Lived experience and perceived advantages of therapeutic De-escalation: A qualitative study of older patients with breast cancer

Abstract

Introduction: One option for therapeutic de-escalation in older women with early breast cancer (EBC) is partial breast irradiation (PBI) instead of whole-breast irradiation (WBI) when the latter has no clear advantages. We aimed to explore the decision-making processes and the lived experiences of WBI and PBI from the perspectives of older women with EBC.

Materials and methods: Thematic content analysis was performed on qualitative data collected using narrative interviews.

Results: Twenty-two women aged 65 and over participated (ten patients who underwent WBI and twelve who underwent PBI). We identified three themes from their narratives: 1) Acceptance of a paternalistic relationship with physicians, 2) Strong need for an informed choice, and 3) PBI can help people conceal cancer-related physical marks. Narratives underlined participants' preferences for each of the two treatments and their perceptions about therapeutic de-escalation. Misconceptions about therapeutic de-escalation were observed.

Discussion: When providing information about EBC treatment options, patients' perceived burden of side effects should be considered. Moreover, eliciting the value older patients place on available breast cancer treatments, as well as their related goals and preferences, could foster their participation in the therapeutic de-escalation decision-making process.

Keywords: De-escalation; Early breast cancer; Intraoperative radiation; Lived experience; Partial breast irradiation; Patient preferences; Radiotherapy; Shared decision-making.