Oncology Pharmacists Can Drive New Strategies to Resolve Disparities in Breast Cancer Care, Patient Outcomes

It's Breast Cancer Awareness Month, and the annual campaign to raise awareness about the impact of breast cancer and to show support for everyone affected by breast cancer is underway. Many oncology pharmacists participate in programs that promote breast cancer awareness and the importance of screening and early detection. Although many of our efforts are primarily in caring for and supporting patients who are undergoing treatment for breast cancer, oncology pharmacists also participate significantly in conversations, research, and publications of that research.

These efforts by oncology pharmacists have helped to highlight not only disparities in cancer care but also gender-based differences in breast cancer treatment. Further, oncology pharmacists have worked tirelessly to provide additional opportunities to support patients with breast cancer throughout their treatment journey to positively impact patient outcomes.

For example, a recent publication reported an association between initiation of adjuvant endocrine therapy, short- and long-term adherence, and continuation of therapy in low-income women with breast cancer. Although nonadherence to and early discontinuation of adjuvant endocrine therapy is associated with increased risk of disease recurrence and mortality, longer time to initiation of therapy was associated with poorer adherence and lower short-term continuation of adjuvant therapy in this low-income patient population.

In the publication, data showed 77% of women were adherent and 24% had continued therapy at 1 year, but only 22% and 24% of women were adherent and continued therapy at 5 years, respectively. These data suggest that early interventions to promote timely treatment initiation could positively impact treatment adherence to endocrine therapy. Additional interventions and strategies to promote medication adherence and continuation of therapy, particularly preventing and managing adverse effects (AEs), are also critical, especially because endocrine-associated toxicities account for early treatment discontinuation in approximately 20% of both pre- and postmenopausal women.

Evidence of gender-based differences among patients receiving cancer treatment was published earlier this year from an analysis of data from over 200 trials spanning several decades and involving more than 23,000 men and women. Women had an approximate 34% increased risk of experiencing severe symptomatic, hematologic, and nonhematologic AEs compared with men. With immunotherapy, the risk of serious AEs was even greater, at approximately 50% higher than the risk of serious AEs experienced by men. Although these trials were conducted among patients with different cancer types, the data suggest women are more susceptible to chemotherapy and immunotherapy AEs rather than being more likely to report adverse symptoms.

In their practice settings, oncology pharmacists are experienced and frequently deal with acute treatment toxicities, some of which may evolve into or develop later as chronic toxicities. Women who transition from neoadjuvant and/or adjuvant chemotherapy to adjuvant endocrine therapy will benefit from additional support to ensure adherence to their treatment plan. Thus, pharmacists will find additional opportunities to improve treatment outcomes for patients in these treatment settings and within survivorship programs. However, it is important to keep in mind, as one breast cancer survivor recently reminded me, that the 1 drug viewed by the oncology pharmacist as being the most important to their treatment may be 1 of many drugs that the patient is actually dealing with.

With a heightened and unique awareness of varying perspectives within the breast cancer treatment space, oncology pharmacists are well positioned to consider new strategies and opportunities to enhance our patients’ care. We have a lot work to do to resolve disparities in cancer care and patient outcomes. Further, despite the continued advances in new therapies and treatment options, much of what we can accomplish will be through optimizing delivery of current therapies.

ABOUT THE AUTHOR

Lisa E. Davis, PharmD, FCCP, BCPS, BCOP, is the new editor in chief of Pharmacy Times Oncology Edition^™. Davis holds positions as a clinical pharmacist in early-phase clinical trial and breast cancer programs at the University of Arizona (Arizona) Cancer Center and a clinical professor of pharmacy practice and science at the Arizona R. Ken Coit College of Pharmacy. Davis also sits on the Hematology/Oncology Pharmacy Association Board of Directors and is a member of the Cancer Prevention and Control Program and scientific review committee at the Arizona Cancer Center.