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Neoadjuvant Patient Decision Aid

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Neoadjuvant Patient Decision Aid NEOADJUVANT PATIENT DECISION AID A GUIDE FOR WOMEN WHO ARE CONSIDERING BREAST CANCER TREATMENT WITH CHEMOTHERAPY AND/OR HORMONAL THERAPY BEFORE SURGERY CONTENTS Introduction 1 What type of breast cancer do I have? 2 What treatments might be given for my breast cancer? 3 Surgery 3 Radiotherapy 3 Chemotherapy 3 Targeted therapy 3 Hormonal therapy 3 How soon do I need to have treatment? 4 What are my options for the timing of chemotherapy and surgery? 4 Why might I choose to have treatment before surgery? 5 Reducing the size of the tumour so you can have 6 breast conserving surgery rather than a mastectomy Reducing the size of the cancer to make surgery 7 easier so that less breast tissue needs to be removed Reducing the number of lymph nodes that need to be removed 7 Planning surgery 7 Taking part in a breast cancer clinical trial 7 Observing the effect of the chemotherapy 9 Chances of the tumour disappearing completely 12 Prognosis (How likely is the cancer to return?) 13 Treatment options after surgery 13 Some other issues with having chemotherapy before surgery 15 What if I can’t have surgery? 16 The pros and cons of adjuvant therapy (surgery first) 18 Advantages of surgery first 18 Disadvantages of surgery first 18 Arriving at a treatment decision 21 Worksheet 22 What happens now? 23 Glossary 24 Further information and support 25 Notes 26 INTRODUCTION Over the years the treatments available to As well as using this decision aid, you might women diagnosed with breast cancer have like to talk to your doctor(s), family and friends improved significantly. More treatment options and read other information that you may have. are available to help cure more women of You may find additional paper and online their cancer, or to keep women alive and well resources to be valuable. A resource list is for longer. Treatment has also become more available at the end of this booklet along with complicated, may be offered at different times space for you to make notes. These resources and may continue for many months. Whenever will give you extra information about breast possible, your treatment will be planned to best cancer that you may find useful to help your fit your personal situation and preference. Your decision about whether to have systemic treatment team is here to help you through this therapy before or after surgery. difficult time and to answer questions that you may have. This booklet is designed to help with some of those questions. In certain situations, doctors may offer This decision aid booklet treatment with chemotherapy or hormonal (systemic) therapy before surgery. You have is for women who have been given this booklet, called a ‘Decision Aid’, recently been diagnosed because your doctor thinks that this option may be suitable for you. with breast cancer, for The purpose of this decision aid is to whom chemotherapy or help women to choose whether to have chemotherapy or hormonal therapy before hormonal therapy before surgery (neoadjuvant) or after surgery surgery (neoadjuvant (adjuvant). After reading the information, you may wish to weigh up reasons for and against therapy) might be a having neoadjuvant therapy using this decision aid. You can then discuss your thoughts with treatment option. your doctor and make a decision. 1 WHAT TYPE OF BREAST CANCER DO I HAVE? There are several different types of breast Women with any of these types of cancer cancer. It is important to know which type you may be offered chemotherapy, surgery and have when thinking about the pros and cons of radiotherapy. If you have hormone receptor treatment prior to surgery. Your doctor will be positive breast cancer, you may also be able to give you information about your type offered hormone blocking medication such of breast cancer. There is also an explanation as tamoxifen, anastrozole (Arimidex®) or in the glossary on page 18. You may wish to letrozole (Femara®). Similarly, if you have mark which type you have, as a reminder (just HER2 positive breast cancer, you may tick the box that describes your cancer). be offered drugs such as trastuzumab (Herceptin®), neratinib and pertuzumab. If a The main types of breast cancer are: clinical trial is an option for you, other types of Hormone receptor (oestrogen and/or medications might also be used. progesterone positive: ER+/PR+), HER2 Treatment options may also depend on other negative (HER2-) factors, including the grade of the tumour (how Hormone receptor (oestrogen and/or much tumour cells look like normal cells), stage progesterone positive: ER+/PR+), HER2 of the tumour (describes the size and location positive (HER2+) of cancer), and whether there are cancer cells in the lymph nodes under your arm. Hormone receptor (oestrogen and progesterone negative: