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The rise of patient advocacy and shared decision-making are transforming breast cancer care.
Shared decision-making is a process whereby the patient and physician participate in the medical decision-making process together. The approach considers all evidence-based treatment options and associated risks, the physician’s expertise, together with the patient’s preferences, values and expectations to arrive at the best treatment plan for the patient. Multiple studies show this collaborative approach improves patient outcomes and satisfaction.
Empowered, self-educated patients are increasingly advocating for themselves, seeking to have a greater voice in their treatment planning. As the only shared decision-making breast cancer app in the World, Breast Advocate® is very proud to be able to facilitate the patient advocacy movement.
Now, patient advocacy is also making positive strides in the research arena. Nowhere has this been more evident than at the 2018 San Antonio Breast Cancer Symposium last month, where patients have become an integral part of the meeting. By participating on panels, asking questions and weighing in on research, patients have “shifted the direction of breast cancer research,” says Dr. Elaine Schattner. “By speaking up, advocates at the meeting have shifted the direction of breast cancer research. Some are alive, improbably, as a consequence of new treatments enabled and promoted by their advocacy.”
Collaboration can only make things better. We look forward to patient advocates having a constant seat at the table at many more scientific meetings!
Triple-negative breast cancer is so called because, unlike more common forms of breast cancer, its cells do not have receptors for estrogen, progesterone, or the HER2 protein.
Triple-negative cancer makes up only about 10-15% of diagnosed breast cancers, but is one of the most aggressive and deadly forms of the disease. It is also more likely to affect younger women under 50. In most cases, triple-negative tumors quickly become resistant to chemotherapy and spread to other parts of the body.
Over the last few years, immunotherapy — a treatment that boosts’ the body’s defenses against infection and diseases — has been gaining ground as a potential therapy for several different types of cancer, including breast cancer.
A recent phase 3 study, published in the New England Journal of Medicine, included over 900 women in 41 countries randomly assigned to one of two treatment groups: one group received the immunotherapy drug atezolizumab (a monoclonal antibody drug) together with chemotherapy, the other group was given a placebo with chemotherapy.
“In a combined treatment approach, we are using chemotherapy to tear away the tumour’s ‘immune-protective cloak’ to expose it as well as enabling people’s own immune system to get at it” said lead author of the study, Professor Peter Schmid.
Patients who received the immunotherapy drug along with chemotherapy extended overall survival by 10 months, reducing the risk of death or disease progression by up to 40%.
Breast Advocate’s Founder Dr. Minas Chrysopoulo this month had the honor of moderating a panel on the importance of shared decision-making in breast reconstruction at this year’s American Society of Plastic Surgeons (ASPS) annual meeting in Chicago. ‘The Meeting’ is the largest plastic surgery meeting in the World and welcomes surgeons from all over the globe. Dr Chrysopoulo had the privilege of being joined on the panel by Breast Advocate co-contributor Dr Hani Sbitany, and patient advocates Terri Coutee and Kirstin Litz.
“Once upon a time, I’d tell a patient their breast reconstruction options and the associated risks and recommend what I thought was best. Then I discovered shared decision-making and it changed my practice forever,” shared Dr. Minas Chrysopoulo.
What exactly is “shared decision-making”?
Shared decision-making is the conversation and information exchange that happens between a patient and their healthcare professional to reach a treatment plan together. The doctor ensures the patient is fully educated about all their treatment options and the associated risks, while the patient shares their preferences, values and any other personal factors that are important in reaching the best plan for the patient.
Shared decision-making flies in the face of the paternalistic approach to healthcare delivery and instead empowers patients to have an equal voice in their treatment planning – It was the driving philosophy behind the creation of the Breast Advocate App.
Listen to the entire shared decision-making presentation here.
Autologous fat grafting, or “lipofilling”, is widely used in conjunction with breast cancer surgery:
1. it can correct partial breast defects after lumpectomy
2. it is used in conjunction with other breast reconstruction techniques to optimize breast contour and improve the final cosmetic results after both implant-based and autologous (flap) reconstruction
3. it is the primary breast reconstruction technique in male breast cancer patients
4. it can fill in contour defects and improve chest soft tissue padding after mastectomy in patients choosing to go flat
Fat grafting has also been shown to improve scar appearance, improve breast pain, and even reverse the soft tissue effects of radiotherapy (such as fibrosis).
