nach oben

Erschienen in:

06.07.2017 | Original Article

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

verfasst von: Cleo A. Samuel, Kea Turner, Heidi A. S. Donovan, Ellen Beckjord, Alexandra Cardy, Mary Amanda Dew, G. J. van Londen

Erschienen in: Supportive Care in Cancer | Ausgabe 12/2017

Einloggen, um Zugang zu erhalten

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.

Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA et al (2015) Annual report to the nation on the status of cancer, 1975–2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst 107(6):djv048. doi:10.1093/jnci/djv048 CrossRefPubMedPubMedCentral

Burstein HJ, Prestrud AA, Seidenfeld J, Anderson H, Buchholz TA, Davidson NE et al (2010) American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 28(23):3784–3796. doi:10.1200/JCO.2009.26.3756 CrossRefPubMedPubMedCentral

McCowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, Thompson AM et al (2008) Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer 99(11):1763–1768. doi:10.1038/sj.bjc.6604758 CrossRefPubMedPubMedCentral

Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V et al (2013) 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 381(9869):805–816. doi:10.1016/S0140-6736(12)61963-1 CrossRefPubMedPubMedCentral

American Cancer Society Hormone Therapy for Breast Cancer 2013. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-hormone-therapy. Accessed March 31 2016

Ayres LR, Baldoni Ade O, Borges AP, Pereira LR (2014) Adherence and discontinuation of oral hormonal therapy in patients with hormone receptor positive breast cancer. Int J Clin Pharm 36(1):45–54. doi:10.1007/s11096-013-9833-5 CrossRefPubMed

Hershman DL, Kushi LH, Shao T, Buono D, Kershenbaum A, Tsai WY et al (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol 28(27):4120–4128. doi:10.1200/JCO.2009.25.9655 CrossRefPubMedPubMedCentral

Partridge AH, LaFountain A, Mayer E, Taylor BS, Winer E, Asnis-Alibozek A (2008) Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol 26(4):556–562. doi:10.1200/JCO.2007.11.5451 CrossRefPubMed

Owusu C, Buist DS, Field TS, Lash TL, Thwin SS, Geiger AM et al (2008) Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer. J Clin Oncol 26(4):549–555. doi:10.1200/JCO.2006.10.1022 CrossRefPubMed

10.

Tan X, Marshall VD, Anderson RT, Donohoe J, Camacho F, Balkrishnan R (2015) Adjuvant therapy use among Appalachian breast cancer survivors. Medicine 94(26):e1071. doi:10.1097/MD.0000000000001071 CrossRefPubMedPubMedCentral

11.

Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ (2007) Early discontinuation of tamoxifen: a lesson for oncologists. Cancer 109(5):832–839. doi:10.1002/cncr.22485 CrossRefPubMed

12.

Bender CM, Gentry AL, Brufsky AM, Casillo FE, Cohen SM, Dailey MM et al (2014) Influence of patient and treatment factors on adherence to adjuvant endocrine therapy in breast cancer. Oncol Nurs Forum 41(3):274–285. doi:10.1188/14.ONF.274-285 CrossRefPubMedPubMedCentral

13.

Demissie S, Silliman RA, Lash TL (2001) Adjuvant tamoxifen: predictors of use, side effects, and discontinuation in older women. J Clin Oncol 19(2):322–328CrossRefPubMed

14.

Kimmick G, Edmond SN, Bosworth HB, Peppercorn J, Marcom PK, Blackwell K et al (2015) Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy. Breast 24(5):630–636. doi:10.1016/j.breast.2015.06.010 CrossRefPubMedPubMedCentral

15.

van Londen GJ, Beckjord EB, Dew MA, Cooper KL, Davidson NE, Bovbjerg DH et al (2014) Associations between adjuvant endocrine therapy and onset of physical and emotional concerns among breast cancer survivors. Support Care Cancer 22(4):937–945. doi:10.1007/s00520-013-2041-y CrossRefPubMed

16.

John DA, Kawachi I, Lathan CS, Ayanian JZ (2014) Disparities in perceived unmet need for supportive services among patients with lung cancer in the Cancer Care Outcomes Research and Surveillance Consortium. Cancer 120(20):3178–3191. doi:10.1002/cncr.28801 CrossRefPubMedPubMedCentral

17.

van Ryn M, Phelan SM, Arora NK, Haggstrom DA, Jackson GL, Zafar SY et al (2014) Patient-reported quality of supportive care among patients with colorectal cancer in the Veterans Affairs Health Care System. J Clin Oncol 32(8):809–815. doi:10.1200/JCO.2013.49.4302 CrossRefPubMedPubMedCentral

18.

