What Women Need to Know About Gynecological Cancers

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World Ovarian Cancer Day takes place May 8 — just before Mother’s Day — and marks the start of National Women’s Health Week (May 9 – 15). This confluence of events makes this an excellent time to shine a light on the symptoms of gynecological cancers and the preventative measures women can take to lessen their risk.

There aren’t many options when it comes to gynecological screenings. That is one reason why knowing the warning signs and keeping up with annual examinations is so important.

Symptoms of Gynecological Cancers

Endometrial cancer, which starts in the inner lining of the uterus, is one of the most common gynecological cancers. According to the American Cancer Society, more than 66,000 cases of endometrial cancer will be diagnosed in 2021 and nearly 13,000 women are projected to die from it. The good thing about endometrial and cervical cancers is they are often easy to identify because they present very specific symptoms such as abnormal vaginal bleeding or discharge.

Ovarian cancer, which ranks fifth in cancer deaths among women, is far more challenging to diagnose because its symptoms including bloating, diarrhea and weight gain can all be attributed to less serious conditions. Consequently, ovarian cancer is often diagnosed when it is already in an advanced — and sometimes untreatable — stage.

Vulvar cancer is exceedingly rare, accounting for less than 1% of cancers in women.  However, the American Cancer Society projects more than 1,500 women will die from vulvar cancer in 2021. Symptoms of vulvar cancer include the presence of unusual moles, itching and irritation. Women, especially those 60 years or older, should see their physician if they are experiencing any of these symptoms.

Remaining Vigilant and Proactive

The healthcare industry has made great strides in understanding the genetic components of many cancers — gynecological cancers included.

Genetic predispositions can be traced to 25% of ovarian, Fallopian tube and primary peritoneal cancers. This allows women in the high-risk category to be screened earlier with the cancer antigen 125 (CA 125) blood test. In some cases, risk-reducing surgeries can be performed.

However, while they are the best option right now for diagnosing these cancers, data has shown that these tests aren’t always effective. Because there aren’t many options in regards to screenings for these cancers, it is important that women remain proactive about their annual check-ups, including a full examination of the uterus and ovaries — especially since malignancies in these areas may go undetected during a Pap smear.

Being proactive means living a healthy lifestyle as well. Obesity can be traced back to conditions such as endometrial cancer, so eating right and getting plenty of exercise can help reduce the risk of a diagnosis. When it comes to staving off cervical cancer, physicians highly recommend the HPV vaccine that prevents the human papilloma virus — the primary cause of cervical cancer.

We are always looking at new and enhanced ways to prevent and ultimately eradicate cancer – a quest that has led to the development of medications such as PARP (poly adenosine diphosphate-ribose polymerase) inhibitors, a targeted therapy that can be taken orally and prevents cancer cells from repairing themselves. Without patient participation in clinical trials, however, advanced treatments such as PARP wouldn’t be possible, which is why patients are encouraged to participate in these trials whenever and wherever they can.

Clinical trials allow patients access to innovative and cutting-edge treatment methods while also helping the healthcare industry move forward in its quest to better treat — and ultimately eradicate — cancer.

The Benefit of Comprehensive Cancer Care

Similar to the other community-based practices in the American Oncology Network (AON), Cancer & Blood Specialists of Arizona offers comprehensive whole-person care.

Our nurses and multidisciplinary oncologists accompany patients on every step of their journey, from initial diagnosis through chemotherapy and, if needed, surgical procedures. We also provide cancer surveillance and survivorship programs to help guard against a recurrence.

Because our patients receive treatments and follow-up in one nearby, convenient location, they are able to form trusting relationships with our nurses, physicians and staff — the greatest benefit to working with a community oncology clinic.

Cancer is one of the most challenging and scariest experiences a person can endure. Doing so in a safe and comfortable environment, however, can go a long way toward lessening some of the emotional and physical burden.

The Crucial Role Nurses Play in Oncology

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Nurses Week takes place May 6 – May 12 and spotlights the millions of nurses across the country who devote their lives to helping others in their time of physical, emotional and spiritual need.

