From the Guidelines
Ibrance therapy would not be the best option for your patient as it primarily aims to prolong life, which is not her goal, and may not significantly improve her quality of life. According to the American Society of Clinical Oncology statement 1, care intended to enhance patients’ quality of life should be a priority throughout the disease trajectory of advanced cancer. The statement emphasizes the importance of discussing the potential impact of cancer-directed therapy on quality of life with patients and presenting symptom-directed palliative care as an alternative.
In the context of metastatic breast cancer, the primary goals of treatment may include maximizing the quality of life, prevention and palliation of symptoms, and prolongation of survival 1. However, since your patient has expressed that she does not want to prolong her life and is accepting of death, focusing on palliative care options that prioritize symptom management and comfort would be more aligned with her goals. This approach would involve a thorough discussion of her values, understanding of her prognosis, and exploration of what meaningful quality of life means to her.
Key considerations in this decision include:
- Respecting patient autonomy in end-of-life decisions
- Documenting her informed refusal of life-prolonging treatment
- Ensuring she receives compassionate care aligned with her wishes
- Discussing the potential benefits and drawbacks of Ibrance therapy, including its side effects and impact on quality of life
- Exploring alternative care options that prioritize symptom management and comfort.
By prioritizing palliative care and respecting your patient's autonomy, you can ensure that her care is aligned with her values and goals, and that she receives the best possible quality of life.
From the Research
Ibrance (Palbociclib) and Quality of Life
- The provided studies do not directly address the impact of Ibrance on quality of life in patients with metastatic cancer who do not want to prolong their life 2, 3, 4, 5, 6.
- However, studies have shown that palbociclib can improve progression-free survival (PFS) in patients with HR+/HER2- metastatic breast cancer when combined with endocrine therapy 5, 6.
- A real-world study found that palbociclib was effective in clinical practice, with a median PFS of 2.5 years and an overall response rate of 55.4% 6.
Ibrance and Patient Goals
- The patient's goal of not wanting to prolong life, but rather to prioritize quality of life, is an important consideration in treatment decisions.
- While the studies do not directly address this specific goal, they do suggest that palbociclib can improve PFS and response rates in patients with metastatic breast cancer 5, 6.
- However, the patient's personal values and priorities should be taken into account when making treatment decisions, and a discussion about the potential benefits and risks of palbociclib should be had with the patient's healthcare provider 4.
Adherence to Treatment
- A study found that the addition of palbociclib to adjuvant endocrine therapy did not decrease adherence to treatment in patients with early breast cancer 4.
- In fact, patient-reported adherence was higher in the palbociclib plus endocrine therapy group compared to the endocrine therapy alone group 4.
- This suggests that patients who are prescribed palbociclib may be more likely to adhere to their treatment regimen, which could potentially improve outcomes.