Advice from one patient to another: A qualitative analysis of patients’ perspectives about chemotherapy initiation.

Abstract

255 Background: Although the association between delays in (neo)adjuvant chemotherapy initiation and adverse outcomes is well-documented, research into what those with breast cancer experience during their delay is sparse. This information can provide insight for newly diagnosed women on preparing for chemotherapy initiation and inform potential interventions to facilitate chemotherapy initiation. This study aimed to assess and identify the multilevel factors contributing to the barriers and facilitators of initiating chemotherapy. We present a qualitative exploration of patient shared experiences navigating the cancer care journey from breast cancer diagnosis to treatment activation. Methods: In this qualitative study, we included English or Spanish-speaking women diagnosed with primary invasive breast cancer who experienced chemotherapy initiation delay. We conducted semi-structured interviews exploring perceptions about individual, community, and system-level barriers and facilitators contributing to starting chemotherapy. We prompted participants to reflect on their personal experience navigating their cancer journeys from initial diagnosis to treatment initiation. Interviews were audio-recorded, transcribed verbatim, and coded using the Sort and Sift, Think and Shift qualitative approach to identify concepts and themes within and across transcripts. Results: Twenty-two participants completed semi-structured interviews and questionnaires (range 27-70 years); they identified as Latina (n = 8), Black (n = 5), and non-Latina White (n = 9). Our participants thought that engaging their medical teams and seeking support earlier was essential for their treatment journeys. They emphasized being proactive and thorough in all aspects of their journey, particularly in processing medical recommendations, communicating with medical personnel, and identifying areas of need. Although explicit insight into chemotherapy delay was rare, participants expressed the importance of beginning treatment promptly. They shared advice on acquiring support (e.g., financial, emotional, logistical, spiritual) and suggested connecting with breast cancer survivors to overcome the complex challenges of cancer care. Conclusions: Patients outlined the benefit of attaining support outside of their medical teams to overcome barriers and initiate treatment promptly. Family, friends, and connecting with breast cancer survivors were vital in achieving activation. Patient perspectives regarding barriers and treatment facilitators are an essential insight into cancer care journeys that can inform interventions to support patients and improve outcomes. We are using these results to develop a pilot study, to test the acceptability and feasibility of a culturally relevant patient navigation intervention to increase self-efficacy and avoid treatment delays.