Report Gives Low Marks to Metastatic Breast Cancer Care

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edited April 2016 in Stage IV/Metastatic Breast Cancer ONLY

Free article at Medscape requires registration to access:

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Report Gives Low Marks to Metastatic Breast Cancer Care

Linda Brookes, MSc

April 12, 2016

Recent advances in the detection and treatment of breast cancer have focused mainly on early-stage disease. Consequently, many women with advanced or metastatic breast cancer (MBC) feel that their needs are not adequately addressed and that fewer community resources are available to them, compared with those for women with early-stage disease.[1]

This view was reinforced by the latest findings in Global Status of Metastatic Breast Cancer (MBC): A 2005-2015 Decade Report, an international assessment of the scientific, societal, economic, and political landscape of advanced/metastatic breast cancer that was commissioned by Pfizer Oncology, working collaboratively with the European School of Oncology.[2] The report forms the basis for a global call to action for policy-makers, advocates, and the medical community to improve MBC outcomes by 2025.

The final report was presented in March at the European Breast Cancer Conference in Amsterdam by steering committee chair Dr Fatima Cardoso, MD, director of the Breast Unit of the Champalimaud Clinical Center in Lisbon, Portugal.[3] The report confirmed the findings of previous US and international surveys[4,5] that MBC "receives inadequate attention globally, and that information for patients is often lacking," Dr Cardoso said.

"Over the past decade there have been a few changes, particularly in the support groups, but little improvement in other areas," Dr Cardoso told congress delegates. "We, the breast cancer medical community, have not made the progress that we would have liked to have seen in treating this disease. There are major shortcomings in the treatment and management of metastatic breast cancer. Median survival has remained for many decades at 2 to 3 years after diagnosis. Our research strategies need a comprehensive overhaul if we are to make progress, with better international collaboration on large, well-designed clinical trials with truly meaningful endpoints/objectives, and smarter analysis of the large amount of biological data being gathered."

Report Suggests MBC Research Has Stalled

Progress in the understanding and treatment of MBC appears to have stalled over the past 10 years, according to the report's findings. "We were the first to get many of the new technologies, molecular classification and subtyping, and the development of targeted therapies, but now we seemed to have reached a point where there is no more evolution and other fields are evolving more rapidly and outpacing us," Dr Cardoso said. She pointed to metastatic melanoma and metastatic lung cancer as fields where disease understanding; level of innovation; transformative approaches, such as immunotherapy; and advances in precision medicine have accelerated compared with MBC.

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"The most shocking finding": 18%-49% of the general population believe that patients with MBC should keep it secret.

According to a survey carried out for the report, 18%-49% of the general population believe that patients with MBC should keep it secret and not discuss it with anyone other than their physician. "This was for me the most shocking finding," Dr Cardoso admitted to Medscape. "We are in the 21st century, in the so-called developed world, and this is still the attitude."

These attitudes have a negative impact on patients, who can feel isolated and helpless because of a lack of understanding and the stigma associated with the disease. "There is a need to educate not just lay people, but everyone who is not directly involved with the disease," Dr Cardoso told Medscape. "People do not realize that there is a period, which we hope will become longer and longer, where a woman receiving treatment can live a more or less normal life.

Dr Cardoso recalled that one effect of the "pink" breast cancer awareness movement, which focused on a positive message of prevention and survival, was that patients with MBC were excluded, because people did not want to see patients who were going to die of their disease. She said that there were two consequences of this: Patients with MBC were marginalized and had no information or support, and they also felt guilty, thinking that perhaps the cancer returned because they did something wrong.

In the 1970s, we had to fight the taboo against talking about breast cancer; now we have to fight the taboo against talking about how breast cancer can kill.

Speaking to Medscape, Dr Cardoso said, "In the 1970s, we had to fight the taboo against talking about breast cancer; now we have to fight the taboo against talking about how breast cancer can kill. Unfortunately, there is not always a happy ending."

The lack of a guaranteed happy ending is why the media currently don't want to report on MBC, Dr Cardoso added. "It is important to educate the media to have them on our side," she said, adding that outside of professional journalism, social media can be very influential in opening up discussion about advanced cancer and death.

The entire article is at:

http://www.medscape.com/viewarticle/861655


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