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Breast Cancer, Supportive Cancer Care CE/CME ACCREDITED Watch Time: 42 mins

touchMDT How can shared decision-making be successfully integrated to optimize care of patients with high-risk early breast cancer?

Watch leading breast cancer specialists within an MDT, plus an early breast cancer (EBC) survivor, share their perspectives on shared decision-making (SDM).

 Overview & Learning Objectives

Patient with high-risk EBC
Oncologist & Nurse Specialist & Patient
Watch Video
Importance of SDM for patients with BC Prof. Boyle, Prof. Abdullah, Ms Ong

Prof. Frances Boyle and Prof. Dr Khatijah Lim Abdullah discuss the importance of SDM and the elements essential to its success in patients with EBC. Plus, Ms Evelyn Ong shares her experience of SDM during her breast cancer journey.

Watch Video
Nurse Specialist & Oncologist & Oncology Surgeon
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The effect of SDM on outcomes in EBC Prof. Abdullah, Prof. Boyle, Prof. Dr Gnant

Prof. Dr Khatijah Lim Abdullah, Prof. Frances Boyle and Prof. Dr Michael Gnant discuss evidence, from studies and from clinical experience, for the effect that SDM has on patient outcomes in EBC.

Watch Video
Oncology Surgeon & Oncologist & Patient
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Challenges around applying SDM in EBC Prof. Dr Gnant, Prof. Boyle, Ms Ong

Prof. Dr Michael Gnant and Prof. Frances Boyle discuss the challenges around implementing SDM and how they can be overcome. Plus, Ms Evelyn Ong recounts her experience of the challenges faced with SDM during her breast cancer journey.

Watch Video
Oncologist & Nurse Specialist & Patient

Prof. Frances Boyle and Prof. Dr Khatijah Lim Abdullah discuss the importance of SDM and the elements essential to its success in patients with EBC. Plus, Ms Evelyn Ong shares her experience of SDM during her breast cancer journey.
Expert Spotlight
Prof. Frances Boyle
Patricia Ritchie Centre for Cancer Care and Research, Sydney, Australia. University of Sydney, Sydney, Australia
Prof. Dr Khatijah Lim Abdullah
Sunway University, Selangor, Malaysia
Ms Evelyn Ong
Singapore, Republic of Singapore

Prof. Frances Boyle, Prof. Dr Khatijah Lim Abdullah and Ms Evelyn Ong discuss the importance of SDM and the elements essential to its success in patients with EBC.

Listen on the Go

 Learn more Back to MDT Hub Time: 14:57
 
Nurse Specialist & Oncologist & Oncology Surgeon

Prof. Dr Khatijah Lim Abdullah, Prof. Frances Boyle and Prof. Dr Michael Gnant discuss evidence, from studies and from clinical experience, for the effect that SDM has on patient outcomes in EBC.
Expert Spotlight
Prof. Dr Khatijah Lim Abdullah
Sunway University, Selangor, Malaysia
Prof. Frances Boyle
Patricia Ritchie Centre for Cancer Care and Research, Sydney, Australia. University of Sydney, Sydney, Australia
Prof. Dr Michael Gnant
Medical University of Vienna, Vienna, Austria

Prof. Dr Khatijah Lim Abdullah, Prof. Frances Boyle and Prof. Dr Michael Gnant discuss the evidence for the effect that SDM has on patient outcomes in EBC.

Listen on the Go

 Learn more Back to MDT Hub Time: 13:30
 
Oncology Surgeon & Oncologist & Patient

Prof. Dr Michael Gnant and Prof. Frances Boyle discuss the challenges around implementing SDM and how they can be overcome. Plus, Ms Evelyn Ong recounts her experience of the challenges faced with SDM during her breast cancer journey.
Expert Spotlight
Prof. Dr Michael Gnant
Medical University of Vienna, Vienna, Austria
Prof. Frances Boyle
Patricia Ritchie Centre for Cancer Care and Research, Sydney, Australia. University of Sydney, Sydney, Australia
Ms Evelyn Ong
Singapore, Republic of Singapore

Prof. Dr Michael Gnant, Prof. Frances Boyle and Ms Evelyn Ong discuss the challenges and potential solutions around implementing SDM in patients with EBC.

