Decisions regarding the use of adjuvant cytotoxic and hormonal therapies for women with breast cancer ideally should be made jointly by the patient and oncologist. For patients to be adequately involved in this decision-making process, they must be provided with appropriate education regarding the potential benefits and risks of adjuvant therapies. The recommended steps for doing this are: 1) understand baseline prognosis with locoregional therapy (surgery, radiation, or both) alone for the individual patient at hand; 2) determine the estimated benefit afforded by adjuvant therapy options for the individual patient; 3) estimate the risk of side effects of adjuvant therapy options; 4) convey the above information to the individual patient; 5) facilitate the individual patient's decision regarding adjuvant systemic therapy; and 6) support the patient's decision. Two computer-based tools (Numeracy and Adjuvant!) are available to facilitate this process.
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Charles L. Loprinzi and Peter M. Ravdin
Maxwell T. Vergo and Al B. Benson III
on which study or data set the user believes is most representative). Numeracy is another Web-based adjuvant therapy tool for colon cancer ( www.mayoclinic.com/calcs/colon/index-ccacalc.cfm ). This calculator uses number of positive lymph nodes, T
Rishi Jain, Michelle J. Savage, Andrea D. Forman, Reetu Mukherji, and Michael J. Hall
and numeracy skill, and information expectations. 25 , 26 Indeed, whole-exome sequencing (WES), whole-genome sequencing (WGS), and large multigene panel tests are together spurring the evolution of genetic counseling that is necessary to meet the
Jeffrey K. Belkora, David W. Hutton, Dan H. Moore, and Laura A. Siminoff
cancer . J Cancer Educ 2009 ; 24 : 194 - 199 . 15 Lipkus IM Peters E Kimmick G . Breast cancer patients' treatment expectations after exposure to the decision aid program Adjuvant Online: the influence of numeracy . Med Decis Making 2010
Luke D. Rothermel, Claire C. Conley, Anuja L. Sarode, Michael F. Young, Zulema L. Uscanga, McKenzie McIntyre, Jason B. Fleming, and Susan T. Vadaparampil
numeracy in diabetes . Clin Diabetes 2010 ; 28 : 171 – 175 . 10.2337/diaclin.28.4.171 15. Schillinger D , Bindman A , Wang F , Functional health literacy and the quality of physician-patient communication among diabetes patients
Robert W. Carlson, Elizabeth Brown, Harold J. Burstein, William J. Gradishar, Clifford A. Hudis, Charles Loprinzi, Eleftherios Paul Mamounas, Edith A. Perez, Kathleen Pritchard, Peter Ravdin, Abram Recht, George Somlo, Richard L. Theriault, Eric P. Winer, Antonio C. Wolff, and for the NCCN Adjuvant Therapy for Breast Cancer Task Force
preference. Decision-Making Tools Physicians provide widely varying estimates of DFS associated with observation or adjuvant therapy in different clinical situations. 41 Numeracy and Adjuvant! Online are Internet-based tools developed to improve and
