Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (firstname.lastname@example.org) for more information.
After completing this case study, the reader should be able to:
Design a pharmacotherapeutic plan for treatment of locally advanced breast cancer.
Develop an appropriate monitoring plan for patients receiving adjuvant hormonal therapy for treatment of breast cancer.
Establish appropriate follow-up for patients after definitive treatment of breast cancer.
Provide patient education on the proper dosing, administration, and adverse effects of letrozole and palbociclib.
Compare and contrast the goals of treatment for locally advanced breast cancer versus metastatic breast cancer.
“I have a lump in my breast.”
Rosalita Garza is a 61-year-old woman presenting for evaluation of a new mass in her left breast. She first noticed a palpable breast mass on self-examination approximately 14 months ago but was unable to have this further investigated due to loss of health insurance. The patient describes the mass as intermittently painful. A mammogram was performed prior to her current visit, which was suspicious for malignancy.
Musculoskeletal injury 6 years ago. Fell from a chair while at work and suffered injuries to her cervical spine. The patient has required bone grafting from her right hip to her cervical spine. She has been prescribed multiple as-needed medications for pain control but uses them infrequently.
Depression (diagnosed 7 years ago)
Sister diagnosed with breast cancer at age 60, now 5 years postsurgery. The patient was unable to recall any further details. No other significant cancer history is noted.
Lives with and acts as primary caretaker for her mother, who has dementia. Denies alcohol use and is a nonsmoker. Has a 35-year-old daughter who also lives with her.
Menarche age 13; menopause age 55; first child age 26; G1P1A0. Last Pap smear at age 40. Took Premarin as HRT for 5 years after the onset of menopause.
Protonix 40 mg PO once daily
Zoloft 50 mg PO once daily
Ambien CR 12.5 mg PO at bedtime PRN sleep
Hydrocodone/acetaminophen 5 mg/300 mg, one to two tablets PO Q 6 H PRN pain
Negative except for complaints noted above
WDWN 61-year-old Hispanic woman. Awake, alert, in NAD.