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Musicco F, Lasala R, Santoleri F, Costantini A, Abrate P, Carretta MT, Proli EM, Romagnoli A, Petragnani N, Vita FD, Zeuli M, Vici P, Sansone M, Pasquantonio M, La Malfa A, Fulgenzio C. A multicentre study with real-world data of the use of palbociclib in the treatment of breast cancer: Treatment duration correlates with dose reductions. J Oncol Pharm Pract 2023; 29:1806-1815. [PMID: 35903919 DOI: 10.1177/10781552221117135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Palbociclib, a highly selective reversible CDK4-6 kinase inhibitor, is indicated in combination with an aromatase inhibitor or in combination with fulvestrant in women who had received prior endocrine treatment. Studies have demonstrated the efficacy of palbociclib in combination with fulvestrant in increasing progression-free survival in patients who relapsed or progressed on previous endocrine therapy, or in combination with aromatase inhibitor in patients who had not received previous treatments. We analysed the prescribing patterns of palbociclib in real practice correlating it with the evidence of treatment-related toxicity management and to time-to-treatment discontinuation and treatment adherence. METHODS For the observational, retrospective study, data were collected from five Italian hospital centres that prescribed palbociclib between April 2017 and April 2020. Each centre provided data derived from an administrative database of adult patients treated with palbociclib for the two therapeutic indications.Treatment adherence was calculated using the proportion of days covered method while time-to-treatment discontinuation was defined as the difference between the first and last date treatment was administered plus the days ideally covered by the last date treatment was given. RESULTS There were 375 patients enrolled during the study period, of whom 159 were treated with palbociclib and aromatase inhibitor and 216 were treated with palbociclib and fulvestrant. The time-to-treatment discontinuation was 8.9 months in the case of P + f (95% CI: 7.1-12.7) and 13.7 months in the case of P + ia (95% CI: 8.9-17.5). In both cohorts, treatments that received at least one dose reduction had a statistically higher time-to-treatment discontinuation than those without dose reduction (17.7 months vs. 9.2 and 16.6 vs. 7.4).The mean adherence in our study was 0.9 and remained high in treatments with one dose reduction (0.83) and this with two dose reductions (0.87). CONCLUSION Based on these findings, it appears that the management of toxicities through reducing doses, as required by the Summary of Product Characteristics, results in a better outcome in terms of therapy duration, and therefore time to failure due to progression or toxicity.
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Affiliation(s)
- Felice Musicco
- Hospital Pharmacy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ruggero Lasala
- Hospital Pharmacy, "Umberto I" Hospital of Corato, Corato, Italy
| | | | | | | | | | | | - Alessia Romagnoli
- Pharmaceutical Service, Local Health Unit of Lanciano Vasto Chieti, Chieti, Italy
| | - Nicola Petragnani
- Hospital Pharmacy, "SS. Annunziata" Hospital of Chieti, Chieti, Italy
| | | | - Massimo Zeuli
- Medical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Clinical Study Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Sansone
- Hospital Pharmacy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Antonia La Malfa
- Hospital Pharmacy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Chiara Fulgenzio
- Hospital Pharmacy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Gernier F, Grellard JM, Dupont C, Castel H, Fernette M, Lahaye F, Charles RM, Leroux T, Ory C, Faveyrial A, Morel A, Emile G, Levy C, Segura C, Allouache D, Johnson A, Geffrelot J, Gunzer K, Lelaidier A, Girault G, Dubot-Poitelon C, San C, Lequesne J, Clarisse B. Impact of web application support versus standard management on adherence with adjuvant hormone therapy in patients treated for breast cancer: the WEBAPPAC study. BMC Cancer 2023; 23:736. [PMID: 37559004 PMCID: PMC10413707 DOI: 10.1186/s12885-023-11242-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Non-metastatic breast cancer treatment is mainly based on surgery, with or without chemotherapy, radiotherapy and/or hormone therapy. To reduce the risk of hormone receptor positive (HR+) disease recurrence, hormone therapy is prescribed for at least 5 years. It may induce adverse drug reactions (ADRs) as joint pain, sexual dysfunction, weight increase, fatigue, mood disorders and vasomotor symptoms. Around 30-40% of patients withhold hormone therapy within 5 years after initiation. Based on encouraging results of mobile health in patient follow-up, we developed a web-application addressed for breast cancer patients initiating adjuvant hormonal therapy and aimed to assess its impact on hormone therapy adherence, ADRs management, and health-related quality of life. METHODS The WEBAPPAC trial is a randomized, open-label, prospective, single-center phase 3 study aiming to assess the interest of a web-application support as compared to standard management among breast cancer patients initiating hormone therapy. The main endpoint is the proportion of patients with hormone therapy adherence failure within 18 months after treatment start, in each arm. Eligible patients will be 1:1 randomized between the WEBAPPAC web-application support (experimental arm,) or standard support (control arm), with stratification on type of hormone therapy (Aromatase inhibitor or Tamoxifen). We plan to enroll 438 patients overall. Failure to hormone therapy will be assessed using the Morisky 8-item self-questionnaire (MMSA8), patient adherence logbook, and medical consultations. Secondary outcomes include hormone therapy adherence at 6 months, pain (Visual Analogue Scale and Brief Pain Inventory), quality of life (EORTC QLQ-C30 and BR23 self-questionnaires), anxiety and depression (Hospital and Depression Scale), and return to work and/or daily activities. The user experience with the WEBAPPAC web-application will be assessed using the System Usability Scale (SUS) questionnaire. DISCUSSION Hormone therapy discontinuation or adherence failure in breast cancer patients may be indirectly related to an increased risk of recurrence. A better control of medication adherence, through the detection of side effects and some proposed actions trying to reduce them, appears therefore essential to limit the risk of disease recurrence. The WEBAPPAC web-application thus aims better monitoring and allowing higher level of responsiveness in case of ADRs, thus improving treatment adherence. TRIAL REGISTRATION NCT04554927, registered September 18, 2020. PROTOCOL VERSION Version 2.1 dated from December 21, 2021.
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Affiliation(s)
- François Gernier
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France.