Yoon J, Malin JL, Tisnado DM, Tao ML, Adams JL, Timmer MJ et al (2008) Symptom management after breast cancer treatment: is it influenced by patient characteristics? Breast Cancer Res Treat 108(1):69–77. doi:10.1007/s10549-007-9580-1 CrossRefPubMed

19.

Taplin SH, Rodgers AB (2010) Toward improving the quality of cancer care: addressing the interfaces of primary and oncology-related subspecialty care. J Natl Cancer Inst Monogr 2010(40):3–10. doi:10.1093/jncimonographs/lgq006 CrossRefPubMedPubMedCentral

20.

Zapka J (2008) Innovative provider- and health system-directed approaches to improving colorectal cancer screening delivery. Med Care 46(9 Suppl 1):S62–S67. doi:10.1097/MLR.0b013e31817fdf57 CrossRefPubMed

21.

van Londen GJ, Donovan HS, Beckjord EB, Cardy AL, Bovbjerg DH, Davidson NE et al (2014) Perspectives of postmenopausal breast cancer survivors on adjuvant endocrine therapy-related symptoms. Oncol Nurs Forum 41(6):660–668. doi:10.1188/14.ONF.660-668 CrossRefPubMedPubMedCentral

22.

Harrow A, Dryden R, McCowan C, Radley A, Parsons M, Thompson AM et al (2014) A hard pill to swallow: a qualitative study of women’s experiences of adjuvant endocrine therapy for breast cancer. BMJ Open 4(6):e005285. doi:10.1136/bmjopen-2014-005285 CrossRefPubMedPubMedCentral

23.

Flanagan J, Winters LN, Habin K, Cashavelly B (2012) Women’s experiences with antiestrogen therapy to treat breast cancer. Oncol Nurs Forum 39(1):70–77. doi:10.1188/12.ONF.70-77 CrossRefPubMed

24.

Hagan TL, Donovan HS (2013) Ovarian cancer survivors’ experiences of self-advocacy: a focus group study. Oncol Nurs Forum 40(2):140–147. doi:10.1188/13.ONF.A12-A19 CrossRefPubMedPubMedCentral

25.

Krueger RA, Casey MA (2015) Participants in a focus group focus groups: a practical guide for applied research, 5th edn. SAGE Publications, Inc.

26.

Boyatzis RE (1998) Transforming qualitative information: thematic analysis and code development. London, & New Delhi SAGE Publications, Thousand Oaks

27.

Patton MQ (1990) Qualitative evaluation and research methods, 2nd edn. Newbury Park, Sage Publications

28.

Saldana J (2009) An introduction to codes and coding the coding manual for qualitative researchers. SAGE Publications, Los Angeles

29.

In: Levit L, Balogh E, Nass S, Ganz PA, editors. Delivering high-quality cancer care: charting a new course for a system in crisis. Washington (DC)2013.

30.

Ganz PA (2014) Institute of Medicine report on delivery of high-quality cancer care. J Oncol Pract 10(3):193-195

31.

Carlson LE, Waller A, Mitchell AJ (2012) Screening for distress and unmet needs in patients with cancer: review and recommendations. J Clin Oncol 30(11):1160–1177. doi:10.1200/JCO.2011.39.5509 CrossRefPubMed

32.

Lorenz KA, Dy SM, Naeim A, Walling AM, Sanati H, Smith P et al (2009) Quality measures for supportive cancer care: the Cancer Quality-ASSIST Project. J Pain Symptom Manag 37(6):943–964. doi:10.1016/j.jpainsymman.2008.05.018 CrossRef

33.

Laugsand EA, Sprangers MA, Bjordal K, Skorpen F, Kaasa S, Klepstad P (2010) Health care providers underestimate symptom intensities of cancer patients: a multicenter European study. Health Qual Life Outcomes 8:104. doi:10.1186/1477-7525-8-104 CrossRefPubMedPubMedCentral

34.

Dy SM, Lorenz KA, O'Neill SM, Asch SM, Walling AM, Tisnado D et al (2010) Cancer Quality-ASSIST supportive oncology quality indicator set: feasibility, reliability, and validity testing. Cancer 116(13):3267–3275. doi:10.1002/cncr.25109 CrossRefPubMed

35.

