Personal and clinical social support and adherence to adjuvant endocrine therapy among hormone receptor-positive breast cancer patients in an integrated health care system

Kroenke, Candyce H.; Hershman, Dawn L.; Gomez, Scarlett Lin; Adams, Sara R.; Eldridge, Elizabeth; Kwan, Marilyn L.; Ergas, Isaac J.; Kubo, Ai; Kushi, Lawrence H.

doi:10.1007/s10549-018-4774-2

Cited by 29 publications

(39 citation statements)

References 28 publications

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“…In-depth, time consuming and person-centered conversations about AET often occurred to ensure women understood the benefits and risks of AET, while also respecting their values and beliefs. These findings are consistent with previous research that also found women's satisfaction with clinical support [22], the quality of the patient-physician relationship [23], frequent, patient-centered communication [24,25], preparedness for the possibility of side effects and physician involvement in decisionmaking [23] were significantly correlated with greater AET adherence.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2021

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Adherence to adjuvant endocrine therapy (AET) for breast cancer is suboptimal. The purpose of this study was to: (1) explore the experiences and perspectives of healthcare providers (HCPs) in providing care to breast cancer survivors prescribed AET, (2) identify how social and structural factors influence the provision of AET-related care, and (3) ascertain HCP recommendations for optimizing AET adherence and related care. Individual, in-depth interviews were conducted with 14 HCPs using an interpretive descriptive approach to inquiry and the theoretical lens of relational autonomy. Data was analyzed using thematic and constant comparative techniques. Healthcare providers focused on four main components of AET-related care: (1) the importance of having careful conversations about AET, (2) difficulties in navigating transitions in care, (3) symptom management as a big part of their role, and (4) dealing with AET discontinuation. Recommendations to improve AET adherence focused on developing sustainable and efficient models of delivering high-quality care to women on AET. Healthcare providers play a pivotal role educating women about AET and supporting their adherence to therapy. Sustainable healthcare system innovations and new models of care that address current system gaps are needed to enhance survivorship care, AET adherence, and ultimately, reduce cancer recurrence and mortality.

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Section: Discussionsupporting

confidence: 92%

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

et al. 2021

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“…A total of 26 studies examined healthcare provider (HCP)-related factors for association with adherence (see Table 6 ) [ 25 , 29 , 31 , 32 , 41 , 44 , 45 , 49 , 50 , 51 , 56 , 60 , 62 , 65 , 67 , 70 , 71 , 72 , 73 , 75 , 79 , 81 , 84 , 85 , 86 , 87 ]. Quality of relationship with HCP was most consistently associated in univariate models (83% of the time) but less so (50% of the time) in multivariate models.…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen studies [ 25 , 31 , 34 , 41 , 52 , 56 , 65 , 73 , 74 , 77 , 79 , 80 , 84 , 86 , 88 ] examined sociocultural factors (see Table 7 ). Social support was examined 13 times, associated with adherence most of the time (78%) in univariate models and over half the time in multivariate models.…”

Section: Resultsmentioning

confidence: 99%

Potentially Modifiable Factors Associated with Adherence to Adjuvant Endocrine Therapy among Breast Cancer Survivors: A Systematic Review

Toivonen

Williamson

Carlson

et al. 2020

Cancers

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Adjuvant endocrine therapy (AET) reduces risk of breast cancer recurrence. However, suboptimal adherence and persistence to AET remain important clinical issues. Understanding factors associated with adherence may help inform efforts to improve use of AET as prescribed. The present systematic review examined potentially modifiable factors associated with adherence to AET in accordance with PRISMA guidelines (PROSPERO registration ID: CRD42019124200). All studies were included, whether factors were significantly associated with adherence or results were null. This review also accounted for the frequency with which a potentially modifiable factor was examined and whether univariate or multivariate models were used. This review also examined whether methodological or sample characteristics were associated with the likelihood of a factor being associated with AET adherence. A total of 68 articles were included. Potentially modifiable factors were grouped into six categories: side effects, attitudes toward AET, psychological factors, healthcare provider-related factors, sociocultural factors, and general/quality of life factors. Side effects were less likely to be associated with adherence in studies with retrospective or cross-sectional than prospective designs. Self-efficacy (psychological factor) and positive decisional balance (attitude toward AET) were the only potentially modifiable factors examined ≥10 times and associated with adherence or persistence ≥75% of the time in both univariate and multivariate models. Self-efficacy and decisional balance (i.e., weight of pros vs. cons) were the potentially modifiable factors most consistently associated with adherence, and hence may be worth focusing on as targets for interventions to improve AET adherence among breast cancer survivors.

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“…37 Very few studies have focused on the role of patients' supportive networks in adherence to adjuvant ET. In a recent study from a large Californian cohort, Kroenke et al 38 showed a higher risk of nonadherence with low social or clinical support. In the French cohort, Huiart et al 31 found a higher risk of early discontinuation of ET in YW with the lowest social support.…”

Section: Discussionmentioning

confidence: 98%

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

Wassermann

Gelber

Rosenberg

et al. 2019

Cancer

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BACKGROUND: Young age is a known factor associated with suboptimal adherence to endocrine therapy (ET) for adjuvant breast cancer (BC) treatment. This study was aimed at assessing nonadherent behaviors and associated factors among young women with early-stage hormone receptor-positive BC. METHODS: As part of a multicenter, prospective cohort of women with a diagnosis of BC at or under the age of 40 years, participants were surveyed 30 months after their diagnosis about adherent behaviors. Among those who reported taking ET, adherence was measured with a 3-item Likert-type scale: Do you ever forget to take your ET? If you feel worse when you take your ET, do you stop taking it? Did you take your ET exactly as directed by your doctor over the last 3 months? Women reporting at least 1 nonadherent behavior were classified as nonadherers. Variables with a P value <.20 were included in a multivariable logistic model. RESULTS: Among 384 women, 194 (51%) were classified as nonadherers. Univariate factors that retained significance in the multivariable model included educational level (odds ratio [OR], 0.50 for high vs low; P = .04), level of social support according to the Medical Outcome Study Social Support Survey (OR, 0.98 per 1 point; P = .01), and confidence with the decision regarding ET measured on a 0 to 10 numerical scale (OR, 0.63 for high vs low; P = .04). CONCLUSIONS: Findings from this study could help to identify young patients at higher risk for nonadherence. Interventions adapted to the level of education and aimed at reinforcing support and patients' confidence in their decision to take ET could improve adherence and associated outcomes in this population. Cancer 2019;125:3266-3274.

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Personal and clinical social support and adherence to adjuvant endocrine therapy among hormone receptor-positive breast cancer patients in an integrated health care system

Abstract: Women with low personal or clinical social support had higher AET non-adherence. Clinician teams may need to fill support gaps that compromise treatment adherence.

Cited by 29 publications

References 28 publications

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

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

Potentially Modifiable Factors Associated with Adherence to Adjuvant Endocrine Therapy among Breast Cancer Survivors: A Systematic Review

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

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