Nurses play an essential role in oncology care, especially throughout the community-based clinics that make up American Oncology Network (AON). They forge meaningful, trusting relationships with our patients — as well as with their families and caregivers — and provide comfort and hope to those battling through some of the most difficult and scariest times of their lives.

While the role of an oncology nurse has expanded and changed over the years, one thing remains constant: the complete commitment and compassion they have for each patient they help treat.

The Role of an Oncology Nurse

Oncology nurses pride themselves on providing whole-person care, which encompasses nurturing the patient’s spiritual and emotional well-being while also addressing their physical needs. This begins at a patient’s very first visit to one of our practices, where they have a thorough meeting with a nurse practitioner to go over their course of care. When the patient undergoes their first chemotherapy infusion — which can be a frightening and overwhelming experience — the nurse remains by their side to guide them through it.

Unlike those at a hospital, nurses who work at community oncology clinics see the same patients several times a week, giving them a chance to earn their trust and tailor their treatment. For example, if a nurse notices one of their patients isn’t feeling particularly well, they can confer with the physician about IV hydration or perhaps delaying the patient’s treatment until they are feeling better. Most nurses get to know their patients so well that they can tell how they’re feeling just by looking at them.

Along with providing care and support, oncology nurses assess a patient’s health and, in consultation with the physician, decide which members of a multidisciplinary team should be involved with their care. To succeed in this expanded role, nurses must listen to their patients, earn their trust and provide them with the tools needed to get the most success out of their treatment.

Getting Your Nurses Involved

More than 500,000 experienced registered nurses are set to retire by 2022, and the U.S. Bureau of Labor Statistics projects that an addition of 1.1 million nurses will be needed to help avoid a shortage.

While the impact of a nursing shortage will cause ripples throughout the healthcare industry, it will have a greater affect on oncology. Because our nurses deal with patients who are being treated for a potentially terminal illness, many young nurses and nursing students mistakenly believe that working each day at an oncology practice is a sad and arduous task.

This is a misconception that needs to be addressed. The truth is, because our patients rely so heavily on a nurse’s care and compassion, working as an oncology nurse is an extremely rewarding career, and the relationships nurses build with patients can last long after treatment is completed.

To help attract more nurses to oncology, many of our nursing society groups offer scholarships to nursing students with an interest in cancer care. AON practices are also very involved with their local oncology nursing societies, many of which offer free memberships to nursing students. Nurses from our clinics visit local colleges and nursing schools and meet with nursing students so they can get an entry-level view of life as an oncology nurse.

The Power in Joining a Network

Oncology nurses who work in practices that partner with AON benefit from working with a national network.

AON offers several different opportunities for nurses to advance their careers while working directly with patients. We also provide financial assistance for nurses who choose to further their degree and also pay membership and certification fees to help nurses become certified in oncology.  AON also pays membership fees for oncology nursing societies, giving our nurses the opportunity to exchange ideas and share new approaches to patient care.

At AON, our nurses take great pride in what they do and understand the role they play in providing compassionate care and support to those who need it the most. They are essential to our ability to deliver high-quality oncology care to patients right in their own community.

How Specialty Infusions Can Best be Provided by Community Oncology

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By Jenny Li, Clinical Oncology Pharmacist, and Camilo Rodriguez, Director of Pharmacy Operations, American Oncology Network

At American Oncology Network (AON), we take pride in providing high-quality care to cancer patients right in their own community. As an extension of that care, we offer specialty infusions throughout our clinics across the country.

Specialty infusions are not associated with a cancer diagnosis and are often used to treat a wide range of illnesses including asthma, genetic and skin disorders, rheumatoid diseases such as arthritis, and Crohn’s disease and other gastrointestinal problems.

Receiving these infusions at one of our practices will make for a convenient, cost-effective experience for oncology and non-oncology patients while they’re being treated by nurses and physicians based right in their own community.

A One-Stop Shop for all Patients

Because the infrastructure is already in place, there are many benefits to receiving specialty infusions at our practices as opposed to a hospital or other outpatient setting.

One important distinction is that the biologic drugs that make up specialty infusions are often similar in nature to the oncology medications we prescribe and administer at AON. Consequently, our staff is already familiar with the procurement processes for these drugs, as well as the pertinent administration preparations.

