Patient Interest in Exploring Nonsurgical Treatment Approaches for Early-Stage Breast Cancer: A Qualitative Study

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IntroductionAdvances in radiotherapy 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 non-surgical treatment approaches for their early stage breast cancer. Material and MethodsWe conducted a qualitative study involving interviews with 21 patients with early stage breast cancer who were eligible for participation in a phase II clinical trial offering omission of definitive surgery. Interviews were transcribed and an inductive, thematic analysis was performed by three independent reviewers to generate themes and subthemes. ResultsData analysis revealed the following factors that impacted patient willingness and desire to explore non-surgical 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 healthcare 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. DiscussionOur findings demonstrate an unmet need directed by patient interest to explore non-surgical options for early stage, biologically favorable breast cancer. These results may shape conversations around shared decision making, clinical trial design, and result in more personalized treatment options for women with early stage breast cancer.