Oncologists' perspectives on adherence/non-adherence to adjuvant endocrine therapy and management strategies in women with breast cancer

Purpose: Adherence to adjuvant endocrine therapy (AET) is suboptimal, and a range of variables have been explored for understanding patients' experiences and motivations for medication-taking. However, oncologists' views on adherence are poorly understood. The aim of this study was to explore oncologists' perspectives on adherence/non-adherence and their strategies to ensure patients continue with treatments to inform the development of potential modifiable interventions. Methods: A qualitative study using in-depth, semi-structured interviews with 16 oncologists was conducted in Argentina. A stratified purposive sampling was used to recruit female and male participants from 3 health subsystems (private, social security, and public). Data were analyzed using the Framework approach. Results: Oncologists believed patients' adherence was overall high and associated it with good tolerance of AET in comparison to chemotherapy, information provided, and patients feeling reassured (fear of recurrence). Non-adherence was not perceived as a major source of concern, and it was related to rare cases of severe side effects, young age, refusing treatment, losing the insurance plan, lack of education, and social circumstances. Patients' complaints of bothersome side effects were not identified as a main reason to discontinuation. Public and private sector patients, however, were perceived as having different attitudes toward side effects. Management strategies included medicine change, referral to support services, and a supportive relationship with the oncologist. Conclusion: Oncologists' perspectives on adherence/non-adherence to AET show similarities and significant differences with those in the literature based on patient-reported factors. Overall adherence was considered high, but the likelihood of unintentional non-adherence seems important in public sector patients. Information to patients should provide clear explanations on both severe and unpleasant side effects. Interventions to improve communication skills in oncologists and specialists responsible for survivorship care should be considered to strengthen patients' self-efficacy and effective medication-taking. Reliable data on adherence are needed.