A breast cancer patient’s perspective on their physical well-being can provide a better indication of their response to cancer treatment than clinician-based tools, a study has found, highlighting the importance of shared decision-making in the treatment process, and turning on its head the patient/doctor knowledge assumption.
The research also identified differences between clinician-based data and the patient-reported data, with some clinicians over-estimating their patient’s physical well-being.
“An essential component of patient-centred care, shared decision-making is a process in which the clinician and patient collate and discuss the available evidence on the benefits and harms of treatments, ensuring the most appropriate and informed decision is made for the patient,” says study lead author Natansh Modi, an NHMRC PhD candidate in the Clinical Cancer Epidemiology Lab at Flinders University, Adelaide, Australia.
Two tools can be used during shared-decision making: the Eastern Co-operative Oncology Group performance status (ECOG PS), a tool interpreted by the doctor, and patient-reported outcomes (PROs), structured tools whereby a patient self-reports their perspective on their physical, social, emotional and functional abilities.
“PROs are generally used as secondary data in clinical trials to help with interpreting results, however, they have recently shown to be important in providing a prognosis to the patient for cancer types including bladder, lung and skin cancers, but their value to HER2-positive advanced breast cancer had yet to be fully explored,” says Modi.
Published in the journal ESMO Open, the study pooled data from several trials to look at almost 3,000 patients who underwent drug treatments for human epidermal growth factor receptor 2 (HER2)-positive breast cancer.
“We found that a number of patient-reported outcomes, including those on physical well-being and mental health, were identified as significant factors associated with either the patient's overall survival of cancer, with cancer not progressing or severe adverse events during treatment,” Modi said.
“The results indicate that information provided by the patients themselves was better able to predict their reaction to the treatment and their overall prognosis than the clinician-interpreted scores.
“Significantly, patient-reported physical well-being was found to be the most useful patient-reported outcome in determining a diagnosis for all available treatment outcomes.”
In some cases, the study found very different results between the clinician-based data and the patient-reported data.
“Around 70% of the patients who their clinicians defined as ‘fully active, and able to carry on all pre-disease performance without restrictions’, went on to report limitations in their physical well-being status when asked to self-report,” he added.
The authors say the research highlights the importance of listening to patients, with both types of tools providing helpful independent prognosis information.
Study details
Patient-reported outcomes predict survival and adverse events following anticancer treatment initiation in advanced HER2-positive breast cancer.
N.D. Modi, N.O. Danell, R.N.A. Perry, A.Y. Abuhelwa, A. Rathod, S. Badaoui, R.A. McKinnon, M. Haseloff, A. Shahnam, S.M. Swain, M. Welslau, M.J. Sorich, A.M. Hopkins.
Published in ESMO Open on 28 April 2022.
Highlights
• The prognostic value of PROs has been minimally explored in ABC.
• Patient-reported physical well-being was demonstrated to be significantly associated with survival and toxicity outcomes.
• Predictive performance of patient-reported physical well-being was superior and provided independent information to ECOG PS.
Background
The prognostic value of patient-reported outcomes (PROs) has been minimally explored in advanced breast cancer (BC), and their comparative prognostic performance against Eastern Cooperative Oncology Group performance status (ECOG PS) is largely unknown.
Patients and methods
This study pooled individual participant data from clinical trials CLEOPATRA, EMILIA, and MARIANNE. Pre-treatment PRO associations with overall survival (OS), progression-free survival (PFS), and grade ≥3 adverse events were evaluated via Cox proportional hazards regression. Prognostic performance was assessed with the C-statistic (c). PRO values were collected via the Functional Assessment of Cancer Therapy—Breast (FACT-B) questionnaire. All analyses were stratified by study and treatment arms. Analyses adjusted for known prognostic variables were conducted. Exploratory analysis of the prognostic performance of PROs compared to ECOG PS was undertaken.
Results
The study included data from 2894 patients initiated on contemporary therapies including pertuzumab (n = 765), trastuzumab (n = 1173), trastuzumab emtansine (n = 1225), taxanes (n = 1173), lapatinib (n = 496), and capecitabine (n = 496). On univariable and adjusted analysis, patient-reported physical well-being, functional well-being, and BC subscale were all identified to be associated with OS, PFS, and grade ≥3 adverse events (P < 0.05). Patient-reported physical well-being was the most prognostic PRO for all assessed outcomes. The OS prognostic performance of physical well-being (c = 0.58) was superior to ECOG PS (c = 0.56) (P < 0.05), with multivariable analysis indicating that both provide independent information (P < 0.0001).
Conclusions
PROs were identified as independent prognostic factors for OS, PFS, and grade ≥3 adverse events in patients with human epidermal growth factor receptor 2 (HER2)-positive advanced BC initiating contemporary treatment options. Further, patient-reported physical well-being was more prognostic of OS than ECOG PS and contained independent information. PROs have value as prognostic and stratification factors for clinical use and research trials of anticancer treatment in HER2-positive ABC.
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