Dawn Hershman, MD, MS

Improving breast cancer outcomes by reducing the long-term side effects of treatment.

Impact

Women with metastatic breast cancer are living longer, and many experience long-term toxicities from therapy and a diminished quality of life. Dr. Hershman is conducting interventional studies that aim to reduce adverse effects, control pain, improve treatment adherence, and improve quality of life for patients in all stages of breast cancer. Her current research focuses on a series of projects seeking to improve the quality of life for patients living with MBC. These include understanding how financial factors influence therapy adherence, creating a risk prediction model for acute and emergency care use, and improving therapy uptake and adherence in premenopausal women with breast cancer.

Progress Thus Far

Dr. Hershman and her team studied a population of patients prescribed CDK4/6 inhibitors, a common treatment for patients with hormone receptor (HR)-positive MBC that has less favorable side effects than endocrine therapy alone and can be costly. She found that 21 percent of patients stopped taking the drug, and those who reported struggling financially were more likely to stop.

They are also investigating reducing unplanned emergency room visits by building a risk prediction model for acute care use among advanced cancer patients. Preventing health crises in patients with MBC can reduce emotional strain, lower health care costs, reduce uncoordinated and ineffective care, and lead to a better quality of life. The team found that those with two or more risk factors, such as hypertension, were three times more likely to need emergency care, suggesting that early identification can help tailor support and early intervention strategies.

Lastly, she and her team are investigating a type of treatment called ovarian function suppression (OFS), which is recommended for younger, high-risk women diagnosed with HR-positive breast cancer and increasingly used for patients with MBC. While the factors influencing the rates of uptake of OFS are currently unknown, the addition of OFS to endocrine therapy can increase the frequency of side effects. They found that only half of eligible women underwent OFS, and non-adherence to endocrine therapy was higher in women undergoing OFS compared to those on endocrine therapy.

What’s next

In addition to her ongoing work, Dr. Hershman and her team aim to launch two new studies in the next year. The first will test whether adherence to CDK4/6 inhibitors can be improved with a pill-dispensing device along with regular symptom check-ins can help women stick to their treatment regimens, addressing the nonadherence to CDK4/6 inhibitors she and the team observed. Their second study will look at how work disruptions related to a breast cancer diagnosis, such as taking time off or losing a job, affect cancer care, including the type, sequencing, and delivery of therapies. The goal is to develop a risk assessment tool to help doctors spot patients who may be at risk of job-related challenges so they can offer support earlier and plan for future interventions. Ensuring patients feel well enough to continue working may help ease the financial burden associated with continued cancer care.

Read more about Dr. Hershman’s work as part of BCRF’s Health Equity Initiative here.