“Keeping the Boogie Man Away”: Medication Self-Management among Women Receiving Anastrozole Therapy

Abstract

The oral hormonal agent anastrozole improves clinical outcomes for women with breast cancer, but women have difficulty taking it for the five-year course. The unique medication-taking experiences related to self-management of anastrozole therapy for women with early stage breast cancer are not known. Our purpose was to describe the medication-taking experiences for postmenopausal women with early stage breast cancer who were prescribed a course of anastrozole therapy. Twelve women aged 58 to 67 years, midway through therapy, participated in audio-recorded interviews. Women's medication-taking experiences involved a belief in their importance and an imperative to take anastrozole. We found that women's side effect experiences, particularly menopausal symptoms, were significant, but only one woman stopped anastrozole due to side effects. Medication-taking included routinization interconnected with remembering/forgetting and a storage strategy. Some women noted a mutual medication-taking experience with their spouse, but most felt taking anastrozole was something they had to do alone. Our results provide insight into the way some women with early stage breast cancer manage their hormonal therapy at approximately the midpoint of treatment. Next steps should include examinations of patient-provider communication, potential medication-taking differences between pre- and postmenopausal women, and the effects of medication-taking on clinical outcomes.

Pretreatment Predictors of Short-Term Nonadherence to Oral Hormonal Therapy for Women With Breast Cancer

“…Other scientists have measured severity of side effects (e.g., severe, moderate, mild, none) (Kahn et al, 2007) or number of side effects (Lash et al, 2006), but we were unable to find specific reports regarding weight concerns and nonadherence for women with breast cancer taking oral hormonal therapy. Our quantitative findings are somewhat consistent with the qualitative analysis of medication-taking for a subset of 12 women who participated in The Aim Study (Wickersham et al, 2012). They provided rich description of their side effects of therapy, which included hot flashes, arthralgias, fatigue, sleep disturbances, and memory problems.…”

“…Despite severity of their symptoms, most (11 of 12 participants, 91.67%) indicated that their side effects would not stop them from taking their anastrozole. The sentiments expressed by the women in our qualitative study (Wickersham et al, 2012) were consistent with the findings of the present secondary analysis; however, only two of the women in the qualitative analysis mentioned weight gain or weight loss in their descriptions of their medication-taking experiences with anastrozole. It is possible that women who had weight concerns had discontinued therapy with anastrozole before the interviews or attributed weight concerns to another process, such as aging.…”

“…Side effect severity and discontinuation of tamoxifen has been examined with mixed results (Lash, Fox, Westrup, Fink, & Silliman, 2006; Wickersham, Happ, & Bender, 2012). Fink et al (2004) reported that side effects were not associated with discontinuation of tamoxifen; however, other researchers have reported that women who experienced side effects were more likely to stop taking tamoxifen (Demissie et al, 2001; Kahn et al, 2007).…”

“…Younger age, out-of-pocket costs of greater than $30 US per AI prescription, no mastectomy, and higher co-morbid condition burden have been associated with 12-month nonadherence to AI therapy (Sedjo & Devine, 2011). In a qualitative analysis of the medication-taking experiences for women with early stage breast cancer who were midway through a five-year course of anastrozole therapy (Wickersham et al, 2012), most women (11/12) (91.7%) continued to take anastrozole due to a strong belief in its importance despite side effect severity.…”

Pain Medication Management Processes Used by Oncology Outpatients and Family Caregivers Part I: Health Systems Contexts

“…The few studies on medication management by patients and family caregivers were conducted in a wide variety of clinical populations, including caregivers of patients receiving hospice services (19,22), breast cancer patients treated with oral chemotherapy (21), and frail older adults receiving home healthcare services (23,24). Medication regimens differ significantly across these populations and present unique challenges.…”