Facilitators and barriers to reducing chemotherapy for early-stage breast cancer: a qualitative analysis of interviews with patients and patient advocates.
Facilitators and barriers to reducing chemotherapy for early-stage breast cancer: a qualitative analysis of interviews with patients and patient advocates.
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DOI：
10.1186/s12885-022-09189-w
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发表时间：
2022-02-04
期刊：
影响因子：
3.8
通讯作者：
Rocque GB
中科院分区：
文献类型：
--
作者：
Andrews C;Childers TC;Wiseman KD;Lawhon V;Ingram S;Smith ML;Wolff AC;Wagner L;Rocque GB
由于全身化疗和靶向化疗相结合会导致严重的不良副作用和长期健康并发症，因此人们有兴趣降低早期乳腺癌 (EBC) 患者的治疗强度。需要临床试验来确定降低治疗强度同时保持 3 年无复发生存率大于 92% 的可行性。为了招募这些试验的参与者，了解患者对减少化疗的看法非常重要。我们收集了 24 名 II-III 期乳腺癌患者和 16 名患者倡导者的定性访谈数据。访谈探讨了参与测试减少化疗量的试验的潜在障碍和促进因素。在数据收集过程中，随着 COVID-19 大流行的爆发，17 名参与者被问及 COVID-19 对他们对这些试验的兴趣的潜在影响。采访被录音和转录，研究人员使用定性内容分析来编码主导主题。 17 名参与者 (42.5%) 表示有兴趣参加减少化疗的试验。减少化疗的障碍包括（1）担心复发和无效，（2）偏好积极治疗，（3）对临床试验不感兴趣，（4）缺乏有关预期结果的信息，（5）担心后悔，以及（6）有年幼的孩子。促进者包括（1）避免身体毒性，（2）了解减少化疗的科学原理，（3）对提供者的信心，（4）持续监测和增加剂量的选择，（5）减少财务和后勤挑战，以及（6）贡献科学知识。在受访者中，几乎所有参与者都表示，在 COVID-19 的背景下，他们会更有动力降低治疗强度，主要是为了避免在接受治疗时接触病毒。在患有 EBC 的个体中，人们对通过降低化疗强度来减轻治疗相关毒性非常感兴趣。如果这些试验是根据个体患者的定制治疗和增加的益处（减少毒性、提高治疗期间的生活质量和降低长期并发症的风险）而不是取消治疗或低于标准护理的方式，那么患者将更倾向于参与测试减少化疗量的试验。在此过程中，医患关系和提供者的支持至关重要。在线版本包含可在 10.1186/s12885-022-09189-w 获取的补充材料。
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. 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. 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. 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. The online version contains supplementary material available at 10.1186/s12885-022-09189-w.
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影响因子：
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作者：
Rocque, Gabrielle;Blayney, Douglas W.;Evans, Tracey
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影响因子：
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