Coordinated Care in Breast Oncology: Role of Radiation Oncology

In this episode of OncChats: Coordinated Care in Breast Oncology, Jason Ye, MD, and Daphne B. Stewart, MD, of Keck Medicine of USC, discuss how early multidisciplinary collaboration in breast cancer care, particularly involving radiation oncology at diagnosis, can alleviate patient fears, guide more informed surgical decisions, and improve access to clinical trials and outcomes.

Ye: For me, personally, as a radiation oncologist, as you know, radiation typically comes toward the tail end of breast cancer treatment. If you’re talking about a localized breast cancer, [patients] typically would get surgery and chemotherapy before they receive radiation, if needed. So, [it is good] for me to be able to see the patient before the surgery, at the time of diagnosis, to introduce myself and really alleviate a lot of the fear and [address some of the] questions that they might have. [I can] let them know that it’s a very safe and effective treatment, toxicity is getting less and less, things are getting more convenient, and treatments are getting faster and easier [to administer]. To be able to really explain that to the patient and make sure they can make an informed decision, for me, is very, very rewarding.

I think a lot of the patients appreciate that, too, because there is a lot of stigma or fear about radiation. It sounds scary. A lot of people don’t know what it is, and so, sometimes people [talk themselves] into getting perhaps a more extensive surgery than necessary, when they could have had a less extensive surgery and received the radiation and actually end up with the exact same oncological outcome and likely better quality of life in many cases. So yeah, having that discussion up front really drives not just the radiation decision, but the surgical decision, as well. We’re going to touch on this, maybe a little bit later, but also, clinical trial eligibility is another thing [we can bring up] during the huddle. [We can say,] ‘Hey, this is maybe a few weeks or months down the line, but if we go in this direction, [the patient] might be eligible for this exciting new clinical trial that’s testing a new paradigm.’

Stewart: I think you’re making a really important point. Often, when people are newly diagnosed with breast cancer, they are initially referred to a surgeon, and the surgeon is often in a big hurry to get to the resection of the tumor immediately. So, a patient often gets their surgical resection without ever having a discussion, like you said, with radiation oncology or medical oncology, and they may fail to understand up front that this really has to be a multidisciplinary team to take advantage of all the resources that reduce the risk of an in-breast recurrence. And, as a medical oncologist, you really worry about a distant metastatic recurrence, and what interventions you can take to reduce that risk. And I think that if you have a conversation up front and understand that surgery is crucial for curing cancer, that radiation oncology is crucial for reducing a chest wall or in-breast or axillary recurrence, and that a medical systemic therapy intervention is crucial to reduce the risk for future new breast cancer or any type of recurrence. I think if a patient has an opportunity to meet with a team that interacts and has a multidisciplinary plan, they can really take advantage of all of those resources, and it's much more streamlined.

Check back tomorrow for the next episode in the series.