As part of Breast Cancer Trials Clinical Fellowship program, Dr Julia Matheson will be assessing the participant experience of undergoing MRI, using patient reported outcome measures or PROMs. The research is an extension of the clinical trial called the Breast MRI Evaluation Study, which aims to establish when breast MRIs improve patient outcomes.
We asked Dr Matheson to explain the aim of this research and some of the barriers for accessing breast MRIs.
“My fellowship project is part of a much bigger clinical trial, which is looking at the role of MRI in women with newly diagnosed breast cancer. So currently the role of MRI in that patient group is incompletely defined. The aim of this study is to try and work out when MRI at the time of breast cancer diagnosis improves outcomes and when it does not.”
“At the moment, we know that up to a fifth of treating teams recommend a breast MRI for a patient with a new diagnosis of breast cancer, but there is quite a lot of variation in terms of whether it’s offered and whether it’s also available to patients. So hopefully this project will help to define the patients where it really makes a difference.”
“My component is looking at patient reported outcome measures. So those are measures that inform us of a patient’s health condition that’s reported directly by the patient. And in this study, we are using internationally recognised standardised questionnaires, and patients are being asked to complete these questionnaires at different points during the treatment pathway.”
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How might MRI not being offered of being financially unattainable impact women?
“Because the exact role of MRI, so which patient group benefits, is unclear, I think it can be quite confusing for patients. There are a lot of different imaging modalities available.”
“Mammography is really the workhorse of breast cancer imaging, mammography and ultrasound are the more sensitive imaging modalities, like MRI. So, if patients are offered an MRI, they might be confused about why they’re being offered it and what it’s going to contribute to their treatment planning and outcomes.”
“It’s an additional test during a journey where they already have a lot of things happening, and some people can also find the MRI quite confronting. For patients who aren’t offered an MRI where they feel like it could be beneficial, it’s also challenging. So, MRI, the funding for it is quite tightly controlled based on Medicare rebates.”
“So in certain situations a clinician might think an MRI could be helpful, but there won’t be funding for it. And in those situations, not all patients will have the ability or the financial means to self-fund that test.”
“So we are hoping that this project provides more information and evidence so that MRI can be available to patients who are going to benefit, and that this component of their healthcare is equitable.”
Why has the role of breast MRI been a theme in breast cancer research?
“In breast cancer research we are always trying to improve outcomes for patients. Breast MRI is a more sensitive modality for looking at abnormalities within a breast. So particularly for patients who have a breast cancer that on MRI might be shown to be a lot more extensively than it looked on mammography, it can have a dramatic impact on the type of treatment and surgery that they’re offered.”
“And in some circumstances, it might mean that they don’t need to have subsequent treatments, or additional surgery. So, it helps to stage the patient to try and work out exactly how large the cancer is, and also if there’s any abnormalities in other areas of that breast or the breast on the other side, because those could also influence the type of treatment the patient gets and what they’re offered.”
“Patient reported outcome measures are any report of the status of a patient’s health condition that comes directly from the patient. So, in this study, we’re using a number of different measures and they’re looking at things like how MRI has influenced the patient’s preferences for the type of surgery they think they should have, their satisfaction with decision making at various time points through their treatment and follow up, the confidence they have in the treatment they’re receiving, and also if they have any regret about the treatment decisions that have been made.”
What are your hopes for the future?
“My hopes for the future of breast cancer research are that it continues to be an extremely dynamic and exciting field, that organizations like Breast Cancer Trials have a huge role in attracting great talent, ensuring that the research being done is of an extremely high standard and really world-class, and that those findings are being translated into better outcomes for patients.”
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