Dr Lawrence Shulman Discusses Pathways and Improvements in Breast Cancer Treatment

Improvements in treatments have led to less toxicities and better quality of life for patients with breast cancer, said Lawrence N. Shulman, MD, director of the Center for Global Cancer Medicine at the Abramson Cancer Center, and professor of Medicine at the Hospital of the University of Pennsylvania.

How is adherence to clinical pathways improving outcomes for patients with breast cancer and delivering high-value care?
Well, we know a few things about pathways. One of the things we know is that if you do them appropriately, you reduce variation in care—it improves standardization. And we know from a lot of studies, reducing variation in care accomplishes 2 things. First of all, it improves the quality of care, reduces errors, reduces inappropriate treatments. We also know that reduction in variation results in decreased costs for the health system overall, and often, for the patients, as well.

How have novel therapies allowed for less toxic ways to treat breast cancer?
Things are pretty different now than they were in the breast cancer area when I started, which was a very long time ago. And I thought a little bit about the patients that I cared for in the ’70s and the ’80s versus the patients that I care for now.

And 2 things have happened. One is that we have developed therapies that are, in fact, often more effective but less toxic. And we’ve also learned to control the toxicities of the therapies that we use much better than we have in the past. And so, the quality of life for breast cancer patients undergoing treatment is much better now than it was even a decade ago. And I think will continue to improve. And that’s true in both short-term toxicities and long-term toxicities.

And it’s not just the drugs. The surgery that we perform now leaves patients with fewer long-term complications. The way we give radiation now results in better cosmetic outcomes and fewer long-term toxicities. So, all aspects of our treatment have really improved over the years.
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