Conference Coverage

Less therapy may suit older patients with breast cancer


AT ASCO 2023

– By definition, all clinical care is – or should be – patient-centered care, and that is especially true for older women with early stage breast cancer.

“Older women need to be informed of the benefits and risks of their treatment options, including the option of omitting a treatment,” said Mara Schonberg, MD, MPH, of the division of general medicine and primary care at Beth Israel Deaconess Medical Center in Boston.

“High quality shared decision-making considers a woman’s risk of recurrence, her tumor characteristics, her overall prognosis based on her general health, the lag-time to benefit from the treatment – how long will it take for this treatment to likely have an effect or a real chance of having any benefit for her – and her values and preferences,” she explained. Dr. Schonberg was speaking at a session on the management of care for older women with breast cancer held during the recent American Society of Clinical Oncology (ASCO) annual meeting.

Care for older women with a new diagnosis of early stage breast cancer is not one-size-fits all, and patients are faced with many decisions that may depend as much on personal preference as on clinical necessity, Dr. Schonberg said.

For example, patients may need to choose between mastectomy or breast conserving surgery (BCS), whether to have radiotherapy after BCS, what type of radiotherapy (e.g., whole breast, partial breast, accelerated partial breast irradiation, boost dose) to have, whether to undergo a lymph node biopsy, and whether to opt for primary endocrine therapy instead of surgery or radiation.

“It is really important that we think about all these decisions that older women face in their preference-sensitive decisions and that we include them in the decision-making, probably even starting at the time of mammography,” Dr. Schonberg said.

Decision-making partnership

Doctor–patient shared decision making improves patient care by helping the patients understand the best available evidence on the risks and benefits of specific choices and their alternatives, Dr. Schonberg said. Discussing and considering all the available options allows the doctor and patient to arrive together at an informed decision based on the individual patient’s needs and preferences, she emphasized.

“It’s particularly useful when there are multiple treatment options, when there’s uncertainty regarding the evidence or uncertainty regarding which patients may benefit or on the outcome, when there are both treatment advantages and disadvantages that patients must weigh, and when the decision is high impact, like for breast cancer treatment,” she said.

Shared decision-making can be complicated by barriers of time, how care is organized, lack of clinician training in patient-centered communication, and mistaken assumptions on the part of clinicians about a particular patient’s preferences or willingness to participate in the process.

Dr. Schonberg and colleagues created the website ePrognosis to consolidate prognostic indices designed to aid clinical decision-making for older adults who do not have a dominant terminal diagnosis. The site contains links to prognostic calculators, information about time to benefit for various cancer screening programs based on life expectancy, and helpful information about communicating information about prognosis, risks, and benefits to patients.


Recommended Reading

How a medical recoding may limit cancer patients’ options for breast reconstruction
MDedge Hematology and Oncology
Breast cancer: Meta-analysis supports ovarian suppression/ablation
MDedge Hematology and Oncology
Chemo avoidance pays off for some women with HER2+ early BC
MDedge Hematology and Oncology
Phone support helps weight loss in patients with breast cancer
MDedge Hematology and Oncology
Ribociclib forestalls recurrence also in early breast cancer
MDedge Hematology and Oncology
ER+/HER2– breast cancer: Is first or second line CDK4/6 inhibitor therapy better?
MDedge Hematology and Oncology
Widespread carboplatin, cisplatin shortages: NCCN survey
MDedge Hematology and Oncology
Breast cancer experts and other HCPs disagree on treatment strategies for early BC
MDedge Hematology and Oncology
In TNBC, repeated biopsies may reveal emergent HER2-low expression
MDedge Hematology and Oncology
New study backs up capecitabine dosing practice in metastatic BC
MDedge Hematology and Oncology