Addressing Challenges in Managing Patients Receiving Oral Therapies for HR+, HER2- Breast Cancer — [VODCAST] Ep 17

Increased use of oral therapies means more freedom for patients with cancer, but also can lead to increased risks. CANCER BUZZ spoke to Tammy Smith, Family Nurse Practitioner for INOVA Fairfax Hospital in Falls Church, VA, and Dr. Pearman Parker, Assistant Professor for the University of Arkansas for Medical Sciences in Little Rock, AR. Hear how to educate patients and their caregivers about the risks and benefits to oral therapies for breast cancer. This is the second episode in a four-part series on breast cancer.

Guests:

Tammy R. Smith, FNP
Family Nurse Practitioner
INOVA Fairfax Hospital
Falls Church, VA

Pearman Parker, PhD, MPH, RN, PMH-BC
Assistant Professor
University of Arkansas for Medical Sciences
Little Rock, AR

Related Content:

• Addressing Challenges in Oral Therapies for HR+, HER2- Breast Cancer
• Resource Library for HR+, HER- Breast Cancer
• Evolving Standards of Care for Advanced HER2+ Breast Cancer
• Metastatic Breast Cancer Project

This is the second video podcast in a series from the “Addressing Challenges in Oral Therapies for HR+, HER2- Breast Cancer” education program.

Funding and support provided by Lilly Oncology. VV-OTHR-US-DEL-0876 © Lilly USA, LLC 2022. All rights reserved.

©2022. Association of Community Cancer Centers. All rights reserved. No part of this production may be reproduced or transmitted in any form or by any means without written permission.

Transcript

CANCER BUZZ: Welcome back to CANCER BUZZ TV. I'm your host, Summer Johnson. Today, the increased use of oral therapies means more freedom for patients with cancer, but it also means increased risks, making patient education especially important before they're sent home with these therapies, we're looking at education.

For patients with HR+, HER2- breast cancer. This is the second episode in our series about this topic. Our guests are Tammy Smith, a family nurse practitioner treating these patients at INOVA Fairfax in Fairfax, Virginia. And Dr. Pearman Parker, a registered nurse and assistant professor, at the University of Arkansas for Medical Sciences. Thank you both for joining me today.

Dr. Parker, let's start with you. What are some of the most important issues to educate patients and their families about regarding these oral therapies?

Pearman Parker, PhD, MPH, RN, PMH-BC: Thank you so much Summer for this question. So I will speak very broadly to this, is these are all very subject to the patients and also the medications that they're on.

So we have our traditional. Low white blood cells. Well, you cannot tell patients, Oh, you're gonna have a low white blood count. That doesn't, we, we must apply this information. So we have our nausea, our vomiting, our, our diarrhea going on. We sometimes have rashes going on, and these are manageable, and we need to really help our patients learn how to manage it, what they can do sort of upfront.

And all this sort of varies and all these strategies vary that I have seen. More off-label uses to some, somehow treat some of these side effects, but also knowing what is a problem. So that is a little bit more of where the education really has the most potency. Say you're having some unexplained bruising, what's going on?

Well, we need to go ahead and get in. We need to know this as clinicians to, you know, reduce any side effects of thrombocytopenia or anything that may be going on with that. The best sort of advice that I've sort of seen working with, you know, our clinicians and then also with my own research, is knowing how to be uncomfortable in this space and asking these questions for your patients anyway.

And then clinicians taking the, the leadership to connect with women, to ask women these questions that they may feel uncomfortable answering. But we've gotta start somewhere because it's just, it's not enough to say you're gonna have menopausal symptoms on these drugs when not everyone would necessarily know what that means.

Especially younger women who haven't actually experienced this. Well, you know, how, what, what are night sweats? How is that any different than, you know, having a flu? So, that is where I really just sort of encourage this conversation to happen, and its interesting summer, so our materials do not really go into it that much depth anyway.

Again, I think it's a reflection of our larger cultural sort of hesitancy to talk about this, but so that's sort of our hormonal aspect of this that's going on, and clinicians have to be very careful. Because these may be reasons why women discontinue their medication early is that they're not prepared to deal the side effects and frankly don't find it of benefit.

