# 76P How to explain current reluctance against therapeutic de-escalation: Results of the exploratory qualitative phase of the mixed method research program CARTE therapy in older women with early breast cancer in France

M.K. Bendiane, D. Rey, A. Richard Tallet, J. Mancini

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M.K. Bendiane, D. Rey, A. Richard Tallet, J. Mancini. 76P How to explain current reluctance against therapeutic de-escalation: Results of the exploratory qualitative phase of the mixed method research program CARTE therapy in older women with early breast cancer in France. Annals of Oncology, 2022, 33, pp.S157-S158. 10.1016/j.annonc.2022.03.092. inserm-05385707

HAL Id: inserm-05385707

https://inserm.hal.science/inserm-05385707v1

Submitted on 2 Feb 2026

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76P - How explain current reluctance on therapeutic de-escalation: results of the exploratory qualitative phase of the Mixed Method Research program CARTE on Intraoperative radiotherapy in older women with early breast cancer in France.

Marc-Karim BenDiane¹, Dominique Rey¹, Marie Bergeaud², Agnès Tallet³, Julien Mancini¹,⁴

¹Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France; ²UNICANCER, Unitrad, Paris, France; ³UNICANCER, Institut Paoli-Calmettes, Marseille, France; ⁴APHM, BIOSTIC, Hop Timone, Marseille, France.

## Background

Intraoperative radiotherapy (IORT) is an effective alternative to whole-breast adjuvant radiotherapy in older women with low-risk early breast cancer (EBC), representing a therapeutic de-escalation option. However, IORT is not available in all French Comprehensive Center Care (10 on 18).

A qualitative study was implemented to describe EBC physicians' point of views on IORT as a de-escalation option and to explore their feelings about patients' information needs to discuss this.

## Methods

Recorded face-to-face or telephone semi-structured interviews were conducted among physicians. A maximum variation sampling strategy included diverse physicians from seven French comprehensive cancer centers, five of which equipped with IORT. Interviews transcripts were grouped as corpus to construct a typology. Thematic analysis was performed using two stages of coding.

## Results

Positions toward IORT were contrasted between the 16 participating physicians (including 11 radiation oncologists). Five fully supported IORT as a de-escalation option, 4 were not in favor, and 7 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, those against pointed 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, de-escalation is not systematically integrated into French medical guidelines and is not consensual among physicians. Further efforts are needed to promote patient-centered care.

<table><caption>Table: Occurrence of the physicians' arguments about IORT</caption><thead><tr><th>Arguments for or against IORT</th><th>In favor of IORT</th><th>Neither for nor against</th><th>Not in favor of IORT</th></tr></thead><tbody><tr><td><strong>Requires strict patient selection</strong></td><td>+++</td><td>++++</td><td>+</td></tr><tr><td>Non-inferiority compared to conventional radiotherapy</td><td>+++</td><td></td><td></td></tr><tr><td>Difficulty to assess the risk of local recurrence</td><td>+</td><td>+++</td><td>+</td></tr><tr><td>Higher risk of local recurrence</td><td></td><td>+++</td><td>++</td></tr><tr><td><strong>Duration of the treatment</strong></td><td>One-day treatment</td><td>+++</td><td></td></tr><tr><td>Extension of the operating time</td><td>+</td><td>+</td><td>+</td></tr><tr><td>Treatment not always definitive</td><td>+</td><td>+</td><td>+</td></tr><tr><td>Side effects and sequelae</td><td>Well-tolerated treatment with less toxicity</td><td>+++</td><td>+++</td></tr><tr><td>Psychologic al impact</td><td>But sequelae anyway</td><td>+</td><td>++</td></tr><tr><td></td><td>Negative</td><td>+</td><td>+</td></tr><tr><td><strong>Requires compliance with hormone therapy</strong></td><td>+</td><td>+</td><td>+</td></tr><tr><td>Increased logistical constraints for hospital and physicians</td><td>+</td><td>+++</td><td>++</td></tr><tr><td>Decreased logistical constraints for patients</td><td>+++</td><td>+++</td><td></td></tr><tr><td><strong>The financial cost is born by the hospital</strong></td><td></td><td>++</td><td></td></tr><tr><td><strong>Other techniques of partial breast irradiation</strong></td><td></td><td>++</td><td>+++</td></tr></tbody></table>

The number of crosses expresses the frequency of the arguments used by the physicians: very often (+++), often (++), sometimes (+++), rarely (+)