Surviving Lung Cancer: Medication-Taking and Oral Targeted Therapy

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors increase survival and improve quality of life for patients with non-small cell lung cancer (NSCLC). Because oral EGFR inhibitors are a new therapy, the implications for medication-taking are unknown. We used grounded theory to explore the process of medication-taking for patients with NSCLC who were receiving therapy with oral EGFR inhibitors. We sought to describe the medication-taking process and to identify factors influencing medication-taking. We enrolled men and women from a National Cancer Institute-designated cancer center aged 18 years or older with NSCLC receiving oral EGFR inhibitors who were able to speak, read, and understand English. Exclusion criteria included central nervous system metastases and evidence of cognitive impairment as assessed by the Mini-Mental Status Exam. Thirteen participants were purposively selected for variation in gender (5 men/8 women), race/ethnicity (2 non-whites), age (52-83 years), time in therapy (1 week to 6 or more years), dose reductions (n = 5), and therapy discontinuation (n = 2). Theoretical sampling focused on age and health insurance carrier. Data were collected through 32 semiformal and brief interviews concerning one’s medication-taking behaviors related to therapy with oral EGFR inhibitors. We employed constant comparative and dimensional analyses. The basic psychosocial process, Surviving Lung Cancer, which participants framed within the recognition of NSCLC as a life-limiting illness without cure, included a dynamic process of (a) Deciding to take targeted therapy with erlotinib, (b) Preparing for erlotinib, and (c) Treating lung cancer as a chronic condition. Participants described thresholds that may result in stopping erlotinib, including side effects and cost. Men described taking erlotinib therapy in partnership with their spouse; most women managed erlotinib alone. These findings may provide the theoretical basis for developing patient-centered interventions to address medication-taking

Examining provider perceptions and practices for comprehensive geriatric assessment among cancer survivors: a qualitative study with an implementation science focus

Introduction: Cancer rates increase with age, and older cancer survivors have unique medical care needs, making assessment of health status and identification of appropriate supportive resources key to delivery of optimal cancer care. Comprehensive geriatric assessments (CGAs) help determine an older person’s functional capabilities as cancer care providers plan treatment and follow-up care. Despite its proven utility, research on implementation of CGA is lacking.Methods: Guided by a qualitative description approach and through interviews with primary care providers and oncologists, our goal was to better understand barriers and facilitators of CGA use and identify training and support needs for implementation. Participants were identified through Cancer Prevention and Control Research Network partner listservs and a national cancer and aging organization. Potential interviewees, contacted via email, were provided with a description of the study purpose. Eight semi-structured interviews were conducted via Zoom, recorded, and transcribed verbatim by a professional transcription service. The interview guide explored providers’ knowledge and use of CGAs. For codebook development, three representative transcripts were independently reviewed and coded by four team members. The interpretive process involved reflecting, transcribing, coding, and searching for and identifying themes.Results: Providers shared that, while it would be ideal to administer CGAs with all new patients, they were not always able to do this. Instead, they used brief screening tools or portions of CGAs, or both. There was variability in how CGA domains were assessed; however, all considered CGAs useful and they communicated with patients about their benefits. Identified facilitators of implementation included having clinic champions, an interdisciplinary care team to assist with implementation and referrals for intervention, and institutional resources and buy-in. Barriers noted included limited staff capacity and competing demands on time, provider inexperience, and misaligned institutional priorities.Discussion: Findings can guide solutions for improving the broader and more systematic use of CGAs in the care of older cancer patients. Uptake of processes like CGA to better identify those at risk of poor outcomes and intervening early to modify treatments are critical to maximize the health of the growing population of older cancer survivors living through and beyond their disease

"Keeping the Boogie Man Away": Medication Self-Management among Women Receiving Anastrozole Therapy

