Health care use and remaining needs for support among women with breast cancer in the first 15 months after diagnosis: the role of the GP

What are the needs in oral antitumor therapy? An analysis of patients' and practitioners' preferences

Background

Since the European approval of CDK4/6 inhibitors in 2016, the treatment of patients with hormone-receptor-positive, HER2-negative metastatic breast cancer has changed significantly. Compared with chemotherapy, endocrine-based therapy has different treatment regimens and is associated with new side effects. Oral therapy aims for optimal drug efficacy and long treatment times while maintaining maximum independence and quality of life resulting in the conservation of medical staff resources.

Methods

A monocentric analysis of therapy preferences of practitioners (25 nurses and physicians) and patients (11 on endocrine monotherapy, 17 on endocrine-based therapy, and 14 on intravenous chemotherapy) was performed using specific questionnaires. Preferences were assessed using a four-point Likert scale or bidirectional response options.

Results

All patients were highly supportive of oral therapy (mean agreement score on the Likert scale 1.3, p < 0.001 vs. all other options) and a consultation interval of 4 weeks (2.0, p = 0.015 vs. 3 weeks). Practitioners also preferred oral therapy (1.4) and visits every 4 weeks (1.6). In general, patients on oral therapies reported higher compatibility of their therapy with daily life than patients on chemotherapy (1.6 and 1.7 vs. 2.6, p = 0.006). Outpatient oncology is the main source of information for all patients, mainly in case of side effects (2.0) and open questions (1.8). Regarding oral antitumor therapy regimens, patients do not show a significant preference for a specific regimen, while practitioners prefer a continuous regimen (1.6) over a 21/7 regimen (21 days on and 7 days off therapy, 2.5). Patients are likely to accept mild side effects (e.g., neutropenia, diarrhea, polyneuropathy, fatigue) and would still adhere to their initial choice of regimen (continuous or 21/7). Only when side effects occur with a severity of CTCAE grade 3 do patients prefer the regimen in which the side effects occur for a shorter period of time.

Conclusion

Patients and practitioners prefer oral antitumor therapy-both continuous and 21/7 regimens-over other application forms. Patient education and proper therapy management, supported by additional tools, contribute to the specific management of side effects and high adherence. This allows quality of life to be maintained during long-term therapy with CDK4/6 inhibitors in patients with metastatic breast cancer.

Unmet supportive care needs of breast cancer survivors: a systematic scoping review

BACKGROUND

Breast cancer is the most common type of cancer in women worldwide. Though improved treatments and prolonged overall survival, breast cancer survivors (BCSs) persistently suffer from various unmet supportive care needs (USCNs) throughout the disease. This scoping review aims to synthesize current literature regarding USCNs among BCSs.

METHODS

This study followed a scoping review framework. Articles were retrieved from Cochrane Library, PubMed, Embase, Web of Science, and Medline from inception through June 2023, as well as reference lists of relevant literature. Peer-reviewed journal articles were included if USCNs among BCSs were reported. Inclusion/exclusion criteria were adopted to screen articles' titles and abstracts as well as to entirely assess any potentially pertinent records by two independent researchers. Methodological quality was independently appraised following Joanna Briggs Institute (JBI) critical appraisal tools. Content analytic approach and meta-analysis were performed for qualitative and quantitative studies respectively. Results were reported according to the PRISMA extension for scoping reviews.

RESULTS

A total of 10,574 records were retrieved and 77 studies were included finally. The overall risk of bias was low to moderate. The self-made questionnaire was the most used instrument, followed by The Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34). A total of 16 domains of USCNs were finally identified. Social support (74%), daily activity (54%), sexual/intimacy (52%), fear of cancer recurrence/ spreading (50%), and information support (45%) were the top unmet supportive care needs. Information needs and psychological/emotional needs appeared most frequently. The USCNs was found to be significantly associated with demographic factors, disease factors, and psychological factors.

CONCLUSION

BCSs are experiencing a large number of USCNs in fearing of cancer recurrence, daily activity, sexual/intimacy, psychology and information, with proportions ranging from 45% to 74%. Substantial heterogeneity in study populations and assessment tools was observed. There is a need for further research to identify a standard evaluation tool targeted to USCNs on BCSs. Effective interventions based on guidelines should be formulated and conducted to decrease USCNs among BCSs in the future.

Conventional health care service utilization among cancer survivors that visit traditional and complementary providers in the Tromsø study: a cross-sectional study

Background

Traditional and complementary medicine (T&CM) is commonly used among cancer patients worldwide. Cancer patients in Norway mainly visit T&CM providers in addition to conventional health care services. It is not known how their utilization of T&CM providers influences their use of conventional health care services. The aim of this study was to investigate the difference between the utilization of conventional health care services among cancer survivors that visit T&CM providers and those that do not, and their associated factors.

Method

Health care service utilization data were obtained from cancer survivors 40 years and above participating in the Tromsø Study: Tromsø 7 conducted in 2015–2016. Data were collected from self-administered questionnaires. Pearson chi-square tests, Fisher exact tests, t-test, and logistic regression were used, with the significance level considered at p < 0.05.

Results

Of 1553 individuals, 10% (n = 155) reported visiting T&CM providers in the past 12 months. As both cancer survivors visiting and not visiting T&CM providers were frequent users of conventional health care, no significant differences were found in the overall use of conventional health care (98.1vs.94.5%, p = .056). Users of T&CM providers were however more likely to visit physiotherapists (40.1% vs 25%, p < .001), emergency rooms (29.2% vs 16.5%, p < .001), chiropractors (17% vs 6%, p < .001), and psychologist/psychiatrist (8.9% vs 3.4%, p < .001). They also had more frequent visits to conventional health care (11.45 vs 8.31 yearly visits, p = 0.014), particularly to general practitioners (5.21 visits vs. 3.94 visits, p = .002).

Conclusion

Results from this study show that visits to T&CM providers are associated with more visits to conventional health care services among cancer survivors. Further studies are needed to investigate the reasons for this high use behavior.

Risk factors of unmet needs among women with breast cancer in the post-treatment phase

OBJECTIVE

Unmet health care needs require additional care resources to achieve optimal patient well-being. In this nationwide study we examined associations between a number of risk factors and unmet needs after treatment among women with breast cancer, while taking into account their health care practices. We expected that more care use would be associated with lower levels of unmet needs.

METHODS

A multicenter, prospective, observational design was employed. Women with primary breast cancer completed questionnaires 6 and 15 months post-diagnosis. Medical data were retrieved from medical records. Direct and indirect associations between sociodemographic and clinical risk factors, distress, care use, and unmet needs were investigated with structural equation modeling.

RESULTS

Seven hundred forty-six participants completed both questionnaires (response rate 73.7%). The care services received were not negatively associated with the reported levels of unmet needs after treatment. Comorbidity was associated with higher physical and daily living needs. Higher age was associated with higher health system-related and informational needs. Having had chemotherapy and a mastectomy were associated with higher sexuality needs and breast cancer-specific issues, respectively. A higher level of distress was associated with higher levels of unmet need in all domains.

CONCLUSIONS

Clinicians may use these results to timely identify which women are at risk of developing specific unmet needs after treatment. Evidence-based, cost-effective (online) interventions that target distress, the most influential risk factor, should be further implemented and disseminated among patients and clinicians.