High-dose chemotherapy with stem cell rescue to treat stage III homologous deficient breast cancer: factors influencing clinical implementation

• Published in: BMC cancer Vol. 23; no. 1; p. 26
• Main Authors: Verbeek, Joost G E, de Jong, Vincent M T, Wijnja, Hanna M, Jager, Agnes, Linn, Sabine C, Retèl, Valesca P, van Harten, Wim H
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07-01-2023; BioMed Central; BMC
• Subjects: BRCA mutations; Breast cancer; Breast Neoplasms; Breast Neoplasms - drug therapy; Breast Neoplasms - genetics; Cancer; Care and treatment; Chemotherapy; Cost benefit analysis; Drug Therapy; Female; Health aspects; Health Personnel; Homologous Recombination; Humans; Implementation Science; Medical law; Methods; Patient outcomes; Qualitative Research; Stem cell research; Stem Cells; Translational Research; Transplantation; Treatment Outcome; Tumor staging; Netherlands; Homologous Recombination; Qualitative Research; Breast Neoplasms; Implementation Science; Drug Therapy; Translational Research
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-022-10412-x

High-dose chemotherapy with autologous stem cell rescue (HDCT) is a promising treatment for patients with stage III, HER2-negative, homologous recombination deficient (HRD) breast cancer. Clinical effectiveness and cost-effectiveness are currently under investigation in an international multicenter randomized controlled trial. To increase the chance of successful introduction of HDCT into daily clinical practice, we aimed to identify relevant factors for smooth implementation using an early comprehensive assessment framework.
This is a qualitative, multi-stakeholder, exploratory research using semi-structured interviews guided by the Constructive Technology Assessment model, which evaluates the quality of a novel health technology by clinical, economic, patient-related, and organizational factors. Stakeholders were recruited by purposeful stratified sampling and interviewed until sufficient content saturation was reached. Two researchers independently created themes, categories, and subcategories by following inductive coding steps, these were verified by a third researcher.
We interviewed 28 stakeholders between June 2019 and April 2021. In total, five overarching themes and seventeen categories were identified. Important findings for optimal implementation included the structural identification and referral of all eligible patients, early integration of supportive care, multidisciplinary collaboration between- and within hospitals, (de)centralization of treatment aspects, the provision of information for patients and healthcare professionals, and compliance to new regulation for the BRCA1-like test.
In anticipation of a positive reimbursement decision, we recommend to take the highlighted implementation factors into consideration. This might expedite and guide high-quality equitable access to HDCT for patients with stage III, HER2-negative, HRD breast cancer in the Netherlands.