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. 2025 Nov 21;215(1):7.
doi: 10.1007/s10549-025-07844-x.

Improving adjuvant endocrine therapy initiation among patients with breast cancer: a nurse-led, culturally sensitive pilot study

Kathryn E Post  1   2 , Laura Dunderdale  3 , Shibani Datta  4 , Leticia Varella  5   6 , Nora Horick  3 , Lara Traeger  7 , Joseph A Greer  3   5 , Beverly Moy  3   5 , Jennifer S Temel  3   5 , Jamie M Jacobs  3   5
Affiliations

Improving adjuvant endocrine therapy initiation among patients with breast cancer: a nurse-led, culturally sensitive pilot study

Kathryn E Post et al. Breast Cancer Res Treat. .

Abstract

Purpose: Up to 30% of patients with hormone receptor-positive (HR +) breast cancer do not start adjuvant endocrine therapy (AET) as prescribed. AET non-initiation is associated with increased recurrence and decreased survival. We conducted a single-arm, open-pilot study to assess the feasibility and acceptability of a nurse-led, culturally sensitive intervention ('INITIATE') to optimize AET initiation.

Methods: From 9/2022 to 8/2024, we recruited 35 patients with stage I-IIIB, HR + breast cancer who delayed or reported hesitancy to start AET. INITIATE included two virtual sessions delivered in English or Spanish with an oncology nurse. Feasibility was defined by enrollment rates (> 50% eligible patients), intervention attendance (≥ 70% of patients attending one of two sessions), and retention (> 70% completing the 3-month questionnaire). At baseline, 1 month, and 3 months post-baseline, patients self-reported sociodemographics, AET initiation, intervention acceptability (Client Satisfaction Questionnaire-3), and other psychosocial outcomes. We conducted semi-structured, qualitative exit interviews to gather additional feedback. We computed descriptive statistics for the quantitative outcomes and conducted a rapid qualitative analysis of the interview data.

Results: We enrolled 45.5% (35/77) of eligible patients; 82.9% (29/35) attended at least one intervention session, and 77.1% (27/35) completed the 3-month assessment. Most patients (68.6%) were White, and 37.1% identified as a racial or ethnic minority. Qualitatively, patients reported that INITIATE helped them understand the importance of taking AET and improved their coping skills. Ninety-six percent reported high acceptability, and 88.9% started their AET by three months post-baseline.

Conclusion: INITIATE is mostly feasible and acceptable and demonstrates promise for promoting AET initiation among patients with HR + breast cancer.

Keywords: Adjuvant endocrine therapy; Breast cancer; Endocrine therapy initiation; Pilot study.

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Conflict of interest statement

Declarations. Conflict of interest: Authors KP, LD, SD, NH, LT, LV, and BM declare that they have no financial interests. Dr. Greer is a consultant for BeOne Medicines, receives research funding from Blue Note Therapeutics, is on the GlaxoSmithKline speakers bureau, and receives royalties from Oxford University Press. Dr. Temel is on the scientific advisory board for ThymeCare. Dr. Jacobs has a financial interest in OncoveryCare (formerly VivorCare, Inc.), a company advancing a virtual survivorship clinic for individuals with cancer. Dr. Jacobs’ interests were reviewed and are managed by MGH and Mass General Brigham in accordance with their conflict of interest policies. Ethical approval: This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Approval was granted by the Dana-Farber/Harvard Cancer Center Institutional Review Board (Protocol #22-091; NCT #05465408). Consent to participate: All individual participants in the study provided informed consent.

References

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