Background/Purpose: Treatment of rheumatoid arthritis (RA) in patients with cancer could potentially result in poor cancer outcomes because of immunosuppression. Adequate data for shared decision-making in patients with RA and cancer is scarce, as there are uncertainties about the risk of various RA therapies on cancer progression and recurrences. The aim of this study was to identify the beliefs, preferences, and informational needs of patients with RA and cancer with respect to the harms, benefits, and risk uncertainties of RA therapy.

Methods: We conducted individual interviews of 20 patients with RA and cancer recruited consecutively at outpatient clinics in a cancer center. We used a semi-structured guide for the interviews. We explored the following themes: i) past experiences in medical encounters, ii) beliefs and attitudes about harms and benefits of RA, and iii) decision making process about RA treatment. We conducted a thematic analysis to interpret data.

Results: Fifteen (75%) patients were female, mean age was 59.4 years (SD 10.2). Median RA duration was 11 years. Four (20%) patients had breast cancer, four (20%) had melanoma, two (10%) had lymphoma, and each of the other 10 had another different cancer. (1) Past experiences. Patients reported discussing concerns with their physicians about RA symptoms, the impact of RA treatment on RA, adverse events, interactions between RA and oncologic therapies, and discontinuation of RA treatment after cancer diagnosis. Most patients felt their concerns were addressed after the discussion with their providers. (2) Beliefs and attitudes. Few patients were concerned about the risk of cancer development or recurrence with RA treatment, and some mentioned lymphoma risk with biologics. Patients were concerned about the impact of cancer treatment on RA, RA flare-ups, and suppression of their immune system. (3) Decision making process. Most patients felt decisions were shared with their providers including discontinuing, changing, or adding new drugs. Most common decision facilitators included discussions with their physicians and their own previous experiences. Most patients would consider taking a drug to improve RA even if the effect on cancer were unknown. Informational needs included the following areas: (i) adverse events and efficacy of drugs, (ii) drug interactions, (iii) impact of RA drugs on cancer, and (iv) costs. With respect to delivery of information, many patients, but not all, found other patients’ testimonials helpful. Preferred types and formats for information included pictures, graphs, and numerical information (e.g. probabilities) on benefits and harms. Various modes of delivery were identified such as mailings, emails, websites, electronic medical records, videos, and through discussion with providers.

Conclusion: We identified important aspects related to the preferences, concerns, and informational needs in the treatment decision making process of patients with RA and cancer. Discussions with physicians were the most important factor to make decisions about RA treatment, but patients also identified other potential sources of information that could aid in this process.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/beliefs-attitudes-and-preferences-of-patients-with-rheumatoid-arthritis-ra-and-concomitant-cancer-with-respect-to-ra-therapy/