Continuing to work while receiving cancer treatment: A financial or a symbolic issue?

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Background: As improved cure rates lead to longer life expectancy, occupational concerns during and after cancer treatment become important. The advent of new drugs with fewer side effects will increase the profile of this issue. We carried out a field survey to explore the question. Methods: We questioned 97 oncologists, and a subgroup of 216 patients treated for breast cancer who were working at the time of diagnosis and who wanted to continue to do so during at least part of the treatment period. Results: Data Collected from Patients: In total, 208 patients (96%) were satisfied or very satisfied with their jobs. Only 68 (31%) were able to achieve the goal of working without interruption while being treated (physicians estimated that figure at only 11%). For the remaining women, who did stop working (69%), the median number of days off work was 59. Data Collected from Physicians: A total of 87 physicians (89%) stated that having information regarding working conditions is very important when counseling patients about whether they could continue to work. Comparison of the answers given by patients and physicians: 36% of physicians thought that the initiative in addressing the work/job issue was taken primarily by themselves, while 53% felt it came from the patient. The patient perspective was different: 61% of patients thought they took the initiative themselves and only 13% of them thought the physician took the lead. The main reason behind the desire to continue working is thought by 56% of physicians to be “Financial gain”; while for patients it is “To feel the same” (42%). A total of 90 (92%) physicians feared that those patients continuing to work would face at least one type of medical difficulty; only 143 (66%) patients shared this fear. Lastly, although 94% of the physicians have access to psychological or psychiatric support workers at the health care center, only 62% have access to a social worker. Conclusions: Of the patients who really wanted to work while being treated for breast cancer, only 31% could achieve that goal without any interruption. There is also a difference of perception regarding patient motivation, with physicians believing that the reasons are mainly financial while the patients see it as more of a symbolic issue.

Prospective study of the impact of using the 21-gene recurrence score assay on clinical decision making in women with estrogen receptor-positive, HER2-negative, early-stage breast cancer in France

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Background: The 21-gene Oncotype DX Recurrence Score (RS) is a validated assay to help inform the appropriate treatment of estrogen receptor-positive (ER+), early stage breast cancer in the adjuvant setting. Treatment traditions regarding choice of adjuvant treatment vary significantly in different countries. This prospective multicenter study is the first to assess the impact of using the Oncotype DX assay in the French clinical setting. Methods: A total of 100 consecutive patients with ER+, HER2-negative, node negative or pN1 (mi) breast cancer were enrolled. Overall treatment recommendation change, change from chemoendocrine to endocrine alone and change from endocrine alone to chemoendocrine treatment were recorded. Medical oncologists completed questionnaires regarding their confidence in their recommendation before and after knowing the patient’s RS. A preliminary analysis was conducted on the first 92 evaluable patients with data available at the time of abstract submission. Final data will be presented at the meeting. Results: Prior to Oncotype DX 49% of patients were recommended chemoendocrine treatment and 51% endocrine treatment alone. After having the RS, 26% were recommended chemoendocrine treatment and 74% endocrine treatment alone. The overall reduction in chemotherapy recommendation from 49% to 26% was significant (p<0.001). Of patients originally recommended chemoendocrine treatment, 58% were changed to endocrine treatment alone after having the RS. Of patients originally recommended endocrine treatment, 11% were changed to chemoendocrine treatment after receiving the RS. There was a significant improvement in physician confidence in treatment recommendations (p=0.002) when using Oncotype DX. Conclusions: These are the first prospective data regarding the impact of using Oncotype DX in France. Using Oncotype DX was associated with a significant change in treatment decisions and an overall reduction in chemotherapy use. The data are consistent with those presented from Germany, Spain, the UK and the US.