title: A hard pill to swallow: a qualitative study of women's experiences of adjuvant endocrine therapy for breast cancer.
abstract: OBJECTIVE
  To explore women's experiences of taking adjuvant endocrine therapy as a treatment for breast cancer and how their beliefs about the purpose of the medication, side effects experienced and interactions with health professionals might influence adherence.
  
  
  METHODS
  Qualitative study using semistructured, one-to-one interviews.
  
  
  METHODS
  2 hospitals from a single health board in Scotland.
  
  
  METHODS
  30 women who had been prescribed tamoxifen or aromatase inhibitors (anastrozole or letrozole) and had been taking this medication for 1-5 years.
  
  
  RESULTS
  Women clearly wished to take their adjuvant endocrine therapy medication as prescribed, believing that it offered them protection against breast cancer recurrence. However, some women missed tablets and did not recognise that this could reduce the efficacy of the treatment. Women did not perceive that healthcare professionals were routinely or systematically monitoring their adherence. Side effects were common and impacted greatly on the women's quality of life but did not always cause women to stop taking their medication, or to seek advice about reducing the side effects they experienced. Few were offered the opportunity to discuss the impact of side effects or the potential options available.
  
  
  CONCLUSIONS
  Although most women in this study took adjuvant endocrine therapy as prescribed, many endured a range of side effects, often without seeking help. Advice, support and monitoring for adherence are not routinely offered in conventional follow-up settings. Women deserve more opportunity to discuss the pros, cons and impact of long-term adjuvant endocrine therapy. New service models are needed to support adherence, enhance quality of life and ultimately improve survival. These should ideally be community based, in order to promote self-management in the longer term.
authors.affiliation: School of Nursing and Midwifery, University of Dundee, Dundee, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Harrow
authors.affiliation: Institute for Research and Innovation in Social Services, Glasgow, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Dryden
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow Boyd Orr Building, Glasgow, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: McCowan
authors.affiliation: NHS Tayside, Directorate of Public Health, Kings Cross Hospital, Dundee, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Radley
authors.affiliation: NHS Tayside, Pharmacy Department, Ninewells Hospital, Dundee, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Parsons
authors.affiliation: Department of Surgical Oncology, MD Anderson Cancer Center, Holcombe Boulevard, Houston, Texas, USA.
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Thompson
authors.affiliation: NMAHP Research Unit, Scion House, University of Stirling, Stirling, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Wells
mesh_terms: D000368:Aged; D000077384:Anastrozole; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D000077289:Letrozole; D055118:Medication Adherence; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use*; D036301:Qualitative Research; D011788:Quality of Life; D013629:Tamoxifen / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole; D000077289:Letrozole
keywords: ORAL MEDICINE; QUALITATIVE RESEARCH