Abstract
Purpose
Adherence to adjuvant endocrine therapy (AET) is suboptimal, and a range of variables have been explored for understanding patients’ experiences and motivations for medication-taking. However, oncologists’ views on adherence are poorly understood. The aim of this study was to explore oncologists’ perspectives on adherence/non-adherence and their strategies to ensure patients continue with treatments to inform the development of potential modifiable interventions.
Methods
A qualitative study using in-depth, semi-structured interviews with 16 oncologists was conducted in Argentina. A stratified purposive sampling was used to recruit female and male participants from 3 health subsystems (private, social security, and public). Data were analyzed using the Framework approach.
Results
Oncologists believed patients’ adherence was overall high and associated it with good tolerance of AET in comparison to chemotherapy, information provided, and patients feeling reassured (fear of recurrence). Non-adherence was not perceived as a major source of concern, and it was related to rare cases of severe side effects, young age, refusing treatment, losing the insurance plan, lack of education, and social circumstances. Patients’ complaints of bothersome side effects were not identified as a main reason to discontinuation. Public and private sector patients, however, were perceived as having different attitudes toward side effects. Management strategies included medicine change, referral to support services, and a supportive relationship with the oncologist.
Conclusion
Oncologists’ perspectives on adherence/non-adherence to AET show similarities and significant differences with those in the literature based on patient-reported factors. Overall adherence was considered high, but the likelihood of unintentional non-adherence seems important in public sector patients. Information to patients should provide clear explanations on both severe and unpleasant side effects. Interventions to improve communication skills in oncologists and specialists responsible for survivorship care should be considered to strengthen patients’ self-efficacy and effective medication-taking. Reliable data on adherence are needed.
Acknowledgments
I would like to express gratitude to the participants of this study, without their contribution this research would have not been possible. I also gratefully acknowledge the help of the anonymous referees and journal editors in the preparation of this manuscript. This study was funded by the School of Social Professions, London Metropolitan University.
Abbreviation list
AET, adjuvant endocrine therapy; AI, aromatase inhibitors; BC, breast cancer; TAM, Tamoxifen.
Ethics approval and informed consent
Ethics approval for this study was obtained from London Metropolitan University Research Ethics Committee (4053016). Written consent was obtained from participants for publication of the data collected in academic journals.
Supplementary materials
Disclosure
The author reports no conflicts of interest in this work.
Interview question guide
How do you consider patient adherence to AET in your clinic?
Do you have access to data on adherence?
What factors do you think can influence patients’ decision to adhere? (probes: information provided, cancer fear, trust in treatment).
What factors do you think can influence patients’ decision to not initiate AET medication?
Do patients discontinue medication before completing the 5 years? If so, can you identify their reasons? (probes side effects, socio-economic factors u others).
How often do you see your patients after they are discharged from clinic?
What are the main complaints regarding side effects that you receive from your patients? (probes physical symptoms, psychological symptoms).
How do you manage patients’ complaints about medication? (probes change of drugs, social services, non-medical treatment).
These questions correspond to a section of the interview guide regarding adherence to treatments. These questions were preceded by a set of questions about oncologists prescribing AET by Eraso.Citation1