Abstract P5-12-13: What goes through your mind when you think about your medication? Thoughts about endocrine medication and treatment adherence
Authors: Partridge AH , Fasse K , Stanton AL , Jones A , Bright E , Petrie KJ 
Published: May 2016

Hormonal therapy in women with breast cancer is an important part of long-term treatment, conferring significant survival benefits. However, a substantial proportion of women are non-adherent to endocrine therapy. Patients' beliefs about their illness and subsequent thoughts about whether the treatment is appropriate for their condition are important factors in treatment adherence. We sought to investigate the thoughts that breast cancer patients have about their endocrine medication and how these thoughts are related to adherence to treatment. Methods: Women with breast cancer were recruited from the Army of Women research registry. Women were asked what thoughts go through their mind when they think about the endocrine medication they were taking. Open-ended responses were coded reliably into 9 independent categories. Adherence to endocrine therapy, using an adapted version of the Morisky Medication Adherence Scale, as well as demographic and medical information was collected. Analysis of covariance (ANCOVA) was used to investigate the relation of treatment-related thoughts with adherence. Results: 1371 women were included in this analysis, mean age 56 years; 76.4% married, 57% currently working full or part-time. Mean years since breast cancer diagnosis was 5.1 years, and most women had early stage breast cancer (87%). With regard to endocrine therapy, 36.3% of participants were taking Arimidex (anastrazole), 29.6% Nolvadex (tamoxifen), 21.5% Femara (letrozole), and 12.5% Aromasin (exemestane). Of the 1371 participants, 1058 responses were able to be coded into 1 of the 9 categories. The most frequent category of thoughts reported was concern about side effects (19%) followed by the drug preventing cancer recurrence (18%), worry about future effects (13%), hope the drug is working (13%), dislike taking the drug (9%), time remaining on treatment (9%), grateful that drug exists (8%), and the drug is saving my life (6%). Treatment-related thoughts were related significantly to self-reported adherence to endocrine medication, F(8, 1013) = 5.97, p &lt; .001, partial η2 = .05. Women who reported thinking that they don't like taking their medication were the least adherent to treatment (M = 7.01, 95%CI[6.60, 7.42]). This group reported significantly lower adherence than participants who reported feeling protected (M = 5.79, 95%CI[5.22, 6.37], p = .025), those who thought about their medication saving their lives (M = 5.88, 95%CI[5.40, 6.35], p = .014), preventing recurrence (M = 5.98, 95%CI[5.70, 6.26], p = .002), those who reported feeling grateful for treatment (M = 6.00, 95%CI[5.59, 6.42], p = .024), and those who thought about their hope that the treatment is working (M = 6.01, 95%CI[5.69, 6.34], p = .006). Women who were worried about the possible long-term effects of the treatment or were concerned about side effects were also significantly less adherent to treatment.

Conclusions: The thoughts that patients with breast cancer have about their medication are significantly related to adherence to endocrine therapy. This simple open-ended question may be useful to assess patients' experiences of their medication and identify cognitions that can be targeted in interventions to improve adherence.

Citation Format: Partridge AH, Fasse K, Stanton AL, Jones A, Bright E, Petrie KJ. What goes through your mind when you think about your medication? Thoughts about endocrine medication and treatment adherence. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-12-13.