• Adjuvant endocrine therapy (AET) after breast cancer: A qualitative study of factors associated with adherence

      Brett, Jo; Boulton, Mary; Fenlon, Deborah F.; Hulbert-Williams, Nicholas J.; Walter, Fiona M.; Donnelly, Peter; Lavery, Bernadette; Morgan, Adrienne; Morris, Carolyn; Watson, Eila; et al. (Dove Medical Press, 2018-02-16)
      Introduction : Despite evidence of the efficacy of Adjuvant Endocrine Therapy (AET) in reducing the risk of recurrence and mortality after treatment for primary breast cancer, adherence to AET is suboptimal. This study aimed to explore factors that influence adherence and non-adherence to adjuvant endocrine therapy (AET) following breast cancer to inform the development of supportive interventions. Methods: Interviews were conducted with 32 women who had been prescribed AET, 2-4 years following their diagnosis of breast cancer,. Both adherers (n=19) and non-adherers (n=13) were recruited. The analysis was conducted using the Framework approach. Results: Factors associated with adherence were: Managing side effects including information and advice on side effects, and taking control of side effects, Supportive relationships, and Personal influences. Factors associated with non-adherence were: Burden of side effects, Feeling unsupported, Concerns about long term AET use, Re-gaining normality, including valuing quality of life over length of life, and Risk perception Conclusions: Provision of timely information to prepare women for the potential side effects of AET and education on medication management strategies are needed, including provision of timely and accurate information on the efficacy of AET in reducing breast cancer recurrence, and on potential side effects and ways to manage these should they arise. . Trust in the doctor-patient relationship and clear patient pathways for bothersome side effects and concerns with AET are important. Training and education around AET for GPs should be considered alongside novel care pathways such as primary care nurse cancer care review, and community pharmacist follow-up.
    • Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer

      Eccles, Suzanne A.; Aboagye, Eric O.; Ali, Simak; Anderson, Annie S.; Armes, Jo; Berditchevski, Fedor; Blaydes, Jeremy P.; Brennan, Keith; Brown, Nicola J.; Bryant, Helen E.; et al. (BioMed Central, 2013-10-01)
      Introduction: Breast cancer remains a significant scientific, clinical and societal challenge. This gap analysis has reviewed and critically assessed enduring issues and new challenges emerging from recent research, and proposes strategies for translating solutions into practice. Methods More than 100 internationally recognised specialist breast cancer scientists, clinicians and healthcare professionals collaborated to address nine thematic areas: genetics, epigenetics and epidemiology; molecular pathology and cell biology; hormonal influences and endocrine therapy; imaging, detection and screening; current/novel therapies and biomarkers; drug resistance; metastasis, angiogenesis, circulating tumour cells, cancer ‘stem’ cells; risk and prevention; living with and managing breast cancer and its treatment. The groups developed summary papers through an iterative process which, following further appraisal from experts and patients, were melded into this summary account. Results The 10 major gaps identified were: (1) understanding the functions and contextual interactions of genetic and epigenetic changes in normal breast development and during malignant transformation; (2) how to implement sustainable lifestyle changes (diet, exercise and weight) and chemopreventive strategies; (3) the need for tailored screening approaches including clinically actionable tests; (4) enhancing knowledge of molecular drivers behind breast cancer subtypes, progression and metastasis; (5) understanding the molecular mechanisms of tumour heterogeneity, dormancy, de novo or acquired resistance and how to target key nodes in these dynamic processes; (6) developing validated markers for chemosensitivity and radiosensitivity; (7) understanding the optimal duration, sequencing and rational combinations of treatment for improved personalised therapy; (8) validating multimodality imaging biomarkers for minimally invasive diagnosis and monitoring of responses in primary and metastatic disease; (9) developing interventions and support to improve the survivorship experience; (10) a continuing need for clinical material for translational research derived from normal breast, blood, primary, relapsed, metastatic and drug-resistant cancers with expert bioinformatics support to maximise its utility. The proposed infrastructural enablers include enhanced resources to support clinically relevant in vitro and in vivo tumour models; improved access to appropriate, fully annotated clinical samples; extended biomarker discovery, validation and standardisation; and facilitated cross-discipline working. Conclusions With resources to conduct further high-quality targeted research focusing on the gaps identified, increased knowledge translating into improved clinical care should be achievable within five years.
    • Factors Associated with Intentional and Unintentional Non-adherence to Adjuvant Endocrine Therapy Following Breast Cancer

      Brett, Jo; Fenlon, Deborah F.; Boulton, Mary; Hulbert-Williams, Nicholas J.; Walter, Fiona M.; Donnelly, Peter; Lavery, Bernadette; Morgan, Adrienne; Morris, Carolyn; Watson, Eila; et al. (Wiley, 2016-11-30)
      Adherence to adjuvant endocrine therapy (AET) following breast cancer is known to be sub-optimal despite its known efficacy in reducing recurrence and mortality. This study aims to investigate factors associated with non-adherence and inform the development of interventions to support women and promote adherence. A questionnaire survey to measure level of adherence, side effects experienced, beliefs about medicine, support received and socio-demographic details was sent to 292 women 2-4 years post breast cancer diagnosis. Differences between non-adherers and adherers to AET were explored, and factors associated with intentional and unintentional non-adherence are reported. Approximately one quarter of respondents, 46 (22%), were non-adherers, comprising 29 (14%) intentional non-adherers and 17 (8%) unintentional non-adherers. Factors significantly associated with intentional non-adherence were: the presence of side effects (p<0.03), greater concerns about AET (p<0.001), and a lower perceived necessity to take AET (p<0.001). Half of the sample (105/211) reported that side effects had a moderate or high impact on their quality of life. Factors associated with unintentional non-adherence were: younger age (<65), (p<0.001), post-secondary education (p=0.046), and paid employment (p=0.031). There are distinct differences between intentional non-adherence and unintentional non-adherence. Differentiation between the two types of non-adherence may help tailor support and advice interventions
    • Psychometric properties of the Beliefs about Medicine Questionnaire (BMQ)-AET for Women taking Adjuvant Endocrine Therapies (AET) following early-stage breast cancer

      Brett, Jo; Hulbert-Williams, Nicholas J.; Fenlon, Deborah F.; Boulton, Mary; Walter, Fiona M.; Donnelly, Peter; Lavery, Bernadette; Morgan, Adrienne; Morris, Carolyn; Horne, Rob; et al. (SAGE, 2017-11-17)
      Objectives: To evaluate the Beliefs about Medicine Questionnaire to explore adherence to adjuvant endocrine therapy after treatment for breast cancer (BMQ-AET). Method: Factor structure of the BMQ-AET was explored alongside internal consistency, convergent validity and acceptability. Results: The BMQ-AET Specific Scale fitted the original 10 item model. Internal consistency of the BMQ-AET was much improved compared to the original BMQ and convergent validity showed predicted direction of correlation, although correlation with BMQ-AET concerns scale was low. Acceptability was good. Conclusions: The evaluation of the BMQ-AET is encouraging, and could facilitate future research around adherence to AET.