Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy

Abstract

Purpose To explore how symptoms and psychosocial factors are related to intentional and unintentional non-adherent medication taking behaviors. Methods Included were postmenopausal women with hormone receptor positive, stage I-IIIA breast cancer, who had completed surgery, chemotherapy, and radiation, and were taking endocrine therapy. Self-administered, standardized measures were completed during a routine clinic visit: Brief Fatigue Inventory, Brief Pain Inventory, Menopause Specific Quality of Life Questionnaire, Functional Assessment of Cancer Therapy General and Neurotoxicity scales, and Self-Efficacy for Appropriate Medication Use Scale. Regression analyses were performed to determine the degree to which demographic, medical, symptom, and psychosocial variables, explain intentional, such as changing one’s doses or stopping medication, and unintentional, such as forgetting to take one’s medication, non-adherent behaviors. Results Participants were 112 women: mean age 64 (SD=9) years; 81% white; mean time from surgery 40 (SD=28) months; 49% received chemotherapy (39% including a taxane); mean time on endocrine therapy, 35 (SD=29.6) months; 82% taking an aromatase inhibitor. Intentional and unintentional non-adherent behaviors were described in 33.9% and 58.9% of participants, respectively. Multivariate analysis showed that higher self-efficacy for taking medication was associated with lower levels of unintentional (p=0.002) and intentional (p=0.004) non-adherent behaviors. The presence of symptoms (p=0.03) and lower self-efficacy for physician communication (p=0.009) were associated with higher levels of intentional non-adherent behaviors. Conclusions These results suggest that women who report greater symptoms, lower self-efficacy for communicating with their physician, and lower self-efficacy for taking their medication are more likely to engage in both intentional and unintentional non-adherent behaviors.

Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer

“…Several other publications have highlighted the importance of patient-physician communication for adherence to treatment recommendations and patients' decisions about treatment. [43][44][45] In combination with our finding that nonadherent behaviors are associated with less confidence in the ET decision, those results highlight the need to identify such hurdles early and develop decision aids to help to ensure young patients' confidence in their decision to take ET.…”

More than just side‐effects: The role of clinical and psychosocial factors in non‐adherence to tamoxifen

“…Women who were White were less likely to be non‐adherent than women who were not White; however, the proportion of women of other ethnicities was small. Women who were older had higher odds of adherence, which has also been found in previous studies (Brett et al ., ; Jacob Arriola et al ., ; Kimmick et al ., ) and may reflect the fact that young women may find have difficulties setting a routine around work or raising a family. Women who were employed had higher odds of non‐adherence, independent of the effects of age.…”

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

“…As well as following the IM framework, the intervention was based on two models of health behaviour (The Common Sense Model and the Theory of Planned Behaviour). These models were chosen as evidence has supported their use in understanding and predicting HT non-adherence [18,24,31,79]. Previous interventions to improve adherence are often not theoretically grounded or evidence based, which may contribute to the lack of efficacy seen across interventions [16,19].…”

“…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.…”