Research points to need for personalized supportive care | SABCS 2023

Background

High-quality cancer care is increasingly personalized. Doctors make treatment recommendations based on molecular testing, genetic testing, tumor size, tumor grade, and extent of the cancer, including lymph node involvement. Taken in sum, this information leads to specific guidance that affects the type and order of recommended therapies. The goal is to help each person have the best chance of becoming and staying free of cancer. But, in some cases, this picture may be incomplete. These studies highlight a gap in information and the need for more tailored support.

Risk of recurrence higher among people with depression and substance use

Women who struggle with depression or addiction before developing cancer have a higher risk of cancer coming back after treatment. A cohort study of women who receive health care through the Veterans Administration (VA) found that women who had major depression or a substance abuse problem before a breast cancer diagnosis were more likely to have a recurrence than women without a history of these conditions.

This study builds on earlier research presented at SABCS in 2022 that showed that women with major depression had a higher risk of developing breast cancer. The authors thought that the higher risk might be due to other characteristics that sometimes go along with depression, such as substance abuse. But the data suggest otherwise.

By looking back at the health records of 6,051 women diagnosed between 2010 and 2019, they found that:

• Women with major depression, a substance abuse condition, or both had a higher risk of breast cancer coming back after treatment than women with similar breast cancers.
• Women with alcohol abuse were 65% more likely to have a recurrence.
• Women with other substance abuse (not alcohol) were 90% more likely to have a recurrence.
• Women with hormone receptor-positive breast cancers who had both conditions had a higher risk of recurrence than women with either condition on its own.
• Age, race, and cancer stage did not affect these results.

These results point to the importance of screening for major depression and substance abuse at diagnosis.

Factors that increase risk for not taking endocrine therapy

Many women with breast cancer benefit from taking endocrine therapy long-term. Despite the known benefits, some people stop taking their endocrine therapy pills over time, increasing the likelihood of cancer coming back.

A study of 702 women who were prescribed aromatase inhibitors (AI), a form of endocrine therapy, tell us more about who is likely to stop taking these drugs. Urine tests given every three months for the first 36 months (about three years) of expected use showed that nearly two-thirds of women in the study had not consistently taken medication as prescribed. The study team analyzed results by:

• Race
• Hispanic ethnicity
• Age
• Education
• Income
• Health insurance type
• Prescription cost
• Socioeconomic deprivation (defined by the area deprivation index score, which measures socioeconomic disadvantage)
• Urban or rural residency

Of this list, five factors were most strongly associated with stopping endocrine therapy: younger age (65 or younger), lower education level (high school graduate or less), lower out-of-pocket prescription costs, and urban location. People with two of these five had a 60% higher risk of not taking their endocrine therapy as prescribed. These findings point to the need for better identification of people who are at risk for not taking medicine and more thoughtful approaches to help them continue.

Risk for financial toxicity: Who is at risk and what might help?

A survey of nearly 1,500 Breastcancer.org community members looked at financial stress due to breast cancer—who was experiencing it and what might help ease their burden. The study included people with both early-stage and metastatic disease with 75% of participants in active treatment. Their average age was 46. They were mostly women (94%) of whom 60% were white, 27% were Hispanic, 8% were Black, and 4% were other races.

Almost half (47%) of participants reported a significant or catastrophic financial burden due to breast cancer. The burden was worse among people with metastatic breast cancer.

Respondents were asked about these resources: patient assistance programs, nonprofit grants, hospital financial assistance departments, coupons and savings cards, free or low-cost transportation to appointments, clinical trials, the use of medical billing advocates, help from social workers, financial advice or education provided by nonprofits, and financial navigators. Most were at least a little or somewhat helpful, none overwhelmingly so.

When asked to rank what would be helpful, participants ranked this list in order of most to least helpful. The top three items were most often ranked as number one:

1. A list of financial grants for people diagnosed with breast cancer
2. A checklist of questions to ask one’s healthcare team about minimizing financial burden
3. Free or reduced-price professionals to help with billing, benefits, financial, and legal issues
4. Tips on what to say when talking to one’s insurance company
5. Guide to navigating employment issues
6. List of phone numbers for patient assistance programs
7. Guide to obtaining the best health insurance
8. Guide to buying life insurance
9. Guide to disability insurance

Results varied by subgroups though, suggesting that one size does not fit all. Hispanic people were most likely to find any assistance program helpful and were more interested in professional services than non-Hispanic respondents.

What does this mean for me?

This conversation is a positive step forward for people with cancer. It reminds us that the cancer experience is multi-faceted and personal.

If the information discussed in this article feels relevant to you or someone you care about, bring it up with a member of your healthcare team even if they don’t ask about it. Ask for advice on where to get help. Many organizations and resources exist to help people with cancer in all kinds of situations. It’s just a matter of making the connection.