Clinical Meaningfulness Poorly Understood and Often Not Considered in the Metastatic Breast Cancer Clinical Setting

Treatment decision-making for patients with metastatic breast cancer involves numerous clinical and non-clinical factors including patient care goals, values, and preferences. These factors influence how treatment options are decided by the patient. Clinically meaningful outcomes and clinical meaningfulness are important for patients with metastatic breast cancer, but the extent of alignment between patients and their oncology care team has not been well studied. To understand clinical meaningfulness in metastatic breast cancer treatment decision-making, perspectives on the concepts of clinical meaningfulness and clinically meaningful outcomes were examined among 5 groups in a recent study. These 5 groups included patients with metastatic breast cancer, patient caregivers, oncology nurses, advanced practice providers, and oncologists. Discussion guides were developed by investigators to elicit perspectives from these stakeholders. Semi-structured in-person and web-based focus groups were conducted, and all conversations were audio recorded. To identify key themes during the focus group discussions a constant comparative approach was used.

The investigators also sought to identify areas of convergence and divergence between 22 study focus groups. Participants included 50 patients, 24 caregivers, 17 oncology nurses, 13 advanced practice providers, and 8 oncologists. Although some providers were familiar with the concepts of clinically meaningful outcomes and clinical meaningfulness, patients and caregivers generally were not familiar with them. The providers who were familiar with the concepts did not use the associated terms when discussing therapy recommendations with patients. This suggests a need for the use of patient-friendly and accessible terminology during treatment decision-making conversations. Quantitative end points were thought by some providers to define clinical meaningfulness. Although participants valued overall survival, all stakeholder groups considered the patient’s ability to achieve life goals such as participating in social activities or milestone events or being able to travel to be of paramount importance. To improve treatment decision-making discussions, a patient-centered approach was recommended along with inclusive, dynamic patient-provider discussions. It was also recommended to have an ongoing evaluation of patient priorities throughout the entirety of the treatment journey. Consideration should be given to meaningful outcomes such as patient quality of life, progression-free survival, minimizing treatment side effects, managing adverse events, improving functioning and symptom burden, and overall survival. Meaningful outcomes were considered to be highly individualized among all the focus group participants. Meaningful outcomes also evolve as the patient continues with their treatment.

Source:

Graff S, Freeman E, Roach M, et al. Understanding clinical meaningfulness in metastatic breast cancer treatment decision-making: experiences and perspectives of patients, caregivers, and clinicians. Poster presented at: San Antonio Breast Cancer Symposium. December 6, 2023; San Antonio, TX. Abstract # PO1-10-06.