Select Page

[av_textblock size=’12’ font_color=” color=” admin_preview_bg=” av_uid=’av-jlhrtw’]
[av_breadcrumbs]
[/av_textblock]

[av_hr class=’invisible’ height=’10’ shadow=’no-shadow’ position=’center’ custom_border=’av-border-thin’ custom_width=’50px’ custom_border_color=” custom_margin_top=’30px’ custom_margin_bottom=’30px’ icon_select=’yes’ custom_icon_color=” icon=’ue808′ font=’entypo-fontello’ admin_preview_bg=” av_uid=’av-huw9ac’]

[av_textblock size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” font_color=” color=” id=” custom_class=” av_uid=’av-fjefes’ admin_preview_bg=”]
9/17/2021

Chemotherapy, Part 2

Season 1, Ep. 4

Welcome to the Ovarian Cancer Education Podcast, a podcast centered around a cancer diagnosis and what that means, a podcast created to help physicians and patients learn from each other, connect, and share stories and knowledge. Today’s episode will focus on treatment options for ovarian cancer.
[/av_textblock]

[av_hr class=’invisible’ height=’10’ shadow=’no-shadow’ position=’center’ custom_border=’av-border-thin’ custom_width=’50px’ custom_border_color=” custom_margin_top=’30px’ custom_margin_bottom=’30px’ icon_select=’yes’ custom_icon_color=” icon=’ue808′ font=’entypo-fontello’ admin_preview_bg=” av_uid=’av-e46pyc’]

[av_codeblock wrapper_element=” wrapper_element_attributes=” codeblock_type=” alb_description=” id=” custom_class=” av_uid=’av-19ep5g’]

[/av_codeblock]

[av_toggle_container faq_markup=” initial=’0′ mode=’accordion’ sort=” styling=” colors=” font_color=” background_color=” border_color=” colors_current=” font_color_current=” background_current=” background_color_current=” background_gradient_current_color1=” background_gradient_current_color2=” background_gradient_current_direction=’vertical’ hover_colors=” hover_background_color=” hover_font_color=” alb_description=” id=” custom_class=” av_uid=’av-apjuro’]
[av_toggle title=’Read the transcript:’ tags=” custom_id=”]
Vanessa:
Welcome to the Ovarian Cancer Education Podcast, a podcast centered around a cancer diagnosis and what that means, a podcast created to help physicians and patients learn from each other, connect and share stories and knowledge. This is the second part of a two-episode podcast on chemotherapy. The first part is being released at the same time and can be found at any major podcast app or at www.ovariancancerpodcast.com. I’m Vanessa, and I’m joined today again by my guest moderator, Rachel.

Rachel:
Thanks for having me back, Vanessa. Hi, I’m Rachel.

Vanessa:
We touched on chemotherapy a bit in our treatment options episode, but this time we’re focusing on just that, we’re going to talk to an ovarian cancer survivor named Eva, and we will also be joined by Dr. Anna Hoekstra, a gynecologic oncologist at the West Michigan Cancer Center in Kalamazoo, Michigan, and Dr. Catherine Christen, a clinical pharmacist who specializes in oncology pharmacy at Michigan Medicine in Ann Arbor, Michigan. They’ll help us understand a bit more about chemotherapy and Rachel and I will help fill in the gaps. If you’re listening to this podcast, there’s a good chance that you or a loved one have been diagnosed with ovarian cancer, which can be a scary and uncertain time. This podcast will help provide information and insight, but there is a wealth of other resources out there for you, and we have included some of those resources in the show notes for this episode.

Vanessa:
We have also helped develop a patient navigation line with the state of Michigan to help patients find gynecologic oncologists. The phone number for that line is 1-844-446-8727. Just as a starting point, it’s really important to realize that the experience of chemotherapy is completely different for every patient. No two patients experience chemotherapy in the same way. It’s about biology and what makes their body different from all of the other bodies. One patient might experience a really extreme side effect, and another patient on the exact same drug for the exact same cancer might not experience that side effect at all. So Eva’s story will act as a guide for us and Dr. Hoekstra and Dr. Christen can help us understand some of the other things they’ve seen people go through, but if you’re listening to this and something you’re experiencing isn’t covered in this episode, communicate with your doctor’s office.