Freeman HP (2012) The origin, evolution, and principles of patient navigation. Cancer Epidemiol Biomark Prev 21(10):1614–1617. doi:10.1158/1055-9965.EPI-12-0982 CrossRef

36.

Paskett ED, Harrop JP, Wells KJ (2011) Patient navigation: an update on the state of the science. CA Cancer J Clin 61(4):237–249. doi:10.3322/caac.20111 CrossRefPubMedPubMedCentral

37.

Hewitt M, Greenfield S, Stovall E (2005) Committee on Cancer Survivorship: improving care and quality of life, Institute of Medicine and National Research Council. From cancer patient to cancer survivor: lost in transition.

38.

McCabe MS, Bhatia S, Oeffinger KC, Reaman GH, Tyne C, Wollins DS et al (2013) American Society of Clinical Oncology statement: achieving high-quality cancer survivorship care. J Clin Oncol 31(5):631–640. doi:10.1200/JCO.2012.46.6854 CrossRefPubMedPubMedCentral

39.

Jabson JM (2015) Treatment summaries, follow-up care instructions, and patient navigation: could they be combined to improve cancer survivor’s receipt of follow-up care? J Cancer Surviv 9(4):692–698. doi:10.1007/s11764-015-0444-0 CrossRefPubMed

40.

Wilcox B, Bruce SD (2010) Patient navigation: a “win-win” for all involved. Oncol Nurs Forum 37(1):21–25. doi:10.1188/10.ONF.21-25 CrossRefPubMed

41.

Wells KJ, Battaglia TA, Dudley DJ, Garcia R, Greene A, Calhoun E et al (2008) Patient navigation: state of the art or is it science? Cancer 113(8):1999–2010. doi:10.1002/cncr.23815 CrossRefPubMedPubMedCentral

42.

Ganz PA, Hahn EE (2008) Implementing a survivorship care plan for patients with breast cancer. J Clin Oncol 26(5):759–767. doi:10.1200/JCO.2007.14.2851 CrossRefPubMed

43.

Mayer DK, Nekhlyudov L, Snyder CF, Merrill JK, Wollins DS, Shulman LN (2014) American Society of Clinical Oncology clinical expert statement on cancer survivorship care planning. J Oncol Pract 10(6):345–351. doi:10.1200/JOP.2014.001321 CrossRefPubMed

44.

American College of Surgeons Commission on Cancer: cancer program standards (2016 Edition). 2016. https://www.facs.org/quality-programs/cancer/coc/standards. Accessed April 7 2016.

45.

Turner K, Samuel CA, Donovan HA, Beckjord E, Cardy A, Dew MA, van Londen GJ (2016) Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management. Support Care Cancer 25(4):1055-1061. doi:10.1007/s00520-016-3491-9

Titel: Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management
verfasst von: Cleo A. Samuel
Kea Turner
Heidi A. S. Donovan
Ellen Beckjord
Alexandra Cardy
Mary Amanda Dew
G. J. van Londen
Publikationsdatum: 06.07.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 12/2017
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-017-3799-0

Neu im Fachgebiet Onkologie

18.04.2024 | Wirbelsäulenmetastase | Nachrichten

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

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

Abstract

Purpose

Methods

Results

Conclusions

Neu im Fachgebiet Onkologie

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Adjuvante Brustkrebstherapie: Doppelt hält besser

Manche Gestagene können das Risiko für Meningeome erhöhen

Einladung zum PSA-Screening senkt die Krebssterblichkeit

Update Onkologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2017

Randomized phase II placebo-controlled study to evaluate the efficacy of topical pure emu oil for joint pain related to adjuvant aromatase inhibitor use in postmenopausal women with early breast cancer: JUST (Joints Under Study)

Evidence of depression-associated circadian rhythm disruption and regret in prostate cancer patients after surgery

Caregiver perspectives on the social competence of pediatric brain tumor survivors

Optimizing VAP scars after childhood cancer treatment: a pilot study

Lifestyle advice provision to teenage and young adult cancer patients: the perspective of health professionals in the UK

Risk factors of pain in breast cancer survivors: a systematic review and meta-analysis

Neu im Fachgebiet Onkologie

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Adjuvante Brustkrebstherapie: Doppelt hält besser

Manche Gestagene können das Risiko für Meningeome erhöhen

Einladung zum PSA-Screening senkt die Krebssterblichkeit

Update Onkologie