Editor’s note: Our panelists would like to highlight these points:
- The patient and the health care team must build trust with each other.
- African Americans have historical reasons for not trusting the health care industry. Much outreach is still needed.
- Inform and educate before the start of treatment and during the treatment.
- Be balanced and do not underestimate common side effects or overestimate rare ones. Adapt the amount and the detail of the information to the wishes of the individual patient. Offer various methods of delivery (e.g., videos, pamphlets, fact sheets).
- Patients will research their condition and treatments online. Instead of trying to stop this, help them find the best sources.
- Patients will connect with others in the patient community and learn from each other’s experiences. Keep in mind that everyone is different, and decisions should always be made together with the medical team.
- Monitor patients regularly, especially during the first few treatment cycles.
- Use different forms of communication between the patient and health care providers (e.g., apps, digital charts, oncology nurses/nurse navigators, responsive oncologists, different forms of telemedicine), but don’t forget to speak directly with the patient.
- The use of new PRO apps can be very useful to help patients differentiate between urgent and nonurgent signs and symptoms.
- As much as possible, use preventive/prophylactic measures, namely for nausea, vomiting, diarrhea/constipation, and mucositis.
- Be aware of late side effects, especially with immunotherapy.
- Don’t forget that grade 1-2 side effects can substantially impact quality of life, particularly if they are persistent.
- Consider quality-of-life issues for each patient. What is acceptable for one patient may not be for another.
- Learn how to manage new and specific side effects (e.g., endocrine, skin related, pneumonitis).
- Keep an open dialogue about treatment and side effects. Things can change, and there are different ways to address issues such as medications for side effects and dosing changes.
- Listen to your patient and respond in a timely fashion.
- Ethnicity and genetics should be studied as a factor for individual side effects. Standard industry dosages of a new anticancer medication might not be as effective in one ethnic group as another due to the lack of diversity in clinical trials.
- Medications with hard-to-manage or dangerous side effects may be counterproductive regardless of effectiveness.
- Cancer treatment varies vastly depending on region and type of treatment facility. There are many unmet needs in rural areas because of lack of oncology personnel, finances, transportation, etc.
Dr. Rugo is a professor in the department of medicine, University of California San Francisco Comprehensive Cancer Center; director, Breast Oncology and Clinical Trials Education, Cancer Infusion Services, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco. Dr. Cardoso is director, breast unit, Champalimaud Clinical Centre, Lisbon. Financial disclosures for both Dr. Rugo and Dr. Cardoso are available on Medscape.com, where this article first appeared. Julia Maués is a patient in Washington. She has disclosed no relevant financial relationships. Sheila Pettiford is a patient in Middletown, Del. She has disclosed no relevant financial relationships.