RESUMEN
BACKGROUND: Intraoperative radiotherapy (IORT) is a therapeutic de-escalation option in older women with low-risk early breast cancer (EBC). A qualitative study was implemented to describe EBC physicians' points of view on IORT as a de-escalation option. METHODS: Recorded face-to-face and telephone semi-structured interviews were conducted among diverse physicians from seven French comprehensive cancer centers. Interview transcripts were grouped as corpus to construct a typology. Thematic analysis was performed. RESULTS: Positions toward IORT were contrasted between the 16 participating physicians. Five fully supported IORT as a de-escalation option, four were not in favor, and seven had a more reserved or neutral opinion. Points of divergence concerned treatment efficacy, treatment duration, side effects and sequelae, psychological impact, compliance with adjuvant endocrine therapy, logistical constraints, financial cost, and availability of other techniques of partial breast irradiation. Physicians in favor of IORT emphasized direct benefits for the patient, and those against pointed the lack of specific guidelines, risk of lost opportunity in older women with long life expectancy, and challenges of shared decision making. CONCLUSIONS: Despite national policies to preserve cancer patients' quality of life and increase their participation in medical decision making, therapeutic de-escalation using IORT is not consensual among physicians. Further efforts are needed to promote patient-centered care.
Asunto(s)
Neoplasias de la Mama , Humanos , Femenino , Anciano , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Calidad de Vida , Radioterapia Adyuvante/métodos , Mastectomía Segmentaria/métodos , Resultado del TratamientoRESUMEN
PURPOSE: This study aimed to investigate the use of non-conventional medicine (NCM) among long-term cancer survivors and its links with healthy behavior. METHODS: This study used data from the VICAN survey, conducted in 2015-2016 on a representative sample of French cancer survivors 5 years after diagnosis. RESULTS: Among the 4174 participants, 21.4% reported using NCM at the time of the survey, including 8.4% who reported uses not associated with cancer. The most frequently cited reasons for using NCM were to improve their physical well-being (83.0%), to strengthen their body (71.2%), to improve their emotional well-being (65.2%), and to relieve the side effects of treatment (50.7%). The NCM users who reported using NCM to cure cancer or prevent relapses (8.5% of the participants) also used NCM for other reasons. They had more often experienced cancer progression, feared a recurrence, and had a poorer quality of life because of sequelae, pain, and fatigue. They also consulted their general practitioners more frequently and had changed their lifestyle by adopting more healthy practices. CONCLUSION: The use of NCM is not an alternative but a complementary means of coping with impaired health. Further research is now required to determine whether the use of NCM reflects a lifestyle change or whether it assists survivors rather to make behavioral changes. IMPLICATIONS FOR CANCER SURVIVORS: The use of NCM should alert physicians to survivors' impaired quality of life. It might be useful to provide patients with NCM guidelines in order to inform their decision and to prevent unrealistic expectations.
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Supervivientes de Cáncer/psicología , Terapias Complementarias/estadística & datos numéricos , Conductas Relacionadas con la Salud , Estilo de Vida , Neoplasias/terapia , Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
PURPOSE: The purpose of this study was to assess the use of non-conventional medicine (NCM) in a representative sample of French patients 2 years after cancer diagnosis. METHODS: The study was based on data obtained in the VICAN survey (2012) on a representative sample of 4349 patients 2 years after cancer diagnosis. Self-reported data were collected at telephone interviews with patients. The questionnaire addressed the various types of non-conventional treatments used at the time of the survey. RESULTS: Among the participants, 16.4% reported that they used NCM, and 45.3% of this group had not used NCM before cancer diagnosis (new NCM users). Commonly, NCMs used were homeopathy (64.0%), acupuncture (22.1%), osteopathy (15.1%), herbal medicine (8.1%), diets (7.3%) and energy therapies (5.8%). NCM use was found to be significantly associated with younger age, female gender and a higher education level. Previous NCM use was significantly associated with having a managerial occupation and an expected 5-year survival rate ≥80% at diagnosis; recent NCM use was associated with cancer progression since diagnosis, impaired quality of life and higher pain reports. CONCLUSION: This is the first study on NCM use 2 years after cancer diagnosis in France. In nearly half of the NCM users, cancer diagnosis was one of the main factors which incited patients to use NCM. Apart from the NCM users' socioeconomic profile, the present results show that impaired health was a decisive factor: opting for unconventional approaches was therefore a pragmatic response to needs which conventional medicine fails to meet during the course of the disease. IMPLICATIONS FOR CANCER SURVIVORS: Better information of patients and caregivers is needed to allow access to these therapies to a larger population of survivors.
Asunto(s)
Terapias Complementarias/métodos , Neoplasias/terapia , Sobrevivientes/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Autoinforme , Encuestas y Cuestionarios , Factores de Tiempo , Adulto JovenRESUMEN
PURPOSE: Aromatase inhibitor therapy (AI) significantly improves survival in breast cancer patients. Little is known about adherence and persistence to aromatase inhibitors and about the causes of treatment discontinuation among older women. METHODS: We constituted a cohort of women over 65 receiving a first AI therapy for breast cancer between 2006 and 2008, and followed them until June 2011. Women were selected in the population-based French National Health Insurance databases, and data was collected on the basis of pharmacy refills, medical records and face-to-face interviews. Non-persistence to treatment was defined as the first treatment discontinuation lasting more than 3 consecutive months. Time to treatment discontinuation was studied using survival analysis techniques. RESULTS: Overall among the 382 selected women, non-persistence to treatment went from 8.7% (95%CI: 6.2-12.1) at 1 year, to 15.6% (95%CI: 12.2-19.8) at 2 years, 20.8% (95%CI: 16.7-25.6) at 3 years, and 24.7% (95%CI: 19.5-31.0) at 4 years. In the multivariate analysis on a sub-sample of 233 women with available data, women using complementary or alternative medicine (CAM) (HR = 3.2; 95%CI: 1.5-6.9) or suffering from comorbidities (HR = 2.2; 95%CI: 1.0-4.8) were more likely to discontinue their treatment, whereas women with polypharmacy (HR = 0.4; 95%CI: 0.2-0.91) were less likely to discontinue. In addition, 13% of the women with positive hormonal receptor status did not fill any prescription for anti-hormonal therapy. CONCLUSION: AI therapy is discontinued prematurely in a substantial portion of older patients. Some patients may use CAM not as a complementary treatment, but as an alternative to conventional medicine. Improving patient-physician communication on the use of CAM may improve hormonal therapy adherence.