- ANTICIPE (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit, Caen, 1086, France.
| | - Jean-Michel Grellard
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France
| | | | - Hervé Castel
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France
| | - Marie Fernette
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France
| | - François Lahaye
- Breast pathway nurse, Centre François Baclesse, Caen, France
| | | | - Tiphaine Leroux
- Breast pathway nurse, Centre François Baclesse, Caen, France
| | - Céline Ory
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Audrey Faveyrial
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Adeline Morel
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - George Emile
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Christelle Levy
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Carine Segura
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | | | - Alison Johnson
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Julien Geffrelot
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Katharina Gunzer
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Anaïs Lelaidier
- North-West Canceropole Data Center, Centre François Baclesse, Caen, France
| | - Gilles Girault
- Comprehensive Cancer Centre F. Baclesse, Medical Library, Caen, France
| | | | - Chankannira San
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France
| | - Justine Lequesne
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France
- ANTICIPE (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit, Caen, 1086, France
| | - Bénédicte Clarisse
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France.
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Wreyford L, Gururajan R, Zhou X. When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review. PLoS One 2023; 18:e0282180. [PMID: 37134109 PMCID: PMC10155980 DOI: 10.1371/journal.pone.0282180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/10/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional. AIM The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention. METHODS A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients-published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included. RESULTS Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: 'Physician factors can influence patient factors in treatment nonadherence'. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies. LINE OF ARGUMENT WAS DRAWN Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors-with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of 'treatment adherence' receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies. CONCLUSION This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.
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Affiliation(s)
- Leon Wreyford
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
| | - Raj Gururajan
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
| | - Xujuan Zhou
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
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Park C, Heo JH, Mehta S, Han S, Spencer JC. Adherence to Adjuvant Endocrine Therapy and Survival Among Older Women with Early-Stage Hormone Receptor-Positive Breast Cancer. Clin Drug Investig 2023; 43:167-176. [PMID: 36740664 DOI: 10.1007/s40261-023-01247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Although improving adherence to adjuvant endocrine therapies (AETs) is critical to ensure better patient outcomes, the evidence is still lacking on differences in 5-year AET adherence trajectories. This study aimed to estimate the time trend of adherence by the type of individual AET and the association of adherence to AETs with overall survival among older women with hormone receptor-positive breast cancer. METHODS This study used the Surveillance, Epidemiology, and End Results-Medicare database 2006-2016. We included women aged ≥ 65 years with newly diagnosed hormone receptor-positive breast cancer and who had initiated AET (anastrozole, letrozole, exemestane, or tamoxifen). Adherence to AETs was defined as the proportion of days covered that was calculated for the follow-up period (5 years). The overall survival time was defined as the time from the date of AET initiation to death. The linear mixed models with repeated measures were used to estimate the changes in adherence to AETs. The Cox proportional hazard model was used to assess the relationships (hazard ratio [HR] and 95% confidence interval [CI]) between adherence to AETs and death. RESULTS A total of 11,617 patients were included. Anastrozole was the most commonly used (n = 6,908), followed by letrozole (n = 2,586), tamoxifen (n = 1,750), and exemestane (n = 373). The mean (standard deviation) of proportion of days covered for 5 years was 57.4 (34.6), indicating the highest proportion of days covered in the anastrozole group [61.1 (34.1)] and the lowest proportion of days covered in the exemestane group [44.0 (35.1)]. Overall, adherence to AET decreased over the 5-year follow-up period in all AET groups, but the decrease in the tamoxifen group was steeper (42.3% decreased) compared with other AETs. Anastrozole, letrozole, and exemestane groups were associated with a lower risk of death compared with the tamoxifen group (HR = 0.80, 95% CI 0.71-0.89 for anastrozole; HR = 0.82, 95% CI 0.72-0.93 for letrozole; HR = 0.82, 95% CI 0.63-1.07 for exemestane). CONCLUSIONS Patients who initiated with tamoxifen had a steeper decrease in adherence over the 5 years compared with anastrozole, letrozole, and exemestane groups. Furthermore, higher adherence was associated with a decreased risk of mortality. Physicians should be cognizant of decreasing adherence over time and choose effective treatment options with minimal side-effect profiles to better support adherence by patients with breast cancer.
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Affiliation(s)
- Chanhyun Park
- College of Pharmacy, The University of Texas at Austin, 2400 Inner Campus Drive, Austin, TX, 78705, USA.
| | - Ji-Haeng Heo
- College of Pharmacy, The University of Texas at Austin, 2400 Inner Campus Drive, Austin, TX, 78705, USA
| | - Sanica Mehta
- College of Natural Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Sola Han
- College of Pharmacy, The University of Texas at Austin, 2400 Inner Campus Drive, Austin, TX, 78705, USA
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Roche N, Le Provost JB, Borinelli-Franzoi MA, Boinon D, Martin E, Menvielle G, Dumas A, Rivera S, Conversano A, Matias M, Viansone A, Di Meglio A, Delaloge S, Vaz-Duarte-Luis IM, Pistilli B, Fasse L. Facing points of view: Representations on adjuvant endocrine therapy of premenopausal patients after breast cancer and their healthcare providers in France. The FOR-AD study. Eur J Oncol Nurs 2023; 62:102259. [PMID: 36623339 DOI: 10.1016/j.ejon.2022.102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Adjuvant endocrine therapy (ET) for 5-10 years is the backbone of the therapeutic strategy in patients with hormone receptor positive (HR+) early breast cancer (BC). However, long-term adherence to adjuvant ET represents a major challenge for most patients. According to prior studies, side effects of adjuvant ET are an important reason for poor adherence. In contrast, better communication and relational bond between patients and healthcare providers (HCPs) may improve adherence. The FOR-AD (Focus on non-adherence) study aimed at better understanding the representation of adjuvant ET by patients and their HCPs, in order to improve the care process. METHODS Three focus groups of premenopausal women (receiving adjuvant ET for variable amount of time) and two focus groups of HCPs (including oncologists, pharmacists, and nurses) were conducted, each including around ten participants. Thematic analyses using a general inductive approach were constructed to report participants' representations. RESULTS Two main themes emerged across groups, and appeared of major importance. Representations on adjuvant ET were often homogenous within each group, but differed between patients and their HCPs. The relationship between both groups was considerably discussed, particularly its importance in facilitating adherence to adjuvant ET. Suggestions on improving the care process were also given, such as systematically including psychologists in follow-up care paths and having a nurse navigator follow patients under treatment with adjuvant ET. CONCLUSION The present qualitative exploration may help buildi future tailored interventions to improve adherence to adjuvant ET, in particular regarding the role of nurse navigators.
