What treatment options are available based on assessment findings?

Treatment Options Based on Assessment Findings

Treatment options should be tailored based on specific assessment findings, with consideration of the patient's condition, disease severity, comorbidities, and previous treatment responses.

Metastatic Breast Cancer Treatment Options

• For patients with metastatic triple-negative breast cancer who have received at least two prior therapies, sacituzumab govitecan should be offered as the treatment of choice 1
• Patients with metastatic triple-negative breast cancer with germline BRCA1 or 2 mutations previously treated with chemotherapy may be offered an oral PARP inhibitor (olaparib or talazoparib) rather than chemotherapy 1
• For metastatic HR-positive breast cancer patients with disease progression on prior endocrine therapy, either endocrine therapy with/without targeted therapy or single-agent chemotherapy may be offered 1
• Patients with HR-positive HER2-negative metastatic breast cancer with germline BRCA1 or 2 mutations no longer benefiting from endocrine therapy may be offered an oral PARP inhibitor in first-to-third-line setting rather than chemotherapy 1
• Single-agent chemotherapy is preferred over combination therapy for HR-positive HER2-negative metastatic breast cancer patients no longer benefiting from endocrine therapy, except in cases of symptomatic or immediately life-threatening disease 1

Inflammatory Arthritis and Osteoarthritis Pain Management

• For peripheral arthritis with DMARD inadequate response, TNF inhibitors, IL-12/23 inhibitors, IL-17 inhibitors, IL-23 inhibitors, JAK inhibitors, or PDE4 inhibitors should be considered 1
• For axial disease that is bDMARD naive, treatment options include NSAIDs, physiotherapy, simple analgesia, TNF inhibitors, IL-17 inhibitors, and JAK inhibitors 1
• For enthesitis and dactylitis, TNF inhibitors, IL-12/23 inhibitors, IL-17 inhibitors, IL-23 inhibitors, JAK inhibitors, and PDE4 inhibitors are recommended 1
• For psoriatic nail disease, TNF inhibitors, IL-12/23 inhibitors, IL-17 inhibitors, IL-23 inhibitors, and PDE4 inhibitors are recommended 1

Fibromyalgia Management

• Exercise is strongly recommended as the primary non-pharmacological therapy for fibromyalgia 1
• Initial management should focus on patient education and non-pharmacological therapies 1
• In case of non-response, psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance), or multimodal rehabilitation programs (for severe disability) may be considered 1

Giant Cell Arteritis and Polymyalgia Rheumatica

• Treatment should aim for remission, defined as the absence of clinical symptoms and systemic inflammation 1
• Treatment of GCA should also aim to prevent tissue ischemia and vascular damage 1
• Treatment selection should be based on disease severity, activity, presence of relevant comorbidities, and potential predictors of outcome 1
• Once remission is reached, it should be maintained with the minimal effective dose of medication 1
• Disease activity should be monitored regularly, as frequently as every 1-4 weeks until remission is achieved 1

Stroke Rehabilitation

• Rehabilitation candidacy should be determined based on medical stability, rehabilitation goals, and patient's willingness and motivation to participate 1
• Factors to consider include stroke characteristics (severity, location, type), functional deficits, cognitive status, and time from onset 1
• Patient characteristics to evaluate include medical stability, rehabilitation goals, tolerance and endurance for therapy, age, pre-stroke frailty, and existing comorbidities 1
• System characteristics to consider include referral process efficiency, availability of rehabilitation professionals, and types of services available 1

Actinic Keratosis Management

• For patients with actinic keratosis, field treatment with 5-fluorouracil is strongly recommended 1
• Treatment options include topical agents, cryosurgery, and photodynamic therapy 1
• Selection of treatment should be based on AK features (e.g., site), treatment-related factors (e.g., efficacy, tolerability), and patient characteristics and preferences 1
• Field-directed treatments are appropriate for managing multiple AKs in a contiguous area, while lesion-directed treatments are used for few or isolated AKs 1

Communication During Assessment

• Effective communication during assessment should include discussion of changes in health since the last visit, past medical conditions, and family history 2
• A complete medication list including prescription drugs, over-the-counter medications, supplements, and herbal remedies should be reviewed 2
• Discussion of preventive screenings appropriate for age, gender, and risk factors is recommended 2
• Current lifestyle factors affecting health, including diet, exercise, sleep patterns, and stress levels should be assessed 2

Shared Decision-Making for Treatment Recommendations

• When making treatment recommendations, evaluate the prognosis and treatment options first 3
• Understand the range of priorities important to the patient given their prognosis 3
• Base recommendations on the patient's priorities most compatible with the likely prognosis and available treatment options 3
• Treatment recommendations may be expressed in different ways (pronouncements, suggestions, proposals, offers, assertions) based on the clinical context 4

Quality of Evidence Considerations

• The strength of a recommendation is defined as the extent to which one can be confident that the desirable effects of an intervention outweigh its undesirable effects 5
• When evaluating evidence, consider whether it directly compares interventions of interest in populations of interest and measures outcomes important to patients 6
• Evidence may be indirect if patients differ from those of interest, interventions tested differ from interventions of interest, or outcomes differ from those of primary interest 6