Shared Decision-Making, Unanswered Questions, and Future Directions

The closing segment focuses on shared decision-making for patients balancing a desire to reduce recurrence risk against concerns about quality of life during years of therapy. The faculty describe how they explain the rationale for adjuvant treatment, share what the trial data do and do not establish, invite patients to voice their concerns, and make clear that dose modification and supportive strategies are available should side effects arise. Looking forward, the panel considers how emerging oral selective estrogen receptor degrader data may reshape the adjuvant endocrine backbone and how CDK4/6 inhibitors would be incorporated alongside them. The discussion also raises the unresolved question of whether biomarkers or genomic testing could identify which patients derive the greatest benefit from CDK4/6 inhibition, paralleling the role such assays already play in chemotherapy decisions. The faculty close by noting that better patient selection carries implications not only for toxicity and individualized care but also for cost and financial toxicity given the extended duration of therapy.