Rachel:
So in the first part of this topic, Eva told us that she had surgery first and then started her chemotherapy.

Vanessa:
Right, and Eva was one of the small number of patients whose first infusion was difficult.

Eva:
I had many side effects from chemotherapy, especially with the first treatment. I was the exception to the rule. They told me that if you were 60 or older, you would have less side effects. And they started my treatment. I would have an hour of premeds, they would load me up with Benadryl, with a steroid and with a long-lasting anti-nausea medication. And that took about an hour, my first hour when I’d come in for treatment. Then they’d move on to the Taxol. I was nervous, but I had a magazine with me, so I was trying to keep my mind distracted, I found an article, I’m going to read this and just keep my mind off it. And they said, “Okay, we’re starting the drip.” And I’m not sure what it meant, but there was a number of 181 that they set the drip to. And I was in the chair 10 minutes and I felt like someone kicked me in the stomach. It was terrible.

Rachel:
That sounds scary.

Vanessa:
Yes, but even in rare experiences like that, there are support staff all around to help.

Eva:
So they stopped the drip, that was the first thing they did, and then they got some oxygen. And it was only a couple minutes after they stopped the drip, everything went back to normal. I was fine. So they restarted the drip in about 15 minutes. They let everything calm down real good, and then they restarted the drip, but they started it at a lower number. It was below 100, whatever that number means. And then every half hour they would increase it by 10 until I got back up to the 180. So I didn’t have any issues with the Carboplatin on that first treatment. And when I got home, I was okay, no problems.

Rachel:
And what about the rest of her treatments?

Vanessa:
She can fill you in.

Eva:
Yeah, I did talk to the nurse practitioner when I went in for my exam before the second treatment and told her I’m really nervous about this. And she said, “Well, I have to tell you that most people, it will lessen if you had side effects during treatment, that it’ll get better with each treatment.” And she was right, she was absolutely right.

Vanessa:
There can be other reactions to infusions and Dr. Christen will tell us about that. Remember, as you’re listening to this podcast though, that all of the reactions and side effects we’re covering are maybes, there are things to look out for and to communicate about with your care team. That team is there to support you through your experience and many patients experience absolutely none of these.

Dr. Christen:
Things you might notice would be like itchiness or wheeziness or hives. The nurses will be checking your blood pressure fairly frequently during the infusion because sometimes the reactions can be signaled by either blood pressure increases or decreases. So you want to make sure you report anything that doesn’t feel quite right, including burning with the infusion because sometimes IV catheters can poke out of the vein and cause infiltration or leaking of the chemotherapy into your arm.

Rachel:
Okay, so it’s important to not be too shy about things you don’t understand.

Vanessa:
Yes, exactly, that’s why your team is there.

Rachel:
And are there side effects when you come home?

Vanessa:
Always different for different patients, of course, but here’s what Eva has to say.

Eva:
After I got home, everything was fine. I just felt kind of odd. You had all these medications in you and it was the next morning because I had to take orally some steroid tablets. They had also given me a anti-nausea pills, but the next morning I was real shaky, real jittery. I was unable to hold a fork to eat or to write anything down, just really jittery. So I called the primary care nurse at the oncologist’s office. They felt that it was the steroid because I was not used to taking anything like that.

Rachel:
Oh, it wasn’t even the chemotherapy in this case.

Vanessa:
Right, when you’re going through cancer treatment, there are so many factors in play. There has to be regular communication about everything.

