Improving Adherence to Adjuvant Hormonal Therapy Among Disadvantaged Women Diagnosed with Breast Cancer in South Carolina: Proposal for a Multimethod Study (Preprint)

BACKGROUND Current clinical guidelines recommend that hormone receptor–positive breast cancer survivors take adjuvant hormonal therapy (AHT) for 5 to 10 years, following the end of definitive treatment. However, fewer than half of patients adhere to the guidelines, and suboptimal adherence to AHT is associated with an increased risk of breast cancer mortality. Research has extensively documented sociodemographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors (eg, knowledge, patient-provider communication) that can be modified and targeted by interventions. OBJECTIVE The goal of this study is to develop and test a theory-based, multilevel intervention to improve adherence to AHT among breast cancer survivors from racially and socioeconomically disadvantaged backgrounds (eg, Medicaid-insured). The specific aims are to (1) explore multilevel (eg, patient, health care system) factors that influence adherence to AHT; (2) develop a theory-based, multilevel intervention to improve adherence to AHT; and (3) pilot test and evaluate the intervention developed in Aim 2. METHODS For Aim 1, we will recruit breast cancer survivors and health care professionals to participate in semistructured interviews to gain their perspectives about barriers and facilitators to AHT use. We will conduct a directed content analysis of the Aim 1 qualitative interview data. For Aim 2, we will integrate Aim 1 findings and current literature into the design of a multilevel intervention using an Intervention Mapping approach. For Aim 3, we will recruit Medicaid-insured breast cancer survivors to assess the feasibility of the pilot intervention. RESULTS From May 2016 to July 2018, we completed interviews with 19 breast cancer survivors and 23 health care professionals in South Carolina. We will conduct a directed content analysis of the qualitative interview data. Results from this analysis will be used, in combination with current literature, to design (Aim 2) and pilot test a theory-based multilevel intervention (Aim 3) in Summer 2021. Results of the pilot are expected for Fall 2021. CONCLUSIONS This study will provide a deeper understanding of how to improve adherence to AHT, using a novel and multilevel approach, among socioeconomically disadvantaged breast cancer survivors who often experience disproportionate breast cancer mortality. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17742

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Improving Adherence to Adjuvant Hormonal Therapy Among Disadvantaged Women Diagnosed with Breast Cancer in South Carolina: Proposal for a Multimethod Study

JMIR Research Protocols ◽

10.2196/17742 ◽

2020 ◽

Vol 9 (9) ◽

pp. e17742

Author(s):

Tisha M Felder ◽

Sue P Heiney ◽

James R Hebert ◽

Daniela B Friedman ◽

Ronit Elk ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

South Carolina ◽

Cancer Survivors ◽

Health Care Professionals ◽

Breast Cancer Survivors ◽

Breast Cancer Mortality ◽

Adjuvant Hormonal Therapy ◽

Socioeconomically Disadvantaged ◽

Multilevel Intervention

Background Current clinical guidelines recommend that hormone receptor–positive breast cancer survivors take adjuvant hormonal therapy (AHT) for 5 to 10 years, following the end of definitive treatment. However, fewer than half of patients adhere to the guidelines, and suboptimal adherence to AHT is associated with an increased risk of breast cancer mortality. Research has extensively documented sociodemographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors (eg, knowledge, patient-provider communication) that can be modified and targeted by interventions. Objective The goal of this study is to develop and test a theory-based, multilevel intervention to improve adherence to AHT among breast cancer survivors from racially and socioeconomically disadvantaged backgrounds (eg, Medicaid-insured). The specific aims are to (1) explore multilevel (eg, patient, health care system) factors that influence adherence to AHT; (2) develop a theory-based, multilevel intervention to improve adherence to AHT; and (3) pilot test and evaluate the intervention developed in Aim 2. Methods For Aim 1, we will recruit breast cancer survivors and health care professionals to participate in semistructured interviews to gain their perspectives about barriers and facilitators to AHT use. We will conduct a directed content analysis of the Aim 1 qualitative interview data. For Aim 2, we will integrate Aim 1 findings and current literature into the design of a multilevel intervention using an Intervention Mapping approach. For Aim 3, we will recruit Medicaid-insured breast cancer survivors to assess the feasibility of the pilot intervention. Results From May 2016 to July 2018, we completed interviews with 19 breast cancer survivors and 23 health care professionals in South Carolina. We will conduct a directed content analysis of the qualitative interview data. Results from this analysis will be used, in combination with current literature, to design (Aim 2) and pilot test a theory-based multilevel intervention (Aim 3) in Summer 2021. Results of the pilot are expected for Fall 2021. Conclusions This study will provide a deeper understanding of how to improve adherence to AHT, using a novel and multilevel approach, among socioeconomically disadvantaged breast cancer survivors who often experience disproportionate breast cancer mortality. International Registered Report Identifier (IRRID) DERR1-10.2196/17742

