The Patient’s Voice: Adherence, Symptoms, and Distress Related to Adjuvant Endocrine Therapy After Breast Cancer

Jacobs, Jamie M.; Walsh, Emily A.; Park, Elyse R.; Berger, Jonathan; Peppercorn, Jeffrey; Partridge, Ann H.; Horick, Nora; Safren, Steven A.; Temel, Jennifer S.; Greer, Joseph A.

doi:10.1007/s12529-020-09908-2

Cited by 23 publications

(50 citation statements)

References 43 publications

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Section: Discussionmentioning

confidence: 99%

“…The aggravating factor in this sense is that the early discontinuation of therapy is directly associated with increased rates of recurrence and specific mortality from breast cancer, as well as higher medical costs. 3,5,16,19,20 In this study, it was possible to identify through the participants speech, the importance of them knowing about their treatments, the action of the medication in the body, possible adverse events and how to manage them. The pharmacist in this scenario placed himself as a key member in the guidelines, clarifying doubts and carrying out continuous monitoring.…”

Section: Discussionmentioning

confidence: 99%

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The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer

Pirolli

Brusamarello

Everton

et al. 2021

J Oncol Pharm Pract

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Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million worldwide and is responsible for the highest number of cancer-related deaths among women. Approximately 80% of breast cancers express on the surface of hormone receptor cells, such as progesterone and estrogen. In these cases, Adjuvant Hormonal Therapy (AHT) is indicated for a period of five to ten years and consists of taking a daily oral pill. The two most used drugs in AHT are tamoxifen and Aromatase Inhibitors. One of the issues most faced by individuals who are subjected to long periods of treatment is the lack of medication adherence and, consequently, therapeutic inefficiency. It is believed that the monitoring by the pharmacist can contribute to the reduction of errors inherent to the medication, making the treatment more effective and improving the patient's quality of life. The present study aimed to know the perception of patients who live with breast cancer and who do AHT in relation to the educational performance of the clinical pharmacist. This is a qualitative, descriptive and exploratory study, carried out from March to October 2020, with 15 women undergoing treatment at the oncology unit of a tertiary-care hospital in south of Brazil. The data were obtained through a semi-structured interview using an instrument composed of two parts, one referring to the characterization of the participants and the other with the guiding question of the research: "How do you perceive the role of the pharmacist in relation to the guidelines for the use of adjuvant hormonal therapy?". The method of theoretical saturation was used to perform the sample closure and the thematic analysis was used to analyze the data. The participants were between 32 and 74 years old, seven were on tamoxifen therapy and eight on anastrozole, ten were on the first year of treatment, two on the second and three on the third year. The themes that emerged were: pharmacist-patient interaction as a safety factor in hormone therapy; role of the pharmacist in the development of strategies for self-management of the patients during hormone therapy; and, challenges for the pharmacist in relation to hormone therapy through continued guidance. It was evident that the pharmacist's educational action encouraged the participants to carry out the treatment in a more confident and assertive manner according to their particularities and beliefs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer

Pirolli

Brusamarello

Everton

et al. 2021

J Oncol Pharm Pract

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“…Psychological distress in breast cancer can include rumination and worry about breast cancer recurrence, di culties in returning to 'normal', and distress from AET side effects (53,58,59). Higher levels of distress are associated with lower adherence (20,55), although some inconsistencies with this relationship have been observed (37,62).…”

