Oncologists’ perspectives on adherence/non-adherence to adjuvant endocrine therapy and management strategies in women with breast cancer

Purpose: Adherence to adjuvant endocrine therapy (AET) is suboptimal, and a range of variables have been explored for understanding patients’ experiences and motivations for medication-taking. However, oncologists’ views on adherence are poorly understood. The aim of this study was to explore oncologists’ perspectives on adherence/non-adherence and their strategies to ensure patients continue with treatments to inform the development of potential modifiable interventions. Methods: A qualitative study using in-depth, semi-structured interviews with 16 oncologists was conducted in Argentina. A stratified purposive sampling was used to recruit female and male participants from 3 health subsystems (private, social security, and public). Data were analyzed using the Framework approach. Results: Oncologists believed patients’ adherence was overall high and associated it with good tolerance of AET in comparison to chemotherapy, information provided, and patients feeling reassured (fear of recurrence). Non-adherence was not perceived as a major source of concern, and it was related to rare cases of severe side effects, young age, refusing treatment, losing the insurance plan, lack of education, and social circumstances. Patients’ complaints of bothersome side effects were not identified as a main reason to discontinuation. Public and private sector patients, however, were perceived as having different attitudes toward side effects. Management strategies included medicine change, referral to support services, and a supportive relationship with the oncologist. Conclusion: Oncologists’ perspectives on adherence/non-adherence to AET show similarities and significant differences with those in the literature based on patient-reported factors. Overall adherence was considered high, but the likelihood of unintentional non-adherence seems important in public sector patients. Information to patients should provide clear explanations on both severe and unpleasant side effects. Interventions to improve communication skills in oncologists and specialists responsible for survivorship care should be considered to strengthen patients’ self-efficacy and effective medication-taking. Reliable data on adherence are needed

Controlling female cancer in Argentina. Divergent initiatives and the road to fragmentation

This article analyses the organisation of cancer control in Argentina, with a special focus on the initiatives, institutions, and models that targeted female or gynaecological cancers. It identifies and examines the main factors in the process of elaborating a national policy to control the disease drawing on a series of actors and instruments such as the state, medical professionals, institutions and services, and the use of technology (notably diagnostic tools) for the detection of the disease. It traces the developments in the organisation highlighting its transformations from a centralising to a decentralised model of service provision. Using the concept of «path-dependence» the article examines the continuities and changes observed in the organisation of female cancer critically signalling the particular time at which a path was taken where «fragmentation» became consolidated within the health system. It also argues that it was within the field of cancer diagnosis that Argentinian doctors first sought to create the foundational structures of cancer organisation. The article contends that the path-dependence analytical approach helps us acknowledge the importance of historical analysis in the identification of factors that led to the lack of service coordination, including the persistent strain between national/provincial states that hampered the development of comprehensive programmes, aspects that have continued to mark efforts in the elaboration of cancer policies to the present day.Research Fellowship awarded by the Wellcome Trust (WT082964), United Kingdo

Female cancers. A perspective from the Latin South

Texto publicado na seção "Dossier".Submitted by Marcus Vinícius Silva ([email protected]) on 2017-04-25T13:04:26Z No. of bitstreams: 1 01_dossier_eraso.pdf: 74593 bytes, checksum: 1157cddb42202bb410c2b726c9974a6c (MD5)Approved for entry into archive by Marcus Vinícius Silva ([email protected]) on 2017-04-25T13:14:30Z (GMT) No. of bitstreams: 1 01_dossier_eraso.pdf: 74593 bytes, checksum: 1157cddb42202bb410c2b726c9974a6c (MD5)Made available in DSpace on 2017-04-25T13:14:30Z (GMT). No. of bitstreams: 1 01_dossier_eraso.pdf: 74593 bytes, checksum: 1157cddb42202bb410c2b726c9974a6c (MD5) Previous issue date: 2014Oxford Brookes University. Faculty of Health and Life Sciences. Oxford, Reino Unido

Género, hormonas y cáncer de mama : perspectivas comparadas en Norte y Sudamérica.

