A qualitative comparison of how older breast cancer survivors process treatment information regarding endocrine therapy

The Experience of Patients with Endocrine Therapy for Breast Cancer: A Patient Journey Map Based on Qualitative Research

(1) Background: While there is extensive documentation on the medical experience of breast cancer, a thorough understanding of the various stages of endocrine therapy remains insufficient. The aim of this study was to map the experiences and coping styles of breast cancer patients during endocrine therapy. (2) Methods: Qualitative research was conducted to gather insights into the experiences of breast cancer patients undergoing endocrine therapy. The themes were organized through content analysis and induction. Subsequently, patients were invited for face-to-face interviews at a top-three hospital in Guangzhou to supplement and validate the findings from the literature review. The patient journey was then mapped based on both the literature review and the semi-structured interviews. (3) Results: A total of 24 studies were included that described patients' experiences and behaviors during the early, middle, and late stages of treatment, leading to the formation of a preliminary framework. Interviews were conducted with 20 patients, which confirmed and enriched the findings from the literature review. Based on these results, a stage trajectory for endocrine therapy in breast cancer was established. (4) Conclusions: The patient journey map developed in this study clearly and intuitively illustrates the thought and emotion matrix, as well as the behavior matrix, of breast cancer patients undergoing endocrine therapy. This provides a theoretical foundation for enhancing clinical services tailored to the needs of these patients.

Clinical Pharmacist-Led Interventions for Improving Breast Cancer Management-A Scoping Review

Breast cancer is the leading cause of cancer-related death in women worldwide and the fifth most common cause of cancer death overall. Most women with breast cancer have a good prognosis if the cancer is detected at an early stage and the patients have access to the appropriate treatment and disease management. This study aims to evaluate the impact of pharmacist-led interventions on breast cancer management and health outcomes. A literature review was carried out through the scientific databases PubMed, Scopus, and Web of Science using predefined keywords. Only full-text original articles written in English that investigated the role of the pharmacist in the management of breast cancer were included in the final analysis. No publication date limits were set. A total of 1625 articles were retrieved from the electronic databases, of which 14 met the inclusion criteria. The current scoping review consists of different study types, including randomized controlled trials, cross-sectional studies, pre-post studies, retrospective cohort studies, quality improvement projects, case-control studies, and one pharmacoeconomic study. Pharmacists commonly provided the following interventions: consultations regarding chemotherapy treatment, risk assessment and patient education, adverse drug reactions and drug-drug interactions detection, and adherence assessment. This scoping review highlights the beneficial effects of the involvement of pharmacists in breast cancer management, such as better quality of life, reduced drug interaction risk, greater adherence rates, and improved patient knowledge. This confirms the importance of including the pharmacist in the oncology team caring for patients with breast cancer.

When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review

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.

Systematic adaptation of the adherence improving self-management strategy to support breast cancer survivors' adherence to adjuvant endocrine therapy: An intervention mapping approach

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.

An intervention mapping-based support program that empowers patients with endocrine therapy management

BACKGROUND

For women diagnosed with hormone-receptor-positive breast cancer, endocrine therapy (ET) is recommended. Patients experience diverse side effects, and difficulties in managing these side effects have been identified as obstacles for treatment continuation. The aim of this study was to describe the development of a support program for patients prescribed ET.

METHODS

Intervention mapping (IM) a comprehensive theory-based approach was used in the support program development. A participatory design was used and four advisory groups was formed including both patients and healthcare professionals.

RESULTS

This study employed the systematic stages of IM to develop a theory-based support program with the goal to empower patients prescribed ET to manage ETrelated symptoms and problems, and to illuminate the healthcare structure. The needs assessment identified three performance objectives: (1) Patients have knowledge of and understand their symptoms and their management strategies. (2) Patients have the knowledge and confidence to express their care needs and to ask for guidance from healthcare professionals. (3) Patients are active in and lead their healthcare process.

CONCLUSION

This is a systematic developed model, built upon aspects of ET both from a patient´ perspective as well as from healthcare professionals' perspectives.

