Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management

doi:10.1007/s00520-017-3799-0

. 2017 Dec;25(12):3723-3731.

doi: 10.1007/s00520-017-3799-0. Epub 2017 Jul 6.

Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management

Cleo A Samuel^{1

2}, Kea Turner³, Heidi A S Donovan⁴, Ellen Beckjord⁵, Alexandra Cardy⁵, Mary Amanda Dew^{6

7}, G J van Londen⁷

Affiliations

¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC, 27599-7411, USA. cleo_samuel@unc.edu.
² Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, USA. cleo_samuel@unc.edu.
³ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC, 27599-7411, USA.
⁴ University of Pittsburgh Medical Center Cancer Center, School of Nursing, University of Pittsburgh, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, USA.
⁵ University of Pittsburgh Medical Center Health Plan, University of Pittsburgh, 600 Grant Street, Pittsburgh, PA, USA.
⁶ Department of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, USA.
⁷ Department of Medicine, University of Pittsburgh, A. 140 Cooper Pavilion, 5115 Centre Avenue, Pittsburgh, PA, USA.

PMID: 28681126
PMCID: PMC5688874
DOI: 10.1007/s00520-017-3799-0

Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management

Cleo A Samuel et al. Support Care Cancer. 2017 Dec.

. 2017 Dec;25(12):3723-3731.

doi: 10.1007/s00520-017-3799-0. Epub 2017 Jul 6.

Authors

Cleo A Samuel^{1

2}, Kea Turner³, Heidi A S Donovan⁴, Ellen Beckjord⁵, Alexandra Cardy⁵, Mary Amanda Dew^{6

7}, G J van Londen⁷

Affiliations

¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC, 27599-7411, USA. cleo_samuel@unc.edu.
² Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, USA. cleo_samuel@unc.edu.
³ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC, 27599-7411, USA.
⁴ University of Pittsburgh Medical Center Cancer Center, School of Nursing, University of Pittsburgh, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, USA.
⁵ University of Pittsburgh Medical Center Health Plan, University of Pittsburgh, 600 Grant Street, Pittsburgh, PA, USA.
⁶ Department of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, USA.
⁷ Department of Medicine, University of Pittsburgh, A. 140 Cooper Pavilion, 5115 Centre Avenue, Pittsburgh, PA, USA.

PMID: 28681126
PMCID: PMC5688874
DOI: 10.1007/s00520-017-3799-0

Abstract

Purpose: Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement.

Methods: We conducted three focus groups (FGs) with a multidisciplinary group of healthcare providers (n = 13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes.

Results: Providers described patient-, provider-, and system-level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers.

Conclusions: Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients' knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.

Keywords: Adjuvant endocrine therapy; Breast cancer; Provider perspectives; Survivorship care; Symptom management.

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Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflict of interest.

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References

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1. Burstein HJ, Prestrud AA, Seidenfeld J, Anderson H, Buchholz TA, Davidson NE, et al. American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol. 2010;28(23):3784–96. doi: 10.1200/JCO.2009.26.3756. - DOI - PMC - PubMed
1. McCowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, Thompson AM, et al. Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer. 2008;99(11):1763–8. doi: 10.1038/sj.bjc.6604758. - DOI - PMC - PubMed
1. Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381(9869):805–16. doi: 10.1016/S0140-6736(12)61963-1. - DOI - PMC - PubMed
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[1] Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, et al. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. Journal of the National Cancer Institute. 2015;107(6):djv048. doi: 10.1093/jnci/djv048. - DOI - PMC - PubMed

[2] Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, et al. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. Journal of the National Cancer Institute. 2015;107(6):djv048. doi: 10.1093/jnci/djv048. - DOI - PMC - PubMed

[3] Burstein HJ, Prestrud AA, Seidenfeld J, Anderson H, Buchholz TA, Davidson NE, et al. American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol. 2010;28(23):3784–96. doi: 10.1200/JCO.2009.26.3756. - DOI - PMC - PubMed

[4] Burstein HJ, Prestrud AA, Seidenfeld J, Anderson H, Buchholz TA, Davidson NE, et al. American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol. 2010;28(23):3784–96. doi: 10.1200/JCO.2009.26.3756. - DOI - PMC - PubMed

[5] McCowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, Thompson AM, et al. Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer. 2008;99(11):1763–8. doi: 10.1038/sj.bjc.6604758. - DOI - PMC - PubMed

[6] McCowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, Thompson AM, et al. Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer. 2008;99(11):1763–8. doi: 10.1038/sj.bjc.6604758. - DOI - PMC - PubMed

[7] Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381(9869):805–16. doi: 10.1016/S0140-6736(12)61963-1. - DOI - PMC - PubMed

[8] Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381(9869):805–16. doi: 10.1016/S0140-6736(12)61963-1. - DOI - PMC - PubMed

[9] American Cancer Society. Hormone Therapy for Breast Cancer. [Accessed March 31 2016];2013 http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-tr....

[10] American Cancer Society. Hormone Therapy for Breast Cancer. [Accessed March 31 2016];2013 http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-tr....

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Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management

Affiliations

Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management

Authors

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Abstract

Conflict of interest statement

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