Oncology providers’ perspectives on endocrine therapy prescribing and management

Abstract

PurposeAdjuvant endocrine therapy (ET) can reduce the risk of recurrence among females with hormone receptor-positive breast cancer. Overall, initiation and adherence to ET are suboptimal, though reasons are not well described. The study’s objective was to better understand ET decision making, prescribing, and patient management from oncology providers’ perspectives.MethodsUsing purposive sampling, we recruited oncology providers who saw five or more breast cancer patients per week (n=20). We conducted 30–45-minute telephone interviews, using a semistructured guide to elicit perspectives on ET use. We used thematic content analysis to systematically identify categories of meaning and double-coded transcripts using Atlas.ti.ResultsProviders recommend ET to all eligible patients except those with contraindications or other risk factors. Providers base their ET prescribing decisions on the patient’s menopausal status, side effects, and comorbidities. ET is typically discussed multiple times: at the onset of breast cancer treatment and in more detail after other treatment completion. Providers felt that the associated recurrence risk reduction is the most compelling argument for patients during ET decision making. While providers rarely perceived noninitiation as a problem, nonadherence was prevalent, often due to unresolvable side effects.ConclusionFrom the clinicians’ perspectives, side effects from ET are the dominant factor in nonadherence. Efforts to improve adherence should focus on strategies to minimize side effects and ensure clinicians and patients are well informed regarding optimal side effect management. This finding has important implications for novel endocrine regimens that offer improved outcomes through longer duration or more intensive therapy.

Barriers and facilitators of adjuvant hormone therapy adherence and persistence in women with breast cancer: a systematic review

“…Researchers and clinicians often assume that side effects, especially menopausal symptoms, trigger nonadherence. 71 , 72 Although some studies found a relationship between side effects and adherence/persistence, the relationship was not always supported. 73 However, studies investigating the effects of hot flushes were low to moderate quality, so further high-quality research is needed.…”

Healthcare Provider Perspectives on Adherence to Adjuvant Endocrine Therapy after Breast Cancer

“…This study provides a comprehensive portrayal of the unique challenges HCPs face in caring for women on AET. Previous qualitative research with HCPs has mainly focused on investigating a single aspect of AET-related care, such as symptom management [ 19 , 20 ] and physician prescribing patterns [ 21 ].…”

How patients experience endocrine therapy for breast cancer: an online survey of side effects, adherence, and medical team support

“…Overcoming the burden of numerous in-office visits, the increase in successful telehealth visits during the COVID-19 pandemic [ 60 ] has demonstrated that virtual platforms can be a means for these discussions. An in-person or virtual visit just prior to treatment initiation could overcome the finding that many patients do not remember having detailed discussions about potential ET-related side effects and may serve to reinforce that ET is just as important a component of treatment as surgery, chemotherapy, or radiation therapy [ 20 , 30 , 61 ]. Intermittent telehealth visits could also address patient decision resolve, as many patients re-visit their commitment to continue ET multiple times throughout the course of treatment [ 2 ].…”