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New Global Survey Highlights Deep Psychological Impact of Breast Cancer Recurrence on Both Patients and Physicians
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- Data Highlight the Need for More Positive Conversations Through Better Communication, Training and Use of Effective Treatments
A devastating moment for a woman undergoing treatment for early breast cancer is to hear from her physician that, despite their best efforts, the disease has returned and she is no longer curable. Presented for the first time today at the European Cancer Conference (ECCO), an international survey of over 1,000 physicians and patients showed that physicians are also deeply affected by these negative conversations. A significant number of physicians stated the worst part of their job was informing a woman about recurrence, and that distressing thoughts and feelings remained with them after leaving the clinic or surgery. Recent studies show that oncologists are already affected by increasing professional pressures leading to stress, depression, burn-out and even suicidal thoughts(2-4), which may detrimentally impact on relationships with patients and, ultimately, on patient care. Therefore, there is a need to help physicians to have more positive conversations.
The survey, conducted among 462 physicians(a) and 600 patients(b) from Europe and the United States, found that, of the physicians surveyed:(1)
- 41.8% felt that telling a woman her breast cancer has recurred to be the worst part of their job
- 72.0% thought that telling a patient she has early breast cancer was easier than telling her she has a recurrence of the disease
- 33.0% take worries about patients who have recurred home with them
- 69.4% worry about whether they are giving the best treatment to their patients.
The majority of physicians have a strong bond with their patients, with 89% feeling a great sense of satisfaction when their patients are confident in their treatment and believe in life beyond breast cancer. (1) A further 62% stated that telling a patient she remains free of distant recurrence is the best part of their job.(1) The issues identified in this survey therefore need to be recognised and physicians need support and help with difficult consultations. Providing access to more efficacious treatments may lead to more positive outcomes for women with early breast cancer and, consequently, more positive conversations.
"What this survey shows is that, whilst the well-being of patients is always our first priority, there is a significant need to support the physicians themselves who regularly have to deliver bad, sad or difficult news, for example, about a breast cancer recurrence," stated Professor Lesley Fallowfield, co-author of the survey. "Recurrence is devastating for the patient so doctors must have access to better treatments. This will in turn reduce the frequency of negative conversations. However, we do need to equip doctors with appropriate communication techniques to help minimise the burden on both patient and doctor when sad, bad and difficult conversations must take place," she concluded.
During the conference, Professor Fallowfield suggested that to move towards more positive conversations, physicians needed to be supported in number of key areas, including:
- Access to appropriate treatment choices supported by greater clinical trial data and personal experience
- Provision of better and earlier training on the importance of good communication
- Optimisation of proven communication strategies and techniques
- Stronger peer-to-peer support networks
"Informing a postmenopausal woman with hormone receptor-positive breast cancer that her disease has returned is awful; the news is usually unexpected. Personally, I find this 'moment of truth' emotionally draining and it worries me to think about the impact the difficult aspects of my job might be having on my emotional well-being and my ability to deliver for my patients," recalled Dr Mark Lansdown, Consultant Surgeon, Leeds Teaching Hospitals NHS Trust, England. "For me, preventing recurrence in the first place is vital in resolving this issue. The good news is that there are newer treatments available that reduce the number of recurrences, allowing physicians to have more positive conversations with our patients."
Physicians surveyed also want mature and convincing data to give them the confidence they need to ensure that their patients can have the best outcomes:
- 90% of physicians citied clinical trial data as being crucial in building trust in treatment decisions
- 72.4% believed prescribing treatments that minimise the incidence of recurrence allows them to have more positive conversations.
Data from the ground-breaking ARIMIDEX(TM)(anastrazole), Tamoxifen, Alone or in Combination (ATAC) trial, which has a median of 68 months of follow-up, demonstrated that women treated with ARIMIDEX experience 26% fewer recurrences compared with those treated with tamoxifen.(5) This compelling, mature data has led to ARIMIDEX replacing tamoxifen as the Gold Standard treatment in a number of countries for post-menopausal hormone receptor-positive early breast cancer. As a consequence, not only are patients more likely to remain recurrence free, but those physicians who stated that the worst part of their job was informing women of a recurrence are likely to have more positive conversations with their patients. Physicians would, therefore, be relieved of some of the intense psychological and emotional burdens that can have a negative effect on their professional and personal lives.
"Data, such as those from the ATAC trial, show that we can improve patient outcomes, meaning fewer women have to hear that their early breast cancer has returned," commented Dr Lee Martin, University Hospital Aintree, Liverpool, England. "And if we as physicians can have more positive conversations with our patients, the burden on us reduces, allowing us to focus on the most important point of all, doing the very best for those women in our care."
(1). Data presented at the European Cancer Conference (ECCO). AstraZeneca Satellite Symposium, Breast Cancer Treatment Strategies: Clinical decisions and Positive Conversations, Sunday 23 September, 17.00-19.00 CET.
(2). Burman et al. Occupational stress in palliative medicine, medical oncology and clinical oncology specialist registrars. Clin Med 2007;7:235-42.
(3). Shanafelt T. Finding meaning, balance, and personal satisfaction in the practice of oncology. J Support Oncol. 2005;3:157-164
(4). Whippen DA, et al. Burnout in the practice of oncology: Results of a follow-up survey. Journal of Clinical Oncology, 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition). Vol 22, No 14S (July 15 Supplement), 2004: 6053.
(5). ATAC Trialists' Group. Results of the ATAC (ARIMIDEX, Tamoxifen, Alone or in Combination) trial after completion of five years' adjuvant treatment for breast cancer. Lancet 2005, 365 (9453):60-62.
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Notes to Editors
(a)Physicians: medical oncologists, gynaecologists and breast cancer surgeons.
(b)Patients: postmenopausal women diagnosed with early breast cancer in the past five years and who had undergone breast cancer surgery.
'More Positive Conversations' Survey
The 'More Positive Conversations' survey was conducted online and via telephone interviews by Harris Interactive on behalf of AstraZeneca. The objectives of the survey, involving 1,062 physicians and patients from France, Germany, Italy, the United Kingdom and the United States, were:
- To evaluate the concept of trust between patient and physician and the extent to which it factors into treatment decisions, compliance and intrinsic benefits such as physician job satisfaction
- To quantify the degree to which, and in what situations physicians are apprehensive in communicating with patients with early breast cancer and how it affects physicians' views of their work
- To measure patient and physician satisfaction with treatments and understand the role of the relationship between the patient and the physician in making treatment decisions
- To understand the degree to which time limitations are present in patient consultations and how this affects the perceived quality of the visit
AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world's leading pharmaceutical companies with healthcare sales of $26.47 billion and leading positions in sales of gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infection products. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4 Good Index.
ARIMIDEX is a trademark, the property of the AstraZeneca group of companies.
ots Originaltext: AstraZeneca
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