Patient Preference and Adherence (Dec 2022)
Advice from One Patient to Another: Qualitative Analysis of Patients’ Perspectives About Chemotherapy Initiation
Abstract
Catalina Malinowski,1 Edna Paredes,2 Ashley J Housten,3 Mariana Chavez-MacGregor2,4 1Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 3Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, USA; 4Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USACorrespondence: Mariana Chavez-MacGregor, 1400 Pressler St Unit 1444, Houston, TX, 77030, USA, Tel +1 713 563 0020, Email [email protected]: Although the association between delays in (neo)adjuvant chemotherapy initiation and adverse outcomes is well-documented, patient perspective regarding the lived experience among those with breast cancer delay is sparse. Project Start was a qualitative study designed to assess and identify the multilevel factors contributing to the barriers and facilitators of initiating chemotherapy. This report explores specific responses where patients with breast cancer provide insight and advice for newly diagnosed women on preparing for chemotherapy initiation and informs potential interventions to facilitate timely chemotherapy initiation.Patients and Methods: Women diagnosed with primary invasive breast cancer who experienced a ≥ 60-day delay in (neo)adjuvant chemotherapy initiation were included. Participants completed semi-structured interviews exploring barriers and facilitators to starting chemotherapy. Interviews were transcribed and coded to identify themes.Results: We enrolled (N = 22) participants with a median age at diagnosis of 53.5 years (range 27– 70) who identified as Latina (n = 8), Black (n = 5), and non-Latina White (n = 9). Our participants indicated that engaging their medical teams and seeking support earlier were essential to initiate 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 (eg, financial, emotional, logistical, spiritual) and suggested connecting with breast cancer survivors to overcome the complex challenges of cancer care.Conclusion: Patient perspectives regarding barriers and treatment facilitators help provide insight into the lived experience of cancer care journeys that can inform interventions to improve patient support and outcomes. We are using these results to develop a pilot study to test the acceptability and feasibility of a culturally tailored patient navigation intervention to increase self-efficacy and avoid treatment delays.Keywords: breast cancer, care delivery, chemotherapy, treatment delay, oncology, qualitative, patient perspectives