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Affiliation(s)
- Nicolas Roche
- Supportive Care Department, Gustave Roussy Hospital, Villejuif, France.
| | | | - Maria-Alice Borinelli-Franzoi
- Department of Medical Oncology, Gustave Roussy Hospital, Villejuif, France; INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Diane Boinon
- Supportive Care Department, Gustave Roussy Hospital, Villejuif, France; Laboratoire de Psychopathologie et Processus de Santé, F 92100, Université de Paris, Boulogne-Billancourt, France
| | - Elise Martin
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Gwenn Menvielle
- Inserm, Institut Pierre Louis d'Epidémiologie et Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | - Agnès Dumas
- Inserm Unit 1123, Unité ECEVE, Université de Paris, France
| | - Sofia Rivera
- Radiotherapy Department, Gustave Roussy Hospital, Villejuif, France
| | - Angelica Conversano
- Oncological and Reconstructive Plastic Surgery Department, Gustave Roussy Hospital, Villejuif, France
| | - Margarida Matias
- Department of Medical Oncology, Gustave Roussy Hospital, Villejuif, France
| | | | - Antonio Di Meglio
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Suzette Delaloge
- Department of Medical Oncology, Gustave Roussy Hospital, Villejuif, France
| | - Ines-Maria Vaz-Duarte-Luis
- Department of Medical Oncology, Gustave Roussy Hospital, Villejuif, France; INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy Hospital, Villejuif, France
| | - Léonor Fasse
- Supportive Care Department, Gustave Roussy Hospital, Villejuif, France; Laboratoire de Psychopathologie et Processus de Santé, F 92100, Université de Paris, Boulogne-Billancourt, France
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Janssen AM, Dam J, Prins J, Buffart LM, de Bruin M. Systematic adaptation of the adherence improving self-management strategy to support breast cancer survivors' adherence to adjuvant endocrine therapy: An intervention mapping approach. Eur J Cancer Care (Engl) 2022; 31:e13721. [PMID: 36263723 PMCID: PMC9787620 DOI: 10.1111/ecc.13721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Non-adherence to adjuvant endocrine therapy (AET) for breast cancer leads to increased recurrence and mortality risk and healthcare costs. Evidence on feasible, effective AET adherence interventions is scarce. This paper describes the systematic adaptation of the cost-effective adherence improving self-management strategy (AIMS) for patients with HIV to AET for women after breast cancer treatment. METHODS We followed the intervention mapping protocol for adapting interventions by conducting a needs assessment, reviewing target behaviours and determinants, reassessing behaviour change methods and adapting programme content. Therefore, we performed a literature review, consulted behavioural theory and organised nine advisory board meetings with patients and healthcare professionals. RESULTS Non-adherence occurs frequently among AET users. Compared to HIV treatment, AET is less effective, and AET side effects are more burdensome. This drives AET treatment discontinuation. However, the key determinants of non-adherence are largely similar to HIV treatment (e.g. motivation, self-regulation and patient-provider relationship); therefore, most strategies in AIMS-HIV also seem suitable for AIMS-AET. Modifications were required, however, regarding supporting patients with coping with side effects and sustaining treatment motivation. CONCLUSION AIMS seems to be a suitable framework for adherence self-management across conditions and treatments. Intervention mapping offered a transparent, systematic approach to adapting AIMS-HIV to AET.
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Affiliation(s)
- Anna M. Janssen
- Department of IQ Health, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Joëlle Dam
- Department of IQ Health, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Judith Prins
- Department of Medical Psychology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Laurien M. Buffart
- Department of Physiology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Marijn de Bruin
- Department of IQ Health, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
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Botelho LOD, Sañudo A, Facina G, Wagner GA. Adesão à Terapia Hormonal Adjuvante com Tamoxifeno e Anastrozol utilizando ARMS-12 e MMAS-4. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n2.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Introdução: Entre os canceres de mama, aproximadamente 75% das mulheres são receptores hormonais positivos, sendo estas mais propensas a responderem a hormonioterapia com anastrozol e tamoxifeno. Apesar de eficazes, apresentam taxas significativas de não adesão. Objetivo: Avaliar a adesão a terapia hormonal adjuvante com tamoxifeno e anastrozol em pacientes atendidos nos Ambulatórios da Mastologia e de Quimioterapia do Hospital São Paulo entre os anos de 2019 e 2020. Método: Estudo transversal com 102 mulheres, realizado entre os meses de setembro de 2019 e marco de 2020. A adesão a terapia hormonal adjuvante foi avaliada utilizando-se as escalas Morisky Medication Adherence Scale (MMAS-4) e Adherence to Refills and Medications Scale of 12 items (ARMS-12). Resultados: A média de idade foi de 61,5 anos (59,3-63,6). Entre as pacientes, 27,7% faziam uso de tamoxifeno e 72,3% de anastrozol. Relataram desconforto em relação ao uso do medicamento 84,4%, sendo as ondas de calor (42,2%) e as dores articulares (55,9%) os mais frequentes. A escala de ARMS>12 foi pontuada por 79,2%; cerca de 90% das mulheres pontuaram a MMAS-4 até dois pontos, porém não houve diferença significativa entre os tipos de hormônios utilizados para escalas de adesão (p=0,815 e p=0,489). Conclusão: A adesão a hormonioterapia observada foi relativamente baixa, independentemente da endocrinoterapia, podendo essas pacientes estarem em risco de inadequação quanto a resposta clínica.
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Nizet P, Touchefeu Y, Pecout S, Cauchin E, Beaudouin E, Mayol S, Fronteau C, Huon JF. Exploring the factors influencing adherence to oral anticancer drugs in patients with digestive cancer: a qualitative study. Support Care Cancer 2022; 30:2591-2604. [PMID: 34812952 PMCID: PMC8794904 DOI: 10.1007/s00520-021-06663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to explore the beliefs, perceptions and representations of patients in order to identify the determinants of oral anticancer drugs adherence and to take action in current practice to improve patient support in digestive oncology. METHODS We constructed a semi-directed interview guide which aimed to explore the patient's relationship with medication, their health history, their experiences at the time of the announcement of treatment, their confidence, their fears, their motivations to adhere to their treatment and the constraints linked to their treatment. The data were analysed and discussed using a thematic approach. RESULTS Seventeen patients agreed to participate in the study. The median age was 60 years. Ten patients had colorectal cancer, 3 patients had hepatocellular carcinoma, 3 patients had gastrointestinal stromal tumour and 1 patient had neuroendocrine pancreatic tumour. We identified five categories of factors influencing adherence: demographic and socioeconomic, disease-related, treatment-related, care system-related, and patient representation and pathways' factors. A majority of patients emphasised the importance of family support in the adherence process and the convenience of per os treatment compared to other intravenous treatments. However, several negative determinants emerged such as the toxicity of the treatment, fears of forgetting to take the medication, difficulties with the galenic formulation and negative beliefs of the family. CONCLUSION This study demonstrates the need to address the different dimensions of the patient in order to understand his or her behaviour with regard to adherence and to identify the levers for improvement.
