Quality Improvement Initiative to Develop Individualized Management Strategies for HER2+ MBC

A quality improvement initiative was conducted to identify and address real-world challenges faced by healthcare professionals (HCPs) in individualizing treatment plans, adverse event management, and patient-centered care for HER2+ metastatic breast cancer (MBC).

To assess practice patterns, challenges, and attitudes related to individualized and patient-centered care for HER2+ MBC, tethered surveys were completed by 22 HCPs who treat patients with breast cancer as well as 51 patients with HER2+ MBC from 2 large US community oncology clinics between September 2022 to December 2022. Patient chart audits (n=100) were performed to assess current practice patterns and track changes. Eligible patients had confirmed HER2+ MBC diagnosis, prescription for ≥2 lines of HER2+ breast cancer treatment, and 1 visit in the 1-year chart abstraction period.

In tethered surveys, the most common challenges reported by HCPs when caring for patients with HER2+ MBC were coordination of care (41%) and individualizing treatment plans (32%), whereas challenges reported by patients receiving care for HER2+ MBC were feeling confident in treatment plan (30%) and being unable to meet work or home responsibilities (22%).

Discordance was noted between patient and HCP perceptions related to treatment goals, patient education, and patient-centered care. Although 82% of HCPs indicated that treatment preferences were often or always discussed with patients, only 8% of patients reported such discussions with their HCP. In contrast to the perception of HCPs (82%) that prolonging survival was the top treatment goal for patients, improving quality of life (57%) and controlling symptoms (41%) were reported as patients’ top treatment goals. Similarly, HCPs perceived that patients found management of nausea/vomiting (68%) and diarrhea (59%) to be the most difficult, whereas patients reported that they have the most difficulty in managing fatigue (46%) and hair loss (44%).

Several gaps in guideline-aligned care were identified in baseline chart audits relating to treatment selection, sequencing, and supportive care. Action plans were developed and implemented based on these areas for improvement; these included increased one-on-one or group educational sessions with patients (50%), increasing use of patient navigators (33%), patient referral to palliative care at time of diagnosis (33%), incorporation of multidisciplinary team–based approaches (42%).

Based on findings of this quality improvement initiative, several gaps in guideline-aligned, patient-centered care were identified for patients with HER2+ MBC, providing opportunities to implement individualized management strategies that improve patient outcomes in the community setting.


Mahtani R, Hamilton E, Dewald I, et al. Empowering oncologists to develop individualized management strategies for HER2+ metastatic breast cancer: findings from a quality improvement initiative. Presented at the 46th San Antonio Breast Cancer Symposium Annual Meeting, December 5-9, 2023; San Antonio, TX: Abstract PO4-04-03.

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