Eva:
When I went back for my second treatment, we went through the same thing, the hour of the premeds and then they started that Taxol and they started it lower. They started it at around 100 and they were going to move it up every 20 minutes rather than half hour. And the only thing that happened that time was I got some hives, so they did stop and let things calm down. And then when they restarted, I was fine and I never had another reaction to the Taxol with the remaining four treatments.

Vanessa:
We can have Dr. Christen tell us more about rashes and hives with chemotherapy.

Dr. Christen:
Yeah, sometimes we see rashes with chemotherapy. Sometimes those are just minor rashes and sometimes they can be very extensive rashes. So any rash that you get, you should report to your doctor’s office. And very rarely, sometimes we can see shingles outbreaks, which is a very well described rash, usually on your trunk or on your head. The danger with that is sometimes people can get a permanent nerve tingling unless we use antiviral therapy. So sometimes it… A rash can also be related to an infection, but most often it’s just a drug side effect and it may mean that we need to change your chemotherapy if the rash is bothersome enough.

Rachel:
So sometimes the reactions are specific to the drug chosen and switching it can help.

Vanessa:
Yes, it’s always a balance of finding the drug that’s helping fight the cancer the best, but also giving the patient the least amount of side effects.

Rachel:
It’s good to hear that Eva had an easier time with her remaining treatments than her first.

Vanessa:
I definitely agree.

Eva:
When I got home, I always followed the same pattern of the fourth, fifth day, losing my appetite and just not wanting to eat, being tired and having a day in bed, but it would pass.

Rachel:
Loss of appetite and fatigue.

Vanessa:
Right, let’s start with fatigue, Dr. Christen can tell us more about what she’s experienced with her patients.

Dr. Christen:
Usually the week after chemotherapy, that’s usually when people are more tired, they may need to rest more, take naps during the day. They may not be able to work. Depending on their job, they might be able to work part-time, but if you have a very physical job, you might not be able to work during that first week after the chemotherapy. And your boss may dictate that you just you can’t work an intermittent schedule, but people usually are most tired that week after the chemotherapy. The second week, they usually have a little bit more energy, are able to do more things. And then the third week, they may actually feel like they’re almost back to normal, but not quite. So you may need more help around the house, as far as usual things that you’re doing, as far as cooking or laundry, you may need to have someone help you with that, or going up and down the stairs multiple times a day, you may want to only make a couple of trips. So it really is very dependent on the chemotherapy drugs that we’re giving you. But most people do experience some tiredness and you really just need to pace your activities, especially to prioritize the things that are really important for you to do.

Vanessa:
And she can weigh in on nutrition too.

Dr. Christen:
Well, one of the things that can be very helpful is trying to maintain a good nutritious diet, especially a well-balanced diet that has a fair amount of protein in it, not an overly huge amount of protein, but just trying to emphasize more higher protein foods. Chemotherapy oftentimes can cause some taste changes so a lot of your favorite foods might not taste good to you and your appetite is going to be low, so people may take a few bites of something and then say, “Okay, I’m done.” It’s important to go back in a couple of hours and try to eat a little bit more to try to stay on top of your nutrition, because good nutrition really does help prevent side effects. And you might even need to use nutritional supplements like Boost or Breathe or Ensure, but the taste changes, sometimes people will have a metallic taste in their mouth. It just really makes some foods not taste appetizing.

Dr. Christen:
The other thing that I tell people to avoid really spicy or greasy foods, foods that will trigger heartburn, especially right after chemotherapy, because that could potentially trigger a nausea episode or even vomiting. So I always tell people eat a little bit more blandly right after the chemotherapy. On the day of chemotherapy, people will oftentimes be eating during their treatment, so you’ll see that as well. I’ve had people who’ve just bottled water, they are having difficulty finding a bottled water that is appealing to them, that they notice the minerals in it, for instance, that can be bothersome. So nutrition is one thing that can be helpful. Trying to be as active as you can be without making yourself tired can also be helpful from a mental health standpoint, as well as a physical standpoint, just engaging with family and friends can also be helpful. The one thing that you do need to be mindful of is that people that are actively sick, you want to avoid being around them because your immune system is going to be compromised and you are at greater risk for infection.