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Affiliation(s)
- Pierre Nizet
- Clinical Pharmacy Unit, Nantes University Hospital, 1 Rue Gaston Veil, 44000, Nantes, France.
| | - Yann Touchefeu
- Digestive Oncology, Institut Des Maladies De L'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - Solange Pecout
- Digestive Oncology, Institut Des Maladies De L'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - Estelle Cauchin
- Digestive Oncology, Institut Des Maladies De L'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - Eva Beaudouin
- INSERM, UMR 1246-SPHERE, MethodS in Patients-Centered Outcomes and HEalth ResEarch, Nantes and Tours, France
| | - Séverine Mayol
- Research Department, Nantes University Hospital, Nantes, France
| | - Clémentine Fronteau
- Clinical Pharmacy Unit, Nantes University Hospital, 1 Rue Gaston Veil, 44000, Nantes, France
| | - Jean-François Huon
- Clinical Pharmacy Unit, Nantes University Hospital, 1 Rue Gaston Veil, 44000, Nantes, France
- INSERM, UMR 1246-SPHERE, MethodS in Patients-Centered Outcomes and HEalth ResEarch, Nantes and Tours, France
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Zhou H, Wang X, Yu D, Du R, Wang H, Zhu J, Zhang H, Chen C, Wang T. Adherence to Oral Targeted Anti-Lung Cancer Therapy: A Qualitative Interview Study. Patient Prefer Adherence 2022; 16:995-1004. [PMID: 35431541 PMCID: PMC9012231 DOI: 10.2147/ppa.s341966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Oral targeted antineoplastic drugs (OTADs) are becoming more and more acceptable for lung cancer treatment due to their advantages such as the convenience of administration and milder side effects. However, medication adherence represents a major issue for prolonged OTAD treatment. In this study, the factors associated with treatment adherence to OTAD were explored through the Adherence Influencing Factor Framework suggested by WHO. Based on these results, we further examined the potential factors related to social psychological cognition in OTAD adherence in patients with lung cancer. METHODS This qualitative study was conducted in public hospitals in Henan, China. Data were collected through semi-structured interviews with selected lung cancer patients. Face-to-face interviews were audio-recorded and transcribed for thematic analysis. RESULTS Of the 21 patients interviewed, 17 were males and 4 were females. The analysis of the data led to four themes, ie, patient-related factors (medication-taking introspection, family structure, weigh the pros and cons of OTAD treatment), medication-related factors (medication experience, adverse reactions, information access), physician/nurse-related factors (shared decision making, doctor's reaction, nurse's inquiry) and society-related factors (fear, stigma). CONCLUSION Family structure, weigh the pros and cons of OTAD treatment, information access, shared decision making, nurse's inquiry are potential factors affecting OTAD adherence in lung cancer patients. Providing drug information support to patients, inviting patients to join in shared decision-making and strengthening doctor-patient-nurse cooperation are important for improving medication adherence. Further research should be conducted to help healthcare providers to promote the medication adherence of lung cancer patients to OTAD treatment.
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Affiliation(s)
- Huiyue Zhou
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Xin Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Dan Yu
- Department of Gengral Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Ruofei Du
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Huaisong Wang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, People’s Republic of China
| | - Jizhe Zhu
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Haoning Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Changying Chen
- Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
- Changying Chen, Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China, Email
| | - Tao Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
- Cancer Centre, Telethon Kids Institute, Perth, WA, 6872, Australia
- Medical School, University of Western Australia, Perth, WA, 6872, Australia
- Department of Oncology, People’s hospital of Hebi, Hebi, Henan, 458010, People’s Republic of China
- Correspondence: Tao Wang, Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China, Email
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10
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Toivonen KI, Oberoi D, King-Shier K, Piedalue KAL, Rash JA, Carlson LE, Campbell TS. Both "Vitamin L for Life" and "One Milligram of Satan": A Multi-Perspective Qualitative Exploration of Adjuvant Endocrine Therapy Use after Breast Cancer. Curr Oncol 2021; 28:2496-2515. [PMID: 34287250 PMCID: PMC8293219 DOI: 10.3390/curroncol28040227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
Adjuvant endocrine therapy (AET) is recommended after hormone receptor-positive breast cancer to reduce risk of recurrence, but adherence is sub-optimal in many women. Behavioral interventions have been ineffective in improving adherence rates to AET. This qualitative descriptive study investigates factors that support women in AET use and suggestions for interventions to improve AET use and management. Interviews with women who persisted with AET (n = 23), women who discontinued AET (n = 15), and healthcare providers (HCPs; oncologists, oncology residents, and pharmacists; n = 9) were conducted, transcribed, and described using thematic analysis. Data collection stopped once saturation occurred (i.e., no new codes or themes emerged during interviews). Two researchers created codes and developed themes in an iterative process; a third researcher verified the representativeness of final themes. This study was approved by the Health Research Ethics Board of Alberta (ID: HREBA.CC-17-0513). Women who persisted described being prepared for side effects and having self-management strategies, strong rationale for AET use, supportive HCPs, and available resources as relevant factors. Women who discontinued described feeling overwhelmed by side effects, information needs, drawbacks of AET, helpful/unhelpful experiences with HCPs, and contextual factors as relevant to their discontinuation. HCPs described health system-related and patient-related barriers, side effect management, and patient-provider interactions as relevant to supporting AET use. The considerable overlap in themes among the three groups suggests broad recognition of salient factors relevant to AET use and that associated strategies to improve use may be acceptable to patients and providers alike. Factors supporting AET use could include the following: education (which may be necessary but insufficient), developing a strong personal rationale for use, being prepared for side effects, having side effect management strategies, reciprocal communication between patients and HCPs, and accessible resources.
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Affiliation(s)
- Kirsti I. Toivonen
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Devesh Oberoi
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (D.O.); (K.-A.L.P.)
| | | | - Katherine-Ann L. Piedalue
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (D.O.); (K.-A.L.P.)
| | - Joshua A. Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada;
| | - Linda E. Carlson
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (D.O.); (K.-A.L.P.)
