Patient information and support

How this guidance was developed

This practice point was considered an important aspect of care. It is informed by the ACS/ASCO 2016 guidelines (US). The source recommendation is based on a systematic review of the evidence conducted to April 2015 and was not graded by the source guideline authors. The indicated level of evidence was ‘0’, i.e. based on expert opinion. The source recommendation was adapted to use language applicable to the Australian health care context. The term ‘culturally appropriate’ was added to the description of resources to align with the Optimal care pathway for Aboriginal and Torres Strait Islander people with cancer and to ensure relevance for people from culturally and linguistically diverse backgrounds.

Clinician-patient communication training (Practice Point)

All clinicians involved in the care of patients with breast cancer should consider clinician-patient communication training. It is essential that training is based on sound educational principles with a focus on ongoing acquisition and enhancement of skills.

How this guidance was developed

No evidence-based source recommendation was identified for this topic, which was considered an important aspect of care. This practice point was developed using an expert consensus process. This practice point aligns with the key principles of the Optimal Care Pathway for women with breast cancer.

Healthy lifestyle advice - General (Recommendation)

Advise all patients with breast cancer that a healthy lifestyle is associated with a lower risk of recurrence and improved survival. Discuss how a healthy lifestyle includes achieving and maintaining a healthy weight, limiting alcohol intake, cessation of smoking and undertaking regular physical activity.

How this guidance was developed

This recommendation was adapted from the NICE 2018 guidelines (UK). The source recommendation is based on a systematic review of the evidence conducted to September 2017 and used wording (‘Advise’) indicative of a strong recommendation by the source guideline authors. The source recommendation was adapted by removal of some of the detail and instead providing links to relevant Australian guidelines for this detail.  

Healthy lifestyle advice - Sedentary behaviour (Recommendation)

All patients with breast cancer should be advised to avoid inactivity and continue normal daily activities after diagnosis, and during and after breast cancer treatment, where possible.

How this guidance was developed

This recommendation was adapted from the ACS/ASCO 2016 guidelines (US). The source recommendation was based on a systematic review of the evidence conducted to April 2015 and was not graded by the source guideline authors. The source recommendation was adapted to remove US-specific language and detail and the words ‘where possible’ were added to reflect that not all patients will be able to continue normal activities or exercise during and immediately after some treatment.

Healthy lifestyle advice - Physical activity (Recommendation)

Advise patients to undertake regular aerobic exercise and resistance exercise (strength training) before, during and after breast cancer treatment appropriate to their treatment and tailored to their general health, medical condition and fitness.

How this guidance was developed

This recommendation was adapted from the ASCO 2016 guidelines (United States). The source recommendation was based on a systematic review of the evidence conducted to April 2015 and was not graded by the source guideline authors. The source recommendation was adapted to remove US-specific language and detail.

It is noted that findings from an RCT, OptiTrain, which assessed the effects of different exercises (aerobic training, combined resistance and aerobic exercise training) versus usual care on the physical and mental health of breast cancer patients undergoing chemotherapy found that being involved in an exercise program during chemotherapy can have long-term benefits for women with breast cancer, but that strategies are needed to create better pathways to support patients to maintain physical activity levels.

Healthy lifestyle advice - Smoking cessation (Practice Point)

Strongly encourage all patients with breast cancer to stop smoking. Advise patients that smoking increases the risk of complications of treatment (e.g. wound infection, deep vein thrombosis) and breast cancer recurrence, and worsens vasomotor symptoms.

How this guidance was developed

This recommendation was adapted from ACS/ASCO (2016) breast cancer survivorship care guideline (US). The source recommendation was based on a systematic review of the evidence conducted to April 2015 and was not graded by the guideline authors. The recommendation was adapted by including detail regarding the reasons for stopping smoking. This additional information was informed by a recommendation in the ASPS 2014 (US) guidelines which indicated that 'Smoking is associated with an increased risk of complications and an increased risk of reconstructive failure in patients undergoing post-mastectomy expander/implant breast reconstruction. Patients should be informed of the increased risks and advised on smoking cessation as means to decrease surgical complications. Additionally, it should be recognised that the decision to proceed with surgery may preclude timely smoking cessation.’

Lymphoedema risk information (Recommendation) 

Inform all patients with breast cancer about the risk of developing lymphoedema and provide relevant information before treatment with surgery or radiation therapy.

How this guidance was developed

This recommendation was adopted from the NICE 2018 guidelines (UK). The source recommendation was based on a systematic review of the evidence conducted to July 2008 and used wording ('give') indicative of a strong recommendation by the source guideline authors. The source recommendation was accepted with minor changes to the language to make it more applicable to the Australian health care context.

Cardiac risk information (Practice Point)

Inform patients and their GPs of potential cardiac risks associated with treatment, the importance of ongoing monitoring and management of cardiac health and cardiovascular risk factors based on their baseline and future risk of cardiac dysfunction, and, encourage a heart-healthy lifestyle.

How this guidance was developed 

This practice point is informed by several source recommendations which recommend a comprehensive assessment of cardiovascular health and cardiovascular risk factors before and after cancer treatment (ASCO 2017). The importance of communicating this information to patients and their primary care providers (GPs) was considered an important aspect of care that is not included in existing guidelines.

It is acknowledged that traditional cardiac risk factors, as well as therapy-related risk factors, may be predictive of cancer therapy-related cardiac dysfunction (as per the Position Statement and new risk assessment tools from the cardio-oncology study group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society 2020)