Rachel:
I know nausea and vomiting are usually associated with chemotherapy.

Vanessa:
True, and that’s a good example of how all patients are different. Eva didn’t experience that.

Eva:
They did give me anti-nausea medications. And I took… I had three of them, I took one pill once and it was that first morning after the first treatment when I was so jittery, just because I thought that that might help, but it didn’t help. And I never took another one. So I had these three prescriptions that I never even needed. I was not sick at all the way that people are told to think about chemotherapy.

Rachel:
Interesting.

Vanessa:
Let’s have Dr. Christen tell us more about nausea for the people who do experience that side effect.

Dr. Christen:
Side effects are fairly well managed. As far as nausea over the last 30 years or so, we have seen a huge development of new anti-nausea medications. And so usually people will get anti-nausea medications before their chemotherapy is administered. And that treats usually the sort of the acute nausea that can occur over the first 24 hours. But people will oftentimes see delayed nausea that can occur over the next two to four days. And so we actually have people take nausea medications on schedule at home to prevent this delayed nausea. So we’ve seen a huge improvement in our nausea medications.

Rachel:
Are there other side effects people experience from chemotherapy?

Vanessa:
Dr. Hoekstra can give us an overview and we can break down some of the side effects we haven’t covered yet.

Dr. Hoekstra:
The most common side effects of chemotherapy include GI issues, such as nausea and bowel dysfunction. Most patients don’t have any vomiting during chemotherapy, but most have some degree of nausea. Bowel dysfunction can include either constipation or diarrhea or alternating constipation and diarrhea during one cycle of treatment. Many patients experience fatigue as well and many patients have hair loss, which starts usually three to four weeks after the start of treatment. A few patients also experience neuropathy, which is numbness and tingling, and sometimes cold sensitivity of the fingertips and toes. This, many times, is reversible but sometimes is not.

Rachel:
We talked about nausea and fatigue.

Vanessa:
Yes, and she also mentioned diarrhea and constipation, neuropathy and hair loss. So diarrhea and constipation, sometimes the chemotherapy drugs are broken down by the liver and then eliminated from the body through the bowel. That can cause problems with the GI system like diarrhea and constipation. Medications can help so remember to report in on any of those problems. It can be difficult to talk about, but your care team is completely comfortable with it.

Rachel:
What is neuropathy exactly?

Vanessa:
It’s damage or dysfunction of nerves. It usually leads to numbness, tingling, or weakness. Dr. Christen can tell us more.

Dr. Christen:
Usually we see this in hands and feet and that can sometimes start to become painful. And so usually when it is starting to become more bothersome, as far as nerve tingling, your doctor may adjust your chemotherapy, either lowering doses, or maybe even changing the drugs because once it starts, there can be a progression of symptoms to nerve tingling to pain. And if we just kept going full speed ahead, sometimes people could have some motor difficulty like handwriting or potentially even walking, and that’s absolutely where we don’t want to go.

Rachel:
Are there things that can help?

Vanessa:
Yes, Eva was actually asked to take vitamin B6.

Eva:
Before I started chemo, they had told me to be on vitamin B6, that it helps with nerves, nerve endings and can help curtail neuropathy. And it does seem to be helpful, I do have neuropathy maybe one or two nights after treatment, but it’s nothing that I can’t live with. And I do look up a lot online whenever I have a question and I keep a notebook. I would recommend to anybody to keep a notebook of your appointments and who you saw and any comments or anything, because it helps you if you end up having to fill out insurance papers or anything, you’re not trying to recall. There is definitely something called chemo-brain that I’ll throw in there. The chemo nurses told me to expect it, and it’s true, just kind of a fogginess to your thoughts and not being able to recall things as quickly.

