Experiences Of Breast Cancer Treatment Research Articles

Understanding Patient Experiences to Inform Future Studies to Optimize Personalization of Treatment for Early Breast Cancer

BackgroundBreast cancer treatment is multimodal, but not all patients benefit from each treatment, and many experience morbidities significantly impacting quality of life. There is increasing interest in tailoring breast cancer treatments to optimize oncological outcomes and reduce treatment burden, but it is vital that future trials focus on treatments that most impact patients. This study was designed to explore patient experiences of treatment to inform future research.MethodsAn online survey was co-developed with patient advocates to explore respondents’ experiences of breast cancer treatment. Questions included simple demographics, treatments received, and views regarding omitting treatments if that is deemed safe. The survey was circulated via social media and patient advocacy groups. Responses were summarized by using simple statistics; free text was analyzed thematically.ResultsOf the 235 participants completing the survey, 194 (82.6%) would choose to omit a specific treatment if safe to do so. The most commonly selected treatments were chemotherapy (n = 69, 35.6%) and endocrine therapy (n = 61, 31.4%) mainly due to side effects. Fewer respondents would choose to omit surgery (n = 40, 20.6%) or radiotherapy (n = 20, 10.3%). Several women commented that survival was their “absolute priority” and that high-quality evidence to support the safety of reducing treatment would be essential.ConclusionsPatients with breast cancer are individuals who may wish to optimize different components of their treatment. A portfolio of studies co-designed with patients is needed to establish an evidence base for greater treatment personalization with studies focused on reducing avoidable chemotherapy and endocrine therapy a priority.

Development of a workflow process mapping protocol to inform the implementation of regional patient navigation programs in breast oncology.

Implementing city-wide patient navigation processes that support patients across the continuum of cancer care is impeded by a lack of standardized tools to integrate workflows and reduce gaps in care. The authors present an actionable workflow process mapping protocol for navigation process planning and improvement based on methods developed for the Translating Research Into Practice study. Key stakeholders at each study site were identified through existing community partnerships, and data on each site's navigation processes were collected using mixed methods through a series of team meetings. The authors used Health Quality Ontario's Quality Improvement Guide, service design principles, and key stakeholder input to map the collected data onto a template structured according to the case-management model. Data collection and process mapping exercises resulted in a 10-step protocol that includes: 1) workflow mapping procedures to guide data collection on the series of activities performed by health care personnel that comprise a patient's navigation experience, 2) a site survey to assess program characteristics, 3) a semistructured interview guide to assess care coordination workflows, 4) a site-level swim lane workflow process mapping template, and 5) a regional high-level process mapping template to aggregate data from multiple site-level process maps. This iterative, participatory approach to data collection and process mapping can be used by improvement teams to streamline care coordination, ultimately improving the design and delivery of an evidence-based navigation model that spans multiple treatment modalities and multiple health systems in a metropolitan area. This protocol is presented as an actionable toolkit so the work may be replicated to support other quality-improvement initiatives and efforts to design truly patient-centered breast cancer treatment experiences. Evidence-based patient navigation in breast cancer care requires the integration of services through each phase of cancer treatment. The Translating Research Into Practice study aims to implement patient navigation for patients with breast cancer who are at risk for delays and are seeking care across 6 health systems in Boston, Massachusetts. The authors designed a 10-step protocol outlining procedures and tools that support a systematic assessment for health systems that want to implement breast cancer patient navigation services for patients who are at risk for treatment delays.

Breast Cancer Treatment Experiences of Witness Project of Kansas Participants

BackgroundAfrican American women continue to die at a higher rate than White women from breast cancer. Kansas has a high death rate among African American women. Their voices needed to be heard. ObjectivesThis exploratory study will ask the following questions: 1) Were African American and White women having different breast cancer treatment experiences with their health care providers? And 2) How satisfied were they with their treatment? MethodA total of 15 breast cancer survivors were recruited to participate in this qualitative research study. We conducted focus groups in two communities in the Midwest. Forty percent of the sample was White women, 53% of the sample was African American women and 7% of the sample was Hispanic/Latina. ResultsOverall six themes emerged. Generally both African American women and White women were satisfied with their health care; both felt they were treated equally by health care professionals. However, they felt that health care professionals should pay more attention to their significant others and to continue to educate young women about early detection. ConclusionsAs a result of the focus groups a gap in services emerged in educating the patient's partners about what is needed for their significant others and what role partners play in the recovery process.

