Doctors Say: Sharing News Breast Cancer Has Come Back Is Worse Than Giving Initial Diagnosis

Main Category: Breast Cancer
Also Included In: Cancer / Oncology;  Primary Care / General Practice
Article Date: 11 Jun 2008 - 4:00 PDT

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"Hearing the sad news that breast cancer has returned can be a devastating experience for patients, especially as this means that the disease is no longer curable. Doctors also find imparting this information to women with whom they have developed a trusting relationship over the years extremely distressing. However, optimal use of available treatments will enable more women to stay cancer-free and reduce the number of these sad, bad and difficult conversations. Doctors meanwhile need help learning how to communicate distressing information in honest, positive and supportive ways."
Professor Lesley Fallowfield, Professor of Psychosocial Oncology, UK

New research, published in Current Medical Research and Opinion, reveals over three-quarters of doctors (78%) find telling women their breast cancer has come back so difficult that they consider it even worse than breaking the devastating news of the original diagnosis.1 When breast cancer comes back, it results in a significant emotional and physical burden on patients and their doctors. For most women, recurrence means their cancer is ultimately no longer curable. Sharing such painful news with a patient and her family is particularly difficult for doctors, with almost half (44%) saying they find discussing recurrence the most stressful part of their job.1

Protecting women from recurrence is the number one priority for doctors treating hormone receptor-positive early breast cancer. As breast cancer is most likely to come back in the first 18 months following diagnosis, prescribing the most effective treatment as early as possible, to minimise the risk of recurrence, is key to saving lives. The majority of women who took part in the research (83%) place their trust in their doctor and are confident they will be given the best treatment available to keep them disease-free.1 However, if their cancer comes back, 41% of patients admit their trust in their doctor would decrease.1

For doctors to be certain they are making the best treatment choice for patients, the research shows almost all (91%) rely on comprehensive clinical data.1 In addition to a strong evidence base, doctors say their experience with a particular treatment is a key factor in selecting the most appropriate treatment. Dr Mark Lansdown, a consulting surgeon based in the UK, comments: "Doctors treating breast cancer have a very trusting relationship with their patients. To protect that trust, doctors need to have confidence in their treatment decisions, which directly impact on patients' lives."

Dr Lansdown continues: "It is important that we base our treatment strategy on robust and mature clinical data to generate a sense of confidence for prescribing oncologists. A good example of this is the change in treatment strategies we have seen in response to the wealth of clinical data on aromatase inhibitors. In postmenopausal women these are now replacing tamoxifen as the gold-standard treatment choice for preventing recurrence of breast cancer."

The most mature clinical data set on aromatase inhibitors (AIs) is seen with the ARIMIDEX, Tamoxifen, Alone or in Combination trial (ATAC). ATAC was the first reported trial to compare tamoxifen with an aromatase inhibitor as upfront adjuvant hormonal therapy, showing superior efficacy at preventing recurrence even four years after treatment ends (24% reduced risk of recurrence with the AI anastrozole compared with tamoxifen). 2 The survey, also presented at the recent 6th European Breast Cancer Conference, reveals 78% of physicians would recommend anastrozole for their family or themselves, highlighting the importance of evidence and personal experience which lead to confidence and trust in treatment choice.1

As the primary source of information for 87% of breast cancer patients, it is crucial doctors feel supported, prepared and equipped to talk with their patients about the risks of recurrence and the most effective means of preventing it.1 However, evidence suggests patients can find it hard to absorb this information3 and it has been proposed that interventions to support doctors to improve their communications skills and stressmanagement techniques, would improve consultations and lead to better quality care.4,5,6

As part of their commitment to support healthcare professionals managing breast cancer, AstraZeneca is working with doctors and communication experts to develop training materials, to help doctors and women with breast cancer communicate more effectively around recurrence. These training materials can be accessed on the Breast Cancer Source website at http://www.breastcancersource.com.

'More Positive Conversations' global survey

The 'More Positive Conversations' survey was deigned to investigate the impact of positive and negative interactions on the relationship between doctors and their patients. It was conducted online and via telephone interviews by Harris Interactive on behalf of AstraZeneca. The survey involved 462 breast cancer physicians and 600 patients* from France, Germany, Italy, the United Kingdom and the United States. The results have been published online in Current Medical Research and Opinion with the full paper scheduled for print publication in the July issue of the journal.

* Postmenopausal women diagnosed with early breast cancer in the past 5 years, who had undergone surgery.

Positive Conversations Oncologist Toolkit

The Positive Conversations training materials are designed for healthcare professionals and can be downloaded here

ATAC Trial

The ARIMIDEX, Tamoxifen, Alone or in Combination (ATAC) trial is one of the world's largest and longest-running clinical studies in postmenopausal women with early breast cancer. ATAC is designed to investigate the comparative efficacy and tolerability of two adjuvant therapies: ARIMIDEX (anastrozole) and tamoxifen.

The 100-month analysis of ATAC, presented for the first time in Europe at the 6th European Breast Cancer Conference (EBCC) last month, reinforces the significant superiority of ARIMIDEX over tamoxifen at reducing the risk of breast cancer returning (also known as 'recurrence') and at increasing disease-free survival (DFS) in postmenopausal women with hormone receptorpositive early disease.2 These new data also show that, even approximately four years after treatment completion, the absolute reduction in the risk of disease recurrence continues to increase with ARIMIDEX compared with tamoxifen.2

AstraZeneca

AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world's leading pharmaceutical companies with healthcare sales of $26.47 billion and leading positions in sales of gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infection products. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4 Good Index. ARIMIDEX (anastrozole) is a trademark, the property of the AstraZeneca group of companies. http://www.astrazeneca.com

References

1 Lansdown M, Martin L and Fallowfield L. Patient-physician interactions during early breast-cancer treatment: results from an international online survey. Current Medical Research and Opinion 2008; 24 (7).

2 The ATAC Trialists' Group. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100 month analysis of the ATAC trial. The Lancet Oncology 2008; 9(1):45-53.

3 Wedgström Y, et al. Patients' knowledge and experience of adjuvant endocrine therapy for early breast cancer: A European study. The Breast 2007.

4 Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R. Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet 2002; 359: 650-656.

5 Jenkins V, Fallowfield L. Can communication skills training alter physicians' beliefs and behaviour in clinics? J Clin Oncol2002; 20: 765-769.

6 Fallowfield L, Jenkins V, Farewell V, Solis-Trapala I. Enduring impact of communication skills training: results of a 12 month follow-up. Br J Cancer 2003; 89: 1445-1449.

http://www.astrazeneca.com