BCI, Patient Preference Guide Nurses in 5-Year Endocrine Counseling

In the long-term treatment of patients with hormone receptor (HR)-positive breast cancer, deciding whether to continue endocrine therapy is a difficult question of risk vs reward. According to Michelle Kirschner, MSN, RN, ACNP, APRN-BC, getting to know the patient better is a key part of counseling these decisions.

As Kirschner highlighted, with any treatment in oncology comes adverse effects. Endocrine therapy is no exception, and for patients who have been treated with anti-estrogen therapy for 5 years or more, providers and patients may start to have discussions about whether the continuation of therapy will be beneficial. Kirschner emphasized the use of the breast cancer index (BCI) in these situations to help patients make an informed decision about whether the continuation of therapy is likely to benefit them.

Additionally, Kirschner, the director of program development at the Cancer Survivorship and Supportive Care Professionals Network, pointed out that while the BCI may suggest that a patient may or may not benefit from continued therapy, the patient may have their preferences that should be taken into consideration, such as severe adverse effects or high anxiety about discontinuing treatment.

Transcript

The idea of patient-centered care is so important. That means that you look at that individual and try to understand what is important to them. What is their mission? What do they want? If you really allow that conversation, and you see that individual is a whole person with a family and interests and things, then you start to understand that your professional opinion is one component of this decision but really understanding what’s important to [the patient] can sway you.

We give our best input, but ultimately, we should always allow the patient to make those decisions. Any cancer treatment has [adverse] effects. Our goal is to minimize [adverse] effects, but treatment has a toll, and it can be in multiple different ways. It’s really having to decide the risk vs benefit ratio, and with each person it’s so individualized.

First of all, I want to understand how they’re doing on treatment, and if it [has] been tolerable. Understanding their [adverse] effect burden is very important as well as understanding the psychosocial impact of that uncertainty of recurrence. There are individuals who are highly anxious, and they really want to do every single thing that they can to feel like they’re helping themselves. I want to understand fully the patient and what’s going on with them, but I definitely think that using our tools, that we have to make these decisions is very helpful, because we’re dealing with uncertainty, and uncertainty is really hard to have.

Anytime we can bring clarity to the situation, it really opens up the conversation. Somebody who might be anxious about stopping treatment, if we could show them that treatment is not going to benefit them beyond 5 years, they might be willing to give up treatment, vs someone who maybe is having some [adverse] effects, and it’s kind of hard for them, but if you could show them that their treatment is really important and is going to have benefit, they might be willing then to just work on lowering their [adverse] effect profile, but they’ll stay on the medication. Methods like these, along with BCI testing, are really helpful in bringing clarity into those decisions.

This transcript has been edited for clarity and conciseness.