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Barriers and facilitators to endocrine therapy adherence among underserved hormone-receptor-positive breast cancer survivors: a qualitative study

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Abstract

Purpose

To evaluate the barriers and facilitators to taking anti-hormonal medications among medically and historically underserved breast cancer survivors within the first 5 years post chemotherapy, radiation, and/or surgery.

Methods

The current study was framed within the National Institutes of Health Centers for Population Health and Health Disparities Model (NIHCPHHD Model). Twenty-five historically or medically underserved breast cancer survivors participated in an in-depth interview, in either English or Spanish. Interviews were audio recorded and transcribed verbatim. Interview data were analyzed using content analysis.

Results

Anti-hormonal medication adherence was facilitated in several ways, including establishing a routine of medication taking, leaving the medicine in a visible or easily accessible place, taking the medication with other medications, reducing the cost of medicine, using a pillbox, understanding the negative consequences of lack of adherence, and having positive interactions with physicians. Side effects were the most commonly mentioned barrier to medication adherence.

Conclusions

Similar to other research, this qualitative study of medically and historically underserved breast cancer survivors in the USA found that side effects are the most frequently endorsed barrier to anti-hormonal medication adherence. Conversely, there were a number of facilitators of correct and consistent anti-hormonal medication use. The management of side effects is critically important to increase adherence to anti-hormonal medications. Health care providers, support providers, and caregivers can encourage breast cancer survivors to better adhere to anti-hormonal medications using a number of approaches that have been successful for other women.

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Acknowledgments

The authors would like to thank the breast cancer survivors who took the time to speak with us regarding their survivorship experiences. Additionally, the authors would like to thank the following community advisory board members: Ms. Estena Campagna, Dr. John Kiluk, Ms. Valerie Storms, Ms. Mary Catherine Thompson, and Ms. JoEllen Warnke. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award numbers R21CA161077, U54 CA132384, and U54 CA132379 and the Bankhead-Coley Cancer Research Program, Florida Department of Health under award number 2BN05. Ms. Coralia Vázquez-Otero’s effort was supported by a National Cancer Institute diversity supplement 3R21CA16077-01A1S1. The University of California, San Diego San Diego Fellowship funded the effort of Ms. Tonya Pan. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Florida Department of Health.

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Authors and Affiliations

  1. Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA

    Kristen J. Wells & Marissa Goldenstein

  2. University of California, San Diego Moores Cancer Center, La Jolla, CA, USA

    Kristen J. Wells, Tonya M. Pan & Amy E. Ustjanauskas

  3. SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA

    Kristen J. Wells, Tonya M. Pan & Amy E. Ustjanauskas

  4. University of South Florida, Tampa, FL, USA

    Coralia Vázquez-Otero, Danielle Ung, Christine Laronga, Richard G. Roetzheim & Gwendolyn P. Quinn

  5. San Diego State University Research Foundation, San Diego, CA, USA

    Dariana Muñoz & Claudia Carrizosa

  6. Moffitt Cancer Center, Tampa, FL, USA

    Christine Laronga, Richard G. Roetzheim & Gwendolyn P. Quinn

  7. Emory University, Atlanta, GA, USA

    Sumayah Nuhaily

  8. South County Oncology and Hematology, Chula Vista, CA, USA

    Kenneth Johnson & Marilyn Norton

  9. Sharp HealthCare, San Diego, CA, USA

    Elizabeth Sims

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  1. Kristen J. Wells
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  2. Tonya M. Pan
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  3. Coralia Vázquez-Otero
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Corresponding author

Correspondence to Kristen J. Wells.

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Conflict of interest

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award numbers R21CA161077, U54 CA132384, and U54 CA132379 and the Bankhead-Coley Cancer Research Program, Florida Department of Health under award number 2BN05. Ms. Coralia Vázquez-Otero’s effort was supported by a National Cancer Institute diversity supplement 3R21CA16077-01A1S1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Florida Department of Health. The University of California, San Diego San Diego Fellowship funded the effort of Ms. Tonya Pan. Kristen J. Wells, Tonya M. Pan, Coralia Vázquez-Otero, Danielle Ung, Amy Ustjanauskas, Dariana Muñoz, Christine Laronga, Richard G. Roetzheim, Marissa Bredice, Claudia Carrizosa, Sumayah Nuhaily, Kenneth Johnson, Marilyn Norton, Elizabeth Sims, and Gwendolyn P. Quinn declare they have no conflict of interest.

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Wells, K.J., Pan, T.M., Vázquez-Otero, C. et al. Barriers and facilitators to endocrine therapy adherence among underserved hormone-receptor-positive breast cancer survivors: a qualitative study. Support Care Cancer 24, 4123–4130 (2016). https://doi.org/10.1007/s00520-016-3229-8

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  • DOI: https://doi.org/10.1007/s00520-016-3229-8

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