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. 2019 Dec 1;125(23):4319-4328.
doi: 10.1002/cncr.32410. Epub 2019 Aug 26.

Physicians' perspectives on medication adherence and health promotion among cancer survivors

Tammy K Stump  1   2 , June K Robinson  2   3 , Betina Yanez  2   4 , Frank Penedo  5 , Adaeze Ezeofor  6 , Sheetal Kircher  2 , Bonnie Spring  1   2
Affiliations

Physicians' perspectives on medication adherence and health promotion among cancer survivors

Tammy K Stump et al. Cancer. .

Abstract

Background: Cancer survivors face an increased risk of cardiovascular events compared with the general population. Adopting a healthy lifestyle may reduce these risks, and guidelines encourage health-promotion counseling for cancer survivors, but the extent of physician adherence is unclear.

Methods: This mixed-method study surveyed 91 physicians, including 30 primary care physicians (PCPs), 30 oncologists, and 31 specialists (urologists, dermatologists, and gynecologists). Interviews also were conducted with 12 oncologists.

Results: Most PCPs (90%) reported recommending health promotion (eg, weight loss, smoking cessation) to at least some cancer survivors, whereas few oncologists (26.7%) and specialists (9.7%) said they ever did so (P < .001). Although most physicians believed that at least 50% of cancer survivors would be adherent to medication regimens to prevent cancer recurrence, they also believed that, if patients were trying to lose weight, they would not remain medication-adherent. In interviews, oncologists expressed fear that providing health-promotion advice would distress or overwhelm patients. Additional health-promotion barriers identified by thematic analysis included: identifying cancer as oncologists' focal concern, time pressure, insufficient behavior change training, and care coordination challenges. Facilitators included perceiving a patient benefit and having health-promotion resources integrated into the cancer care system.

Conclusions: Physicians often do not have the time, expertise, or resources to address health promotion with cancer survivors. Research is needed to evaluate whether health-promotion efforts compromise medical regimen adherence, as physicians' responses suggest.

Keywords: cancer survivors; comorbidity; health promotion; oncologists; primary health care.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
Healthy lifestyle promotion practices for cancer survivors (percentage of physicians in each group endorsing each response) Abbreviation: HP, Health-Promoting Option; PCP, Primary Care Physician
Figure 2.
Figure 2.
Beliefs about treatment adherence and practices for those with comorbidities (percentage of physicians in each group endorsing each response option) Abbreviation: PCP, Primary Care Physician
Figure 3.
Figure 3.
Barriers to healthy lifestyle discussions with cancer survivors (percentage of physicians in each group endorsing each response option)
See this image and copyright information in PMC

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