What question did this study set out to answer?

This research aims to understand the journey of premenopausal breast cancer patients in joining de-escalation trials by identifying barriers, facilitators, and their expectations.

March 28, 2026Open Access

Understanding the Patient Journey: Barriers, Facilitators, and Expectations in Joining a Chemotherapy De-escalation Trial Among Premenopausal Patients with Breast Cancer

PZPetya ZyumbilevaInserm TSTanja SpanicEuropa Donna EGEmma GillandersInserm

Key Points

This research aims to understand the journey of premenopausal breast cancer patients in joining de-escalation trials by identifying barriers, facilitators, and their expectations.
Conducted focus groups with patients and healthcare professionals to explore decision-making and quality of life priorities.
Investigated themes related to emotional responses, social influences, and coping strategies in the context of trial participation.
Utilized MAXQDA software for analysis of discussions recorded from focus groups.
Identified three main themes: emotional responses to diagnosis, influences on treatment choices, and coping with side effects.
Barriers included poor emotional support, inconsistent shared decision-making, and fear of recurrence.
Recommendations for training were made to enhance communication and shared decision-making skills for patients and healthcare professionals.

Abstract

Background: De-escalation trials aim to balance clinical outcomes and quality of life (QoL), especially for premenopausal women with early breast cancer (BC), who often experience a greater treatment burden affecting their physical and psychosocial wellbeing.We sought to understand their patient journey-barriers, facilitators, and expectations-when joining de-escalation trials to inform patient-centered design and implementation.Methods: OPTIMA-YOUNG, an EU-co-funded international trial, investigates a genomic assay-guided approach to de-escalate chemotherapy in premenopausal patients with early-stage hormone receptor (HR)+ BC.A Co-creation Board of patients and healthcare professionals (HCPs) ensured stakeholder involvement throughout the trial.Focus groups (FGs) explored decision-making, needs, and QoL priorities related to joining a de-escalation clinical trial.Discussions were recorded, transcribed, anonymized, and analyzed using MAXQDA software.Results: The three FGs included 20 participants (11 patients, 9 HCPs) from 14 countries.Three themes emerged: 1) emotional and cognitive responses to BC diagnosis/treatment; 2) environmental, HCP, and social influences on choices; 3) coping with side effects and QoL challenges.Barriers to joining a de-escalation trial included limited emotional support at diagnosis, cross-country variations in shared decisionmaking, poor communication on long-term side effects, fear of recurrence, and HCPs' tendency to overtreat younger patients.Developing training for patients and HCPs was seen essential for improving communication, shared decision-making skills, and enhancing symptom management and QoL.Conclusions: This pre-implementation study identified factors at the patient, HCP, and system levels that, if addressed, could improve the trial experience.Insights helped refine the OPTIMA-YOUNG protocol and implementation plan and may inform future deescalation trials.

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Cite This Study

Zyumbileva et al. (Sun,) studied this question.

synapsesocial.com/papers/69c770418bbfbc51511e071c https://doi.org/https://doi.org/10.1016/j.breast.2026.104770

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