Jo Cumming
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The document discusses the challenges that arthritis patients face when choosing treatment options and how helplines can help support them. Some of the treatment options mentioned are prescribed medication, complementary treatments, diet, exercise, and surgery. The unpredictable nature of arthritis combined with painful symptoms and disability can make decision making difficult. Many callers to helplines seek information to help cope with pain. Helplines aim to help the process of choice by centering the individual, listening to understand their perspective, responding to their needs, and giving them time. This partnership approach can support medical consultations by providing more personalized attention, information, and enabling decision making.
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Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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- 1. Ms Jo Cumming Helplines Manager Arthritis Care Choosing treatments: risks and benefits The patient’s perspective
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- In my presentation I will look at the wide perspective of what we the people living with arthritis consider and treatments. The choices we face, the barriers to making those choices and finally how can we be helped to make decisions and weigh up the risks and benefits. I have chosen to present this not just from my own perspective as someone living with osteoarthritis but also from what people who contact Arthritis Care’s Helplines team tell us. Taking real examples and figures from anonymous case studies and data collected over the past 3 years.