VIDEO: Tailoring patient conversations following metastatic breast cancer diagnosis

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The truth is, metastatic breast cancer, regardless of the subtype, is a tough conversation. A lot of the time, our words can betray how patients feel. And you know, granted it is one of these times where we, you know have to really tailor our conversation with the patient. And then the first thing that we discuss with the patients, that the treatment of stage four or metastatic breast cancer is not the same that it was 10, 15, 20 years ago. And it is not the same, I would say, dismal diagnosis that it was, you know, over the past couple of decades. In today's age, you know, we have numerous options that are fairly effective in keeping the cancer at bay for years and years to come. In the triple negative breast cancer setting, we typically would discuss with the patients similar to what I just mentioned. How the landscape have changed drastically with introduction of very novel, kind of treatments. We do discuss with them that the philosophy in stage four and this is just regardless of the type of the cancer, changes from a treatment paradigm to a control paradigm. Rather than treating the cancer, and I usually use the example of treating an infection versus controlling something like a blood pressure. So rather than treating the infection, we control it with something. And that something, as long as we're taking it and controlling the cancer, we fairly have a good control over it. And a lot of colleagues and physicians would approach the discussion of stage four that way. Now this is important to discuss and important to clarify the patients because sometimes, it's counterintuitive how in stage four setting we actually use less treatments and less number of chemotherapies used, you know, administered compared to stage one, two, and three. And that's because when we go for a cure, we typically go for a heavier regimen in the hopes of curing the cancer once and for all, and in stage four, however, because the goal is control we tend to use the lowest amount of treatment that can get the job done. So this is the big picture. Now it's typically very important conversation to delve a little bit into the biology of breast cancer as well as the exciting new frontiers of treatment usually with recent approvals or clinical trials. And on the NCCN guidelines there is a footnote in all the treatment guidelines. That discussion of clinical trial is almost always recommended. Irrespective of where in the treatment journey the patients are. So even patients that just got diagnosed, you know, we talk to them about lines of therapy and we discuss first line, second line, third line what the lines of therapy means and then we tell them there are clinical trials that are designed for all of these as well as the late clinical trials you call, you know, phase one, stuff like that. So yeah, that was a overwhelming answer but truly it really boils down to, you know, I believe that clinicians should discuss with their patient their diagnosis, their outcome, the philosophy of the treatment, the exciting new advances that allows patients to do a lot better over the past, you know, few years, as well as all the upcoming advances in the form of recent approvals or expected approvals and clinical trials.