Dr Adam Brufsky Discusses Value Coordinates of Breast Cancer Care

Adam M. Brufsky, MD, PhD, co-director of the Comprehensive Breast Cancer Center at University of Pittsburgh, notes important value coordinates of breast cancer care.

What are some important value coordinates in cancer care overall, and in breast cancer in particular?
When we speak of value coordinates, I’m going to use the following definition: Survival, progression-free, and overall survival are very important value coordinates. I think symptom-free interval is a good one. So, I think in breast cancer, how long we can keep women who are asymptomatic from developing symptoms or problems from their breast cancer. So, a lot of women will come in with asymptomatic bone metastasis, maybe somatic visceral metastasis in lung or liver and you know one should ask do we treat them all? Why are we treating them, if they don’t have any symptoms and you can’t cure them of the disease with what we have in 2018? The reason to treat them is to prevent them from getting into trouble 2 or 3 months later, 2 or 3 years later. I think that’s what we are trying to do. The symptom free interval is a really good way to assess value in the treatment of metastatic cancer.

Obviously, the treatment of early-stage breast cancer is how many people relapse versus how many don’t. I think that’s what it comes down to. Whatever compounds, drugs, therapies, interventions you do in early stage, you’re really trying to prevent the recurrence of disease. Now, distant recurrence disease is really important. Local recurrence is important too, but I think one thing over time we are doing in breast cancer is really beginning to understand that while local recurrence is important as a value coordinate, I think distant recurrence is a little bit, at least to me, a little bit more important because local disease can be managed locally. Distant disease generally can be managed systemically and unfortunately, most distant disease in 2018 is not curable. So, for me, distant disease recurrence is a little more bit value coordinate than local, number 1. Number 2 again, once you have metastatic disease, I think it’s really that symptom-free interval. Symptom-free progression. So, symptom-free progression, I don’t know how to describe it but it’s not so much radiologic progression, which is important, but it’s radiologic progression that actually has a clinical consequence for the patient. That’s what you’re trying to prevent.
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