title: Exploring patient experiences of neo-adjuvant chemotherapy for breast cancer.
abstract: OBJECTIVE
  Neo-adjuvant chemotherapy is recommended for 'inoperable' locally advanced and inflammatory breast cancers. For operable breast cancers, trials indicate no survival differences between chemotherapy given pre or post-surgery. Communicating evidence based information to patients is complex and studies examining patient experiences of neo-adjuvant chemotherapy are lacking. This study aims to explore the experiences of women who received neo-adjuvant chemotherapy for breast cancer.
  
  
  METHODS
  A qualitative approach using in-depth interviews with 20 women who had completed neo-adjuvant chemotherapy for breast cancer. Interview data were analysed using thematic analysis.
  
  
  RESULTS
  The sample included a relatively young group of women, with caring responsibilities. Five main themes emerged: coping with the rapid transition from 'well' to 'ill', information needs and decision making, needing support and empathy, impact on family, and creating a new 'normal'. More support was needed towards the end of chemotherapy, when side effects were at their most toxic, and decisions about forthcoming surgery were being made. Some women were referred to psychological services, but usually when a crisis point had been reached.
  
  
  CONCLUSIONS
  Information and support would have been beneficial at key time points. This information is vital in developing services and interventions to meet the complex needs of these patients and potentially prevent late referral to psychological services. Specialist oncology nurses are able to develop empathetic relationships with patients and have the experience, knowledge and skills to inform and support women experiencing neo-adjuvant chemotherapy. Targeting key time points and maintaining relationship throughout neo-adjuvant chemotherapy would be highly beneficial.
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK. Electronic address: kbeaver@uclan.ac.uk.
authors.forename: Kinta
authors.initials: K
authors.lastname: Beaver
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK. Electronic address: Swilliamson2@uclan.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Williamson
authors.affiliation: Department of Clinical Psychology, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK. Electronic address: DRJ.Briggs@bfwhospitals.nhs.uk.
authors.forename: Jean
authors.initials: J
authors.lastname: Briggs
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology*; D017024:Chemotherapy, Adjuvant / Q000523:psychology* / Q000592:standards; D003142:Communication; D003657:Decision Making; D004739:England; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000523:psychology* / Q000592:standards; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology*
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; Interviews; Neo-adjuvant chemotherapy; Patient experiences; Pre-operative chemotherapy; Primary systemic therapy; Qualitative