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Accessing Breast Cancer Treatment During Coronavirus

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Published on August 26, 2020

Getting Personalized Medicine and Treatment for Breast Cancer During COVID-19

Is personalized medicine, including genomic testing, is still available to breast cancer patients during the coronavirus outbreak. Patient Power host, Megan-Claire Chase sit down with Shonte Drakeford, patient advocate and a representative from the Tigerlily Foundation, and experts Dr. Shaveta Vinayak, Seattle Cancer Care Alliance, Dr. Catherine Park, UCSF Helen Diller Family Comprehensive Cancer Center, and Dr. Freya Schnabel, NYU Lagone Health to discuss how aspects of a patient's situation are taken into consideration when making personalized medical decisions and available treatments. These breast cancer experts explain what situations might indicate the need to postpone some treatments, the role of genomic testing in making treatment decisions and why there is no one right answer for every breast cancer patient. Watch the full discussion.

This is Part 4 from our Breast Cancer Answers Now Live Program. Watch the other parts below:

This program is supported by an educational grant from Daiichi Sankyo. This organization has no editorial control. It is produced by Patient Power and Patient Power is solely responsible for program content.

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Transcript | Accessing Breast Cancer Treatment During Coronavirus

Megan-Claire Chase:
We have chemotherapy, radiation, surgery and of course, none of it can be done at home and patients have to go into the clinic multiple times. So they want to know what can I defer? What shouldn't I put off? How can I be safe as I receive treatment?

Dr. Schnabel:
I think that that's a complicated multi-pronged question. No simple answer. It depends on the clinical situation. I'm sure my colleagues will agree. And honestly, I think we've all communicated that we're very sensitive to this issue. I think all of the medical professionals here and all of us, I speak for all of us, honestly, that we recognize the fact that we have to take COVID into consideration when we develop our treatment plans. And we try to communicate honestly and accurately with the patient, what the dangers are. And some of this is about who the patient is, what their age is, what their other medical problems are, the seriousness or lack thereof, frankly, of their cancer, and then make a decision that a strategy that's really not only patient-specific but also disease-specific.

Dr. Park:
I'd say that's exactly right. We personalize all the treatments. Sometimes we have to, when we can afford a delay and the patient prefers it, for example, a very early stage hormone receptor-positive patient who might be a little bit older and is afraid to be exposed anywhere, we could put that person on hormone therapy, for example, and then wait for a while to start radiation. So, we have had those individualized discussions based on those types of factors.

Dr. Vinayak:
Even in sort of the beginning when this sort of pandemic came around and Seattle was sort of at the epicenter of it, so we had to create guidelines very quickly and adopt them at our institution. But whenever we made recommendations that were just away from sort of the standard sequence that we typically use, the patient has to be a partner in that decision. And we obviously go over the pros and cons, and it does come down to preferences. Well, some patients are okay with waiting, some patients just wanted to go ahead with surgery sort of no matter what the risks were. So, it really does come down to patient preference and definitely partnering with them, because at the end of the day, it's about their treatment.

Shonte Drakeford:
I just wanted to kind of ask an additional question in relation to treatment options. So, the risk of disease progression for those who are delayed with their initial treatment, for newly diagnosed, and those of us who are metastatic, and I know sometimes you could do genetic and genomic testing on a tumor, are those things still being done? And are you considering a recurrence rate? And yeah, that's the question.

Dr. Vinayak:
Absolutely, we are thinking about treatments, I would say for me, probably at the forefront of my mind is what's going to be the best treatment for the patient, the treatment for the metastatic breast cancer or early stage. And then whether it's targeted therapy, so what you alluded to using genomic testing. So, for other patients who may not be familiar with that term, genomic testing is really testing the tumor that's been removed from, it could be from the breast or at any other place in the body.

And what we're looking at is doing a certain test to figure out what's driving the growth of that cancer. And sometimes we're fortunate that we can identify a pathway where there's a matching drug to block that pathway. And that's what targeted therapy is. So, when it's appropriate, absolutely, I think doing genomic testing, doing genetic testing because if you identify a genetic mutation we have two drugs that are approved in that particular indication. PARP inhibitors for metastatic breast cancer. So, I think just doing what's best for the patient and best for the cancer treatment, all of those things are still moving forward in this pandemic.

Shonte Drakeford:
Okay, good.

Dr. Schnabel:
This is genuinely the era of individualized or personalized medicine. I know people hear those buzz words, so to speak, all the time, but this is exactly what it's about. Learning as much as we possibly can, really taking a deep dive into learning about the cancer in as much detail as we can, and of course, in the context of understanding our patients and who they are and where they are medically and socially and everything else to try to develop the best treatment plan. And you're absolutely right, worrying about someone who may be at high risk for recurrence may push us into encouraging them to go to treatment more quickly than someone who perhaps has a very early stage of breast cancer that has a lot of favorable biological factors who has a bit of a luxury of time where they can wait safely before initiating treatment.

Shonte Drakeford:
These are questions that I have on a day to day basis. I live with metastatic breast cancer and I'll be on treatment for lifelong. So this has impacted me, in a way, big, and I had to adjust my lifestyle significantly. And learning about the ways we can just live in an alternative way, but still have, for me, especially a quality of life is very essential to all of this. So, I just think that everyone should find something, a piece in this somehow, and find something that gives you joy every day. We are in this together.


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