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 Adherence to adjuvant endocrine therapy among breast cancer survivors: a systematic review and meta-synthesis of the qualitative literature using grounded theory

2020 ◽  
Vol 28 (11) ◽  
pp. 5075-5084 ◽  
Author(s):  
Othman AlOmeir ◽  
Nilesh Patel ◽  
Parastou Donyai
Keyword(s):  
Breast Cancer ◽  
Grounded Theory ◽  
Cancer Survivors ◽  
Endocrine Therapy ◽  
Breast Cancer Survivors ◽  
Cancer Recurrence ◽  
Qualitative Studies ◽  
Adjuvant Endocrine Therapy ◽  
Medication Side

Abstract Purpose Numerous studies have examined non-adherence to adjuvant endocrine therapy in women recovering from breast cancer, but none provides a comprehensive theory to explain the challenges of long-term medication taking and resilience needed to continue. The aim of this study was to source, appraise, and synthesize data from existing qualitative studies to develop an in-depth explanatory model of non-adherence and discontinuation of hormonal medication among breast cancer survivors. Methods A comprehensive search of databases and the literature identified 24 eligible qualitative studies published 2010–2019. Quotations (n = 801) listed within these papers and the original author interpretations were synthesized using NVivo, and grounded theory methodology. Results At the beginning, knowledge about adjuvant endocrine therapy, trust in doctors, and worries and expectations, mean agreeing to medication is the only viable option, akin to a Hobson’s choice. Thereafter, women’s ability to deal with medication side-effects, knowledge and support received affect their decision to continue, akin to a horned dilemma where giving up the medication risks cancer recurrence and continuing means reduced contentment. Women stopping medication altogether question treatment necessity, search for normalcy and prioritize quality of life. Conclusion Shared experiences and understandings were uncovered by examining commonalities in existing publications. The core category explained the difficulties women face with the initial decision to accept long-term endocrine therapy and then the everyday challenges of continuing or deciding to stop treatment early. An educational tool to inform survivors and health professionals about these challenges could potentially improve women’s experience on treatment and in turn their adherence.

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

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 A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy

2017 ◽  
Vol 9 (4) ◽  
pp. 269-285 ◽  
Author(s):  
Mariana S. Sousa ◽  
Michelle Peate ◽  
Sherin Jarvis ◽  
Martha Hickey ◽  
Michael Friedlander
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Endocrine Therapy ◽  
Breast Cancer Survivors ◽  
Early Recognition ◽  
Adjuvant Endocrine Therapy ◽  
Estrogen Deprivation ◽  
Natural Menopause ◽  
Appropriate Treatment ◽  
Multiple Domains

There is increasing attention and concern about managing the adverse effects of adjuvant endocrine therapy for women with early breast cancer as the side effects of therapy influence compliance and can impair quality of life (QoL). Most side effects associated with tamoxifen (TAM) and aromatase inhibitors (AIs) are directly related to estrogen deprivation, and the symptoms are similar to those experienced during natural menopause but appear to be more severe than that seen in the general population. Prolonged estrogen deprivation may lead to atrophy of the vulva, vagina, lower urinary tract and supporting pelvic structures, resulting in a range of genitourinary symptoms that can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of QoL. The genitourinary side effects may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment. We provide an overview of practical clinical approaches to understanding the pathophysiology and the management of genitourinary symptoms in postmenopausal women receiving adjuvant endocrine therapy for breast cancer.

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