TARGET AUDIENCE
This activity has been designed to meet the educational needs of oncology nurses, nurse practitioners and clinical nurse specialists involved in the treatment of breast cancer (BC).

OVERVIEW OF ACTIVITY
BC remains the most frequently diagnosed cancer in women, and in 2018 in the United States alone the disease will culminate in an estimated 268,670 new cases and 41,400 deaths. The current clinical management of BC is multidisciplinary and includes surgical resection of local disease with or without radiation therapy and the treatment of systemic disease with cytotoxic chemotherapy, endocrine therapy, biologic therapy or combinations of these approaches. The indication and/or utility of these local and systemic treatment options is largely based on a number of prognostic and predictive risk factors present within the patient or tumor at the time of diagnosis. In fact, as the field of oncology is challenged to improve the precision with which it therapeutically targets malignant cells, biomarker-driven treatment algorithms have become the “norm” for many tumor types, particularly BC. Increasingly, an emphasis is being placed on a “personalized medicine” approach that promises to more effectively identify specific treatments that will benefit individuals based on specific patient- and disease-related characteristics. In conjunction with this approach researchers are actively attempting to develop novel agents and immunotherapeutic strategies, with the aim of generating additional benefit, enhancing the efficacy of existing treatments or overcoming resistance to endocrine therapy, chemotherapy or biologic therapy. As such, the pace of change in the field of breast medical oncology has been rapid, and it is expected that a plethora of new data will continuously be disseminated requiring ongoing efforts to keep medical professionals informed.

Although medical oncologists have been routinely responsible for counseling patients with regard to therapeutic decision-making, oncology nurses play an integral role in the successful delivery of systemic anticancer therapy and the preservation of patient physical and psychosocial well-being. These video proceedings from the final part of a 6-part integrated CNE curriculum originally held at the 2018 ONS Annual Congress feature discussions with leading BC investigators and their nursing counterparts regarding actual patient cases and recent clinical research findings affecting the optimal therapeutic and supportive care for each patient scenario.

PURPOSE STATEMENT
By providing information on the latest research developments in the context of expert perspectives, this CNE activity will assist oncology nurses, nurse practitioners and clinical nurse specialists with the formulation of state-of-the-art clinical management strategies to facilitate optimal care of patients with BC.

LEARNING OBJECTIVES

• Apply existing and emerging research data to the diagnostic, therapeutic and supportive care of patients with early and advanced BC.
• Describe the influence of tumor phenotypes and/or molecular profiling assays in tailoring systemic treatment decisions for patients with early and advanced BC.
• Discuss the benefits and risks associated with existing and recently approved evidence-based therapies for BC, including endocrine agents, chemotherapy regimens and biologic treatments.
• Develop a plan to manage the side effects associated with commonly employed systemic therapies to support quality of life and continuation of treatment.
• Recall ongoing trials of other investigational approaches and agents in BC, and refer patients and obtain consent for study participation.
• Identify opportunities to enhance the collaborative role of oncology nurses in the comprehensive biopsychosocial care of patients with BC to optimize clinical and quality-of-life outcomes.

ACCREDITATION STATEMENT
Research To Practice (RTP) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation.

CREDIT DESIGNATION STATEMENT
CNE credit is no longer available for this issue

ONCOLOGY NURSING CERTIFICATION CORPORATION (ONCC)/INDIVIDUAL LEARNING NEEDS ASSESSMENT (ILNA) CERTIFICATION INFORMATION
CNE credit is no longer available for this issue

FOR SUCCESSFUL COMPLETION
This is a video CNE program.
CNE credit is no longer available for this issue

CONTENT VALIDATION AND DISCLOSURES
RTP is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess conflicts of interest with faculty, planners and managers of CNE activities. Conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

FACULTY — The following faculty (and their spouses/partners) reported relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

Lisa A Carey, MD
Richardson and Marilyn Jacobs Preyer Distinguished Professor for Breast Cancer Research
Chief, Division of Hematology and Oncology
Physician-in-Chief
North Carolina Cancer Hospital
Associate Director for Clinical Research
Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina

Advisory Committee: Bristol-Myers Squibb Company, Genentech, GlaxoSmithKline, MediGene Inc, Novartis, Pfizer Inc, Roche Laboratories Inc, Sanofi Genzyme; Consulting Agreements: Bristol-Myers Squibb Company, Genentech, GlaxoSmithKline, MediGene Inc, Novartis, Pfizer Inc, Sanofi Genzyme; Contracted Research: GlaxoSmithKline, Genentech, Sanofi Genzyme; Speakers Bureau: Bristol-Myers Squibb Company, Genentech, GlaxoSmithKline, MediGene Inc, Novartis, Pfizer Inc, Sanofi Genzyme.

Lauren Czapla, MSN, WHNP-BC, AOCNP
Nurse Practitioner
Dana-Farber Cancer Institute
Boston, Massachusetts

No relevant conflicts of interest to disclose.

Sara A Hurvitz, MD
Associate Professor of Medicine
Director, Breast Oncology Program, Division of Hematology/Oncology
University of California, Los Angeles
Medical Director, Jonsson Comprehensive Cancer Center Clinical Research Unit
Los Angeles, California
Co-Director, Santa Monica-UCLA Outpatient Oncology Practices
Santa Monica, California

Contracted Research: Amgen Inc, Bayer HealthCare Pharmaceuticals, BioMarin, Boehringer Ingelheim Pharmaceuticals Inc, Cascadian Therapeutics, Dignitana, Genentech, GlaxoSmithKline, Lilly, Medivation Inc, a Pfizer Company, Merrimack Pharmaceuticals Inc, Novartis, OBI Pharma Inc, Pfizer Inc, Puma Biotechnology Inc, Roche Laboratories Inc, Seattle Genetics; Paid Travel: Bayer HealthCare Pharmaceuticals, Lilly, Novartis, OBI Pharma Inc.

Madelaine C Kuiper, NP
Nurse Practitioner
University of California, Los Angeles
Santa Monica, California

Advisory Committee: Pfizer Inc; Speakers Bureau: Novartis.

MODERATOR — Dr Love is president and CEO of Research To Practice. Research To Practice receives funds in the form of educational grants to develop CME/CNE activities from the following commercial interests: AbbVie Inc, Acerta Pharma — A member of the AstraZeneca Group, Adaptive Biotechnologies, Agendia Inc, Agios Pharmaceuticals Inc, Amgen Inc, Ariad Pharmaceuticals Inc, Array BioPharma Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Baxalta Inc, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, CTI BioPharma Corp, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech, Genomic Health Inc, Gilead Sciences Inc, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Janssen Biotech Inc, administered by Janssen Scientific Affairs LLC, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Medivation Inc, a Pfizer Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pfizer Inc, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sanofi Genzyme, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro Inc, Teva Oncology and Tokai Pharmaceuticals Inc.

RESEARCH TO PRACTICE CME/CNE PLANNING COMMITTEE MEMBERS, STAFF AND REVIEWERS — Planners, scientific staff and independent reviewers for Research To Practice have no relevant conflicts of interest to disclose.

This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

This activity is supported by educational grants from Genentech, Lilly, Merck and Novartis.

Hardware/Software Requirements:
A high-speed Internet connection
A monitor set to 1280 x 1024 pixels or more
Internet Explorer 11 or later, Firefox 56 or later, Chrome 61 or later, Safari 11 or later, Opera 48 or later
Adobe Flash Player 27 plug-in or later
Adobe Acrobat Reader
(Optional) Sound card and speakers for audio

Last review date: July 2018
Expiration date: July 2019

There is no implied or real endorsement of any product by RTP or the American Nurses Credentialing Center.