Adjuvant endocrine therapy after breast cancer: a qualitative study of factors associated with adherence

Abstract

IntroductionDespite evidence of the efficacy of adjuvant endocrine therapy (AET) in reducing the risk of recurrence and mortality after treatment for primary breast cancer, adherence to AET is suboptimal. This study aimed to explore factors that influence adherence and nonadherence to AET following breast cancer to inform the development of supportive interventions.MethodsInterviews were conducted with 32 women who had been prescribed AET, 2–4 years following their diagnosis of breast cancer. Both adherers (n=19) and nonadherers (n=13) were recruited. The analysis was conducted using the Framework approach.ResultsFactors associated with adherence were as follows: managing side effects including information and advice on side effects and taking control of side effects, supportive relationships, and personal influences. Factors associated with nonadherence were as follows: burden of side effects, feeling unsupported, concerns about long-term AET use, regaining normality, including valuing the quality of life over length of life, and risk perception.ConclusionProvision of timely information to prepare women for the potential side effects of AET and education on medication management strategies are needed, including provision of timely and accurate information on the efficacy of AET in reducing breast cancer recurrence and on potential side effects and ways to manage these should they arise. Trust in the doctor–patient relationship and clear patient pathways for bothersome side effects and concerns with AET are important. Training and education on AET for GPs should be considered alongside novel care pathways such as primary care nurse cancer care review and community pharmacist follow-up.

Experiência Subjetiva com Medicamentos de Pacientes convivendo com o Câncer de Mama: um Fotovoz

“…Existe uma grande preocupação pelos profissionais com a adesão ao tratamento com a terapia endócrina em pacientes com câncer de mama, e vários estudos quantitativos e qualitativos com registros de baixa adesão já foram publicados 26,27,28 . Em um dos estudos, os participantes enfatizam o fardo das reações adversas experimentadas 27 . Estudo anterior identificou três comportamentos diferentes em relação à adesão ao tratamento de mulheres com câncer de mama.…”

Development of a self-management intervention to improve tamoxifen adherence in breast cancer survivors using an Intervention Mapping framework

“…Key barriers and facilitators of tamoxifen non-adherence identified by the needs assessment are shown in Table 1. More positive medication beliefs, such as higher necessity beliefs and lower concerns have consistently been associated with improved HT adherence and persistence [18,31,[33][34][35]. Recent research has also highlighted the utility of illness perceptions, defined as the beliefs that patients hold about their illness, in understanding nonadherence to tamoxifen, a finding which has been supported across other conditions [36].…”

“…For example, women who perceived higher consequences of taking tamoxifen, who thought that their likelihood of cancer recurrence was low and believed that psychological stress would cause a recurrence were more likely to be non-adherent, whereas women who believed that health behaviours caused a recurrence were less likely to be non-adherent [18,31]. Concerns about medication [18,31,33]* Specific concerns (e.g. risk of endometrial cancer)…”

“…Necessity beliefs [18,33]* [31,34,35] Illness perceptions Tamoxifen consequences [18]* Causal beliefs (psychological attributions) [18,31]*…”

“…Theory of planned behaviour -Coherence [31] Positive attitude towards tamoxifen [31] Self-efficacy for taking medication [17] † [79] †* Perceived behavioural control [18]* [31] Side effects Number / intensity of side effect experience (e.g. fatigue, vaginal dryness) [17,33]* [7,31,39] -Social support -Perceived good social support [31,[43][44][45] Perceived self-efficacy in patient/doctor relationship [80] Knowledge Lack of information about treatment [17,40,43] Information about treatment is understandable [43] Distress High levels of distress [31,46,81] -Note. *Indicates that a factor was associated with intentional non-adherence.…”