EXCLUSIVE: What is overtreatment of breast cancer and how can it impact patients? An expert opines
When 36-year-old Raina was diagnosed with early-stage breast cancer, her first thoughts were about the kind of treatment she has to undergo and the impact it will have on her quality of life. Her cancer was still at an early stage and she was uncertain whether to opt for chemotherapy or not. Like Raina, many early-stage breast cancer patients undergo this dilemma of whether to undergo chemotherapy.
Breast cancer and risk of recurrence
Breast cancer has four stages: stage 1 and 2 is considered as early stage and it currently accounts for 50% of newly diagnosed cases in India. In the early stages, the cancer is contained and it has not yet started spreading to other areas of the body. Once a patient is diagnosed with breast cancer, the tumour is surgically removed. Post-surgery, an oncologist creates a treatment plan based on the risk of recurrence. Chemotherapy is recommended only for those patients who have a ‘high risk’ of cancer recurrence.
Many early-stage breast cancer patients undergo chemotherapy to avoid cancer recurrence. A clear understanding of the risk of cancer recurrence will help in planning optimum treatment, ensuring that patients are not overtreated which may lead to toxic side effects.
Breast cancer and the treatment plan largely includes surgery, systemic therapies such as anticancer chemotherapy, hormonal therapy, targeted therapy, and immunotherapy and radiation therapy. They are associated with significant influences on physical and mental state, specifically the quality of life of the patient and their caregivers. The economic status of the patient and their family is largely impacted. The fact of recurrence and cascading fear has devastating effects which often leads to overtreatment.
Chemotherapy-related adverse events
The most frequent chemotherapy-related adverse events which are observed in patients with breast cancer include alopecia(hair fall), nail discolouration, dysgeusia(change in taste perception), loss of appetite or weight changes, nausea and vomiting and diarrhoea. Chemotherapy also affects blood-forming cells of bone marrow leading to decreased immunity due to reduced white blood cell counts, easy bleeding due to lowering of platelet counts and fatigue due to lowered red blood cells. However, these side effects are mostly gone with the completion of chemotherapy treatment. The side effects caused by breast cancer chemotherapy bring about emotional trauma, which may be augmented by a lack of proper professional support. Even though drugs are used and other approaches are used to overcome these effects of cancer chemotherapy, they are often seen to be incompletely effective. Treatment of the side effects also adds to the financial burden of the disease. A study that was performed in a health care setting in the United States estimated that chemotherapy-related side effects resulted in a large incremental expenditure of USD 1,271 per patient annually. The additional financial burden caused by these side effects results in worsening the quality of life of the patient with cancer.
Even though breast cancer treatment is lifesaving, the physical effects of cancer treatment and the associated treatment costs reduce the quality of life of breast cancer survivors, which is already lowered with the diagnosis of cancer. The quality of life further declines if the patients have certain comorbidities (hypertension, diabetes, and arthritis), receive chemotherapy, have less social support, or have more unmet needs. Breast cancer overtreatment can put the recipients at the receiving end of all the adverse events of cancer treatment. Every effort should be taken to prevent cancer overtreatment by identifying those patients in whom the administration of these treatment modalities can be safely avoided.
Predicting recurrence to avoid overtreatment
One of the ways to accurately predict whether a patient has a high risk or low risk of breast cancer recurrence is through prognostic tests. One such test available in India is ‘CanAssist Breast’ which is validated on the Indian breast cancer population. These tests accurately indicate whether a patient falls under the low or high-risk category, thereby helping low-risk patients avoid treatment through chemotherapy thus avoiding the side effects that it causes.
About the author: Dr Harish Dara, Consultant Surgical Oncologist, HCG Cancer Center, Bangalore