Photo By Bernard Little | The Murtha Cancer Center has hosted the breast cancer summit annually since it opened...... read more read more
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Other than skin cancer, breast cancer is the most commonly diagnosed cancer among women in the United States, accounting for approximately 280,000 cases and more than 40,000 deaths each year, according to Dr. Stan Lipkowitz, chief and senior investigator of the National Cancer Institute’s Women’s Malignancies Branch.
One of a numbers of speakers during the 2021 Murtha Cancer Center Breast Cancer Summit held Oct. 13, Lipkowitz said better screening, surgery, radiation treatment and systemic therapy have resulted in a steady decline of female deaths from breast cancer since the 1990s. “But this still leaves about 40,000 deaths a year,” he added.
This is why the John P. Murtha Cancer Center, located at Walter Reed National Military Medical Center (WRNMMC), annually hosts the breast cancer summit during October, Breast Cancer Awareness Month. The summit brings together military and civilian surgeons, oncologists, nurses and other cancer-trained clinicians and researchers from across the country to discuss the latest advances in cancer research, care and treatment.
“For the longest time, the diagnosis of breast cancer meant bad outcomes and life-altering events. Even today, our patients fear the worst whenever they hear those three words, ‘You have cancer.’ My patients used to call it ‘the C word’ because they didn’t want to say it,” said Brig. Gen. Jack Davis, WRNMMC director, in opening the one-day virtual summit.
Davis added the Murtha Cancer Center and WRNMMC offer those diagnosed with breast and other cancers, hope. “We can let them know they are getting state-of-the-art care [here].” He also described the care as “personalized, holistic and multi-disciplinary,” addressing all of the concerns of patients and their families, whether those concerns are medical, spiritual, dietary or administrative. “We will leave no stone unturned when it comes to providing them the best care possible so they can quickly change their status from cancer patient to cancer survivor.”
Some of that hope in the treatment may come in the form of immunotherapy, and Dr. Geeta Upadhyay explained that in 2019, there were approximately 4,000 immuno-oncology therapies in the global drug development pipeline worldwide, representing a 91 percent increase since 2017. “The landscape is not specific to breast cancer, [and] most of these treatments are targeted towards melanoma and other blood cancers,” she said. As of April 2018, a review by ClinicalTrials.gov identified nearly 300 actively accruing trials evaluating immunotherapeutic agents in breast cancer.
Upadhyay said the PD-1 inhibitor treatment has had some success for treating breast cancer that has come back or recurred locally and can’t be removed by surgery or has spread to other parts of the body.
Cancer immunotherapy, or immuno-oncology, uses the body’s own immune system to prevent, control, and eliminate cancer. Treatment can come in a variety of forms, including targeted antibodies, cancer vaccines, adoptive cell transfer, tumor-infecting viruses, checkpoint inhibitors, cytokines, and adjuvants.
“This is an exciting time for systemic therapies in breast cancer because there are so many in the last five or six years,” Lipkowitz said. In the treatment of metastatic HER2+ breast cancer, Lipkowitz said there’s been eight approved therapies based on antibodies and tyrosine kinase inhibitors within the last 20 years.
He explained the majority of breast cancer patients present with localized or regional disease, and these patients typically do very well based on the five-year survival rate. For patients presenting with distant or metastatic disease, the five-year survival rate is not as good. Also, African-American women have the worse outcome across all stages of the disease and tend to present later in the disease. “So there’s both a need for better treatment, and there’s a health disparity in both the outcomes and presentation of breast cancer,” he added.
Dr. Matthew Poppe, a radiation oncologist at the Huntsman Cancer Institute located at the University of Utah, discussed hypofractionation for women who have undergone a mastectomy. He explained hypofractionation as a treatment in which more doses of radiation are delivered per treatment so patients can complete their course of radiation therapy faster than conventional treatment. He said while short-course radiation treatment, or hypofractionation, improves access and patient satisfaction with care, it’s currently not recommended for reconstructive patients.
“Post-mastectomy radiation is an important component of locally-advanced breast cancer treatment [and] it improves survival, local regional recurrence, and distant recurrence. We know short-course radiation, if we can offer it to more patients by improving access, will ultimately result in improved survival, and it may lead to better cosmetic outcomes and we hope, decreased reconstructive complications,” Poppe said.
In addition to the physical toll cancer can cause patients, the disease can also present a financial burden for patients and their families, explained Dr. Fukimo Chino, a radiation oncologist at the Memorial Sloan Kettering Cancer Center in New York. She discussed financial toxicity in breast cancer treatment.
“I think that the hardest thing for a cancer patient – for me, wasn’t the treatment themselves, it was the stress and the burden of the financial hardship that you go through. Losing your hair and losing your breast and your eyelashes, and feeling like you’ve lost your identity, then the financial burden on top of all of it, is unbelievably stressful. You feel like it’s never going to end,” said Chino in quoting a 52-year-old cancer patient.
