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

PURPOSE: Advances in radiation therapy 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 nonsurgical treatment approaches for their early-stage breast cancer. METHODS AND MATERIALS: We conducted a qualitative study involving interviews with 21 patients with early-stage breast cancer who were eligible for participation in a phase 2 clinical trial offering omission of definitive surgery. Interviews were transcribed and an inductive, thematic analysis was performed by 3 independent reviewers to generate themes and subthemes. RESULTS: Data analysis revealed the following factors that affected patient willingness and desire to explore nonsurgical 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 health care 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. CONCLUSIONS: Our findings demonstrate an unmet need directed by patient interest to explore nonsurgical options for early-stage, biologically favorable breast cancer. These results may shape conversations around shared decision-making and clinical trial design, and result in more personalized treatment options for women with early-stage breast cancer.

Frontolimbic activity and cognitive bias in major depression.

In order to explore neural activity that accompanies cognitive bias in mood disorders, the authors had clinically depressed and nondepressed controls complete a self-evaluation procedure in which they indicated whether trait words were self-descriptive. Dense-array (256-channel) electroencephalography was recorded. Greater depression and low Positive Affect were associated with decreased endorsement of favorable (Good) traits, and greater anxiety and high Negative Affect were associated with increased endorsement of unfavorable (Bad) traits. For controls, the event-related potential (ERP) showed an enhanced visual N1 for trials in which Bad traits were endorsed. For depressed participants, this N1 was attenuated, specifically for these endorsed Bad trials. A similar pattern was observed in the P2-medial frontal negativity (P2-MFN) complex, with controls showing an enhanced MFN to the endorsed Bad words, while depressed participants showed an attenuated or absent medial frontal response on these items specifically. Distributed linear-inverse source analysis of the ERP localized the N1 effect to the inferotemporal-occipital cortex and the medial frontal effect to the dorsal anterior cingulate cortex. The altered ERP responses in depressed participants may provide clues to the neurophysiological processes associated with negatively biased cognition and self-evaluation in clinical depression.