Treatment decisions in hormone receptor-positive (HR+) metastatic breast cancer are rarely based on efficacy alone. At the 2026 ASCO Annual Meeting, patient advocate Stephanie Walker, BSN, RN, Chair of the Metastatic Breast Cancer Alliance (MBCA), emphasized that patients weigh far more than progression-free survival when considering treatment options, including side effects, quality of life, work and caregiving responsibilities, financial strain, and transportation barriers, and whether clinicians truly understand their lived experiences.
“As patients, we want to be involved in treatment planning very early,” Walker said during the presentation. “Shared decision-making doesn’t mean you make the decision, and then share it with the patient.”
Walker, who shared that she was diagnosed with HR-positive, HER2-negative oligometastatic breast cancer at age 56, discussed how personalized care and meaningful communication remain central concerns for many patients navigating metastatic disease.
Patients with HR-positive metastatic breast cancer often remain on endocrine and targeted therapies long term, making quality of life an important part of treatment planning.
“Quality of life is more than progression-free survival,” Walker said. “Death remains the endpoint. Our goal is to delay that endpoint for as long as possible.”
Treatment-related side effects — including fatigue, cognitive effects, mobility challenges, and sexual dysfunction — can significantly affect patients’ daily lives, relationships, and ability to work or care for family members.
Walker emphasized that patients may define treatment success differently from clinicians and that tolerability should not be measured solely by clinical standards.
“We want treatments that are accessible, effective, and tolerable — not tolerable by clinical standards, but tolerable by us,” she said.
Another major focus of the presentation involved communication between patients and oncology teams.
Walker stressed that patients want timely information about treatment options, biomarker results, side effects, monitoring requirements, and clinical trial opportunities so they can make informed decisions aligned with their values and goals.
“Shared decision-making is not optional, but it is actually fundamental to ethical care,” Walker said.
The presentation also reinforced that treatment decisions should prioritize individualized care rather than a one-size-fits-all approach.
Walker highlighted how social determinants of health can heavily influence cancer care experiences, particularly for patients from underserved communities.
“Zip code matters,” she said, noting that transportation barriers, medication access, financial strain, and proximity to treatment centers or clinical trials can all affect patient outcomes and day-to-day quality of life.
The presentation also addressed the importance of culturally responsive communication and representation in patient outreach efforts.
“If you’re trying to reach those patients that are underrepresented or minoritized, you need to have people from those populations,” Walker said. “I live in a predominantly Hispanic and Black community. Please don’t send a blonde woman in stilettos into my community to teach me anything.”
Walker added that patients often want clinicians to understand who they are beyond their diagnosis.
“If you learn just a little bit about us, it makes us feel seen and heard,” she said.
Walker also discussed how older adults and underrepresented populations may face additional barriers during treatment, including age-related bias, limited representation in clinical trials, and competing health conditions.
Walker emphasized that improving patient-centered care requires clinicians to better understand the broader realities patients face outside the clinic.
“The patient is both the center and the purpose of all work being done in metastatic breast cancer,” she said.
Walker’s ASCO presentation reinforced a growing emphasis on patient-centered care in metastatic breast cancer. The session highlighted that meaningful shared decision-making involves more than discussing treatment efficacy alone — it also requires understanding patients’ quality of life, personal priorities, cultural backgrounds, and real-world barriers to care
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