Sticking to the script: Breast cancer patients' decision making regarding oral endocrine therapy

Stephanie B Wheeler; Megan C Roberts; Austin R Waters; Diane Bloom; Jeffrey Peppercorn; Carol Golin; Katherine E Reeder-Hayes

doi:10.1016/j.pec.2024.108349

Sticking to the script: Breast cancer patients' decision making regarding oral endocrine therapy

Patient Educ Couns. 2024 Oct:127:108349. doi: 10.1016/j.pec.2024.108349. Epub 2024 Jun 11.

Authors

Stephanie B Wheeler¹, Megan C Roberts², Austin R Waters³, Diane Bloom⁴, Jeffrey Peppercorn⁵, Carol Golin⁶, Katherine E Reeder-Hayes⁷

Affiliations

¹ Department of Health Policy and Management, University of North Carolina at Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA. Electronic address: stephanie_wheeler@unc.edu.
² Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC, USA.
³ Department of Health Policy and Management, University of North Carolina at Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA.
⁴ Department of Health Policy and Management, University of North Carolina at Chapel Hill, NC, USA.
⁵ Dana Farber Cancer Center, Harvard University, MA, USA.
⁶ Department of Health Behavior, University of North Carolina at Chapel Hill, NC, USA.
⁷ Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA; Division of Hematology and Oncology, University of North Carolina at Chapel Hill, NC, USA.

PMID: 38878585
DOI: 10.1016/j.pec.2024.108349

Abstract

Objectives: We sought to understand why some women with early-stage breast cancer decide to forgo or discontinue endocrine therapy (ET), and to identify factors that might lead to greater acceptance of, and long-term adherence to, this treatment.

Methods: We conducted in-depth interviews with N = 53 stage I-III HR+ women who were either non-initiators of ET, initiators who discontinued or initiators who continued with variable daily patterns of adherence. An inductive content analysis was performed to explore the decision-making process of women prescribed ET.

Results: Qualitative analyses revealed 55 themes that drove complex decision making. The initiators generally trusted their physicians and did little research before starting the medication. Non-initiators were more suspicious of the medical system, believing that ET presented more risks than benefits. Most discontinuers stopped ET because of side effects. Both non-initiators and discontinuers indicated that push-back from their physicians could have changed their decision. Stories and social support were important in decision making.

Conclusions: Although ET can significantly reduce the risk of breast cancer recurrence, substantial barriers prevent many women from initiating or continuing it.

Practice implications: Physicians have powerful influence over patients' decisions to initiate ET and can be important levers for motivating patients to persist.

Keywords: Breast cancer; Endocrine therapy; Oncology; Qualitative interviews.

MeSH terms

Administration, Oral
Adult
Aged
Antineoplastic Agents, Hormonal* / therapeutic use
Breast Neoplasms* / drug therapy
Breast Neoplasms* / psychology
Decision Making*
Female
Humans
Interviews as Topic*
Medication Adherence / psychology
Middle Aged
Physician-Patient Relations*
Qualitative Research*
Social Support

Substances

Antineoplastic Agents, Hormonal