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.

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 Adherence and Beliefs to Adjuvant Hormonal Therapy in Patients with Breast Cancer: A Cross-Sectional Study (Conference Paper) #

2022 ◽  
Vol 30 (Suppl.) ◽  
pp. 31-39
Author(s):  
Anwar Habeeb Saad ◽  
Ihsan Rabeea ◽  
Haider Salih
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Hormonal Therapy ◽  
Cross Sectional Study ◽  
Cancer Center ◽  
Adjuvant Hormonal Therapy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Major Barrier ◽  
Factors Affecting

  Breast cancer is the most common cancer among women over the world. To reducing reoccurrence and mortality rates, adjuvant hormonal therapy (AHT) is used for a long period. The major barrier to the effectiveness of the treatment is adherence. Adherence to medicines among patients is challenging. Patient beliefs in medications can be positively or negatively correlated to adherence. Objectives: To investigate the extent of adherence and factors affecting adherence, as well as to investigate the association between beliefs and adherence in women with breast cancer taking AHT. Method: A cross-sectional study included 124 Iraqi women with breast cancer recruited from Middle Euphrates Cancer Center. Morisky medication adherence scale (MMAS) and beliefs about medication questionnaires (BMQ) are used to assess adherence and beliefs respectively. Result: 25% of women were fully adherent (MMAS = 8). 83.06% of all women developed side effects from medications received. Side effects and unemployed women were significantly associated with non-adherence. Additionally, there is no significant association between beliefs in medications and adherence. conclusion The enormous percent of poor adherence caused by side effects suggests the need for interventions by educating patients about the importance of their treatment and how to overcome side effects.

Challenges in Treating Premenopausal Women with Endocrine-Sensitive Breast Cancer

2016 ◽  
pp. 23-32 ◽  
Author(s):  
Hatem A. Azim ◽  
Nancy E. Davidson ◽  
Kathryn J. Ruddy
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Side Effects ◽  
Sexual Dysfunction ◽  
Aromatase Inhibitor ◽  
Endocrine Therapy ◽  
Ovarian Function ◽  
Hot Flashes ◽  
Premenopausal Women ◽  
Ovarian Function Suppression

For the hundreds of thousands of premenopausal women who are diagnosed annually with endocrine-sensitive breast cancer, treatment strategies are complex. For many, chemotherapy may not be necessary, and endocrine therapy decision making is paramount. Options for adjuvant endocrine regimens include tamoxifen for 5 years, tamoxifen for 10 years, ovarian function suppression (OFS) plus tamoxifen for 5 years, and OFS plus an aromatase inhibitor for 5 years. There are modest differences in efficacy between these regimens, with a benefit from OFS most obvious among patients with higher-risk disease; therefore, choosing which should be used for a given patient requires consideration of expected toxicities and patient preferences. An aromatase inhibitor cannot be safely prescribed without OFS in this setting. Additional research is needed to determine whether genomic tests such as Prosigna and Endopredict can help with decision making about optimal duration of endocrine therapy for premenopausal patients. Endocrine therapy side effects can include hot flashes, sexual dysfunction, osteoporosis, and infertility, all of which may impair quality of life and can encourage nonadherence with treatment. Ovarian function suppression worsens menopausal side effects. Hot flashes tend to be worse with tamoxifen/OFS, whereas sexual dysfunction and osteoporosis tend to be worse with aromatase inhibitors/OFS. Pregnancy is safe after endocrine therapy, and some survivors can conceive naturally. Still, embryo or oocyte cryopreservation should be considered at the time of diagnosis for patients with endocrine-sensitive disease who desire future childbearing, particularly if they will undergo chemotherapy.

