Highlights of the #CANCERSM - Basics of Biomarker Testing Chat

We joined with the #lcsm, #bcsm,  and #btsm Twitter Communities and Dr.Tim Allen (@TimAllenMDJD) for this important discussion on Biomarkers. The chat focused on molecular biomarkers for cancer.

You may find the transcript here .

Below are a few highlights from last night's chat. Resources may be found at the end of the post.

T1: What is a biomarker and how is it identified?

• T1 A biomarker is a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease.
• T1 A biomarker may be used to see how well the body responds to a treatment for a disease or condition. Also called molecular marker and signature molecule.
• T1 Tumor markers, which are a type of biomarker, have traditionally been proteins or other substances that are made by both normal and cancer cells but at higher amounts by cancer cells.
• T1 Tumor markers provide information about a cancer, such as how aggressive it is, whether it can be treated with a targeted therapy, or whether it is responding to treatment:
• T1 A biomarker can be predictive of treatment response or prognostic for disease course independent of treatment
• basic info on Wikipedia: https://t.co/CfEcQ77LCv.
• T1 Cancer researchers are working to develop new biomarkers that can be used to identify cancer in its early stages, to predict the effectiveness of treatment, and to predict the chance of cancer recurrence.
• T1: In the brain tumor community, biomarkers are how we patients introduce ourselves to each other. No longer do we talk about the types or grades (i.e. stage) of our tumors, we talk about our biomarkers. For reals.

T2: What is biomarker testing used for?

• T2 There are two main types of tumor markers that have different uses in cancer care: circulating tumor markers and tumor tissue markers. 
• T2 Molecular biomarker tests are generally of three types of biomarkers: diagnostic, therapeutic, prognostic
• T2 Circulating tumor markers, which can be found in the blood, urine, stool, or other bodily fluids of some patients with cancer, are used, for example, to estimate prognosis and to assess the response to treatment.
• T2: Molecular biomarker testing involves laboratory tests that evaluate and identify the presence, on the surface of a cancer cell for e.g. a protein, or the identification of mutations or other changes in the cancer cell genes
• T2 Tumor tissue markers, which are found in actual tumors, are used to diagnose, stage, and/or classify cancer, to estimate prognosis, and to select an appropriate treatment (e.g., treatment with a targeted therapy)
• T2: In cancer, biomarker testing is analysis of DNA, RNA, or proteins that provide info about the diagnosis, prognosis, or are predictive for response to treatment
• T2 An example of a diagnostic biomarker is prostate-specific antigen (PSA) used for screening of prostate cancer. An example of a therapeutic biomarker is EGFR gene testing in patients with lung cancer.
• While the traditional breast carcinoma prognostic markers ER, PR, Her 2 neu predicts whether a patient will need hormonal therapy or chemotherapy or Herceptin, more recently in April 2019, immunotherapy has been approved by FDA in triple negative breast ca patients
• Many non-small cell #lungcancer people also identify with biomarkers--EGFR, ALK, ROS1, BRAF, NTRK, KRAS, RET ....
• T2: Diagnostic biomarkers help in the diagnosis of the cancer itself; therapeutic biomarkers help in determining whether or not a patient might respond to a molecular therapy; and prognostic biomarkers help determine the patient’s chances for long-term survival.
• T2: Here's an overview of what is being studied for #ovariancancer Diagnostic and Prognostic Biomarkers in ovarian cancer and the potential roles of cancer stem cells – An updated review https://t.co/Lo7npjtVOw

T3: What treatment options can be identified through biomarker testing?