Furthermore, if a patient receiving a specialty infusion starts experiencing side effects—especially when they mirror those that accompany oncology medications—our staff has the expertise and equipment to begin immediate treatment. And by receiving these treatments in a community setting, patients won’t be hit with the extra facility fees they would have to pay at a hospital. This helps ease the financial burden and enrich a patient’s physical and mental health.

For oncology patients who also need treatment for non-oncology disorders, providing specialty infusions lets us serve as a one-stop shop where they can receive comprehensive care in one convenient, familiar location. Rather than going to an infusion center or hospital to receive treatment from staff they’re not familiar with, our patients will see the AON physicians and nurses with whom they’ve already built a trusting relationship.

The Enhanced Benefits of a Network

Joining a national network such as AON offers a whole host of benefits for independent community-based oncology practices that wish to also provide specialty infusions to their patients.

AON has contracting power that gives our practices access to a wide formulary of non-oncology medications that may not be available to smaller private practices.

Some independent practices may not have the time or manpower to research and investigate the specifics regarding specialty infusions. AON manages all that with standardized education and training, as well as a reference library our clinicians can access at any time to learn more about a medication. That includes such important information as preparation instructions and monitoring parameters under the Food and Drug Administration’s Risk Evaluation and Mitigation Strategy (REMS) program. REMS is a drug safety program required by the FDA for certain drugs to help ensure the benefits outweigh the risks.

Ultimately, supporting our practice partners in offering specialty infusions is another way AON provides top-shelf service to our patients right in their own backyard—which is precisely what community-based care is all about.

The Importance of a Patient-Centric Approach

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At American Oncology Network (AON), we encourage our practices to adopt a patient-centric approach and deliver exceptional care with compassion and kindness. It’s a method of care delivery that supports the value-based care model, which has revolutionized healthcare by rewarding providers based on their delivery of the highest quality patient care.

One of our practices, Oncology Hematology Associates (OHA), located in Springfield, Missouri, has long embodied this approach by embracing patient-centered care. By placing its patients first, OHA continuously earns high patient satisfaction scores of 96.1% and above.

Treating the Whole Person — and Their Family

As part of our patient-centered approach, AON practices embrace the Whole-Person Care model, which is defined as taking care of a patient’s mental and spiritual health as well as treating them physically. At OHA, whole-person care permeates every aspect of care management, including financial burdens. Battling cancer is stressful enough without patients having to concern themselves with how they are going to pay for treatment. That’s why OHA helps its patients connect with local organizations that provide financial assistance ranging from utility bills and groceries to mortgage payments and even affordable housing. Alleviating a patient of some of their financial burdens can be a great boost to their physical and mental health.

The practice also offers nutritional assistance for patients who are undergoing chemotherapy and radiation treatments by recommending which foods to eat and which they should avoid when it comes to managing side effects. OHA also works with a local organization that supplies mental and spiritual support to those recently diagnosed with cancer.

Understanding that caregiver fatigue is a very real, very serious issue, OHA includes members of a patient’s support team when it comes to nurturing mental and spiritual health. Its infusion centers are open to a patient’s caregivers, friends and family, allowing our nurses to interact and bond with whomever accompanies the patients to their treatments.

Building Relationships with Patients

One of the many benefits of a community oncology practice is that patients often see the same physicians, nurses and other clinical team members during their visits, which leads to meaningful relationships built on trust.  OHA focuses on establishing these relationships when a patient walks into the practice for the first time — regardless of where they are in their diagnosis.

Cancer patients are taking a journey, and OHA employees will be there to support them every step of the way. Because OHA’s clinics offer a variety of services, patients do not need to go anywhere else for blood work or infusions, which allows them to become more comfortable each time they walk into the office and interact with our staff. OHA wants its patients to feel like they’re visiting family — not just physicians and nurses. Part of that is encouraging patients to reach out anytime. For example, our nurse practitioners are standing by and ready to assist any patient suffering through uncomfortable side effects from treatment by sharing tips on managing symptoms and offering up a library of educational collateral to share.

Strength in Numbers

Joining a national network such as AON can supply local, independent practices with the structure and resources they need to enhance a patient-centric approach to oncology care — which is the backbone of community-based care.

