Decision-Making For Patients With Resectable Breast Cancer: Individualized Decisions For and By Patients and Their Physicians

Decisions regarding the use of adjuvant cytotoxic and hormonal therapies for women with breast cancer ideally should be made jointly by the patient and oncologist. For patients to be adequately involved in this decision-making process, they must be provided with appropriate education regarding the potential benefits and risks of adjuvant therapies. The recommended steps for doing this are: 1) understand baseline prognosis with locoregional therapy (surgery, radiation, or both) alone for the individual patient at hand; 2) determine the estimated benefit afforded by adjuvant therapy options for the individual patient; 3) estimate the risk of side effects of adjuvant therapy options; 4) convey the above information to the individual patient; 5) facilitate the individual patient's decision regarding adjuvant systemic therapy; and 6) support the patient's decision. Two computer-based tools (Numeracy and Adjuvant!) are available to facilitate this process.

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Developing Ethical Web- and Mobile-Based Technologies for Dementia

Intelligent Assistive Technologies for Dementia ◽

10.1093/med/9780190459802.003.0014 ◽

2019 ◽

pp. 240-264

Author(s):

Julie M. Robillard ◽

Tanya E. Feng

Keyword(s):

Health Information ◽

Cognitive Engagement ◽

Diagnostic Tools ◽

Ethical Challenges ◽

Dementia Prevention ◽

Potential Benefits ◽

Cross Platform ◽

Computer Based ◽

Negative Impacts ◽

The Individual

The availability of web- and mobile-based technologies (WMBTs) for dementia prevention and care has grown exponentially over the last decade. These include computer-based resources such as online self-diagnostic tools, mobile-based resources such as applications (“apps”) that track lifestyle metrics or provide interactive platforms for cognitive engagement, and cross-platform resources such as websites providing health information. Despite their potential benefits, key ethical challenges have been identified in WMBTs for dementia both at the individual and societal levels, including issues of privacy, quality, and accessibility. This chapter explores the ethical challenges surrounding the use of WMBTs for dementia and highlights recent evidence on the positive and negative impacts of WMBT solutions. The chapter reviews development and design recommendations that have been put forward to maximize the benefits and minimize the harms of using WMBTs for dementia. It closes by looking to the future and proposing development considerations for future WMBT development.

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Panel evaluates adjuvant-therapy options for breast cancer

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/57.24.2255 ◽

2000 ◽

Vol 57 (24) ◽

pp. 2255-2255

Author(s):

John L. Miller

Keyword(s):

Breast Cancer ◽

Adjuvant Therapy ◽

Therapy Options

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Women's Interest in Gene Expression Analysis for Breast Cancer Recurrence Risk

Journal of Clinical Oncology ◽

10.1200/jco.2006.09.6255 ◽

2007 ◽

Vol 25 (29) ◽

pp. 4628-4634 ◽

Cited By ~ 26

Author(s):

Suzanne C. O'Neill ◽

Noel T. Brewer ◽

Sarah E. Lillie ◽

Edward F. Morrill ◽

E. Claire Dees ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Early Stage ◽

Cancer Recurrence ◽

Treatment Decision ◽

Recurrence Risk ◽

Anticipated Regret ◽

Treatment Decision Making ◽

Potential Benefits ◽

Previously Treated

Purpose Genomic and other technologies are improving the accuracy with which clinicians can estimate risk for recurrence (RFR) of breast cancer and make judgments about potential benefits of chemotherapy. Little is known of how patients will respond to genomic RFR testing or interact with their physicians to make informed decisions regarding treatment. We assessed interest in genomic RFR testing and patient preferences for incorporating results into treatment decision making. Patients and Methods One hundred thirty-nine women previously treated for early-stage breast cancer completed surveys that presented hypothetical scenarios reflecting different test outcomes and potential decisions. We assessed women's attitudes toward RFR testing, how results would affect their choices about adjuvant treatment, and potential concerns about and perceived benefits of testing. Results The majority of participants said they would “definitely” want to be tested (76%), receive their results (87%), and discuss these results with their physicians. They were willing to pay, on average, $997 for testing. Those who expressed more concerns about testing were less interested in testing and in incorporating results into treatment decision making. Participants were more likely to want chemotherapy when presented with high-risk results and would worry more about those results. They were least likely to trust and most likely to express potential anticipated regret in response to intermediate RFR results. Conclusion Participants expressed strong interest in testing. Although these decisions were sensitive to RFR, participants’ complex reactions to intermediate RFR suggest care is needed when communicating such results.

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A Practical Clinical Approach to Adjuvant Therapy in Breast Cancer—An Update

Oncology & Hematology Review (US) ◽

10.17925/ohr.2009.05.1.49 ◽

2009 ◽

Vol 05 (01) ◽

pp. 49

Author(s):

Stephanie L Hines ◽

Winston Tan ◽

Alvaro Moreno-Aspitia ◽

Vivek Roy ◽

Laura A Vallow ◽

...

