Suzanne B. Coopey, MD, FACS, discusses ways that women in oncology can feel further supported and advocated for in the cancer care space.

Dr Coopey on Institutional and Societal Initiatives to Support Women in Oncology

Suzanne B. Coopey, MD, FACS, surgical oncologist, chairperson, Breast Cancer, AHN Cancer Institute, discusses strategies that can be implemented to support and further advocate for women in the cancer care space.

Women in oncology offer a unique perspective that patients, especially women, with cancer often deeply connect with, Coopey says. Female clinicians can relate to young, working mothers with cancer who are trying to balance their career, family, and the ramifications of their cancer diagnosis, Coopey explains. Clinicians who are women are also very empathetic, and there continues to be a need for them in the cancer care space, Coopey continues. Patients with cancer require a great deal of emotional support and women are good at listening to patients and advocating for their needs, Coopey concludes.

Women should continue to be encouraged to pursue medical and oncologic training, Coopey says. According to a study published in 

, women represent approximately 36% of the oncology workforce, but account for just 20% of full professors and one-third of department leaders. Although trends in a positive direction have been observed, the proportion of women who are authors in major oncology journals remains at approximately 20% to 30%. Additionally, women represented approximately 40% of invited speakers at international oncology congresses and one-third of board members of oncologic societies.

Moreover, study authors noted that there was a substantial increase in women’s leadership of clinical trials over time. In 1999, only 17.5% of clinical trials had a female primary investigator; this figure increased to 30.6% in 2019 (5-year interval: 17.5%, 22.1%, 25.6%, 28.9%, 30.6%), equating to an average annual increase of 0.65%. The investigators concluded that although positive trends are present, women as primary investigators remain the minority and significant differences remain between oncology fields, geographical regions, study phases, and funding agencies.

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Suzanne B. Coopey, MD, FACS, discusses the importance of addressing gender disparities in cancer care.

 Dr Coopey on Addressing Gender Disparities in Cancer Care

Suzanne B. Coopey, MD, FACS, surgical oncologist, chairperson, Breast Cancer, AHN Cancer Institute, discusses disadvantages that are often faced by female clinicians early on in their careers, highlighting the importance of addressing gender disparities in cancer care.

Early on in a woman’s career within the landscape of cancer care, these individuals can often be faced with challenges when taking time away from work to have children, Coopey begins. Taking a 2 to 3 month break for maternity leave can severely impede their careers when they are just getting started, Coopey says.

, early-career or trainee clinicians (n = 114) reported feeling overwhelmed with demands of work and home upon their return to work at a rate of 79%. Most respondents (60%) also reported feeling guilty when asking colleagues for help upon their return from parental leave and 50% felt pressured to work during their parental leave.

Additionally, only 19% reported having the option to work part time or choose lighter rotations during their transition back to work from parental leave, 32% said that they had additional responsibilities upon their return, and only 27% said they felt that they had the resources to address the transition back to work. Fellowship program directors or associate program directors of training programs who were surveyed (n = 23) reported that their current parental leave duration is either adequate (61%) or too short (39%). Over half of the directors (52%) reported that their institution had a differing parental leave policy for trainees compared with faculty.

Support for these issues can be provided in the form of dedicated time, resources, and a team of people who can continue the clinician’s research when they are not necessarily on-site each day, Coopey explains. Support on a personal level in terms of understanding the career and home life balance from colleagues is also crucial, Coopey explains. No clinician should reasonably be expected to continue research and other academic pursuits in the evening, on weekends, or at home, during time that should be spent with family, Coopey concludes.

Suzanne B. Coopey, MD, FACS, surgical oncologist, director, Wexford Breast Program, co-strategy and growth officer, Allegheny Health Network (AHN) Breast Cancer Program, AHN Cancer Institute, discusses the benefits seen with the de-escalation of axillary lymph node surgery for patients with breast cancer, as well as current recommendations for the de-escalation or omission of this procedure.

Axillary surgery is primarily performed to remove breast cancer that has already spread to nearby lymph nodes and prevent further metastasis. However, this procedure is associated with several complications, including arm lymphedema, chronic pain, chronic fluid collections, problems with range of motion in the shoulder, and axillary web syndrome, Coopey states. De-escalation of axillary surgery could reduce the likelihood of a patient with breast cancer developing these postoperative symptoms, Coopey says.

Axillary surgery consists of either sentinel lymph node biopsy (SNLD) alone, SNLB followed by axillary lymph node dissection (ALND), or ALND alone. There are several patient populations in which complete omission of axillary surgery, or de-escalation from ALND to SLNB alone should be considered, Coopey continues. According to the Choosing Wisely campaign, SLNB should not be routinely performed in women aged 70 or older who have early-stage endocrine receptor (ER)–positive, HER2-negative breast cancer, she says.

Additionally, ALND should be omitted in patients with 1 or 2 sentinel lymph nodes containing metastatic breast cancer provided they meet remaining criteria from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial (NCT00003855), Coopey details. These include histologically confirmed T1 or T2 invasive primary breast cancer, and no palpable axillary adenopathy. If patients convert from node-positive to node-negative status following the administration of neoadjuvant chemotherapy, ALND omission should also be discussed, Coopey notes.

Suzanne B. Coopey, MD, FACS, discusses the benefits seen with the de-escalation of axillary lymph node surgery for patients with breast cancer, as well as current recommendations for the de-escalation or omission of this procedure.

Suzanne B. Coopey, MD, FACS

Articles

Dr Coopey on Institutional and Societal Initiatives to Support Women in Oncology

Dr Coopey on Addressing Gender Disparities in Cancer Care

Dr Coopey on the Benefits of Axillary Surgery Omission or De-Escalation in Breast Cancer