Identifying factors that influence the decision to reduce, delay, or discontinue treatment due to chemotherapy-induced peripheral neuropathy: A community-centered approach.
Authors: Radwan Rotana M , Hertz Daniel Louis , Hickey Erin , Vachhani Hetal Ravikumar , Lustberg Maryam B. , Bridges John F.P , Sabo Roy , Sheppard Vanessa , Salgado Teresa M. 
Published: June 2023

e13123 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, debilitating side effect of several chemotherapy agents that may necessitate treatment alteration, i.e., dose reduction, delay, or discontinuation. The decision to alter treatment requires careful consideration between the risk of compromising treatment effectiveness and the benefit of reducing CIPN. Because clinical guidelines do not provide sufficient guidance on when and how to alter treatment in patients experiencing CIPN, it is important to incorporate patients' priorities and preferences in shared decision-making so that the treatment plan aligns with desired outcomes. Currently, little is known about what factors influence the decision to alter treatment from the patient's perspective. Our aim was to identify factors influencing treatment alteration decisions in the context of metastatic breast cancer (mBC). Methods: A community-centered approach was used by engaging oncology clinicians (n = 3) and patients with mBC who experienced CIPN (n = 7). First, the research team conducted a literature review and synthesized 20 factors associated with the decision to alter treatment due to CIPN. Next, researchers presented these factors to clinician and patient stakeholders through individual and group interviews. Clinicians were consulted about the clinical accuracy and relevance of the factors. Patients were asked if factors resonated with their experiences and encouraged to suggest additional ones. To ensure validity, two researchers performed an iterative revision of factors and their descriptions after two individual interviews with patients. Further revisions happened during a group meeting with five patients to ensure that factors and descriptions appropriately described their experience and were comprehensible by others. Results: Eleven factors were identified: (1) fear of decreasing treatment effectiveness, (2) worry of looking back and regretting the decision, (3) opinion of family or friends, (4) recommendation from a medical oncologist, (5) input from other healthcare providers, (6) input from other mBC patients, (7) reduce the worsening of CIPN symptoms, (8) reduce the risk of permanent CIPN, (9) option to switch to alternative treatment less likely to cause CIPN, (10) absence of effective therapies to manage CIPN, and (11) knowledge of the risks and benefits of treatment alteration. Conclusions: Engaging community members was a successful approach to identifying 11 factors influencing treatment alteration decisions in patients experiencing CIPN. In future research, an innovative best-worst scaling (BWS) instrument will measure how patients prioritize these factors. The findings will help inform the development of a patient-centered shared decision-making tool to guide treatment decisions and optimize outcomes.