Treatment experiences of Latinas after diagnosis of breast cancer.

The authors examined racial/ethnic differences in patient perspectives regarding their breast cancer treatment experiences. A weighted random sample of women newly diagnosed with breast cancer between 2013 and 2015 in Los Angeles County and Georgia were sent surveys 2 months after undergoing surgery (5080 women; 70% response rate). The analytic sample was limited to patients residing in Los Angeles County (2397 women). The pattern of visits with different specialists before surgery was found to be similar across racial/ethnic groups. Low acculturated Latinas (Latinas-LA) were less likely to report high clinician communication quality for both surgeons and medical oncologists (<69% vs >72% for all other groups; P<.05). The percentage of patients who reported high satisfaction regarding how physicians worked together was similar across racial/ethnic groups. Latinas-LA were more likely to have a low autonomy decision style (48% vs 24%-50% for all other groups; P<.001) and were more likely to report receiving too much information versus other ethnic groups (20% vs <16% for other groups; P<.001). Patients who reported a low autonomy decision style were more likely to rate the amount of information they received for the surgery decision as "too much" (16% vs 9%; P<.001). There appears to be moderate disparity in breast cancer treatment communication and decision-making experiences reported by Latinas-LA versus other groups. The approach to treatment decision making by Latinas-LA represents an important challenge to health care providers. Initiatives are needed to improve patient engagement in decision making and increase clinician awareness of these challenges in this patient population. Cancer 2017;123:3022-30. © 2017 American Cancer Society.

African American Women's Recollected Experiences of Adherence to Breast Cancer Treatment.

To explore African American women's recollected experiences of breast cancer treatment. . Qualitative description and narrative analysis. . South Carolina Oncology Associates, an outpatient oncology clinic serving rural and urban populations. . 16 African American women with breast cancer previously enrolled in the control arm (n = 93) of a completed randomized, controlled trial. . Feminist narrative analysis of in-depth individual interviews. . The authors identified three themes within the African American breast cancer survivors' recollected experiences of treatment adherence. Although little evidence was presented of shared decision making with providers, patients were committed to completing the prescribed therapies. The narratives highlighted the value of in-depth examination of patients' perspectives, particularly among minority and underserved groups. With the exception of voicing personal choice of surgical treatment, the women trusted providers' recommendations with a resolve to "just do it." Although trust may enhance treatment adherence, it may also reflect power differentials based on gender, race, education, and culture. . Nurses should listen to patients describe their experience with cancer treatment and compare the themes from this study with their patients' story. This comparison will help nurses support patients through various aspect of diagnosis and treatment.

Breast Cancer Treatment: Experiences of Changes and Social Stigma Among Thai Women in Southern Thailand.

Women with breast cancer receive different forms of treatment. Although treatment can save the lives of women, they can result in adverse physical, psychological, and social effects that can impact the women's quality of life. The objective of this study was to describe the experiences of breast cancer treatment among Thai women in southern Thailand. This study used qualitative methods (in-depth interviewing and drawings) with 20 Thai women who had been diagnosed with breast cancer. Data were analyzed using thematic analysis methods. Three themes emerged: (a) being a breast cancer patient: visible signs and adverse effects of therapy, (b) experiencing emotional chaos, and (c) experiencing social dysfunction. The women had to deal with physical body changes, emotional burden, treatment-related social stigma, and being marginalized within their own social context. Women experienced changes including social stigma after receiving breast cancer treatments. They had to manage stigma and difficulties themselves without sufficient professional support. It is important for nurses to understand such experiences so that they may support appropriate coping strategies suited to each woman. Community health nurses need to view each woman with breast cancer as a unique person and appreciate how to provide appropriate care and support based on each woman's experience with her illness and treatment.

