Patient Expert Dialogue: Shared Decision making in eBC Care

Patients could seek for second opinion  to reassure about the assessment and diagnosis. Accurate assessment of tumour biology is extremely important to ensure patients receive the optimal treatment. MDT is a group of individuals (Surgeon, oncologist, pathologist, radiologist and nurse) who have their own specialties to discuss the rationale for different viewpoints and then communicate with patients. Therefore, instead of one individual making a decision, a decision is made based on what is in the best interest of the patients with the knowledge from a group of expertises.

For patients undergoing neoadjuvant treatment, there are several advantages to it. First, there is systemic advantage- the treatment starts treating early micrometastatic disease and second, there is local advantage- the effect of tumour shrinkage and reduction of tumor size are seen by having  in vivo response to treatment.  Moreover,. It may allow patients to have choices for breast conservative surgery and mastectomy and gain more time to discuss the different choices with patients according to the response of the neoadjuvant treatment and preference of patients. Moreover,  the adjuvant treatment after surgery could be tailored according to the absence or presence of the residual disease in the tumor in the breast, which is an important feature since 2019.

Physicians explain each part of the treatment regimen separately and discuss all the available neoadjuvant treatment options with patients. If clinical studies enrollment is available in the country, discuss all options for optimal treatment for the patients. Physicians should also discuss side effects, both short term and long term to patients for different types of drugs and chemotherapy used and related documents accessible.

Patients are often unaware of the terminology and clinical impact of “pCR” and “residual disease” and HCPs should not be too focused on pCR before the patients have the systemic treatment. HCPs should manage patients’ expectations regarding outcomes after neoadjuvant and explain the goal of neoadjuvant treatment. HCPs should also not be painted pCR as the be-all and end-all because even patients who do not have a pCR can be cured of their cancer.

Moreover, patient information should use simple language and is easy to understand for patients.

Support should be tailor made to manage patient’s side effects, quality of life and self-esteem. Treatment schedules, list of side effects, emergency contact number should be provided to the patients throughout the breast cancer journey. Involve psychologist, nutritionist, nurses and patient groups in the patient journey which could provide holistic breast cancer care to the patients. Moreover, support from patient advocacy groups, websites, local patient groups, 1:1 patient interactions beyond their anti-cancer treatment are also helpful for patients during their breast cancer journey.

In the patient breast cancer journey, it is important to involve people who are taking care of the patients as well in the whole decision. Patient supports can be family members and/or friends and they also need to understand which treatment the patient is going through, what means the surgery afterwards. Patient support may also be responsible for treatment decisions on the patient’s behalf, with treatment-related information directed to the patient supports. Education of patients and their supports is important to enable them to make the right treatment decisions and make sure that they feel that they are part of the decision-making process.. Patient supports may accompany patients for emotion/physical support, with the patients responsible for their own treatment.