Integrating Psychosocial Support and Quality of Life into Endometrial Cancer Pathways

In this interview, Don S. Dizon, MD, discusses the need to address research gaps, integrate quality-of-life and psychosocial considerations, and improve care pathways to optimize outcomes for endometrial cancer patients.

Please introduce yourself by stating your name, title, organization, and relevant professional experience.

Don S. Dizon, MD: My name is Don S. Dizon. I am a professor of medicine and professor of surgery at Brown University, director of the Pelvic Malignancies Program at Brown University Health Cancer Institute, and associate director of community outreach and engagement at the Legorreta Cancer Center at Brown University. I am an academic oncologist with a dominant interest in uterine cancer for over 20 years. I have led clinical trials in this space and participated in both cooperative group and industry-funded clinical trials throughout my career.

What gaps in research or evidence hinder the development of more effective care pathways for endometrial cancer?

Dr Dizon: Beyond deficient mismatch repair (dMMR) and HER2, we do not have sufficient biomarkers that predict response to treatments. As we move towards molecular characterization of these diseases—recognizing that endometrial adenocarcinoma likely comprises a collection of diseases that behave heterogeneously—it becomes more important to develop biomarkers that predict therapeutic approaches, rather than solely providing prognostic information.

What are the most pressing concerns for survivors of endometrial cancer, and how can pathways support their long-term care needs?

Dr Dizon: The treatment of endometrial cancer often requires surgery, radiation, chemotherapy, or a combination of these modalities. This can profoundly impact the pelvis, with vaginal toxicities—such as long-term vaginal agglutination—among the most serious. Attention to vaginal health and addressing the genitourinary symptoms of menopause are critical. Radiation can also result in long-term toxicities, including gastrointestinal dysfunction causing abdominal pain and/or diarrhea. Chemotherapy toxicities, such as neuropathy, may persist long after treatment concludes. Pathways should should address post-treatment care, suggesting referrals for specialist evaluation (e.g., sexual health specialists) wherever indicated. Too often, the follow-up after treatment is not covered in pathways, neglecting a holistic approach to patient care.

How do you approach integrating quality-of-life considerations into the treatment and management of endometrial cancer?

Dr Dizon: It starts with an understanding of what options are available and reviewing them with patients, ensuring they are informed of the benefits and risks. The choice requires information so that patients feel comfortable with the path that we agree to take. Quality-of-life considerations that are important can only be determined by the person facing those choices. The job of the clinician is to provide information and respect the choices ultimately made.

What role does psychosocial support play in the care of endometrial cancer patients, and how can it be better integrated into clinical pathways?

Dr Dizon: People with endometrial cancer likely experience heightened points of distress along their journey, whether that be when imaging is performed, treatment ends, or disease recurs. It is essential that distress monitoring is not a one-time event; patients should be systematically assessed throughout their journey, particularly during changes in disease state. Pathways can provide the important prompts to ensure that this is done.

What strategies can be implemented to improve communication between patients and providers about treatment options and potential outcomes?

Dr Dizon: Some centers already have systems in place, like we do at Brown. Our treatment team embraces the responsibility for follow-up of anyone on treatment, including call-backs 24 hours after treatment infusions. Providing patients with the ability to inform us of how they are doing without these prompts can also be very effective (e.g., use of electronic patient-reported outcomes [PROs]); however, we need to realize that this technology is unlikely to be universally embraced. Centers need to be sensitive to the diverse ways people choose to interact with their treatment teams and adjust accordingly. There is no one-size-fits-all solution.