• T3 A number of tumor markers are currently being used for a wide range of cancer types. Here’s a list of tumor markers in common use: https://t.co/NtPLX1lStR
• T3 In breast cancer, testing tumors for estrogen and progesterone receptors and the HER2 protein can help doctors help determine whether treatment with hormone therapy or some targeted therapies is appropriate.
• T3 In non-small cell lung cancer, an analysis of mutations in the EGFR gene can help doctors determine a patient’s treatment and estimate prognosis.
• T3: identifying #NTRK fusion in #glioma (est 1% of gliomas) opens up avenues for 2 therapies #btsm
• T3 in lung cancer oncogenic alterations in EGFR ALK ROS1 RET et cetera determine treatment choicces
• T3 In many types of cancer, seeing whether the tumor makes the PD-L1 protein can determine whether treatment with a type of #immunotherapy drug called an immune checkpoint inhibitor is appropriate.
• T3: and... finding #H3K27m mutations opens the door to try drugs like #ONC201 (as seen at #ASCO19
• T3: SO MANY OPTIONS can be identified through biomarkers. Hormone therapy, immunotherapy, targeted kinase inhibitors, antibodies like herceptin... They can also point to clinical trials
• Analysis of mutations in EGFR+ NSCLC (and other oncogene-driven cancers) can also help determine how to treat resistance to targeted therapies.
• In myeloma the expression of BCMA is used as a biomarker for CAR-T cell therapy
• T3: If the molecular biomarker testing shows that the patient's cancer contains the therapeutic target, then that patient might benefit from treatment with the corresponding drug. This is personalized medicine!
• T3 These drugs, like all drugs, have side effects, so beyond the needless cost, it is important to not treat patients with these molecular therapies if the biomarker testing shows that the drug would not benefit the patient

T4: What biomarker tests should be run for which types of cancers? What is a liquid biopsy and when is useful?

• T4 There are guidelines for what biomarker testing must be performed on different cancer types. https://t.co/0NmT5EaL4E
• T4: "Liquid biopsy" refers to molecular biomarker testing performed not on a patient's cancer tissue, but on cancer cells or cancer cell DNA or RNA that is floating in the blood stream.
• T4 For lung cancers, the minimum testing that must be performed is to look at the EGFR gene for mutations and ALK1 and ROS genes for rearrangements. Many pathologists examine other more recently recognized mutations.
• T4 A #liquidbiopsy is a test done on a sample of blood to look for cancer cells from a tumor that are circulating in the blood or for pieces of DNA from tumor cells that are in the blood.
• T4 For colon cancers, RAS gene testing to guide anti-EGFR therapy. BRAF mutational testing should also be performed for prognostic information.
• T4 For Breast cancers, the pathologist performs testing for estrogen receptor, progesterone receptor, and HER2 by immunohistochemistry
• T4 A liquid biopsy may also be used to help plan treatment or to find out how well treatment is working or if cancer has come back. Taking multiple samples of blood over time may also reveal the molecular changes taking place in a tumor.
• T4 From NCI’s Cancer Currents blog last year: Liquid biopsy may predict the risk of breast cancer returning years later: https://t.co/zuL4GnA0CV
• T4: Liquid biopsy is used in cases where a biopsy of a patient's cancer cannot be performed because the patient is too ill to tolerate the diagnostic procedure, or where the cancer site is difficult to access with a biopsy e.g., a lesion deep inside the body
• T4 And here’s an overview from 2017 of the evolving science around liquid biopsies and the important research questions: https://t.co/zqj48vhMbG
• T4: I love the quote about liquid biopsies-- It's like looking for a needle in a haystack. If you find a needle, it's a needle. But if you don't find the needle, it doesn't mean one's not there. A negative result always needs to be followed up by testing tissue
• Most liquid biopsy tests are not yet covered by insurance. However, most test manufacturers can provide some financial assistance.

T5: Can and should patients pursue biomarker testing for treatment options if their doctor does not offer it?

• Yes! Push for best care possible. It's my oncologist's job but it's my life
• T5 NCI does not have guidelines for the use of tumor markers. However, some national and international organizations have guidelines for the use of tumor markers for some types of cancer: https://t.co/o85pqHZKoy
• T5: Molecular testing and molecular therapy has become the standard of care for many cancers. Most doctors are performing the recommended molecular testing on particular types of cancer.
• T5 absolutely! doctor should always point out all possible options even if not available at his/her own institution
• As @JFreemanDaily bought up, the NCCN guidelines are a great resource and an excellent place for patients to find out what the current recommendations are and ask questions of their doc's if there is a variance https://t.co/X5OVXPY9g6
• T5 The basic question to ask your doctor is "Given my diagnosis, is molecular biomarker testing is right for me?" You can read about guidelines which are specifically designed for patients at 
• https://t.co/yyMAKwn2RK
• T5: Second opinions are almost always a good idea - especially in cancer. Seek doc's with high case volume of your specific type of cancer. You are you own best advocate and the science is changing fast
• T5: It's always a good idea to ask your doctor about molecular testing; but given the confusion in this rapidly changing area, it may be difficult to know what to ask your doctor. Feel free to call your pathologist and discuss!
• Get your pathology report and usually there's a phone number. If not, your hospital or clinic should be able to provide

We are so glad that #gyncsm could be an part of this important discussion. 

