Don Dizon, M.D., F.A.C.P.
My motivations for this line of research are embedded in both my professional practice as an oncology provider for women with cancer and as a friend for women with metastatic breast cancer. I have written extensively about my experiences in my column for the American Society of Clinical Oncology and I point you to some of my writing that illustrates why this line of research is so important.
Current standards of care in the US include recommendations for health maintenance to reduce the risks of any one person from being diagnosed or suffering complications of a common disease. These recommendations serve as the groundwork for the prevention of disease and call for the administration of a specific therapy to prevent the disease itself (primary prevention, eg: vaccines versus infectious diseases) or screening to detect disease at its earliest point (secondary prevention, eg: cholesterol screening for minimizing heart disease risk). These prevention measures are most appropriate for patients who are otherwise well and who stand to benefit from prevention, in terms of maintenance of current quality of life, productivity, and well-being. Whether there is a benefit to health maintenance procedures for patients living with advanced or metastatic cancer is not known. As a result, providers and patients are at a loss on how to make decisions about whether detecting other medical conditions results in more harms (physically and emotionally) or benefits.
There is only limited data to inform the role of health care prevention and the utilization of screening evaluations in patients living with cancer as a chronic disease.
This project will help establish a line of research for patients living with advanced cancer. The first part of this project aims to determine the utilization of screening in women living with advanced or metastatic breast or ovarian cancers, including surveillance for cardiac health (aspirin for primary prevention, screening for dyslipidemia), and cancer screening (mammography, colonoscopy, and pap smears). We will utilize the MGH Institutional Database to answer our questions.
There are two objectives in this project which will concentrate on women living with advanced or metastatic breast or ovarian cancer:
- To describe how preventative methods are being utilized as it relates to cardiovascular (aspirin for primary prevention and screening for dyslipidemia) and cancer screening (specifically utilization of mammography, colonoscopy, and pap smears).
- To determine if there is a subgroup that may be most likely to benefit from screening for other conditions and those in whom screening is not likely to be of any benefit
We hope to provide more data to help both patients and their doctors make shared and informed decisions about whether to proceed with screening of other medical conditions while keeping in mind their diagnosis of advanced cancer.
Why is this important?
This project will hopefully inform the rationale use of screening methods in patients living with cancer. In the era of biologic and targeted therapies, the life expectancy of patients has increased, yet much of our data is drawn from patients with advanced illness utilizing data from the Surveillance, Epidemiology, and End-Results (SEER) system, which restricts patients to age 65 years or older. There are many physical, emotional, and ongoing medical needs that these patients are already living with, on the basis of their cancer diagnosis, which for most patients cannot be cured with standard of care. Despite this, patients and their providers are still unsure about the role of screening for other medical conditions. This may be a source of unnecessary anxiety for patients but also may represent a source of medical over-utilization. However, in the absence of any data there is no guidance that either patients or their clinicians can access.
Who will benefit?
This project will evaluate women living with advanced breast or ovarian cancers. It is my hope to ask and answer those questions that these patients find both most informative and relevant.