New Global Survey Highlights Deep Psychological Impact of Breast Cancer Recurrence on Both Patients and Physicians

New Global Survey Highlights Deep Psychological Impact of Breast Cancer Recurrence on Both Patients and Physicians

September 24, 2007

- Data Highlight the Need for More Positive Conversations
Through Better Communication, Training and Use of Effective
Treatments -

    BARCELONA, Spain, Sept. 23 /Xinhua-PRNewswire/ -- A
devastating moment for a woman undergoing treatment for
early breast cancer is to hear from her physician that,
despite their best efforts, the disease has returned and
she is no longer curable. Presented for the first time
today at the European Cancer Conference (ECCO), an
international survey of over 1,000 physicians and patients
showed that physicians are also deeply affected by these
negative conversations. A significant number of physicians
stated the worst part of their job was informing a woman
about recurrence, and that distressing thoughts and
feelings remained with them after leaving the clinic or
surgery. Recent studies show that oncologists are already
affected by increasing professional pressures leading to
stress, depression, burn-out and even suicidal
thoughts(2-4), which may detrimentally impact on
relationships with patients and, ultimately, on patient
care. Therefore, there is a need to help physicians to have
more positive conversations. 

    The survey, conducted among 462 physicians(a) and 600
patients(b) from Europe and the United States, found that,
of the physicians surveyed:(1)

    -- 41.8% felt that telling a woman her breast cancer
has recurred to be 
       the worst part of their job
    -- 72.0% thought that telling a patient she has early
breast cancer was 
       easier than telling her she has a recurrence of the
disease
    -- 33.0% take worries about patients who have recurred
home with them
    -- 69.4% worry about whether they are giving the best
treatment to their 
       patients.

    The majority of physicians have a strong bond with
their patients, with 89% feeling a great sense of
satisfaction when their patients are confident in their
treatment and believe in life beyond breast cancer. (1) A
further 62% stated that telling a patient she remains free
of distant recurrence is the best part of their job.(1) The
issues identified in this survey therefore need to be
recognised and physicians need support and help with
difficult consultations. Providing access to more
efficacious treatments may lead to more positive outcomes
for women with early breast cancer and, consequently, more
positive conversations.

    "What this survey shows is that, whilst the
well-being of patients is always our first priority, there
is a significant need to support the physicians themselves
who regularly have to deliver bad, sad or difficult news,
for example, about a breast cancer recurrence," stated
Professor Lesley Fallowfield, co-author of the survey.
"Recurrence is devastating for the patient so doctors
must have access to better treatments. This will in turn
reduce the frequency of negative conversations. However, we
do need to equip doctors with appropriate communication
techniques to help minimise the burden on both patient and
doctor when sad, bad and difficult conversations must take
place," she concluded. 

    During the conference, Professor Fallowfield suggested
that to move towards more positive conversations,
physicians needed to be supported in number of key areas,
including:  
   
    -- Access to appropriate treatment choices supported by
greater clinical 
       trial data and personal experience
    -- Provision of better and earlier training on the
importance of good 
       communication
    -- Optimisation of proven communication strategies and
techniques
    -- Stronger peer-to-peer support networks

    "Informing a postmenopausal woman with hormone
receptor-positive breast cancer that her disease has
returned is awful; the news is usually unexpected.
Personally, I find this 'moment of truth' emotionally
draining and it worries me to think about the impact the
difficult aspects of my job might be having on my emotional
well-being and my ability to deliver for my patients,"
recalled Dr Mark Lansdown, Consultant Surgeon, Leeds
Teaching Hospitals NHS Trust, England. "For me,
preventing recurrence in the first place is vital in
resolving this issue. The good news is that there are newer
treatments available that reduce the number of recurrences,
allowing physicians to have more positive conversations
with our patients."

    Physicians surveyed also want mature and convincing
data to give them the confidence they need to ensure that
their patients can have the best outcomes:

    -- 90% of physicians citied clinical trial data as
being crucial in 
       building trust in treatment decisions
    -- 72.4% believed prescribing treatments that minimise
the incidence of 
       recurrence allows them to have more positive
conversations.
 