Eva:
So I think that everyone should be aware of that and the notebook has helped me considerably. So if I’m online and I want to look up things the doctor had said, I shouldn’t be surprised if he recommends a PARP inhibitor in the future. And I wanted to know about PARP inhibitors, so I started reading online and I had questions and I always put them in my notebook and take it to Patty, the nurse practitioner, and ask her. And most of the time she will tell me, “Don’t believe everything you read.”

Rachel:
So what is a PARP inhibitor?

Vanessa:
A PARP inhibitor is a type of drug. PARP stands for poly ADP-ribose polymerase, which is a huge long word. PARP helps damaged cells repair themselves and cancer cells are damaged cells. So a PARP inhibitor stops cancer cells from repairing themselves and they die.

Dr. Christen:
So there’s three PARP inhibitors that we use for ovary cancer, Olaparib, Rucaparib, as well as Niraparib. And Olaparib was the first one that came out onto the market, but the other two agents are also available. So these are oral agents that are taken on a daily basis to keep your cancer in remission. And they work best if you have a BRCA mutation. So all patients with ovarian cancer, at some point in their treatment process are offered genetic counseling and testing if the patients opt to do that, to determine if you have this mutation or other mutations as well, which may be useful to us down the road if we need to target your tumor with treatment.

Rachel:
But I take it they work better with some patients than others?

Vanessa:
Exactly, and there are other factors that come into play. Dr. Christen can give us an example.

Dr. Christen:
So for instance, with our PARP inhibitors, I actually tell people not to eat grapefruit because it can increase likelihood for side effects because it interferes with one of the pathways that clears the drug from your body.

Rachel:
Okay, I think I got the basic idea. I think the last thing Dr Hoekstra brought up was hair loss, that’s a big topic in ovarian cancer, right?

Vanessa:
You’re definitely right. Let’s let Eva tell us about her experience.

Eva:
I asked the oncologist on my appointment after surgery, how soon I would lose my hair. And he said, “Most people lose it 10 to 14 days after their first treatment.” And for me, the thought of that was devastating because I always liked my hair. I was all… I was completely gray at the time, but I colored it and I felt like it was a good color. And I just liked my hair. So I did not start to lose my hair. Then after the second treatment, which, and my treatments were spaced three weeks apart, after my second treatment, it was just a couple days after, and it started to fall out.

Eva:
I had been told that it would come out in clumps, that I’d find it on my pillow in the morning and things like that, and that never happened. It was just if I went to run my hands through or to comb it, and there would be a lot of hair coming out. It thinned considerably, but it wasn’t until it was almost Thanksgiving when it was so thin that I couldn’t stand it. And I ended up taking an electric shaver and just going down to a brush cut, maybe a quarter inch long. And it was hard, but once it was done, I felt like I could breathe again. And I was prepared. I had already bought all my caps and things like that.

Rachel:
She mentioned caps. I know she probably meant regular caps, but I’ve also heard of these things called ice caps that try to stop the hair loss.

Vanessa:
Dr. Christen went into that a little with me.

Dr. Christen:
Some infusion centers are using ice caps that has worked well for some patients and not so well for others. It is using dry ice with connected to a cap on your head and you change out the dry ice. So it’s very, very cold. A lot of patients complain of the coldness and the may have a headache, and then they lose their hair anyway. But I have seen some good results, but not all infusion centers offer this. We don’t at our center, but we do allow patients if they want to contract their own to use and sort of an ice cap. In the past, when we use ice bags, just a bag with ice cubes in it, we tried that back in the ’70s and ’80s, that really wasn’t that effective. So just using an ice bag on your head really doesn’t do the trick.

Rachel:
Okay, so it works for some, but certainly not for all.

Vanessa:
Yes, that’s what I heard from her too.

Rachel:
And I imagine that only works on head hair when it works, do you lose your body hair too?