Lived experience and perceived advantages of therapeutic De-escalation: A qualitative study of older patients with breast cancer

INTRODUCTION

One option for therapeutic de-escalation in older women with early breast cancer (EBC) is partial breast irradiation (PBI) instead of whole-breast irradiation (WBI) when the latter has no clear advantages. We aimed to explore the decision-making processes and the lived experiences of WBI and PBI from the perspectives of older women with EBC.

MATERIALS AND METHODS

Thematic content analysis was performed on qualitative data collected using narrative interviews.

RESULTS

Twenty-two women aged 65 and over participated (ten patients who underwent WBI and twelve who underwent PBI). We identified three themes from their narratives: 1) Acceptance of a paternalistic relationship with physicians, 2) Strong need for an informed choice, and 3) PBI can help people conceal cancer-related physical marks. Narratives underlined participants' preferences for each of the two treatments and their perceptions about therapeutic de-escalation. Misconceptions about therapeutic de-escalation were observed.

DISCUSSION

When providing information about EBC treatment options, patients' perceived burden of side effects should be considered. Moreover, eliciting the value older patients place on available breast cancer treatments, as well as their related goals and preferences, could foster their participation in the therapeutic de-escalation decision-making process.

The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A qualitative systematic review and thematic synthesis

BACKGROUND

Hormone Therapy (HT) reduces the risk of breast cancer recurrence and mortality in women with breast cancer. Despite these clinical benefits, rates of HT non-adherence and non-persistence are high. Research suggests this may be due to the impact of HT side effects. However, little research has explored the individual contribution of side effects to non-adherence and non-persistence behaviours, thereby hindering the implementation of targeted intervention strategies. Our aim is to review the published literature on breast cancer survivors' lived experiences of HT side effects and explore how these may be related to non-adherence and non-persistence behaviour.

METHODS

Electronic searches were conducted from inception to May 2020, utilising Cochrane CENTRAL, Medline, Embase, Web of Science and PsycINFO databases. Searches included a combination of terms related to breast cancer, adherence, hormone therapy and side effects.

RESULTS

Sixteen eligible papers were identified, and study quality was high. Data were thematically synthesised into four analytical themes, which encompassed 13 descriptive sub-themes: 'Daily impact of side-effects', 'Role of Health Care Professionals', 'Managing HT side-effects', and 'Weighing up the pros and cons'.

CONCLUSIONS

HT side effects significantly impact breast cancer survivor's quality of life. A lack of support from healthcare providers leads to self-management strategies, which negatively affects adherence and persistence behaviour.

The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer

Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million worldwide and is responsible for the highest number of cancer-related deaths among women. Approximately 80% of breast cancers express on the surface of hormone receptor cells, such as progesterone and estrogen. In these cases, Adjuvant Hormonal Therapy (AHT) is indicated for a period of five to ten years and consists of taking a daily oral pill. The two most used drugs in AHT are tamoxifen and Aromatase Inhibitors. One of the issues most faced by individuals who are subjected to long periods of treatment is the lack of medication adherence and, consequently, therapeutic inefficiency. It is believed that the monitoring by the pharmacist can contribute to the reduction of errors inherent to the medication, making the treatment more effective and improving the patient's quality of life. The present study aimed to know the perception of patients who live with breast cancer and who do AHT in relation to the educational performance of the clinical pharmacist. This is a qualitative, descriptive and exploratory study, carried out from March to October 2020, with 15 women undergoing treatment at the oncology unit of a tertiary-care hospital in south of Brazil. The data were obtained through a semi-structured interview using an instrument composed of two parts, one referring to the characterization of the participants and the other with the guiding question of the research: "How do you perceive the role of the pharmacist in relation to the guidelines for the use of adjuvant hormonal therapy?". The method of theoretical saturation was used to perform the sample closure and the thematic analysis was used to analyze the data. The participants were between 32 and 74 years old, seven were on tamoxifen therapy and eight on anastrozole, ten were on the first year of treatment, two on the second and three on the third year. The themes that emerged were: pharmacist-patient interaction as a safety factor in hormone therapy; role of the pharmacist in the development of strategies for self-management of the patients during hormone therapy; and, challenges for the pharmacist in relation to hormone therapy through continued guidance. It was evident that the pharmacist's educational action encouraged the participants to carry out the treatment in a more confident and assertive manner according to their particularities and beliefs.

