Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management
- 307 Downloads
Providers’ communication skills play a key role in encouraging breast cancer survivors to report symptoms and adhere to long-term treatments such as adjuvant endocrine therapy (AET). The purpose of this study was to examine provider perspectives on patient-provider communication regarding AET symptom management and to explore whether provider perspectives vary across the multi-disciplinary team of providers involved in survivorship care.
We conducted three one-hour focus groups with a multi-disciplinary group of health care providers including oncology specialists, primary care physicians, and non-physician providers experienced in caring for breast cancer survivors undergoing AET (n = 13). Themes were organized using Epstein and Street’s (2007) Framework for Patient-Centered Communication in Cancer Care.
The findings of this study suggest providers’ communication behaviors including managing survivors’ uncertainty, responding to survivors’ emotions, exchanging information, and enabling self-management influences the quality of patient-provider communication about AET symptoms. Additionally, lack of systematic symptom assessment tools for AET requires providers to use discretion in determining which symptoms to discuss with survivors resulting in approaches that vary based on providers’ discipline.
There may be AET-specific provider communication skills and behaviors that promote effective patient-provider communication but additional research is needed to identify practices and policies that encourage these skills and behaviors among the many providers involved in survivorship care. Efforts are also needed to coordinate AET symptom assessment across providers, clarify providers’ roles in symptom assessment, and determine best practices for AET symptom communication.
KeywordsPatient-provider communication Breast cancer Adjuvant endocrine therapy Aromatase inhibitors Symptom management Patient-centered communication
Compliance with ethical standards
Conflict of interest statement
We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.
We wish to confirm that we have ownership over the primary data used in this manuscript and give permission to Supportive Care in Cancer to review the data if needed.
American Federation for Aging Research/John A. Hartford Foundation, the Magee-Women’s Research Institute and Foundation, the University of Pittsburgh Multidisciplinary Clinical Research Scholars Program–National Institutes of Health Clinical and Translational Science Award(CTSA)(05 KL2 RR024154), the National Cancer Institute Cancer Center Support Grant (P30 CA047904), and the National Cancer Institute Award Diversity Supplement Award (3 R01 CA150980-04S1).
- 1.Burstein HJ, Temin S, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, Giordano SH, Hudis CA, Rowden D, Solky AJ, Stearns V, Winer EP, Griggs JJ (2014) Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32(21):2255–2269. doi: 10.1200/JCO.2013.54.2258 CrossRefGoogle Scholar
- 2.Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, Hoctin-Boes G, Houghton J, Locker GY, Tobias JS, Group AT (2005) Results of the ATAC (Arimidex, tamoxifen, alone or in combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet 365(9453):60–62. doi: 10.1016/S0140-6736(04)17666-6 CrossRefPubMedGoogle Scholar
- 3.Coombes RC, Hall E, Gibson LJ, Paridaens R, Jassem J, Delozier T, Jones SE, Alvarez I, Bertelli G, Ortmann O, Coates AS, Bajetta E, Dodwell D, Coleman RE, Fallowfield LJ, Mickiewicz E, Andersen J, Lønning PE, Cocconi G, Stewart A, Stuart N, Snowdon CF, Carpentieri M, Massimini G, Bliss JM, van de Velde C, Study IE (2004) A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 350(11):1081–1092. doi: 10.1056/NEJMoa040331 CrossRefPubMedGoogle Scholar
- 5.Hershman DL, Kushi LH, Shao T, Buono D, Kershenbaum A, Tsai WY, Fehrenbacher L, Gomez SL, Miles S, Neugut AI (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 28(27):4120–4128. doi: 10.1200/JCO.2009.25.9655 CrossRefGoogle Scholar