160 Study of interaction with a group of cancer patients: guiding cancer patients through psychoeducational interventions

shameful disease. As a result, those women have encountered such traumatic experiences. The purpose of this study was to explore the experiences of breast cancer treatment among Thai women in southern Thailand. Material and Methods: Qualitative methods, comprising in-depth interviewing and drawing were used to collect data from 20 women who had breast cancer. Thematic analysis was employed to analyzed the in-depth data. Results and Discussion: Three themes emerged from the thematic analysis: (1) living as a visible being as a breast cancer patient; (2) experiencing psychological burdens; and (3) experiencing social dysfunction. Most women with breast cancer experienced visible symptoms from chemotherapy treatment such as nausea, vomiting, hair loss, fatigue and lack of appetite. For women who had one breast completely removed, they felt unbalanced and perceived their physical state as “difference” and “deviance”. This condition led to feeling of embarrassment because their image was seen as “abnormal” by others in the society. They seek ways to hide their physical appearance, improve their looks and avoid being stigmatized. Although these side effects are common symptoms that most breast cancer patients have to face with, they decrease self-worth and the quality of life of women with breast cancer. Conclusion: Breast cancer treatment including chemotherapy, radiotherapy and mastectomy treatment gave the women a feeling of overwhelming stigma because of the effects of treatment. Although individual women might have had differences in their experiences of the physical, psychological and social health dimensions, overall their quality of life was reduced. This study suggested that nurses should not only pay attention to each patient as a unique person, but also to understand how to provide appropriate care and support based on each individual’s experiences about the illness and treatment. No conflict of interest.

Breast cancer treatment among African American women in north St. Louis, Missouri.

Similar to disparities seen at the national and state levels, African American women in St. Louis, Missouri have higher breast cancer mortality rates than their Caucasian counterparts. We examined breast cancer treatment (regimens and timing) in a sample of African American breast cancer patients diagnosed between 2000 and 2008 while residing in a North St. Louis cluster (eight zip codes) of late stage at diagnosis. Data were obtained from medical record extractions of women participating in a mixed-method study of breast cancer treatment experiences. The median time between diagnosis and initiation of treatment was 27 days; 12.2% of the women had treatment delay over 60 days. These findings suggest that treatment delay and regimens are unlikely contributors to excess mortality rates for African American women diagnosed in early stages. Conflicting research findings on treatment delay may result from the inconsistent definitions of treatment delay and variations among study populations. Breast cancer treatment delay may reduce breast cancer survival; additional research is needed to better understand the points at which delays are most likely to occur and develop policies, programs, and interventions to address disparities in treatment delay. There may also be differences in treatment-related survivorship quality of life; approximately 54% of the women in this sample treated with mastectomies received breast reconstruction surgery. Despite the high reconstruction rates, most women did not receive definitive completion. African American women have higher reconstruction complication rates than Caucasian women; these data provide additional evidence to suggest a disparity in breast reconstruction outcomes by race.

Breast Cancer Treatment Experiences by Race and Location in Georgia's Women's Health Medicaid Program

BackgroundThis study seeks to understand the breast cancer treatment patterns and experiences of women enrolled in Georgia's Breast and Cervical Cancer Prevention and Treatment Act program, the Women's Health Medicaid Program (WHMP), and whether these experiences vary by race or location. MethodsWe conducted a mixed-methods analysis of WHMP breast cancer enrollees by race and urban/rural location. Quantitative analysis used a hazard rate model approach to identify differences in the timing of diagnosis, enrollment into Medicaid, and various modalities of treatment for 810 enrollees. Qualitative analysis used a systematic retrieval and review of coded data from 34 in-depth disease life history interview transcripts to a complete, focused analysis of enrollees' cancer treatment experiences. FindingsAfrican-American women began treatment, on average, 6 days later after diagnosis than White women, driven by delays of one month among African-American women with late-stage cancers. This time delay for African-American women was not significant on multivariate analysis of time from enrollment to treatment. Once enrolled in WHMP, women reported gaining access to equitable breast cancer treatment regardless of race or location, with the exception of breast reconstruction, for which some women in our sample reported barriers to care. ConclusionsThe equitable access to cancer treatment and other health services provided by WHMP to low-income, uninsured women in Georgia with breast cancer makes it a critical health care safety net program in Georgia, the need for which will continue through the implementation of the Affordable Care Act.

