Investigating how patients, doctors make breast cancer treatment decisions
As more breast cancers are diagnosed at an earlier stage, patients and doctors are faced with a growing challenge: How to effectively treat the cancer without overtreating the patient and causing unnecessary side effects and quality-of-life problems.
A new $13.6 million program award from the National Cancer Institute will allow a national team of researchers centered at the University of Michigan Comprehensive Cancer Center to examine how patients make treatment decisions, how doctors make treatment recommendations and how to improve the process for better outcomes.
"Many women diagnosed with breast cancer have a favorable prognosis, and these women are particularly vulnerable to harm if treatment is too aggressive. We can't optimally improve women's health unless we address the challenges of individualizing cancer treatments," says Steven J. Katz, M.D., M.P.H., principal investigator of the new program grant.
"This program is about helping patients and their doctors avoid doing more harm than good on the journey from treatment to recovery from a diagnosis of breast cancer," says Katz, a professor of internal medicine and of health management and policy at the U-M, and co-director of the socio-behavioral program at the UMCCC.
The number of women diagnosed with the earliest stages of breast cancer has nearly tripled in the last 20 years. These early diagnoses tend to have good prognoses, with up to 95% of women surviving.
But these women face complicated decisions about how aggressively to treat the disease. Answers can vary based on each patient's specific tumor, family history or lifestyle.
"What's important is that treatment decisions are based on an accurate understanding of the options, risks and benefits, and that the choice is consistent with the patient's underlying values," says Sarah Hawley, Ph.D., M.P.H., a program lead investigator, associate professor of internal medicine at the U-M, and research investigator at the Ann Arbor VA Center of Excellence in Clinical Care Management Research.
As part of the grant, the researchers will survey patients and doctors about the use of MRI in diagnosing and assessing breast cancer, testing for the BRCA1 and BRCA2 gene mutations, and the use of a 21-gene assay that can help determine the benefit of chemotherapy. In addition, the researchers will develop an online decision tool to help improve the quality of patients' decision-making. The decision aid will be tested in a randomized, controlled clinical trial to assess its effectiveness.
"The findings from this research hold the promise of improving care for women with breast cancer and can serve as a model for the approach to evaluating and improving the individualization of treatment for other cancer and non-cancer conditions," says Jennifer Griggs, M.D., M.P.H., a program lead investigator and professor of internal medicine and of health management and policy at the U-M.
The program grant will be led by investigators in the Cancer Surveillance and Outcomes Research Team, a research group from multiple institutions nationwide focused on quality of cancer care and outcomes.
"I regard this program award as a signature accomplishment for the CanSORT investigators and one of the most important that we've funded over the past few years," says Robert T. Croyle, Ph.D., director of the Division of Cancer Control and Population Sciences at the National Cancer Institute.