Advances and Best Practices in the Utilization of Novel Agents in Metastatic Breast Cancer - Episode 13
Sara M. Tolaney, MD, MPH: I do think it does take time to discuss these drugs with patients because you need to inform them when they’re taking the drug, how they’re taking the drug and what to expect in terms of adverse effects. What do they need to call us about? What do they need to come in for? Why are we monitoring them? What are we looking for? And then I think also to make sure there’s good adherence to treatment. And so it is a discussion. Just with all oral therapies, it does take time to review these things. But I think that if that education is provided up front, patients usually know when to call us, they know to call us if they are having loose stool on abemaciclib. They know to call us if they have a fever. And those are things that we do tell them up front. We counsel them on how to manage nausea or diarrhea up front. We often provide those medications to them prophylactically before they’ve started so they have an armamentarium at home from which they can choose if symptoms arise.
And, again, as Lindsay alluded to, communication is so key. If the patients are aware of what to expect and then they can communicate back to us with any adverse effects they’re experiencing, then we can certainly help, whether it be dose holds or help them understand how to take their loperamide. I think it’s usually very doable.
Lindsay Shaw, NP: Patients will see Sara when they’re initially changing therapy, but then before they start taking the medicine they’ll see me once again for usually cycle 1, day 1; or even prior to cycle 1, day 1. I’ll repeat and go over everything again and make sure they have all their prescriptions for their anti-nausea medication, their anti-diarrheal medication, and I’ll often say to them, “You know, if anything happens or you’re not feeling well, if you feel nauseated, you have loose stool, just call me. Call me right in the moment and we’ll talk about what to do and how to manage things.”
Sara M. Tolaney, MD, MPH: Well certainly over the last few years we’ve had a number of FDA approvals for new agents, so this is becoming a more common issue where we do have to inform our staff about new agents as they get approved. We also create internal clinical pathways. These are regular meetings that we have to review any new FDA approvals and how they would fall into our pathways, and those are sort of unique times when we can discuss with our staff what they really feel clinically we should be using these drugs for and in which settings. But then also to review toxicities that arise with these agents and whether internally we need to have plans in place about how to manage adverse effects as they arise. Because I do think it is important. As a group, we like to practice in a uniform way, and so we do like to have these discussions up front as new drugs come out.
Lindsay Shaw, NP: And there’s a lot of discussion amongst all of us in the clinic about making sure everyone’s doing best practice and educating each other, just on a day-to-day basis.