CTA: What types of educational interventions to improve patient understanding of recurrence score assay results would you recommend?
Dr Friese: A breast cancer diagnosis can be very challenging for patients. There is a lot of information to consume, the information comes rapidly, and decisions can be difficult. Our work points to the need for education before the breast biopsy, soon after the results are available, and additional information throughout the period of treatment. We recommend a combination of written and verbal instructions. We know that understanding risk estimates is hard, and there are some excellent examples of how to display statistics in easier ways. Patients should be encouraged to write down questions for their providers and be sure their questions are answered during or after clinic visits. We also recommend whenever possible that a friend or family member accompany a patient to visits to be sure all key information is relayed. In most cases of early-stage breast cancer, the patient can take some time to make these important decisions. It’s essential that patients have complete information and have their questions answered satisfactorily before they proceed with treatment decisions.
CTA: What role can oncology nurses and other members of the breast cancer treatment team play in helping patients understand the importance of the recurrence score test, how to interpret its results, and its effect on chemotherapy treatment decisions?
Dr Friese: As clinicians, we need to remember that these test names and interpretations are easy for us to remember, but are brand new to patients and families. Providing high-quality educational materials, repeating material covered previously, and encouraging patients to contact their provider with questions are keys to assuring adequate education. From our prior work, we know that patients who report their education needs were addressed were more satisfied with care and reported higher quality of life.
CTA: Did any of the findings surprise you? What are your next steps?
Dr Friese: We were surprised that 40% of women either did not know they had the test or did not report the results of the test accurately. This speaks to the need for robust educational strategies like the ones outlined above. We are investigating whether test knowledge varies by other social factors, like race/ethnicity, age, income, etc.
CTA: What might I not have asked that you would like our oncology clinician readers to know about your study?
Dr Friese: Recurrence score assay use in breast cancer represents an ‘early win’ for precision medicine in cancer. Our study shows there is an obligation and opportunity to engage patients fully in these discussions, so that precision medicine is also patient-centered.
- Friese CR, Li Y, Bondarenko I, et al. Chemotherapy decisions and patient experience with the recurrence score assay for early-stage breast cancer. Cancer. 2016 Oct 24. doi: 10.1002/cncr.30324 [Epub ahead of print]