For those who work at OHA and in other practices across AON, oncology is more than just a job — it has become a very important part of their lives. They love the bonds they get to forge with their patients and are proud to be a part of their journey, regardless of where or how that journey ends.

Racial Disparities in Cancer Care and Research: The Causes and Possible Solutions

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February was Black History Month, making this an important time to note the racial disparities that exist in cancer care and research. Black people have higher death rates than members of all other ethnic groups for most types of cancer — specifically multiple myeloma and prostate cancer — and black women are more likely to die from breast cancer than white women despite a similar rate of diagnosis.

While there has been progress toward erasing these inequities in treatment and care, a great deal more work remains to be done. To that end, it is important to stay informed of these disparities so we can learn how to eliminate them forever.

The Causes of Racial Disparities

There are many reasons why racial disparities exist in cancer care, one of which is based in socioeconomics. The reality is that a wide wealth gap remains between black and white households, even within the same income class, which can put higher quality medical care out of financial reach. This is especially true for those seeking treatment for costly cancer care.

Another reason is an inherent distrust African Americans have traditionally had with the healthcare industry. While this distrust dates back to the highly unethical Tuskegee syphilis study in 1932, more recent research has provided additional reasons why it persists: an implicit bias in healthcare that black people often receive lower quality care than their white counterparts. According to a survey conducted by Genentech and published by WebMD in partnership with the All of Us Research Program, 1 in 3 medically disenfranchised black and Hispanic people said they didn’t participate in clinical trials or receive vaccinations because of their lack of trust in the healthcare industry.

The restoration of trust in the healthcare industry would be a huge step forward in greatly reducing or eliminating racial disparities.

The Need for Diversity in Research

While social and economic barriers do play a role in higher rates of cancer in the U.S., it is also true that African Americans are more susceptible to the disease than other ethnic groups. This can be attributed to genetics, limited access to quality care and, most importantly, substandard care stemming from a lack of diversity in clinical research and drug trials.

Black people make up about 13% of the U.S. population, yet we seldom see that portion of the population represented in research. Notably, African Americans make up just 1-2% of the participants in clinical trials. This lack of diversity makes it impossible to see what effect certain drugs may have on people of African-American descent, especially when trying to treat multiple myeloma, of which African Americans account for approximately 30% of the patients.

One way to combat this is to assign a diversity officer to all research studies and clinical trials. Currently, there are data safety and monitoring boards for studies to ensure the patients and participants are being properly cared for and protected. The diversity officer can play a similar role by ensuring study populations don’t heavily skew in the direction of one race or another. This helps ensure that all patients are represented equally, making available the data that lets researchers know the effect a certain drug or treatment has on all members of the population.

Steps in the Right Direction

Disparities and gaps in care do exist, but for the first time, we are seeing progress toward rectifying this problem. While the Food and Drug Administration cannot mandate population-based studies, it is beginning to encourage drug manufacturers and the healthcare industry to focus research on generating data applicable to African Americans. The industry seems to be listening, too, as evidenced by the creation of think tanks and advisory boards to learn how to be more inclusive.

The American Society of Clinical Oncology, which is the world’s largest cancer society that features representation from 150 different countries, recently announced the addition of a diversity and inclusion officer to its administrative structure. This role will address some of these racial disparities and work toward solutions to eliminate them.

At American Oncology Network (AON), we are in a unique position because of our diverse patient population and geographic footprint. This combination allows all patients, but especially African Americans, to participate in trials right in their own community – trials that are being conducted by physicians and doctors they know and trust.

This sort of inclusion is a significant step toward making sure patients from all walks of life are receiving the care they deserve.

COVID Pandemic Has Negative Impact on Cancer Care

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According to a national study conducted by Avalere Health and published in the November 2020 issue of the journal JCO Clinical Cancer Informatics, the COVID-19 pandemic has had a negative impact on cancer care with a decline in screenings, diagnosis and treatments — problems that could lead to an increase in cancer morbidity and mortality for years to come.

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The COVID-19 Vaccine: Safe for Cancer Patients?

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As we approach the one-year mark of the pandemic, nearly 60 million doses of the two currently approved COVID-19 vaccines have been administered nationwide. However, public opinion differs on the efficacy and safety of these vaccines, and some people have expressed reluctance — or outright refused — to receive one.