So that is our job as clinicians to assess where a patient is continually, you know, this, this doesn't stop. It's not a one and done. So, ask them where they are, what they need. Do they know what this means in a, you know, a very warm way, not a, not a con. I don't have to tell our clinicians not to be condescending.

But just in such a way to make this conversation that can be a little difficult, open and, and help our, our women, you know, manage this. So, it's, we're all, I think it's important to acknowledge it's, it's all a little uncomfortable, but that's just part of it.

CANCER BUZZ: Tammy, I'm going to ask you the same thing.

What are you talking to your patients and their families about what do they need to know about these oral therapies?

Tammy R. Smith, FNP: Right, so I always try to manage expectations up front and, um, so that the patients understand. What they're looking at as far as side, side effects and what we can help them manage as well as what they will have to do on their own in order to increase their quality of life, um, throughout the process.

And the key to that, of course, is education. Um, making sure that the patients are educated on possible side effects. Um, and the best ways to not only treat those side effects, but more importantly how to prevent them.

CANCER BUZZ: Tammy, what are some of the side effects and potential consequences of oral therapies that you emphasize in patient education?

Tammy R. Smith, FNP: Yeah, you know, hematologic toxicities are really the, um, are number one focus initially because, uh, you know, this can lead to infections, um, anemia, which leads to fatigue, Um, and. Monitoring their blood levels, letting them know that initially they're gonna have to come in for frequent blood work. Um, just so we can monitor that.

And then, you know, once we see how their body's gonna handle it, we can certainly lengthen that time. Um, in between blood draws. Um, and so just educating them on what that process looks like and that it doesn't always mean weekly visits and that, that time can be ex expanded quite a bit. But, um, that's probably the, our most serious side effects because it can have the most daunting complications.

With infection. Um, and then certainly it's the daily day to day kind of nagging side effects that, that bother patients the most, like gastrointestinal, um, upset, uh, changes in their bowel function. Um, so using anti diarrheas. Um, educating patients that for them they really have to focus on staying hydrated, exercising so that they don't become too fatigued and too, um, debilitated.

Um, and then, um, certainly skin issues of, of the hands, um, hands and feet. They can get some swelling, pain of the hands and feet itching, um, rashes. Um, but I would say what patients complain about the most is likely the GI upset, the and the fatigue.

CANCER BUZZ: Dr. Parker closes us out. Talk to your colleagues. What do we need to keep in mind when it comes to educating and treating these patients on oral therapies?

Pearman Parker, PhD, MPH, RN, PMH-BC: Yes, this with our, specifically with our hormonal therapies, I think it will just be very good sort of in moving forward with our clinicians and our patients just to be very, Empathetic to how challenging these side effects specifically with hormonal therapies can be and how scary it can seem to have, you know, all these side effects which you are not anticipating.

And you know, like patients get very scared and then they don't necessarily know what to do and that can erode the relationship a little bit. Think the advice, and again, again, I've just been thinking a lot about this, one of the advice would be just for our clinicians to just really maintain this, this deep level of empathy for our patients beyond what sort of is normally there with hormonal medications.

Cuz it, it's just, it's very hard, it's very challenging, specifically with our premenopausal women. So that, that's my, my soapbox and that's where my research is focused. So that is where I have spent a lot of time and energy. I just really appreciated the opportunity to speak today. I've been very passionate about teaching and then also about creating these bonds with our patients to help them have the best, you know, experience even though they're going through, through cancer.

So, you know, I, I know that's a bit, a bit odd to say, but why not? We, you know, they're, they're surviving and we get to treat them, so we might as well get to treat them and them go through it, not suffer at the same.

CANCER BUZZ: Thank you Tammy, and thank you, Dr. Parker. This show is a resource of the Association of Community Cancer Centers developed to bring oncology professionals the news and the latest trends in cancer care.

If you're enjoying this content, please let us know by sharing it with your colleagues on Twitter or LinkedIn. This episode was made possible through funding and support provided by Lilly Oncology. Stay tuned right here for more in our four-part series on patient education for breast cancer oral therapies.

On behalf of all of us here at CANCER BUZZ TV, thank you for watching. I'm Summer Johnson.