Dee
#gyncsm co-founder


Resources
Kyle Strimbu and Jorge A. Tavel, M.D. What are Biomarkers? (2011) https://t.co/CV1ROepZnS

NIEHS: Biomarkers https://t.co/cNuwLouCPJ

FDA: BIOMARKER TERMINOLOGY: SPEAKING THE SAME LANGUAGE https://t.co/Ua6gPOZevl

FDA: What Are Biomarkers and Why Are They Important? Transcript https://t.co/Ndpiy1XWlp

lay friendly overview https://t.co/GnpK7bWJkm #cancersm @CancerDotNet

This is a great slide. #MMSM #Biomarkers https://t.co/XvmjWfL296

Salivary Biomarkers: Toward Future Clinical and Diagnostic Utilities https://t.co/Q4bzv0UQoc 

Salivary biomarkers and proteomics: future diagnostic and clinical utilities https://t.co/Epp0cUOsdq

VOC breath biomarkers in lung cancer (2016) https://t.co/TmvUTPyxkp Blinded Validation of Breath Biomarkers of Lung Cancer, a Potential Ancillary to Chest CT Screening (2015) https://t.co/ccpsi93wS2

MIT Tech Review: Liquid Biopsy Fast DNA-sequencing machines are leading to simple blood tests for cancer. (2015) https://t.co/hw4kQVftKq

Biopsia líquida https://t.co/jsmZvQYM8H

"What is OK During Treatment" August 8, 2018 Chat

Tonight we had the chance to learn "What is OK during treatment?". We covered what is OK in terms of exercise, food, sexual intimacy and vitamins. We also allowed our participants to ask their own "Is it OK to..." question at the end of the chat. It was a pleasure for us to have Sangeeta Agarawal RN, Ms, CAS (@sanHelpsy), founder of Helpsy join us as a guest for this evening's chat and provide valuable information on a number of topics. 

You may find our transcript here and analytics here. 

We are happy to share a few highlights from tonight's chat below. Resources may be found at the bottom of this post. 


T1: Is it OK to… take supplements and vitamins during chemotherapy? How about during radiation therapy?

• It is important to let your MD know any vitamins/supplements you are taking to ensure that they will not counteract your chemo

• For example, antioxidants can counteract the effect of chemotherapy by clearing out the free radicals that damage the cancer

• We recommend a simple multivitamin during treatment for cancer

• You can find more information about herb supplements on NCCIH's HerbList App and Memorial Sloan Kettering's About Herbs app

• Avoid taking high doses of antioxidant supplements during chemotherapy and radiation treatments as they may interfere with treatment

T2: Is it OK to… exercise during treatment? Are there specific exercises that are good to do after abdominal surgery?

• We absolutely encourage exercise during treatment for cancer - it can help reduce stress and manage symptoms such as fatigue

• Start with light exercises - slow with yoga, walking or stretching, work your way up to cycling, swimming, aerobic exercise once you feel ready. Talk to your oncologist and care team to design the right fitness routine for you

• After abdominal surgery, it's important to avoid anything that strains your core/abdomen, stick w walking & low impact exercise

• Supervised resistance training is good during and after treatment as it helps maintain muscle and bone mass

• Try exercises like finger rolls, finger taps to help with neuropathy in your hands and fingers; exercises like calf raises, ankle circles, standing heel to toe for neuropathy in feet

• There are even tutorials for seated yoga - you can get in your movement in many different ways.

• Maintain a diary to record exercise sessions. Plan exercise for good and bad days, days when you experience intense symptoms

• And exercise (appropriate for your current level of health) is excellent for your mental health, too

• Exercise reduces fatigue at 40-50%, provides muscle strength, flexibility & general conditioning, control weight. Avoid swimming if on R/T chlorine irritate radiated skin as per reading

T3: Is it OK to… eat raw fruits and vegetables during treatment?

