Baylor College of Medicine, Houston, Texas.
University of Texas School of Nursing, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2024 Feb 1;118(2):443-454. doi: 10.1016/j.ijrobp.2023.08.065. Epub 2023 Oct 5.
Advances in radiation therapy have enabled the ability to deliver ablative treatments, but there has been limited application of these treatments to early-stage breast cancers with a goal of omitting surgery. The purpose of this study was to explore patient interest in pursuing nonsurgical treatment approaches for their early-stage breast cancer.
We conducted a qualitative study involving interviews with 21 patients with early-stage breast cancer who were eligible for participation in a phase 2 clinical trial offering omission of definitive surgery. Interviews were transcribed and an inductive, thematic analysis was performed by 3 independent reviewers to generate themes and subthemes.
Data analysis revealed the following factors that affected patient willingness and desire to explore nonsurgical treatment options: (1) perceptions and feelings about their cancer; (2) current quality of life and the level of support available in their daily life; (3) external conversations focusing on family members' and friends' experiences with cancer and/or cancer treatments; (4) personal health care experiences, including their current breast cancer diagnosis; (5) perceptions and feelings about their physicians; (6) conversations with their physicians about their treatment options; and (7) self-identified desire to direct care decisions. Specifically, patients verbalized fearing surgery and surgical recovery; wanting to preserve their breast(s); the prior negative surgical experiences of friends, family, and themselves; a desire to receive treatment per the latest research; wanting to match the level of treatment with the severity of their cancer; and other comorbidities as reasons for wanting to explore omitting surgery.
Our findings demonstrate an unmet need directed by patient interest to explore nonsurgical options for early-stage, biologically favorable breast cancer. These results may shape conversations around shared decision-making and clinical trial design, and result in more personalized treatment options for women with early-stage breast cancer.
放射治疗的进步使人们能够实施消融治疗，但将这些治疗方法应用于早期乳腺癌以避免手术的情况却很有限。本研究旨在探讨患者对早期乳腺癌采用非手术治疗方法的兴趣。
我们进行了一项定性研究，对 21 名有资格参加提供避免确定性手术的 2 期临床试验的早期乳腺癌患者进行了访谈。对访谈进行了转录，并由 3 位独立评审员进行了归纳、主题分析，以生成主题和子主题。
数据分析揭示了影响患者探索非手术治疗选择的意愿和愿望的以下因素：（1）对癌症的认知和感受；（2）当前的生活质量以及日常生活中可获得的支持水平；（3）重点关注家庭成员和朋友癌症经历和/或癌症治疗的外部对话；（4）个人医疗保健经历，包括当前的乳腺癌诊断；（5）对医生的认知和感受；（6）与医生就治疗选择进行的对话；以及（7）自我确定的主导护理决策的愿望。具体而言，患者表示担心手术和手术恢复；希望保留乳房；朋友、家人和自己的先前负面手术经历；希望根据最新研究接受治疗；希望将治疗水平与癌症的严重程度相匹配；以及其他合并症，这些都是他们想要探索避免手术的原因。
我们的研究结果表明，患者对探索早期、生物学有利的乳腺癌非手术选择存在未满足的需求。这些结果可能会影响围绕共同决策和临床试验设计的对话，并为早期乳腺癌女性提供更多个性化的治疗选择。
