Article

Women's Experiences With Antiestrogen Therapy to Treat Breast Cancer

Jane Flanagan

Loren Winters

Karleen R. Habin

Barbara J. Cashavelly

estrogen, breast neoplasms
ONF 2011, 39(1), 70-77. DOI: 10.1188/12.ONF.70-77

Purpose/Objectives: To understand the experiences of women undergoing antiestrogen therapy (AET) to treat breast cancer.

Research Approach: Content analysis of tape-recorded focus group interviews.

Setting: Breast oncology center of a large medical center in the northeastern United States.

Participants: Purposive sample of 21 women undergoing AET to treat breast cancer.

Methodologic Approach: A nonexperimental qualitative, descriptive design using open-ended interviews and content analysis to isolate themes.

Main Research Variables: Women's experiences with AET.

Findings: Five themes were isolated and were focused on the overall experience of having breast cancer: symptoms related to AET, shared decision making, being strong for others, discovering new priorities, and recognizing vulnerability.

Conclusions: Oral therapies are an increasingly popular treatment option for various types of cancer, particularly in women with estrogen-sensitive breast cancer. Although this type of treatment has been efficacious in terms of disease-free and overall survival, women undergoing AET face many challenges related to treatment. Healthcare providers need to understand women's perceptions of AET and its effects as a first step in the process of developing interventions to improve care.

Interpretation: More research is needed to distinguish whether the presence of preexisting chronic illness, differences in type of AET, age, and ethnicity impact the overall experience of women on AET. Individual interviews may be necessary to fully explore the experience. Oncology nurses should implement surveillance care to explore the effects of AET on women with breast cancer.

