We have taken part in a unique evolution in medicine, as we have modified our clinical processes and practices, clinical trials and research programs, and educational vehicles because of the COVID-19 pandemic in 2020. And of course, these ways of delivering cancer care continue now that we are in 2021 and still dealing with the pandemic.
Our patients who are courageously fighting metastatic breast cancer have continued to need our help with education, navigation, psychosocial support, shared decision-making opportunities, and receiving their needed treatments in the midst of this pandemic. We have learned together how to support these patients in different and innovative ways. For those who are working virtually, we can still “see” our patients through the computer screens but have lost the opportunity to directly hold their hands or embrace them, which is, as you know, one of the joys of being in the field of oncology, and for me, specializing in metastatic breast cancer. For those delivering care and treatment face to face, we have lost the ability to see our patients’ faces and they too cannot see ours, and hand-holding is done wearing disposable gloves. Some positive innovations and methods of taking care of our patients that have proven to work quite well will likely continue to be utilized long after the pandemic thankfully ends.
From a clinical perspective, many of us increased our use of telemedicine, electronic prescribing, and more collaborative multidisciplinary healthcare approaches. In the future, this may help reduce unnecessary risk of infections and improve clinical management that could prevent adverse events as well as serious side effects from even occurring. We have learned through telemedicine and different forms of diagnostic testing that there are opportunities to improve the management of chronic comorbidities such as diabetes and hypertension.
We also saw significant changes in the dissemination of cutting-edge treatment advances that had historically been presented at live scientific meetings. To deliver the latest research on oncology care advancements, both national and international conferences, including the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO), and the San Antonio Breast Cancer Symposium (SABCS), convened virtually in 2020. To support you in clinical practice as you seek to optimize breast cancer care, we are synthesizing the most important research findings from these meetings in this Year in Review series. Below are a few highlights.
A presentation at SABCS specifically addressed whether pandemic patients with metastatic breast cancer were facing changes in routine clinical treatment in the United States. The COVID-19 Pandemic Breast Cancer Consortium Recommendations had suggested some patients be considered for dosage or schedule adjustments to mitigate the risk of side effects and the frequency of healthcare visits, while beginning treatments with less need for monitoring. In some regions, hoping to save protective equipment and minimize exposures, hospitals postponed a portion of cancer surgeries that were deemed “safe to wait.” Clinicians modified management protocols for metastatic breast cancer with delays in treatment initiation and shifts in prescription patterns for patients beginning new therapies. And when possible, there was more utilization of oral agents for treatments instead of relying as much as we commonly did on intravenous infusions.
Exciting results were reported during a late-breaking presentation at the ESMO Virtual Congress 2020. Targeting endocrine-resistant, hormone receptor (HR)-positive metastatic breast cancer, the PI3K inhibitors represent the most recent introduction to the breast cancer treatment armamentarium. An investigation showed that treatment with alpelisib plus fulvestrant demonstrated benefits, thereby instilling new promise for patients with PIK3CA-mut advanced breast cancer despite the poor prognosis of this population at baseline.
At ASCO, updated results from CompLEEment-1, the largest trial of a CDK4/6 inhibitor in an advanced breast cancer population to date, closely resembled real-world clinical practice. The outcomes strongly support the safety and efficacy of ribociclib plus letrozole when treating patients with HR-positive, HER2-negative advanced breast cancer and no previous exposure to endocrine therapy for advanced breast cancer.
There were also quality-of-life (QOL) studies that were published focusing more on the importance of QOL over Quantity of Life, which is where my own passion lies. A critical look was taken at patients receiving chemotherapy during the last month of their lives and the realization that treatment for treatment’s sake is not what patients with stage IV breast cancer need. They need time with their family, time for reflection, preservation of QOL, and rigorous palliative care along with hospice care.
As a breast cancer community, we hope to move forward together, extracting the best of 2020, incorporating recent advances and practice-changing developments into our clinical practices.
We hope that you enjoy these Year in Review highlights and find them useful!
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Editor-in-Chief, Journal of Oncology Navigation & Survivorship; Co-Founder, AONN+
University Distinguished Service Professor of Breast Cancer
Professor of Surgery, Johns Hopkins University School of Medicine
Former Administrative Director, The Johns Hopkins Breast Center
Former Director, Johns Hopkins Cancer Survivorship Programs
Co-Developer of Work Stride–Managing Cancer at Work. Johns Hopkins Healthcare Solutions