Keyword(s):

Breast Cancer ◽

Molecular Markers ◽

Adjuvant Therapy ◽

Potential Benefit ◽

Recurrence Risk ◽

Clinical Approach ◽

Her2 Positive ◽

Heterogeneous Nature ◽

The Individual ◽

Disease Specific

Adjuvant therapy for breast cancer has evolved to reflect the heterogeneous nature of the disease. Specific subtypes such as luminal, HER2- positive, and basal subtypes express different molecular markers that can be targeted by a variety of novel agents; therapy is tailored to the individual profile of each tumor. New risk-stratification models, including models based on a tumor’s genetic expression, enhance assessments of recurrence risk so that the potential toxicities of a particular regimen can be weighed against the potential benefit. More precise tailoring of adjuvant therapy may be possible in the future with advances in pharmaco-genetics, which will help to predict an individual’s response to various agents. Optimal adjuvant treatment of breast cancer involves tailoring therapy to the individual patient and tumor.

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Neoadjuvant Chemotherapy for Breast Cancer: Moving Beyond Pathological Complete Response in the Molecular Age

Acta Medica Academica ◽

10.5644/ama2006-124.328 ◽

2021 ◽

Vol 50 (1) ◽

pp. 88

Author(s):

Elena Provenzano

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Neoadjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Pathological Complete Response ◽

Residual Disease ◽

Complete Response ◽

Specimen Handling ◽

Cancer Management ◽

Recent Advances

This review focuses on neoadjuvant chemotherapy for breast cancer which introduces practical issues for pathologists, including predicting response, optimising specimen handling, size measurement and assessment of residual disease, and recent advances in management of the axilla. The role of neoadjuvant chemotherapy in breast cancer is increasing, and it has become standard of care for high risk Human Epidermal Growth Factor Receptor 2 positive and triple negative breast cancers. The benefits of the neoadjuvant approach extend beyond pathological complete response to tumour downstaging permitting conservative surgi- cal options in the breast and axilla, and assessment of response provides valuable prognostic information to enable escalation and de-escalation of adjuvant therapy to optimise oncological outcomes. Hence histopathologists play a vital role in patient management in the neoadjuvant setting. Optimal patient selection for neoadjuvant chemotherapy requires consideration of pre- treatment histopathological and molecular tumour characteristics. Post chemotherapy, tumour staging can be challenging, and changes in criteria for measurement of primary tumour and metastases in the 7th and 8th editions of the TNM have led to confu- sion amongst pathologists. This review offers practical guidance on specimen handling and measurement of lesion size. Mov- ing forwards more detailed information on degree of response will be required for adjuvant therapy decision making, and the Residual Cancer Burden is emerging as the preferred method for quantifying residual disease not just within clinical trials but in routine practice. Recent advances in management of the axilla are discussed, including the significance of minimal residual disease in the form of isolated tumour cells and micrometastases which portend a worse prognosis in the neoadjuvant setting.Conclusion. Neoadjuvant chemotherapy now forms part of routine breast cancer management, and detailed histopathological assessment and an understanding of the importance of molecular tumour biology is essential for clinical decision making.

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Comparison of outcome prediction in node-negative breast cancer based on biomarkers uPA/PAI-1 or Adjuvant Online using the 10-year follow-up of the randomized multicenter Chemo N0 trial

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.534 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 534-534 ◽

Cited By ~ 3

Author(s):

U. Euler ◽

C. Meisner ◽

C. Friedel ◽

M. Schmidt ◽

M. Untch ◽

...

Keyword(s):

Breast Cancer ◽

Risk Assessment ◽

Clinical Trial ◽

High Risk ◽

Adjuvant Therapy ◽

Computer Program ◽

Risk Patients ◽

The Individual ◽

Pai 1

534 Background: Chemo N0 was the first multicenter randomized clinical trial in breast cancer using biomarkers uPA/PAI-1 for risk stratification and chemotherapy selection. Chemo N0 validated uPA/PAI-1 as clinically relevant parameters for risk assessment in N0 breast cancer. About 50% of N0 patients have low uPA/PAI-1 in their primary tumor with excellent 5-year OS (>95%), even without adjuvant therapy. Patients with high uPA/PAI-1 benefit from adjuvant chemotherapy. We evaluated whether biomarkers can predict outcome more accurately than a computer-program. Methods: In Chemo N0, patients (n=689, 1993–98) were stratified according to uPA/PAI-1: High-risk patients were randomized (6x CMF vs. observation), low-risk patients observed. Retrospectively, we divided recruited patients into two groups (chemotherapy vs. no adjuvant therapy) and stratified using uPA/PAI-1 (low vs. high). Individual 10-year OS was calculated by www.adjuvantonline.org (Version 7.0); these estimated values were compared to the observed 10-year OS in Chemo N0. Results: 81/151 patients with already available complete follow-up data 10 years after trial start have 10-year OS results. Median 10-year OS estimated by Adjuvant Online was 77.1% (median 78.6%) taking into account administered adjuvant therapy. 10-year Chemo N0 follow-up revealed an observed 10-year OS of 66.7% (27/81 deceased). 64/81 did not receive chemotherapy: In high-risk untreated patients (n=22), 10-year OS was 54.6% vs. estimated 75.0%. In CMF-treated patients (all high-risk, n=17), observed OS was 58.8% vs. estimated 74.6%. Conclusions: For the first time, risk assessment by novel biomarkers is compared to that by Adjuvant Online in data from a randomized clinical trial. In patients with high uPA/PAI-1, the individual 10-year OS calculated by Adjuvant Online seems to be underestimated compared to observed patient outcome. Further follow-up data will show whether uPA/PAI-1 can predict the individual course of disease more precisely than a computer-program based on large clinical data sets. Final Chemo N0 10-year follow-up is currently being completed. No significant financial relationships to disclose.

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