Consultant Nurse, Portsmouth Hospital
As worrying as the word ‘cancer’ may be, it is heartening to hear of medical innovations in the field. And breast cancer care has made striding advancements over the last 30 years.
According to Cancer Research UK, one in eight women and one in 870 men will be diagnosed with breast cancer during their lifetime. But, in recent years, important breakthroughs in the field have led to better patient outcomes and a more personalised approach.
When Consultant Nurse, Maria Noblet, was first drawn to nursing, three decades ago, there was very little in terms of variations in treatment. Today, most patients under her care would be offered a fully-personalised plan, which takes into account a patient’s medical history alongside personal choice.
It is this approach that, while relatively new, gives Nurse Maria Noblet’s ‘toolbox’ the boost she needs. “Breast cancer is hard,” she says. “As nurses, we try and treat all of our patients as individuals with their own circumstances, but in the past, we have perhaps been over-cautious.
“Chemotherapy is never an easy treatment to go for, but the benefits of the latest trials mean we can outline the benefits for each individual much more easily. We’re really helping people come to terms with their decisions.”
Maria is talking about the results of one of breast cancers biggest trials published this year, TAILORx. The global study, Trial Assigning Individualised Options for Treatment (TAILORx), followed patients whose treatment was assigned by the Oncotype DX® test. This trial sought to understand how many patients actually needed chemotherapy compared with those who would do well on hormone therapy alone.
A patient’s likelihood of cancer recurring, and level of benefit from chemotherapy, is given a score
The test gives patients a Recurrence Score® result between 1 and 100. The result rates the likelihood of the patient’s breast cancer returning and whether chemotherapy will provide an additional survival benefit. Patients with a Recurrence Score results of 25 or below, can safely be treated with hormonal therapy alone. However, for those with a score over 26, chemotherapy provide additional benefit.
However, results from an exploratory analysis of the TAILORx study showed variation of chemotherapy benefit according to the age of the patients. For those patients under the age of 50 and with a test score between 16 and 25, there was still some benefit from chemotherapy.
Hormone therapy or chemotherapy – women can make better informed treatment decisions
What this means is that physicians can use the Oncotype DX test to guide treatment decisions for patients. The test result enables a personalised chemotherapy treatment plan avoiding over and under treatment for many breast cancer patients treated within the NHS.
Previously, patients have been offered chemotherapy, often with gruelling side effects such as hair loss and fatigue. However, since the NHS has implemented the Oncotype DX test, it is now a large part of nurses’ jobs – like Maria – to explain the results to each patient to help them make a treatment decision. And one that she is glad to share.
She says: “From a nursing point of view, this data is incredibly useful to share with patients. After all, breast cancer is a fairly serious disease in the western world and, although we know about certain biological markers, we do not currently have a cause. In this case, tailor-made treatment is important because we will all come to the table with different markers, and potentially a different outcome.”
While this extra degree of personalisation is life-changing for most patients, there is a group who is currently exempt on the NHS from being tested – those where the cancer has spread to the nodes in the armpit. Currently NICE is reviewing their guidelines, Maria thinks it would be logical to extend the test where possible. “This is the future of healthcare” she says. “I’m a pragmatist. I think red tape is necessary as you can’t have everything, but even to me as a non-scientist, I believe it is only a matter of time.”
As a nurse who joined in 1980 to “look after sick people”, it was her father’s own cancer diagnosis that spurred Maria into oncology. The strength and courage of the women she meets daily on the breast cancer unit only serves to bring her back each day.
She reflects: “At the end of the day, this genomic test is an extra guide for both patients and us as healthcare professionals. These patients could be our mums, sisters, daughters and friends, and we have to remember – we are all in this together.”