Stevens Lena, Brown Zachary J, Zeh Ryan, Monsour Christina, Wells-Di Gregorio Sharla, Santry Heena, Ejaz Aslam M, Pawlik Timothy Michael, Cloyd Jordan M
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States.
World J Gastrointest Oncol. 2022 Jun 15;14(6):1175-1186. doi: 10.4251/wjgo.v14.i6.1175.
Neoadjuvant therapy (NT) has increasingly been utilized for patients with localized pancreatic ductal adenocarcinoma (PDAC). It is the recommended approach for borderline resectable (BR) and locally advanced (LA) cancers and an increasingly utilized option for potentially resectable (PR) disease. Despite its increased use, little research has focused on patient-centered metrics among patients undergoing NT, including patient experiences, preferences, and recommendations. A better understanding of all aspects of the patient experience during NT may identify opportunities to design interventions aimed at improving quality of life; it may also facilitate the completion of NT and receipt of surgery, ultimately optimizing long-term outcomes.
To understand the experience of patients initiating and receiving NT to identify opportunities to improve neoadjuvant cancer care delivery.
Semi-structured interviews of patients with localized PDAC during NT were conducted to explore their experience initiating and receiving NT. Interviews took place between August 2020 and October 2021. Due to the descriptive nature of the research, questions were open ended. Interviews were conducted over the phone, audio recorded and then transcribed. All interviews were coded by two independent researchers using NVivo 12, iteratively identifying themes until thematic saturation was achieved. An integrative approach to qualitative analysis was used, utilizing both inductive and deductive methods.
A total of 12 patients with localized PDAC were interviewed. Patients with BR ( = 7), PR ( = 2), and LA ( = 3) cancers participated in the study. All patients indicated that choosing NT was the doctor's recommendation, while most reported not being familiar with the concept of NT ( = 11) and that NT was presented as the only option ( = 8). Five themes describing the patient experience emerged: physical symptoms, emotional symptoms, coping mechanisms, access to care, and life factors. The most commonly cited recommendation for improving the experience of NT was improved education before and during NT ( = 7). Patients highlighted the need for more information on the rationale behind choosing NT prior to surgery, the anticipated surgery and its likelihood of surgery occurring after NT, as well as general information prior to starting NT treatment. The need for seeing different members of the healthcare team, including ancillary services was also frequently cited as a recommendation for improving the experience of NT ( = 5).
This study provides a framework to allow for a better understanding of the PDAC patient experience during NT and highlights opportunities to improve quality and quantity of life outcomes.
新辅助治疗（NT）越来越多地应用于局部胰腺导管腺癌（PDAC）患者。它是可切除边缘（BR）和局部晚期（LA）癌症的推荐治疗方法，也是潜在可切除（PR）疾病越来越常用的治疗选择。尽管其使用越来越广泛，但很少有研究关注接受NT治疗的患者以患者为中心的指标，包括患者的经历、偏好和建议。更好地了解NT治疗期间患者体验的各个方面，可能会发现设计旨在改善生活质量的干预措施的机会；这也可能有助于NT治疗的完成和手术的接受，最终优化长期治疗效果。
了解开始并接受NT治疗的患者的体验，以确定改善新辅助癌症护理的机会。
对NT治疗期间的局部PDAC患者进行半结构化访谈，以探讨他们开始并接受NT治疗的体验。访谈于2020年8月至2021年10月期间进行。由于研究的描述性性质，问题是开放式的。访谈通过电话进行，录音后转录。所有访谈由两名独立研究人员使用NVivo 12进行编码，反复确定主题，直到达到主题饱和。采用了一种定性分析的综合方法，同时运用归纳法和演绎法。
共访谈了12例局部PDAC患者。BR（n = 7）、PR（n = 2）和LA（n = 3）癌症患者参与了研究。所有患者均表示选择NT是医生的建议，而大多数患者报告不熟悉NT的概念（n = 11），且NT被视为唯一选择（n = 8）。出现了五个描述患者体验的主题：身体症状、情绪症状、应对机制、医疗服务可及性和生活因素。改善NT治疗体验最常被提及的建议是在NT治疗前和治疗期间加强教育（n = 7）。患者强调需要更多关于手术前选择NT的理由、预期手术及其在NT治疗后进行手术可能性的信息，以及开始NT治疗前的一般信息。经常被提及的改善NT治疗体验的建议还包括需要见到医疗团队的不同成员，包括辅助服务人员（n = 5）。
本研究提供了一个框架，以便更好地了解NT治疗期间PDAC患者的体验，并突出了改善生活质量和数量的机会。