Chino shared a national cancer opinion survey conducted by the American Society of Clinical Oncology which showed just as many Americans are worried about cancer’s financial impact (57 percent) as they are about dying of cancer (54 percent). Also, 61 percent of caregivers say they or a loved one have taken at least one onerous step to pay for cancer care, including 35 percent have dipped into savings account, 23 percent worked extra hours, 14 percent postponed retirement, and 13 percent took on an additional job. In addition, 43 percent of cancer patients experienced barriers to accessing the best possible care due to health insurance coverage.
Financial toxicity is a side effect of cancer for which medical professionals should warn their patients, Chino said. “Cost are really making patients compromise their care because of affordability issues,” she added.
Chino, whose husband succumb to cancer, said medical bills from his care “chased her for more than a decade” after he died.
The National Cancer Institute defines financial toxicity as the problems a patient has related to the cost of medical care. Cancer patients are more likely to have financial toxicity than people without cancer, Chino added.
“Even with health insurance, the high costs of cancer care are leaving some vulnerable American families adrift in debt,” Chino furthered. “Out-of-pocket costs can have real effects on quality of life, satisfaction with care and quality of care. Greater financial toxicity was associated with higher patient-reported anxiety, fatigue, lower social and physical functioning,” she added.
To combat financial toxicity, Chino said solutions must come from policymakers, providers and patients.
“A broad set of stakeholders must contribute to efforts to align cancer drug prices with their value, ensure affordable access to cancer drugs for all patients, and promote future innovation in cancer drug development,” stated the President’s Cancer Panel in 2018.
Financial toxicity also impacts cancer survivorship, the “phase of care that follows primary treatment,” said Sarah Bernstein, a gynecologic oncology clinical nurse specialist at WRNMMC. “This is the phase of care where patients often experience a loss of the strong connection to their care team.”
Bernstein said a survivorship care plan should include prevention of new cancers and of late effects of the disease; surveillance for cancer spread, recurrence or second cancers, as well as assessment of medical and psychological late effects; intervention for consequences of cancer and it’s treatment, including sexual, physical, psychological and financial concerns; and coordination between the care team to ensure all of the survivor’s health needs are met.
“Patients may need a guide to help them determine their new ‘normal,’ as well as when they can expect some of these situations to improve,” Bernstein added.
Dr. Amy Xu, another radiation oncologist at the Memorial Sloan Kettering Cancer Center, discussed cancer treatment during the global COVID-19 pandemic. “This pandemic has impacted nearly everyone’s life in profound ways,” she said.
Xu explained that at Memorial Sloan Kettering during the initial stages of the pandemic in 2020, breast lumpectomies were considered elective and non-urgent procedures when most resources were directed to the care of COVID-19 patients. She added during that time, her team looked for other ways to provide safe, quality care to breast cancer and other patients.
“We certainly made recommendations for shortening radiation treatment schedules in ways we thought would be safe,” Xu said. She added the use of telemedicine at Memorial Sloan Kettering also increased during the pandemic. She explained pre-pandemic, the facility averaged about 500 telemedicine visits a week. Now, Memorial Sloan Kettering is averaging more than 20,000 telemedicine visits per week, which equates to approximately 50 percent of all visits to the hospital. Most telemedicine visits are to discuss definitive or adjuvant treatments.
“The lessons we learned in cancer treatment during a global pandemic [as related to Memorial Sloan Kettering], include the critical need to address disparities in care, and taking advantage of the opportunities to improve patient-centered care and acknowledging the importance of patient convenience and how to better adapt to those issues. Within radiation, we certainly moved more toward hypofractionated approaches, and telemedicine, I think, is here to stay,” Xu said.
The Murtha Cancer Center has hosted the breast cancer summit annually since it opened in December 2012. The center is a tri-service facility where military beneficiaries can receive care in all disciplines of cancer treatment. The center resulted from the integration of the Walter Reed Army Medical Center, National Naval Medical Center, Malcolm Grow Medical Clinic, and the U.S. Military Cancer Institute. It has more than 300 board-certified oncologists and professional clinical and support staff who specialize in all aspects of cancer care, from first diagnosis, through therapy and follow-up care, to survivorship.
For more information about breast cancer, visit the Centers for Disease Control and Prevention (CDC) website at https://www.cdc.gov/cancer/breast/basic_info/symptoms.htm.
| Date Taken: | 10.22.2021 |
| Date Posted: | 10.22.2021 15:09 |
| Story ID: | 407830 |
| Location: | BETHESDA, MARYLAND, US |
| Web Views: | 265 |
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