Presenting Author: Jodi L. Taraba, PharmD, MS, BCOP, Mayo Clinic, Rochester, MN
Co-Authors: Pamela K. Ginex, EdD, MPH, RN, OCN, State University of New York at Stony Brook, Stony Brook, NY; Qinli Lily Ma, PhD, Kelli Thoele, PhD, RN, OCN, Alexandra S. Vitko, PhD, Astra M. Liepa, PharmD, Wambui Gathirua-Mwangi, PhD, Elyse H. Panjic, PharmD, and Engels Chou, MS, Eli Lilly and Company, Indianapolis, IN; Hilary Ellis, BA, Charlotte Clewes, MSc, and Joanna de Courcy, BSc, Adelphi Real World, Bollington, UK; Hope S. Rugo, MD, University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
BACKGROUND: In the past decade, the number of options and use of oral anticancer medications (OAMs) has grown among patients with hormone receptor–positive (HR-positive) and HER2-negative breast cancer. Adherence to OAMs is critical to ensure treatment effectiveness and long-term outcomes.1 However, there is limited evidence on methods used by healthcare providers (HCPs) to support adherence to OAMs.
OBJECTIVE: To describe methods used by HCPs (pharmacists, oncologists, and advanced practice providers [APPs]) at individual and system levels to support adherence to OAMs for HR-positive, HER2-negative breast cancer.
METHODS: Between July 2023 and October 2023, a cross-sectional survey was conducted among HCPs with ≥12 months of experience in treating patients with HR-positive, HER2-negative breast cancer in community settings across the United States. A total of 282 HCPs (100 pharmacists, 91 oncologists, and 91 APPs) completed a one-time online questionnaire.
RESULTS: The majority of HCPs (87.0% pharmacists, 95.6% oncologists, and 71.4% APPs) had ≥5 years of experience treating patients with breast cancer. Half of HCPs (53.0% of pharmacists, 49.5% of oncologists, and 49.5% of APPs) were extremely or very satisfied with the methods they use in practice to support adherence to OAMs. The 3 most common patient-level methods to support adherence reported by HCPs included dose adjustments (pharmacists: 65.0%, oncologists: 50.5%, and APPs: 79.1%), use of prophylactic medications (pharmacists: 68.0%, oncologists: 39.6%, and APPs: 76.9%), and advising nonpharmacological interventions (pharmacists: 69.0%, oncologists: 35.2%, and APPs: 60.4%). Retail pharmacists reported higher use of nonpharmacological interventions and lower use of dose adjustments and prophylactic medications than pharmacists working in clinical or specialty settings. Overall, dose adjustment was reported to be most successful across HCPs, with 66.6% of users perceiving this approach as extremely or very successful in supporting adherence; 64.4% and 32.7% reported prophylactic medications and advising nonpharmacological interventions, respectively, to be similarly successful. The most common system-level methods include staff to help navigate insurance approvals (59.9%) and referral to patient assistance programs (59.2%).
CONCLUSION: Dose adjustments and use of prophylactic medications were considered the most successful patient-level methods to support adherence in patients with HR-positive, HER2-negative breast cancer and were reported as the most commonly used by HCPs. Notably, pharmacists and APPs appeared to use all methods more extensively than oncologists, highlighting their vital role in supporting adherence. Broader incorporation of pharmacists into the management of patients receiving OAMs will help enhance the implementation of these methods, with the goal of increasing patient adherence to OAMs.
- Makubate B, Donnan PT, Dewar JA, et al. Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer. 2013;108:1515-1524.