For patients with breast cancer, the approach to treatment requires an individualized approach accounting for factors such as genetic risk, symptom management, and more recently, the challenges of the COVID-19 pandemic. In this interview, Dr. Valerie Brutus, a breast surgical oncologist at St. Vincent's Medical Center of Hartford HealthCare, discusses strategies for successfully incorporating each of these factors into patients' treatment.
Oncology Data Advisor: Welcome to Oncology Data Advisor. Today I'm here with Dr. Valerie Brutus.
Valerie Brutus, MD, FACS: Hi, thank you so much for having me. It's my pleasure to be here. I can talk a little bit about myself. My name is Dr. Valerie Brutus. I'm a breast surgical oncologist specializing in breast cancer care at St. Vincent's Medical Center at Hartford HealthCare.
Oncology Data Advisor: We're very excited to have you. As a surgical oncologist, how do you incorporate genetic risk and testing into your treatment decisions?
Dr. Brutus: All the patients who come to us get what's called a risk assessment, where they receive a detailed questionnaire that helps us assess their risk. Anyone who qualifies, who we feel would benefit from genetic testing, is referred to a genetic counselor. Knowing one's risk is extremely important. So far, only 5% to 10% of breast cancers are associated with a known genetic mutation, but it definitely affects the recommendation that we make—not only for surgery, but also for treatment options like chemotherapy, because it really takes into consideration the person's own genetic risk. We refer the patients and encourage them to get genetic testing, and then that helps us guide them and helps us make the best decisions about their cancer care.
Oncology Data Advisor: What are some of the strategies that you implement to minimize symptoms and optimize quality of life for patients with breast cancer?
Dr. Brutus: We have a very good support team. When a patient is diagnosed, not only are we a team of experts who are here to support the patient, but we also have social services and nurse navigators who are here to guide the patient throughout treatment. As patients are being treated, they get counseled in nutrition. We always try to encourage patients to keep their normal routine as much as possible. They get assessed for emotional support. Some patients are very lucky to have good support with their friends and loved ones. Other benefits come from going to support groups; we have virtual support groups. Some people also benefit from having one-to-one counseling. Continued assessment is how we help our patients.
Once they're done with the treatment, there's also constant assessment every time they come for follow-up. These are questions that we ask. "How are you doing?" We want to know not only how they're doing if the cancer has come back, but also how they are dealing with being a breast cancer survivor and how they are incorporating their history into their work. This is where we always help patients to try to live the best life they can.
Something that we always tell people is to eat healthy, such as lots of fruit and vegetable and a low-fat diet. Processed food is never a good idea. For those who are smoking, we encourage them to stop smoking, and we have a different clinic to which we refer them to help them with that. Alcohol is the same thing: definitely in moderation. We always encourage patients to try to have an active exercise program. For our post-operative patients, we always refer them to a physical therapist. We also have an integrative medicine program to help patients with relaxation and acupuncture, as needed. Those services are offered both during and after treatment, regardless of how long since the treatment was completed.
Oncology Data Advisor: How have the challenges of the COVID-19 pandemic impacted screening and treatment for patients with breast cancer?
Dr. Brutus: The COVID pandemic, unfortunately, has led to a very sharp decline in cancer screening. For breast cancer specifically, there's some data suggesting that about 3.9 million women did not receive breast cancer screening. In my practice, what I'm seeing so far is that patients tend to present with more advanced cancer. The story that we always get is that, "I felt something; I wasn't sure; I was afraid to go check it out because of COVID." Some people also have issues with finances and insurance. We're seeing patients present at a later stage.
For patients who had to be treated during the pandemic, we also had to modify our treatment algorithm. For example, most of the time with early breast cancer, surgery is a first step of treatment, but we were very limited with doing non–life-threatening surgery. Treatment was modified to help patients go through this period of limited access to surgery. So far, we're happy to be back and to put this behind us, but I really want to encourage people to resume their cancer screening, because it's very important. When cancers are discovered at an early stage, this is when the chance of cure and survival are the greatest. So don't wait. Start now!
Oncology Data Advisor: In your practice, have any other changes been implemented to counteract the challenges of the pandemic?
Dr. Brutus: Oh, yes. There are many changes that we have implemented. First of all is the safety of our staff and our patients. We followed all the guidelines that are recommended from the Centers for Disease Control (CDC) to minimize transmission risk. Everybody wears a mask. All the staff have daily questionnaire assessments for COVID symptoms. Being in Connecticut, we have required all personnel to be vaccinated, and the compliance rate has been extremely high among our staff. These are things that we offer amongst ourselves. We also have support; for example, if someone is sick, we have backup available to make sure that the flow of the work is not disrupted if someone is sick or needs to be treated for COVID-19.
For our patients themselves, we reach out, we call them, and we offer virtual visits as needed. It's just for us to make sure that patients, even if they cannot come in, can talk to someone or have a virtual visit if needed, just to make sure that we're still monitoring them and caring for them as needed.
Oncology Data Advisor: Well, thank you to so much for sharing all this great information with us.
Dr. Brutus: Thank you so much for having me. It's my pleasure.
About Dr. Brutus
Valerie Brutus, MD, FACS, is a breast surgical oncologist at St. Vincent's Medical Center of Hartford HealthCare in Connecticut. She specializes in the treatment of patients with all stages of breast cancer, with particular interest in genetic testing, oncoplastic surgery, breast reconstruction, neoadjuvant chemotherapy, and sentinel node procedures. Dr. Brutus is a member of the American Association of Breast Surgeons, a member of the Society of Surgical Oncology, and a Fellow of the American College of Surgeons.
For More Information
Chen RC, Haynes K, Du S, et al (2021). Association of cancer screening deficit in the United States with the COVID-19 pandemic. JAMA Oncol, 7(6):878-884. DOI:10.1001/jamaoncol.2021.0884
Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of i3 Health.