Cancer Care: Smarter Decisions, Safer Treatments

Personalized Cancer Care

A diagnosis of cancer triggers a tidal wave of tough decisions. Patients and their loved ones, feeling hurried by a sense that the disease is progressing with every passing moment, find themselves struggling to become instant experts on the last topic they ever wanted to study.

Oncology professionals, eager to help with those tough choices, struggle with questions of their own. How can we help patients substitute clarity for fear when making decisions about surgery, radiation and chemotherapy? In our attempt to wipe out cancer, are we actually ‘overtreating’ some patients? As we move toward diagnostics and therapies personalized to an individual’s genetics, are we giving patients and their relatives enough information and support to navigate these new options? Do our efforts to deliver the safest, highest quality care place providers at risk?

IHPI members, many of whom maintain active clinical practices in cancer care, are addressing issues like these with novel studies and interventions designed to help patients and providers partner more effectively throughout the treatment journey.

Decision-making in breast cancer

U-M’s Cancer Surveillance and Outcomes Research Team (CanSORT), an IHPI affiliate, is home to the only NIH-funded research program in the country focused on cancer decision-making, primarily related to breast cancer treatment. Faculty from U-M’s schools of medicine, nursing, and public health are collaborating with colleagues at Stanford, USC, Emory, Harvard, and New York’s Memorial Sloan Kettering Cancer Center to understand how patients and their doctors make choices about surgery, chemotherapy and radiation treatment options.

Several projects within the program illustrate the potential of “big data” to curate volumes of patient and provider data about treatment experiences, length of life and quality of life. Along with large population studies, investigators are designing new interventions to help breast (and other) cancer patients make better-informed decisions about screening and treatment. One example is a randomized controlled trial of a tool called iCanDecide, with features that enable it to act as a shared learning decision support system that both patients and clinicians can use to communicate and collaborate on treatment decisions.

Learn more about iCanDecide.

Decision support through precision medicine

In their rush to prevent cancer from returning, some patients default to the most aggressive treatment possible, even when it is not necessary to save their lives. This is the case for the 70 percent of patients diagnosed with early stage non-invasive breast cancer who elect a double mastectomy. In these patients, less aggressive treatments have been shown to result in near 100 percent survival.

Precision medicine is changing decision-making by giving doctors evaluative tools to better target individual treatment. These advances have markedly reduced dangling uncertainty for these patients, the stress of treatment decision-making and improved health outcomes.– Steven Katz, M.D., M.P.H., who directs CanSORT

Genomic testing of a tumor to determine the risk of cancer coming back is one tool doctors and patients can use to reduce uncertainty about treatment choices. Specifically, these tests help verify if chemotherapy is actually needed for a particular patient, and can help avoid overtreatment if it is not needed. Another is genetic germline testing, which identifies genetic mutations in a patient (like BRCA1 and BRCA2) that may predispose her to future cancer.

CanSORT has received a $13.7 million grant from the National Cancer Institute focused on the challenges of individualizing treatment for breast cancer, including issues of genetic and genomic testing, use of breast imaging, and assessing patient-reported experiences and outcomes. The study involves a diverse population of English- and Spanish-speaking breast cancer patients in Los Angeles and Georgia, along with their treating medical, surgical, and radiation oncologists. The program examines physician behavior and attitudes to assess current uptake of new tests and treatments and to identify challenging clinical scenarios in breast cancer care. The team is also studying how to best improve the treatment decision process for breast cancer patients through the iCanDecide tool.

In cancer care, we tend to focus on the services needed for survivorship, when many patients have other conditions that also need to be addressed. Looking at the patient as a whole and finding the best ways to provide coordinated, consistent care and engaging them in managing their own care are big challenges.– Sarah Hawley, Ph.D., M.P.H., a CanSORT investigator whose primary research is in decision-making related to cancer prevention and control, particularly among racial/ethnic minority and underserved populations

Learn more here. 

Safer chemotherapy for patients—and nurses

The infusion suite where patients receive chemotherapy is one of the busiest areas in a cancer clinic, and for decades it has been known that chemotherapy drugs pose a significant health risk to nurses who handle them on a regular basis.

The remedy, consistent use of protective equipment to safeguard them from these caustic substances, is often overlooked as nurses work to provide compassionate care in a high-volume environment.

IHPI members, including those from the U-M Cancer Center, School of Public Health, the Ross School of Business, and the College of Pharmacy, are studying nurses’ exposure to hazardous drugs and designing specific interventions to empower them to take better care of themselves each and every time they administer chemotherapy.

I was influenced early on by my grandmother’s journey with breast cancer. It didn’t go well. She had lots of decisions to make and not a lot of support. That experience shaped my career in cancer, both as a nurse and a researcher focused on issues of cost and quality of care.– Christopher Friese, R.N., Ph.D., A.O.C.N.®, F.A.A.N., whose program of research is focused on understanding and improving healthcare delivery in high-risk settings, such as cancer

Learn more about Friese's DEFENS study.