Amalia Mara Rosu, Medical Oncologist at Ponderas Academic Hospital in Bucharest, Romania, shared an article with OncoDaily reflecting on the evolving role of precision oncology and the importance of placing patients’ priorities at the center of cancer care.
In her article, she explores fertility preservation, survivorship, multidisciplinary care, and the lessons she has learned from her patients.
“The hardest part of my job is not the treatment decision.
It is the moment before it – sitting across from a woman in her thirties who has never imagined that breast cancer would be part of her story. She arrives with a pathology report. I arrive with treatment algorithms, risk calculators and evidence-based guidelines. And somewhere between those two realities, the real consultation begins.
The question that reframes everything
She was thirty-four years old. The pathology report described multifocal hormone receptor-positive breast cancer with a pathogenic ATM mutation — a finding that would immediately orient any oncologist toward aggressive systemic therapy and extended endocrine treatment.
The report told me what her tumor was.
It did not tell me that she had been trying to conceive for two years before the diagnosis.
That the question she carried into the consultation had nothing to do with recurrence scores or Ki67 values. That what she needed to know, before anything else, was whether she would still have a chance to become a mother.
That conversation – about oocyte cryopreservation, about the window we had before chemotherapy, about what ‘preserving options’ actually means when time is limited — became the foundation of everything that followed. The ATM mutation shaped the oncological strategy. Her priorities shaped the human one.
Precision oncology, I have come to believe, is not only about identifying the right target. It is about understanding what matters most to the person sitting across from you.
When progress creates new responsibilities
A decade ago, her prognosis would have been starkly different.
She was forty-one, diagnosed with HER2-positive breast cancer, and she came to me having already read everything available online. She knew about trastuzumab, about pertuzumab, about the survival curves that had shifted dramatically in the last fifteen years. She was, in her own words, “cautiously optimistic.”
A decade ago, her prognosis would have been starkly different.
She was forty-one, diagnosed with HER2-positive breast cancer, and she came to me having already read everything available online. She knew about trastuzumab, about pertuzumab, about the survival curves that had shifted dramatically in the last fifteen years. She was, in her own words, “cautiously optimistic.”
What she had not read about was what surviving would look like.
We discussed cardiotoxicity monitoring — the echocardiograms, the thresholds, the moments when we pause and reassess. But the more important conversations happened later, as treatment continued: about fatigue that did not resolve between cycles, about the relationship between her and her body that had fundamentally changed, about returning to work and finding that she was not quite the same person who had left.
Anti-HER2 therapies have transformed outcomes in ways that would have seemed implausible twenty years ago. They have also created a new population of long-term survivors who need oncologists to think beyond response rates. Managing cardiotoxicity is a clinical skill. Accompanying a patient through survivorship is a different one — and equally essential.
What multidisciplinary care actually means
The best decisions I have made for my patients were not made alone.
They emerged from conversations between surgeons, fertility specialists, geneticists, cardiologists and oncologists — sometimes with very little time, always with the patient’s priorities at the center. The value of a multidisciplinary team is not the checklist of specialties represented. It is the quality of thinking that happens when different perspectives meet around a single, complex human case. Some of the most important moments in my practice have been those small corrections — a radiologist who noticed something that changed a surgical plan, a fertility specialist who identified a narrow but viable window, a psycho-oncologist who named what a patient could not yet articulate herself.
What my patients have taught me
Resilience, I have learned, does not appear in staging systems.
I have seen women continue to care for their families while receiving chemotherapy. I have seen patients return to work, set new goals and rebuild their lives in ways that surprised even them. I have witnessed fear and uncertainty and vulnerability. And I have witnessed something that clinical training does not fully prepare you for — the extraordinary capacity of people to move forward, even when forward is uncertain.
Precision medicine is changing what is possible in oncology. The next challenge is ensuring that we deliver equally precise attention to the lives surrounding the disease. ecause every biomarker tells us something about the disease. Only the patient can tell us what we are fighting for.”
You can also read: Chemotherapy-Induced Fatigue: Causes, Risk Factors, and Management