- 8.Partridge AH, LaFountain A, Mayer E, Taylor BS, Winer E, Asnis-Alibozek A (2008) Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 26(4):556–562. doi: 10.1200/JCO.2007.11.5451 CrossRefGoogle Scholar
- 9.Owusu C, Buist DS, Field TS, Lash TL, Thwin SS, Geiger AM, Quinn VP, Frost F, Prout M, Yood MU, Wei F, Silliman RA (2008) Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 26(4):549–555. doi: 10.1200/JCO.2006.10.1022 CrossRefGoogle Scholar
- 10.Crew KD, Greenlee H, Capodice J, Raptis G, Brafman L, Fuentes D, Sierra A, Hershman DL (2007) Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 25(25):3877–3883. doi: 10.1200/JCO.2007.10.7573 CrossRefGoogle Scholar
- 14.Loprinzi CL, Kugler JW, Sloan JA, Mailliard JA, LaVasseur BI, Barton DL, Novotny PJ, Dakhil SR, Rodger K, Rummans TA, Christensen BJ (2000) Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet 356(9247):2059–2063. doi: 10.1016/S0140-6736(00)03403-6 CrossRefPubMedGoogle Scholar
- 15.Crew KD, Capodice JL, Greenlee H, Brafman L, Fuentes D, Awad D, Yann Tsai W, Hershman DL (2010) Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 28(7):1154–1160. doi: 10.1200/JCO.2009.23.4708 CrossRefGoogle Scholar
- 17.van Londen GJ, Donovan HS, Beckjord EB, Cardy AL, Bovbjerg DH, Davidson NE, Morse JQ, Switzer GE, Verdonck-de Leeuw IM, Dew MA (2014) Perspectives of postmenopausal breast cancer survivors on adjuvant endocrine therapy-related symptoms. Oncol Nurs Forum 41(6):660–668. doi: 10.1188/14.ONF.660-668 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Alfano CM, McGregor BA, Kuniyuki A, Reeve BB, Bowen DJ, Baumgartner KB, Bernstein L, Ballard-Barbash R, Malone KE, Ganz PA, McTiernan A (2006) Psychometric properties of a tool for measuring hormone-related symptoms in breast cancer survivors. Psychooncology 15(11):985–1000. doi: 10.1002/pon.1033 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Liang W, Burnett CB, Rowland JH, Meropol NJ, Eggert L, Hwang YT, Silliman RA, Weeks JC, Mandelblatt JS (2002) Communication between physicians and older women with localized breast cancer: implications for treatment and patient satisfaction. J Clin Oncol Off J Am Soc Clin Oncol 20(4):1008–1016CrossRefGoogle Scholar
- 23.Ong LM, Visser MR, van Zuuren FJ, Rietbroek RC, Lammes FB, de Haes JC (1999) Cancer patients' coping styles and doctor-patient communication. Psychooncology 8(2):155–166. doi: 10.1002/(SICI)1099-1611(199903/04)8:2<155::AID-PON350>3.0.CO;2-A CrossRefPubMedGoogle Scholar
- 25.Hewitt M, Greenfield S, Stovall E (2005) From cancer patient to cancer survivor: lost in transition. National Academies Press, Washington DCGoogle Scholar
- 30.Epstein RM, Street RLJ (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering. National Cancer Institute, Bethesda, MDGoogle Scholar
- 34.Canivet D, Delvaux N, Gibon AS, Brancart C, Slachmuylder JL, Razavi D (2014) Improving communication in cancer pain management nursing: a randomized controlled study assessing the efficacy of a communication skills training program. Support Care Cancer 22(12):3311–3320. doi: 10.1007/s00520-014-2357-2 CrossRefPubMedGoogle Scholar
- 35.Oberguggenberger A, Hubalek M, Sztankay M, Meraner V, Beer B, Oberacher H, Giesinger J, Kemmler G, Egle D, Gamper EM, Sperner-Unterweger B, Holzner B (2011) Is the toxicity of adjuvant aromatase inhibitor therapy underestimated? Complementary information from patient-reported outcomes (PROs). Breast Cancer Res Treat 128(2):553–561. doi: 10.1007/s10549-011-1378-5 CrossRefPubMedGoogle Scholar
- 36.Ruhstaller T, von Moos R, Rufibach K, Ribi K, Glaus A, Spaeti B, Koeberle D, Mueller U, Hoefliger M, Hess D, Boehme C, Thuerlimann B (2009) Breast cancer patients on endocrine therapy reveal more symptoms when self-reporting than in pivotal trials: an outcome research study. Oncology 76(2):142–148. doi: 10.1159/000195540 CrossRefPubMedGoogle Scholar
- 37.Wu AW, Kharrazi H, Boulware LE, Snyder CF (2013) Measure once, cut twice--adding patient-reported outcome measures to the electronic health record for comparative effectiveness research. J Clin Epidemiol 66(8 Suppl):S12–S20. doi: 10.1016/j.jclinepi.2013.04.005 CrossRefPubMedPubMedCentralGoogle Scholar