Emotional experiences of oncologists treating women with metastatic breast cancer (MBC).

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 97-97
Author(s):  
Adam Brufsky ◽  
Musa Mayer ◽  
Robyn Bell Dickson ◽  
Marc L. Citron
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Emotional Support ◽  
Support Services ◽  
Metastatic Breast ◽  
Geographic Region ◽  
Psychological Status ◽  
Emotional Impact ◽  
Emotional Experiences ◽  
Medical Oncologists

97 Background: Research on the psychological status of medical oncologists (MO) is limited. The Make Your Dialogue Count survey explored emotional experiences of licensed US MOs who treat ≥ 5 women with MBC/month as well as women ( ≥ 21 y) with MBC. Methods: A survey was conducted (June-Aug 2014) online, by paper and telephone; MOs responded online only. Patient (pt) data were unweighted. MO data were weighted by geographic region and years in practice by sex to match actual proportions in the population. Statistically significant differences between groups were determined by standard t-test of column proportions and means at the 95% confidence level (marked by *). Results: 359 pts (median age 53 y) and 252 MOs (median age 49 y; median 15 y in practice) completed surveys. At initial MBC diagnosis, more MOs than pts felt that showing care and compassion (81% vs 72%) and helping pts cope with the diagnosis (63% vs 51%) were very important, and fewer felt that referring pts to support services (24% vs 38%) was very important. More MOs practicing < 15 y vs ≥ 15 y said it was very important to refer pts to support services at first diagnosis (30% vs 19%*). Slightly more MOs with more experience perceived emotions like anxiety, commitment, hopefulness, and determination in their pts at initial diagnosis. Many MOs (42%) reported that treating women with MBC had a lot/a great deal of negative emotional impact; 81% strongly/somewhat agreed that it is unprofessional to let emotions impact treatment recommendations; and 23% reported that emotions kept them from providing some information to pts. Less experienced MOs said their emotions kept them from providing some information to their pts than their more experienced counterparts (29% vs 17%*). Most MOs (93%) did not want to give their pts false hope; yet 27% reported that in certain situations, they do not discuss with pts that MBC is incurable. Conclusions: MOs empathize with pts and feel responsible for providing them emotional/psychological support. MOs revealed the negative emotional weight of their work. MOs with less experience were more impacted by their emotions than MOs with more experience. Acknowledging MOs’ emotions is important and underscores their own need for psychological/emotional support.

Treatment and Monitoring Variability in US Metastatic Breast Cancer Care

2021 ◽  
pp. 600-614
Author(s):  
Jennifer L. Caswell-Jin ◽  
Alison Callahan ◽  
Natasha Purington ◽  
Summer S. Han ◽  
Haruka Itakura ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Tumor Markers ◽  
Search Engine ◽  
Query Language ◽  
Growth Factor Receptor ◽  
Metastatic Breast ◽  
Geographic Region ◽  
Factors Affecting ◽  
Positron Emission

PURPOSE Treatment and monitoring options for patients with metastatic breast cancer (MBC) are increasing, but little is known about variability in care. We sought to improve understanding of MBC care and its correlates by analyzing real-world claims data using a search engine with a novel query language to enable temporal electronic phenotyping. METHODS Using the Advanced Cohort Engine, we identified 6,180 women who met criteria for having estrogen receptor–positive, human epidermal growth factor receptor 2–negative MBC from IBM MarketScan US insurance claims (2007-2014). We characterized treatment, monitoring, and hospice usage, along with clinical and nonclinical factors affecting care. RESULTS We observed wide variability in treatment modality and monitoring across patients and geography. Most women received first-recorded therapy with endocrine (67%) versus chemotherapy, underwent more computed tomography (CT) (76%) than positron emission tomography-CT, and were monitored using tumor markers (58%). Nearly half (46%) met criteria for aggressive disease, which were associated with receiving chemotherapy first, monitoring primarily with CT, and more frequent imaging. Older age was associated with endocrine therapy first, less frequent imaging, and less use of tumor markers. After controlling for clinical factors, care strategies varied significantly by nonclinical factors (median regional income with first-recorded therapy and imaging type, geographic region with these and with imaging frequency and use of tumor markers; P < .0001). CONCLUSION Variability in US MBC care is explained by patient and disease factors and by nonclinical factors such as geographic region, suggesting that treatment decisions are influenced by local practice patterns and/or resources. A search engine designed to express complex electronic phenotypes from longitudinal patient records enables the identification of variability in patient care, helping to define disparities and areas for improvement.