• Try to include colorful fruits and vegetables, at least 2.5 cups every day, be sure to wash them thoroughly

• Include citrus fruits like grapefruits and oranges and deep yellow and dark green vegetables

• very imp to wash them thoroughly before eating. Check any warnings about breakout of disease

• Vegetable sprouts such as mung bean, alfalfa, broccoli and radish should not be eaten raw, only consume pasteurized juices

• Do not consume from outside - fresh salsa or salad dressings found in refrigerated sections of the grocery store; shelf-stable salsa and dressings are okay

• This literature review found no need for a neutropenic diet: https://t.co/FBixFWj5Nt

• In case of loss of appetite or desire to eat, talk to your health care team about nutrition consult so they can suggest recommendations to help improve taste and appetite

• No need to avoid raw food completely! Avoid outside raw food. Avoid raw sushi

• I also tell patients that beware of coffee and soda. You don't get proper hydration from those products.

T3 cont'd - What about soy and soy products?

• Soy products contain phytoestrogens and not estrogen, soy contains essential amino acids, magnesium, potassium, fiber, and other vitamins. Try picking organic sources of soy

• Soy dietary supplements may not be a healthy choice, consult your physician 

• No harm in eating soy. Just ensure your body can digest it. Eat organic soy products.

T4: Is it OK to… have sexual relations while in treatment?

• No reason to avoid sexual relations, it is not sexually transmitted or contagious and won't cause the cancer to return

• You can absolutely have sex during treatment - there is no risk as long as you have the energy for it!

• If you are in the mood or have energy for it! Go for it! Sex releases happy chemicals and builds closer bond with partner. 

• Fatigue, pain, and discomfort after surgery could interfere with sexual relations, use vaginal lubricants to alleviate the pain

• Radiation may cause vaginal swelling and bladder inflammation, sexual relations may be comfortable after a short healing period of about 2-4 weeks 

• Cuddling, kissing and other forms of intimacy feel good too! :)

• It's very important to bring up this topic and discuss any questions. Many times providers and patients both avoid it, but it's an important part of our life that needs discussion and clarity 

T5: We’ll now open the floor to allow our participants to ask other “Is it OK to...” questions. What haven't covered? 

Question: How about getting your flu shot? I think it is ok with chemo and radiation but they aren't sure about getting it with immunotherapy and other new kinds of treatment....

• Usually it's given, but based on some treatments like immunotherapy - it may be held for a bit. Important to check with oncologist 

Question: Is it ok to be around kids or adults ( shingles ) who have had vaccines?

• Most are safe, but when WBC is very low, better to avoid contact during days of nadir/lowest white blood cell count

Question: For nutrition and exercise... any different recommendations for immunotherapy vs. more standard treatments? Or is there not much studies on that yet?

• so far, our recommendations for nutrition and exercise don't change for immunotherapy - we are still learning though

Thank you everyone who took part in our discussion. Remember if you are a patient or caregiver you may continue this discussion on the Smart Patients Platform ( https://www.smartpatients.com/gyncsm ). 

We hope you will join us for the next #gyncsm chat: Wednesday, September 12, 2018 where in addition to chatting about on We need support - Where do we find it?.  We will also be celebrating the #gyncsm Community's 5th Anniversary. 

See you in September. 

Dee
#gyncsm co-founder


RESOURCES

Taking vitamins/supplements:

https://blog.dana-farber.org/insight/2014/02/should-i-take-vitamins-and-supplements-during-cancer-treatment/

Supplement Showdown : A Look at Vitamins and the Fight Against Cancer
https://www.curetoday.com/articles/supplement-showdown-a-look-at-vitamins-and-the-fight-against-cancer-

Dietary Supplements During Cancer Treatment: Yes or No?
https://health.usnews.com/health-news/patient-advice/articles/2015/07/01/dietary-supplements-during-cancer-treatment-yes-or-no

ACS @AmericanCancer website
https://www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine/dietary-supplements.htm

Exercise:

http://ovarian.org/component/content/article/33-latest-nocc-updates/362-tips-for-exercising-during-and-after-cancer-treatment

https://www.roswellpark.org/media/news/exercise-may-reduce-risk-cervical-cancer

http://exerciseismedicine.com.au/wp-content/uploads/2016/11/2014-Gynaecological-Cancer-FULL.pdf

pelvic exercises via @PelvicGuru1
 https://pelvicguru.com/2013/12/28/what-is-pelvic-physical-therapy-and-why-doesnt-everyone-know-about-it/

