title: Oncology providers' perspectives on endocrine therapy prescribing and management.
abstract: OBJECTIVE
  Adjuvant endocrine therapy (ET) can reduce the risk of recurrence among females with hormone receptor-positive breast cancer. Overall, initiation and adherence to ET are suboptimal, though reasons are not well described. The study's objective was to better understand ET decision making, prescribing, and patient management from oncology providers' perspectives.
  
  
  METHODS
  Using purposive sampling, we recruited oncology providers who saw five or more breast cancer patients per week (n=20). We conducted 30-45-minute telephone interviews, using a semistructured guide to elicit perspectives on ET use. We used thematic content analysis to systematically identify categories of meaning and double-coded transcripts using Atlas.ti.
  
  
  RESULTS
  Providers recommend ET to all eligible patients except those with contraindications or other risk factors. Providers base their ET prescribing decisions on the patient's menopausal status, side effects, and comorbidities. ET is typically discussed multiple times: at the onset of breast cancer treatment and in more detail after other treatment completion. Providers felt that the associated recurrence risk reduction is the most compelling argument for patients during ET decision making. While providers rarely perceived noninitiation as a problem, nonadherence was prevalent, often due to unresolvable side effects.
  
  
  CONCLUSIONS
  From the clinicians' perspectives, side effects from ET are the dominant factor in nonadherence. Efforts to improve adherence should focus on strategies to minimize side effects and ensure clinicians and patients are well informed regarding optimal side effect management. This finding has important implications for novel endocrine regimens that offer improved outcomes through longer duration or more intensive therapy.
authors.affiliation: Department of Health Policy and Management; Lineberger Comprehensive Cancer Center.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
authors.affiliation: Department of Health Policy and Management.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Roberts
authors.affiliation: Department of Health Policy and Management.
authors.forename: Diane
authors.initials: D
authors.lastname: Bloom
authors.affiliation: Lineberger Comprehensive Cancer Center; Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Reeder-Hayes
authors.affiliation: Department of Health Policy and Management.
authors.forename: Maya
authors.initials: M
authors.lastname: Espada
authors.affiliation: Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Peppercorn
authors.affiliation: Department of Health Behavior; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Golin
authors.affiliation: Lineberger Comprehensive Cancer Center; Department of Health Behavior.
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Earp
keywords: breast cancer; endocrine therapy; oncologist; oncology; qualitative interviews