Conquer Cancer, the American Society of Clinical Oncology (ASCO) foundation, has presented UNC Lineberger’s Emily Ray, MD, MPH, with the 2021 Conquer Cancer – Marc L. Citron, MD, Career Development Award in Breast Cancer. The three-year, $200,000 grant will support her research testing the accuracy and usability of a prognostic calculator for patients with metastatic breast cancer.
Ray, assistant professor of medicine at the UNC School of Medicine, specializes in the treatment of breast cancer and conducts cancer outcomes research with a focus on health care utilization among patients with advanced cancer.
Determining when a patient with advanced cancer is nearing the end of life and how aggressively to treat their cancer can be challenging for both the clinician and the patient, due to the current lack of evidence-based determinants of prognosis. Ray is focused on addressing this shortcoming by developing an assessment tool to help oncologists better estimate the 30-day mortality of a patient with metastatic breast cancer.
“Our goal in caring for our patients is always to help and not harm,” Ray said. “However, we are often faced with the challenging decision about whether more cancer-directed therapy will benefit the patient or cause harm. We don’t want to withhold therapy that could help, but too often we treat patients up until the very end of life, which can contribute to suffering and sometimes prevent a ‘good death.’”
Ray and her colleagues are completing the development of a metastatic breast cancer-specific prognostic calculator using the ASCO CancerLinQ Discovery database, which contains de-identified clinical information on more than 1.5 million cancer patients. The next phase of their research is to assess the accuracy and usability of the assessment tool.
Aggressive care at a patient’s end of life is costly to the health system but more importantly leads to poor outcomes for patients, including high symptom burden and emotional distress, Ray said. She added that the goal of the calculator is to help clinicians determine when a change in goals may be warranted and to support patients by providing a level of care that aligns with their goals and preferences.
“If we can identify patients with metastatic breast cancer who are nearing the end of life, we can better deploy supportive care interventions to focus on quality of life,” Ray said. “High-risk patients may benefit from a transition to supportive care alone. This prognostic calculator will help flag patients who are high risk so their oncologists can address goals of care and patient preferences to ensure high-quality cancer care at the end of life.”