Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana
PURPOSEBreast cancer (BC) is the most common female cancer worldwide, and the burden is increasing across sub-Saharan Africa. For women with hormone receptor–positive (HR+) cancers, endocrine therapy (ET) taken for 5-10 years can reduce the risk of recurrence by half. We explored experiences with ET...
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| Format: | Article |
| Language: | English |
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American Society of Clinical Oncology
2024-12-01
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| Series: | JCO Global Oncology |
| Online Access: | https://ascopubs.org/doi/10.1200/GO.24.00180 |
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| author | James R. Wester Rachel B. Wagner Bosa Motladiile Isaac Nkele Nkhabe Chinyepi Moeketsi J. Makhema Tara M. Friebel-Klingner Peter Vuylsteke Shahin Lockman Scott Dryden-Peterson Racquel E. Kohler |
| author_facet | James R. Wester Rachel B. Wagner Bosa Motladiile Isaac Nkele Nkhabe Chinyepi Moeketsi J. Makhema Tara M. Friebel-Klingner Peter Vuylsteke Shahin Lockman Scott Dryden-Peterson Racquel E. Kohler |
| author_sort | James R. Wester |
| collection | DOAJ |
| description | PURPOSEBreast cancer (BC) is the most common female cancer worldwide, and the burden is increasing across sub-Saharan Africa. For women with hormone receptor–positive (HR+) cancers, endocrine therapy (ET) taken for 5-10 years can reduce the risk of recurrence by half. We explored experiences with ET and barriers to utilization among survivors in Botswana.METHODSWe recruited women with nonmetastatic disease from a survivorship cohort who had undergone mastectomy within 1-5 years for semi-structured interviews to explore experiences with treatment. This thematic content analysis focused on ET, so the sample included women with HR+ cancer who should have received ET and HR− women who reported taking ET.RESULTSWe analyzed interviews with 19 women (mean age 54 years, 42% stage I/II, 58% stage III). Three key themes were identified: (1) limited provider counseling, (2) challenges refilling prescriptions at public pharmacies, and (3) high medication and transportation costs associated with private pharmacies. Subthemes included immunohistochemistry result communication, lack of knowledge, frequent public pharmacy stockouts, inconvenient prescription refill policies, and medication switching and discontinuation, especially among participants with low socioeconomic positions (SEPs). Women's persistence, SEP, and financial support facilitated refills. Although some experienced side effects, they were not a common reason for discontinuation.CONCLUSIONBC survivors in Botswana face multilevel barriers to accessing and adhering to ET. Provider and health system improvements are needed to effectively communicate ET importance and increase access to consistently available and affordable medication. |
| format | Article |
| id | doaj-art-ac094f74aaf4460ea17824cd2f8b9ca4 |
| institution | OA Journals |
| issn | 2687-8941 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | JCO Global Oncology |
| spelling | doaj-art-ac094f74aaf4460ea17824cd2f8b9ca42025-08-20T01:59:09ZengAmerican Society of Clinical OncologyJCO Global Oncology2687-89412024-12-011010.1200/GO.24.00180Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in BotswanaJames R. Wester0Rachel B. Wagner1Bosa Motladiile2Isaac Nkele3Nkhabe Chinyepi4Moeketsi J. Makhema5Tara M. Friebel-Klingner6Peter Vuylsteke7Shahin Lockman8Scott Dryden-Peterson9Racquel E. Kohler10Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PACenter for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJBotswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, BotswanaBotswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, BotswanaDepartment of Surgery, University of Botswana, Gaborone, BotswanaBotswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, BotswanaRutgers Global Health Institute, New Brunswick, NJDepartment of Internal Medicine, University of Botswana, Gaborone, BotswanaBotswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, BotswanaBotswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, BotswanaCenter for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJPURPOSEBreast cancer (BC) is the most common female cancer worldwide, and the burden is increasing across sub-Saharan Africa. For women with hormone receptor–positive (HR+) cancers, endocrine therapy (ET) taken for 5-10 years can reduce the risk of recurrence by half. We explored experiences with ET and barriers to utilization among survivors in Botswana.METHODSWe recruited women with nonmetastatic disease from a survivorship cohort who had undergone mastectomy within 1-5 years for semi-structured interviews to explore experiences with treatment. This thematic content analysis focused on ET, so the sample included women with HR+ cancer who should have received ET and HR− women who reported taking ET.RESULTSWe analyzed interviews with 19 women (mean age 54 years, 42% stage I/II, 58% stage III). Three key themes were identified: (1) limited provider counseling, (2) challenges refilling prescriptions at public pharmacies, and (3) high medication and transportation costs associated with private pharmacies. Subthemes included immunohistochemistry result communication, lack of knowledge, frequent public pharmacy stockouts, inconvenient prescription refill policies, and medication switching and discontinuation, especially among participants with low socioeconomic positions (SEPs). Women's persistence, SEP, and financial support facilitated refills. Although some experienced side effects, they were not a common reason for discontinuation.CONCLUSIONBC survivors in Botswana face multilevel barriers to accessing and adhering to ET. Provider and health system improvements are needed to effectively communicate ET importance and increase access to consistently available and affordable medication.https://ascopubs.org/doi/10.1200/GO.24.00180 |
| spellingShingle | James R. Wester Rachel B. Wagner Bosa Motladiile Isaac Nkele Nkhabe Chinyepi Moeketsi J. Makhema Tara M. Friebel-Klingner Peter Vuylsteke Shahin Lockman Scott Dryden-Peterson Racquel E. Kohler Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana JCO Global Oncology |
| title | Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana |
| title_full | Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana |
| title_fullStr | Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana |
| title_full_unstemmed | Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana |
| title_short | Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana |
| title_sort | access to and utilization of endocrine therapy among breast cancer survivors in botswana |
| url | https://ascopubs.org/doi/10.1200/GO.24.00180 |
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