Advertisement

Supportive Care in Cancer

, Volume 23, Issue 11, pp 3115–3130 | Cite as

Women’s experiences of hormonal therapy for breast cancer: exploring influences on medication-taking behaviour

  • Caitriona Cahir
  • Stephan U. Dombrowski
  • Catherine M. Kelly
  • M. John Kennedy
  • Kathleen Bennett
  • Linda Sharp
Original Article

Abstract

Purpose

Five to 10 years of adjuvant hormonal therapy is recommended to prevent breast cancer recurrence. This study investigated modifiable influences on adjuvant hormonal therapy medication-taking behaviour (MTB) in women with stage I–III breast cancer.

Methods

Semi-structured face-to-face interviews among women with stage I–III breast cancer prescribed adjuvant hormonal therapy purposively sampled by their MTB at two cancer centres. Thematic analysis was conducted based on the Framework approach, with the Theoretical Domains Framework (TDF) informing the analysis framework; the TDF is an integrative framework consisting of 14 domains of behavioural change to inform intervention design.

Results

Thirty-one women participated in interviews (14 adherent/persistent; 7 non-adherent/persistent; 10 non-persistent). Three domains identified both barriers and enablers to hormonal therapy MTB across the three MTB strata: beliefs about consequences, intentions and goals and behaviour regulation, but their influence was different across the strata. Other domains influenced individual MTB strata. Key enablers for adherent/persistent women were identified within the domain beliefs about consequences (breast cancer recurrence), intentions and goals (high-priority), beliefs about capabilities (side effects) and behaviour regulation (managing medication). Barriers were identified within the domain behaviour regulation (no routine), memory, attention and decision processes (forgetting) and environmental context and resources (stressors) for non-adherent/persistent women and intentions and goals (quality of life), behaviour regulation (temporal self-regulation), reinforcement, beliefs about consequences (non-necessity) and social influences (clinical support) for non-persistent women.

Conclusion

This study identified modifiable influences on hormonal therapy MTB. Targeting these influences in clinical practice may improve MTB and hence survival in this population.

Keywords

Hormonal therapy Medication-taking behaviour Adherence Breast cancer 

Notes

Acknowledgments

We wish to thank all of the women at the two cancer centres who kindly gave their time to participate in this study. We wish to acknowledge Aileen Timmons who helped develop the coding index for this study.

Funding

CC is Health Research Board, Ireland (HRB) ICE fellow (ICE/2011/9) and this grant funded data collection.

Conflict of interests

All authors have nothing to declare.

Contributors

CC, KB, MJK, CMK and LS planned and designed the study. CC and AT developed the coding index. CC and SD analysed and interpreted the study data. CC drafted the manuscript. CC, SD, CMK, MJK, KB and LS critically reviewed and approved the final manuscript. CC is guarantor.

Ethical approval

Ethical approval was obtained from the individual hospital Research Ethics Boards and all participants provided informed consent.

Independence of researchers

All authors and their affiliated institutions are independent of the Health Research Board.

