Dr Richard Simcock
Consultant Clinical Oncologist, Sussex Cancer Centre
Featuring Jane, a breast cancer patient from Somerset
There is no single experience of breast cancer. To ensure a tailored treatment plan, more testing may be required to help provide personalised cancer care.
Patients diagnosed with breast cancer in the UK will be assessed and treated by a multi-disciplinary team, where surgeons, specialist oncologists and nurses offer advice on individual patient care. The Oncotype DX® test provides patients with additional information about the chance of breast cancer coming back and likely benefit of chemotherapy through a score derived from the individual’s tumour either at core biopsy, or after surgery.
In addition to relying on population based estimates, the results of the Oncotype DX® test are entirely individual. Combining these different pieces of information means patients and clinicians can put together a treatment plan that outlines the chance of breast cancer recurrence, and the individual patient’s likely benefit from chemotherapy.
As Dr. Richard Simcock, Consultant Clinical Oncologist at the Sussex Cancer Centre explains, communication is key when outlining a patient’s prognosis: “Surgeons deal with certainty, but oncology is founded on uncertainty, only reduced through information. The Oncotype DX® test enhances this certainty by giving a clear indication of the chance of recurrence and the patients’ individual benefit of chemotherapy.”
Chemotherapy challenges
Currently in some areas of the UK, there is a backlog of breast cancer treatment in part due to reduced staffing levels and increased patient safety measures during COVID-19. With the potential that patients could be more advanced on first diagnosis due to the delay, Dr. Simcock believes that additional genomic testing could improve patient confidence, whilst also reducing the chemotherapy burden on the NHS.
He said, “Chemotherapy is a field which requires a highly specialised team. Given that many NHS staff have been redeployed to other areas during the COVID-19 pandemic, knowing whether someone could actually benefit from chemotherapy treatment or not would greatly free up resources.”
With conversations now taking place via phone or online where nuances can get missed, it is more important than ever that patients feel they are in control.
Patient perspective
These results can help patients make much more informed decisions. This was certainly the case for 50-year old Jane who had her cancer picked up on a routine mammogram. Although there was no prominent lump to be found, shortly after her core biopsy the cancer was confirmed. In the consultation room Jane had many questions, hoping to fully understand her diagnosis and her choices.
As one of the first treatment steps, she had her operation with analysis showing that her cancer had only spread to one lymph node. “I was incredibly lucky” said Jane. “Not only with my cancer being caught early, but also with it only spreading to one node. I was lucky for a third time when my consultant mentioned Oncotype DX®.”
Within two weeks, Jane had the news she was waiting for. She said, “My family viewed the cancer pragmatically, but we knew that treatment during my daughter’s exams would be chaotic. Finding out that I had a low score and did not need chemotherapy was a godsend.”
Communication through COVID-19
While traditionally, patient communications have been face-to-face, new procedures due to COVID-19 have changed the dynamics. Dr. Simcock explains, “The first thing a consultant needs to do with a patient is listen, as they may have their own reasons to continue down a particular care path. With conversations now taking place via phone or online where nuances can get missed, it is more important than ever that patients feel they are in control. By having a defined breast cancer recurrence score, patients feel that their care is tailored to them and not just aggregated into population data.”
While there are further considerations to be made as to whether the Oncotpye DX® test is suitable for different patient groups, such as those whose cancer has spread to the lymph nodes, Dr. Simock hopes that by building an individual risk profile through genomic testing, the test could potentially reduce the burden of chemotherapy on the service. He hopes that the Oncotype DX® test will continue as a standard diagnostic tool for the NHS, increasingly important considering the challenging situation presented by COVID-19.
