Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2022; 14(6): 1175-1186
Published online Jun 15, 2022. doi: 10.4251/wjgo.v14.i6.1175
Characterizing the patient experience during neoadjuvant therapy for pancreatic ductal adenocarcinoma: A qualitative study
Lena Stevens, Zachary J Brown, Ryan Zeh, Christina Monsour, Sharla Wells-Di Gregorio, Heena Santry, Aslam M Ejaz, Timothy Michael Pawlik, Jordan M Cloyd
Lena Stevens, Zachary J Brown, Christina Monsour, Heena Santry, Aslam M Ejaz, Timothy Michael Pawlik, Jordan M Cloyd, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Ryan Zeh, Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Sharla Wells-Di Gregorio, Department of Psychiatry, Center for Palliative Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Cloyd JM designed the research study; Stevens L, Zeh R, Monsour C and Cloyd JM performed the research; Stevens L, Brown ZJ and Cloyd JM analyzed the data and wrote the manuscript; Wells-Di Gregorio S, Santry H, Ejaz AM and Pawlik TM provided expert opinion and edits to the manuscript; and All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of The Ohio State University.
Informed consent statement: All study participants provided informed verbal consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jordan M Cloyd, MD, Assistant Professor, Doctor, Department of Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, United States. jordan.cloyd@osumc.edu
Received: January 14, 2022
Peer-review started: January 14, 2022
First decision: March 13, 2022
Revised: April 1, 2022
Accepted: May 17, 2022
Article in press: May 17, 2022
Published online: June 15, 2022
Abstract
BACKGROUND

Neoadjuvant therapy (NT) has increasingly been utilized for patients with localized pancreatic ductal adenocarcinoma (PDAC). It is the recommended approach for borderline resectable (BR) and locally advanced (LA) cancers and an increasingly utilized option for potentially resectable (PR) disease. Despite its increased use, little research has focused on patient-centered metrics among patients undergoing NT, including patient experiences, preferences, and recommendations. A better understanding of all aspects of the patient experience during NT may identify opportunities to design interventions aimed at improving quality of life; it may also facilitate the completion of NT and receipt of surgery, ultimately optimizing long-term outcomes.

AIM

To understand the experience of patients initiating and receiving NT to identify opportunities to improve neoadjuvant cancer care delivery.

METHODS

Semi-structured interviews of patients with localized PDAC during NT were conducted to explore their experience initiating and receiving NT. Interviews took place between August 2020 and October 2021. Due to the descriptive nature of the research, questions were open ended. Interviews were conducted over the phone, audio recorded and then transcribed. All interviews were coded by two independent researchers using NVivo 12, iteratively identifying themes until thematic saturation was achieved. An integrative approach to qualitative analysis was used, utilizing both inductive and deductive methods.

RESULTS

A total of 12 patients with localized PDAC were interviewed. Patients with BR (n = 7), PR (n = 2), and LA (n = 3) cancers participated in the study. All patients indicated that choosing NT was the doctor’s recommendation, while most reported not being familiar with the concept of NT (n = 11) and that NT was presented as the only option (n = 8). Five themes describing the patient experience emerged: physical symptoms, emotional symptoms, coping mechanisms, access to care, and life factors. The most commonly cited recommendation for improving the experience of NT was improved education before and during NT (n = 7). Patients highlighted the need for more information on the rationale behind choosing NT prior to surgery, the anticipated surgery and its likelihood of surgery occurring after NT, as well as general information prior to starting NT treatment. The need for seeing different members of the healthcare team, including ancillary services was also frequently cited as a recommendation for improving the experience of NT (n = 5).

CONCLUSION

This study provides a framework to allow for a better understanding of the PDAC patient experience during NT and highlights opportunities to improve quality and quantity of life outcomes.

Keywords: Pancreatic ductal adenocarcinoma, Neoadjuvant therapy, Patient experience, Patient-centered care, Quality of life, Qualitative research

Core Tip: This study aims to understand the experience of localized pancreatic ductal adenocarcinoma (PDAC) patients initiating and receiving neoadjuvant therapy (NT). Semi-structured interviews of patients with localized PDAC during NT were conducted; 12 patients were interviewed. All patients indicated that choosing NT was the doctor’s recommendation. Most reported not being familiar with the concept of NT. Five themes describing the patient experience emerged. This study provides a framework to allow for a better understanding of the patient experience and highlights opportunities to improve quality and quantity of life outcomes for patients with PDAC.