For cancer patients and survivors, who are at a high risk of becoming severely ill from a COVID-19 infection, this is an extremely important decision. It is essential that they and their caregivers know all the information regarding these vaccines and whether they are safe to take.

The Safety of the Vaccine

In short, it is safe for cancer patients and survivors to receive a COVID-19 vaccine. Nor does it matter which one they receive.  Vaccines created by both Moderna and Pfizer have been approved by the Food and Drug Administration (FDA) and report an efficacy rate of approximately 95%. Cancer patients and survivors of all ages are encouraged to get vaccinated whenever they can.

The vaccine is also safe for anyone currently undergoing chemotherapy and radiation treatment. However, patients receiving very intensive cytotoxic chemotherapy, such as 7+3 regimen for acute myeloid leukemia (AML), should wait until their absolute neutrophil count (ANC) recovers before getting the vaccine.  Those receiving bone-marrow transplants or cellular therapy such as chimeric antigen receptor (CAR) T-cell therapy should wait at least three months after their therapy has been completed.

There may be side effects to receiving a COVID-19 vaccine, such as pain and swelling at the injection site, as well as headaches, chills and fever. These aren’t expected to be any worse or different for cancer patients and survivors.

Caregivers and Vaccines

COVID-19 is highly contagious, so it is important that caregivers also be vaccinated in order to mitigate the risk of exposing patients or loved ones to infection. It is safe, too, because receiving a vaccine will not turn a caregiver into a carrier.

However, data from trials have shown that while vaccines decrease the incidence of COVID-19 and its ensuing complications, it is unclear if they prevent infection and possible transmission. Consequently, people should continue to wear a mask, maintain social distancing, and wash their hands regularly even after they have been vaccinated.

Cancer patients are also at a high risk of developing serious complications from the flu, so it is important that they and their caregivers receive a flu shot. This is especially true during the pandemic; while the flu shot won’t stave off COVID-19, it will lessen the severity of the flu and ease the burden on hospitals and healthcare organizations that are already overwhelmed treating the millions fighting COVID-19.

Keeping our Patients Safe

Since the pandemic was first declared last March, American Oncology Network (AON) has prioritized the safety of our staff and patients. We continue to do so by encouraging all employees to get vaccinated as soon as they can, which allows us to continue administering top-quality care to our patients right in their own community.

In the future, we hope to be able to administer the vaccines to patients and staff all throughout our network.

Cervical Cancer: How it can be Prevented and Treated

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January was Cervical Cancer Awareness Month — and awareness has played a big role in its shift from the leading cause of death among women in the United States to the most preventable of female cancers. This is due largely to the emphasis placed on annual screenings and the emergence of vaccines for the human papilloma virus (HPV), the primary cause of cervical cancer.

While this progress is encouraging, more than 14,000 women are still expected to be diagnosed with cervical cancer in the U.S. in 2021, and more than 4,000 will die. Which is why it is so important to continue educating women — and men — about cervical cancer and how to prevent it.

Causes and Symptoms

The main cause of cervical cancer is HPV, a sexually transmitted disease that infects about 14 million men and women in the U.S. each year. Smoking, multiple sexual partners and taking oral contraceptives for longer than five years can also increase a woman’s risk.

Symptoms of cervical cancer include pelvic pain, abnormal discharge and abnormal periods, fatigue, nausea, weight loss and pain during intercourse. It is also very common for women not to have any symptoms at all, which is why keeping up with annual screenings is so important.

Preventative Measures

The most effective measure in guarding against cervical cancer is an annual Pap smear test, a procedure that involves collecting cells from the cervix and analyzing them for the presence of precancerous or cancerous cells. These annual screenings are crucial because cervical cancer, when diagnosed in the early stages, is very treatable. Too often, by the time symptoms present themselves, the cancer has already metastasized to other areas of the body.

Another effective measure is the HPV vaccine, which is typically given to females from ages 12-15, or before they become sexually active. While cervical cancer occurs only in women with a cervix, HPV can be passed from female to male and male to female, so it is a good idea for boys of the same age to receive the HPV vaccine as well. There are also new HPV vaccines recommended for an older population under the age of 45.

