Patient Impact

Patient Impact

By carefully selecting which pharmaceutical clinical trials our BCTU will be involved in and by designing our own Investigator Initiated Studies to investigate the needs and experiences of our own patients seen here at BCRC-WA, we can see the positive impact our research has for patients with breast cancer and their families here in Western Australia. Here are just a few examples of clinical trials that have been conducted which have provided direct benefits for our patients.

Cold Cap Study

One of the most common side effects of certain breast cancer treatments is hair loss (alopecia). This can be very distressing for patients and may lead to negative self-image and feelings of depression or anxiety. A study designed and performed by BCRC-WA recently looked at the use of scalp cooling technology to decrease the likelihood and severity of this very unwelcome side effect. Scalp cooling can alter the growth rate of hair follicles during chemotherapy and lead to a reduction in hair loss. At the time of the study, access to cold cap machines was very limited in WA so the study provided access to technology they would not otherwise have had. The majority of patients involved in the study were satisfied with the use of the technology and were pleased to have been offered an option for treatment of hair loss. The results of our study enabled us to learn what the likelihood of success with use of the cold cap is, based on which specific chemotherapy drugs are administered to women. This now allows us to inform new patients about to start on chemotherapy as to success with the cold cap, so that women can make an informed decision as to whether to use the cap or not.

There are now two scalp cooling machines available for patients of BCRC-WA being treated at Hollywood Private Hospital.

Neratinib

Professor Chan was the lead author and chairperson of the steering committee on a study of neratinib given to patients with early stage, HER2 positive breast cancer after chemotherapy and trastuzumab (Herceptin). The study aimed to show that adding neratinib in this setting would reduce the risk of breast cancer recurring in other parts of the body in the two years following chemotherapy and trastuzumab. More than 40 patients participated in the study at BCTU out of more than 2,800 participants across 495 locations worldwide. The study found that 12 months of neratinib given after chemotherapy and trastuzumab did significantly improve the outcome for these patients. Neratinib is now approved for use in Australia in this setting and this trial led to the drug’s approval in the USA and Europe.

To watch an interview with Prof Chan and patient Shereen Jolly as they discuss the trial, head to 10 News with Professor Arlene Chan and Shereen Jolly on Neratinib.

Epiphora

Epihora, excessive tearing, is a symptom often reported by patients receiving adjuvant chemotherapy particularly with docetaxel. The study, the first to evaluate the incidence of tearing and other eye symptoms in the early breast cancer setting, sought to show whether underlying blockage of the tear ducts (lacrimal duct obstruction) was a major contributor to this side effect. A blockage of the tear duct can be treated by insertion of a stent, a tiny tube, into the lacrimal duct.

The study was conducted by BCRC-WA at two different centres in Australia and employed two different methods to assess for an association between obstruction of the tear duct and excess tearing. Up to 18% of patients had a tear duct obstruction with no symptoms prior to receiving any chemotherapy, however patients developed excess tearing regardless of whether or not they had lacrimal obstruction. The study, therefore, did not support the need for preventative lacrimal stenting prior to commencing on chemotherapy.

Knowing when invasive interventions are not required is of great benefit to our patients.

LABC – A consistent approach to Locally Advanced Breast Cancer

Prior to 2005, there was no standard approach to the clinical management of women with locally advanced breast cancer in WA. Prof Chan collaborated with a multidisciplinary team of surgeons, radiologists, nuclear medicine specialists, radiation oncologists and other medical oncologists to develop and test a uniform approach for these patients. In the study, all patients received the same chemotherapy regimen of docetaxel, doxorubicin and cyclophosphamide. Breast imaging, to determine how much invasive cancer was left after chemotherapy, was performed with MRI and PET. Breast surgery was then followed by radiotherapy according to the protocol. Most patients involved in the study were able to complete the standardised management plan. MRI was shown to be the most accurate method for assessing how much invasive cancer remained after chemotherapy.

This standardised approach became the treatment of choice in Western Australia for treating patients with locally advanced breast cancer and improved outcomes for our patients through optimising multidisciplinary care.

G-CSF Study

To ensure the best outcomes from chemotherapy in the early breast cancer setting, patients should receive at least 85% of the planned dose of chemotherapy. However, one of the most common reasons reported in the medical literature as to why a patient may not receive the optimal dose is the side effect of low neutrophils in the blood; neutropoenia. The management of this side effect includes treatment reduction, treatment delay or minimisation of neutropenia  with the use of G-CSF, a type of drug called a growth factor which increases the number of neutrophils in the blood. G-CSF can be given preventatively for use only with certain chemotherapy regimens known to increase the risk of neutropoenia. If dose reductions and delay are done unnecessarily, this will contribute to some patients not receiving the optimal amount of treatment.

Prof Chan designed this study to show that using G-CSF with other approved chemotherapies in the early breast cancer setting could reduce the risk and severity of neutropoenia, indicating that  patients were more likely to receive the optimal treatment and thus the best long term likelihood of cure.

Between 1999 and 2010, information about the frequency of this side effect was collected on 1655 patients treated with chemotherapy regimens approved for patients with early breast cancer. The patients’ neutrophil levels were tested during the first cycle of treatment which showed the likelihood of severe neutropoenia with ongoing chemotherapy. These patients could then be given G-CSF preventatively for the rest of their chemotherapy, leading to optimal treatment being given and better outcomes overall.