"It Just Hit Me Like a Ton of Bricks": Improving the Patient Experience of Receiving a Breast Cancer Diagnosis at an Older Age

The purpose of the current study was to describe the experiences of older women receiving a diagnosis of early-stage breast cancer. Thematic analysis informed by techniques from constructivist grounded theory was used to analyze interviews with 54 women aged ≥65 years an average of 19.6 months after diagnosis. Two themes were identified: The Overwhelming Shock of Receiving a Diagnosis and Contextualizing the Diagnosis in Relation to Age. Results suggest these participants were deeply shocked by a diagnosis that clinicians may view as highly treatable. Age-related factors impacting how the bad news was received include misunderstanding risk factors, the impact of comorbidities, concurrent life events, and evolving perceptions of cancer at her life stage. To establish a solid foundation for age-appropriate communication when giving bad news, these participants help clinicians acknowledge what women may be thinking. Potential clinician responses to the variety of concerns are presented. [Research in Gerontological Nursing, 14(2), 79-89.].

Use of Adjuvant Endocrine Therapy Among Post-Menopausal Breast Cancer Patients in Malaysia

CONTEXT

Globally, breast cancer is the most common cancer affecting women, and adjuvant endocrine therapy (AET) is part of its treatment modality, which improves patients' outcome. However, there are concerns on side effects related to its use, which may affect treatment adherence.

PURPOSE

This study was conducted to explore attitude and practice on using AET among breast cancer patients in Malaysia.

PATIENTS AND METHODS

Postmenopausal breast cancer patients on at least 3 months of AET attending the outpatient oncology clinic at a tertiary care hospital were interviewed. Patients underwent in-depth interviews exploring their attitude and practices while on AET using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using thematic analysis.

RESULTS

There were four main themes for attitude toward the use of AET: 1) benefits of using AET, 2) concerns on taking AET, 3) beliefs on alternative treatment, and 4) beliefs toward the doctor. For practice, six themes were obtained: 1) correct use of AET, 2) appointment adherence, 3) information-seeking behavior, 4) counseling services obtained, 5) experienced side effects of AET, and 6) usage of complementary and alternative medicines.

CONCLUSION

Several themes concerning attitude and practice of breast cancer patients receiving AET were identified, which may be addressed during treatment consultations in clinical practice.

Aromatase inhibitors: The unexpected breast cancer treatment

OBJECTIVE

Suboptimal adherence with endocrine treatment for breast cancer is influenced by a number of factors but remains poorly understood. We sought to describe the prior knowledge about and expectations of breast cancer treatments among older women retrospecting on their diagnosis and treatment.

METHODS

Thematic analysis was used to systematically analyze data obtained with face-to-face, open-ended interviews conducted with 54 women who had filled at least one prescription for an aromatase inhibitor. The average age was 71.9 (65-93) years at diagnosis.

RESULTS

Three salient themes were described: the sources of information on which preknowledge and expectations surrounding treatment were founded, and two phases of treatment, primary (surgery, chemotherapy and radiation therapy) and anti-hormonal. The main source of information was from family and friends who had been treated for cancer. These peers reported both positive and negative experiences and in many cases contributed to the women having some degree of misinformation. A foundational knowledge of primary treatments was evident (necessity, duration, intensity, side-effects) and that receiving one or more treatments was needed. Compared to primary treatments, anti-hormonal treatment (AHT) was unexpected, the women knew less about it, and felt comparatively under-prepared for this treatment.

CONCLUSIONS

The transition from primary treatments to adjuvant AHT therapy with receiving a prescription for an aromatase inhibitor caught many participants off guard. Our findings elucidate areas to enhance clinical practice, expand the research agenda to more thoroughly explore AHT information and design of an age-appropriate supportive intervention to improve continuation with AHT.