The procedure involves liposuctioning from one part of the patient’s body, purifying it and then injected into the breast. It can be performed in conjunction with other breast procedures or as a stand-alone procedure. There are several fat grafting techniques that are used by plastic surgeons. There is no “set way” that has been shown to be the best in terms of long-term results. However, studies have shown that regardless of the technique used, the collection, handling, and transplantation of the fat cells must be optimized to obtain the best long-lasting results.
Despite the associated benefits, fat grafting in patients with a history of breast cancer has been somewhat restricted by 2 main concerns: the fear that it can interfere with breast cancer imaging, and that the regenerative cells could increase the risk of local breast cancer recurrence.
Some of the injected fat can turn hard after lipofilling. This is known as “fat necrosis”. Areas of fat necrosis cause calcifications (macrocalcifications) on mammograms. However, previous studies have shown that these macrocalcifications do not interfere with subsequent detection of breast cancer. The question regarding the risk of recurrence remains a topic of debate due to animal studies that have shown adipose-derived stem cells can stimulate cancer growth in nude mice. Although we don’t truly know whether the interaction between human fat tissue and cancer cells injected in immunodeficient mice can accurately reflect what happens in people, this uncertainty has led to obvious concerns about lipofilling patients with a history of breast cancer, particularly after a lumpectomy.
A recent study aimed to answer whether patients with breast cancer treated with autologous fat grafting are at an increased risk of cancer relapse compared with those who receive conventional breast reconstruction alone. No significant difference in the rate of local recurrence was seen after a 5-year follow-up. These findings confirm the results of previous studies; there is no clinical evidence to suggest that autologous fat grafting increases the risk of local breast cancer recurrence.
Research data pulled from nine separate clinical trials has shown that women choosing to undergo breast conservation (ie lumpectomy and radiation) have an overall rate of local recurrence at 5 years of less than 5%. This statistic compares similarly with mastectomy local recurrence rates.
The study shows “that in the modern era, the rate of local recurrence after breast-conserving surgery is quite low — lower than what has often been used historically to counsel women. These modern-era estimates should be used to inform discussions between patients and surgeons regarding the decision between breast conservation and mastectomy.”
It is important for patients diagnosed with breast cancer to fully discuss all their surgical options with their breast surgeon. They should also consult with a board-certified plastic surgeon before undergoing breast surgery whenever possible. Regardless of whether a patient chooses a lumpectomy or mastectomy, oncoplastic surgery and breast reconstruction options should be offered to all patients and fully discussed prior to any breast cancer surgery.
After being in remission from breast cancer for a year, Shannen Doherty underwent breast reconstruction surgery in May, reports People magazine.
She chose DIEP flap reconstruction. This procedure uses a patient’s own skin and fat from the lower tummy to recreate the breast following a mastectomy. Because of Doherty’s thin physique, she had to gain a little weight before surgery. The surgeon performed what is referred to as a “Stacked DIEP” which is a great option for thin patients. The stacked DIEP flap procedure uses tissue from both sides of the lower abdomen to reconstruct a single breast. The standard DIEP flap procedure uses one side of the abdomen to reconstruct each breast.
Usually, when women select DIEP flap surgery they are looking for the best long-term solution to breast reconstruction since tissue reconstructions age with them — the reconstructed breast(s) gain weight when they gain weight and lose weight when they lose weight. The tissue ages more naturally and, unlike implants, these reconstructions never need to be redone.
It is important for patients to know implants are not the only option for reconstructive surgery. Unfortunately, advanced procedures like the DIEP flap are not offered by all reconstructive plastic surgeons since extensive experience in microsurgery is required to perform these surgeries successfully. Patients must therefore do their homework in finding surgeons with the appropriate expertise.
Breast cancer treatment is changing . . . and in a big way! A landmark study suggests that women with a common form of early-stage breast cancer can safely avoid chemotherapy without increasing the risk of recurrence.
The TAILORx study found that genetic testing on tumors could identify women who can safely skip chemotherapy. Rather than enduring the harsh side effects of chemo, such patients can take a drug (like tamoxifen) that safely blocks the hormone estrogen or stops the body from making it.
The results of this study could enable up to 70,000 US patients annually to avoid chemotherapy.
Following a breast cancer diagnosis, women still need regular screening. However, a recent study shows many women are not following through with getting the recommended screenings they need.
The study followed over 27,000 women after their initial breast cancer surgery. The results showed one year after surgery, 13% of women had NOT had a mammogram. Over five years, only 50% of women had at least one mammogram each year.
The study also found that black women were less likely than white women to get an annual mammogram. “Lack of screening may contribute to higher death rates among black women, because recurrence of breast cancer is a major cause for poor outcomes in black women,” the researchers said.
