Expert Strategies for Shared Decision-Making in Prostate Cancer Care

Dr. Nicole Rochester:

So, Dr. Loeb, I’m gonna go back to you. Based on your comparative effectiveness research and active surveillance work, you study what actually matters to patients beyond just the survival numbers. When the quote-unquote best choice isn’t obvious, like choosing between active surveillance versus immediate treatment, how can providers better partner with their patients in making these decisions, and are there any communication strategies that you’ve seen that actually work?

Dr. Stacey Loeb:

Yes, this is a great question, and I loved this paper that was published that said there’s… that there’s more to life than death, so certainly survival is definitely not the only variable to consider, and there are always going to be a substantial number of impacts for quality of life, not only for the patient, but also for their partner and their family members. We’ve done a lot of work looking at the impact of prostate cancer on the quality of life of partners, and that is significant, too. So there’s a lot that goes in there.

In terms of communication strategies, the bedrock for shared decision making is preference elicitation. So it’s very important to ask patients and their families what matters most to you, and to explore these trade-offs with them. For example, maybe somebody prefers shorter survival time in favor of better quality of life, and others may not have that preference, and that can really help to guide what might be the best option for that particular patient and their family.

Dr. Nicole Rochester:

Thank you. Thank you for sharing that. Well, we want to talk about patient education in the context of community oncology, and I’m gonna go to you, Dr. Burnham, for this question.

Your work on HER2 overexpression and genetic variations in prostate cancer is cutting-edge research happening at an academic medical center, but we know the reality is that most prostate cancer care happens in community oncology settings. How do we bridge that gap, and what needs to happen to ensure that innovations like Ancestry-informed biological insights and some of the other amazing things that you’ve been talking about reach the community providers and their patients, particularly in marginalized communities.

Dr. Leanne Woods-Burnham:

So, this is gonna be, like, a personal anecdotal approach, because how I have to do it was… Literally move my family across the country. Because what happened was, when I started this HER2 journey a few years ago, and saw that there was this link between HER2 and West African genetic ancestry, and realizing the implications that that could have on the prostate cancer space and the ability to fast-track potential treatments due to, you know, repurposing of currently FDA-approved drugs, I knew that I wanted to be able to have the biggest impact and collect as much data as I could sooner rather than later.

And so, when the opportunity came for me to relocate to Atlanta, Georgia… Atlanta has the third worst incidence and mortality for Black men with prostate cancer in the nation, so it’s only behind Washington, D.C. and Detroit. And so, coming to Atlanta, I learned the landscape very quickly, because as you pointed out, you know, an academic setting is different than what’s actually reaching the patient, and so… and I work at an academic institution, for sure. So, I was very intentional my first 3 months, really, finding out what the clinical landscape looks like in Atlanta.

And so, was quick to form collaborations with comprehensive cancer centers, with public hospitals in the area, with some FQHCs. And so, as I would talk to them about what we were finding, and we put our heads together in regular meetings, I sort of built this team out that was gonna address this from multiple institutions at one time. Now, is that easy? Absolutely, no way it’s not, in any way, shape, or form, because you have to do all the legal agreements and confidentiality agreements and data transfer agreements and material transfer agreements and all of those things. So, we had to work to get that in place, which can take, you know, several months, even up to a year.

But once that was in place, then we were able to hit the ground running, because one thing… one comment I heard a nurse say at one of the hospitals that I was visiting, and, you know, I don’t want to knock her approach, because I was a new face coming in town to where she was working, but I heard her say, overheard her say, well, who does she think she is, and why can’t she do this over where she’s at? You know? And so that just… what it turned into was a conversation to say, this is what I’m doing. I chose your institution specifically because this is your patient population that can benefit the most. I want these patients to have access to this type of a treatment. They’re not necessarily always offered this type of thing in this certain clinical setting.

And furthermore, I dragged my husband and kids across the country to come here to make this happen, so please, work with me here! So, it ended up, by the end of that conversation, we were besties, and she wanted me to hire her on my team. So it worked itself out, right? But yeah, it takes a lot of networking and work, if you really have that goal of making sure the underserved populations are able to have access to it. I was very intentional in my approach to make that happen.

Dr. Nicole Rochester:

Wow, that’s a great story. Thank you for making it personal, and thank you for your commitment.