Center for Medical Consumers

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Breast cancer treatment decision aid

Posted by medconsumers on December 14, 2011

You have breast cancer and the initial surgical treatment is over. Now there is help with another decision that just about all breast cancer patients must make:  Should I go on adjuvant therapy, which can mean months of chemotherapy and/or years of hormone therapy? A terrific easy-to-use decision aid freely available on the Web has just been brought to my attention. It is set up to help both breast cancer patients and physicians make informed decisions about adjuvant therapy.

First, a reminder about the role of adjuvant therapy, which refers to postoperative treatments given to reduce the chance of a cancer recurrence. My recent post shows that adjuvant therapy is the main reason for the 2% annual drop in breast cancer deaths since the 1990s.  Click here  This drop, observed in many countries, coincides with the introduction of adjuvant drugs like tamoxifen and more recently Herceptin.

The decision aid is called PREDICT because it predicts a woman’s survival without and with adjuvant treatment.  Put another way, PREDICT shows how much (or how little) the additional treatment improves the chances of having a cancer recurrence.

Here’s how the website describes the basis for its predictions:  “Breast cancer comes in different types and several different factors affect the response to treatment. From research and studies involving many thousands of women we know that the response to treatment is affected by the size and type of the cancer at diagnosis, whether the cancer has spread to involve lymph nodes and whether there are estrogen or HER-2 receptors on the surface of the cells.”

To use this website you must be able to answer a few questions about your diagnosis such as tumor grade and estrogen receptor status. The predictions are presented in two easy-to-understand formats: a color chart and frequencies statistics. Here’s an example of the latter for an estrogen-positive, tumor grade 2 breast cancer in a 68-year-old woman:

“Five-year survival—90 out of 100 women are alive at 5 years with no adjuvant therapy after surgery.   An extra 1 out of 100 women treated are alive because of hormone therapy.

Ten-year survival—78 out of 100 women are alive at 10 years with no adjuvant therapy after surgery.
An extra 3 out of 100 women treated are alive because of hormone therapy.”

Unfortunately, this website does not address quality-of-life issues such as the rates of serious harm associated with each adjuvant treatment choice. Still, this is a great decision aid that deserves replication for other life-threatening diseases.

PREDICT has been developed by a partnership between the Breast cancer Unit at Cambridge University NHS Hospital, the University of Cambridge Department of Oncology and the NHS Eastern Cancer Registry and Information Centre, UK.

Maryann Napoli,Center for Medical Consumers(c)

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