Supportive Care in Cancer

, Volume 25, Issue 12, pp 3723–3731 | Cite as

Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management

  • Cleo A. SamuelEmail author
  • Kea Turner
  • Heidi A. S. Donovan
  • Ellen Beckjord
  • Alexandra Cardy
  • Mary Amanda Dew
  • G. J. van Londen
Original Article



Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement.


We conducted three focus groups (FGs) with a multidisciplinary group of healthcare providers (n = 13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes.


Providers described patient-, provider-, and system-level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers.


Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients’ knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.


Symptom management Adjuvant endocrine therapy Provider perspectives Breast cancer Survivorship care 



This study was supported by the following funding sources: 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) (grant number: 05 KL2 RR024154), the National Cancer Institute Cancer Center Support Grant (grant number: P30 CA047904), and the National Cancer Institute Award Diversity Supplement Award (grant number: 3 R01 CA150980-04S1).

Compliance with ethical standards

The University of Pittsburgh’s Institutional Review Board approved this study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Cleo A. Samuel
    • 1
    • 2
    Email author
  • Kea Turner
    • 1
  • Heidi A. S. Donovan
    • 3
  • Ellen Beckjord
    • 4
  • Alexandra Cardy
    • 4
  • Mary Amanda Dew
    • 5
    • 6
  • G. J. van Londen
    • 6
  1. 1.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.University of Pittsburgh Medical Center Cancer Center, School of NursingUniversity of PittsburghPittsburghUSA
  4. 4.University of Pittsburgh Medical Center Health PlanUniversity of PittsburghPittsburghUSA
  5. 5.Department of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational ScienceUniversity of PittsburghPittsburghUSA
  6. 6.Department of MedicineUniversity of PittsburghPittsburghUSA

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