*Adriana Olivo, NP is a consultant for Biotheranostics, Inc., A Hologic Company. Statements reflect the speakers’ own personal views and interpretations.
[00:00:00]Adam Walker: This podcast is sponsored by Biotheranostics Inc, a Hologic company. The Breast Cancer Index® test is the only test recognized by the NCCN guidelines and the ASCO® Clinical Practice Guideline to predict which patients are likely to benefit from extension of adjuvant anti-estrogen therapy beyond five years.
[00:00:25] From Susan G Komen, this is Real Pink. A podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.
[00:00:39] On today’s episode, we’re discussing a topic that affects most women with hormone receptor positive early-stage breast cancer after they finish their initial treatment and begin navigating survivorship. To lower the risk of recurrence, most women begin taking anti-estrogen therapy, also called hormone therapy or endocrine therapy.
[00:00:59] But these treatments do not come without the risk side effects. When side effects become severe, survivors may be faced with the task of weighing the benefits of hormone therapy against the associated side effects. This can be challenging and may even lead them to wonder how much longer they need to continue the medication.
[00:01:18] Joining us today to discuss how patients and providers can balance fear of recurrence against potential side effects of treatment, and how genomic testing can help guide treatment decisions is nurse practitioner at Memorial Sloan Kettering Cancer Center. Adriana Olivo. Adriana, welcome to the show. Hi, happy to be here.
[00:01:38] I’m so glad to have you. You know we talk about survivorship a decent amount and I think what I’ve learned on the show is that it’s not as easy as I think many of us would think, right? There’s a lot of complexities to it. And so I’m really glad that we’re talking about this today and I appreciate it.
[00:01:56] So so let me just kind of tee up the conversation if you would. I think sometimes when someone’s in active treatment, they’re seeing doctors regularly, they’re used to receiving a constant flow of information and monitoring, and then they get to survivorship, and the appointments become less frequent, and they feel uneasy, and it’s it, and then, we start talking about recurrence, right?
[00:02:19] And so it’s this fear that almost every survivor I speak to has. Can you help us understand the risk of recurrence for women with hormone receptor positive early-stage breast cancer?
[00:02:31]Adriana Olivo: Sure. So I work in survivorship with breast cancer patients, and I think it’s a really interesting and challenging area because, like you said, they’re under this constant care and security blanket if you want to say that way of the medical team and then the baton gets kind of passed to us in survivorship and it’s scary for a lot of patients.
[00:02:52] They don’t feel like they’re under as much of a watchful eye and they may feel like you know they just are in a more vulnerable position. Right. So in survivorship, we really focus on the long game, right? All of the side effects of treatment, but some of these patients are on therapies for up to 10 years.
[00:03:11] So it’s definitely a long process, but going back to your question generally speaking, estrogen positive early-stage breast cancer patients do well. There are variables. It depends on their initial staging, which means the size of the tumor, if any lymph nodes are involved, what kind of treatments they’ve had, if they’ve had surgery, radiation, the type of chemotherapy, if they have chemotherapy.
[00:03:39] There’s many factors involved but generally speaking they do very well on treatment.
[00:03:45]Adam Walker: Oh, that’s good. Okay. And I know that anti-estrogen therapy is used to treat you know, many of these women. Can you explain how and why these therapies are used?
[00:03:55]Adriana Olivo: Sure. So when we look, when they get their initial biopsy or pathology back and they look under the microscope, there’s something called an estrogen receptor.
[00:04:04] And if that estrogen receptor is present, it means that estrogen was fueling the growth of that cancer cell. So for premenopausal women, that’s done by the ovaries. And in postmenopausal women, other cells in the body can make estrogen.
[00:04:27] So the goal of anti-estrogen therapy is to block or reduce the production of estrogen that’s fueling that cancer cell.
[00:04:35]Adam Walker: So essentially it starves the cancer cells so they can’t, you know, grow, multiply, do the things that they do, right?
[00:04:40]Adriana Olivo: Exactly.
[00:04:52]Adriana Olivo: Right. Okay.
[00:05:04]Adam Walker: And what are the typical side effects of these?
[00:05:08]Adriana Olivo: So a lot of the side effects mimic postmenopausal symptoms. So hot flashes, joint pain, hair thinning, vaginal dryness, or painful sex can be a side effect. Bone density changes, decreased bone density. So a lot of postmenopausal side effects that are really hard for patients to tolerate and contribute to quality of life.
[00:05:34]Adam Walker: Yeah, that doesn’t sound enjoyable. You know, none of those side effects sound great. So do you have any tips on how to manage some of those side effects or to improve quality of life? I mean, I know some women are about even bringing up side effects with their care team. So how do you, so what are your tips and how should they address their care team about their concerns?