Dr. Christen:
Some of our chemotherapy drugs do cause hair loss, others don’t. Taxol, which we oftentimes use for ovarian cancer, usually causes complete hair loss of head hair, but also other body hair, such as underarm hair, leg hair, and sometimes the hair inside your nose. So sometimes people will have a sniffy nose, but usually once we’re done, it can be slow, but usually a couple of months after the chemotherapy has been completed, people will have regrowth of hair, although it can be slow and it can be different. The texture can be different. It can be thicker or thinner. It could be different color. It could be curly.

Rachel:
Did Eva’s hair come back?

Vanessa:
Let’s ask her.

Eva:
So I was able to keep my hair longer than most women do, which was nice. And then as soon as I stopped that Taxol, which I believe was December 16th was my last Taxol treatment, and when I… By the time I saw the doctor first week in January, it was already starting to grow back. So I don’t know if you can see it, but it’s kind of… I’m naturally brunette, but it’s getting long, it’s over a quarter. It’s probably coming up on a half inch now. So it’s coming in thicker and yeah, I… My hair grows fast, so I’m hoping it stays that way. I was told you don’t know how it’s going to come back when it does come back. It seems like what had been left on my head that hadn’t fallen out is silver-white right now. And all my new growth is dark, brunette dark.

Rachel:
That’s great.

Vanessa:
Agreed.

Rachel:
Are there other side effects we haven’t covered yet?

Vanessa:
I asked Dr. Christen that, and she told me a bit about something called tinnitus. She can explain more.

Dr. Christen:
With some of our platinum agents, they will have ear ringing or what we call tinnitus with the Carboplatin or Cisplatin, and that can be very annoying, as if anyone has had ear ringing before. And it usually is somewhat constant during the chemotherapy. And it’s because the platinum agents can damage the audic nerve. So it also can cause some nerve damage. And sometimes if people have hearing loss already before we start, that hearing loss can actually get worse, we may need to adjust hearing aids afterwards.

Vanessa:
And then she also always tells her patients to look for signs of infection.

Dr. Christen:
And then low blood counts, especially risk for infection. So any symptoms of infection, such as fevers, cough, sore throat, sinusitis, as far as burning when you urinate, maybe like you have a bladder infection, all of those can be early warning signs of infection. So you don’t have to continuously take your temperature but if you don’t feel well, you should take your temperature. And each doctor has sort of different breakpoints as far as when they want you to call. But if you have symptoms of infection, but don’t have a full-blown fever, and sometimes that happens when your white blood count is low, you should still call because we want to intervene with antibiotic therapy as early as possible. And sometimes we may need to use antifungal therapy if people have mouth sores and thrush inside of their mouth.

Rachel:
So you have to be paying attention all the time, stressful.

Vanessa:
It can be, Dr. Christen recommends trying to stay positive.

Dr. Christen:
So just trying to do everything you can to be maintaining positive attitude. We have people that can help because it’s very easy to spiral into anxiety, be overwhelmed with depression. So we try to keep people in a positive mind space. And it’s easy to, just because of all of the life changes that have happened, it’s very easy to become very anxious or depressed, and that can actually be very counterproductive. So reaching out to mental health providers can really be of benefit to you.

Rachel:
That’s smart.

Vanessa:
Yes, and there are a ton of different relaxation techniques like meditation, lighting candles, playing calming music or uplifting music depending on your mood. It really can’t be overlooked just how helpful those things can be. Let’s let Eva give us some final advice.

Eva:
I would say lessons learned, pay attention if something’s not right. If you just have an inkling that this isn’t good or this isn’t right, pay attention to it and get in and see somebody. I don’t know if it was luck that my situation moved as quickly as it did from the time I was in the emergency room, it was like July 30th, to my surgery, August 17th, three weeks. It was quick, real quick, everything moved quickly. And I think that benefited me. I think that you’re better off to surround yourself with people who will take care of you. My husband, my kids are both grown, I have a son and a daughter. My grandkids just make me smile. So that’s good. And I still have my parents, they’ve been very supportive and two sisters. So just make sure you have good people around you.

