Dr Kristine Slam: In Breast Cancer, Patient Values and Treatment Goals May Differ

"Part of the discussion we have with patients is, what are their values? It's really bringing the patient front and center and asking them about their short- and long-term goals, and their fears, because each patient chooses different surgery and different therapy based on that," noted Kristine Slam, MD, Central Ohio Surgical Associates, in an interview from our September 14 Institute for Value-Based Medicine^® event, held in partnership with the Zangmeister Cancer Center of Columbus, Ohio.

Transcript

What roles do patient engagement and shared decision-making play in value-based care for breast cancer?

So patient decision-making and patient involvement in decision-making is critical. What I have found over my years is patients have different values and expectations. One of the things that comes to forefront with this is the application of breast radiation for, again, elderly lower-risk women. For years, we told patients a lumpectomy goes with radiation like peanut butter and jelly—you can't do one without the other. We have 2 very-long-term studies that clearly prove in low-risk elderly women, radiation does not make a patient live longer. It lowers the recurrence rate in the breast, but never eliminates it.

So part of the discussion we have with patients is, what are their values? Is their value and is their goal for their therapy living longer? Because if so, radiation is not going to help that. Is their goal to reduce their breast cancer risk as much as possible? If so, radiation might help. It's really bringing the patient front and center and asking them what their short-term and long term goals are, what their fears are, because each patient chooses different surgery and different therapy based on that.