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
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11
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Kuo CC, Wang HH, Tseng LP. Using data mining technology to predict medication-taking behaviour in women with breast cancer: A retrospective study. Nurs Open 2021; 9:2646-2656. [PMID: 34156764 PMCID: PMC9584494 DOI: 10.1002/nop2.963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/10/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022] Open
Abstract
Aims Medication‐taking behaviours of breast cancer survivors undergoing adjuvant hormone therapy have received considerable attention. This study aimed to determine factors affecting medication‐taking behaviours in people with breast cancer using data mining. Design A longitudinal observational retrospective cohort study with a hospital‐based survey. Methods A total of 385 subjects were surveyed, analysing existing data from January 2010 to December 2017 in Taiwan. Three data mining approaches—multiple logistic regression, decision tree and artificial neural network—were used to build the prediction models and rank the importance of influencing factors. Accuracy, specificity and sensitivity were used as assessment indicators for the prediction models. Results Multiple logistic regression was the most effective approach, achieving an accuracy of 96.37%, specificity of 96.75% and sensitivity of 96.12%. The duration of adjuvant hormone therapy discontinuation, duration of adjuvant hormone therapy use and age at diagnosis by data mining were the three most critical factors influencing the medication‐taking behaviours of people with breast cancer.
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Affiliation(s)
- Chen-Chen Kuo
- The Cancer Prevention and Treatment Center, St. Martin De Porres Hospital, Chiayi, Taiwan.,School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiu-Hung Wang
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Ping Tseng
- Management Center, St. Martin De Porres Hospital, Chiayi, Taiwan.,Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
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12
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Kaptein AA, Schoones JW, van der Meer PB, Matsuda A, Murray M, Heimans L, Kroep JR. Psychosocial determinants of adherence with oral anticancer treatment: 'we don't need no education'. Acta Oncol 2021; 60:87-95. [PMID: 33151764 DOI: 10.1080/0284186x.2020.1843190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Given the potentially fatal consequences of inadequate adherence with oral anticancer treatment in persons with cancer, understanding the determinants of adherence is vital. This paper aims at identifying psychosocial determinants of adherence to oral anticancer treatment. METHODS We reviewed the literature on psychosocial determinants of adherence with oral anticancer treatment, based on published literature in English, from 2015 to present. Literature searches were performed in PubMed, Embase, Web of Science, Cochrane library, Emcare, and PsychINFO, with 'cancer', 'medication adherence', 'psychology', and 'oral anticancer treatment' as search terms. The obtained 608 papers were screened by two independent reviewers. RESULTS In the 25 studies identified, illness perceptions, medication beliefs, health beliefs, and depression were found to be the major psychosocial determinants of adherence to oral anticancer treatment; sociodemographic and clinical characteristics were found to be of no major importance. The quality of the identified studies as assessed by two independent reviewers was found to be acceptable overall. The majority of papers were from North America and focused on patients with breast cancer; sample size varied from 13 to 1371; adherence was assessed with questionnaires derived from various theoretical models, pill counts and electronic pharmacy records; illness perceptions reflecting adaptive coping, and medication beliefs reflecting high necessity and low concerns were found to be associated with adherence. CONCLUSION Psychosocial concepts are major determinants of adherence with oral anticancer treatment. 'Beliefs about medicines' and 'illness perceptions' in particular determine adherence with this treatment. Studies aiming at impacting adherence would benefit from interventions with a solid basis in behavioral theory in order to help health care providers explore and address illness perceptions and medication beliefs. Pre-consultation screening of adherence behavior may be a helpful supportive approach to improve adherence. Blaming the victim ('patients should be educated about the importance of adherence') is better replaced by encouraging health professionals to identify and address maladaptive psychosocial determinants of adherence.
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Affiliation(s)
- Adrian A. Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Pim B. van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ayako Matsuda
- Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan
| | - Michael Murray
- School of Psychology, Keele University, Newcastle-under-Lyme, UK
| | - Lotte Heimans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R. Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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13
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Bourdin A, Dubois J, Foley RA, Schluep M, Bugnon O, Berger J. Satisfaction and experiences of patients taking fingolimod and involved in a pharmacy-based patient support program in Switzerland - a qualitative study. BMC Health Serv Res 2020; 20:425. [PMID: 32410681 PMCID: PMC7227186 DOI: 10.1186/s12913-020-05278-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/30/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Fingolimod is an oral multiple sclerosis drug that is considered a specialty drug due to its high cost and safety issues. The Fingolimod Patient Support Program (F-PSP) is a specialty pharmacy service developed to ensure the responsible use of fingolimod by promoting patient safety and medication adherence. This study aims to explore the satisfaction, experiences and perceptions regarding the F-PSP among patients currently involved in this program or recently withdrawn. METHODS A qualitative study was conducted via individual, face-to-face semistructured interviews with patients involved in the F-PSP. The interviews were audio-recorded, transcribed verbatim, coded and analyzed via thematic content analysis. RESULTS The main themes identified from the interviews (n = 17) were overall perception of the F-PSP, perception of the pharmacist-led consultations, perception of the tools (electronic monitor and drug intake graph), reasons to participate or potentially withdraw, and suggestions for improvements. Participants perceived the F-PSP as a reassuring support that complemented their medical care, providing a more human, personalized and person-centered approach than usual pharmacy care. Pharmacist-led consultations were valued for the medication-related and holistic support they provided. The importance of the pharmacist's attitude was emphasized. The electronic monitor was valued for promoting daily medication adherence and allowing the involvement of relatives, which reassured participants and their relatives. The participants appreciated the drug intake graph because it provided an objective overview of medication adherence, thereby reassuring, rewarding, and motivating them. The main reason to join the program was to be supported, especially with respect to medication adherence. CONCLUSIONS Participants were satisfied with the F-PSP, each for different reasons. Their feedback enabled the identification of measures for the optimization of the F-PSP and should facilitate its dissemination and transfer to other drugs/diseases/populations. Essential elements of generic pharmacist-led patient support programs considered valuable from the patients' perspective were identified.
