Abstract P5-15-07: Let's talk about it: Communicating about risk of recurrence in early-stage breast cancer
Authors: Smith Mary L , Railey Elda M , White Carol B 
Published: March 2022

Abstract
Introduction: Risk of recurrence underlies virtually all decision-making in early-stage breast cancer (EBC). Yet, patients and physicians (HCPs) express challenges, limitations, and unmet needs related to HCP-patient communication about recurrence risk. Methods: This qualitative study included: (A) 16 individual interviews with patients diagnosed with EBC in the last 2 years, for their ability to draw on their experience and (B) 2 focus groups with consumers who have never had a cancer diagnosis, for their ability to provide the “cancer-naïve” perspective that may more closely match newly diagnosed patients. Prior to and after the qualitative research, several breast cancer HCP thought leaders were consulted regarding questions and takeaways. Patients were identified via Wellness House, a cancer support organization, whose staff provided counseling support in case the topic was distressing to interviewees. Consumers were identified via a nationwide market research panel. Research took place online in 02/2021. Within the domain of HCP-patient communication about risk of recurrence, questions differed a bit for patients vs consumers but focused on: Experience, Desires, Objectives, and Reactions to methods of explaining risk. Discussion guides, recruiting/screening materials, informed consent documents, and processes were submitted to Advarra IRB and received exempt status. Results: A total of 32 women (16 patients; 16 consumers) participated, with a mix of ages, educational attainment, and racial and ethnic social identities. Information needs were high with objectives centered on being part of treatment decision-making and being motivated to adhere to treatment, screening, and follow-up. Respondents noted that communication about hard topics is central to building a trusting HCP relationship. Many patients felt they had not heard much about their risk, with some admitting they did not want to hear about it. HCPs face a mix of attitudes, but no patients thought they were told too much. Communication timing was a central theme. Many described the information overload that occurs at/near diagnosis and felt they might need a general understanding of recurrence risk at that time, with intentional revisiting of recurrence risk at each decision or transition point (most often connected to changes in modalities or treatments). Within ER+/HER2- disease, patients discussed the transition to oral (endocrine) therapies and specifically noted that time with physicians was limited at that point. In such cases, recurrence risk was insufficiently linked to the recommendation to take a long course of oral therapy that often has significant side effects. Some interviewees were reticent to continue oral therapy, particularly without knowing why it mattered. Communication methods garnered a wide mix of reactions and revealed misinterpretations, underscoring the need to simplify and individually tailor tools. Some group-level tailoring is also possible with degree of risk over time differing by subtype and stage. From a “misunderstanding” standpoint, it seemed time horizons were even less likely to be recalled or understood by patients with ER+/HER2- disease. Respondents focused on wanting information on how they could reduce risk (e.g., diet, exercise, alcohol) and many felt they received inadequate information from HCPs. This led them to search elsewhere for such information. Conclusions: Improving HCP-patient communication about risk of recurrence appears very likely to contribute to shared decision-making and adherence. In particular, the timing of communication may offer a key opportunity to achieve these objectives. In addition, providing tips and tools to oncologists to enhance two-way communication may be helpful, particularly to simplify and tailor by subtype and patient need.
Citation Format: Mary L Smith, Elda M Railey, Carol B White. Let's talk about it: Communicating about risk of recurrence in early-stage breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-15-07.