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    References

    American Cancer Society. (2011). Cancer facts and figures 2011-2012. Retrieved from http://www.cancer.org/Research/CancerFactsFigures/BreastCancerFactsFigures/breast-cancer-facts-and-figures-2011-2012
    Ashing-Giwa, K., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A., … Hills, D. (2004). Understanding the breast cancer experience of women: A qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psycho-Oncology, 13, 408-428. doi:10.1002/pon.750
    Baum, M., Buzdar, A., Cuzick, J., Forbes, J., Houghton, J., Howell, A., … Arimidex, Tamoxifen Alone or in Combination Trialists' Group. (2003). Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early-stage breast cancer: Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial efficacy and safety update analyses. Cancer, 98, 1802-1810. doi:10.1002/cncr.11745
    Breast International Group 1-98 Collaborative Group. (2005). A comparison of letrozole and tamoxifen in postmenopausal women with early stage breast cancer. New England Journal of Medicine, 353, 2747-2757.
    Burstein, H. J., Prestrud, A. A., Seidenfeld, J., Anderson, H., Buchholz, T. A., Davidson, N. E., … Griggs, J. J. (2010). American Society of Clinical Oncology clinical practice guideline: Update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. Journal of Clinical Oncology, 28, 3784-3796.
    Coombes, R. C., Hall, E., Gibson, L. J., Paridaens, R., Jassem, J., Delozier, T., … van de Velde, C. (2004). A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. New England Journal of Medicine, 350, 1081-1092. doi:10.1056/NEJMoa040331
    Cuzick, J., Sestak, I., Cella, D., & Fallowfield, L. (2008). Treatment-emergent endocrine symptoms and the risk of breast cancer recur-rence: A retrospective analysis of the ATAC trial. Lancet Oncology, 9, 1143-1158. doi:10.1016/S1470-2045(08)702596
    Fallowfield, L., Cella, D., Cuzick, J., Francis, S., Locker, G., & Howell, A. (2004). Quality of life of postmenopausal women in the Arimidex, Tamoxifen, Alone or in Combination (ATAC) Adjuvant Breast Cancer Trial. Journal of Clinical Oncology, 22, 4261-4271.
    Fellowes, D., Fallowfield, L. J., Saunders, C. M., & Houghton, J. (2001). Tolerability of hormone therapies for breast cancer: How informative are documented symptom profiles in medical notes for "well tolerated" treatments? Breast Cancer Research and Treatment, 66(1), 73-81. doi:10.1023/A:1010684903199
    Fink, A. K., Gurwitz, J., Rakowski, W., Guadagnoli, E., & Silliman, R. A. (2004). Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor-positive breast cancer. Journal of Clinical Oncology, 22, 3309-3315. doi:10.1200/JCO.2004.11.064
    Fisher, B., Jeong, J. H., Bryant, J., Anderson, S., Dignam, J., Fisher, E. R., & Wolmark, N. (2004). Treatment of lymph-node-negative, oestrogen-receptor-positive breast cancer: Long-term findings from National Surgical Adjuvant Breast and Bowel Project randomised clinical trials. Lancet, 364(9437), 858-868. doi:10.1016/S0140-6736(04)16981-X
    Gennari, A., Sormani, M., Pronzato, P., Puntoni, M., Colozza, M., Pfeffer, U., & Bruzzi, P. (2008). HER2 status and efficacy of adjuvant anthracyclines in early breast cancer: A pooled analysis of randomized trials. Journal of the National Cancer Institute, 100, 14-20.
    Glass, A. G., Lacey, J.V, Jr., Carreon, J. D., & Hoover, R. N. (2007). Breast cancer incidence, 1980-2006: Combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. Journal of the National Cancer Institute, 99, 1152-1161.
    Hewitt, M., Greenfield, S., & Stovall, E. (2006). From cancer patient to cancer survivor: Lost in transition. Washington, DC: National Academies Press.
    Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press.
    Kooken, W. C., Haase, J. E., & Russell, K. M. (2007). "I've been through something": Poetic explorations of African American women's cancer survivorship. Western Journal of Nursing Research, 29, 896-919.
    Meneses, K., McNees, P., Azuero, A., Loerzel, V. W., Su, X., & Hassey, L. A. (2009). Preliminary evaluation of psychoeducational support interventions on quality of life in rural breast cancer survivors after primary treatment. Cancer Nursing, 32, 385-397.
    Meneses, K. D., McNees, P., Loerzel, V. W., Su, X., Zhang, Y., & Hassey, L. A. (2007). Transition from treatment to survivorship: Effects of a psychoeducational intervention on quality of life in breast cancer survivors. Oncology Nursing Forum, 34, 1007-1016. doi:10.1188/07.ONF.1007-1016
    Mishel, M. H., Germino, B. B., Gil, K. M., Belyea, M., Laney, I.C, Stewart, J., … Clayton, M. (2005). Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psycho-Oncology, 14, 962-978.
    Morgan, D. L. (1999). Qualitative content analysis: A guide to paths not taken. Qualitative Health Research, 3, 112-121.
    National Cancer Institute. (2011a). Estimated U. S. cancer prevalence counts: Who are our cancer survivors in the U. S.? Retrieved from http://dccps.nci.nih.gov/ocs/prevalence/index.html
    National Cancer Institute. (2011b). Research focus areas. Retrieved from http://dccps.nci.nih.gov/ocs/research_areas.html
    Oncology Nursing Society. (2009). Oncology Nursing Society 2009-2013 research agenda. Retrieved from http://www.ons.org/Research
    Partridge, A., LaFountain, A., Mayer, E., Taylor, B., Winer, E., & Asnis-Alibozek, A. (2006). Adherence with adjuvant anastrozole therapy among women with early stage breast cancer. Journal of Clinical Oncology, 28, 556-562.
    Partridge, A., Wang, P., Winter, E., & Avorn, J. (2003). Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. Journal of Clinical Oncology, 21, 602-606.
    Patton, M. Q. (1990). Qualitative evaluation and research methods. Newbury Park, CA: Sage.
    Rogers, M. E. (1992). Nursing science and the space age. Nursing Science Quarterly, 5, 27-34. doi:10.1177/089431849200500108
    Ruddy, K., Mayer, E., & Partridge, A. (2009). Patient adherence and persistence with oral anticancer treatment. CA: A Cancer Journal for Clinicians, 59, 56-66. doi:10.3322/caac.20004
    Scheier, M. F., Helgeson, V. S., Schulz, R., Colvin, S., Berga, S., Bridges, M. W., … Pappert, W. S. (2005). Interventions to enhance physical and psychological functioning among younger women who are ending nonhormonal adjuvant treatment for early-stage breast cancer. Journal of Clinical Oncology, 23, 4298-4311. doi:10.1200/JCO.2005.05.362
    Stanton, A. L., Ganz, P. A., Kwan, L., Meyerowitz, B. E., Bower, J. E., Krupnick, J. L., … Belin, T. R. (2005). Outcomes from the Moving Beyond Cancer psychoeducational, randomized, controlled trial with breast cancer patients. Journal of Clinical Oncology, 23, 6009-6018. doi:10.1200/JCO.2005.09.101
    Stewart, D. W., & Shamdasani, P. N. (1990). Focus groups: Theory and practice. Newbury Park, CA: Sage.
    Tchen, N., Juffs, H. G., Downie, F. P., Yi, Q. L., Hu, H., Chemerynsky, I., … Tannock, I. F. (2003). Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 21, 4175-4183.
    Whelan, T. J., Goss, P. E., Ingle, J. N., Pater, J. L., Tu, D., Pritchard, K., … Muss, H. B. (2005). Assessment of quality of life in MA.17: A randomized, placebo-controlled trial of letrozole after 5 years of tamoxifen in postmenopausal women. Journal of Clinical Oncology, 23, 6931-6940. doi:10.1200/JCO.2005.11.181
    Winters, L., Habin, K., Flanagan, J., & Cashavelly, B. J. (2010). "I feel like I am 100 years old!" Managing arthralgias from aromatase inhibitors. Clinical Journal of Oncology Nursing, 14, 379-382. doi:10.1188/10.CJON.379-382
    Winters, L., Habin, K., & Gallagher, J. (2007). Aromatase inhibitors and musculoskeletal pain in patients with breast cancer. Clinical Journal of Oncology Nursing, 11, 433-439. doi:10.1188/07.CJON.433-439