[00:05:53]Adriana Olivo: So great question. So I like to certainly in my clinic, I like to talk about all of the potential side effects. It’s related to the hormone treatment, hot flashes, vaginal dryness, joint pain. So when the patient comes in, usually I say, what are the side effects that you’re experiencing? How are you tolerating it?
[00:06:12] And if it’s to the point where it’s really affecting their quality of life, we talk about ways to mitigate those side effects. So we don’t want them using any exogenous hormones, because that would defeat the whole purpose of blocking the estrogen.
[00:06:25] And we don’t want to further fuel any potential cells that could be lingering.
[00:06:31] But we do talk about non-hormonal ways to combat hot flashes and vaginal dryness and joint pain. So there are many things on the market we can use. There are also some non-hormonal things that we usually say is our first option. So dressing in layers, avoiding triggers such as maybe spicy food or alcohol using a cold pillow, using a fan, things of that nature.
[00:07:01] But like I said, there are some things that are on the market as well that we say are okay to use. Sometimes people use antidepressants actually can be a useful tool to target hot flashes. So that’s interesting.
[00:07:14]Adam Walker: I would never have thought of that. It’s fascinating.
[00:07:17]Adriana Olivo: Yeah. Yeah. Okay. Added bonus.
[00:07:19]Adam Walker: I like your, I like the, you know, fans and no spicy food.
[00:07:21] Like again, like these are practical tips. They’re great tips.
[00:07:24]Adriana Olivo: Yeah. Yeah. And stresses. I mean, who doesn’t have stress? But like I’ve heard patients like that have to give a big presentation and they’re like, I just feel the heat rising. Yeah. Yeah. It’s really interesting. You know, we talk about acupuncture using pressure points.
[00:07:39] So there’s a lot of things out there. At Memorial Sloan Kettering, we have an integrative medicine team. So they also are a resource for me to draw upon to talk about other ways that we could kind of hone in on combating some of these symptoms.
[00:07:55]Adam Walker: I love that. It’s a, I mean, it sounds like there’s a lot of good options out there, right?
[00:08:00]Adriana Olivo: Yeah. Yeah. Similar for the vaginal dryness. It’s a really big side effect that a lot of these women face and it can lead to other health issues as well. So it’s not the most comfortable conversation. So I always, again I sometimes bring that up because we want, number one, we want the patient to develop a trusting relationship with their provider and I don’t want them to be afraid to tell me symptoms.
[00:08:27] especially symptoms that can really be affecting their quality of life. So again, there are non-hormonal options we talk about and guide them towards. But in this case, there are some vaginal estrogens that we do say are okay to use. Oh, interesting. It’s kind of the last option. And there’s data to support that use in patients taking hormone medication.
[00:08:48]Adam Walker: You know, I love that you’re bringing this up, you know, with your patients. Because I mean, I, you know, I would imagine some of these things are probably uncomfortable to talk about. But I think like what I would say to listeners is that you know, medical professionals, like this is what y’all do.
[00:09:02] Like, yeah you’re great at all this and you’re, you know, you can have these conversations freely and it’s not awkward for you at all. And it doesn’t need to be awkward for the patient either. Right?
[00:09:10]Adriana Olivo: Right, right. And I certainly want them to come to us. And I always say, going back to kind of that fear of recurrence, if something’s not sitting right with you or, you know, you’re losing sleep about it and it’s really driving you crazy, I always say, reach out, please call us because that’s our job is to say, okay.
[00:09:28] I’m not worried about this or I am worried about this and that you need to come in and we need to address this. So I always try to, you know, set that tone from the beginning that we are here for you. We’re here to support you. We’re here to get you through treatment and survivorship is a lifelong process.
[00:09:43] And that fear, I don’t think ever goes away. So he’s lingering in the back of their head. So if it’s, you know, and, but the whole goal is live their life and be happy. And. We try to support that as much as we can.
[00:09:56]Adam Walker: So, yeah, let’s talk more about that because I mean, essentially what we’re talking about, right, is that they’re on these hormone blockers.
[00:10:04] In order to reduce the risk of recurrence, those hormone blockers can have side effects that are problematic to varying degrees to different patients. If the degrees, if the side effects become severe enough, at what point do you start talking about the hormone blockers being a good thing or a bad thing?
[00:10:20] Like, how do they balance the side effects of the treatment to keep away recurrence with the fear of recurrence? Can you talk a little bit about that?
[00:10:28]Adriana Olivo: Sure, so when they’re when a patient is first diagnosed again, based on the tumor staging they might be given options of chemotherapy, surgeries, radiation therapy, and if they are estrogen receptor positive, this option of endocrine therapy and the duration varies from 5 to 10 years.
[00:10:48] So it’s a long trajectory of treatments all designed to reduce that risk of recurrence. So again the endocrine therapy is somewhat of a long game. We want to make sure that we’re catching those late recurrences as well, which is why the duration of therapy for some was changed to up to 10 years, but definitely the goal is to treat the cancer.