Eating raw fruits and vegetables:

https://www.cancer.org/content/dam/cancer-org/cancer-control/en/booklets-flyers/life-style-changes-that-make-a-difference.pdf

http://www.aicr.org/new-american-plate/cancer-preventive-diet-model-plate.html

https://medlineplus.gov/ency/patientinstructions/000061.htm

Savor Health blog
http://savorhealth.com/blog/

Health Care System Eliminates Neutropenic Diet in Patients with Cancer with no Rise in Infection
https://www.curetoday.com/articles/health-system-eliminates-neutropenic-diet-in-patients-with-cancer-with-no-rise-in-infections

Eating soy: 

https://www.oncologynutrition.org/erfc/hot-topics/soy-and-hormone-related-cancers/

Tamar Rothenberg, RDN Is Soy Helpful or Harmful for Cancer Patients
https://www.tamarrothenbergrd.com/single-post/2018/01/10/Is-soy-helpful-or-harmful-for-cancer-survivors

@fredhutch Soy Is it Safe for Cancer Survivors
https://www.fredhutch.org/en/treatment/survivorship/survival-strategies/soy-safe-for-cancer-survivors.html

Having sexual relations during treatment:

https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/problems.html

https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/faqs.html

Guide to Sexuality During & After Cancer Treatment
https://www.oncolink.org/support/sexuality-fertility/sexuality/women-s-guide-to-sexuality-during-after-cancer-treatment

Foundation For Womens Cancer
http://www.foundationforwomenscancer.org/wp-content/uploads/Sexuality-Brochure_Final.pdf

Mindy Schiffman, PhD. Sexuality and Intimacy after Cancer in this video
https://t.co/8bw9Lr79Zc

Be around children who are recently vaccinated: 

https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/infections/vaccination-during-cancer-treatment.html

Eating cake and sugary foods:

https://www.oncologynutrition.org/erfc/healthy-nutrition-now/sugar-and-cancer/

Miscellaneous:
The Chemotherapy Survival Guide Authors Judith McKay, RN, OCN and Tamera Schachen, RN, OCN, MSN

August 8, 2018 What is OK during Treatment?

Over the past few years #gyncsm has heard questions from women about what they should or should not do during treatment. Such as, is it OK to...

• exercise? 
• eat raw fruits and vegetables? 
• have sexual relations during treatment? 
• take vitamins? 
• eat soy or not? 
• take supplements during chemotherapy? 
• be around children who have recently been vaccinated? 
• eat cake and other sugary food?

Even as treatments options are expanding for women diagnosed with a gynecologic cancer - from chemotherapy and radiation therapy to targeted therapies and immunotherapies - women still are looking for guidance in these areas.

Join us as this month as we welcome Sangeeta Agarawal RN, Ms, CAS (@sanHelpsy), founder of Helpsy "an integrative medicine platform for improving symptoms and health outcomes", as our guest. Sangeeta has long been involved with the Stanford MedicineX conferences and her mission is to empower people with the best quality of life by bringing together the best of eastern and western medicine and disseminating it using the power of technology. Sangeeta hosted a panel discussion in 2016 with the Oncology Nursing Society: Complementary & Alternative Medicine – A 360-degree View.

During the chat we'll be sharing information such as this National Comprehensive Cancer Network article on Exercise During Cancer Treatment and Memorial Sloan Kettering Cancer Center's article on Eating Well During and After Your Treatment.

We look forward to seeing you on Wednesday, August 8, 2018 at 9pmET (8pmCT, 6pmPT).

Dee
#gycnsm Co-Founder

Dealing with Side Effects - August 12,2015 Chat

A wealth of information and support was shared during the night's chat on Dealing with the Short and Long Term Side Effects of Gynecologic Cancer Treatment. The lively chat included twenty-five participants including Dr. Matthew Katz, Dr. Anne Becker-Shutte and Dr. Elizabeth Dickson.
We had over 999,000 impressions with 15 tweets per participant.

Here are the questions that guided our chat and a sample of responses.

T1: Let’s start w/ surgery side effects...  Which affected you most? Which do patients say are most impactful? Tips to address?

T1: via MS @smartpatients “worst part of surgery was the pain meds after and the side effects of those, constipation” #gyncsm

— Women of Teal (@womenofteal) August 13, 2015

@edicksonMD: T1: Re pain meds: ask your provider for alternatives to pain medication. Advances in local pain control are happening!! #gyncsm

— Elizabeth Dickson (@edicksonMD) August 13, 2015

T2: Now let's talk about chemo. What were your side effects? Which are common? How aware of side effects are patients before start?

