patient care perspectives
HER2+ Breast Cancer: Discussing Treatment Options
Shared decision making in human epidermal growth factor receptor 2–positive (HER2+) breast cancer may be informed by the patient’s preferences and their particular concerns about treatment. Discussions at different points in the cancer treatment journey might include topics such as hair loss, fertility, the impact on daily life, and time spent away from family and work.
Chief, Division of Breast Oncology
“It is critical to make sure that we understand the patient’s concerns regarding their breast cancer treatment as we explain what their options are. It is important to have these conversations with the patient so that, together, we can figure out what is best for them.”
When deciding on treatment for a patient with HER2+ breast cancer, you really do have to factor in patient preferences. It is critical to make sure that we understand the patient’s concerns regarding their breast cancer treatment as we explain what their options are. It is important to have these conversations with the patient so that, together, we can figure out what is best for them.
One factor to consider and discuss with patients is the hair loss that can occur with some of these therapies (eg, first-line therapy with a taxane). We are now able to use interventions such as scalp cooling, which works very well to prevent hair loss. Further, it is very important to understand that some young women with breast cancer may want to have children. In the early-stage setting, you have to consider what the impact of treatment could be on their fertility and determine the timing of when it may be safe for a patient to try to conceive after completing therapy.
It is also important to acknowledge how a patient’s day-to-day life is impacted by HER2+ breast cancer treatment. These drugs are predominantly intravenous medications, which means that patients are spending a lot of time during their day getting treatment at an infusion center; however, we are working toward decreasing this burden. For example, trastuzumab had always been an intravenous drug, but now it is also available in a subcutaneous formulation, as is the combination of trastuzumab and pertuzumab. This means that treatments that could have taken 2 to 3 hours to infuse can now be administered as a 5-minute injection. So, there are ways to make the amount of time spent at the infusion center shorter if you know that someone would rather get the injection than the infusion.
It can be difficult for a patient to know exactly what treatment will look like in advance, so I think that we need to help walk them through the process, including giving them an idea ahead of time of the amount of time that they will spend away from their family for treatment. For instance, you should consider not only their time spent at the infusion center but also how far away they live from the infusion center and how that chunk of time for treatment is going to impact their life and their work. Patients will often ask if they need to take time off from work during and/or after treatment.
In conclusion, all of these types of conversations are really important to have with patients so that they can understand how to live their lives while undergoing therapy. Most patients can do it very well, but it does take a little bit of adjustment.
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