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Facilitators and barriers to reducing chemotherapy for early-stage breast cancer: a qualitative analysis of interviews with patients and patient advocates.
Andrews, Courtney; Childers, Timothy C; Wiseman, Kimberly D; Lawhon, Valerie; Ingram, Stacey; Smith, Mary Lou; Wolff, Antonio C; Wagner, Lynne; Rocque, Gabrielle B.
  • Andrews C; College of Arts and Sciences, University of Alabama, 1720 2nd Avenue South, Birmingham, Alabama, 35294, USA. cjandrews@uab.edu.
  • Childers TC; University of Alabama School of Medicine, 1670 University Boulevard, Birmingham, AL, 35233, USA.
  • Wiseman KD; Wake Forrest School of Medicine, Bowman Gray Center for Medical Education, 475 Vine St, Winston-Salem, NC, 27101, USA.
  • Lawhon V; University of Alabama School of Medicine, 1670 University Boulevard, Birmingham, AL, 35233, USA.
  • Ingram S; University of Alabama School of Medicine, 1670 University Boulevard, Birmingham, AL, 35233, USA.
  • Smith ML; Research Advocacy Network, Park Blvd, Suite 305, Plano, TX, 6505 W75093, USA.
  • Wolff AC; The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA.
  • Wagner L; Wake Forrest School of Medicine, Bowman Gray Center for Medical Education, 475 Vine St, Winston-Salem, NC, 27101, USA.
  • Rocque GB; University of Alabama School of Medicine, 1670 University Boulevard, Birmingham, AL, 35233, USA.
BMC Cancer ; 22(1): 141, 2022 Feb 04.
Article in English | MEDLINE | ID: covidwho-2162322
ABSTRACT

BACKGROUND:

As the combination of systemic and targeted chemotherapies is associated with severe adverse side effects and long-term health complications, there is interest in reducing treatment intensity for patients with early-stage breast cancer (EBC). Clinical trials are needed to determine the feasibility of reducing treatment intensity while maintaining 3-year recurrence-free survival of greater than 92%. To recruit participants for these trials, it is important to understand patient perspectives on reducing chemotherapy.

METHODS:

We collected qualitative interview data from twenty-four patients with Stage II-III breast cancer and sixteen patient advocates. Interviews explored potential barriers and facilitators to participation in trials testing reduced amounts of chemotherapy. As the COVID-19 pandemic struck during data collection, seventeen participants were asked about the potential impact of COVID-19 on their interest in these trials. Interviews were audio-recorded and transcribed, and researchers used qualitative content analysis to code for dominant themes.

RESULTS:

Seventeen participants (42.5%) expressed interest in participating in a trial of reduced chemotherapy. Barriers to reducing chemotherapy included (1) fear of recurrence and inefficacy, (2) preference for aggressive treatment, (3) disinterest in clinical trials, (4) lack of information about expected outcomes, (5) fear of regret, and (6) having young children. Facilitators included (1) avoiding physical toxicity, (2) understanding the scientific rationale of reducing chemotherapy, (3) confidence in providers, (4) consistent monitoring and the option to increase dosage, (5) fewer financial and logistical challenges, and (6) contributing to scientific knowledge. Of those asked, nearly all participants said they would be more motivated to reduce treatment intensity in the context of COVID-19, primarily to avoid exposure to the virus while receiving treatment.

CONCLUSIONS:

Among individuals with EBC, there is significant interest in alleviating treatment-related toxicity by reducing chemotherapeutic intensity. Patients will be more apt to participate in trials testing reduced amounts of chemotherapy if these are framed in terms of customizing treatment to the individual patient and added benefit-reduced toxicities, higher quality of life during treatment and lower risk of long-term complications-rather than in terms of taking treatments away or doing less than the standard of care. Doctor-patient rapport and provider support will be crucial in this process.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Advocacy / Breast Neoplasms Type of study: Observational study / Prognostic study / Qualitative research / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Middle aged Language: English Journal: BMC Cancer Journal subject: Neoplasms Year: 2022 Document Type: Article Affiliation country: S12885-022-09189-w

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Advocacy / Breast Neoplasms Type of study: Observational study / Prognostic study / Qualitative research / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Middle aged Language: English Journal: BMC Cancer Journal subject: Neoplasms Year: 2022 Document Type: Article Affiliation country: S12885-022-09189-w