Hayley Knollman, MD, Highlights Growing Role of Patient Preferences in Breast Cancer Care

As treatment options for metastatic breast cancer continue to expand, shared decision-making is becoming increasingly central to patient care, according to one oncology expert who emphasized the growing importance of balancing efficacy with quality of life.

Patients Play Increasingly Active Role in Treatment Decisions

Hayley M. Knollman, MD, assistant professor of clinical medicine, University of Pennsylvania, explained that patients today are often highly informed before they even step into the clinic, driven in part by social media discussions, targeted advertising, and easier access to medical information online. Many patients seek multiple opinions and arrive prepared with detailed questions about therapies, toxicities, and treatment sequencing.

In response, clinicians are spending more time helping patients navigate increasingly complex treatment decisions, particularly in estrogen receptor (ER)–positive metastatic breast cancer. One major consideration is determining when a patient should transition from oral therapies to intravenous (IV) treatment.

Although IV therapies may offer strong clinical benefits, many patients prioritize remaining on oral medications for as long as possible to avoid frequent infusion visits and disruptions to daily life. Others may prefer treatments that minimize adverse effects, such as hair loss.

Knollman described this balancing act as “the art of medicine,” noting that treatment decisions are rarely based on efficacy alone. Instead, clinicians must consider what matters most to each individual patient, whether that means maximizing therapeutic benefit, preserving quality of life, reducing adverse effects, or limiting time spent traveling to medical centers.

Social Determinants Continue to Drive Inequities in Care

The conversation also highlighted persistent inequities affecting patients with breast cancer, particularly financial and social challenges, rather than access to precision medicine itself. Working at a large institution in downtown Philadelphia, Knollman noted that transportation barriers, childcare responsibilities, and other social determinants of health can significantly affect patients’ ability to receive care.

By contrast, access to genomic and circulating tumor DNA testing was described as relatively standardized at her institution, with few insurance-related obstacles encountered in practice. When billing issues do arise, they are often resolved quickly through coordination with testing representatives.