The incurable condition of metastatic breast cancer (mBC) presents difficult treatment decisions for patients and physicians.¹

MBC patients will spend the rest of their lives on treatment, and may regularly change therapies if they develop resistance over time. Their treatment and care choices are often time-sensitive and must balance personal therapeutic goals, drug toxicities, quality of life, and the reality of uncertain outcomes.² Ideally, the final decision regarding treatment should be jointly made by the patient and their physician, in line with the patient’s actual desire for participation.^1,3 This can, however, be challenging in practice and requires clear information and sensitive conversations between patient and physician about the available options.³

A clear majority of patients want to be consulted on their treatment journey, but they don’t always feel they have sufficient information or opportunity to participate in decision-making. Healthcare providers estimate that almost two thirds (65%) of patients want to be involved in making decisions about their next therapy, according to research among 530 physicians and nurses developed by Pfizer Oncology, working collaboratively with the European School of Oncology (ESO).⁴ However, these healthcare providers also state that only about half (56%) of patients are likely to proactively explain their personal treatment goals to their doctor, such as their willingness to endure treatments which may cause side effects.⁴

In order to play an active role in decision-making, patients need to be accurately informed about their diagnosis and prognosis, and understand the available treatment options.⁵ However, only one third of the affected feel they are given enough information on future treatments, according to a pan-European survey among 230 women with advanced or metastatic breast cancer as well as carers from 17 European countries.⁶ To increase patient involvement in treatment decisions, there is a need to provide more information and create more opportunities for patients to communicate their treatment goals with their healthcare providers, as well as for clinicians to ask more probing questions in conversations with patients.⁶

Involving patients in the decision-making process makes it easier to identify treatment options that best suit each patient’s individual priorities, tolerance and personal situation.³ MBC is not a single disease: each patient will experience it differently, both physically and psychologically, which will impact their particular needs and priorities.^3,7

New approaches allow for more personalised management of mBC. Instead of standardised support packages, which may not be optimal for every individual, patients can receive customised and tailored information. Ensuring that patients receive appropriate information about the prognosis of their cancer and the likely outcomes of treatment may facilitate the process of informed decision-making regarding their care.³

While shared decision-making can be very beneficial for the patient, it presents additional challenges for healthcare professionals (HCPs), due to the complexity of considering different options and preferences, as well as the stressful disease setting for patients.² Dedicated training sessions and information on how to communicate with patients and their families can help to guide HCPs through these challenging situations.² However, the Global Decade Report revealed that only 43% of respondents had received this form of training in 2015, despite 83% ranking it among their top three training priorities.⁸ This presents an opportunity to offer more dedicated training sessions in this area, in order to make HCPs feel comfortable when tackling challenging issues with patients and discussing end-of-life care and planning.²

Patients with mBC face more complex decisions regarding their care as they live longer and have more treatment choices.² While some progress has been made in joint decision-making between patients and their physicians, more needs to be done.

Dedicated platforms such as ecancerpatient and iManageCancer are aiming to empower patients by sharing information. The recently launched Me & MBC Patient website developed by Pfizer working closely with patients, provides mBC patients with information not only about the disease, but also on topics such as how to tell loved ones and how to manage working life. The idea behind these dedicated platforms is for patients to receive all the information they need, in order for them to play a more active role in the decision-making process.

¹ Filleron T, et al. Prospective construction and validation of a prognostic score to identify patients who benefit from third-line chemotherapy for metastatic breast cancer in terms of overall survival: the METAL3 Study. Contemp Clin Trials. 2015;40:1-8.

² Danesh M, et al. Informational needs of patients with metastatic breast cancer: what questions do they ask, and are physicians answering them? J Cancer Educ. 2014;29:175-180.

³ Grunfeld EA, et al. Advanced breast cancer patients’ perceptions of decision making for palliative chemotherapy. J Clin Oncol. 2006;24:1090-1098.

⁴ Breast Cancer Centre Survey. Sponsored by Pfizer Oncology. July 2015. Pfizer data on file. ⁵ Chiew KS, et al. Development and evaluation of a decision aid for patients considering first-line chemotherapy for metastatic breast cancer. Health Expect. 2008;11:35-45.

⁶ Harding V, et al. ‘Being there’ for women with metastatic breast cancer: a pan-European patient survey. Br J Cancer 2013;109:1543-1548.

⁷ Mosher C, et al. Living with Metastatic Breast Cancer: A Qualitative Analysis of Physical, Psychological, and Social Sequelae. Breast J 2013;19:285-292.

⁸ Global Status of Advanced/Metastatic Breast Cancer: 2005 - 2015 Decade Report. Sponsored by Pfizer Oncology. March 2016. Available at www.breastcancervision.com.

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