scholarly journals Primary Results of ROSE/TRIO-12, a Randomized Placebo-Controlled Phase III Trial Evaluating the Addition of Ramucirumab to First-Line Docetaxel Chemotherapy in Metastatic Breast Cancer

2015 ◽  
Vol 33 (2) ◽  
pp. 141-148 ◽  
Author(s):  
John R. Mackey ◽  
Manuel Ramos-Vazquez ◽  
Oleg Lipatov ◽  
Nicole McCarthy ◽  
Dmitriy Krasnozhon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Growth Factor ◽  
Growth Factor Receptor ◽  
Data Monitoring Committee ◽  
Metastatic Breast ◽  
Geographic Region ◽  
Phase Iii ◽  
Double Blind ◽  
Phase Iii Trial

Purpose Currently, antiangiogenic strategies in metastatic breast cancer have demonstrated modest improvements in progression-free survival (PFS) but not improved quality or duration of survival, warranting evaluation of new agents in a placebo-controlled setting. Ramucirumab is a human immunoglobulin G1 antibody that binds vascular endothelial growth factor receptor-2 and blocks ligand-stimulated activation. The ROSE/TRIO-012 trial evaluated ramucirumab with docetaxel in unresectable, locally recurrent, or metastatic breast cancer. Patients and Methods In this double-blind, placebo-controlled, randomized, multinational phase III trial, 1,144 patients with human epidermal growth factor receptor 2 (HER2) –negative breast cancer who had not received cytotoxic chemotherapy in the advanced setting were randomly assigned at a two-to-one ratio to receive docetaxel 75 mg/m2 plus ramucirumab 10 mg/kg or docetaxel 75 mg/m2 plus placebo once every 3 weeks. Treatment continued until disease progression, unacceptable toxicity, or other withdrawal criteria. Patients were stratified by previous taxane therapy, visceral metastasis, hormone receptor status, and geographic region. An independent data monitoring committee oversaw the trial. The primary end point was investigator-assessed PFS. Results Median PFS in patients treated with ramucirumab plus docetaxel was 9.5 months, compared with 8.2 months in patients who received placebo plus docetaxel (hazard ratio [HR], 0.88; P = .077). Median overall survival was 27.3 months in patients who received ramucirumab plus docetaxel, compared with 27.2 months in patients who received placebo plus docetaxel (HR, 1.01; P = .915). Toxicities seen at significantly higher rates in patients receiving ramucirumab included fatigue, hypertension, febrile neutropenia, palmar-plantar erythrodysesthesia syndrome, and stomatitis. Conclusion Addition of ramucirumab to docetaxel in HER2-negative advanced breast cancer did not meaningfully improve important clinical outcomes.

Should we be talking about guidelines with patients? A qualitative analysis in metastatic breast cancer.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 217-217
Author(s):  
Gabrielle Betty Rocque ◽  
Audrey S. Wallace ◽  
Soumya J. Niranjan ◽  
Beverly R Williams ◽  
Yasemin E. Turkman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Qualitative Analysis ◽  
Scientific Evidence ◽  
Insurance Coverage ◽  
Metastatic Breast ◽  
Academic Medical ◽  
Medical Oncologists ◽  
Prior Experiences ◽  
To Receive