Listen on the Go

 Learn more Back to MDT Hub Time: 13:24
 
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Learning Objectives & Overview
Overview

In this activity, specialists in the MDT involved in caring for patients with EBC, plus a breast cancer survivor, share their perspectives on the importance of shared decision making (SDM), evidence for its effect on patient outcomes, and addressing the challenges of SDM in daily practice.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of oncologists (including breast cancer surgeons), oncology nurse specialists, pathologists and radiologists involved in the management of early breast cancer.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty 

Prof. Frances Boyle discloses: Advisory board fees from Eisai, Eli Lilly, Gilead, Novartis, Pfizer and Roche. Consultancy fees from Eli Lilly.

Prof. Dr Michael Gnant discloses: Advisory board/Speakers bureau fees from Amgen, AstraZeneca, Daiichi Sankyo, Eli Lilly, Life & Brain, Merck Sharp & Dohme, Novartis, Pierre Fabre, and Veracyte.

Prof. Dr Khatijah Lim Abdullah has no interests/relationships or affiliations to disclose in relation to this activity.

Ms Evelyn Ong has no interests/relationships or affiliations to disclose in relation to this activity.

Content reviewer

Rebecca Gonzalez, PharmD BCOP has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Sola Neunie has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu. 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 0.75 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

Date of original release: 30 March 2022. Date credits expire: 30 March 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

After watching this activity, participants should be better able to:

  • Recognize the importance and relevance of SDM in the context of EBC
  • Evaluate the evidence for the effect that SDM has in optimizing outcomes for patients with breast cancer
  • Assess the challenges of implementing SDM and formulate strategies to overcome them
Faculty & Disclosures
Prof. Frances Boyle

Patricia Ritchie Centre for Cancer Care and Research, Sydney, Australia. University of Sydney, Sydney, Australia

Prof. Frances Boyle, AM, is a Medical Oncologist practising in breast cancer at The Patricia Ritchie Centre for Cancer Care and Research, of which she is a Director, at Mater Hospital in Sydney, Australia. She is Professor of Medical Oncology at the Sydney Medical School, involved in teaching both oncology and clinical communication in the MD programme. read more

Her research at the Mater has a focus on early and metastatic breast cancer treatment, cancer supportive care and health professional communication. Recent work has included the evaluation of a decision aid for patients considering neoadjuvant systemic therapy. 

Prof. Boyle represents Australia on national and international research committees and is the current President of the Clinical Oncology Society of Australia. In 2008 she was awarded Membership of the Order of Australia for her contributions to cancer education, research and advocacy.

Prof. Frances Boyle discloses: Advisory board fees from Eisai, Eli Lilly, Gilead, Novartis, Pfizer and Roche. Consultancy fees from Eli Lilly.
Prof. Dr Michael Gnant

Medical University of Vienna, Vienna, Austria

Prof. Dr Michael Gnant is Full Professor of Surgery at the Medical University of Vienna, Austria, where he also serves as President of the Austrian Breast & Colorectal Cancer Study Group. He has been co-chair of the renowned St Gallen Consensus Panel for Early Breast Cancer since 2015. read more

Prof. Dr Gnant graduated in medicine in Vienna and subsequently specialized in surgery and surgical oncology. From 1997 to 1999, he worked as a visiting scientist at the National Cancer Institute, National Institutes of Health, Bethesda, USA.

Prof. Dr Gnant’s research interests include several fields of surgical oncology, such as breast and pancreatic cancer, immunotherapy, and pathway-directed therapies such as mTOR and CDK4/6 inhibition; he has been the Principal Investigator of more than 30 clinical trials in these fields.

The author of more than 500 original peer-reviewed papers and with an h-index of 69, Prof. Dr Gnant has presented over 1,000 lectures at national and international meetings. He is the recipient of multiple awards including the prestigious Claudia von Schilling Prize from the Medical University of Hannover, and a Corresponding Member of the Austrian Academy of Sciences.

He is involved in many scientific societies including ASCO, AACR, ACS, Breast International Group (BIG), EORTC, ESSO, EUSOMA and UICC, is an independent reviewer and IDMC member for the EORTC, UICC and other international bodies, and is a scientific reviewer and process evaluator for the European Union. 

Prof. Dr Gnant is Editor-in-Chief of Breast Care, and an editorial board member and reviewer for many high-impact peer-reviewed journals including The Lancet, New England Journal of Medicine, Journal of Clinical Oncology, and Annals of Oncology.

