Abstract
Purpose
Adjuvant endocrine therapy (ET) can reduce the risk of recurrence among females with hormone receptor-positive breast cancer. Overall, initiation and adherence to ET are suboptimal, though reasons are not well described. The study’s objective was to better understand ET decision making, prescribing, and patient management from oncology providers’ perspectives.
Methods
Using purposive sampling, we recruited oncology providers who saw five or more breast cancer patients per week (n=20). We conducted 30–45-minute telephone interviews, using a semistructured guide to elicit perspectives on ET use. We used thematic content analysis to systematically identify categories of meaning and double-coded transcripts using Atlas.ti.
Results
Providers recommend ET to all eligible patients except those with contraindications or other risk factors. Providers base their ET prescribing decisions on the patient’s menopausal status, side effects, and comorbidities. ET is typically discussed multiple times: at the onset of breast cancer treatment and in more detail after other treatment completion. Providers felt that the associated recurrence risk reduction is the most compelling argument for patients during ET decision making. While providers rarely perceived noninitiation as a problem, nonadherence was prevalent, often due to unresolvable side effects.
Conclusion
From the clinicians’ perspectives, side effects from ET are the dominant factor in nonadherence. Efforts to improve adherence should focus on strategies to minimize side effects and ensure clinicians and patients are well informed regarding optimal side effect management. This finding has important implications for novel endocrine regimens that offer improved outcomes through longer duration or more intensive therapy.
Acknowledgments
This research was funded by the American Cancer Society (ACS) Mentored Research Scholar Grant (MRSG-13-157-01-CPPB: “Improving Endocrine Therapy Utilization in Racially Diverse Populations”). SBW was also supported as a faculty trainee through the Carolina Community Network Center to Reduce Cancer Health Disparities (CCN II), funded by the National Cancer Institute’s Center to Reduce Cancer Health Disparities through its Community Network Program Centers (U54-CA153602). JAE and MCR were supported through UNC Lineberger, Cancer Control Education Program (R25 CA57726). During the conduct of this research, KRH received funding from a career development award through the Building Interdisciplinary Careers in Womens’ Health (BIRCWH) program of the National Institutes of Health (5K12HD001441-12). CEG was partially supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24-HD06920).
Disclosure
The authors report no conflicts of interest in this work.