Though breast cancer patients are now living longer than ever before, treatments for the disease can have wide-ranging effects on their long-term quality of life. Physical, social, and sexual wellbeing all can be impacted by radiation, chemotherapy, surgery, antiendocrine therapy and other challenges that go along with a breast cancer battle.
University of Colorado Cancer Center member Sarah Tevis, MD, is investigating those quality-of-life issues through patient-reported outcomes, surveying women about their breast cancer treatment, and looking for ways to use that data to improve care for future patients.
“One of the things I’ve always been interested about in oncology and surgical oncology is quality of life,” says Tevis, assistant professor in the division of surgical oncology. “The thing that initially got me interested in oncology was that when I was in high school, my dad had lung cancer. He had a thoracotomy and he had radiation and chemotherapy, and he had tons of side effects from his treatment and long-term side effects after he completed treatment. During my general surgery residency, I really enjoyed my time in clinic, seeing patients throughout all the phases of their care. That was something that resonated with me — the different oncology patients and the different quality-of-life issues they faced.”
Questions to answer questions
To study those issues in her current patients, Tevis is administering a survey called the BREAST-Q to all new breast cancer patients, gauging their physical, psychosocial, and sexual health at multiple points throughout their care. She is now looking at whether sharing a patient’s results with them over time spurs those patients to seek out more support services in the areas where their scores are low.
“I’m also starting to look at how those scores change over time based on other things, like the type of surgery they choose — whether they have a lumpectomy or a mastectomy — and how the scores change longitudinally through different phases of their treatment, such as during chemotherapy or radiation,” Tevis says. “I just wrote a grant for a study on how we could use long-term patient-reported-outcome data to help patients make treatment decisions early on in their treatment. Could we use that data to tell patients, ‘If you have a lumpectomy, not only will your survival from cancer be the same as if you have a mastectomy, but your psychosocial wellbeing will be better at one year,’?” Our goal is to build a personalized shared-decision aid for patients when they’re initially diagnosed with breast cancer.”
Addressing sexual health
Another piece of Tevis’s work with patient-reported outcomes is looking at ways to improve sexual health in women with breast cancer.
“Even when women first present with a breast cancer diagnosis, their sexual health scores on the BREAST-Q are quite low,” Tevis says. “Then everything we do to them — surgery, anti-endocrine therapy, chemotherapy — all of those things just make their sexual health worse.”
She is working with the sexual health consultation service and a medical oncologist to survey women about their sexual health side effects during cancer treatment and asking them what they wished they’d known before starting treatment.
“Now we’re following up with some of those women and doing focus groups,” she says. “Our goal is to create educational videos patients can access at any point during their treatment to understand the effects of the treatment on their sexual health and ways to manage those symptoms.”
A patient-first approach
Tevis sees her research as part of her ongoing work to improve shared decision-making for patients and to provide more patient-centered care.
“If we’re measuring these outcomes regularly and incorporating them into our clinical workflow, then maybe we could have algorithms for, if someone’s score drops this much, we reach out to them to say, ‘Would you be interested in a consultation with a sexual health service? We see your scores in sexual health have dropped significantly at this part of your treatment,’” she says. “We could personalize their care to address these issues.”