217 Background: Little data exist on patient perceptions of guideline-based care. This qualitative analysis describes patient and oncologist views on the value of discussing guidelines when making metastatic breast cancer (MBC) treatment decisions. Methods: In-person interviews completed by MBC patients and community medical oncologists and focus groups for academic medical oncologists were audio-recorded and transcribed. Two coders utilized a content analysis approach to analyze transcripts independently using NVivo. Major themes and exemplary quotes were extracted. Results: Participants included 20 MBC patients, 6 community oncologists, and 5 academic oncologists. The majority of patients (80%) were unfamiliar with the term “guidelines”. However, all patients desired to know if they were receiving guideline discordant treatment. As one patient commented “ I'm supposed to know the guidelines and it's not supposed to be a secret to me.” Among patients willing to receive care inconsistent with guidelines, several themes emerged including trusting the oncologist, relying on the oncologist’s prior experiences, being informed of rationale for deviation, personalized treatment, and openness to novel therapies. Physician discussions on the importance of guidelines revealed themes such as consistency with scientific evidence, insurance coverage, and limiting unusual practices. Oncologists identified limitations to guidelines including lack of expert consensus, inability to “ think outside the box” to personalize treatment, and lack of guideline timeliness. Although some oncologists discussed guidelines, a common sentiment was that sharing this information is not a priority. One physician commented that sharing the guidelines with patients is, “ getting too much into the how you practice medicine, and they may not want to know, kind of like eating at a restaurant. You don't need to know how the cook's preparing everything.” Conclusions: Both patients and physicians expressed reasons why guideline discordant treatments would be acceptable. Providers’ preference to limit discussions of guidelines is discordant with patients’ desire for this information and may limit shared decision-making.

scholarly journals Broad consensus on the optimal sequence for the systemic treatment of metastatic breast cancer: results from a survey of Spanish medical oncologists

2019 ◽  
Vol 8 (1) ◽  
pp. 62-69
Author(s):  
Pedro Sánchez-Rovira ◽  
Pilar Zamora ◽  
Javier Salvador-Bofill ◽  
Serafín Morales ◽  
Noelia Martínez-Jáñez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Systemic Treatment ◽  
Metastatic Breast ◽  
Optimal Sequence ◽  
Medical Oncologists ◽  
Broad Consensus

scholarly journals My Alma: A Digital App Supporting Metastatic Breast Cancer Patients in Greece

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 98s-98s
Author(s):  
C. Mitsi ◽  
E. Tzintziropoulou ◽  
L. Panagiotopoulou
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Metastatic Breast Cancer ◽  
Cancer Patients ◽  
Metastatic Breast ◽  
Scientific Data ◽  
Emotional Impact ◽  
Breast Cancer Patients ◽  
Healthy Behaviors

Background: Current research has shown that women with MBC patients feel ashamed and isolated. In Greece, “Alma Zois”, as a patient group, has made several attempts to provide support, but with a moderate success. Nevertheless, MBC patients have unmet needs that consist of better information and knowledge about MBC, better support for physical and emotional impact of MBC and better quality of life. Especially when it comes to younger women, these needs seem to be less covered. The development of a specially designed digital application (app) will cover the gap between support services and MBC patients by embracing the digital era in a country where 66% of the population uses smartphones. Aim: The development of the app aims at: 1) providing useful information about metastatic breast cancer, 2) reaching out to MBC patients, 3) improving the quality of life, 4) increasing healthy behaviors, and 5) increasing compliance. Methods: The project “My Alma App” is designed according to three major pillars: 1) Awareness, 2) Support 3) Communication. The 1st part AWARENESS includes: information about MBC. Calendar - Daily record of healthy behaviors (walking, nutrition, etc.). The 2nd part SUPPORT includes: 1) Psychological advice provided by psycho-oncologists, 2) Emotional-meter: issue the daily question “How are you feeling today?” and based on the patient's answer, the app can provide multiple suggestions/call to action. The 3rd part COMMUNICATION includes: personalized motivation, calendar with reminders of medication, therapies and events that might be of interest according to each patient's profile. Results: To achieve the best quality for the project: 1) A technical development of the app is been held, 2) The app will be tested by a group of patients as a pilot study and 3) Updates and improvements based on users feedback (metastatic breast cancer patients) and latest scientific data will be made. After the official launch, a short satisfaction survey will be addressed to every registered user. Finally, to motivate patients to use the app, a special social media campaign about the app will be launched. Conclusion: It is expected that the app will provide to MBC patients ways and methods to deal with the emotional challenges, distress and ways to improve their daily activities and their quality of life. Upon the end of the launch of the app, it is expected that a number of 500 Stage III and IV breast cancer patients will start using the app. The number of people who will download the app, the data provided by app users and the ratings and answers on “emotion-meter” during a period of time will be indexes of impact of the project to the MBC community in Greece.

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