[00:11:14] as well as balancing quality of life.
[00:11:17]Adam Walker: Right.
[00:11:17]Adriana Olivo: So it’s, and we make modifications. There are things we can do along the way, such as drawing in some of these resources from our supportive care. Sometimes we have to change therapy and sometimes if it’s really intolerable and the risks are outweighing the benefits, we do discontinue therapy assuming they’ve done at least the five years.
[00:11:40] We try to at least get patients to five years.
[00:11:43]Adam Walker: Yeah, that’s understandable. Now, what kind of tools exist to assess if these therapies are helping to reduce the risk of recurrence?
[00:11:51]Adriana Olivo: So, Breast Cancer Index is a great tool that we could use to help.
[00:12:05] it gives a really nice, precise answer and it’s personalized. It also gives us a risk of recurrence. So it gives us a percentage of what their risk of late recurrence is. So, this is a very helpful tool on my patients, because I have information that I can share to my patient based on their specific pathology
[00:12:34] So it helps make that decision easy.
[00:12:55] That’s great. That’s a great tool that we can use. And same thing if, you know, they’re like, Oh, I don’t know. Should I stay on it? Should I not? And if their pathology is somewhat wishy washy, meaning they have some risk factors, but others, some other good risk factors. And they’re I’ll do whatever you say.
[00:13:13] This is another way to kind of say, all right, well, we’ve analyzed your specific pathology and we came up with this answer and it may push a patient to say, you know what? I can deal with the, I could deal with the joint pain. I could deal with this because I know it’s working for me.
[00:13:28]Adam Walker: Yeah. Well, it takes away the, like a lot of that guessing, right?
[00:13:30] A lot of that guess, guesswork from it. You’ve got something to like base your analysis or your decision making on, which I would imagine is an incredibly valuable tool. So how can results from genomic tests help doctors and patients make treatment decisions? And why is that important?
[00:13:46]Adriana Olivo: So we work collectively with the oncology teams.
[00:13:49] So I always reinforce that we are still part of the team, even though they may not be seeing the physician anymore. We do always reach out to them. And they are still the patient’s oncology team. But we just have taken the, we’ve taken the leadership role, I guess, in their care.
[00:14:08] But these tools are really helpful because they help, again, determine if they are going to be on extended therapy or not. And it, it leads to a conversation of, you know, what is their risk? What, how can we lower that risk? Is medication the answer? Is staying on these medications the answer? If it is, we talk about some supportive measures to get them through.
[00:14:31] Or hopefully, maybe we can spare them some symptoms and get them off treatment if that’s really not what’s driving this cancer.
[00:14:39]Adam Walker: Yeah.
[00:14:40]Adriana Olivo: And we can get them off treatment, which is nice.
[00:14:42]Adam Walker: Yeah, that’s fantastic. Okay. Adriana, this has been fantastic. Last question. Do you have any final advice for patients?
[00:14:49] To help empower survivors to take charge of their health as they navigate survivorship.
[00:14:55]Adriana Olivo: So this is a really great question. So we’re so focused on oncology and breast cancer and you know the risk of it coming back so there is survivorship and we are always here your medical team is always there for you to help, you know lower your risk of cancer recurrence But also, we want to talk about the whole body and wellness.
[00:15:16] So keeping a good exercise routine, a nice diet, heart health is important all of these things. We always say maintain a relationship with your primary care physician to make sure that the whole body is taken care of because it’s not just so much you know, your risk of breast cancer, but there’s so many other things as well.
[00:15:40] So we need to pay attention to all of this. And also to just maintain a relationship. We are here for you. We’re here to support you and get you through treatment. So, you know, just reach out to us. We are a resource for you. Survivorship is lifelong. So.
[00:15:55]Adam Walker: Yeah, yeah, that’s right. Well, it sounds like you’ve got a great team and I really appreciate the work that you’re doing to support people.
[00:16:03] It’s amazing work. Thank you for being on the show today.
[00:16:07]Adriana Olivo: You’re welcome. Thanks for having me.
[00:16:09]Adam Walker: And thank you to Biotheranostics Inc., a Hologic company, for supporting the Real Pink Podcast. Visit breastcancerindex.com to learn how you can find your finish to anti-estrogen therapy with the help of the Breast Cancer Index Test.
[00:16:30] Thanks for listening to Real Pink, a weekly podcast by Susan G. Komen. For more episodes, visit realpink.komen.org, and for more on breast cancer, visit komen.org. Make sure to check out Susan G Komen on social media. I’m your host, Adam. You can find me on Twitter at AJ Walker or my blog, adamjwalker.com.
For Breast Cancer Index Intended Use and Limitations, visit breastcancerindex.com.