Saudi Arabian women’s experiences of breast cancer treatment

Howaida Saati discusses a study to explore how cultural beliefs affect patients’ responses to diagnosis and therapy, and how nurses can help improve outcomes

Surgeon-Level Variation in Patients’ Appraisals of Their Breast Cancer Treatment Experiences

While variation in breast cancer quality indicators has been studied, to date there have been no studies examining the degree of surgeon-level variation in patient-reported outcomes. The purpose of this study is to examine surgeon-level variation in patient appraisals of their breast cancer care experiences. Survey responses and clinical data from breast cancer patients reported to Detroit and Los Angeles Surveillance, Epidemiology and End Results registries from 6/2005 to 2/2007 were merged with attending surgeon surveys (1,780 patients, 291 surgeons). Primary outcomes were patient reports of access to care, care coordination, and decision satisfaction. Random-effects models examined variation due to individual surgeons for these three outcomes. Mean values on each patient-reported outcome scale were high. The amount of variation attributable to individual surgeons in the unconditional models was low to modest: 5.4% for access to care, 3.3% for care coordination, and 7.5% for decision satisfaction. Few factors were independently associated with patient reports of better access to or coordination of care, but less-acculturated Latina patients had lower decision satisfaction. Patients reported generally positive experiences with their breast cancer treatment, though we found disparities in decision satisfaction. Individual surgeons did not substantively explain the variation in any of the patient-reported outcomes.

Latina a LatinaSM: developing a breast cancer decision support intervention

Latinas have the fastest rising incidence of breast cancer. Yet, little data are available about Latinas' breast cancer treatment experiences. Aims were to: (1) identify factors in Latinas' treatment decision making and (2) develop and pilot a decision support intervention. Thirty-seven Latinas diagnosed with breast cancer participated. Qualitative data were used to identify intervention messages. Most women desired help in asking questions. Women were most concerned about chemotherapy side effects. Cultural values (e.g. personalismo, familismo) helped structure intervention messages. In phase two, participants completed a face-to-face skill-building session with a trained breast cancer survivor. Women found the intervention acceptable and reported better communication and decision-making skills. Interventions that focus on cultural strengths may improve Latinas treatment experiences and informed decision making.

Breast Cancer Treatment Experiences of Latinas in Los Angeles County

We examined breast cancer treatment experiences of and outcomes for Latinas in Los Angeles County. We conducted a population-based survey of women who were diagnosed with breast cancer between December 2001 and November 2002 (n=910) to evaluate the types of treatments received, communication with clinicians, and satisfaction. About two thirds were non-Latina White, 18.8% were African American, and 18.9% were Latina (with 11.0% preferring English and 7.9% preferring Spanish). The rest indicated other ethnic groups. Latinas who preferred Spanish were more likely to experience a delay of 3 months or more from diagnosis to surgical treatment (36.4% vs 9.1% for non-Latina Whites, 18.6% for African Americans, and 12.7%, for other Latinas, P<.001). African Americans and Latinas who preferred Spanish had very low rates of reconstruction (13.8% and 9.2%, respectively, compared with 42.1% for Whites and 34.5% for Latinas who preferred English, P=.009). Latinas who preferred Spanish had the highest odds ratio for low satisfaction. Latinas who preferred Spanish received different treatments and perceived a different treatment experience than did other cultural groups.