Access to the data

All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

References

  1. 1.
    Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687-717Google Scholar
  2. 2.
    Davies C, Godwin J, Gray R, Clarke M, Cutter D, Darby S et al (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 378(9793):771–784CrossRefPubMedGoogle Scholar
  3. 3.
    Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497CrossRefPubMedGoogle Scholar
  4. 4.
    Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW (2012) Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat 134(2):459–478PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ (2007) Early discontinuation of tamoxifen: a lesson for oncologists. Cancer 109(5):832–839CrossRefPubMedGoogle Scholar
  6. 6.
    Barron TI, Cahir C, Sharp L, Bennett K (2013) A nested case-control study of adjuvant hormonal therapy persistence and compliance, and early breast cancer recurrence in women with stage I-III breast cancer. Br J Cancer 109(6):1513–1521PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L et al (2011) Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat 126(2):529–537PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    DiMatteo M, Giordani P, Lepper H, Croghan T (2002) Patient adherence and medical treatment outcomes: a meta-analysis. Med Care 40(9):794–811CrossRefPubMedGoogle Scholar
  9. 9.
    Wouters H, Maatman GA, Van Dijk L, Bouvy ML, Vree R, Van Geffen ECG et al (2013) Trade-off preferences regarding adjuvant endocrine therapy among women with estrogen receptor-positive breast cancer. Ann Oncol 24(9):2324–2329CrossRefPubMedGoogle Scholar
  10. 10.
    Gale N, Heath G, Cameron E, Rashid S, Redwood S (2013) Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 13(1):117PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A (2005) Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 14(1):26–33PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 7(37):1–17Google Scholar
  13. 13.
    Michie S, Johnston M, Francis J, Hardeman W, Eccles M (2008) From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol 57(4):660–680CrossRefGoogle Scholar
  14. 14.
    Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP et al (2010) What is an adequate sample size? operationalising data saturation for theory-based interview studies. Psychol Health 25(10):1229–1245CrossRefPubMedGoogle Scholar
  15. 15.
    Ritchie J, Lewis J (2012) Qualitative research practice. SAGE Publications Ltd, LondonGoogle Scholar
  16. 16.
    Francis JJ, Stockton C, Eccles MP, Johnston M, Cuthbertson BH, Grimshaw JM et al (2009) Evidence-based selection of theories for designing behaviour change interventions: using methods based on theoretical construct domains to understand clinicians' blood transfusion behaviour. Br J Health Psychol 14(4):625–646CrossRefPubMedGoogle Scholar
  17. 17.
    McSherry L, Dombrowski SU, Francis JJ, Murphy J, Martin CM, O’Leary JJ (2012) 'It's a can of worms': understanding primary care practitioners' behaviours in relation to HPV using the theoretical domains framework. Implement Sci 7(1):73PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Brewer NT, Chapman GB, Gibbons FX, Gerrard M, McCaul KD, Weinstein ND (2007) Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination. Health Psychol 26(2):136CrossRefPubMedGoogle Scholar
  19. 19.
    DiMatteo MR, Haskard KB, Williams SL (2007) Health beliefs, disease severity, and patient adherence: a meta-analysis. Med Care 45(6):521–528CrossRefPubMedGoogle Scholar
  20. 20.
    DiMatteo MR, Haskard-Zolnierek KB, Martin LR (2012) Improving patient adherence: a three-factor model to guide practice. Health Psychol Rev 6(1):74–91CrossRefGoogle Scholar
  21. 21.
    Horne R, Weinman J (1999) Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47(6):555–567CrossRefPubMedGoogle Scholar
  22. 22.
    Fink AK, Gurwitz J, Rakowski W, Guadagnoli E, Silliman RA (2004) Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor-positive breast cancer. J Clin Oncol 22(16):3309–3315CrossRefPubMedGoogle Scholar
  23. 23.
    Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA (2006) Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat 99(2):215–220CrossRefPubMedGoogle Scholar
  24. 24.
    Simon R, Latreille J, Matte C, Desjardins P, Bergeron E (2014) Adherence to adjuvant endocrine therapy in estrogen receptor-positive breast cancer patients with regular follow-up. Can J Surg 57(1):26–32PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Friese C, Pini TM, Li Y, Abrahamse P, Graff J, Hamilton A et al (2013) Adjuvant endocrine therapy initiation and persistence in a diverse sample of patients with breast cancer. Breast Cancer Res Treat 138(3):931–939PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Corter AL, Findlay M, Broom R, Porter D, Petrie KJ (2013) Beliefs about medicine and illness are associated with fear of cancer recurrence in women taking adjuvant endocrine therapy for breast cancer. Br J Health Psychol 18(1):168–181CrossRefPubMedGoogle Scholar
