Patient-reported outcomes predict survival and adverse events following anticancer treatment initiation in advanced HER2-positive breast cancer

HPS Pharmacies is delighted to share the following study overview written by Natansh Modi, a pharmacist at HPS Pharmacies St Andrew’s. The study, conducted by Natansh and her colleagues,  looked at patient-reported outcomes in advanced breast cancer. Click here to read the full study.

1. What was the main purpose of your study?

The study aimed to evaluate the prognostic performance of pre-treatment patient-reported outcomes for prognosis and toxicity in patients initiating anticancer treatment for HER2-positive advanced breast cancer.

2. What was the rationale behind the study? Why is it important to do research on this topic?

Shared decision making is the process in which the clinician and the patient collate and discuss the available evidence on the benefits and harms of treatments to make the most appropriate informed health decisions for the patient. Shared decision making is an essential component of providing patient-centred care.

Eastern Cooperative Oncology Group performance status (ECOG PS) is a clinician-interpreted tool used to evaluate the daily living abilities of patients. Patient-reported outcomes (PROs) are structured self-reported tools that provide the patients’ perspective and voice to their physical, social, emotional, and functional abilities.

PROs have shown to be of prognostic importance in other cancer types (including bladder cancer, non-small-cell lung cancer, and melanoma), with some studies demonstrating patient-reported physical function/well-being as more prognostic than ECOG PS. Additionally, PROs have shown the potential to detect serious adverse events earlier than clinician reporting. However, the prognostic value of PROs in HER2-positive advanced breast cancer has been minimally explored.

3. What was the key finding of your study?

Patient-reported physical well-being, trial outcome index score, total FACT-B score, functional well-being, and BC subscale score were identified as significantly and independently associated with overall survival. This study found that both patient-reported physical well-being and clinician-interpreted ECOG PS provide independent prognostic information.

4. What are the implications of your findings for patient care?

The present study demonstrates that patient-reported physical well-being has independent, and potentially superior, prognostic performance to the clinician-interpreted ECOG PS. It is, therefore, essential that clinical practice transforms to place a greater emphasis on the patient’s perspective and voice.

5. What are the key limitations of your study?

Randomised controlled trials (RCTs) are the backbone of evidence-based medicine; however, strict inclusion criteria within RCTs can limit the generalisability of results (e.g., the study cohort was almost entirely restricted to participants with better ECOG PS than what would be observed in the general population).

6. What are the next steps?

Future research should examine the association between clinician interpreted ECOG PS and patient-reported outcomes in early breast cancer, other breast cancer subtypes, and in real-world populations, which are more likely to have broader distributions of ECOG PS and PROs scores.