Cham Stephanie, Pozzar Rachel A, Horowitz Neil, Feltmate Colleen, Matulonis Ursula A, Lai Jennifer C, Wright Alexi A
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States.
Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
J Geriatr Oncol. 2025 Mar;16(2):102173. doi: 10.1016/j.jgo.2024.102173. Epub 2024 Dec 20.
We performed a qualitative study to explore key stakeholders' perspectives about the impact of frailty on ovarian cancer care and evaluate a candidate prehabilitation intervention.
We conducted semi-structured interviews with patient-caregiver dyads and multi-disciplinary clinicians. Patients were ≥ 50 years of age with a new diagnosis of advanced stage (III/IV) ovarian cancer who received cancer-directed treatment (chemotherapy and/or surgery) during the past year and met criteria as pre-frail or frail using the FRAIL scale. We used a semi-structured interview guide to elicit participants' views on frailty, nutrition, physical therapy, and a candidate prehabilitation intervention. We used inductive and deductive approaches to code and analyze interviews and identify emergent themes and patterns.
Ten patients and caregivers (five dyads) and 10 providers were interviewed. We identified four themes: (1) frailty screening is essential to prevent over- and under-treatment, but underused; (2) stakeholders preferred a multidisciplinary approach to providing tailored care for frail patients over a candidate prehabilitation intervention; (3) patient, family caregiver, and clinician stakeholders reported multiple barriers to prehabilitation programs, including concerns about selection bias, and (4) frail patients and family members are vulnerable and require more psychosocial support.
We identified significant barriers to prehabilitation interventions for frail patients with ovarian cancer; initiatives to increase frailty screening and provide tailored multi-disciplinary approaches may have a greater impact.
我们开展了一项定性研究，以探究关键利益相关者对虚弱对卵巢癌护理影响的看法，并评估一项候选的术前康复干预措施。
我们对患者-照顾者二元组和多学科临床医生进行了半结构化访谈。患者年龄≥50岁，新诊断为晚期（III/IV期）卵巢癌，在过去一年接受了针对癌症的治疗（化疗和/或手术），并使用FRAIL量表符合虚弱前期或虚弱标准。我们使用半结构化访谈指南，以引出参与者对虚弱、营养、物理治疗和一项候选术前康复干预措施的看法。我们采用归纳和演绎方法对访谈进行编码和分析，以识别新出现的主题和模式。
访谈了10名患者及其照顾者（5个二元组）和10名医疗服务提供者。我们确定了四个主题：（1）虚弱筛查对于防止治疗过度和治疗不足至关重要，但未得到充分利用；（2）与一项候选术前康复干预措施相比，利益相关者更倾向于采用多学科方法为虚弱患者提供量身定制的护理；（3）患者、家庭照顾者和临床医生利益相关者报告了术前康复计划的多个障碍，包括对选择偏倚的担忧；（4）虚弱患者及其家庭成员很脆弱，需要更多的心理社会支持。
我们确定了卵巢癌虚弱患者术前康复干预措施存在的重大障碍；加强虚弱筛查并提供量身定制的多学科方法的举措可能会产生更大影响。
