Patient perspectives on chemotherapy de-escalation in breast cancer.
Patient perspectives on chemotherapy de-escalation in breast cancer.
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DOI：
10.1002/cam4.3891
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发表时间：
2021-05
期刊：
影响因子：
4
通讯作者：
Wagner L
中科院分区：
文献类型：
--
作者：
Rocque GB;Williams CP;Andrews C;Childers TC;Wiseman KD;Gallagher K;Tung N;Balch A;Lawhon VM;Ingram SA;Brown T;Kaufmann T;Smith ML;DeMichele A;Wolff AC;Wagner L
鉴于乳腺癌的良好生存结果，人们对减少患者化疗的剂量感兴趣。在 COVID-19 大流行的背景下，这种方法可能更为重要。这项同时进行的混合方法研究包括（1）对患者和患者倡导者的访谈，以及（2）对由慈善非营利组织服务的乳腺癌女性进行的横断面调查。问题评估了参与降级试验的兴趣、参与的感知障碍/促进因素以及描述降级的语言。 16 名患者权益倡导者和 24 名患者接受了采访。降级的主要障碍包括担心复发、担心决定后悔、缺乏临床试验兴趣以及不喜欢关注较少的治疗。促进因素包括对医生建议的信任、毒性避免、进展监测、良好预后的感知以及对日常生活的影响。参与者报告说，COVID-19 大流行使他们更有可能在可能的情况下避免化疗。在 91 名调查受访者中，许多 (43%) 患者不愿意参加降级临床试验。最常见的参与障碍是担心复发（85%）。很少有患者 (19%) 认为临床试验本身是参与降级试验的障碍。描述化疗降阶梯最流行的术语是“最低有效化疗剂量”（53%）；没有患者喜欢“降级”这个词。对复发的恐惧是乳腺癌幸存者和患者倡导者普遍担心的问题，导致他们抵制参与降级临床试验。需要进行更多研究来了解如何让患者参与降级试验。超过 40% 的患者对参与测试降阶梯的临床试验不感兴趣，最常见的障碍是担心复发。常见的促进因素包括避免毒性、信任医生以及使用以患者为中心的语言来描述试验。
Given excellent survival outcomes in breast cancer, there is interest in de‐escalating the amount of chemotherapy delivered to patients. This approach may be of even greater importance in the setting of the COVID‐19 pandemic. This concurrent mixed methods study included (1) interviews with patients and patient advocates and (2) a cross‐sectional survey of women with breast cancer served by a charitable nonprofit organization. Questions evaluated interest in de‐escalation trial participation, perceived barriers/facilitators to participation, and language describing de‐escalation. Sixteen patient advocates and 24 patients were interviewed. Key barriers to de‐escalation included fear of recurrence, worry about decision regret, lack of clinical trial interest, and dislike for focus on less treatment. Facilitators included trust in physician recommendation, toxicity avoidance, monitoring for progression, perception of good prognosis, and impact on daily life. Participants reported that the COVID‐19 pandemic made them more likely to avoid chemotherapy if possible. Of 91 survey respondents, many (43%) patients would have been unwilling to participation in a de‐escalation clinical trial. The most commonly reported barrier to participation was fear of recurrence (85%). Few patients (19%) considered clinical trials themselves as a barrier to de‐escalation trial participation. The most popular terminology describing chemotherapy de‐escalation was “lowest effective chemotherapy dose” (53%); no patients preferred the term “de‐escalation.” Fear of recurrence is a common concern among breast cancer survivors and patient advocates, contributing to resistance to de‐escalation clinical trial participation. Additional research is needed to understand how to engage patients in de‐escalation trials. Over 40% of patients would not be interested in participating in clinical trials testing de‐escalation, with the most common barriers being fear of recurrence. Common facilitators included toxicity avoidance, trust in the physician, and use of patient‐centric language to describe the trial.
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