Rachel:
Good people around you, that’s a great reminder that it’s okay to ask for help.

Vanessa:
Going through cancer isn’t easy. Like we said, in the last part of our chemotherapy topic, we hope this helps you feel like you’re not alone. And there are resources available to you. The side effects that we covered in this episode are some of the most common, but there could be others we haven’t covered. As one last reminder, any side effects vary from patient to patient and from drug to drug. We don’t want to scare you, we’re just hoping to shed some light on issues that some patients experience to help educate and support. Remember that your physician’s office is an invaluable resource for you. They are there every step of the way, and it is okay to ask for help. As we find or develop resources, we’ll continue to list them in our show notes. Thank you again for joining us.

Vanessa:
The information contained herein is information only. Users are solely responsible for all medical care and services delivered to their patients and all decisions related to such medical care and services. Neither MOQC, nor other regions of the University of Michigan shall be responsible for any delivery of medical care or other services to any patient or any decisions, acts or omissions of persons in connection with the delivery of medical care or other services to any patient.
[/av_toggle]
[av_toggle title=’Show resources:’ tags=” custom_id=” av_uid=’av-2cybh9′]
Michigan Dept. of Health and Human Services (MDHHS) Ovarian Cancer Patient Navigation Line:
1-844-446-8727
https://www.michigan.gov/mdhhs/

Society of Gynecologic Oncology: Ovarian Cancer
https://www.sgo.org/patient-resources/ovarian-cancer/

Foundation for Women’s Cancer: Ovarian Cancer
https://www.foundationforwomenscancer.org/gynecologic-cancers/cancer-types/ovarian/

NCCN Patient Guidelines: Epithelial Ovarian Cancer
https://www.nccn.org/patients/guidelines/content/PDF/ovarian-patient.pdf

American Cancer Society: Ovarian Cancer
https://www.cancer.org/cancer/ovarian-cancer.html

Center for Disease Control and Prevention: Ovarian Cancer
https://www.cdc.gov/cancer/ovarian/index.htm

Clinical Trials
https://clinicaltrials.gov/

Facing Our Risk of Cancer Empowered (FORCE)
https://www.facingourrisk.org/

Michigan Oncology Quality Consortium
https://moqc.org/

Michigan Ovarian Cancer Alliance (MIOCA)
https://www.mioca.org/

National Ovarian Cancer Coalition (NOCC)
http://ovarian.org/
[/av_toggle]
[/av_toggle_container]

[av_hr class=’default’ height=’50’ shadow=’no-shadow’ position=’center’ custom_border=’av-border-thin’ custom_width=’50px’ custom_border_color=” custom_margin_top=’30px’ custom_margin_bottom=’30px’ icon_select=’yes’ custom_icon_color=” icon=’ue808′ av_uid=’av-5iryl0′]

[av_one_full first min_height=” vertical_alignment=’av-align-top’ space=” margin=’0px’ margin_sync=’true’ padding=’20px’ padding_sync=’true’ border=” border_color=” radius=’0px’ radius_sync=’true’ background_color=’#ececec’ src=” attachment=” attachment_size=” background_position=’top left’ background_repeat=’no-repeat’ animation=” mobile_display=” av_uid=’av-gf3pg’]
[av_textblock size=’11’ font_color=” color=” admin_preview_bg=” av_uid=’av-2bs338′]
DISCLAIMER
The information contained herein is information only.  Users are solely responsible for all medical care and services delivered to their patients and all decisions related to such medical care and services.  Neither MOQC or the Regents of the University of Michigan shall be responsible for any delivery of medical care or other services to any patient, or any decisions, acts or omissions of persons in connection with the delivery of medical care or other services to any patient. These materials were made possible by a generous grant from the Michigan Department of Health and Human Services.
[/av_textblock]
[/av_one_full]

TRANSLATE »