Este capítulo propone abordar una de las aplicaciones más relevantes en la clínica: el uso de testosterona para el tratamiento del cáncer de mama. Iniciada hacia fines de la década de 1930, la administración de hormonas ‘contra-sexuales’ para tratar enfermedades femeninas, a pesar de sus resultados clínicos positivos, fue altamente controversial. Este fue el caso del cáncer cuando componentes hormonales fueron identificados como agentes paliativos o anti-recidivantes para el tratamiento, sobre todo en casos avanzados e incurables. Quizás ninguna terapia oncológica como la testosterona para el cáncer de mama llevó a primer plano tantas consideraciones genéricas como cuando, en los años de 1940 y 1950, la preocupación por los efectos masculinizantes del tratamiento, indujo a cirujanos, ginecólogos y endocrinólogos a reconsiderar el uso de andrógenos en la clínica. Las implicancias de género, sin embargo, tuvieron un impacto diferenciado en ciertos lugares de Norte y Sudamérica, especialmente en países como Estados Unidos y Argentina, donde repercutieron en la forma en que estas terapias fueron usadas en institutos líderes del cáncer. En este trabajo, propongo analizar los primeros usos clínicos de la testosterona en ambos países, los debates a que dieron lugar, como así también cómo éstos se relacionaron con el contexto cultural, político y médico en el cual los tratamientos fueron emprendidos, cuestionados o defendidos. Al resaltar las particularidades de las variaciones en las culturas médicas locales, este capítulo propone analizar cómo las percepciones de feminidad/masculinidad configuraron el tratamiento del cáncer femenino, influenciando tanto la forma en la cual las hormonas sexuales fueron prescriptas como el lugar que encontraron en la clínica

Self-isolation and quarantine during the UK's first wave of COVID-19: a mixed-methods study of non-adherence

Self-isolation and quarantine measures were introduced by the UK Government on 12 March 2020 as part of the 'delay' phase to control the spread of SARS-CoV-2. Non-adherence to self-isolation for 7 days after the development of symptoms is considered suboptimal and little is known about adherence to quarantine for 14 days if a co-habitant developed symptoms. This study aims to analyse non-adherence behaviours to self-isolation and quarantine measures by identifying their potential psycho-social and demographic predictors and by exploring people's accounts of their experiences with these measures. A mixed-methods convergent design was used, comprising an online survey ( = 681) completed by residents in six North London boroughs and qualitative interviews with a subsample of participants ( = 16). Findings identified not accessing community support, lack of control over leaving the house, and lack of perceived benefit and need to follow the rules as behaviours associated with non-adherence to quarantine (42.7%). Non-adherence to self-isolating measures (24.4%) was associated with individuals' perceived lack of control over responsibilities, lack of control over leaving the house, uncertainty about symptoms experienced, lack of access to tests, and distrust in the Government. Adherence to self-isolation and quarantine could be improved through strengthening perceived benefit to self-isolate with messages emphasising its effectiveness, by implementing a two-way information system to support symptoms identification, and with Government-funded, locally supported packages at different levels (financial, food, and practical needs)

Factors associated with non-adherence to social distancing rules during the COVID-19 pandemic: a logistic regression analysis

Background: On March 23, 2020, the government of the United Kingdom told the British people to stay home, an unprecedented request designed to limit the spread of the COVID-19 virus and stop the National Health Service from being overwhelmed. Methods: This study undertook a cross-sectional design to survey a convenience sample of 681 residents of North London on their social distancing (SD) behaviours, demographics, housing situation, politics, psychology and social support using an online questionnaire. Logistic regression was used to measure the associations between these explanatory factors and non-adherence to all SD rules and intentional non-adherence to SD rules. Results: The vast majority (92.8%) of participants did not adhere to all SD rules and nearly half (48.6%) engaged in intentional non-adherence of rules. The odds of not adhering to all SD rules increased if a participant was not identified as highly vulnerable to COVID-19 [OR = 4.5], had lower control over others’ distancing [OR = .724], had lower control over responsibilities for which coming into contact with others was unavoidable [OR = .642], and if SD behaviours were reported after lockdown was first relaxed [OR = .261]. The odds of intentionally not adhering to SD rules increased if a participant had a lower intention to socially distance [OR = .468], had lower control over others’ distancing [OR = .829], had a doctoral degree compared to a master’s degree [OR = .332], a professional qualification [OR = .307], a bachelor’s degree [OR = .361] or work-related qualification [OR = .174], voted for the UK Government compared to not voting for the Government [OR = .461], perceived higher normative pressure from neighbours [OR = 1.121] and had greater support from friends [OR = 1.465]. Conclusions: Non-adherence to all SD rules had a stronger association with vulnerability to COVID-19 and control over SD, whereas intentional non-adherence had a stronger association with intention and anti-social psychological factors. It is recommended that people living in high-risk environments, such as those living in houses of multiple occupancy, should be specially supported when asked to stay at home, and public health messaging should emphasise shared responsibility and public consciousness

