Jun 28th 2021

How Oncology Case Management Improves Outcomes for Young Breast Cancer Patients

As breast cancer cases continue to rise among women under 40, clinical trials offer hope for better outcomes—both now and in the future.

According to a January 2021 study in the Journal of Oncology Practice, one in 196 young women are diagnosed with breast cancer in the U.S. It's not just an increase in cases that is concerning. The study found that young breast cancer patients tend to have poorer outcomes, because they are “more likely than older women to present with aggressive subtypes and advanced disease."

The study authors recommend considering oncology clinical trials whenever possible—particularly for patients who present with metastatic disease—as traditional cancer treatments may not be enough to prevent recurrence or progression.

Unfortunately, younger breast cancer patients are underrepresented in clinical trials, which makes it even more important to encourage participation that will lead to a better understanding of early-stage interventions.

Unique challenges require multidisciplinary care

In theory, the benefits of cancer clinical trials for this growing patient population are clear. But in practice, there are a number of obstacles standing in the way.

First, a cancer diagnosis and subsequent treatment is an all-consuming and complex experience for almost anyone. As young breast cancer patients are often relatively inexperienced users of healthcare services and systems, there is a steep learning curve just in terms of making appointments, getting prior authorizations, and navigating care.

Another complicating layer: young adults are often still pursuing higher education, establishing careers, and raising families at the time of diagnosis. Some have yet to start a family and are forced to consider difficult issues such as fertility preservation due to the side effects of cancer treatment. The emotional, mental, and financial weight of these life decisions must not be discounted.

These challenges aside, finding appropriate clinical trials—or even understanding clinical trial phases—is difficult, even for well-versed health professionals.

Oncology case managers (OCMs), whose critical role as a liaison between patients and providers carries more weight when clinical trials are included in a cancer treatment plan, can help address these issues.

Leveraging oncology case managers in clinical trials

In addition to providing expertise in matching patients to appropriate clinical trial phases, another key role of oncology case managers is determining eligibility. Much of the data generated by clinical trials is dependent on patient compliance and reporting, and an OCM ensures successful outcomes for all involved by vetting patients before recommending them for clinical trials.

For example, as new patients are diagnosed, an OCM completes an initial screening—measuring things like the ability to handle daily living activities, transportation, work, and finances while undergoing treatment—allowing the OCM to assess levels of support and identify areas of need or concern. This data, along with establishing patient and caregiver rapport over time, also helps the OCM determine whether a patient may be a good candidate for radiation treatments versus a drug clinical trial.

As the OCM gets to know the patients on their caseload during the course of cancer treatment, they are better able to assess the patient’s commitment to participating in a clinical trial. "Did the patient show up for treatment regularly? Did the patient cancel appointments often?" By asking these questions and evaluating data, the OCM gains insights into the patient’s motivation and what holds them back. Such insights are highly valuable in mitigating the challenges of clinical trial compliance and completion.

Managing side effects to ensure success

Transportation to and from treatment is one of the biggest barriers to participation and compliance, as clinical trials are not always conducted in the same location as the one where the patient is receiving treatment. Even patients who have access to transportation may find it difficult to drive to a clinical trial center while experiencing side effects from radiation treatments or chemotherapy. Another complicated aspect of clinical trial participation are the unknowns, such as side effects that are not yet established.

Though traditional treatments like radiation or chemotherapy affect every patient differently, decades of data point to common side effects. Some patients may not experience all or any treatment side effects, but they are aware of the possibilities, as countless others who have gone before them have experienced these side effects.

In the case of clinical trials, this volume of data is not yet established. "Can the patient manage the unknowns? Does the patient have enough support?" These are among the questions an OCM asks when working with patients whose treatment plan includes clinical trial participation.

Delivering positive outcomes under difficult circumstances

For the growing number of young adults receiving the difficult diagnosis of invasive breast cancer while launching careers and families, the hope of better treatments leading to a better quality of life and a more positive prognosis is invaluable.

Often it is not a lack of motivation that prevents these young patients from participating in clinical trials, but rather the enormity of the task ahead of them: navigating the all-consuming world of cancer treatment in their 20s or 30s.

Thanks to the critical multidisciplinary work of oncology case managers, there is a greater chance providers, patients, and clinical trial leaders collaborate successfully. OCMs make sure patients feel supported and are given critically needed resources to overcome obstacles during treatment, which enables providers to target cancer treatments and recommend clinical trials.

In a world where young adult cancer cases are ever increasing and prognoses are still rather poor, this successful partnership—and the positive outcomes it produces—are more needed than ever.