Success Factors and Barriers in Combining Personalized Medicine and Patient Centered Care in Breast Cancer. Results from a Systematic Review and Proposal of Conceptual Framework

Antonio De Belvis,Roberta Pastorino,Alisha Morsella,Carolina Castagna,Rossella Pellegrino,Stefania Boccia

doi:10.3390/jpm11070654

Abstract

Breast Cancer (BC) is the leading cause of death due to cancer in women. Ensuring equitable, quality-assured and effective care has increased the complexity of BC management. This systematic review reports on the state-of-the art of available literature investigating the enactment of personalized treatment and patient-centered care models in BC clinical practice, building a framework for the delivery of personalized BC care within a Patient-Centered model. Databases were searched for articles (from the inception to December 2020) reporting on Patient-Centered or Personalized Medicine BC management models, assessing success factors or limits. Out of 1885 records, 25 studies were included in our analysis. The main success factors include clearly defined roles and responsibilities within a multi-professional collaboration, appropriate training programs and adequate communication strategies and adopting a universal genomic language to improve patients’ involvement in the decision-making process. Among detected barriers, delays in the use of genetic testing were linked to the lack of public reimbursement schemes and of clear indications in timing and appropriateness. Overall, both care approaches are complementary and necessary to effectively improve BC patient management. Our framework attempts to bridge the gap in assigning a central role played by shared decision-making, still scarcely investigated in literature.

Highlights

Among today’s major public health concerns, female Breast Cancer (BC) is responsible for an estimated 2.3 million new cases every year, surpassing lung cancer as the most commonly diagnosed cancer (11.7% of all cases) and leading cause of death due to cancer in women [1]
Quality-assured and effective care have led to an increasing complexity and specialization of BC management, inevitably backed by an integration of multi-specialist inputs provided collaboratively through the efforts of several healthcare practitioners
To report on the state-of-the art of available literature investigating the enactment of personalized treatment and patientcentered care models in BC clinical practice

Summary

Introduction

Among today’s major public health concerns, female Breast Cancer (BC) is responsible for an estimated 2.3 million new cases every year, surpassing lung cancer as the most commonly diagnosed cancer (11.7% of all cases) and leading cause of death due to cancer in women [1]. Multidisciplinary care in BC, represented by the Breast Unit model, has become the gold-standard of patient-centered BC care and has been included among the determinants for accreditation and funding of facilities, given its capacity to improve patients’ quality of life and survival rates [2,3,4]. Responses to therapies, especially when dedicated clinical governance tools (i.e., molecular tumour boards) are instituted within the care pathway. Despite such documented progress, literature seems to highlight that the application of such innovations into routine clinical practice is proceeding at a slower pace compared to the generation of such findings [6], stressing the need to concentrate efforts on their implementation into real-life settings. To propose a comprehensive care management framework for the delivery of personalized care to patients with BC, within a patient-centered care model

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Discussion

Conclusion