"Hot Girls Pearls" and other coping strategies for women experiencing adverse effects from endocrine therapy in the treatment of breast cancer.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 197-197
Author(s):  
Meghan Halley ◽  
Louise Beryl ◽  
Katherine Gillespie ◽  
Katharine Rendle ◽  
Suepattra Grace May ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Side Effects ◽  
Coping Strategies ◽  
Endocrine Therapy ◽  
Qualitative Interviews ◽  
Influential Factors ◽  
Lifestyle Changes ◽  
Theory Approach ◽  
Breast Cancer Patients

197 Background: While endocrine therapy can significantly improve outcomes for women with hormone receptor-positive breast cancer, as few as 50% of patients take the medication as prescribed. Studies have shown that physical side effects contribute to non-adherence with hormone therapy. This study draws on prospective, qualitative interviews with patients to identify coping strategies patients employ to manage concerns over current and anticipated side effects, and suggests methods for encouraging adherence. Methods: Interviews were conducted with breast cancer patients (n = 41) at four time points throughout their treatment, resulting in over 150 patient narratives. Using a grounded theory approach, data were coded and analyzed to identify influential factors in decision-making. Here we present data from a subset of our participants (n = 18) focused on the role of side effects in patients' endocrine therapy decision-making. Results: Patients expressed a variety of concerns about current and anticipated side effects associated with endocrine therapy. Our data suggest five categories of coping strategies participants employed to manage these concerns: 1) emphasizing control over their choice to remain adherent; 2) focusing on a future free from side effects and cancer instead of current concerns or discomfort; 3) "familiarizing" side effects to make current and potential treatment risks feel less strange and/or intimidating; 4) making lifestyle changes to mitigate physical discomfort; and 5) seeking help from both medical and social sources. Patients often described using these multiple strategies to help navigate the functional, social and physical responses to side effects, and remain adherent to their treatment regimen. Conclusions: Our data describe the diverse coping strategies employed by women to manage current or anticipated side effects, and maintain adherence to prescribed endocrine therapy. Discussion of these different coping strategies by clinicians with patients may help to improve adherence rates by personalizing approaches to managing side effects.

scholarly journals Adverse effects of adjuvant endocrine therapy

2018 ◽  
pp. 64-69
Author(s):  
E. I. Kovalenko ◽  
I. B. Kononenko ◽  
A. V. Snegovoi ◽  
O. P. Grebennikova ◽  
L. V. Manzyuk
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Side Effects ◽  
Adverse Effects ◽  
Adverse Events ◽  
Endocrine Therapy ◽  
Aromatase Inhibitors ◽  
Hormonal Therapy ◽  
Adjuvant Endocrine Therapy

Hormonal therapy is a highly effective and well tolerable treatment of hormone-responsive breast cancer. However, it has some side effects that can affect quality of life and lead to treatment discontinuation. Common side effects of tamoxifen and aromatase inhibitors are discussed in this article: menopausal, gynecological symptoms, cardiovascular and musculoskeletal adverse events. Some of them are preventable and manageable. In order to maintain good quality of life during treatment the oncologists should pay more attention to the side effects that lead to it’s deterioration and not be too anxious about insignificant ones.

Adherence to hormone treatment for breast cancer and beliefs about treatment and screening.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11004-e11004
Author(s):  
Jenny J Lin ◽  
Kathie-Ann P. Joseph ◽  
Kezhen Fei ◽  
Rebeca Franco ◽  
Nina Bickell
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Cancer Recurrence ◽  
Hormone Treatment ◽  
Term Therapy ◽  
Stepwise Logistic Regression ◽  
Breast Cancer Patients ◽  
Treatment And Prevention