Prof. Dr Michael Gnant discloses: Advisory board/Speakers bureau fees from Amgen, AstraZeneca, Daiichi Sankyo, Eli Lilly, Life & Brain, Merck Sharp & Dohme, Novartis, Pierre Fabre, and Veracyte.
Prof. Dr Khatijah Lim Abdullah

Sunway University, Selangor, Malaysia

Prof. Dr Khatijah Lim Abdullah is Professor and Head of Nursing at Sunway University, Selangor, Malaysia. She is also an Adjunct Professor for the National University of Malaysia, Universities of Airlangga, Surabaya, and Universitas Pahlawan Tuanku Tambusai, Indonesia. After qualifying as a nurse at the University of Malaya, Prof. Dr Abdullah completed her midwifery training in the UK where she pursued her postgraduate and doctoral studies. She obtained a BSc in Nursing and an MSc in Health Services Management from the University of Manchester, before completing her Doctorate in Clinical Practice at the University of Southampton, UK. read more

With over 40 years’ nursing experience, Prof. Dr Abdullah is a committed advocate for equality and inclusion in both teaching and research, and actively champions diversity within nursing practice. Her current research interests include interprofessional education, patient shared decision-making, women’s and child health, patient safety and clinical leadership. As a clinical expert and champion of patient-centred care that addresses patient preferences and values, Prof. Dr Abdullah embraces diverse methods within her own research, notably qualitative measures and mixed-model research. 

As a leading academic, Prof. Dr Abdullah has successfully supervised over 30 doctoral students to graduation, and has published more than 50 peer-reviewed papers. She is currently the Chief Editor for the Malaysia Journal of Qualitative Research, and Academic Editor for PLoS ONE. In recognition of her achievements, Prof. Dr Abdullah has been allocated for excellent service (2006, 2012 and 2019), and awarded Best Lecturer (2020) by the Faculty of Medicine, University of Malaya.

Prof. Dr Khatijah Lim Abdullah has no interests/relationships or affiliations to disclose in relation to this activity.
Ms Evelyn Ong

Singapore, Republic of Singapore

Ms Evelyn Ong is a breast cancer survivor who lives in Singapore. Based on her own experiences along her treatment and survivorship journeys following a diagnosis of Stage II breast cancer in 2018, Ms Ong is a vocal and highly active patient advocate for women with early breast cancer. read more

Ms Ong is determined to raise awareness of the need for regular self-checks and mammogram attendance to support earlier diagnoses in breast cancer. Through her social media presence and advocacy work, Ms Ong champions approaches for her fellow breast cancer survivors to live well and embrace the activities they enjoy to improve their quality of life and access support networks. She has supported the Living Boldly campaign and Breast Cancer Forum (BCF) Singapore engagement and outreach activities.

Ms Ong is a visible member of the BCF Singapore Paddlers in the Pink Dragon Boat Programme that aims to improve the physical and mental well-being of women affected by breast cancer, and demonstrate that women living with breast cancer can continue to lead full, active lives.

Ms Evelyn Ong has no interests/relationships or affiliations to disclose in relation to this activity.
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This Activity Is Funded By:

An independent medical education grant from Eli Lilly.
This medical education is jointly provided by USF Health and touchIME.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 30 March 2022. Date credits expire: 30 March 2023.

This content is intended for healthcare professionals outside of the UK.

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Question 1/5
Your department is implementing SDM for your patients with high-risk early breast cancer. Which of the following actions would you adopt in your own practice to support decisional control for patients throughout the SDM process?

SDM, shared decision-making.
 Correct

Use of PtDAs, recognition of the individual patient’s information needs and preferred learning styles have been identified as strategies to support effective SDM implementation in breast cancer.1,2 Physicians need to appreciate social, cultural and religious influences on patient decision-making to meaningfully implement SDM.3,4 In a recent study, most physicians noted little change in consultation time when implementing SDM using a NAST PtDA.5

Abbreviations

NAST, neoadjuvant systemic treatment; PtDA, patient decision aid; SDM, shared decision-making.

References

  1. Josfeld L, et al. J Cancer Res Clin Oncol. 2021;147:1725–32.
  2. van Veenendaal H, et al. Patient Educ Couns. 2022;105:114–27.
  3. Agyemang LS, et al. BMC Womens Health. 2021;21:364.
  4. Abdullah A, et al. Asian Pac J Cancer Prev. 2013;14:7143–7.
  5. Zdenkowski N, et al. J Natl Compr Canc Netw. 2018;16:378–85.
Question 2/5
Your 32-year-old patient with a 3.4 cm HR-positive tumour in her left breast expresses concerns surrounding how her planned mastectomy may change her body image and worries she may feel less feminine. What might you consider in the ongoing management of this patient?

