Written by Kim Furlow, Institute for Public Health
Meeting the needs of patients with metastatic breast cancer (MBC) can be challenging due to the multifaceted coordination required to address their complex care. An ongoing project lead by Institute Faculty Scholar, Ashley Housten, is using implementation science to adapt an evidence-informed intervention. Housten is an assistant professor in the School of Medicine, Division of Preventative Science, which is led by the Niess-Gain Professor of Surgery, Deputy Director of the Institute for Public Health and a leading Implementation Science scholar, Graham Colditz.
“Although national guidelines exist for the treatment of MBC, they do not clearly state the best sequence of treatments, nor do they describe how and when to identify and engage patients in clinical trials,” says Housten. “The lack of a clear process for routine MBC patient care can lead to under- and over-use of care and undue patient and health system burden.”
Using an implementation science approach to guide a multi-level program adaptation, Housten’s team is adapting and evaluating the coordinated care model, Ending Metastatic Breast Cancer for Everyone (EMBRACE), from the Dana Farber Cancer Institute, to the St. Louis region. This adaptation will enhance collaboration between academic and community oncology practices to improve satisfaction and acceptability among patients and clinicians.
Housten worked with Center for Dissemination and Implementation colleagues to add a D&I component to the project to help fulfill goals, which include improving breast cancer patient health outcomes.
“Most of the research in this field has focused on drug development to improve clinical outcomes such as progression free survival and overall survival,” says Housten. “However, research that improves planning the sequence of therapy, selecting therapy based on genomic testing results, and accessing and enrolling in clinical trials, could improve outcomes without adding toxicity.”
The project’s adaptation will build upon the EMBRACE model to modify the intervention to fit the proposed collaborative environment. According to Housten, “Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we will be able to assess our multi-level implementation strategy, incorporate ongoing feedback and make modifications during the investigation. These cutting-edge implementation science methods will enhance our ability to improve the intervention in real-time to advance the pace in which we translate evidence to practice.”
Housten adds that experts at the Center for Dissemination & Implementation at the Institute for Public Health have provided guidance throughout the development of the project. Her team connected with center experts to help them identify a powerful framework central to their study design.
“Both the Center for Dissemination & Implementation and WUSTL implementation science resources have helped me and my collaborators advance our research questions from initial clinical observations into rigorous research studies,” Housten says.
The infrastructure evaluated by this study will allow for a larger-scale investigation (e.g., R01) of the impact not only on patient and provider acceptability, but also key clinical cancer outcomes such as living without cancer progressing and overall survival. In addition to being adapted to those with metastatic breast cancer, this approach could also be adapted to patients with early stage breast cancer with the aim of improving care and outcomes in all stages, ultimately reducing the metastatic breast cancer mortality rates.