Patients’ experience of medication brand changes during hormone therapy for breast cancer: an interpretative phenomenological analysis

Abstract: Medication adherence to hormone therapy (HT) in breast cancer survivors is often suboptimal and is affected by a range of factors. Patients are usually prescribed different generic formulations of HT drugs and their impact on side effects and on adherence and persistence is poorly understood. This study aimed to explore women’s lived experience of HT medication brand changes (generic substitution) and its impact on side effects, quality of life and medication-taking behaviors, as well as on adherence and persistence. Nine female breast cancer survivors who had previous experience of HT medication brand changes participated in the study. Individual, online, semi-structured interviews were conducted and analyzed using interpretative phenomenological analysis. The findings identified three superordinate themes and nine subordinate themes that influenced the lived experience of medication brand changes for these patients: (i) experiencing brand changes, (ii) responsiveness of health care providers and (iii) future expectations. Women reported negative physical and emotional experiences of brand changes, which is often compounded by healthcare professionals’ lack of information and reassurances, disbelief in the worsening of side effects and inconsistent advice regarding generics. These have implications for women’s self-efficacy for medication-taking behaviors, ability to manage side effects and HT adherence and persistence

NHS North Central London clinical commissioning group winter resilience communications and engagement campaign 2021/2022. Evaluation report

This evaluation study was commissioned by the Communications and Engagement team at the NHS North Central London Clinical Commissioning Group to assess the performance of the Winter Resilience Communications and Engagement campaign during the months of December 2021 and March 2022. The campaign aimed to deliver ‘an integrated system-wide communications and engagement programme to support residents, patients and health and care workers prepare for, and stay well this winter, reminding them that services are open and ready to provide care when needed and to access care in the right place at the right time’ (NCL CCG, 2021). The evaluation was conducted following the Evaluation Framework 2.0, with metrics for the 3 components of the Winter resilience campaign which sought to raise awareness, change behaviour intentions, and effect behaviour change. A mixed-methods complementarity study was used, combining quantitative and qualitative methods of data collection and analysis. We envision a three-stage process: 1) A baseline survey used as the control; 2) a modify repeat survey (post-campaign); 3) one-to-one interviews with staff involved in the delivery and with respondents to the final survey. Contextual data from NHS digital and GOV.UK were used to strengthen the evidence for the evaluation analysis. The evaluation makes recommendations directly relevant to the Communications and Engagement team as they prepare for the next Winter campaign. Recommendations focus on two main areas, campaign preparation and content, the latter is mapped against a diagnosis of behavioural components using the COM-B theoretical model and interventions informed by the Behaviour Change Wheel

Extending adjuvant endocrine therapy for 10 years: a mixed-methods analysis of women’s decision making in an online breast cancer forum

An additional 5 years of treatment with adjuvant hormonal therapy, to complete 10 years of medication, is recommended to reduce the risk of breast cancer recurrence. Yet professionals and patients should balance this benefit against side effects and toxicities. Little is known about women’s decision making regarding persistence with extended endocrine therapy. In this study, we collected data from a UK online breast cancer forum to analyse patterns of persistence and its associated factors. A mixed-methods exploratory sequential design was used, with a qualitative analysis of text (n = 61 individuals) informing the development of a quantitative instrument to statistically analyse the prevalence of the findings (n = 130). Our findings identified three different groups of women who had to make decisions regarding persistence with treatment: those about to complete 5 years of therapy, those who decided to extend treatment, and those who were initially prescribed 10 years. Factors affecting persistence were, lack of self-efficacy in managing side effects, lack of reassurance about individual risk of recurrence, and impact on quality of life. Interventions such as training of healthcare professionals including risk communication, medication reviews by clinical pharmacists, and re-planning of services in follow-up care, should better support women’s needs in extended hormonal therapy