Although breast cancer treatment varies between individuals, most people with breast cancer will usually have multimodal treatment consisting of surgery and radiotherapy to treat local disease, and antineoplastic agents, hormone therapy and/or targeted therapies such as Herceptin to target micrometastases. The use of multimodal therapies for treatment of breast cancer today may affect the person's quality of life because of the range of adverse effects that may be experienced with combining treatments.13, 30-36
Treatment recommendations are based on the final histopathological features and prognostic factors of the tumour such as grade, size, hormone receptors (including C-erb2 status) and nodal status. Other factors such as age, menopausal status, pre-existing co-morbidities, logistics, costs, treatment adverse effects, treatment outcomes, and individual preferences are also considered.30-36
A person with breast cancer is faced with making complex treatment decisions at a time when they may be extremely anxious and stressed. People vary in the extent to which they wish to participate in treatment related decisions, although most prefer a collaborative approach rather than being given a choice without adequate information and support.23
Clinical practice guidelines
Evidence-based information about current and new treatments to support the information needs of people affected by breast cancer and clinicians can be found in clinical practice guidelines. These documents guide appropriate practice, and are followed subject to the clinician's judgment and the woman's preference in each individual case. The following are key Australian guidelines available through the Cancer Australia website:
- Recommendations for the management of central nervous system (CNS) metastases in women with secondary breast cancer (2014)
- Recommendations for the management of early breast cancer in women with an identified BRCA1 or BRCA2 gene mutation or at high risk of gene mutation (2014)
- Recommendations for use of bisphosphonates in early breast cancer (2011)
- Recommendations for use of hypofractionated radiotherapy in early (operable) breast cancer (2011)
- Recommendations for staging and managing the axilla in early (operable) breast cancer (2011)
- Recommendations for follow-up of women with early breast cancer (2010)
- Recommendations for use of Taxane-containing chemotherapy regimens for the treatment of early (operable) breast cancer (2008)
- Recommendations for use of Sentinel node biopsy in early (operable) breast cancer (2008)
- Recommendations for Aromatase inhibitors as adjuvant endocrine therapy for post-menopausal women with hormone receptor-positive early breast cancer (2006)
- Recommendations for use of bisphosphonates for advanced breast cancer (2011)
- Recommendations for use of chemotherapy for the treatment of advanced breast cancer (2010)
- Recommendations for use of endocrine therapy for the treatment of hormone receptor-positive advanced breast cancer (2008)
- Recommendations for use of Trastuzumab (Herceptin®) for the treatment of HER2-positive breast cancer (2007)
M ☐ F ☑
Left-sided wide local excision and sentinel lymph node biopsy (three positive nodes) - clear margins were obtained. This was followed by a second procedure for axillary clearance due to the positive lymph nodes.
Libby's story 4: Clinical practice guidelines
Describe the key tumour-related factors which will be considered in planning Libby's treatment.
Explain why it is likely that Libby will receive combined modality treatment.
Discuss how the MDT could assess Libby's preferences for information and involvement in decision making.