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Health Care Utilization and Depression Among Breast Cancer Survivors

PsycEXTRA Dataset ◽

10.1037/e625372009-001 ◽

2009 ◽

Author(s):

Sarah R. Ormseth ◽

Narineh Hartoonian ◽

Jason E. Owen

Keyword(s):

Breast Cancer ◽

Health Care ◽

Health Care Utilization ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Care Utilization

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Perspectives of Survivorship Care Plans Among Older Breast Cancer Survivors: A Pilot Study

Cancer Control ◽

10.1177/1073274820917208 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482091720

Author(s):

Jessica L. Krok-Schoen ◽

Michelle J. Naughton ◽

Anne M. Noonan ◽

Janell Pisegna ◽

Jennifer DeSalvo ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Pilot Study ◽

Focus Groups ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Survivorship Care Plan ◽

Survivorship Care ◽

Care Providers ◽

Term Care

The Commission on Cancer’s standard 3.3 represents a paradigm shift in the care of cancer survivors, recommending that survivors receive a treatment summary and survivorship care plan (SCPs). A focus on older breast cancer survivors is needed, as they are the majority of the breast cancer population and their experiences and perspectives of SCPs is limited in the literature. This pilot study utilized a mixed methods approach (focus groups and self-report questionnaire data) to gather information on older (≥65 years) breast cancer survivors’ perspectives of their SCPs, cancer survivorship, and communication with their health-care providers. The questionnaire was completed individually by the participants prior to the focus group and contained items on basic demographics and their health status following cancer treatment. The focus groups indicated that only a minority of women actually developed a SCP. Those who developed a SCP in collaboration with their providers valued the personal care and attention received. However, some participants reported poor communication with their providers and within their health-care team, resulting in frustration and confusion. Participants’ suggestions for ideal SCPs included better education and personalization, particularly in appropriate nutrition and exercise, and managing side effects and comorbidities. Lastly, the women believed that additional long-term care resources, such as health coaches, were important in improving their survivorship. These findings provide insight into enhancing the content, communication, and application of SCPs to improve the survivorship experience of older breast cancer survivors.

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Mammography Surveillance and Mortality in Older Breast Cancer Survivors

Journal of Clinical Oncology ◽

10.1200/jco.2006.09.9572 ◽

2007 ◽

Vol 25 (21) ◽

pp. 3001-3006 ◽

Cited By ~ 85

Author(s):

Timothy L. Lash ◽

Matthew P. Fox ◽

Diana S.M. Buist ◽

Feifei Wei ◽

Terry S. Field ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Cancer Mortality ◽

