title: New oral targeted therapies for metastatic breast cancer disrupt the traditional patients' management-A healthcare providers' view.
abstract: Although a cure still cannot be expected for metastatic breast cancer, thanks to progressive advances in treatments, life expectancy has been increasing over the past 15 years. This study aims to present the impact on the organisation of patients' management of newly released oral targeted therapies dedicated to metastatic breast cancer and the obstacles to their diffusion. Our work is based on the analysis of 40 semi-structured interviews, conducted with oncology healthcare professionals in three regions of France (2015-2016). It shows three main results. First, the prescription of an oral targeted therapy requires greater collaboration between healthcare professionals than traditional intravenous oncology drugs, which may be challenging. Second, there remain many barriers to the dissemination of oral targeted therapies. Third, taking an oral targeted therapy keeps the patient away from the hospital facility and asks for a strong therapeutic alliance. The management of oral targeted therapies is time-consuming for medical oncologists and disrupts the traditional care pathway. The multiplication of actors involved in patients' management reinforces the slowdown in the deployment and acceptance of therapeutic innovations. More players equal a higher risk of slowdown. Questioning and re-designing hospital organisation and management modalities towards this type of care are critical.
authors.affiliation: Université Paris-Sud/Paris Saclay, Le Kremlin-Bicêtre, France.|Laboratoire EA 1610, Faculté des sciences d'Orsay, Orsay, France.
authors.forename: E
authors.identifier: http://orcid.org/0000-0001-9679-7226
authors.initials: E
authors.lastname: Martin
authors.affiliation: Université Paris-Sud/Paris Saclay, Le Kremlin-Bicêtre, France.|Laboratoire EA 1610, Faculté des sciences d'Orsay, Orsay, France.
authors.forename: L
authors.initials: L
authors.lastname: Pourtau
authors.affiliation: Département Ambulatoire, Gustave Roussy, Villejuif, France.
authors.forename: M
authors.initials: M
authors.lastname: Di Palma
authors.affiliation: Département de Médecine Oncologique, Gustave Roussy, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Delaloge
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000188:drug therapy*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008495:Medical Oncology / Q000458:organization & administration; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents
keywords: France; care pathways; everolimus; metastatic breast cancer; oral targeted therapy; patient management; semi-structured interviews