Dr. Holcomb, who instructs other surgeons on the technology. "Recently I was able to debulk a patient's ovarian cancer robotically. She was rendered in complete clinical remission with a surgery that lasted about 2 hours and she didn't have to stay in the hospital overnight. I think that is a huge benefit and it isn't being offered in many places."
Additionally, patients contraindicated for a minimally invasive surgical approach, such as the morbidly obese and patients with severe comorbidities, also have shown positive outcomes when robotics were employed for surgery. "We're routinely approaching these patients and doing complete staging with robotic assistance," Dr. Holcomb said. "Obviously, performing primary abdominal surgery in the instance of big, bulky abdominal disease is problematic, but we are finding that there is a role for robotic assisted surgery. There is the patient who has an isolated recurrence after 3 years of being disease-free, for example, or the patient who has undergone chemotherapy and whose tumor shrank appreciably - very often, I elect to go back and handle these types of cases robotically. They're not necessarily getting a survival benefit from it, but there is a huge benefit for QoL."