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UBC Theses and Dissertations

Understanding adherence to adjuvant endocrine therapy in breast cancer survivors Lambert, Leah Kimberley


Background: Adjuvant endocrine therapy (AET) is highly efficacious, significantly reducing breast cancer recurrence and mortality for women with hormone receptor-positive breast cancer. Yet, many women do not adhere to prescribed AET. The purpose of this study was to explore breast cancer survivors’ and healthcare providers’ (HCPs) experiences and perspectives related to AET and adherence. Methods: This study explored personal, social, and structural factors influencing breast cancer survivors’ AET adherence, including an integrative review of patient-reported factors associated with AET adherence and two interpretive description studies with breast cancer survivors prescribed AET and with HCPs who care for women undergoing AET. Findings: The integrative review summarized patient-reported factors associated with AET adherence, including side effects, necessity beliefs, self-efficacy, the patient-HCP relationship, social support, and continuity of follow-up care. Interviews with 22 breast cancer survivors revealed that they struggled with persistence with AET, which they described as a balancing act between quantity and quality of life that was influenced by several different, yet connected, factors. Interviews with 14 HCPs highlighted unique experiences and challenges they faced in providing care to women undergoing AET. They described the nature of AET discussions, challenges in transitioning women to primary care, the difficulty addressing AET-related side effects, and dealing with AET discontinuation. HCPs made key recommendations for improving AET adherence, including developing sustainable models of care for delivering high-quality, cost-effective care to breast cancer survivors. Conclusion: The study findings highlight the multifaceted nature of AET adherence from the perspectives of breast cancer survivors and HCPs. Improving understanding of real-world factors influencing AET adherence is an important step in developing effective patient- and HCP-informed interventions. The development and evaluation of supportive care strategies that address the AET-related challenges experienced by breast cancer survivors and HCPs are needed to potentially increase the quality of women’s lives, improve AET adherence, and ultimately, disease-free survival.

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