Patient perspectives on chemotherapy de‐escalation in breast cancer

Rocque, Gabrielle Betty; Williams, Courtney; Andrews, Courtney; Childers, Timothy C.; Wiseman, Kimberly D.; Gallagher, Kathleen D.; Tung, Nadine; Balch, Alan; Lawhon, Valerie; Ingram, Stacey A.; Brown, Tamara L.; Kaufmann, Tara; Smith, Mary Lou; DeMichele, Angela; Wolff, Antonio C.; Wagner, Lynne I.

doi:10.1002/cam4.3891

Cited by 19 publications

(25 citation statements)

References 23 publications

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“…Indeed, some previous reports showed that the term 'de-escalation' may not be the most preferred term by some patients, who may feel that they will receive substandard treatments. 53,54 Patients can hold high expectations on adjuvant therapy and may prefer chemotherapy, albeit providing small benefits, when the communication of the absolute benefit is imperfect or the benefits of alternative approaches are not comprehensively articulated. [55][56][57] Fear surrounding recurrence has been reported as a major barrier to participation in clinical trials of treatment modulation.…”

Section: Clinical and Decisional Issuesmentioning

confidence: 99%

“…[55][56][57] Fear surrounding recurrence has been reported as a major barrier to participation in clinical trials of treatment modulation. 53 At the same time, the reduction of physical and financial toxicities and the description of a positive impact on daily life were attractive aspects of treatment with reduced intensity. 53 Importantly, patients' views on de-escalated treatment regimens may vary according to individual values and priorities.…”

Section: Clinical and Decisional Issuesmentioning

confidence: 99%

“…53 At the same time, the reduction of physical and financial toxicities and the description of a positive impact on daily life were attractive aspects of treatment with reduced intensity. 53 Importantly, patients' views on de-escalated treatment regimens may vary according to individual values and priorities. Some patients will focus on reducing toxicity and burden; others may be more concerned about not compromising disease control and future outcomes.…”

Section: Clinical and Decisional Issuesmentioning

confidence: 99%

“…The use of patient-centred rather than treatment-centred language has been preferred by patients, with positive reactions to words such as 'personalised', 'customised', 'tailored', and 'risk-modulated' therapies. 53 In this regard, this working group favour the terms 'modulated' or 'tailored' with the explanation that this approach will provide the best balance between optimal disease control with the least risk of harm and burden.…”

Section: Clinical and Decisional Issuesmentioning

confidence: 99%

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Risk-adapted modulation through de-intensification of cancer treatments: an ESMO classification

et al. 2022

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Section: Clinical and Decisional Issuesmentioning

confidence: 99%

Section: Clinical and Decisional Issuesmentioning

confidence: 99%

Section: Clinical and Decisional Issuesmentioning

confidence: 99%

Section: Clinical and Decisional Issuesmentioning

confidence: 99%

See 2 more Smart Citations

Risk-adapted modulation through de-intensification of cancer treatments: an ESMO classification

et al. 2022

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“…Our cross-sectional survey of women with breast cancer found that 58% of respondents would have been interested in participating in a clinical trial testing less than standard chemotherapy, the primary motivating factor being to avoid physical toxicity [6]. Remaining survey respondents expressed unwillingness to participate in such a trial, primarily due to fear of recurrence.…”

Section: Introductionmentioning

confidence: 97%

Facilitators and barriers to reducing chemotherapy for early-stage breast cancer: a qualitative analysis of interviews with patients and patient advocates

et al. 2022

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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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Examining the association among fear of COVID‐19, psychological distress, and delays in cancer care

et al. 2021

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Background: Given the high risk of COVID-19 mortality, patients with cancer may be vulnerable to fear of COVID-19, adverse psychological outcomes, and health care delays.Methods: This longitudinal study surveyed the pandemic's impact on patients with cancer (N= 1529) receiving Patient Advocate Foundation services during early and later pandemic. Generalized estimating equation with repeated measures was conducted to assess the effect of COVID-19 on psychological distress. Logistic regression with repeated measures was used to assess the effect of COVID-19 on any delays in accessing health care (e.g., specialty care doctors, laboratory, or diagnostic testing, etc.).Results: Among 1199 respondents, 94% considered themselves high risk for COVID-19. Respondents with more fear of COVID-19 had a higher mean psychological distress score (10.21; 95% confidence intervals [CI] 9.38-11.03) compared to respondents with less fear (7.55; 95% CI 6.75-8.36). Additionally, 47% reported delaying care. Respondents with more fear of COVID-19 had higher percentages of delayed care than those with less (56; 95% CI 39%-72% vs. 44%; 95% CI 28%-61%). These relationships persisted throughout the pandemic. For respondents with a COVID-19 diagnosis in their household (n = 116), distress scores were similar despite higher delays in care (58% vs. 27%) than those without COVID-19.Conclusions: Fear of COVID-19 is linked to psychological distress and delays in care among patients with cancer. Furthermore, those who are personally impacted see exacerbated cancer care delays. Timely psychosocial support and health care coordination are critical to meet increased care needs of patients with cancer during the COVID-19 pandemic.

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Patient perspectives on chemotherapy de‐escalation in breast cancer

Cited by 19 publications

References 23 publications

Risk-adapted modulation through de-intensification of cancer treatments: an ESMO classification

Risk-adapted modulation through de-intensification of cancer treatments: an ESMO classification

Facilitators and barriers to reducing chemotherapy for early-stage breast cancer: a qualitative analysis of interviews with patients and patient advocates

Examining the association among fear of COVID‐19, psychological distress, and delays in cancer care

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