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Affiliation(s)
- Aline Bourdin
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, Lausanne, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausannee, Lausanne, Switzerland.
| | - Julie Dubois
- Qualitative Research Platform, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Rose-Anna Foley
- Qualitative Research Platform, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Myriam Schluep
- Division of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, CHUV, Lausanne, Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausannee, Lausanne, Switzerland
| | - Jérôme Berger
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausannee, Lausanne, Switzerland
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14
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Clancy C, Lynch J, OConnor P, Dowling M. Breast cancer patients' experiences of adherence and persistence to oral endocrine therapy: A qualitative evidence synthesis. Eur J Oncol Nurs 2019; 44:101706. [PMID: 32007696 DOI: 10.1016/j.ejon.2019.101706] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/26/2019] [Indexed: 11/15/2022]
Abstract
PURPOSE Adjuvant endocrine therapy (AET) significantly reduces the risk of breast cancer recurrence and mortality in women with hormone receptor (HR+) breast cancer. Despite the documented survival benefits with AET, non-adherence and non-persistence remains a significant problem. This systematic review of qualitative research aimed to synthesise breast cancer patients' experiences of adherence and persistence to oral endocrine therapy. METHODS The ENTREQ guidelines were followed. A systematic search strategy was performed across eleven electronic databases (Embase, Cinahl, Pubmed, Psychinfo, Proquest, Lenus, Scopus, Web of Science, Rian.ie, EThOS e-theses online, DART Europe). Thomas and Harden's three-stage approach to thematic analysis was undertaken on the findings of all included studies. Confidence in the findings were reviewed using GRADE-CERQual. RESULTS Twenty-four qualitative studies were included in the synthesis. Three analytic themes were identified (We don't have an option; the side effects are worse than the disease; help us with information and support). Adherence was often driven by women feeling they had no option and a fear of cancer recurrence. Persistence was helped with support and information. Non-adherence and non-persistence were associated with debilitating side effects, inadequate information and lack of support. CONCLUSIONS Adherence and persistence to AET was often suboptimal among breast cancer patients. Women commonly felt isolated and neglected as a result of insufficient information and support from healthcare professionals. If women are to persist with AET, primary care providers should be aware of the facilitators and barriers to adherence, and they should be knowledgeable in symptom management strategies.
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Affiliation(s)
- Caroline Clancy
- Oncology department, Letterkenny University Hospital, Ireland.
| | - Johanna Lynch
- Letterkenny University Hospital, Letterkenny, Ireland.
| | - Pamela OConnor
- Library and Information Services, Letterkenny University Hospital, Ireland.
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland Galway, Ireland.
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15
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Xu H, Zhang XJ, Wang DQ, Xu L, Wang AP. Factors influencing medication-taking behaviour with adjuvant endocrine therapy in women with breast cancer: A qualitative systematic review. J Adv Nurs 2019; 76:445-458. [PMID: 31657028 DOI: 10.1111/jan.14253] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/25/2019] [Accepted: 10/21/2019] [Indexed: 12/25/2022]
Abstract
AIMS To explore the experience and feelings associated with the endocrine therapy treatment trajectory in women with breast cancer and what affects medication taking behaviour. DESIGN Qualitative systematic review. DATA SOURCES Qualitative studies were extracted from PubMed, EMBASE, CINAHL, PsycINFO from inception of each database until February 2019. REVIEW METHODS The systematic search method SPIDER (sample, phenomenon of interest, design, evaluation, research type) was used. Thematic synthesis of the qualitative data was used. RESULTS A total of 478 were identified in the initial search. Only 17 articles met inclusion criteria and were included in this review. Five analytical themes and 17 descriptive subthemes were identified. CONCLUSIONS The systematic review highlights knowledge, balancing the scales, self-efficacy and support influence medication taking behaviour to women with breast cancer. IMPACT The medication taking behaviour of breast cancer women can be classified into four types: acceptance/persistence, bearing/suffering, hesitation/adjustment, refusing/abandoning. The four types can switch from one to another. Medication taking behaviour is affected by knowledge, balancing the scales, self-efficacy, and support. The medical institutions, communities, and families can gain knowledge of the treatment experiences of women to better understand medication taking behaviour and those at risk for non-adherence. Women wanted different types and amounts of information. Healthcare providers should be aware of patient preferences and take targeted interventions to help them receive treatment.
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Affiliation(s)
- Hui Xu
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Insititute, Shenyang, China
| | - Xiu-Jie Zhang
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Da-Qiu Wang
- Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Lei Xu
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ai-Ping Wang
- Department of Nursing, The First Affiliated Hospital of China Medical University, Shenyang, China
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16
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Ahlstedt Karlsson S, Wallengren C, Olofsson Bagge R, Henoch I. "It is not just any pill"-Women's experiences of endocrine therapy after breast cancer surgery. Eur J Cancer Care (Engl) 2019; 28:e13009. [PMID: 30748038 DOI: 10.1111/ecc.13009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 11/05/2018] [Accepted: 01/17/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE For patients diagnosed with hormone-receptor-positive breast cancer, endocrine therapy (ET) is usually prescribed to reduce recurrence and mortality rates. Despite the benefits, compliance with treatment varies. The aim of this study was to provide qualitative data about women's experiences with ET after breast cancer surgery. METHODS Twenty-five women, treated with Tamoxifen after breast cancer surgery, were interviewed in seven focus groups. Six open-ended questions were used to explore their experiences. The interviews were recorded, transcribed verbatim and analysed using inductive content analysis. RESULTS The analysis resulted in three categories that described the women's experiences: the treatment "creates discomfort"; "promotes levels of management"; and "causes feelings of abandonment". Women's experiences of treatment could at first glance be seen as positive, as perceived protection, but after further analysis, a deeper meaning was identified: protection with reservation. When experiencing discomfort, the women tried to manage the situation, although the mode of management sometimes varied. The women reported that they needed support, but when the support did not appear, they felt as though they had been abandoned. Moreover, knowledge about side effects became an obstacle, as it could create fear of more severe symptoms. They also described that their disease was perceived by healthcare professionals as "cancer light". CONCLUSION The information needs to be customised specifically to each person.
