Most patients diagnosed with breast cancer have a subtype that is hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-). While this form of breast cancer is generally highly treatable in its earlier stages, some patients will unfortunately develop metastatic disease. However, the treatment landscape for HR+, HER2- metastatic breast cancer has seen significant advancements in recent years, with the introduction of new therapies that improve both quality of life and progression-free survival. These treatment options include endocrine therapies, CDK4/6 inhibitors, and antibody-drug conjugates (ADCs).
As the number of promising treatment options expands, it remains a challenge for community oncology providers to stay abreast of the latest and most effective management strategies for their patients. To address this need, the Association of Cancer Care Centers (ACCC) has launched an educational initiative to equip community oncology providers with up-to-date education and information about evidence-based practices for managing HR+, HER2- metastatic breast cancer.
This program will cover evidence-based treatment options and treatment selection strategies, the management of treatment-related adverse events, and ways to optimize quality of life for patients with HR+, HER2- metastatic breast cancer. Earn up to 1.5 CE/CME hours.
This project is supported by AstraZeneca
In 2023, ACCC launched a reassessment survey to reevaluate the current landscape of BRCA mutation testing for patients with breast cancer, assess the status of barriers and challenges experienced by cancer care teams, and assess what improvements have been made and their impact on treatment strategies, testing, and referrals. The goal of this initiative is to improve access to BRCA mutation testing for patients with breast cancer. Building on the 2018 initial BRCA Testing survey and the 2020 Quality Improvement interventions, this project aims to:
ACCC sought to evaluate a quality improvement initiative completed at 15 sites across the United States. The initiative aimed to increase rates of germline BRCA1/2 testing for patients diagnosed with early stage or metastatic breast cancer. This summary provides findings from the initial study conducted in 2018 and tracks how and which results changed after implementation of the quality improvement initiative, which was evaluated with a follow-up survey completed in 2023.
Through this project, ACCC seeks to enhance genetic counseling and testing access, ultimately improving treatment outcomes and patient engagement. By understanding and addressing the current barriers and challenges, we can work towards better breast cancer care and outcomes for all patients.
This educational activity is supported by an educational grant from AstraZeneca Pharmaceuticals
HR+ HER2- breast cancer is the most common subtype of breast cancer, accounting for about 70 percent of breast cancer cases.1,2 An HR+, HER2- diagnosis can require a complex treatment regimen tailored to an individual patient, that may include hormone therapy, chemotherapy, or a combination of these.3
The complex and evolving treatment landscape for locally advanced or metastatic HR+, HER2-breast cancer poses a challenge to community oncologists, who are tasked with ensuring the tolerability and adherence of patients to their treatment regimens. Difficult dosing schedules and side effect profiles of oral anti-cancer therapies require working knowledge of a rapidly growing body of medical literature.
As oral anticancer medications become a common treatment option, patient adherence to medication is essential to ensuring positive clinical outcomes. ACCC developed the “Addressing Challenges in Oral Therapies for HR+, HER- Breast Cancer,” to identify challenges with oral anti-cancer therapies and provide methods to better support patients.
African Americans are disproportionately affected by the prevalence and severity of breast cancer and consistently exhibit poorer health outcomes. For example, African American women have a higher risk of developing triple negative breast cancer (TNBC)—which represents approximately 15% to 20% of all breast cancer cases—than any other racial or ethnic group. A 2021 publication from the Tigerlily Foundation found that 53% cases of TNBC are diagnosed in African American women under age 50, compared to 16% of White women.
People with TNBC have worse prognoses than those with other breast cancer subtypes. They also have a shorter time to relapse after standard chemotherapy, a higher frequency of metastases to the lung, liver, and brain, and an overall lower survival rate. A 2020 study found non-biologic contributing factors to poorer outcomes for TNBC, such as poverty, social stress, unsafe neighborhoods, and lack of healthcare access. These factors have been demonstrated to negatively affect the stage of diagnosis and length of survival for patients with TNBC.
