Mapping the Decision-Making Process for Adjuvant Endocrine Therapy for Breast Cancer

2016 ◽  
Vol 37 (1) ◽  
pp. 79-90 ◽  
Author(s):  
Louise L. Beryl ◽  
Katharine A. S. Rendle ◽  
Meghan C. Halley ◽  
Katherine A. Gillespie ◽  
Suepattra G. May ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Endocrine Therapy ◽  
Health Care Organization ◽  
Cancer Recurrence ◽  
Decisional Conflict ◽  
Adjuvant Endocrine Therapy ◽  
Decision Making Process ◽  
Care Organization ◽  
Patient Decision Making

Background. Studies show adjuvant endocrine therapy increases survival and decreases risk of breast cancer recurrence for hormone receptor–positive tumors. Yet studies also suggest that adherence rates among women taking this therapy may be as low as 50% owing largely to adverse side effects. Despite these rates, research on longitudinal patient decision making regarding this therapy is scant. Objective. We sought to map the decision-making process for women considering and initiating adjuvant endocrine therapy, paying particular attention to patterns of uncertainty and decisional change over time. Methods. A longitudinal series of semistructured interviews conducted at a multispecialty health care organization in Northern California with 35 newly diagnosed patients eligible for adjuvant endocrine therapy were analyzed. Analysis led to the identification and indexing of 3 new decision-making constructs—decisional phase, decisional direction, and decisional resolve—which were then organized using a visual matrix and examined for patterns characterizing the decision-making process. Results. Our data reveal that most patients do not make a single, discrete decision to take or not take hormone therapy but rather traverse multiple decisional states, characterized by 1) phase, 2) direction, and 3) strength of resolve. Our analysis tracks these decisional states longitudinally using a grayscale-coded matrix. Our data show that decisional resolve wavers not just when considering therapy, as the existing concept of decisional conflict suggests, but even after initiating it, which may signal future decisions to forgo therapy. Conclusions. Adjuvant endocrine therapy, like other chronic care decisions, has a longer decision-making process and implementation period. Thus, theoretical, empirical, and clinical approaches should consider further exploring the new concept and measurement of decisional resolve, as it may help to improve subsequent medication adherence.

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

2021 ◽  
Vol 28 (2) ◽  
pp. 1472-1482
Author(s):  
Leah K. Lambert ◽  
Lynda G. Balneaves ◽  
A. Fuchsia Howard ◽  
Stephen L. K. Chia ◽  
Carolyn C. Gotay
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Breast Cancer Survivors ◽  
Current System ◽  
Quality Care ◽  
Healthcare Providers ◽  
Cancer Recurrence ◽  
Adjuvant Endocrine Therapy ◽  
Structural Factors ◽  
Provider Perspectives

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.

scholarly journals Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality

2013 ◽  
Vol 108 (7) ◽  
pp. 1515-1524 ◽  
Author(s):  
B Makubate ◽  
P T Donnan ◽  
J A Dewar ◽  
A M Thompson ◽  
C McCowan
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Endocrine Therapy ◽  
Cancer Recurrence ◽  
Adjuvant Endocrine Therapy ◽  
Breast Cancer Recurrence

Health economic impact of breast cancer index (BCI) in patients with hormone responsive breast cancer (HRBC) considering extended adjuvant endocrine therapy (EET).

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 25-25
Author(s):  
Tara Beth Sanft ◽  
Alyssa Berkowitz ◽  
Brock Schroeder ◽  
Christos Hatzis ◽  
Catherine A. Schnabel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Health Economic ◽  
Cost Effectiveness ◽  
Endocrine Therapy ◽  
Cost Savings ◽  
Adjuvant Endocrine Therapy ◽  
Sensitivity Analyses ◽  
Breast Cancer Index ◽  
The Cost

25 Background: Previous research has demonstrated the benefit of EET for HRBC, however, the absolute benefit is modest and commits women to an extra 5 yrs of treatment. The Breast Cancer Index (BCI) is a gene expression-based test that has been validated to quantify the risk of late recurrence (BCI subscore) and to predict likelihood of benefit from EET (H/I subscore). We have previously shown that the use of BCI increases patient and physician confidence in decision-making and leads to fewer recommendations for EET. The current analysis extends our results to a larger sample size and presents a health economic analysis to assess the cost effectiveness of the use of BCI for EET decision-making. Methods: We developed a fact-based economic model to project the cost effectiveness of BCI using a cohort of 140 patients with stage I-III HRBC from Yale Cancer Center and University of Pittsburgh Medical Center who had completed ≥3.5 yrs of endocrine therapy and had undergone BCI testing in the context of this study. Physicians completed questionnaires to indicate their recommendations for EET before and after BCI results. Costs associated with EET, toxicity, follow-up, and metastatic recurrence were modeled over 5 yrs of extended therapy. Model inputs were based on published literature. Sensitivity analyses were performed around key inputs to estimate effects on the model. Results: Changes in EET recommendations after BCI were observed in 29% of patients, with 21% changing from recommended to not recommended, and 8% from not recommended to recommended. The projected net cost savings of BCI testing in this population of patients who are disease free at 5 yrs post-diagnosis is $5,190 per patient tested. Gross cost savings were projected to be achieved through reduced recurrence in patients receiving EET based on BCI results and decreased adverse events and comorbidities for patients with low BCI scores who did not receive EET. Conclusions: Based on the decision impact of BCI in a real-world cohort, the test is projected to be cost saving for women with early stage hormone receptor positive breast cancer who are recurrence free at 5 yrs post-diagnosis on adjuvant endocrine therapy.

