The question is no longer just “surviving”, but how do you want to live?
More and more women recover from breast cancer. This changes the question: not only how to get rid of the cancer, but also what life looks like afterwards. Radiation oncologist and professor Liesbeth Boersma (GROW) has spent decades researching that question. What does her work mean for patients?
Her research centres on one question: how do we tailor treatment to the patient, and how do we make that decision together with the patient? ‘Step 1 is of course “the cancer has to go”, and nowadays that very often succeeds. But after that, you still have a whole life ahead of you: what do you want to keep, and what do you want to keep doing?’
Radiation for those that really need it
Which women benefit from radiation, who can do without it, and who might need a little more? By characterising patients as precisely as possible, treatment can be tailored to their needs.
That is why Boersma investigates options such as radiating less often, with a higher dose per session, and how this affects quality of life. Her research showed, for example, that a high extra to the tumour site gave young women only a little extra protection, but more often led to hardened breast tissue. She is also investigating whether radiation can be omitted when chemotherapy before surgery has already eliminated the entire tumour.
As a result, patients need to visit the hospital less often, experience fewer side effects and enjoy a better quality of life.
The patient is part of the decision
Boersma has developed a decision aid that doctors can use to make decisions about radiation treatment together with their patients. The effect is clear. ‘With the decision aid, more patients decided against radiation. Well-informed patients often choose a less intensive treatment plan.’
Patients have also become more critical. ‘In the past, you would often do what the doctor told you. Now people ask much more: this treatment is better than the other, but how much better? What are downsides or the side effects? This is a good development,’ Boersma says.
The future of treatment
Boersma expects that more women will be able to go without radiation, and doctors will be better able to identify who needs more. The initial results of a European study show that in older women with a low-risk tumour, radiation can lead to a better quality of life than hormone therapy. Insights like these can lead to different choices in the clinic.
The research group would also like to start contributing to new treatments, for example for triple-negative breast cancer, an aggressive subtype. Potentially, one to three high doses of radiation before immunotherapy and surgery could make immunotherapy work better.
She sees plenty of new innovations on the horizon. With extra funding, she would like to study targeted radionuclide therapy: a drug that seeks out tumour cells and delivers radiation to them, wherever they are in the body. “Cells can be resistant to chemotherapy, but not to radiation.” This could help patients where tumour cells remain after chemotherapy.
To make sure innovations like these also reach the patient, Boersma helped develop an implementation protocol. The most important step was to involve all stakeholders from the start from patient associations to doctors. That can sometimes lead to surprises, such as how differently patients and doctors view certain risks. ‘Doctors sometimes consider a ten percent chance of recurrence too high, while patients find it acceptable.’
“You have a lot of choice, if you want it”
Her message to women this month: ‘There are many possibilities. Prepare well for the conversation with your doctor: what matters to me? What do I want to keep: my breast, a full range of movement in my arm?’
‘It is no longer black and white, with a doctor telling you what to do. You have a lot of choice and control, if you want it.’ Those who would rather be less involved can choose that too: the doctor and patient then use targeted questions to find the treatment fits. The point is not that everyone has to make every decision themselves, but that there is room for personal preferences.
Text and photo: Liline Fermin