ER-/PR-), HER2 positive (HER2+) Hormone receptor (oestrogen and progesterone negative: ER-/PR-), HER2 negative (HER2-) (triple negative) You can make notes about the important features of your cancer here: 2 WHAT TREATMENTS MIGHT BE GIVEN FOR MY BREAST CANCER? Your doctors and nurses will explain the breast cancer, it is usually given intravenously details about the exact treatments that you (though a drip or injection into the vein) every could receive. There are two main types of 1-3 weeks, for a total of 12-24 weeks. There breast cancer treatment: Local and Systemic. are many different types of chemotherapy, and your doctor will be able to describe the LOCAL TREATMENTS: Treat cancer cells in risks and benefits of the treatments that are the breast area only most suitable for you. SURGERY TARGETED THERAPY Surgery involves removing any visible Targeted therapy, such as trastuzumab cancer. The whole breast can be removed (a ® mastectomy) or just the cancer and the area (Herceptin ), is given to women with around it (a lumpectomy, or breast conserving HER2 positive breast cancer. This type of surgery). You would also have surgery to check treatment works by targeting the HER2 whether the lymph nodes (glands) in your armpit receptors on tumour cells, stopping the have any cancer in them. This may be done as cells from dividing and growing. They are a sentinel node biopsy at the same time as your usually given intravenously (through an IV breast operation. If there is cancer in the lymph drip) once every three weeks for a year in node(s) that were removed, you may also have total, including any trastuzumab that you an operation to remove some more lymph might receive before surgery. Other nodes from under the arm (axillary dissection). HER2-targeted drugs may also be used, If the lymph nodes appear to be involved before depending on the circumstances. surgery, an axillary dissection may be done at the time of the initial breast surgery. Sometimes a second operation is needed because some HORMONAL THERAPY cancer has been left behind in the breast. Hormonal (endocrine) therapy is a tablet that Having chemotherapy before surgery does not is taken every day, for women with oestrogen make this more or less likely to occur. (ER) and/or progesterone (PR) receptor positive breast cancer. For premenopausal RADIOTHERAPY women, a medication such as goserelin If you have breast conserving surgery, then (Zoladex) may be used to stop the ovaries you are likely to be offered radiotherapy. You from making oestrogen, or they may be may also be offered radiotherapy after a removed surgically. Hormonal therapy works mastectomy, depending on the size of the by interfering with the signal that oestrogen cancer, whether any lymph nodes are involved, sends to cause this type of breast cancer to or other factors that your doctors think are grow. Hormonal treatments are usually given important. Radiotherapy kills cancer cells in the for 5 years or longer. area it is aimed at and is similar to the rays that are used when you have a chest X-ray. Why might it be necessary to have chemotherapy or hormonal therapy? SYSTEMIC TREATMENTS: Using drugs that Chemotherapy and hormonal therapy are can reach all parts of the body given to some women with early breast cancer, to reduce the chance that the cancer CHEMOTHERAPY will return in the future. Chemotherapy is a medicine that is given to kill cancer cells throughout the body. For 3 HOW SOON DO I NEED TO HAVE TREATMENT? You might think that treatment for breast you. After you have made a decision, surgery cancer needs to start within a very short or chemotherapy may take days to a couple time. However, research has shown that of weeks to commence, depending on local most breast cancers take several years scheduling at the hospital where you are to grow to a size that can be seen on a planning to have treatment. Again, there is no mammogram. So most of the time there is evidence to suggest that waiting those few no harm in taking one or two weeks to make weeks makes any difference to the success of a decision about which treatment is right for your treatment. WHAT ARE MY OPTIONS FOR THE TIMING OF CHEMOTHERAPY AND SURGERY? Neoadjuvant: This means you will start with therapy or receive treatment for a longer time, chemotherapy, targeted therapy or hormonal just that the timing is different. therapy, and then have surgery, usually after several months of treatment. Hormonal Adjuvant: This means you will have surgery therapy or targeted therapy (such as first. You will then be offered further therapy trastuzumab) may also continue after surgery. that may include chemotherapy, targeted You may also need radiotherapy, which is therapy, hormonal therapy and radiotherapy usually given after surgery. This option does depending on the stage and type of cancer not usually mean that you will receive more you have.
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