‘Breast cancer is a team sport’
Dr. Lisa Carey talks about the importance of research, coordinated care and helping patients make informed choices.
More than 300,000 people in the U.S. are diagnosed with breast cancer each year. Dr. Lisa Carey, a UNC Health oncologist and UNC School of Medicine professor, finds encouragement from the 40% increase in cancer survivorship in the past 20 years, largely due to research discoveries.
“Before medical school, I was a researcher. I wanted to work where discoveries directly help people,” Carey says. “Cancer, particularly breast cancer, offered that immediacy. The patients were incredibly inspiring, and I wanted to help them.”
Her clinical trials include molecular analyses of tumor samples to better understand metastatic breast cancer. She is the L. Richardson and Marilyn Jacobs Preyer Distinguished Professor for Breast Cancer Research and deputy director of clinical sciences at the Lineberger Comprehensive Cancer Center.
Carey answered The Well’s questions about patient care and research.
What do you tell patients who’ve been diagnosed with breast cancer?
We usually begin by talking about treatment options and the best treatment tailored for what the patient has. We have many more tools for treating breast cancer than when I started. It’s remarkable. But that means patients face more complex decisions. For example, adding drugs, which also adds side effects and other types of toxicity, involves a discussion about what the patient is willing to undergo and what their values are. We also don’t want to use the same level of aggressiveness on everyone. Some patients simply don’t need it.
I’m the medical therapy person on a multidisciplinary team. Patients often meet me, the surgeon and the radiation doctor, all in the same timeframe. I emphasize that the best care comes from understanding what kind of breast cancer they have, its biology and its risk profile. That informs our treatment plan. But ultimately, the patient decides what they want to do.
UNC’s superpower is our team, which includes an advanced practice provider, a primary nurse, a nurse navigator who supports patients in many ways and a pharmacist — all working together to guide patients, coordinate care and ensure safe treatment.
So coordination is key to patient care?
Yes. I generally tell patients that breast cancer is a team sport with the patient making decisions with us, the surgical team, then often with the radiation oncology team. We decide together whether it’s medical therapy first, then surgery or maybe surgery first, then medical therapy, or when treatment is integrated, meaning we alternate or combine different treatment modalities in a coordinated manner. I think that patients find it reassuring to know that their doctors talk with each other.
What can patients tell you that enables you to better help them?
Just as it’s important that patients understand what we’re trying to accomplish, we need to know what they want. It’s particularly important for metastatic patients, who I can’t cure, that they tell us their wishes and values. Each patient’s answers differ. I do everything I can to honor their choices.
Patients commonly say it’s incredibly stressful, complex and scary. Breast cancer, particularly curable breast cancer, is like going over a series of bridges. Sometimes you must cross the surgery bridge, then the chemo bridge and so on. I generally counsel them, ‘Let us lay out the whole picture, then focus on the decisions you need to make right now.’
Why is cancer research important?
Thanks to clinical trials and scientific advances, the chance of dying from breast cancer has dropped by 40%. We aim to give patients the highest quality care. Research gives us new tools to do that. To become foundationally better at treating cancer, the one-word answer is “research.”
