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Breast Cancer Awareness Q&A with Therapeutic Radiologist, Christin Knowlton, MD

October 15, 2021

As we honor Breast Cancer Awareness month, what do you want our patients and families to pause and remember?

As we honor Breast Cancer Awareness month, I would encourage our patients and families as well as all of us at Smilow Cancer Hospital to pause and remember that each person's breast cancer experience is unique and meaningful. Please speak up to your treatment team regarding your questions, concerns, recommendations, and positive feedback, whether you are newly diagnosed or in long-term follow-up. As oncology health care providers, we learn from our interactions with each patient and family member. We are a team, and the patient and family members are the most valuable members.

How do you collaborate with the Breast Cancer team at Smilow Cancer Hospital to care for your patients?

Oncology care requires strong collaboration between various specialties: surgical oncology, medical oncology, radiation oncology, diagnostic radiology, pathology, genetics, social work, nutrition, physical therapy, and others. Open and frequent communication between health care providers from the various specialties is a key component of high-quality patient care. We work together and communicate by sending notes and messages to each other through the medical record, through phone and video conversations, and during multiple disciplinary tumor boards and meetings during which patient cases are discussed in detail with all major specialties in attendance. This collaboration ensures that the members of the treatment team fully understand the details of each case so that we can provide the most up-to-date and seamless care for the patient.

What advances have made the biggest impact in the treatment of patients with breast cancer over the last 5 years?

Over the last 5-10 years, there has been an emphasis on de-escalation of treatment for breast cancer while preserving or even improving outcomes. For example, in my field of radiation oncology, there has been an emphasis on shortening the treatment course from the traditional 5-6 weeks of treatment to 3-4 weeks and even just 5 treatments for appropriate patients. These shorter courses are associated with less side effects and interfere less with the patient's work and personal life. Another major advance has been the increase in the percentage of patients who are eligible for sentinel lymph node biopsy, which is a targeted sampling of the lymph nodes in the axilla, as opposed to a full axillary dissection. A full axillary dissection is associated with a higher risk of lymphedema (swelling of the arm). For patients who do undergo axillary dissection, Smilow Cancer Hospital offers comprehensive physical therapy and occupational therapy services for patients. The modern PT/OT approaches to lymphedema can be very successful in minimizing symptoms from lymphedema.

Clinical trials are often the best option for therapy, how do you explain this to patients who may be hesitant?

Clinical trials are certainly important in cancer care as they provide information to help us to learn and improve care for patients. They can also be a vehicle to provide modern treatment that may not be available off-trial. While clinical trial participation is encouraged, it is the patient's choice to participate or not. It is important to provide information to the patient regarding the potential benefits and risks of trial participation as well as what other treatment options are available. If patients are hesitant or undecided, it is important to make time to answer their questions. I also remind patients that they have the right to change their mind and that their treatment team is here to provide guidance and support.

What support can we offer our patients?

The number one way that oncology providers can support patients is by providing an atmosphere that encourages patients to ask questions and to discuss what challenges they are facing. One often hears about how important it is to listen to our patients. A key component of that is providing the patient with opportunities to express themselves in an open, non-rushed environment.

Submitted by Eliza Folsom on October 15, 2021