    Data from the ground-breaking
ARIMIDEX(TM)(anastrazole), Tamoxifen, Alone or in
Combination (ATAC) trial, which has a median of 68 months
of follow-up, demonstrated that women treated with ARIMIDEX
experience 26% fewer recurrences compared with those treated
with tamoxifen.(5) This compelling, mature data has led to
ARIMIDEX replacing tamoxifen as the Gold Standard treatment
in a number of countries for post-menopausal hormone
receptor-positive early breast cancer. As a consequence,
not only are patients more likely to remain recurrence
free, but those physicians who stated that the worst part
of their job was informing women of a recurrence are likely
to have more positive conversations with their patients.
Physicians would, therefore, be relieved of some of the
intense psychological and emotional burdens that can have a
negative effect on their professional and personal lives.

    "Data, such as those from the ATAC trial, show
that we can improve patient outcomes, meaning fewer women
have to hear that their early breast cancer has
returned," commented Dr Lee Martin, University
Hospital Aintree, Liverpool, England. "And if we as
physicians can have more positive conversations with our
patients, the burden on us reduces, allowing us to focus on
the most important point of all, doing the very best for
those women in our care."

    References

    (1). Data presented at the European Cancer Conference
(ECCO). AstraZeneca 
         Satellite Symposium, Breast Cancer Treatment
Strategies: Clinical 
         decisions and Positive Conversations, Sunday 23
September, 17.00-
         19.00 CET.
    (2). Burman et al. Occupational stress in palliative
medicine, medical 
         oncology and clinical oncology specialist
registrars. Clin Med 
         2007;7:235-42.
    (3). Shanafelt T. Finding meaning, balance, and
personal satisfaction in 
         the practice of oncology. J Support Oncol.
2005;3:157-164
    (4). Whippen DA, et al. Burnout in the practice of
oncology: Results of a 
         follow-up survey. Journal of Clinical Oncology,
2004 ASCO Annual 
         Meeting Proceedings (Post-Meeting Edition). Vol
22, No 14S (July 15 
         Supplement), 2004: 6053.
    (5). ATAC Trialists' Group. Results of the ATAC
(ARIMIDEX, Tamoxifen, 
         Alone or in Combination) trial after completion of
five years' 
         adjuvant treatment for breast cancer. Lancet 2005,
365 (9453):60-62.

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    Notes to Editors

    (a) Physicians: medical oncologists, gynaecologists and
breast cancer 
        surgeons.
    (b) Patients: postmenopausal women diagnosed with early
breast cancer in 
        the past five years and who had undergone breast
cancer surgery.

    'More Positive Conversations' Survey

    The 'More Positive Conversations' survey was conducted
online and via telephone interviews by Harris Interactive
on behalf of AstraZeneca. The objectives of the survey,
involving 1,062 physicians and patients from France,
Germany, Italy, the United Kingdom and the United States,
were:
 
    -- To evaluate the concept of trust between patient and
physician and the 
       extent to which it factors into treatment decisions,
compliance and 
       intrinsic benefits such as physician job
satisfaction 
    -- To quantify the degree to which, and in what
situations physicians are 
       apprehensive in communicating with patients with
early breast cancer 
       and how it affects physicians' views of their work
    -- To measure patient and physician satisfaction with
treatments and 
       understand the role of the relationship between the
patient and the 
       physician in making treatment decisions 
    -- To understand the degree to which time limitations
are present in 
       patient consultations and how this affects the
perceived quality of 
       the visit 

    AstraZeneca

    AstraZeneca is a major international healthcare
business engaged in the research, development, manufacture
and marketing of prescription pharmaceuticals and the
supply of healthcare services. It is one of the world's
leading pharmaceutical companies with healthcare sales of
$26.47 billion and leading positions in sales of
gastrointestinal, cardiovascular, neuroscience,
respiratory, oncology and infection products. AstraZeneca
is listed in the Dow Jones Sustainability Index (Global) as
well as the FTSE4 Good Index. 

    ARIMIDEX is a trademark, the property of the
AstraZeneca group of companies.


    



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