Section: Psychological Distressmentioning

confidence: 99%

Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy

Green

French

Graham

et al. 2022

Preprint

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Background Adjuvant endocrine therapy (AET) reduces the risk of breast cancer recurrence and mortality. However, up to three-quarters of women with breast cancer do not take AET as prescribed. Existing interventions to support adherence to AET have largely been unsuccessful, and have not focused on the most salient barriers to adherence. This paper describes the process of developing four theory-based intervention components to support adherence to AET. Our aim is to provide an exemplar of intervention development using Intervention Mapping (IM) with guidance from the Multiphase Optimisation Strategy (MOST). Methods Iterative development followed the six-stage IM framework with stakeholder involvement. Stage 1 involved a literature review of barriers to adherence and existing interventions, which informed the intervention objectives outlined in Stage 2. Stage 3 identified relevant theoretical considerations and practical strategies for supporting adherence. Stage 4 used information from Stages 1-3 to develop the intervention components. Stages 5 and 6 detailed implementation considerations and evaluation plans for the intervention package, respectively. Results The final intervention package comprised four individual intervention components: Short Message Service to encourage habitual behaviours surrounding medication taking; an information leaflet to target unhelpful beliefs about AET; remotely delivered Acceptance and Commitment Therapy-based guided self-help to reduce psychological distress; and a website to support self-management of AET side-effects. Considerations for implementation within the NHS, including cost, timing and mode of delivery were outlined, with explanation as to how using MOST can aid this. We detail our plans for the final stage of IM which involve feasibility testing. This involved planning an external exploratory pilot trial using a 24−1 fractional factorial design, and a process evaluation to assess acceptability and fidelity of intervention components and overall trial experience. Conclusions We have described a systematic and logical approach for developing a theoretically informed intervention package to support medication adherence in women with breast cancer using AET. Further research to optimise the intervention package, guided by MOST, has the potential to lead to more effective, efficient and scalable interventions.

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“…To address the significant need to optimise AET adherence, improve self-management of side effects and reduce distress for patients taking AET, we iteratively developed a patient-centred, small-group, evidencebased, videoconference intervention: Symptom-Targeted Randomised Intervention for Distress and Adherence to Adjuvant Endocrine Therapy (STRIDE). Intervention development was informed by a comprehensive systematic literature review, 18 a qualitative in-depth analysis of patient experiences and preferences, 21 prior efficacious treatments 22 23 and expert feedback from oncology clinicians and behavioural scientists. We then modified intervention content and duration, logistics, and study procedures using quantitative and qualitative feedback from exit interviews with five patients who participated in a run-in phase of the intervention.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Briefly, 30 patients enrolled and engaged in semistructured interviews with trained study staff to understand experiences with and perceptions of AET, barriers and facilitators to adherence, emotional and symptom-related distress. 21 Interviews also solicited feedback from patients about their preferences for a psychosocial intervention, such as whether they preferred videoconference vs in person, individual versus group and session length, frequency and duration. Recurrent themes from these interviews informed intervention content and procedures.…”

Section: Patient and Public Involvementmentioning

confidence: 99%

Study protocol for a randomised controlled feasibility trial of a virtual intervention (STRIDE) for symptom management, distress and adherence to adjuvant endocrine therapy after breast cancer

et al. 2021

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IntroductionPatient adherence to adjuvant endocrine therapy (AET) after a diagnosis of hormone-sensitive breast cancer is poor. Previous interventions have failed to produce changes in adherence, address patient preferences or include theoretically informed and evidence-based components. Therefore, we iteratively developed a patient-centred, evidence-based, small-group, videoconference intervention to improve adherence and symptom management as well as reduce distress for patients taking AET after breast cancer (Symptom-Targeted Randomised Intervention for Distress and Adherence to Adjuvant Endocrine Therapy, STRIDE).Methods and analysisThe current study is a non-blinded, randomised, controlled, feasibility trial of STRIDE compared with a medication monitoring control group. The primary objective is to examine the feasibility and acceptability of STRIDE, while secondary objectives are to assess changes in objective and subjective adherence, symptom distress and satisfaction with AET. Patients will be recruited from the Massachusetts General Hospital Cancer Center in Boston, Massachusetts. The total number of patients accrued will be 75, with ≥60 patients completing the study. All patients will store their AET in an electronic pill bottle for objective adherence monitoring. Patients randomly assigned to the STRIDE intervention will receive 6 weekly 1-hour sessions, in small groups of two, delivered via videoconferencing by a trained mental health professional. Patients assigned to the control group will store their medication in the electronic pill bottle and receive follow-up oncology care as usual. All participants will complete self-report psychosocial measures at baseline, 12 weeks and 24 weeks postbaseline.Ethics and disseminationThe study is funded by the National Cancer Institute of the National Institutes of Health and is approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board (Protocol #18–603, V.1.2, first approval date 1 February 2019). The study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. Results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated to patient organisations and media outlets.Trial registration numberNCT03837496; Pre-results.

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The Patient’s Voice: Adherence, Symptoms, and Distress Related to Adjuvant Endocrine Therapy After Breast Cancer

Cited by 23 publications

References 43 publications

The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer

The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer

Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy

Study protocol for a randomised controlled feasibility trial of a virtual intervention (STRIDE) for symptom management, distress and adherence to adjuvant endocrine therapy after breast cancer

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