Women’s Beliefs on Early Adherence to Adjuvant Endocrine Therapy for Breast Cancer: A Theory-Based Qualitative Study to Guide the Development of Community Pharmacist Interventions

Abstract

Adjuvant endocrine therapy (AET) taken for a minimum of five years reduces the recurrence and mortality risks among women with hormone-sensitive breast cancer. However, adherence to AET is suboptimal. To guide the development of theory-based interventions to enhance AET adherence, we conducted a study to explore beliefs regarding early adherence to AET. This qualitative study was guided by the Theory of Planned Behavior (TPB). We conducted focus groups and individual interviews among women prescribed AET in the last two years (n = 43). The topic guide explored attitudinal (perceived advantages and disadvantages), normative (perception of approval or disapproval), and control beliefs (barriers and facilitating factors) towards adhering to AET. Thematic analysis was conducted. Most women had a positive attitude towards AET regardless of their medication-taking behavior. The principal perceived advantage was protection against a recurrence while the principal inconvenience was side effects. Almost everyone approved of the woman taking her medication. The women mentioned facilitating factors to encourage medication-taking behaviors and cope with side effects. For adherent women, having trouble establishing a routine was their main barrier to taking medication. For non-adherent women, it was side effects affecting their quality of life. These findings could inform the development of community pharmacy-based adherence interventions.

Quality of Life in Women Diagnosed with Breast Cancer after a 12-Month Treatment of Lifestyle Modifications

“…Cancer patients report declines in physical functioning, increased pain and generally reduced quality of life [10][11][12]. This can reduce compliance to oncologic treatment with adverse consequences on cancer prognosis and mortality [13,14]. Diet has been shown to improve quality of life in BC survivors [6,[15][16][17][18] and a greater adherence to the Mediterranean diet has been associated with higher physical functioning and health status in women recently diagnosed with BC [4].…”

Mediterranean diet and quality of life in women treated for breast cancer: A baseline analysis of DEDiCa multicentre trial

“…Self-perceived HRQoL may be a predictor of mortality [ 18 , 19 ] and could be influenced by dietary patterns [ 16 ]. Cancer patients report declines in physical functioning, increased pain and generally reduced quality of life [ 20 – 22 ] which could reduce compliance to oncologic treatment with potential consequences on cancer prognosis and mortality [ 23 , 24 ]. No studies investigated the association between adherence to the MedDiet and HRQoL in patients diagnosed with breast cancer albeit evidence suggests that high consumption of key components of the MedDiet such as vegetables and fruit, were positively associated with HRQoL in breast cancer survivors.…”

The Impact of Medication Side Effects on Adherence and Persistence to Hormone Therapy in Breast Cancer Survivors: A Qualitative Systematic Review and Thematic Synthesis

“…Side effects were self-reported by participants and both physical and psychological side effects from HT were reported in the included studies. The most commonly reported physical side effects were fatigue (26)(27)(28)(29)(30)(31)(32)(33), hot flashes (26,27,(29)(30)(31)(33)(34)(35)(36)(37), night sweats (29,31,33,34,37), musculoskeletal pain (25)(26)(27)29,(31)(32)(33)(34)(35)(36)(37)(38), weight gain (26)(27)(28)(29)32,33,37), alopecia (29,32,33,35,37), sexual dysfunctions including loss of sexual interest (27,…”

“…As well as restricting physical capability at work, cognitive side effects of hormone therapy (including difficulty concentrating and memory loss) made it difficult for women to focus on tasks (41). Women also described themselves as more forgetful, which was exacerbated by the interruption of sleep due to hot flushes, night sweats and joint pain (31,34,35,37). This loss of sleep was related to lack of energy for social activities and professional responsibilities (31).…”