Building a Collaborative Oncology Culture Around First-Line HER2+ GEA treatment Decisions

Gastroesophageal adenocarcinoma (GEA) is a cancer that requires a thoughtful consideration of the patient’s diagnosis, the tumor itself and the patient’s overall health as well as their treatment goals. Patients with HER2-positive GEA, that is advanced or metastatic, benefit from a first-line treatment of their GEA that is determined by a team of various specialists in oncology. The first-line treatment should be based on solid clinical evidence in combination with the patient’s preferences and good collaborative communication among the involved team members.

When choosing to employ chemotherapy, targeted therapy, and/or immunotherapy in the treatment of cancer, many considerations must be considered by the oncology team. There are potential benefits and also possible toxic effects of the treatment as well as the necessary monitoring for certain adverse events. Bringing all aspects of cancer treatment to the table when planning for individual patients can help in choosing the best individualized treatment plan for the patient and their family.

Understanding the Importance of Collaborative Oncology Care

All these healthcare professionals will share information, discuss their clinical observations and jointly make treatment decisions as necessary. Treatment decisions for the individual patient are made by the medical oncologist in consultation with other specialists, including gastroenterologists, surgeons and radiation-oncologists as required.

First, different specialties are involved in gastroesophageal cancer treatment. This is why in addition to the medical oncologists, there are also gastroenterologists, surgeons, radiologists and pathologists involved in the patient’s treatment and care. Nurses and supportive care specialists including dietitians and other specialists also are important members of the cancer patient’s care and treatment.

There are many factors that must be considered by a gastroesophageal cancer team and these can often be best discussed between all team members before a treatment decision is made. A collaborative approach may support consideration of multiple aspects of patient care.

The Role of Biomarker Testing in Treatment Decisions

In terms of specific tumor characteristics for HER2-positive GEA, the HER2 biomarker needs to be tested. HER2, or human epidermal growth factor receptor 2, is a protein active in cell growth. Some gastric and gastroesophageal cancers are classified as HER2-positive because they have an overabundance of this protein. They may be treated with specific HER2-targeted therapies.

When considering other biomarkers, the oncology team consider test results for PD-L1 expression and mismatch repair (MMR)deficiency or microsatellite instability (MSI) as appropriate to the clinical scenario under discussion.

A team of doctors are best placed to consider all of a patient’s circumstances and decide as to what is the best combination of treatments that a patient could receive. This may involve further investigations to clarify a patient’s circumstances.

The pathology report and the recommendations from the oncology team for treatment of the cancer based on biopsy and/or endoscopy should be explained to the patient in understandable terms and he/she should be given the opportunity to ask for clarification of any questions on the report.

Coordinating First-Line Treatment Planning

First-line treatment for advanced or metastatic disease refers to the initial treatment to be given and typically would comprise a combination of HER2-targeted therapy and chemotherapy. On occasion immunotherapy may be considered and several factors including relevant biomarkers and clinical guidelines would influence this decision.

Many factors need to be taken into consideration when choosing a First-Line HER2+ GEA treatment, in addition to the tumor expressing HER2. These would include the extent of the cancer and the patient’s general health and medical problems as well as any treatment preferences the patient may have. The potential benefits and risks of any proposed treatment should also be discussed with the patient.

The patient’s other health problems: these could influence the decision to treat and the choice of treatment and the patient’s potential capacity to complete treatment in good health and the patient’s potential and ability to be treated at home or in hospital. Swallowing difficulties, weight loss, and nutritional problems are also to be considered pre- and during treatment.

The documentation of treatment plans and follow-up of patients within oncology must be organized in a way that ensures all team members are aware of their tasks, of the time frame given to complete these and of the required referrals.

Encouraging Shared Decision-Making with Patients

By acknowledging cancer and its treatment in a collaborative oncology culture, patients will be treated as equal partners in their treatment decisions. That the treatment choices that are recommended by health care professionals will be viewed by the patient in the context of their priorities, of their circumstances, of their concerns and of their preferences.

One patient may place great value on being able to eat, or to continue working or look after family members. Other patients with different circumstances may place greater weight on being able to walk, or to continue to enjoy time with friends and family. Their wishes and concerns should be explored in detail, to help explain the pros and cons of the various treatment options available to them.

Care should be taken to explain the aims and benefits of proposed treatments as well as possible side effects and monitoring needed for the duration of treatment. Patients should also be able to ask for further clarification as necessary of complex terms and results. Family members may be included where appropriate, and this is the patient’s preference. The patient’s preferences, needs and concerns should be considered when treatment decisions are made to ensure that they receive the best care.

Managing Side Effects Through Coordinated Support

Most importantly, cancer treatment has the potential to affect patients’ appetite, their energy levels, the way they digest food and how they feel emotionally. Many chemotherapy drugs cause nausea and/or be very tired-asy. Others can affect blood counts. Certain HER2-targeted medicines require special monitoring of the heart.

ONS care can be given and monitored, and all complications and side effects can be dealt with by the oncology team, and all laboratory results can be analyzed by the treatment team to take appropriate action as necessary.

Dietitians are also available to help look after the nutritional needs of people with cancer and their families. Dedicated teams of oncology nurses are also on hand to offer additional support and to reinforce key points of treatment and management of symptoms. Ensuring supportive care is given as part of cancer treatment and is integrated with cancer-directed treatment is important and can be given on an on-going basis to help deal with any problems that occur.

Strengthening Communication Across the Oncology Team

As already stated, collaboration to achieve good cancer care is achieved by sharing of information, clearly defined roles and holding regular meetings between different disciplines. These meetings should be recorded in medical records.

A further key aspect of communication within the Oncology team is the ongoing evaluation of the progress of the treatment and, where appropriate, consideration of other options, including the issuing of further tests to clarify a change in the condition of the patient, or unusual side effects, etc.

Building a Patient-Centered Oncology Culture

A Patient-Centered Oncology Culture is one that combines Clinical Expertise, Accurate Diagnostic Information and Effective Support with Informed Decisions made with all patients. In this culture all teams of oncology specialists work together to develop the best treatment for each case taking into consideration the Biological Oncology of the tumor as well as the individual needs of each patient.

For patients with HER2-positive GEA cancers, a coordinated patient-centered approach to decision-making about their treatment can help to explain the range of treatments available and ensure that appropriate monitoring and support is in place. Shared decision-making may help inform individualized treatment planning.

Patients and families researching First-Line HER2+ GEA treatment can use these discussions to better understand how collaborative decision-making supports individualized care.

Disclaimer: The information provided in this article is intended for educational purposes only and should not be interpreted as medical advice, a clinical guideline, or a recommendation for any specific treatment.