Breast Cancer Survivors ◽

Care Delivery ◽

Breast Cancer Mortality ◽

The United States ◽

Stage I ◽

Early Stage Disease

Purpose There are more than 2,000,000 breast cancer survivors in the United States today. While surveillance for asymptomatic recurrence and second primary is included in consensus recommendations, the effectiveness of this surveillance has not been well characterized. Our purpose is to estimate the effectiveness of surveillance mammography in a cohort of breast cancer survivors with complete ascertainment of surveillance mammograms and negligible losses to follow-up. Patients and Methods We enrolled 1,846 stage I and II breast cancer patients who were at least 65 years old at six integrated health care delivery systems. We used medical record review and existing databases to ascertain patient, tumor, and therapy characteristics, as well as receipt of surveillance mammograms. We linked personal identifiers to the National Death Index to ascertain date and cause of death. We matched four controls to each breast cancer decedent to estimate the association between receipt of surveillance mammogram and breast cancer mortality. Results One hundred seventy-eight women died of breast cancer during 5 years of follow-up. Each additional surveillance mammogram was associated with a 0.69-fold decrease in the odds of breast cancer mortality (95% CI, 0.52 to 0.92). The protective association was strongest among women with stage I disease, those who received mastectomy, and those in the oldest age group. Conclusion Given existing recommendations for post-therapy surveillance, trials to compare surveillance with no surveillance are unlikely. This large observational study provides support for the recommendations, suggesting that receipt of surveillance mammograms reduces the rate of breast cancer mortality in older patients diagnosed with early-stage disease.

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Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review

Breast Cancer Research and Treatment ◽

10.1007/s10549-012-2114-5 ◽

2012 ◽

Vol 134 (2) ◽

pp. 459-478 ◽

Cited By ~ 297

Author(s):

Caitlin C. Murphy ◽

L. Kay Bartholomew ◽

Melissa Y. Carpentier ◽

Shirley M. Bluethmann ◽

Sally W. Vernon

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Clinical Practice ◽

Cancer Survivors ◽

Hormonal Therapy ◽

Breast Cancer Survivors ◽

Adjuvant Hormonal Therapy

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A Behavior-Modification, Clinical-Grade Mobile Application to Improve Breast Cancer Survivors' Accountability and Health Outcomes

JCO Clinical Cancer Informatics ◽

10.1200/cci.18.00054 ◽

2018 ◽

pp. 1-11 ◽

Cited By ~ 6

Author(s):

Renee Stubbins ◽

Tiancheng He ◽

Xiaohui Yu ◽

Mamta Puppala ◽

Chika F. Ezeana ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cancer Survivors ◽

Behavior Modification ◽

Technology Use ◽

Breast Cancer Survivors ◽

Health Care Team ◽

Care Team ◽

Feasibility Trial ◽

System Usability Scale

Purpose Only 34% of breast cancer survivors engage in the recommended level of physical activity because of a lack of accountability and motivation. Methodist Hospital Cancer Health Application (MOCHA) is a smartphone tool created specifically for self-reinforcement for patients with cancer through the daily accounting of activity and nutrition and direct interaction with clinical dietitians. We hypothesize that use of MOCHA will improve the accountability of breast cancer survivors and help them reach their personalized goals. Patients and Methods Women with stages I to III breast cancer who were at least 6 months post–active treatment with a body mass index (BMI) greater than 25 kg/m2 were enrolled in a 4-week feasibility trial. The primary objective was to demonstrate adherence during weeks 2 and 3 of the 4-week study period (14 days total). The secondary objective was to determine the usability of MOCHA according to the system usability scale. The exploratory objective was to determine weight loss and dietitian-participant interaction. Results We enrolled 33 breast cancer survivors who had an average BMI of 31.6 kg/m2. Twenty-five survivors completed the study, and the average number of daily uses was approximately 3.5 (range, 0 to 12) times/day; participants lost an average of 2 lbs (+4 lbs to −10.6 lbs). The average score of usability (the second objective) was 77.4, which was greater than the acceptable level. More than 90% of patients found MOCHA easy to navigate, and 84% were motivated to use MOCHA daily. Conclusion This study emphasizes the importance of technology use to improve goal adherence for patients by providing real-time feedback and accountability with the health care team. MOCHA focuses on the engagement of the health care team and is integrated into clinical workflow. Future directions will use MOCHA in a long-term behavior modification study.

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