Factors influencing oncologists’ prescribing hormonal therapy in women with breast cancer: a qualitative study in Córdoba, Argentina

Abstract

Background Hormonal therapy is an integral component for breast cancer treatment in women with oestrogen receptor positive tumours in early-stage and advanced cases of the disease. Little is known about what factors influence oncologists’ prescribing practices, especially non-biological factors, although this information may have important implications for understanding inequalities in health care quality and outcomes. This paper presents findings from research on factors influencing oncologists’ prescribing hormonal therapy for women with early and advanced cases of breast cancer in the city of Córdoba, Argentina. Methods A qualitative study using in-depth, semi-structured interviews with 16 oncologists was conducted. A stratified purposive sampling was used to recruit female and male participants and working at 3 health subsystems (private, social security, public). Data was analysed using the Framework approach. Results According to the respondents, factors influencing prescribing practices of hormonal therapy are varied. Women’s socio-economic status (poverty and wealth) and their level of health literacy can affect oncologists’ prescribing practices. Overall, in comparison to male, female oncologists reported more awareness of patients’ needs, more involvement in communicating drug side-effects, and in offering treatment options in private health settings. The 3 health subsystems provided a differential access to drugs and lines of hormonal treatment, which ranged from a limited availability in the public sector, to administrative restrictions imposed by the social security system, and to a lesser extent, the private sector. This happened in the backdrop of national legislation covering oncological treatments and drugs free of charge. Conclusions Addressing prescribing practices for hormonal therapy as a distinct type of breast cancer treatment (chronic care) is fundamental in the understanding of breast cancer care and can shed light on inequalities in treatments. Identifying the underlying care gaps in the prescription of hormonal therapy can help in the design of tailored interventions. Electronic supplementary material The online version of this article (10.1186/s12939-019-0936-z) contains supplementary material, which is available to authorized users.

<p>Oncologists’ perspectives on adherence/non-adherence to adjuvant endocrine therapy and management strategies in women with breast cancer</p>

“…Management strategies reported by oncologists to ensure adherence and persistence in this study appeared to differ according by gender. As reported previously during AET prescribing,24 female oncologists seemed to develop more partnership-building behaviors. The identification of patients’ depression and mood swings, as well as the nature of communication exchange (partner relationships, cosmetic concerns), reveals a more empathetic, person-centered type of communication 38,39.…”

“…This paper reports on data from a larger study of male and female oncologists’ roles and practices in AET in contexts of public/private health system providers. While findings on prescribing practices have been reported in detail elsewhere,24 this article focuses on perspectives and management strategies related to adherence. A stratified purposeful sample was used to obtain representatives of male/female oncologists working at three different health subsystems, public, private, and social security, in the city of Córdoba, Argentina.…”

“…These questions correspond to a section of the interview guide regarding adherence to treatments. These questions were preceded by a set of questions about oncologists prescribing AET by Eraso 1…”

“…The fragmented nature of Argentina’s health system, comprising the public sector (free of charge), social security (through employment), and private health insurance, poses a challenge to seamless access to cancer treatments46 despite the national coverage of free of charge, protocol-approved oncological drugs. Problems identified in relation to AET were limited availability of hormonal lines in the public sector in comparison to the private sector, difficulties in accessing expensive drugs in the social security system, and in prescribing drugs outside the protocol in the public sector 24. Although the most common drugs (TAM and anastrozole) seem to be easily accessible, it is worth noting that the population groups assisted by providers of the three-health subsystems vary in terms of their socioeconomic status (from most deprived to most affluent groups).…”

Costs of Breast Cancer Treatment Incurred by Women in Vietnam

“…Targeted therapy for HER2 + patients does not tend to be prescribed in Vietnam when it is known that patients cannot afford the treatment (personal communication). The effect of cost on doctor's prescribing behaviour and patient treatment decisions were documented elsewhere [28][29][30] and need further research in Vietnam. Polices involving higher HI coverage rate for targeted therapy and/or an OOP maximum (a cap on the amount of money that a patient pays for covered healthcare services plan/year) is likely to impact positively on access by patients to appropriate BC treatment.…”