Women's experiences of hormonal therapy for breast cancer: exploring influences on medication-taking behaviour.
OBJECTIVE
Five to 10 years of adjuvant hormonal therapy is recommended to prevent breast cancer recurrence. This study investigated modifiable influences on adjuvant hormonal therapy medication-taking behaviour (MTB) in women with stage I-III breast cancer.


METHODS
Semi-structured face-to-face interviews among women with stage I-III breast cancer prescribed adjuvant hormonal therapy purposively sampled by their MTB at two cancer centres. Thematic analysis was conducted based on the Framework approach, with the Theoretical Domains Framework (TDF) informing the analysis framework; the TDF is an integrative framework consisting of 14 domains of behavioural change to inform intervention design.


RESULTS
Thirty-one women participated in interviews (14 adherent/persistent; 7 non-adherent/persistent; 10 non-persistent). Three domains identified both barriers and enablers to hormonal therapy MTB across the three MTB strata: beliefs about consequences, intentions and goals and behaviour regulation, but their influence was different across the strata. Other domains influenced individual MTB strata. Key enablers for adherent/persistent women were identified within the domain beliefs about consequences (breast cancer recurrence), intentions and goals (high-priority), beliefs about capabilities (side effects) and behaviour regulation (managing medication). Barriers were identified within the domain behaviour regulation (no routine), memory, attention and decision processes (forgetting) and environmental context and resources (stressors) for non-adherent/persistent women and intentions and goals (quality of life), behaviour regulation (temporal self-regulation), reinforcement, beliefs about consequences (non-necessity) and social influences (clinical support) for non-persistent women.


CONCLUSIONS
This study identified modifiable influences on hormonal therapy MTB. Targeting these influences in clinical practice may improve MTB and hence survival in this population.
Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland. cacahir@tcd.ie.
Caitriona
C
Cahir
Division of Psychology, University of Stirling, Stirling, Scotland.
Stephan U
SU
Dombrowski
Medical Oncology, Mater University Hospital, Ireland and University College Dublin, Dublin, Ireland.
Catherine M
CM
Kelly
Medical Oncology, St James's Hospital, Ireland and Trinity College Dublin, Dublin, Ireland.
M John
MJ
Kennedy
Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland.
Kathleen
K
Bennett
National Cancer Registry Ireland, Cork, Ireland.
Linda
L
Sharp
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000523:psychology*; D005260:Female; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011788:Quality of Life; D011795:Surveys and Questionnaires
D018931:Antineoplastic Agents, Hormonal
Adherence; Breast cancer; Hormonal therapy; Medication-taking behaviour