To effectively manage TNBC, the patient must receive regular care, follow strict adherence to treatment regimens, and identify and seek support of any side effects. Although patient self-empowerment is imperative for increasing medication adherence and side effect management, it remains difficult to address in underserved populations.
ACCC is partnering with the Tigerlily Foundation to capture patient and provider perspectives on the specific challenges and barriers they encounter regarding the diagnosis and treatment of TNBC. Experts on care disparities will collect and analyze these perspectives to guide the development of specific interventions to eliminate identified knowledge and practice gaps.
As part of this initiative, we will develop a patient-provider care sequence plan that will map the entire cancer care journey, from diagnosis through treatment to survivorship care. The utility and feasibility of these plans will be assessed by implementing them at two ACCC member cancer programs. These patient-centric interventions will target the entire multidisciplinary cancer care team, as well as patients and their caregivers.
Overexpression or amplification of the human epidermal growth factor receptor 2 (HER2) is present in approximately 15 percent to 20 percent of patients with metastatic breast cancer. First-line therapy with anti-HER2 targeted agents have significantly improved outcomes for patients with HER2-positive breast cancer. Nevertheless, most of these patients eventually relapse.
Novel therapies have recently become available for patients who continue to progress following first and second-line anti-HER2 targeted therapies. As the number of these therapies increases, so too does the challenge for providers to keep current on the latest clinical advances.
While anti-HER2 targeted agents have improved outcomes, they also require providers to closely monitor and manage potential treatment-related adverse events. Because many practitioners treat a wide range of tumor types; they often find it challenging to stay up to date with recent safety and efficacy data for targeted therapies. In previous ACCC educational programs, community oncology practitioners have said that keeping current with clinical advances is a primary barrier to implementing best practices in managing patients being treated by targeted therapies.
This project enabled a series of meaningful small-group interactions among clinicians involved in the care of breast cancer patients that —through a variety of collaborative educational experiences—helped them optimally manage patients with HER2-positive breast cancer who have received prior anti-HER2 targeted therapies.
ACCC is partnering with AXIS Medical Education in an educational research project to assess the value of a robust, independent, quality-focused educational intervention that aims to improve quality measures related to management of patients with HER2+ breast cancer (all stages). The online educational interventions offered will include clinical updates, case application, and quality processes.
The project will run approximately 12-18 months. Two ACCC Member programs have been selected to participate in baseline data collection, a practice survey, a live focus group, a series of online educational interventions, and post-intervention data collection. The project team will work closely with the participating programs to ensure a smooth and successful experience.
The Lefcourt Family Cancer Treatment & Wellness Center at Englewood Hospital and Medical Center
Englewood, NJ
Research Coordinator: Christina Cancel
UNC REX Cancer Care
UNC REX Hospital
Raleigh, NC
Research Coordinator: Cynthia Jones, BSHA, CPHQ
Funding & support provided by Genentech
Quality Improvement in Breast Cancer Through BRCA Testing
In a recent ACCC survey of community oncology practitioners, more than 80 percent of respondents reported that 50 percent or fewer of their patients with early or metastatic breast cancer have ever had germline BRCA mutation testing. The survey revealed both patient- and provider-related barriers to BRCA testing, including institutional barriers.
To support quality improvement (QI) projects in breast cancer, ACCC has partnered with Pfizer Global Medical Grants to award more than $1.8 million in funding to 15 projects that are aimed at improving the quality of breast cancer patient care. The projects will focus on conducting quality improvement initiatives that support increasing the rates of BRCA testing for patients with early stage or metastatic breast cancer.
he grant awards are providing an opportunity for community oncology programs to implement initiatives that will address barriers to counseling and testing. The grantees will utilize innovative approaches to extend best practices to a much larger patient population, including underserved minority patient groups. As part of the initiatives, sites will review their progress and evaluate how changes in testing practices impact treatment decision-making.
The following organizations were selected to participate:
Supported by a grant from Pfizer, Inc.
For more information on any of these projects, please contact the ACCC Provider Education department.