Treatment Options

One common method in the treatment of cervical cancer is the loop electrosurgical excision procedure (LEEP). Often performed in a gynecologist’s office, a LEEP features a heated wire loop that removes the area of the cervix affected with the abnormal cells. This is typically the first stage in treating cervical cancer, and some patients who undergo a LEEP don’t experience a reoccurrence. More advanced treatments include immunotherapy for certain types of cervical cancer, and chemotherapy and radiation when the cancer is more extensive.

Precision therapy is being studied as another possible way to treat cervical cancer. However, its use is not yet widespread because there is not always a genetic component to cervical cancer and its primary cause is a virus.

Power in Partnership

At Zangmeister Cancer Center, we pride ourselves in delivering high-quality care to cancer patients right in their own backyard. Partnering with American Oncology Network (AON) two years ago has enhanced our ability to treat our patients, including those with cervical cancer.

AON provides us with extended resources and enables us to accept a wider array of insurance plans, which allows us to help even more patients. Most importantly, working with AON allows us to expand patient education and provide more in-depth information on all types of cancer. This includes cervical cancer, which, with the right amount of vigilance, is preventable as well as easily treatable in early stages.

Celebrating Women Physicians: An Interview with Dr. Jeanna Knoble

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February 3 is National Women Physicians Day, celebrating women’s contributions to healthcare as well as the birthday of Elizabeth Blackwell, who in 1849 became the first woman to earn a medical degree in the United States.

The impact of women on the healthcare industry continues to grow — according to the U.S. Census Bureau’s American Community Survey, the number of women working in healthcare full-time and year-round jumped from 5 million in 2000 to 9 million in 2019. And that number is expected to continue growing as more and more women enroll in medical school.

To celebrate National Women Physicians Day, we spoke with Jeanna Knoble, M.D., a medical oncologist at Zangmeister Cancer Center who was also recently elected as the practice’s managing partner. She is also co-medical director of the breast cancer program at Mount Carmel Health System.

At Zangmeister, Dr. Knoble treats all cancer and blood disorders, but does have a special focus on breast cancer, as well as blood clotting abnormalities. She is also active in the practice’s research program and serves as the principal investigator of several active trials.

Dr. Knoble graduated from Miami University — summa cum laude with a B.A. in Microbiology — and received her medical degree from The Ohio State University Department of Medicine and Public Health. Following her residency at The Ohio State University Medical Center, she completed a fellowship in hematology and oncology at the University of Virginia Health System.

In this interview, Dr. Knoble talks about what led her to oncology, what advice she has for women just starting or considering a career in healthcare and what National Women Physicians Day means to her.

What led you to a career in healthcare? Was oncology always your chosen discipline?

I always found science so fascinating, but I am also kind of a “people person.” I felt like medicine merged the two because you can apply science every day directly to people’s lives. You are guiding and helping patients with the proven principles of science and improvements in care brought by clinical research.  For me, medicine was the perfect confluence of science and helping people.

I didn’t know until my residency that I would fall in love with oncology. There’s a lot of cutting-edge science contributing to the advancement of patient care in oncology. But…the patients are what led me to pursue oncology. Cancer doesn’t discriminate. It’s life-threatening and it can happen to anyone, changing lives in an instant. Taking care of cancer patients is motivating and humbling at the same time. Cancer patients teach you a new perspective on life.

Along with interacting with patients, what are some of the other things you love about your job and working in oncology?

Again, it gets back to the science and the research and the fact that we are seeing progress in real time.  All of medicine is advancing, but in oncology our treatments have really evolved, even since I started practicing 10 years ago. I love the research end of it, and we have a real chance to participate in research here at Zangmeister.

I also find purpose in educating patients about what their cancer means for them so we can develop realistic goals of care and they can prioritize what is most important in their lives.

What accomplishments are you most proud of?

For me it isn’t really degrees or awards — the most important things are knowing you’ve made a difference, that you’re helping people do the right thing in a difficult situation and you’re standing up for people who need to be stood up for, whether it’s a patient or a co-worker. That’s what really makes me want to get up in the morning and keep doing what I’m doing.

