Better Supporting Patients with HR+, HER2- Breast Cancer

Last month (October) was breast cancer awareness month—a time dedicated to raising awareness for patients with and survivors of breast cancer, including those with HR+, HER2- mutations. A diagnosis of HR+, HER2- breast cancer requires a complex treatment regimen tailored to the individual, which may include hormone therapy, chemotherapy, or a combination of these. The emergence of oral targeted anti-cancer therapies has provided significant improvement in patient outcomes for this disease. However, the complex and evolving treatment landscape for HR+, HER2- breast cancer poses a challenge to oncology care teams, who are tasked with ensuring patients’ tolerability and adherence to their treatment regimen(s). 

ACCC has engaged experts through a vodcast series from CANCER BUZZ TV, focusing on specific issues regarding treatment adherence to oral therapies, treatment-related side effects, patient education, and financial barriers. 

Adverse Events

In the first episode, Pavani Chalasani, MD, MPH, program director of the Hematology and Medical Oncology Fellowship at Banner University Medical Center, University of Arizona Cancer Center, shares how she educates patients on what to expect from oral anti-cancer therapies and her focus on one of the most underestimated symptoms for patients.

Oral anti-cancer therapies are associated with distinctive dosing schedules, as well as side effect profiles that require knowledge of a rapidly growing body of medical literature. It is crucial for patients and caregivers to be taught the appropriate assessment and management of the potential side effects to ensure safe, accurate treatment. Given the potential for these issues to impact patient adherence and quality of life, routine monitoring for side effects and high-quality symptom management are critical.

Side effects from oral targeted therapies may include:

• Fatigue 
• Gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea) 
• Hematological issues (e.g., low blood cell count) 
• Skin issues (e.g., rash)
• Headache 
• Mouth sores 
• Hair loss.

Side effects from oral hormonal therapies may include: 

• Hot flashes 
• Vaginal dryness  
• Pain in the bones, joints, and/or muscles 
• Night sweats.

“It’s an exciting time in terms of oral treatment for these patients, but they do come with side effects. So educating patients…is important to proactively manage adverse events,” said Dr. Chalasani. 

Patient Education

In the second episode, CANCER BUZZ TV spoke to Tammy Smith, FNP, family nurse practitioner at Inova Health System, Fairfax Hospital and Pearman Parker, PhD, MPH, RN, PMH-BC, assistant professor in the College of Nursing at the University of Arkansas for Medical Sciences, Winthrop P. Rockfeller Cancer Institute. This episode covers how to educate patients and their caregivers about the risks and benefits of oral therapies for treating breast cancer.

When patients are prescribed oral anti-cancer therapies, they assume responsibility for safe and accurate administration of those medications. Compounding the issue, these medications typically require complex treatment regimens and close monitoring for dangerous side effects. Patients and their caregivers must be educated about the importance of adherence and know what side effects to look for, including how to best respond to them before they become serious or life-threatening. “We need to educate patients and their caregivers about potential side effects of oral therapies—low white blood cell count, nausea, vomiting, and diarrhea,” said Dr. Parker. “All of these are manageable.” 

Treatment Adherence

In the third episode of the four-part series, CANCER BUZZ TV spoke to Maryam Lustberg, MD, MPH, associate professor of Internal Medicine and director, Center for Breast Cancer at Yale-New Haven Hospital, Smilow Cancer Hospital, and Sandra Cuellar, PharmD, BCOP, FHOPA, clinical associate professor, Department of Pharmacy Practice at the University of Illinois at Chicago College of Pharmacy. In this episode, experts examine challenges with oral anti-cancer therapies and provide methods to better support patients. 

Patient adherence and persistence (taking medications as prescribed for the prescribed duration) are critical to maximize the effectiveness of oral anti-cancer therapies. There are several issues, however, that can make it challenging for patients to take their oral therapies as prescribed. 

Potential barriers include:

• Side effects and symptom burden related to medications and/or illness 
• Complexity of treatment plan and dosing schedules 
• Financial- and/or insurance-related barriers 
• Lack of social support 
• Poor communication from provider and/or low health literacy.

“Each patient faces a unique blend of these various challenges—remembering to take the[ir] pills, financial burden, toxicities/side effects, etc.,” said Dr. Lustberg.

Financial Barriers

In the fourth and final episode of the series, Aimee Hoch, LSW, MSW, oncology financial navigator at Grandview Health, discusses how to identify barriers to better support patients.

For some patients, there are financial barriers to accessing their prescribed anti-cancer therapies, particularly novel oral targeted therapies that can be costly. In addition to affecting patient adherence, financial toxicity is associated with increased distress and reduced quality of life for patients. It is critical for multidisciplinary cancer care teams to be aware of patient financial barrier, and work to put support in place to help their patients access the medications they need. “We like to focus on the cost of medication first, then zero in on the whole picture, such as what are the other out-of-pocket costs or co-pays,” Hoch said.

Educational Resources

ACCC’s Addressing Challenges in Oral Therapies for HR+, HER2- Breast Cancer education program is working to build the capacity of community oncology professionals to manage patients who are receiving oral therapies for HR+, HER2- breast cancer through the provision of high-quality educational content and resources. Some of these resources, includes:

• A resource library for HR+, HER- breast cancer
• Evolving standards of care for advanced HER2+ breast cancer
• A metastatic breast cancer education program.

For more information on ACCC’s education program dedicated to oral therapies for HR+, HER2- breast cancer, visit the ACCC website. 

The Addressing Challenges in Oral Therapies for HR+, HER2- Breast Cancer education program is supported by Lilly Oncology.