Adherence to adjuvant endocrine therapy among White British and ethnic minority breast cancer survivors in the United Kingdom

Scoping review identifying interventions that have been tested to optimise the experience of people from ethnic minority groups receiving systemic anticancer therapy (SACT)

BACKGROUND

Disparities have been identified in many aspects of the cancer care pathway for people from minority ethnic groups (MEGs). Adherence to systemic anticancer therapies (SACTs) has been shown to impact morbidity and mortality, and therefore, inequitable experiences can have a detrimental effect on outcomes.

OBJECTIVES

To identify interventions that focused on improving the experiences and clinical outcomes in people from MEG receiving SACT treatments.

METHODS

A scoping review was conducted according to Arksey and O'Malley's methodological framework to map the available literature. A comprehensive search was performed using three electronic databases (Medline, Embase and CINAHL). Standard scoping review methodology following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was used. Studies were included that assessed interventions to improve MEG patients' experience with SACT. Study types included in the review were evaluation studies, randomised/non-randomised controlled trials and all observational studies. Exclusion criteria were applied to studies including opinion pieces, literature and systematic reviews, non-English studies, conference abstracts and studies that were not describing an intervention. Independent duplicate screening, study selection, data extraction and quality assessment were undertaken. Results of the studies were synthesised using a published equity framework.

RESULTS

Searches yielded 1356 articles. Nine studies were included after exclusion criteria were applied. Studies described six digital, two in-person and one hybrid intervention employing different research methodologies, ranging from randomised controlled trials (RCTs), feasibility studies and mixed methods studies. The majority of interventions in this study were delivered remotely, using digital platforms such as websites, recorded educational training materials as well as social media. These interventions were conducted in the USA and primarily targeted patients with early breast cancer from African American backgrounds.

CONCLUSIONS

This scoping review showed that there has been a very small number of studies investigating interventions to optimise SACT treatment experiences in people from MEG. We found evidence of interventions incorporating the equity domains that reported improved patient engagement and experience. This new knowledge will help to implement future SACT interventions, addressing health inequities across the cancer continuum.

Cross-cultural adaptation of the simple Chinese version of the medication adherence reasons scale in patients undergoing adjuvant endocrine therapy for breast cancer

Adjuvant endocrine therapy (AET) is essential for improving survival and reducing mortality and recurrence rates in breast cancer (BrCa) patients. However, the adherence to AET among BrCa patients is poor, and there is no scale to measure adherence to AET or the reasons for non-adherence among BrCa patients in mainland China. The aim of this study was to assess the psychometric properties of the simple Chinese version of the Medication Adherence Reasons (MAR) scale in BrCa patients undergoing AET. This study utilized a cross-sectional research design with two phases: (1) translation and cross-cultural adaptation of the original English version of the MAR scale into simple Chinese and (2) validation of the simple Chinese version of the MAR scale (s-ChMAR scale) in BrCa patients. Instrument assessments included content validity, face validity, item analysis, construct validity, criterion-related validity and reliability testing. This study recruited participants using convenience sampling to investigate adherence to AET among BrCa patients. Inclusion criteria were: (a) female, (b) aged 18 years or older, (c) diagnosed with Stage I to III BrCa, (d) completed primary treatment for hormone receptor-positive BrCa and had been on AET for more than six months but less than five years, (e) proficient in Mandarin, and (f) provided informed consent. Exclusion criteria included psychiatric illness, cognitive impairment, or a diagnosis of another cancer type. The sample size for exploratory factor analysis (EFA) was determined based on a ratio of five to ten participants per scale item to ensure sufficient statistical power. Data were collected from a sample of 325 participants who received AET for over six months. All the items had a content validity index (CVI) of more than 0.80. Regarding construct validity, the s-ChMAR scale fit a four-dimensional model, the same as the original MAR scale tested in asthma patients. The s-ChMAR scale had good internal reliability (Cronbach's α = 0.896) and good stability (ICC = 0.837). In terms of quantifying non-adherence, the s-ChMAR scale identified a non-adherent participant rate of over 50%. The study findings support the reliability and validity of the s-ChMAR scale in measuring the non-adherence of Chinese BrCa patients to AET.

Predictors of self-care in patients with cancer treated with oral anticancer agents: A systematic review

BACKGROUND

In the last two decades, the use of oral anticancer agents (OAAs) has increased in cancer patients. Despite this, patients and their caregivers face some challenging issues (side effects, drug-to-drug interactions, etc.) related to OAA administration. The three dimensions of self-care by Riegel et al., self-care maintenance (i.e., stability of patient condition), self-care monitoring (i.e., detection of side effects), and self-care management (i.e., management of side effects), may be implemented to avoid negative outcomes. However, knowledge of self-care determinants is necessary to recognise people at risk of poor self-care behaviours.

AIMS

Determine which are the predictors of self-care maintenance, self-care monitoring and self-care management in patients with cancer taking OAA.

METHODS

A systematic review with narrative synthesis was conducted. We included studies on adult patients with cancer using any kind of oral anticancer agent and describing a predictor of self-care. The search was performed on PubMed, CINAHL/PsycINFO, and Web of Science.

RESULTS

Of 3,061 records, 45 studies were included in this review. Forty-six predictors organised into 14 categories were identified. In general, all studies focused only on adherence, considered as a self-care maintenance component, and none of them focused on other dimensions of self-care. The predictors of OAA adherence most reported were age, side effects, and socioeconomic factors (e.g., insurance status, and annual income).

