A new study has found that a breast cancer patient’s perspective on their physical health can provide a better indicator of their response to cancer treatment than medical tools, highlighting the importance of joint decision-making in the treatment process.
The research also identified differences between physician-based data and patient-reported data, with some clinicians overestimating their patient’s physical well-being.
“An essential component of patient-centered care, joint decision-making is a process in which clinician and patient collect and discuss available evidence about the benefits and harms of treatment, ensuring that the most appropriate and informed decision is made for the patient,” The study’s lead author says Natansh Moody, a doctoral candidate at NHMRC in the Clinical Cancer Epidemiology Laboratory at Flinders University.
Two tools can be used during joint decision making: the Eastern Collaborative Oncology Group Performance Status (ECOG PS), a clinician interpreted tool, and patient-reported outcomes (PROs), which are structured tools where the patient self-reports their view of their physical, social, emotional and functional capabilities .
General queries are generally used as secondary data in clinical trials to help interpret results; However, they have recently demonstrated their importance in providing patient prognosis for types of cancer including bladder, lung and skin cancer, but their value for HER2-positive advanced breast cancer has not yet been explored.”
Mr. Natansh Modi, lead author of the study, is a PhD candidate at NHMRC in the Clinical Cancer Epidemiology Laboratory, Flinders University.
Published in the magazine Unlock ESMOThe study combined data from several trials examining nearly 3,000 patients who had undergone drug treatments for human epidermal growth factor receptor 2 (HER2)-positive breast cancer.
“We found that a number of patient-reported outcomes, including those related to physical well-being and mental health, were identified as significant factors associated with either the patient’s overall survival from cancer, with no progression of the cancer or severe adverse events during treatment,” Mr. Moody says.
“The results indicate that the information provided by the patients themselves was better able to predict their response to treatment and their general prognosis than the results interpreted by the physician.
“Remarkably, patient-reported physical well-being was found to be the most useful patient-reported outcome in determining the prognosis of all available treatment outcomes.”
In some cases, the study found very different results between physician-based data and patient-reported data.
“We determined that about 70% of patients defined by their physicians as ‘fully active, able to perform all pre-illness performance without restriction’ went on to report limitations in their physical condition when asked to report themselves,” Mr. Moody says.
The authors say the research highlights the importance of listening to patients, as both types of tools provide useful, alarm-independent information.
“This study demonstrates that patient-reported physical well-being can predict better prognosis than clinician-interpreted ECOG PS. Therefore, it is imperative that clinical practice shift to place greater emphasis on the patient’s perspective and voice,” Mr. Moody says.
“By combining patient-reported questionnaires with clinically interpreted measures, we can provide the best clinical insights that allow joint decision-making in cancer treatment, while also enhancing the design of future clinical trials.”
Patient-reported outcomes predict survival and adverse events after initiation of anticancer therapy in advanced HER2-positive breast cancer. ND Modi, NO Danell, RNA Perry, AY Abuhelwa, A. Rathod, S. Badaoui, R. A. McKinnon, M. Haseloff, A. Shahnam, S. M. Swain, M. Welslau, M. J. Sorich, and A. M. Hopkins are published in the journal Unlock ESMO. DOI: 10.1016/j.esmoop.2022.100475.
This work was supported by an Emerging Lead Investigator Grant from the National Health and Medical Research Council, Australia (APP2008119) to AMH; Beat Cancer Research Fellowships from the Cancer Council of South Australia to RAM and MJS; and a Postgraduate Scholarship from the National Health and Medical Research Council, Australia (APP2005294) to NDM.
Moody, N.D., et al. (2022) Patient-reported outcomes predict survival and adverse events after initiation of anticancer therapy in HER2-positive advanced breast cancer. Unlock ESMO. doi.org/10.1016/j.esmoop.2022.100475.