HR+ HER2- Breast Cancer
Preserving Quality of Life in Advanced HR+ HER2- Breast Cancer: Toxicity Management
Substantial progress has been made in the treatment of hormone receptor–positive (HR+)/human epidermal growth factor receptor 2–negative (HER2-) breast cancer. Despite these treatment advances, side effects and their potential impact on quality of life (QOL) remain important considerations.
President, International Cardio-Oncology Society
“Chemotherapy, of course, comes with more toxicities than some other treatments, but there are very few breast cancer treatment options that come without any toxicities. That is why it is important to understand each patient's situation, their comorbidities, and the potential negative impact of each treatment on their QOL."
Newer treatment options for advanced HR+/HER2- breast cancer are emerging at an incredible pace. With an increase in life expectancy from advanced breast cancer, there is now more emphasis on considering the impact of cancer treatment–related toxicities on an individual’s QOL.
For patients with advanced HR+/HER2- breast cancer, endocrine therapy in combination with a CDK4/6 inhibitor is now considered standard of care, with survival rates now exceeding 60 months. Although individuals with advanced breast cancer may respond to multiple lines of endocrine-based therapy, chemotherapy will eventually be part of their treatment plan. Chemotherapy, of course, comes with more toxicities than some other treatments, but there are very few breast cancer treatment options that come without any toxicities. That is why it is important to understand each patient's situation, their comorbidities, and the potential negative impact of each treatment on their QOL.
At a certain point, in those with advanced disease, the potential benefit of the next treatment option may become exceedingly small, and this might coincide with the patient’s increasingly diminished ability to tolerate systemic treatment. In such cases, I believe that it is important to have a conversation with the individual, saying, “Yes, we do have this additional option, but there is only a very, very small likelihood that it will help you, and it will almost certainly make you feel worse. So, I'm worried that this treatment would actually do more harm than good.” The timing of this type of discussion will vary depending on the patient and the specific circumstances, but it is important to have this discussion. It is also important for patients to understand that, even if they stop active cancer treatment, their care will continue, with a focus on QOL, comfort, and time with loved ones.
In addition to the standard ways of following patients who are receiving treatment, many practices incorporate simple inventories that patients can use to report and track their physical, emotional, social, practical, and spiritual/religious concerns, giving visibility to the whole team. We record the responses in the patient's electronic medical record and track changes over time. Such tools can help provide an overall sense of the patient’s well-being, level of functioning, and performance status during their cancer treatment journey.
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