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Affiliation(s)
- Susanne Ahlstedt Karlsson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Catarina Wallengren
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ingela Henoch
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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17
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Paladino AJ, Anderson JN, Graff JC, Krukowski RA, Blue R, Jones TN, Buzaglo J, Kocak M, Vidal GA, Graetz I. A qualitative exploration of race-based differences in social support needs of diverse women with breast cancer on adjuvant therapy. Psychooncology 2019; 28:570-576. [PMID: 30636189 DOI: 10.1002/pon.4979] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Social support is a critical component of breast cancer care and is associated with clinical and quality of life outcomes. Significant health disparities exist between Black and White women with breast cancer. Our study used qualitative methods to explore the social support needs of Black and White women with hormone receptor-positive breast cancer on adjuvant endocrine therapy (AET). METHODS We conducted four focus group (FG) interviews (N = 28), stratified by race (ie, Black and White) and time on AET. FGs were audiotaped, transcribed, and analyzed according to conventions of thematic analysis. RESULTS Participants noted the importance of having their informational and emotional social support needs met by friends and family members. White participants reported support provided by others with breast cancer was crucial; Black women did not discuss other survivors as part of their networks. Notably, both White and Black participants used the FG environment to provide experiential social support to each other. CONCLUSIONS White participants noted that having other breast cancer survivors in their support network was essential for meeting their social support needs. However, Black participants did not reference other breast cancer survivors as part of their networks. Cancer centers should consider reviewing patients' access to experiential support and facilitate opportunities to connect women in the adjuvant phase.
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Affiliation(s)
- Andrew J Paladino
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Janeane N Anderson
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - J Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rebecca A Krukowski
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ryan Blue
- College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Tameka N Jones
- West Cancer Center, Department of Hematology and Oncology, Germantown, Tennessee
| | - Joanne Buzaglo
- Vector Oncology, PRO Solutions Department, Memphis, Tennessee
| | - Mehmet Kocak
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gregory A Vidal
- West Cancer Center, Department of Hematology and Oncology, Germantown, Tennessee
| | - Ilana Graetz
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.,Rollins School of Public Health, Emory University, Atlanta, Georgia
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18
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Hagen KB, Aas T, Kvaløy JT, Søiland H, Lind R. Adherence to adjuvant endocrine therapy in postmenopausal breast cancer patients: A 5-year prospective study. Breast 2019; 44:52-58. [PMID: 30641300 DOI: 10.1016/j.breast.2019.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/20/2018] [Accepted: 01/07/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Adjuvant endocrine therapy (ET) in breast cancer reduces recurrence risk and increases overall survival. The aim of the study was to quantify non-adherence and discontinuation to ET in postmenopausal women with breast cancer, and identify possible clinical or social risk factors. METHODS Women with hormone-receptor positive breast cancer (N = 138), mean age 58 (SD 9.3) years, filled in 4 questionnaires within 1-12, 24, 36 and 48-60 months after surgery; Subjective Health Complaints Inventory (SHC), Functional Assessment of Cancer Therapy-Social Support Subscale (FACT-ES), and Quality of Patient Information Questionnaire (QPI).
Adherence to Tamoxifen (Tam) or Aromatase Inhibitors (AI) was examined using self-reported adherence and data from the Norwegian Prescription Database (NorPD) [corrected]. Kaplan-Meier curves and Cox proportional hazards regression models estimated adherence to ET. RESULTS The estimate of discontinued ET within 60 months was 38%. Self-reported discontinuation was 7% compared with 25% from the NorPD. Being overweight or obese were significantly time dependent factors predictive for discontinuing ET, p = 0.025. CONCLUSION Closer follow-ups, tailor-made information about the proven benefits of ET, and keeping a normal body mass index (BMI) may improve adherence to ET in postmenopausal women with breast cancer.
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Affiliation(s)
- Kari Britt Hagen
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Turid Aas
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway.
| | - Jan Terje Kvaløy
- Research Department, Stavanger University Hospital, Stavanger, Norway; Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway.
| | - Håvard Søiland
- Department for Breast and Endocrine Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Ragna Lind
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway.
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19
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Lambert LK, Balneaves LG, Howard AF, Chia SK, Gotay CC. Understanding adjuvant endocrine therapy persistence in breast Cancer survivors. BMC Cancer 2018; 18:732. [PMID: 29996816 PMCID: PMC6042363 DOI: 10.1186/s12885-018-4644-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/28/2018] [Indexed: 01/13/2023] Open
Abstract
Background Adjuvant endocrine therapy (AET) significantly decreases the risk of breast cancer recurrence and mortality. Notwithstanding the demonstrated efficacy of AET, 31–73% of breast cancer survivors do not persist with AET. The purpose of this study was to explore breast cancer survivors’ experiences and perspectives of persisting with AET and to identify the psychosocial and healthcare system factors that influence AET persistence. Methods Informed by interpretive descriptive methodology and relational autonomy theory, individual interviews were conducted with 22 women diagnosed with early-stage breast cancer who had been prescribed AET. These participants also completed a demographic form and a survey that assessed their perceived risk of recurrence. Interviews were analysed using inductive thematic and constant comparative analysis to iteratively compare data and develop conceptualizations of the relationships among data. Descriptive statistics were used to summarize the quantitative data. Results The personal, social, and structural factors found to influence AET persistence included AET side effects, perception of breast cancer recurrence risk, medication and necessity beliefs, social support, the patient-provider relationship, and the continuity and frequency of follow-up care. For most women, over time, the decision-making process around AET persistence became a balancing act between quality of life and quantity of life. The interplay between the personal, social, and structural factors was complex and the weight women placed on some factors over others influenced their AET persistence or non-persistence. Conclusion Expanding our understanding of the factors affecting breast cancer survivors’ AET persistence from their perspective is the first step in developing efficacious, patient-centered interventions aimed at improving AET persistence. In order to improve AET persistence, enhanced symptom management is required, as well as the development of supportive care strategies that acknowledge the values and beliefs held by breast cancer survivors while reinforcing the benefits of AET, and addressing women’s reasons for non-persistence. Improved continuity of health care and patient-healthcare provider communication across oncology and primary care settings is also required. The development and evaluation of supportive care strategies that address the challenges associated with AET experienced by breast cancer survivors hold the potential to increase both women’s quality and quantity of life. Electronic supplementary material The online version of this article (10.1186/s12885-018-4644-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leah K Lambert
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Helen Glass Centre for Nursing, Winnipeg, MB, R3T 2N2, Canada.
| | - A Fuchsia Howard
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Stephen K Chia
- British Columbia Cancer Agency, 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Carolyn C Gotay
- School of Population and Public Health, University of British Columbia, V2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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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. PHARMACY 2018; 6:pharmacy6020053. [PMID: 29890738 PMCID: PMC6024955 DOI: 10.3390/pharmacy6020053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 12/31/2022] Open
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.
