It’s October, the month of apples, pumpkins, and pink — as in the coloUr of Breast Cancer Awareness Month. While you will see everything under the sun adorned in pink, and you'll hear a lot about prevention and screening, what you may not come across are the everyday struggles of women with breast cancer. While the field of breast cancer is incredibly hopeful right now (more than 90% of women who get diagnosed survive), women continue to toil through difficult treatments, struggling for their lives and hoping for a cure.
As a breast medical oncologist, I do my best to answer the tough questions my patients ask me, questions like how much closer we are to less toxic treatments and when we will find a cure. There isn’t a day that goes by that I don’t wish I were out of a job because we found the answer to both of those questions.
So how will we get there?
Every major advance in cancer treatment has come from clinical trials, yet only 3 to 5% of cancer patients are enrolled in these trials. Clinical trials offer patients the chance to receive effective new therapies that might not be on the market for years to come.
So why are so few people enrolled in trials that could be offering groundbreaking treatment? For starters, many don’t understand what a clinical trial is. It can be very confusing. There are different types of trials, and trials often involve more than one type of therapy – usually one group of patients receives a newer therapy or test while the other group receives the standard option. Many patients are understandably afraid of unknown side effects, potential costs, and inconveniences, or they may be worried that they will be used as a “guinea pig.” A 2016 survey conducted on behalf of my colleagues at Memorial Sloan Kettering (MSK) found that only 40% of Americans had a positive impression of clinical trials and only 35% were likely to enrol.
While patients’ concerns about clinical trials are understandable, it is critical that we in the cancer community address the negative perceptions. Fortunately, what we’ve learned is that we can do that effectively through education. Providing education about clinical trials can make a measurable difference. In the MSK survey, the number of respondents who had a positive impression of these studies jumped significantly, from 40 to 60 percent, after reading a brief statement that defined what a clinical trial is. But it’s not just information that can help patients become more comfortable with clinical trials; the doctor-patient relationship is also key. Doctors usually tell people looking for trials to go to Clinicaltrials.gov, a national registry that can be hard to navigate. But we can do more than direct them to a database. At Memorial Sloan Kettering, we have teams of experts that guide patients through their journey. More accessible websites, like SurvivorNet provide patients with important questions to ask doctors about clinical trials and cancer treatment in general.
Another misconception is that many patients (and doctors) think a clinical trial is only a last resort option. To the contrary, at major academic centres like Memorial Sloan Kettering, there are clinical trials for every stage of disease. Patients who choose to participate in a trial receive the most advanced cancer treatment available.
So how do patients join a clinical trial? First, they need to be “eligible.” This means that the patient’s diagnosis is appropriate for the clinical trial. Patients might also need additional tests to determine whether they are eligible. The patient’s doctor will explain what the potential benefits and risks of the trial are so they can make an informed decision. Together, the doctor and patient will then sign an agreement called an informed consent that reviews the reasoning for the trial and what the patient can expect.
Research is the only thing that will lead us to a cure. Everyone with cancer should feel empowered to ask their doctor about available clinical trials and to consider getting second opinions so that they can review all their potential treatment options. For breast cancer patients, awareness isn’t solely about the month of October — it’s about each and every day of their lives.