PHM’s Evidence-Based Approach Reduces Treatment Uncertainty for Our Patient with Breast Cancer

Many cancer patients are faced with deep, personal decisions about what treatment path will be right for them. There are many factors to consider, including the likelihood that the cancer may come back and whether the side effects of treatment will impact quality of life. For our client, Danielle*, these decisions were compounded by the recent loss of her loved one to a similar cancer diagnosis.

Danielle, aged 50, received a diagnosis of early-stage triple-negative breast cancer (TNBC), known for its aggressiveness and limited treatment options. She had a lumpectomy to remove the tumor, which revealed that the cancer was at an early stage (1b); this diagnosis is associated with a favorable prognosis and a lower risk of subsequent recurrence. For her next treatment step, she consulted two oncologists for chemotherapy recommendations. One recommended a 2-drug combination, while the other proposed a more aggressive 3-drug regimen, including the potent anthracycline-based chemotherapy, which is commonly referred to as the “red devil” in the medical community. This drug is one of the most powerful chemotherapy options for a wide range of cancers and is associated with treatment related toxicities that often include nausea/vomiting, total hair loss, diarrhea, mouth sores, and susceptibility to infection from low white blood cell numbers. Now, Danielle needed to decide which option was right for her.

Based on a recommendation from a family member, Danielle came to Private Health Management (PHM) for support in making her treatment decisions. Understandably, she had deep anxiety about the loss of her relative to this same cancer and wanted to pursue an aggressive treatment plan to optimize the chances for a durable response. She also wanted to maintain her quality of life during treatment so that she could continue to care for her young children, which made the toxicity of the 3-drug combination concerning. Danielle’s PHM Personal Care Team helped to reassure her that while these decisions were complicated, there was no ‘wrong’ choice; it was most important to choose the path that was best for her and met her personal care goals.

The researchers on her PHM Care Team did a systematic review and meta-analysis of the scientific literature, comparing the 2-drug regimen and the 3-drug regimen in similar TNBC patient cohorts. They compiled an in-depth presentation on the latest clinical data, showing that the 3-drug combination was not more effective at holding off disease progression or extending overall survival than the 2-drug combination. In addition, the 3-drug combination was associated with a significantly increased side effect profile. Her team also ordered molecular profiling tests, which demonstrated undetectable residual disease systematically in her bloodstream, indicating that a 2-drug regimen would be reasonable. With the reassurance provided by understanding the clinical data and testing results, Danielle decided on the 2-drug treatment combination and completed this treatment course.

Once she finished her chemotherapy, Danielle was faced with an additional clinical decision. While the standard of care for her cancer diagnosis is lumpectomy followed by chemotherapy and radiation, she was strongly considering a radical mastectomy of both breasts instead of radiation. She was concerned that radiation may not be aggressive enough and wanted to make sure that she had done everything she could to prevent recurrence. Her PHM Care Team connected her with experts to review radiation and surgical options, including the benefits and side effects of each.

PHM researchers analyzed the latest clinical data and presented a summary to Danielle and her husband, which showed that radiation had better overall survival and a decreased chance of relapse in several studies relative to those who had double mastectomies without radiation. In addition, patient-reported outcomes from breast cancer survivors that underwent a lumpectomy showed that they were significantly more satisfied with cosmetic results compared to mastectomy. After much consideration of the scientific data and her personal situation, Danielle was confident in her decision to pursue radiation, sparing herself from a more invasive surgery and difficult recovery.

Danielle’s PHM Personal Care Team stays in regular communication and frequently monitors her clinical status, while staying on the forefront of potential maintenance treatment and testing options for her next stage of care. Like all patients with cancer, she will be faced with decisions about managing her disease in the future, and PHM will continue to offer support and education to assist her in making those tough choices.

*Name changed to protect privacy.