“Return to work, for women with metastatic breast cancerit is possible and greatly desired. In fact, the objective of treatment is to improve the survival and quality of life of patients, making it as normal as possible also from a relational point of view. Returning to work has an extremely strong and important psychological impact, and today it is possible thanks to innovative therapies, often oral, to be taken at home, and which allow the tumor disease to become chronic with a significant prolongation of survival and therefore, with evident positive effects also on the patient’s quality of life and well-being”. As Carmelo Bengala, director of Medical Oncology Unit 1, Pisa University Hospitaldescribes the prospect of a complete return to normalityfor a disease that has become treatable with fewer side effects and faster and longer efficacy times.
“The natural history of the disease has changed in recent years – continues Bengala – From literature data we know that, in Italy, 66% of women with breast cancer can be cured: almost 2 out of 3 women. Metastatic breast cancer is a pathology complex, with different biological characteristics in terms of aggressiveness and treatability. There are also forms with widespread involvement of the organs and forms, however, much more frequent, which are limited to the level of individual organs and tissues. Diagnostic and subsequently therapeutic innovation has led to the development of specific drugs for hormone-sensitive tumors, for so-called triple-negative tumors and for tumors that overexpress a protein, Her2, including tumors with low expression of Her2″.
These innovative treatments “allow molecular targeted therapy – specifies the oncologist – with drugs that bind to specific molecules and receptors of breast tumor cells, significantly increasing the therapeutic index, therefore increasing effectiveness and reducing toxicity and with reduction of the risk of disease progression”. In this regard, “another aspect of particular impact is the ability of new treatments to reduce the risk of recurrence even in women who have been diagnosed with the disease at an early stage”. At the last congress of the American Society of Oncology (Asco), “the results of drugs delivered through monoclonal antibodies that recognize the tumor cell receptor, bind to the cell receptor and release the drug were presented. This mechanism of action – he clarifies – has significantly increased the effectiveness by reducing its toxicity, effectively changing the history of the disease. All of this is to the advantage of the patients’ quality of life: being able to make the disease chronic, with the prolonged maintenance of a response to treatment, for years, women, often young, therefore very active, can maintain a life as normal as possible”, including returning to work.
The new therapies pose a new challenge for the oncologist: “being able to convey this awareness to the patient so that it becomes hers too”. We need a change of mentality. Sometimes it is difficult to envisage a “return to work”, but also “a return to a normal diet, without particular restrictions” also thanks to the “reduced side effects of drugs. It’s about trying to make the patient feel less ill than she essentially perceives – underlines the expert – and this passes through communication. Beyond the scientific notions on the effectiveness of drugs, it is important to talk to patients about this aspect relating to well-being, the return to life, relational, emotional and work normality. All this must enter our clinical practice.”
The same recurrence of metastatic breast cancer, “which can occur a few years after surgery in a single, very limited site, or in multiple sites – explains Bengala – with new therapies can be addressed, in both cases, with rapid responses, and therefore a regression of the disease. In the case of skeletal involvement, supportive pain therapy may be necessary, but from the first months of treatment, the woman can resume a normal life, including working life. Of course, possible subsequent evolutions of the disease cannot be avoided, but survival in the absence of disease progression is extremely prolonged, with times more than doubled with the new treatments compared to the old ones. This extra life time is particularly precious because, thanks to the speed of research, it opens up the prospect of the arrival of new therapeutic opportunities.”
Furthermore, research “is important because it gives patients the opportunity, in the case of cancer resistant to therapies, to enter clinical trials and thus already access therapies that are being tested – highlights the expert – Clearly this opportunity only exists in high level specialist centres, in Breast units where there is a management of the multidisciplinary therapeutic path, both for the purely oncological and psychological aspects – it seems like a paradox, but women are sometimes afraid of returning to work – which in ‘be involved in clinical trials and anticipate access to new treatments. We don’t want to give false hopes, there are still side effects, tests to undergo – concludes Bengala – but it is possible to recover a certain normality, especially if the patients are motivated. In this, an important role is reserved for the oncologist, the psycho-oncologist, but also for family members: supporting the woman in her motivation to seek treatment is fundamental.” Further information on the topic is available on the ‘E’ tempo di Vita’ website, etempodivita.it
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