Breast Nurse Intervention to Improve Adherence to Endocrine Therapy Among Breast Cancer Patients in South Ethiopia

Abstract

Introduction Many women in rural Ethiopia do not receive adjuvant therapy following breast cancer surgery despite the majority being diagnosed with estrogen-receptor-positive breast cancer and tamoxifen being available in the country. We aimed to compare a breast nurse intervention to improve adherence to tamoxifen therapy for breast cancer patients. Methods and Materials The 8 hospitals were randomized to intervention and control sites. Between February 2018 and December 2019, patients with breast cancer were recruited after their initial surgery. The primary outcome of the study was adherence to tamoxifen therapy by evaluating 12-month medication-refill data with medication possession ratio (MPR) and using a simplified medication adherence scale (SMAQ) in a subjective assessment. Results A total of 162 patients were recruited (87 intervention and 75 control). Trained nurses delivered education and provided literacy material, gave additional empathetic counselling, phone call reminders, and monitoring of medication refill at the intervention hospitals. Adherence according to MPR at 12 months was high in both the intervention (90%) and control sites (79.3%) (P = .302). The SMAQ revealed that adherence at intervention sites was 70% compared with 44.8% in the control sites (P = .036) at 12 months. Persistence to therapy was found to be 91.2% in the intervention and 77.8% in the control sites during the one-year period (P = .010). Conclusion Breast nurses can improve cost-effective endocrine therapy adherence at peripheral hospitals in low-resource settings. We recommend such task sharing to overcome the shortage of oncologists and distances to central cancer centers.

Adherence to Oral Anticancer Medications Among Women With Breast Cancer in Africa: A Scoping Review

“…Sample sizes ranged from 26 to 250. Overall, eight studies reported operational definitions of medication adherence before assessment or measurement, 47 - 54 whereas five did not. 55 - 59 Eleven studies (85%) evaluated endocrine medications, one evaluated cytotoxic chemotherapies, 52 and one evaluated combined medications.…”

“…One randomized controlled trial (RCT) evaluated adherence-enhancing interventions. 47 The barriers and facilitators of OAM adherence and measurements are given in the Data Supplement. Five studies reported barriers only, 49 , 51 - 54 one reported facilitators only, 56 and four reported both barriers and facilitators.…”

“…According to the MMAT-Version 2018, three studies were rated as high quality, 47 , 49 , 50 six studies as average quality, 48 , 51 , 53 , 56 , 58 , 59 and the remaining four as low quality 52 , 54 , 55 , 57 (Data Supplement).…”

Intrinsic subtypes in Ethiopian breast cancer patient

“…This allows utilization of a cost-effective treatment with very little side-effects that can be administered even at primary or secondary level health facilities. A study from Ethiopia proved that a strategy involving the specialized training of "cancer nurses" to support patients during their 5 year treatment can improve adherence [37].…”

Improving Adherence to Adjuvant Endocrine Therapy in Sub-Saharan Africa: Challenges and Innovative Nurse-Driven Solutions

“…The study by Getachew et al examines the use of a multi-pronged nurse-led intervention to improve adherence to endocrine therapy in Ethiopia. 9 While the concept of oral medication adherence may appear simple, it encompasses multiple components (see Fig. 1 ).…”