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. 2018 Jul 11;18(1):732.
doi: 10.1186/s12885-018-4644-7.

Understanding adjuvant endocrine therapy persistence in breast Cancer survivors

Leah K Lambert  1 , Lynda G Balneaves  2 , A Fuchsia Howard  1 , Stephen K Chia  3 , Carolyn C Gotay  4
Affiliations

Understanding adjuvant endocrine therapy persistence in breast Cancer survivors

Leah K Lambert et al. BMC Cancer. .

Abstract

Background: Adjuvant endocrine therapy (AET) significantly decreases the risk of breast cancer recurrence and mortality. Notwithstanding the demonstrated efficacy of AET, 31-73% of breast cancer survivors do not persist with AET. The purpose of this study was to explore breast cancer survivors' experiences and perspectives of persisting with AET and to identify the psychosocial and healthcare system factors that influence AET persistence.

Methods: Informed by interpretive descriptive methodology and relational autonomy theory, individual interviews were conducted with 22 women diagnosed with early-stage breast cancer who had been prescribed AET. These participants also completed a demographic form and a survey that assessed their perceived risk of recurrence. Interviews were analysed using inductive thematic and constant comparative analysis to iteratively compare data and develop conceptualizations of the relationships among data. Descriptive statistics were used to summarize the quantitative data.

Results: The personal, social, and structural factors found to influence AET persistence included AET side effects, perception of breast cancer recurrence risk, medication and necessity beliefs, social support, the patient-provider relationship, and the continuity and frequency of follow-up care. For most women, over time, the decision-making process around AET persistence became a balancing act between quality of life and quantity of life. The interplay between the personal, social, and structural factors was complex and the weight women placed on some factors over others influenced their AET persistence or non-persistence.

Conclusion: Expanding our understanding of the factors affecting breast cancer survivors' AET persistence from their perspective is the first step in developing efficacious, patient-centered interventions aimed at improving AET persistence. In order to improve AET persistence, enhanced symptom management is required, as well as the development of supportive care strategies that acknowledge the values and beliefs held by breast cancer survivors while reinforcing the benefits of AET, and addressing women's reasons for non-persistence. Improved continuity of health care and patient-healthcare provider communication across oncology and primary care settings is also required. The development and evaluation of supportive care strategies that address the challenges associated with AET experienced by breast cancer survivors hold the potential to increase both women's quality and quantity of life.

Keywords: Adjuvant endocrine therapy; Breast cancer; Cancer survivorship; Medication persistence.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the University of British Columbia Behavioural Research Ethics Board certificate H13–00207. Written informed consent was obtained from all individual participants included in the study.

Consent for publication

Participants’ consent included the development of research reports (i.e. publications) on the condition of confidentiality in that no identifying information was included in the reports that would allow participants to be identified.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Sampling Diagram
Fig. 2
Fig. 2
Balancing Act Between QOL and Quantity of Life in the Context of AET Persistence
See this image and copyright information in PMC

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