CONCLUSIONS

This systematic review highlighted the literature gap on the analysis of determinants of self-care behaviours in patients taking OAAs. This element could be a starting point for future research that can provide elements to support the oncology nursing research agenda, aimed at recognising patients at risk of poor self-care.

Evaluation of adherence to pharmacological treatments by undocumented migrants with chronic diseases: a 10-year retrospective cohort study

OBJECTIVES

To investigate the time course of medication adherence and some of the factors involved in this process in undocumented migrants with chronic diseases.

DESIGN

Retrospective cohort study.

SETTING

A big non-governmental organisation in Milano, Italy, giving medical assistance to undocumented migrants.

PARTICIPANTS

1918 patients, 998 females and 920 males, with at least one chronic condition (diabetes, cardiovascular diseases (CVDs), mental health disorders) seen over a period of 10 years (2011-2020). Their mean age was 49.2±13 years.

RESULTS

Adherence to medications decreased over 1 year in all patients. This was more evident during the first 2 months of treatment. Patients on only one medication were less adherent than those on more than one medication; at 6 months the percentage of patients with high adherence was 33% vs 57% (p<0.0001) for diabetes, 15% vs 46% (p<0.0001) for mental disorders and 35% vs 59% (p<0.0001) for CVDs. Patients with mental disorders had the lowest adherence: 25% at 6 months and 3% at 1 year. Mental disorders, when present as comorbidities, greatly reduced the probability of being highly adherent: risk ratio (RR) 0.72 (95% CI 0.57 to 0.91; p=0.006) at 3 months, RR 0.77, (95% CI 0.59 to 1.01; p=0.06) at 6 months, RR 0.35 (95% CI 0.13 to 0.94; p=0.04) at 1 year. This was especially evident for patients with CVDs, whose percentage of high adherents decreased to 30% (p=0.0008) at 6 months and to 3% (p=0.01) at 1 year. We also noted that highly adherent patients usually were those most frequently seen by a doctor.

CONCLUSIONS

Interventions to increase medication adherence of undocumented migrants with chronic diseases are necessary, particularly in the first 2 months after beginning treatment. These should be aimed at people-centred care and include more outpatient consultations. Educational interventions should especially be taken into consideration for patients on monotherapy.

Beliefs about medicines' association with endocrine therapy adherence in early breast cancer survivors in Croatia

This observational, cross-sectional study conducted at the University Hospital Centre Zagreb (UHC Zagreb) aimed to explore patients' beliefs about adjuvant endocrine therapy (AET) as well as their association with non-adherence and sociodemographic and clinical factors. Out of 420 early breast cancer (BC) patients included in the study, 79.5 % perceived AET necessary and important for their health, as measured by the Belief About Medicines Questionnaire (BMQ), with the mean necessity score (20.4 ± 3.68) significantly higher than the mean concerns score (13 ± 4.81) (p < 0.001). Based on the Medication Adherence Report Scale (MARS-5), 44.4 % (n = 182) of the participants were non-adherers, out of which 63.2 % (n = 115) were unintentional and 36.8 % (n = 67) intentional non-adherers. Significantly higher concern beliefs were found among patients that were younger (p < 0.001), employed (p < 0.001), intentionally non-adherent to AET (p = 0.006), had a lower body-mass index (p = 0.005) and a higher level of education (p < 0.001), were premenopausal at the time of diagnosis (p < 0.001), taking tamoxifen treatment (p = 0.05) and receiving ovarian suppression (p < 0.001). Younger patients should be recognized as being at risk of non-adherence as they hold greater concern beliefs about medicines.

Completeness of endocrine therapy information in the Primary Care Prescription Database (PCPD) and secondary care treatment datasets: A national population-based cohort study using routine healthcare data

BACKGROUND

Endocrine therapy (ET) is a widely used treatment for breast cancer. In the UK, use is typically initiated in secondary care, with subsequent treatment in primary care. Evaluating use of ET depends on data sources containing accurate and complete information. This study aimed to evaluate the completeness and consistency of ET recorded in primary and secondary care data (SCD) and determine the value of combining data sources in describing use of ET.

METHODS

This cohort study included women (50 + years) diagnosed with hormone receptor-positive invasive breast cancer in England, April-2015 to December-2019. Concordance of ET recorded in SCD and the Primary Care Prescription Database (PCPD) was evaluated. Factors associated with recording of ET in each setting were assessed using statistical models.

RESULTS

Overall 110,529 women were included. 94% had ET recorded in either SCD or PCPD. ET captured in SCD varied from 3% (in Systemic Anti-Cancer Therapy data) to 52% (in the Cancer Outcomes and Services Dataset; COSD). By contrast, 93% of patients had an ET prescription in PCPD. Among patients with ET recorded, this was not captured in COSD for 45%. Capture in COSD was lowest for younger women, those with no comorbidity/frailty, with lower stage or HER2-positive disease, or with other treatments recorded. Overall concordance between COSD and PCPD was 57%, but varied substantially across NHS trusts (lowest decile≤28%; highest decile≥86%). Among women with ET recorded in both settings, the earliest record was in COSD for 97%; 59% of initial ET prescriptions recorded in COSD were not captured in PCPD. Combining PCPD and COSD data enabled estimation of ET duration.

CONCLUSIONS

PCPD is vital for understanding the use of ET within this population. Completeness of SCD could be improved by ensuring information on first ET prescription is recorded. PCPD (linked to SCD) is a valuable resource for examining patterns of care for patients with cancer, including treatment duration and adherence.