scholarly journals The Impact of a Risk-Based Breast Cancer Screening Decision Aid on Initiation of Mammography Among Younger Women: Report of a Randomized Trial

2019 ◽  
Vol 4 (1) ◽  
pp. 238146831881288 ◽  
Author(s):  
Marilyn M. Schapira ◽  
Rebecca A. Hubbard ◽  
Holli H. Seitz ◽  
Emily F. Conant ◽  
Mitchell Schnall ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Decision Aid ◽  
Decisional Conflict ◽  
Individual Risk ◽  
Control Group ◽  
Decision Making Process ◽  
Strength Of Association

Background. Guidelines recommend that initiation of breast cancer screening (BCS) among women aged 40 to 49 years include a shared decision-making process. The objective of this study is to evaluate the effect of a breast cancer screening patient decision-aid (BCS-PtDA) on the strength of the relationship between individual risk and the decision to initiate BCS, knowledge, and decisional conflict. Methods. We conducted a randomized clinical trial of a BCS-PtDA that included individual risk estimates compared with usual care. Participants were women 39 to 48 years of age with no previous mammogram. Primary outcomes were strength of association between breast cancer risk and mammography uptake at 12 months, knowledge, and decisional conflict. Results. Of 204 participants, 65% were Black, the median age (interquartile range [IQR]) was 40.0 years (39.0–42.0), and median (IQR) breast cancer lifetime risk was 9.7% (9.2–11.1). Women who received mammography at 12 months had higher breast cancer lifetime risk than women who had not in both intervention (mean, 95% CI): 12.2% (10.8–13.6) versus 10.5% (9.8–11.2), P = 0.04, and control groups: 11.8% (10.4–13.1) versus 9.9% (9.2–10.6), P = 0.02. However, there was no difference between groups in the strength of association between mammography uptake and breast cancer risk ( P = 0.87). Follow-up knowledge (0–5) was greater in the intervention versus control group (mean, 95% CI): 3.84 (3.5–4.2) versus 3.17 (2.8–3.5), P = 0.01. There was no change in decisional conflict score (1–100) between the intervention versus control group (mean, 95% CI): 24.8 (19.5–30.2) versus 32.4 (25.9–39.0), P = 0.07. Conclusions. The BCS-PtDA improved knowledge but did not affect risk-based decision making regarding age of initiation of BCS. These findings indicate the complexity of changing behaviors to incorporate objective risk in the medical decision-making process.

scholarly journals Extending Adjuvant Endocrine Therapy for 10 Years: A Mixed-Methods Analysis of Women’s Decision Making in an Online Breast Cancer Forum

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 688
Author(s):  
Yolanda Eraso ◽  
Denes Stefler ◽  
Zoe Moon ◽  
Leda Rossi ◽  
Sidona Assefa
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Mixed Methods ◽  
Side Effects ◽  
Endocrine Therapy ◽  
Hormonal Therapy ◽  
Cancer Recurrence ◽  
Individual Risk ◽  
Factors Affecting ◽  
Medication Reviews

An additional 5 years of treatment with adjuvant hormonal therapy, to complete 10 years of medication, is recommended to reduce the risk of breast cancer recurrence. Yet professionals and patients should balance this benefit against side effects and toxicities. Little is known about women’s decision making regarding persistence with extended endocrine therapy. In this study, we collected data from a UK online breast cancer forum to analyse patterns of persistence and its associated factors. A mixed-methods exploratory sequential design was used, with a qualitative analysis of text (n = 61 individuals) informing the development of a quantitative instrument to statistically analyse the prevalence of the findings (n = 130). Our findings identified three different groups of women who had to make decisions regarding persistence with treatment: those about to complete 5 years of therapy, those who decided to extend treatment, and those who were initially prescribed 10 years. Factors affecting persistence were, lack of self-efficacy in managing side effects, lack of reassurance about individual risk of recurrence, and impact on quality of life. Interventions such as training of healthcare professionals including risk communication, medication reviews by clinical pharmacists, and re-planning of services in follow-up care, should better support women’s needs in extended hormonal therapy.

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