Achieving Comprehensive Care in MBC : Pre-test

1.

How confident are you in planning communication strategies and using shared decision-making to optimize patient–physician trust and understand patient goals when selecting metastatic breast cancer (MBC) treatment?

A. Not confident
B. Low confidence
C. Moderate confidence
D. Confident

2.

A 69-year-old woman was recently diagnosed with hormone receptor–positive (HR+)/HER2-negative (HER2-) MBC. Her Eastern Cooperative Oncology Group (ECOG) performance status (PS) is 1. She is symptomatic but fully ambulatory and capable of self-care. She is currently receiving treatment for hypertension, type 2 diabetes which is controlled, atrial fibrillation, hyperlipidemia, and insomnia.

Which of the following assessments would you prioritize as the most important to perform before initiating treatment for this patient to achieve optimal outcomes?

A. Bone health for osteopenia or osteoporosis
B. Concurrent medications/polypharmacy
C. Endocrine tests for A1C, thyroid function, and hyperlipidemia
D. Renal and hepatic function laboratory results

3.

A 66-year-old postmenopausal woman is diagnosed with HR+/HER2- MBC involving the bone and liver; no actionable mutations. Prior history includes: HR+/HER2- stage IIB (T2N1M0) invasive ductal carcinoma for which she underwent lumpectomy and radiation therapy → adjuvant chemotherapy with doxorubicin, cyclophosphamide and paclitaxel (AC-T) → anastrozole x 3 year → progressive disease to MBC. She also has a history of irritable bowel syndrome and epilepsy, for which she has been on phenytoin (300 mg daily) for several years. She is concerned about adverse effects and her quality of life and is started on palbociclib plus fulvestrant. At her 3-month follow-up, a CT scan shows disease progression, and her oncologist is concerned about suboptimal treatment response.

What is the most appropriate multidisciplinary team approach to take to treat the patient’s progressing disease while considering the patient’s preexisting conditions, concurrent medications, and treatment goals?

A. Consult the neurologist to consider alternative seizure medications and assess the need for therapeutic drug monitorin
B. Consult the radiation oncologist, continue current therapy without changes, and reassess treatment approach after the next CT scan
C. Involve the genetic counselor about potential mutations, discontinue palbociclib, and switch treatment to single-agent endocrine therapy
D. Involve the pharmacist and increase the dose of palbociclib to compensate for potential drug–drug interactions

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Practical Guidance for the Care of Patients With HR+/HER2- MBC With Comorbidities

La-Urshalar B. Brock, FNP-BC, CNM, PhD Candidate

Elizabeth Diaz, PA-C

Pretest

Please answer the questions below.

1.

2.

3.