For decades, one of the most severe treatments that breast cancer patients have had to undergo has been chemotherapy. It comes with many serious side effects including nausea and vomiting, hair loss, cognitive dysfunction, and even kidney or liver damage.
However, a study from the Stanford University School of Medicine and the University of Michigan shows that the use of chemotherapy has significantly declined among patients with early stage breast cancer.
According to a press release from the Stanford University Medical Center, the study followed about 3,000 women with early stage breast cancer and found a decrease in the number of patients undergoing chemotherapy despite the fact that no variations occurred to national treatment guidelines.
The reasoning behind this decline may be due to more oncologists understanding that, for some patients, the harms of chemotherapy may be bigger than the potential benefits of this treatment.
“For patients with early stage breast cancer, we’ve seen a significant decline in chemotherapy use over the last few years without a real change in evidence,” Allison Kurian, MD, associate professor of medicine and of health research and policy at Stanford and lead author, said in the press release. “This likely reflects a change in the culture of how physicians are practicing, and a move toward using tumor biology to guide treatment choices rather than solely relying on clinical measures.”
The researchers found that, whenever patients request a treatment that doesn’t align with physician recommendations, their doctor may start looking at tumor genetic testing.
This study was published on December 11 in the Journal of the National Cancer Institute. The researchers also suspect that many oncologists have been attempting to reduce overtreatment among breast cancer patients.
“Our study shows how breast cancer is a model for how doctors have driven advances in personalized medicine into the exam room to reduce overtreatment,” stated Steven Katz, MD, MPH, professor of medicine and of health management and policy at the University of Michigan and senior author.
The research study began with looking at 5,080 women diagnosed with early stage breast cancer in Georgia and Los Angeles between 2013 and 2015. The researchers were able to narrow down this number to 2,926 patients with stage 1 or stage 2 breast cancer positive for estrogen receptor expression and negative for human epidermal growth factor receptor-2 expression. This made sure the women in this group have a similar diagnosis.
The researchers also put the patients into categories based on lymph node involvement. Finally, the study authors asked each woman whether their oncologist had recommended chemotherapy and whether they received the treatment.
Next, a total of 504 oncologists were asked how they decided whether to suggest chemotherapy for these early stage breast cancer patients. The results showed the surprising finding that the use of chemotherapy has declined in these regions among early stage breast cancer patients.
Between 2013 and 2015, chemotherapy use dropped from 34.5 percent to 21.3 percent among the study subjects. Chemotherapy recommendations from oncologists were also reduced from 44.9 percent to 31.6 percent.
Early stage breast cancer patients with lymph node involvement had a higher chance of undergoing chemotherapy, but a decline was still noted. Patients with lymph node involvement had chemotherapy use fall from 81.1 percent to 64.2 percent.
Breast cancer patients who had no lymph node involvement had their use of chemotherapy drop from 26.6 percent to 14.1 percent.
Among cases where the patient with lymph node involvement disagreed with her doctor’s advice on receiving chemotherapy, 67.4 percent of physicians ordered genomic testing to better understand the patient’s likelihood of breast cancer recurrence.
However, if both the patient and doctor agreed on the treatment plan, a mere 17.5 percent would order a genomic test.
“We believe this study indicates that physicians are attempting to be more selective in their recommendations and to spare patients toxicity when possible,” said Kurian. “As personalized medicine becomes more widely available, doctors are using test results as part of their dialogue with patients about their preferences and overall treatment goals. But the long-term outcomes of these recent changes in chemotherapy use are uncertain.”
Better understanding advanced and novel treatment options for breast cancer patients is vital in order to move away from more toxic treatments like chemotherapy or radiation. Since one in eight women are diagnosed with breast cancer in their lifetime, it is vital to expand on current treatments and find a way to prevent this disease.
This is why the Breast Health and Healing Foundation is dedicated to investigating the viral causes of breast cancer and investing in furthering cancer vaccine research. Prevention will always be the pure cure in the realm of breast cancer.