I am also proud of the fact my colleagues trust me to represent them as a part of our leadership team here at the Zangmeister Center and also with our multidisciplinary cancer program. It means a lot to be trusted with the opportunity to improve the future for our patients, staff, and my fellow clinicians.

What would you tell other women who are just starting a career in healthcare or oncology?

I love mentoring young women and it is something I am very passionate about. The most important thing I can do is encourage them and give them confidence. I think sometimes women turn away from a career in healthcare because they don’t think they can handle the hard work and the pressure, or don’t think it’s possible to have a demanding career and also raise a family. I don’t have children myself, but many of my female comrades in medicine do. We need to adapt and accommodate that and let women know, “You can do this, you can be a part of this.”

Women make great oncologists — and great physicians in general — because they have unique insight, communication skills, and empathy when it comes to patients. Not more empathy than men, but empathy from a different perspective.  There have been studies that found that women physicians had lower mortality rates and fewer patient readmissions. Many patients have told me, “I just feel more comfortable asking questions and being completely honest with women.”

You mentioned taking pride in mentoring younger women. Who were some of your mentors?

There are several. One who comes to mind is Dr. Manisha Shah, whom I met on my oncology rotation as a second-year resident at Ohio State. She was an independent, strong woman who was very confident and caring. She not only had passion for the research trials she was leading, but equal compassion for each of her patients. Both my intern and I chose a career path in oncology after working with her that month.

At the University of Virginia, our fellowship director, Gail B. Macik, had a very similar personality. She inspired you to be confident and keep moving forward. I was very fortunate to have women like these in my life who have been such great mentors.

What are some of the challenges you’ve encountered in your journey?

Helping patients develop realistic expectations while maintaining some hope and optimism can be one the most difficult challenges, particularly when delivering bad news. It is so important for patients to understand what likely lies ahead, but also find hope in the journey.

Another challenge in oncology is keeping up to date with all the research advancements in care. The field is constantly evolving — and evolving quickly. I not only have to be up on breast oncology, which is an area I focus on, but also on all other subspecialties in oncology and benign blood disorders. It is a wonderful thing that we’re getting more and more therapies out there — but being knowledgeable on all of them can be a challenge.

For women physicians in general, I think maintaining a work-life balance can be difficult. My hat goes off to women that are trying to raise a family and advance their career because it is a huge challenge for them. It’s a challenge for young fathers as well, but it’s almost always more so for women because of the inherent and societal role that motherhood entails.

Studies have shown that only about 34% of oncologists are women. What can the healthcare industry do to help increase that number?

I read where there is now a 50-50 split of men and women in medical school. So hopefully as those numbers go up, the number of women oncologists will go up too. However, there are challenges in oncology and other subspecialties, especially when it comes to women deciding when they are finished with their residency if they want to go out and work or do another three years of a fellowship.

Fellowship programs often require you to move somewhere else and require long hours away from home. For women who want to start a family, that can be a deterrent. I think we need to add more flexibility to our training and give women more time [to complete it] while making sure they maintain integrity and the necessary experience. It’s also important for women to know, even at a young age, that they can have options and flexibility in their education and careers — that they can have a family and still have a career in healthcare and oncology. It is a continued challenge but it is something we’re working on.

What does National Women Physicians Day mean to you?

It means that we are recognizing that women are very important in healthcare and bring a unique perspective and distinct qualities. Most women have faced and continue to face additional challenges and obstacles through training and as attending physicians. It is important to recognize this and work to prevent this from hindering success. This is also true in other professions and with other disparities.

I also think it points out that qualified women need to be a part of leadership in healthcare. The workforce in healthcare is approximately 80% women.  The majority of our patients’ caregivers are women. Having women actively involved in crucial decision making is essential for any health care organization to reach its full potential. Our voices need to be heard and we deserve a seat at any important table.

The Dawn of a New Year: A Message from Our President & COO

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As we usher in the New Year, I wanted to take this opportunity to look back on what was one of the most challenging years on record. COVID-19 claimed hundreds of thousands of lives in 2020 and took an emotional, physical, and financial toll on countless others worldwide—and we are not out of the woods yet even with vaccinations underway.

