Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France.
Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France; LPS EA 849, Aix Marseille Univ, Aix-en-Provence, France; Delegation for Clinical Research and Innovation, APHM, Marseille, France.
J Geriatr Oncol. 2022 Jun;13(5):600-605. doi: 10.1016/j.jgo.2022.01.013. Epub 2022 Feb 1.
One option for therapeutic de-escalation in older women with early breast cancer (EBC) is partial breast irradiation (PBI) instead of whole-breast irradiation (WBI) when the latter has no clear advantages. We aimed to explore the decision-making processes and the lived experiences of WBI and PBI from the perspectives of older women with EBC.
Thematic content analysis was performed on qualitative data collected using narrative interviews.
Twenty-two women aged 65 and over participated (ten patients who underwent WBI and twelve who underwent PBI). We identified three themes from their narratives: 1) Acceptance of a paternalistic relationship with physicians, 2) Strong need for an informed choice, and 3) PBI can help people conceal cancer-related physical marks. Narratives underlined participants' preferences for each of the two treatments and their perceptions about therapeutic de-escalation. Misconceptions about therapeutic de-escalation were observed.
When providing information about EBC treatment options, patients' perceived burden of side effects should be considered. Moreover, eliciting the value older patients place on available breast cancer treatments, as well as their related goals and preferences, could foster their participation in the therapeutic de-escalation decision-making process.
对于早期乳腺癌（EBC）老年女性，在全乳照射（WBI）没有明显优势的情况下，选择部分乳房照射（PBI）代替 WBI 是一种治疗降级的选择。我们旨在从 EBC 老年女性的角度探讨 WBI 和 PBI 的决策过程和真实体验。
采用叙事访谈收集定性数据，并进行主题内容分析。
22 名年龄在 65 岁及以上的女性参与了研究（10 名接受 WBI 的患者和 12 名接受 PBI 的患者）。从她们的叙述中确定了三个主题：1）接受与医生的家长式关系，2）强烈需要知情选择，3）PBI 可以帮助人们掩盖与癌症相关的身体痕迹。叙述强调了参与者对两种治疗方法的偏好以及他们对治疗降级的看法。观察到对治疗降级的误解。
在提供 EBC 治疗选择的信息时，应考虑患者对副作用的感知负担。此外，了解老年患者对现有乳腺癌治疗方法的重视程度，以及他们的相关目标和偏好，可以促进他们参与治疗降级决策过程。