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21
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Pan Y, Heisig SR, von Blanckenburg P, Albert US, Hadji P, Rief W, Nestoriuc Y. Facilitating adherence to endocrine therapy in breast cancer: stability and predictive power of treatment expectations in a 2-year prospective study. Breast Cancer Res Treat 2018; 168:667-677. [PMID: 29330625 PMCID: PMC5842254 DOI: 10.1007/s10549-017-4637-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/23/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE To identify modifiable factors predictive of long-term adherence to adjuvant endocrine therapy (AET). METHODS As part of a 2-year cohort study in primary care (n = 116), we investigated whether initial treatment expectations predict adherence at 24 months after controlling for demographic, medical, and psychosocial variables. Treatment expectations were measured as necessity-concern beliefs, expected side-effect severity, and expected coping with side effects. Their stability over time and differences of trajectories between the adherent and nonadherent group were examined. RESULTS Nonadherence at 24 months was 14.7% (n = 17). Side-effect severity at 3 months [OR 0.25, 95% CI (0.08, 0.81), p = 0.02] and necessity-concern beliefs [OR 2.03, 95% CI (1.11, 3.72), p = 0.02] were the sole predictors of adherence. Necessity-concern beliefs remained stable over 2 years, whereas expected side-effect severity (p = 0.01, η p2 = 0.07) and expected coping with side effects became less optimistic over time (p < 0.001, η p2 = 0.19), the latter particularly among nonadherers (p < 0.01, η p2 = 0.10). CONCLUSIONS Patients' initial necessity-concern beliefs about the AET and early severity of side effects affect long-term adherence. Expecting poor management of side effects may also facilitate nonadherence. We suggest that discussing benefits, addressing concerns of AET, and providing side-effect coping strategies could constitute a feasible and promising option to improve adherence in clinical practice.
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Affiliation(s)
- Yiqi Pan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
- Schön Klinik Hamburg Eilbek, University Clinic for Psychosomatic Medicine and Psychotherapy, Dehnhaide 120, 20081, Hamburg, Germany.
| | - Sarah R Heisig
- Clinical Psychology and Psychotherapy, University of Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Ute-Susann Albert
- AWMF-Institute for Medical Knowledge Management, Philipps-University of Marburg, Karl-von-Frisch-Str. 1, 35043, Marburg, Germany
| | - Peyman Hadji
- Department of Gynecology and Obstetrics, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Yvonne Nestoriuc
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
- Schön Klinik Hamburg Eilbek, University Clinic for Psychosomatic Medicine and Psychotherapy, Dehnhaide 120, 20081, Hamburg, Germany
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22
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Moon Z, Moss-Morris R, Hunter MS, Hughes LD. Understanding tamoxifen adherence in women with breast cancer: A qualitative study. Br J Health Psychol 2017; 22:978-997. [PMID: 28850763 DOI: 10.1111/bjhp.12266] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 07/20/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Non-adherence to tamoxifen is common in breast cancer survivors and is associated with poor clinical outcomes. This study aimed to understand womens' experiences of taking tamoxifen and to identify factors which may be associated with non-adherence. DESIGN A qualitative study using semi-structured interviews. METHODS Thirty-two breast cancer survivors who had been prescribed tamoxifen took part in interviews conducted face to face or over the telephone. They were transcribed verbatim and analysed using inductive thematic analysis with elements of grounded theory. RESULTS A key theme identified in the data was weighing up costs and benefits of treatment, which resulted in women falling into three groups; tamoxifen is keeping me alive, tamoxifen is not worth the reduced risk of recurrence, or conflicting beliefs about the harms and benefits of treatment. Additional themes were living with risk of recurrence and information & support. CONCLUSIONS Women who believed that the necessity of tamoxifen outweighed its costs were more likely to be adherent, whereas women who thought that the benefits did not outweigh the side effects were more likely to have discontinued. A third more ambivalent group believed strongly in the importance of treatment, but were struggling with side effects and were often non-adherent. Patients sometimes felt unsupported and discussed a need for more comprehensive information. To increase adherence, future research needs to explore ways to increase beliefs around tamoxifen necessity and how to help women cope with side effects. Statement of contribution What is already known on this subject? Non-adherence to tamoxifen is associated with increased risk of recurrence and mortality. Up to 50% of patients are non-adherent to tamoxifen by the fifth year of treatment Few consistent predictors of tamoxifen non-adherence have been identified. What does this study add? Many women report not knowing how to manage their side effects. Non-adherence is related to how women weigh up their side effects against their medication beliefs. Interventions aiming to increase necessity beliefs and improve symptom management may be effective.
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Affiliation(s)
- Zoe Moon
- Institute of Psychiatry, Psychology & Neuroscience, Health Psychology Section, King's College London, UK
| | - Rona Moss-Morris
- Institute of Psychiatry, Psychology & Neuroscience, Health Psychology Section, King's College London, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology & Neuroscience, Health Psychology Section, King's College London, UK
| | - Lyndsay D Hughes
- Institute of Psychiatry, Psychology & Neuroscience, Health Psychology Section, King's College London, UK
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23
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Brett J, Fenlon D, Boulton M, Hulbert-Williams N, Walter F, Donnelly P, Lavery B, Morgan A, Morris C, Watson E. Factors associated with intentional and unintentional non-adherence to adjuvant endocrine therapy following breast cancer. Eur J Cancer Care (Engl) 2016; 27. [DOI: 10.1111/ecc.12601] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- J. Brett
- Faculty of Health and Life Sciences; Oxford Brookes University; Oxford UK
| | - D. Fenlon
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - M. Boulton
- Faculty of Health and Life Sciences; Oxford Brookes University; Oxford UK
| | - N.J. Hulbert-Williams
- Department of Psychology; Chester Research Unit for the Psychology of Health (CRUPH); University of Chester; Chester UK
| | - F.M. Walter
- Primary Care Cancer Research; Lucy Cavendish College; Cambridge University; Cambridge UK
| | - P. Donnelly
- South Devon Healthcare NHS Foundation Trust; Torbay Hospital; Torquay UK
| | - B. Lavery
- Cancer Services; Churchill Site; Oxford University; Hospitals Foundation NHS Trust; Oxford UK
| | - A. Morgan
- Independent Cancer Patient Voice; London UK
| | - C. Morris
- Independent Cancer Patient Voice; London UK
| | - E. Watson
- Faculty of Health and Life Sciences; Oxford Brookes University; Oxford UK
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