Decision making on aromatase inhibitors in breast cancer survivors 65 and older

描述(由申请人提供)：年龄本身是死于乳腺癌(BC)的一个强烈和独立的危险因素。考虑到BC是女性中最常见的癌症，也是第二致命的癌症，这一点变得非常重要。荷尔蒙阳性的BC在老年女性中尤其常见。虽然激素辅助治疗被证明可以显著降低激素敏感型BC的癌症复发和死亡率，但有证据表明，在所有65岁的女性中，约有一半停止了这种挽救生命的治疗。是什么导致了停产，人们对此知之甚少。芳香酶抑制剂(AIs)与不良副作用有关，如关节痛综合征、潮热、骨密度下降和心血管事件，这些事件可能会影响女性是否坚持治疗。尽管患有BC的老年女性的数量正在增长，而且与年轻女性相比，这一人群的死亡率高得不成比例，但很少或根本没有研究探索65岁女性决定继续或停止人工智能治疗的过程。我们的多学科研究将引发深入的叙事，以探索在65岁及以上女性的生活背景下，是什么影响了继续或停止人工智能的轨迹。我们将了解65岁的女性如何解读，并根据她们收到的关于人工智能的信息采取行动。此外，基于女性自己话语中的语用证据，我们将开发一个新颖的描述性框架，描述在女性生活背景下使用人工智能的决策过程。研究方法的选择是建构主义的基础理论，提供了一种从个人角度访问和理解意义和决策过程的方法论。对40名65岁的女性进行的大约50次个人采访将提供数据，这些女性曾接受过原发的侵袭性区域性BC治疗，正在接受人工智能治疗或已停止治疗。根据初步发现，包括PI对最近完成早期BC治疗的70岁女性的研究，制定了一份重点访谈指南。访谈指南将扩展之前的研究，包括关于接受人工授精信息的首选方式以及女性如何自我管理副作用的可修改因素的问题。此外，从癌症存活学的角度来看，采访指南包含了关于家庭和支持人员的角色的问题。这项研究将产生一个新的框架，为设计和测试适合年龄和成本效益的支持性干预措施提供基础，以改善知情决策并增加对认可机构的持续支持。我们还预计，这些发现可能会在老年肿瘤学和其他肿瘤学领域的其他背景下适用于65岁的女性，例如使用人工智能来降低健康绝经后女性首次侵袭性BC的相对风险。

DESCRIPTION (provided by applicant): Age is a strong and independent risk factor for dying from breast cancer (BC) in and of itself. This becomes highly significant when considering that BC is the most commonly diagnosed cancer in women and the second most deadly. Hormone positive BC is especially common among older women. While adjuvant hormonal treatment is proven to dramatically reduce the risk of cancer recurrence and mortality for hormone- sensitive BC, evidence shows that about half of all women 65 years discontinue this life-saving treatment. What contributes to discontinuation is poorly understood. Aromatase inhibitors (AIs) are associated with adverse side effects such as an arthralgia syndrome, hot flashes, loss of bone density, and cardiovascular events which may influence whether women persist with the treatment. Although the numbers of older women with BC is growing and this population has disproportionately high mortality rates compared with younger women, little or no research has explored the processes by which women 65 years decide to continue or discontinue AI treatment. Our multidisciplinary study will elicit in-depth narratives to explore what influences te trajectory of continuing or discontinuing an AI in the context of the lives of women 65 years and above. We will gain understanding of how women 65 years interpret, and act upon information that they have received about AIs. In addition, based on the pragmatic evidence in the women's own words, we will develop a novel descriptive framework of the decisional processes about using AIs within the context of the women's lives. The choice of research method is constructivist grounded theory, providing a methodology to access and understand meanings and decisional processes from a personal perspective. Approximately 50 personal interviews with 40 women, 65 years who were treated for primary, invasive loco-regional BC and are either taking an AI or have discontinued the treatment will supply the data. A focused interview guide has been developed from preliminary findings including the PI's research with women 70 years who recently completed treatment for early stage BC. The interview guide will extend previous research to include questions about preferred ways to receive information about AIs and what the women did to self-manage the modifiable factors of side effects. Furthermore, from the perspective of cancer survivorship science, the interview guide contains questions about the role of family and support people. A novel framework will result from this study to provide the foundation to design and test an age- appropriate and cost-effective supportive intervention to improve informed decision making and increase continuation with AIs. We also foresee that the findings may be transferable to women 65 years in other contexts of geriatric oncology and other areas of oncology such as the use of an AI to reduce the relative risk of a first time invasive BC in healthy postmenopausal women.