Routine screening for patient-reported outcomes may improve access to supportive care services among long-term metastatic breast cancer survivors.
Most patients diagnosed with metastatic breast cancer self-reported that they did not utilize supportive care services, according to an analysis presented at the 2024 San Antonio Breast Cancer Symposium.
Physician’s Weekly (PW) spoke with presenting author Ashley P. Davenport, MD, about the disparities that she and her colleagues identified in their research, as well as the importance of routine screening for patient-reported outcomes in clinical practice.
Can you describe your study’s purpose and design?
We conducted a small analysis of a larger study called the Symptoms and Needs of Metastatic Breast Cancer Survivors. The purpose of this analysis was to evaluate referral patterns and supportive care utilization for patients living with metastatic breast cancer. Additionally, we evaluated sociodemographic, psychosocial, and clinical predictors of supportive care utilization.
Patients who were at least one year out from their metastatic breast cancer diagnosis filled out a one-time survey. We used validated surveys to have patients self-report QOL, self-rated health symptoms, supportive care needs, and reflections on their cancer diagnosis and treatment. The assessments included the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health score and Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) items, among others.
We used multivariate logistic regression to determine sociodemographic factors like age, race, education income, rural/urban residency, psychosocial QOL (PROMIS physical component score, PROMIS mental component score, social supports), and clinical factors. We looked at the associations between supportive care service utilization and time since diagnosis, current treatment, metastatic site, etc.
What are the key findings from your study?
A total of 224 patients participated. The majority were female (221 of 224); the mean age was 60 years; 92% self-identified as White, and 98% self-identified as non-Hispanic. Fifty percent of patients had a total household income less than $75,000. Twenty-nine percent resided in rural areas.
We found that more than 25% of patients used three or more supportive care services. However, the vast majority (55.3%) reported not using any supportive care services.
The patients receiving services in our study were more likely to self-report as being non-White and more highly educated, as well as having lower PROMIS physical and mental health scores, higher self-reported fatigue and pain, and lower QOL scores.
Why do you think more than half of the participants reported not using any supportive care services?
I think this study raised a lot of important questions. A big one was the extent to which the differences are related to physician referral habits versus patient preferences. In addition, are healthcare professionals being reactive in terms of their prescribing, given the association with higher needs as indicated by symptom scores?
Are the services being offered in alignment with patient needs? For example, on a previous poster at a different meeting, we found that the top five symptoms reported by this patient population were decreased sexual interest, fatigue, insomnia, pain with sex, and pain.
In your opinion, how can physicians take steps to improve access to supportive care services for patients with metastatic breast cancer?
There is great ongoing work about the importance of routine screening for patient-reported outcomes like needs and symptoms. We need to investigate whether there would be more equipoise if referrals were automatic and driven by set criteria as opposed to patient reports and clinicians having to screen and set referrals.
Are there ways to make access easier, such as opportunities for self-referral to supportive care services? Also, are we normalizing supportive care and offering referrals early and consistently throughout the patient’s journey?
What remains to be explored in future research?
We’re continuing to analyze this survey, but I think it highlights the importance of understanding patient needs and barriers to supportive care, particularly in this growing population of survivors living long-term with metastatic disease.
When are patients being approached? How do patients and caregivers prefer to be approached? How often should we be reoffering these services?
A lot remains to be understood in terms of the impact of financial and time toxicities. Additionally, with all the competing demands on time and schedules, are patients regarding supportive care in the same way as other appointments? Is there a way to better help patients get to the right resource at the right time?
Is there anything you would like to add?
One significant limitation of this study is that we did not include caregivers. When we think about access, whether that’s to our medical system or supportive care, we need to think about how we are including caregivers’ voices and needs as well.