e11004 Background: Beliefs about medications, more than knowledge, have been found to affect medication adherence. For breast cancer patients, at least 5 years of daily adjuvant hormonal therapy (HT) improves survival but it is often difficult for women to sustain therapy. Qualitative studies suggest women take HT to prevent breast cancer recurrence. We sought to assess whether beliefs about HT and screening were associated with ongoing HT adherence. Methods: Patients with a new early-stage breast cancer enrolled in an IRB-approved RCT to reduce disparities in care in New York City were telephone surveyed 6 months after their surgical treatment for breast cancer to assess knowledge, attitudes and beliefs about breast cancer, its treatment and prevention. Adherence was defined as a positive response to “are you now taking hormonal therapy (e.g., tamoxifen, arimidex)?” Beliefs about HT and mammogram screening were assessed. Bivariate analyses were conducted with t tests, chi square or Wilcoxon rank sum tests; multivariate analysis used a stepwise logistic regression. Results: Of 333 enrolled women, 233 were recommended to take HT. Of these, 187 (80%) women were prescribed HT and 172 (92%) were still adherent 6 months after surgery. Fifty-three percent of women were bothered by side effects but all were adherent; however, of the 15 women who stopped HT, 6 (40%) stopped due to side effects. Sixteen percent of women expressed difficulty paying for HT but all were adherent. Patients adherent to HT had stronger beliefs in both HT as treatment and prevention and in the importance of regular mammograms to stay healthy. A multivariate model including race, insurance, HT knowledge and beliefs found that only beliefs about HT and mammogram screening were associated with adherence (belief about HT: OR=1.1; 95%CI: 1.03-1.11; belief about mammogram: OR=1.55; 95% CI: 1.06-2.27) [model c=.84; p<0.0001]. Conclusions: Ongoing HT adherence is related to beliefs about both treatment and screening.Adherence is not related to HT knowledge, side effects, cost, insurance or patient race. Understanding patients’ beliefs about screening and treatment may help physicians enable women to adhere to long-term therapy.

scholarly journals The Modern Landscape of Endocrine Therapy for Premenopausal Women with Breast Cancer

Breast Care ◽  
2015 ◽  
Vol 10 (5) ◽  
pp. 312-315 ◽  
Author(s):  
Lorenzo Rossi ◽  
Olivia Pagani
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Ovarian Function ◽  
Treatment Options ◽  
Endocrine Resistance ◽  
Premenopausal Women ◽  
New Drugs ◽  
Fine Tuning ◽  
Individual Risk ◽  
Ovarian Function Suppression

The optimal endocrine therapy for premenopausal women with early and advanced breast cancer still remains an important and controversial issue. For over 30 years, tamoxifen has been the gold standard in the adjuvant setting. New therapeutic options, such as the addition of ovarian function suppression to oral endocrine therapy (either tamoxifen or aromatase inhibitors), can improve outcomes over tamoxifen alone in well-selected patients. Treatment duration has also been revisited, and extended therapy is becoming a new standard of care, especially in high-risk patients. Endocrine therapy for advanced disease still represents a challenge and a research priority. New drugs and combinations able to overcome endocrine resistance are at the horizon, and their role in premenopausal women should be better elucidated. Side effects and quality of life (including family planning considerations) play an important role in treatment selection and in the patients' treatment adherence and should always be discussed before start of treatment. The paper will specifically focus on how to integrate all new treatment options in the current armamentarium of endocrine therapy of premenopausal women, with the aim of best fine-tuning treatment selections according to the individual risk/benefit evaluation.

scholarly journals Information needs and decision-making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer

2017 ◽  
Vol 26 (12) ◽  
pp. 2094-2100 ◽  
Author(s):  
Maria Burton ◽  
Karen Kilner ◽  
Lynda Wyld ◽  
Kate Joanna Lifford ◽  
Frances Gordon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Older Women ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Information Needs ◽  
Primary Endocrine Therapy

Evidence-based approaches for the management of side-effects of adjuvant endocrine therapy in patients with breast cancer

2021 ◽  
Author(s):  
Maria Alice Franzoi ◽  
Elisa Agostinetto ◽  
Marta Perachino ◽  
Lucia Del Mastro ◽  
Evandro de Azambuja ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Endocrine Therapy ◽  
Adjuvant Endocrine Therapy ◽  
Evidence Based

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.

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