#gyncsm extreme nausea, shortness of breath, changes in mental status/chemobrain, extreme fatigue constipation fear shakiness anxiety

— Denise Archuleta (@Servivorgirl) August 13, 2015

T2: adjusting support meds and even dosing or schedule of chemo drugs can help with side effects. Discuss with your doctor #gyncsm

— Elizabeth Dickson (@edicksonMD) August 13, 2015

T3: What are some of the side effects of radiation? Which did you experience? What are patients most concerned about?

@gyncsm T3: Depends upon treatment type, external beam or brachytherapy, and location of treatment #gyncsm

— Matthew Katz (@subatomicdoc) August 13, 2015

@womenofteal T3. Fatigue, skin redness/irritation, hair loss in treated area common. #gyncsm

— Matthew Katz (@subatomicdoc) August 13, 2015

T4: For targeted therapy (TT) - Oliparib, Avastin, etc. - what are the side effects? Different from chemo?

T4: there can be high blood pressure and skin issues with targeted therapies #gyncsm

— Christina Lizaso (@btrfly12) August 13, 2015

T4: Good general info on side effects for Targeted Therapy from @NCI http://t.co/YjAGKB9Db7 #gyncsm

— Women of Teal (@womenofteal) August 13, 2015

T4: Many targeted therapies are still being studied. Whole side effect profile may not be known. Make sure to ask questions #gyncsm

— Elizabeth Dickson (@edicksonMD) August 13, 2015

T5: What side effects persist? Have you talked to your provider about them? Other side effects we haven't covered so far?

@btrfly12 #gyncsm My PCP manages most of the side effects but requires a lot of communication. I am 6 years out OC, praise God

— Denise Archuleta (@Servivorgirl) August 13, 2015

T6: What impacts are you willing to deal with to get more effective treatment? Have we seen changes in how side effects are managed?

T6: excellent question and one as individual as each woman fighting cancer. Only you know the answer and what is right for you #gyncsm

— Elizabeth Dickson (@edicksonMD) August 13, 2015

To read the complete transcript visit Symplur here.

Remember if you are a patient or caregiver you can join us and continue the conversation on the Smart Patients Platform at https://www.smartpatients.com/gyncsm. 


Our September chat will mark our 2nd anniversary as a health care chat and community on Twitter. We hope you can join us on Wednesday September 9 at 9pm EST . Our topic that night will be Gyn Cancer Awareness Month - Spotlight on Uterine/Endometrial Cancer. 

And as the song goes "See you in September..." .

Dee
#gyncsm co-moderator

Resources mentioned during the chat:

Insights Into Preferences for Psycho-Oncology Services in Women With GYN Cancer Following Distress Screening: http://t.co/7Lb70v9UeZ

Hair Loss: Research with DigniCap presented at #ASCO15 http://t.co/GF5MSXbSb2

Infographic from @NOCC_Illinois https://t.co/fJpNGSBnKh

How To Deal With Surgical Menopause? Helpful questions & answers http://t.co/Xz9UloxXjl

The #NCCN Patient Guidelines for Ovarian Cancer http://t.co/QMxTSiFOTG

Complementary and Alternative Medicine - National Cancer Institute http://t.co/fZuf5f4aMN

Side Effects of Radiation Therapy via ACS: http://t.co/P2ma187CqM

Radiation Therapy from the Foundation for Women's Cancer @GYNCancer http://t.co/2NfK8BvZGQ

Specific cancer information from SGO Patients, Caregivers and Survivors | SGO https://t.co/6pRgApbwyp

Overview page per side effect from @PRPCancerGuide and downloadable guide http://t.co/vMnLWw7ScR

Long-term side effect info from @cancerdotnet http://t.co/nymF9z7fW9

Additional Resources on Side Effects:

Radiation oncology:  @RWJMS

http://rwjms.rutgers.edu/departments_institutes/radiation_oncology/clinical/programs/gynecologic.html#potential

Foundation for Women's Cancer 

Surgery: http://www.foundationforwomenscancer.org/types-of-gynecologic-cancers/ovarian/surgery/

Chemotherapy:http://www.foundationforwomenscancer.org/types-of-gynecologic-cancers/ovarian/chemotherapy/

Coping with Side Effects:

http://www.cancer.net/cancer-types/ovarian-cancer/coping-side-effects