BCAC Committee members Fay Sowerby, Libby Burgess and Emma Crowley attended the Breast Cancer inSIGhts conference on 1-3 September 2022 in Auckland. This biennial conference is run by the Breast Cancer Foundation NZ and the Breast Special Interest Group of NZ specialists.
It was wonderful to be able to attend in person after being at so many online events over the last two years. We were able to network with breast nurses, radiologists, pathologists, surgeons, medical and radiation oncologists, pathologists and psychologists from across Aotearoa as well as Australia. We also heard from policy makers from Te Aka Whai Ora and Te Whatu Ora. There were some great international speakers, some presenting in person and others online.
In ‘Hearing the Patient Voice’, an Australian clinician/researcher stated that delivering high value for patients must be a central goal. Patients want swift, accurate diagnosis, better information, support and shared decision-making, leading to the best possible outcomes. They also want integrated multidisciplinary, high quality, affordable care. She spoke about Patient Reported Outcome Measures (PROMS) – a person’s perception of their health gains after treatment and PREMS – patients’ perceptions of their healthcare experience. Cancer care navigators are an important part of delivering better care.
‘Pre-habilitation’ to help patients prepare for upcoming physical and mental stresses of breast cancer treatment was discussed. It includes exercise, nutrition and psychological tools such as mindfulness. Pre-habilitation has been shown to help people retain physical and mental fitness through the challenging process of treatment and recovery. It is used in Australia and Italy, and is the subject of a current study at Auckland Hospital.
Adhering to endocrine therapy is hugely important to prevent recurrence of hormone receptor positive breast cancer. Strategies for managing unpleasant symptoms from this therapy were discussed as was the importance of tailoring these to suit each individual. One size does not fit all and clinicians were encouraged to work with their patients to find optimal solutions.
Oncobrain, or cancer-related cognitive impairment, was discussed, along with a range of strategies that doctors and patients can use to manage it. Self-management techniques include reducing fatigue, avoiding multitasking, simplifying and pacing activities, getting plenty of exercise and training your brain by learning a new activity.
Exciting new developments in gene assay tests to guide therapy were described. These may enable low risk and some higher risk patients to have less chemo, and even cure some HER2 positive patients without chemo. These tests can also impact surgery and neoadjuvant therapy decisions, the nature of systemic therapy given, and whether to have shorter versus standard trastuzumab treatment.
New approaches to radiation therapy were described, in which treatments are tailored more precisely to individual patients’ needs. One aim is to ‘de-escalate’ treatment and ensure radiation is delivered only to cancerous tissue.
Evidence for the advantages of neo-adjuvant (pre-surgery) chemotherapy continues to grow and BCAC hopes that clinicians here will adopt this approach more widely. Benefits can include reducing the size of tumours before surgery, evaluating the effectiveness of medicines in controlling the patient’s disease, exposing any micrometastases (cancerous cells that could cause the cancer to spread) to treatment early, and providing time for genetic tests to guide selection of the best targeted therapies.
Advances in screening technologies that will allow better, earlier detection of breast cancer were presented, including abbreviated MRI and Contrast Enhanced Mammography.
Research on the breakthrough medicine Enhertu (aka trastuzumab deruxtecan) continues, with more trials looking at ways in which it could be used to help different groups of patients. Enhertu and other Antibody Conjugate Drugs as well as immunotherapies such as pembrolizumab (Keytruda) are showing great promise for treating both early and advanced breast cancer.
Overviews of New Zealand’s new government health organisations, Te Whatu Ora and Te Aka Whai Ora, were presented. The Cancer Control Agency, Te Aho o Te Kahu reported on progress in developing breast Quality Performance Indicators.
BCAC was pleased to hear that New Zealand’s Advanced Breast Cancer Guidelines have been updated, based on European guidelines and adapted for our local population. These will soon be published and are intended to be implemented.
A Saturday morning workshop on Knowledge Mobilisation for Clinical Change enabled three groups to workshop barriers and solutions in the areas of surgery, treatment and follow-up to find new ways to tackle persistent problems in breast cancer care. It was good see national thinking beginning to develop and also the realisation that there has been excellent innovation outside the main centres.
Fay noted that she had begun to get a sense of what is possible nationally while recognising regional and locality differences. She also observed that there was recognition that workforce has been under pressure for some time and yet more change will be required.
Libby commented that it was great to meet in person with so many of the wonderful breast care nurses and specialists who care for our breast cancer community. Hearing from researchers whose work is continually improving treatments and care on so many fronts was a privilege and provided a positive vision for those diagnosed in the future.
BCAC greatly appreciates the hard work of Adèle Gaultier of the Breast Cancer Foundation and others to bring this conference together.
16th September 2022