The oral hormonal agent anastrozole improves clinical outcomes for women with breast cancer, but women have difficulty taking it for the five-year course. The unique medication-taking experiences related to self-management of anastrozole therapy for women with early stage breast cancer are not known. Our purpose was to describe the medication-taking experiences for postmenopausal women with early stage breast cancer who were prescribed a course of anastrozole therapy. Twelve women aged 58 to 67 years, midway through therapy, participated in audio-recorded interviews. Women's medication-taking experiences involved a belief in their importance and an imperative to take anastrozole. We found that women's side effect experiences, particularly menopausal symptoms, were significant, but only one woman stopped anastrozole due to side effects. Medication-taking included routinization interconnected with remembering/forgetting and a storage strategy. Some women noted a mutual medication-taking experience with their spouse, but most felt taking anastrozole was something they had to do alone. Our results provide insight into the way some women with early stage breast cancer manage their hormonal therapy at approximately the midpoint of treatment. Next steps should include examinations of patient-provider communication, potential medication-taking differences between pre-and postmenopausal women, and the effects of medication-taking on clinical outcomes

Assessing fidelity to an intervention in a randomized controlled trial to improve medication adherence

Background: Behavioral intervention effectiveness in randomized controlled trials requires fidelity to the protocol. Fidelity assessment tools tailored to the intervention may strengthen intervention research. Objective: The aim of this study was to describe the assessment of fidelity to the structured intervention protocol in an examination of a nurse-delivered telephone intervention designed to improve medication adherence. Methods: Fidelity assessment included random selection and review of approximately 10% of the audiorecorded intervention sessions, stratified by interventionist and intervention session. Audiotapes were reviewed along with field notes for percentage of agreement, addressing whether key components were covered during the sessions. Visual analog scales were used to provide summary scores (0 = low to 5 = high) of interaction characteristics of the interventionists and participants with respect to engagement, demeanor, listening skills, attentiveness, and openness. Results: Four nurse interventionists delivered 871 structured intervention sessions to 113 participants. Three trained graduate student researchers assessed 131 intervention sessions. The mean percentage of agreement was 92.0% (±10.5%), meeting the criteria of 90% congruence with the intervention protocol. The mean interventionist interaction summary score was 4.5 ± 0.4, and the mean participant interaction summary score was 4.5 ± 0.4. Discussion: Overall, the interventionists successfully delivered the structured intervention content, with some variability in both the percentage of agreement and quality of interaction scores. Ongoing assessment aids in ensuring fidelity to study protocol and having reliable study results. Copyright © 2011 Lippincott Williams & Wilkins

Prevalence of food insecurity among cancer survivors in the United States: a scoping review

BACKGROUND: Medical financial hardship is an increasingly common consequence of cancer treatment and may lead to food insecurity. However, food security status is not routinely assessed in the healthcare setting, and the prevalence of food insecurity among cancer survivors is unknown. OBJECTIVE: This scoping review aimed to identify the prevalence of food insecurity among cancer survivors in the United States (US) prior to the COVID-19 pandemic. METHODS: Five databases (PubMed, Scopus, CINAHL, Web of Science, and ProQuest Dissertations and Theses) were systematically searched for articles that reported on food security status among US patients receiving active cancer treatment or longer-term cancer survivors and were published between January 2015- December 2020. RESULTS: Among the 15 articles meeting the inclusion criteria, overall food insecurity prevalence ranged from 4.0% among women presenting to a gynecologic oncology clinic to 83.6% among patients at Federally Qualified Health Centers (FQHCs). Excluding studies focused specifically on FQHC patients, prevalence of food insecurity ranged from 4.0-26.2%, which overlaps the food insecurity prevalence in the general US population (10.5-14.9%) during the same time period. Women were more likely than men to report being food insecure, and the prevalence of food insecurity was higher among Hispanic and Black compared to non-Hispanic White patients. CONCLUSIONS: Given significant heterogeneity in study populations and sample sizes, it was not possible to estimate an overall food insecurity prevalence among cancer survivors in the US. Routine surveillance of food security status and other social determinants of health is needed to better detect and address these issues