Physicians’ Opinion on Intraoperative Radiotherapy as a Therapeutic De-Escalation Option in Older Women with Early Breast Cancer

Agnès Tallet (1) , Dominique Rey (2, 3) , Clémence Casanova (2, 3) , Delphine Lecourtois (2, 3) , Marie Bergeaud (4, 5) , Marc-Karim Bendiane (2, 3) , Julien Mancini (2, 6)

1 IPC - unicancer - Institut Paoli-Calmettes - unicancer marseille
2 SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
3 ISSPAM - Institut des sciences de la santé publique [Marseille]
4 UNITRAD/Groupe d'Experts - Unicancer de recherche translationnelle et développement en radiothérapie oncologique [Louviers]
5 UNICANCER
6 BiosTIC - Biostatistique et technologies de l'information et de la communication (BioSTIC) - [Hôpital de la Timone - APHM]

Background: Intraoperative radiotherapy (IORT) is a therapeutic de-escalation option in older women with low-risk early breast cancer (EBC). A qualitative study was implemented to describe EBC physicians' points of view on IORT as a de-escalation option. Methods: Recorded face-to-face and telephone semi-structured interviews were conducted among diverse physicians from seven French comprehensive cancer centers. Interview transcripts were grouped as corpus to construct a typology. Thematic analysis was performed. Results: Positions toward IORT were contrasted between the 16 participating physicians. Five fully supported IORT as a de-escalation option, four were not in favor, and seven had a more reserved or neutral opinion. Points of divergence concerned treatment efficacy, treatment duration, side effects and sequelae, psychological impact, compliance with adjuvant endocrine therapy, logistical constraints, financial cost, and availability of other techniques of partial breast irradiation. Physicians in favor of IORT emphasized direct benefits for the patient, and those against pointed the lack of specific guidelines, risk of lost opportunity in older women with long life expectancy, and challenges of shared decision making. Conclusions: Despite national policies to preserve cancer patients' quality of life and increase their participation in medical decision making, therapeutic de-escalation using IORT is not consensual among physicians. Further efforts are needed to promote patient-centered care.

Mots clés: early breast cancer; intraoperative radiotherapy; therapeutic de-escalation; patientcentered care; shared decision-making

Domaines: Santé publique et épidémiologie

Agnès Tallet, Dominique Rey, Clémence Casanova, Delphine Lecourtois, Marie Bergeaud, et al.. Physicians’ Opinion on Intraoperative Radiotherapy as a Therapeutic De-Escalation Option in Older Women with Early Breast Cancer. Current Oncology, 2023, 30, pp.2812 - 2824. ⟨10.3390/curroncol30030214⟩. ⟨inserm-04547134⟩