HR, hormone receptor.
 Correct

Change in self-image is a contributing factor to depression and anxiety in patients living with breast cancer, and beyond into long-term survivorship.1–3 Reported rates of depression (38–69%) and anxiety (32–73%) amongst women with breast cancer vary widely;3,4 younger women and those undergoing surgery are more likely to be affected during their breast cancer treatment journey.1,4 Current European Society for Medical Oncology guidelines for early breast cancer recommend addressing psychosocial patient needs to help manage treatment and survivorship implications. Breast units should have or be able to refer to a psychologist when appropriate.2 

References

  1. Niedzwiedz CL, et al. BMC Cancer. 2019;19:943.
  2. Cardoso F, et al. Ann Oncol. 2019;30:1194–220.
  3. Tsaras K, et al. Asian Pac J Cancer Prev. 2018;19:1661–9.
  4. Alagizy HA, et al. Middle East Current Psychiatry. 2020;27:29.
Question 3/5
Which of the following statements best reflects current consensus on the use of PtDAs to support SDM in breast cancer treatment and care?

PtDA, patient decision aid; SDM, shared decision-making.
 Correct

Meta-analyses of PtDAs to support SDM in breast cancer highlight the heterogeneity of outcomes measures and limitations surrounding evaluation of effects on patient outcomes. There remains an ongoing need for more effective tools to meaningfully assess the impact of PtDAs,1,2 and further research assessing PtDAs for breast cancer is needed, including larger-scale studies, for evidence generation.1,3 Differences in cultural background and context have been shown to influence SDM.4,5

Abbreviations

PtDA, patient decision aid; SDM, shared decision-making.

References

  1. Zdenkowski N, et al. The Breast. 2016;26:31–45. 
  2. Spronk I, et al. BMC Palliat Care. 2018;17:74.
  3. Hawley ST, et al. Patient. 2016;9:161–9.
  4. Abdullah A, et al. Asian Pac J Cancer Prev. 2013;14:7143–7. 
  5. Agyemang LS, et al. BMC Womens Health. 2021;21:364.
Question 4/5
Which of the following statements best summarizes how PtDA use can influence outcomes amongst women navigating neoadjuvant therapy decisions in operable breast cancer?

PtDA, patient decision aid.
 Correct

Evaluation of a tool to support neoadjuvant therapy decisions in operable breast cancer showed that PtDA use improved decision-related outcomes, with no adverse effects. Use of the PtDA reduced decisional regret (p=0.0176), supported improvements in treatment decision satisfaction (p=0.005) and decreased patient-reported anxiety levels (p<0.001). Decisional conflict was decreased in total and across all subscales assessed after use of the PtDA (p<0.002 for all subscales).

Abbreviation

PtDA, patient decision aid.

Reference

Zdenkowski N, et al. J Natl Compr Canc Netw. 2018;16:378–85.

Question 5/5
You are discussing treatment options with your patient with operable high-risk EBC. They express frustration in trying to understand the risks and benefits associated with NAST. Which of the following next steps would you consider most appropriate to support your patient in understanding the data and reaching a shared decision?

EBC, early breast cancer; NAST, neoadjuvant systemic therapy.
 Correct

A recently validated PtDA designed to support neoadjuvant decision-making in early breast cancer included a 1,000-dot diagram displaying the likelihood of tumour progression (3%) or becoming inoperable (0.3%) while on NAST.1 The majority (80%) of patients found this PtDA useful in supporting their NAST decision-making.2 Research has shown that patients recognize the importance of information sharing during consultations, but often feel overwhelmed, highlighting a need for more effective methods of information sharing.3,4 

Abbreviations

NAST, neoadjuvant systemic therapy; PtDA, patient decision aid.

References

  1. Zdenkowski N, et al. JMIR Res Protoc. 2016;5:e88.
  2. Zdenkowski N, et al. J Natl Compr Canc Netw. 2018;16:378–85.
  3. Josfeld L, et al. J Cancer Res Clin Oncol. 2021;147:1725–32. 
  4. Abdullah A, et al. Asian Pac J Cancer Prev. 2013;14:7143–7.
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