Qualitative Assessment and Pilot Study for Young Women's Intervention

Breast cancer in young women is a not a common disease, yet over 12,000 women under 40 are diagnosed with invasive breast cancer yearly in the United States alone and an additional 2,000 are diagnosed with noninvasive disease. Breast cancer is the leading cause of cancer-related deaths in women under 40, and survival rates for young women with breast cancer are lower than for their older counterparts. Further, in addition to being at higher risk of dying from breast cancer, despite often receiving more aggressive therapy, young women are at higher risk of distress both at diagnosis and in follow-up. Young women often have multiple roles and responsibilities that are harder to adjust to or get others to take on (e.g., parenting of young children, completing education, or building a career). Many young women are interested in having biologic children following treatment and are concerned about their future fertility. They also have an increased risk of harboring a genetic risk factor for breast cancer. Finally, in contrast to older women with breast cancer, who represent the majority of women with the disease, young women often feel isolated and lacking information, and they sometimes are concerned that their doctors are unsure of how to treat them. Distress may be confounded by lack of information on some of the risks they face, lack of provider awareness, information, and resources to address young women's concerns, and lack of peer support. These issues may contribute to the greater psychosocial distress seen in younger women at both diagnosis and in follow-up compared with older women. Thus, attention to these issues in younger women is warranted. Yet, research has revealed that needs of young women are not being met.

The primary goals of this study are to:

1. conduct a qualitative assessment, through focus groups and key informant interviews, of concerns facing young women with breast cancer;
2. evaluate materials developed to provide young women newly diagnosed with breast cancer information and resources regarding their unique concerns or physical activity through focus groups and a pilot study;
3. conduct a pilot study of the Young Women's Intervention (YWI) as well as a Physical Activity Intervention (PAI) at 4 unique sites (3 will use the YWI and 2 will use the PAI- DFCI will pilot both interventions, one following the other) to evaluate the process for the intervention as well as to pilot surveys.

We aim to use the findings from the focus groups, key informant interviews and pilot study to inform the larger future Young Women's Intervention (YWI) study where the YWI arm will be compared to a Physical Activity Intervention (PAI). We plan to develop, implement and test a refined exportable and sustainable education and support intervention for young women with breast cancer and their oncology providers. First, we want to conduct focus groups and key informant interviews aiming to qualitatively assess the following domains: health/medical issues (i.e. side effects, breast cancer recurrence, long-term risks, genetic issues), psychosocial issues (coping, relationship and family concerns), beauty/body image, sexual functioning, fertility concerns, and work/school issues. In addition, the focus groups will be used to review the study materials and provide constructive feedback. In order to get a more diverse view of young women's concerns, we will conduct key informant interviews by telephone with young women with a history of breast cancer recruited from various regions of the country.

Information gained through the focus groups, key informant interviews and pilot of the intervention at four diverse practices will help us discover and resolve issues related to: administering the baseline survey, follow-up survey and provider survey; ensuring that the adapted intervention meets patient and provider needs, and evaluation the implementation process. When evaluating the patient surveys, investigators will assess issues that may have posed a barrier to patients' comprehension of study questions, such as the use of jargon or difficult vocabulary. In addition to piloting patient and provider surveys for material content, we will evaluate the intervention for feasibility of recruitment and implementation. We will refine materials and methods based on our pilot experience.