The pandemic has also had a catastrophic effect on cancer care and research. Over the past year, fewer patients scheduled office visits, screenings, biopsies and even surgeries because they feared COVID-19 exposure. It’s an alarming and potentially deadly trend. By causing a decrease and delay in identifying new cancers or discovering new forms of treatment, these pandemic-generated care gaps could accelerate cancer mortality rates for many years.

At American Oncology Network (AON), dealing with the fallout from COVID-19 while providing our patients with top-quality care is one of the many challenges we continue working to overcome in 2021.

Working Through the Pandemic

According to a recent study in JCO Clinical Cancer Informatics, when the pandemic hit its peak in April, screenings for breast cancer (85%), colon cancer (75%), prostate cancer (74%) and lung cancer (56%) sharply decreased from where they were in 2019. And even though stay-at-home orders were lifted (in some cases temporarily) throughout most of the country, the study also reported that fewer patients are having surgery, receiving treatment and scheduling critical follow-up appointments for existing cancers.

This dip in office visits not only has an adverse effect on patients who were undergoing treatment prior to the pandemic, but it also leads to fewer cancer diagnoses—cancers that will eventually be diagnosed at a later stage and require more complex care. Late-stage diagnoses often lessen the chances for a cure, which drives up mortality rates.

While the presence of COVID-19 continues, AON is working with the practices in our network to remind patients to stay on top of their appointments and screenings. Our practices offer telehealth, allowing patients to meet with their providers from the comfort of home.

We also have in place exceptional safety protocols. Days after the World Health Organization declared COVID-19 a pandemic in March, we assembled an emergency task force to identify and monitor protective measures and supplied our clinics and staff with copious amounts of personal protection equipment (PPE) and appropriate cleaning products, thereby ensuring patients who had to come to our clinics could do so safely. And we continue to perform daily temperature screenings on patients and employees across all our locations.

Vaccines will bring us some relief in 2021. But AON will continue to do all we can to prevent and mitigate the spread of COVID-19 to keep our patients safe while getting the care they need and deserve.

Fighting for Our Patients and Practices

We are doing everything in our power to ensure our patients have access to the great care and medications provided by our practices. To that end, we are working with our public policy partners and the Community Oncology Alliance (COA) to put a stop to the Most Favored Nation (MFN) Model announced by the Centers for Medicare & Medicaid Services (CMS).

In accordance with the MFN, Medicare will reimburse only the 38 most used drugs in oncology at a rate below the average sale price. According to COA, these include mainstay breast, lung and prostate cancer drugs, as well as the latest cutting-edge immunotherapies that have had significant results in improving survival rates. The rate will continue to decrease over a five-year period until it hits MFN price — which, according to COA, will be so low that clinics will have to send patients to 340B hospitals for treatment.

One recent study shows that, under the MFN model, out-of-pocket drug costs will be lowered for less than 1% of Medicare beneficiaries. According to COA, CMS estimates that in the first year of the MFN, 20% of seniors will be required to find new oncologists and treatment and nearly half of those will forgo treatment. By 2023, 30% of Medicare seniors may be displaced with 1 in 5 not getting treated.

It appears, however, the MFN may not come to pass. The U.S. District Court in Washington, D.C. is in the process of hearing COA’s complaint, as well as a temporary restraining order and preliminary injunction that have been filed to delay the measure’s implementation.  

Medicare Reimbursement Sequestration

Because of the extensive financial burden placed on patients and clinics by the COVID-19 pandemic, we are also fighting against the extension of the Sequestration on Medicare Reimbursement, which is part of The Coronavirus Aid, Relief and Economic Security (CARES) Act. Extending these 2% cuts, which were enacted by Congress in 2013, will drive up costs for both patients and clinics across the country and no doubt lead to more harmful lapses in care.

The moratorium began on May 1, 2020 and was set to expire on December 31, 2020. Because of the ongoing pandemic, however, it has been extended through March 31, and the 2% Medicare cuts will not be applied in the first quarter of this year.

Despite these challenges, AON’s top priority for 2021 and beyond will always be our patients. We and our participating practices vow to continue to do what we do best — provide top-quality cancer care to patients right in their own backyard.