  27. 27.
    Leventhal H, Diefenbach M, Leventhal E (1992) Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cogn Ther Res 16(2):143–163CrossRefGoogle Scholar
  28. 28.
    Bickell NA, Weidmann J, Fei K, Lin JJ, Leventhal H (2009) Underuse of breast cancer adjuvant treatment: patient knowledge, beliefs, and medical mistrust. J Clin Oncol 27(31):5160–5167PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Atkins L, Fallowfield L (2006) Intentional and non-intentional non-adherence to medication amongst breast cancer patients. Eur J Cancer 42(14):2271–2276CrossRefPubMedGoogle Scholar
  30. 30.
    Arbuthnott A, Sharpe D (2009) The effect of physician–patient collaboration on patient adherence in non-psychiatric medicine. Patient Educ Couns 77(1):60–67CrossRefPubMedGoogle Scholar
  31. 31.
    Arora NK, McHorney CA (2000) Patient preferences for medical decision making: who really wants to participate? Med Care 38(3):335–341CrossRefPubMedGoogle Scholar
  32. 32.
    Trevino KM, Fasciano K, Prigerson HG (2013) Patient-oncologist alliance, psychosocial well-being, and treatment adherence among young adults with advanced cancer. J Clin Oncol 31(13):1683–1689CrossRefPubMedGoogle Scholar
  33. 33.
    Lam WW, Kwok M, Chan M, Hung WK, Ying M, Or A et al (2014) Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery? Patient Educ Couns 94(2):243–249CrossRefPubMedGoogle Scholar
  34. 34.
    Gollwitzer PM, Sheeran P. (2006) Implementation intentions and goal achievement: A Meta‐analysis of effects and processes. In: Mark PZ, editor. Advances in Experimental Social Psychology: Academic Press; p. 69-119Google Scholar
  35. 35.
    Zimbardo PG, Boyd JN (1999) Putting time in perspective: a valid, reliable individual-differences metric. J Pers Social Psychol 77(6):1271–1288CrossRefGoogle Scholar
  36. 36.
    Sansbury B, Dasgupta A, Guthrie L, Ward M (2014) Time perspective and medication adherence among individuals with hypertension or diabetes mellitus. Patient Educ Couns 95(1):104–110PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Manuel JC, Burwell SR, Crawford SL, Lawrence RH, Farmer DF, Hege A, Phillips K et al (2007) Younger women's perceptions of coping with breast cancer. Cancer Nurs 32(2):85–94CrossRefGoogle Scholar
  38. 38.
    Pellegrini I, Sarradon-Eck A, Soussan PB, Lacour AC, Largillier R, Tallet A et al (2010) Women's perceptions and experience of adjuvant tamoxifen therapy account for their adherence: breast cancer patients' point of view. Psychooncology 19(5):472–479CrossRefPubMedGoogle Scholar
  39. 39.
    Nielsen-Bohlman LN, Panzar AM, Kindig DA (2004) Health literacy: a prescription to end confusion. National Academic Press, Washington DCGoogle Scholar
  40. 40.
    Pass M, Belkora J, Moore D, Volz S, Sepucha K (2012) Patient and observer ratings of physician shared decision making behaviors in breast cancer consultations. Patient Educ Couns 88(1):93–99CrossRefPubMedGoogle Scholar
  41. 41.
    Fowler FJ Jr, Gerstein BS, Barry MJ (2013) How patient centered are medical decisions? results of a national survey. JAMA 173(13):1215–1221Google Scholar
  42. 42.
    Fallowfield L (2005) Acceptance of adjuvant therapy and quality of life issues. Breast 14(6):612–616CrossRefPubMedGoogle Scholar
  43. 43.
    Jacob Arriola KR, Mason TA, Bannon KA, Holmes C, Powell CL, Horne K et al (2014) Modifiable risk factors for adherence to adjuvant endocrine therapy among breast cancer patients. Patient Educ Couns 95(1):98–103CrossRefPubMedGoogle Scholar
  44. 44.
    Zolnierek KB, Dimatteo MR (2009) Physician communication and patient adherence to treatment: a meta-analysis. Med Care 47(8):826–834CrossRefPubMedGoogle Scholar
  45. 45.
    Cane J, Richardson M, Johnston M, Ladha R, Michie S (2014) From lists of behaviour change techniques (BCTs) to structured hierarchies: comparison of two methods of developing a hierarchy of BCTs. Br J Health Psychol. doi: 10.1111/bjhp.12102 PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Caitriona Cahir
    • 1
  • Stephan U. Dombrowski
    • 2
  • Catherine M. Kelly
    • 3
  • M. John Kennedy
    • 4
  • Kathleen Bennett
    • 1
  • Linda Sharp
    • 5
  1. 1.Department of Pharmacology and TherapeuticsTrinity College DublinDublinIreland
  2. 2.Division of PsychologyUniversity of StirlingStirlingScotland
  3. 3.Medical Oncology, Mater University HospitalIreland and University College DublinDublinIreland
  4. 4.Medical Oncology, St James’s HospitalIreland and Trinity College DublinDublinIreland
  5. 5.National Cancer Registry IrelandCorkIreland

Personalised recommendations