Abstract A069: “ ‘She was like, “I'm done. I'm not taking this anymore’ ”: Health care provider perspectives about breast cancer survivors' nonadherence to adjuvant endocrine therapy
Authors: Felder Tisha M. , Heiney Sue P. , L. Rubin , Friedman Daniela B. , Franco Regina , Hebert James R. , Ford Marvella E. 
Published: August 2020

Abstract
Background: For women diagnosed with hormone-receptor positive breast cancers, adjuvant endocrine therapy (AET) can significantly reduce their risk of recurrence and mortality. Yet, nearly two-thirds of breast cancer survivors do not take AET as prescribed. AET nonadherence rates are even higher among women who are both financially disadvantaged (e.g., Medicaid enrollees) and African American. Health care providers (HCPs) not only prescribe AET but also educate and support women who are taking AET. Thus, it is imperative to elicit HCP perspectives as part of the solution to addressing nonadherence to AET.
Purpose: To describe HCPs' perspectives about factors that influence survivors' nonadherence to AET.
Methods: We recruited HCPs from oncology sites in South Carolina to participate in semistructured interviews (May 2016 - May 2017). We audio recorded, transcribed, and analyzed the interviews using Assarroudi et al.'s (2018) method of directed qualitative content analysis.
Results: Twenty-three HCPs completed interviews. Most HCPs were non-Hispanic White (n=20, 87%) and female (n=19, 83%). Many HCPs had been in their professions for ≥ 15 years (n=11, 48%) and held a variety of positions, such as nurses (n=13, 57%), oncologists (n=4, 19%), and social workers (n=2, 9%). From the interviews, we derived 6 main intervention targets (consisting of 19 specific modifiable factors) informed by the World Health Organization's Multidimensional Adherence Framework and Taplin et al.'s (2012) Multilevel Context of Cancer Care Model. The most frequently discussed intervention targets were individual patients (n=23 HCPs), health care systems/teams (n= 23) and therapy-related concerns, e.g., complexity or duration of treatment regimen (n= 23). The most frequently discussed modifiable factors were AET-related side effects (n= 23, 160 mentions), general patient education about AET (n=20, 114 mentions), and patient-provider communication (n=23, 108 mentions).
Conclusions: Our findings suggest that future AET adherence interventions should target multiple levels (e.g., individual patients + HCPs) and aim to improve knowledge, skills, and/or perceptions about patient-provider communication, AET, and AET-related side effects. Future research should explore the extent to which HCP perspectives about AET align with perspectives from breast cancer survivors, particularly among survivors who are African American and financially disadvantaged.
Citation Format: Tisha M. Felder, Sue P. Heiney, Rubin L., Daniela B. Friedman, Regina Franco, James R. Hebert, Marvella E. Ford. “ ‘She was like, “I'm done. I'm not taking this anymore’ ”: Health care provider perspectives about breast cancer survivors' nonadherence to adjuvant endocrine therapy [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A069.