Oncology providers' perspectives on endocrine therapy prescribing and management.

Abstract

Purpose: Adjuvant 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. Methods: Using 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. Results: Providers 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. Conclusion: From 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.

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].…”

Facilitating adherence to endocrine therapy in breast cancer: stability and predictive power of treatment expectations in a 2-year prospective study

“…Although due to the correlative nature of the data, we cannot answer the question whether patients discontinue treatment because they expect their management to be ineffective or whether they discontinue first and rationalize their behavior thereafter, our findings nonetheless reinforce the importance of side-effect coping in AET. Its pivotal role considering adherence optimization has also been pointed out by both patients [ 46 , 48 ] and practitioners [ 49 ] in prior qualitative studies. Furthermore, in a trial of cognitive-behavioral therapy for vasomotor symptoms of breast cancer survivors, beliefs about coping and control of hot flushes were found to be the main mediator of how burdensome symptoms were perceived after the therapy [ 10 ].…”

Factors Associated with Endocrine Therapy Non‐Adherence in Breast Cancer Survivors

“…We used ET‐specific survey questions assessing reasons for ET non‐adherence (See online supplemental materials). These questions were based on existing medication adherence intruments and previous qualitative assessments of reasons for ET non‐adherence . Questions were cognitively tested with 12 breast cancer patients and revised iteratively based on patient input.…”

“…Previous studies have evaluated the extent of ET non‐adherence in self‐report or claims data and have assessed reasons for non‐adherence qualitatively . Qualitative studies highlight a need to improve provider communication, particularly around the benefit of ET in recurrence risk reduction and need to help patients to better manage potential ET side effects .…”

“…Previous studies have evaluated the extent of ET non‐adherence in self‐report or claims data and have assessed reasons for non‐adherence qualitatively . Qualitative studies highlight a need to improve provider communication, particularly around the benefit of ET in recurrence risk reduction and need to help patients to better manage potential ET side effects . Quantitative studies have identified a number of reasons for non‐adherence and patient characteristics associated with non‐adherence, but reasons for non‐adherence have not been mapped to thematic domains that can be targeted by potential interventions.…”