[논문]What influences aromatase inhibitor continuation intention among breast cancer survivors?

Seo, Young Kyung; Park, Jeongok; Park, Jin-Hee; Kim, Sue

doi:10.4069/kjwhn.2021.01.19

What influences aromatase inhibitor continuation intention among breast cancer survivors? 원문보기

KJWHN : Korean journal of women health nursing, v.27 no.1, 2021년, pp.49 - 57

Seo, Young Kyung (College of Nursing, Yonsei University) , Park, Jeongok (College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University) , Park, Jin-Hee (College of Nursing, Research Institute of Nursing Science, Ajou University) , Kim, Sue (College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University)

Abstract ▼ AI-Helper

Purpose: Aromatase inhibitors (AIs) are widely prescribed for postmenopausal women with breast cancer and are known to cause musculoskeletal pain. This study aimed to identify factors associated with AI continuation intention among breast cancer survivors (BCS). Methods: A cross-sectional survey was conducted on 123 BCS (stages I-III), who had been taking AIs for at least 6 weeks. Participants were recruited from a cancer center in Goyang, Korea, from September to November 2019. Descriptive statistics, Welch analysis of variance, Pearson correlation coefficients, and simple linear regression were used for the analysis. Results: Beliefs about endocrine therapy was a significant predictor of AI continuation intention (β=.66, p<.001). The majority of participants (87.0%) reported experiencing musculoskeletal pain since taking AIs and the score for the worst pain severity within 24 hours was 5.08±2.80 out of 10. Musculoskeletal pain, however, was not associated with AI continuation intention. Fear of cancer recurrence (FCR) was clinically significant (≥13) for 74.0% of the respondents (mean, 17.62±7.14). Musculoskeletal pain severity and pain interference were significantly associated with FCR (r=.21, p<.05; r=.35, p<.01, respectively). Pain interference was significantly associated with beliefs about endocrine therapy (r=-.18, p<.05). Conclusion: AI continuation intention can be modified by reinforcing patients' beliefs about endocrine therapy. Musculoskeletal pain may have a negative effect on beliefs about endocrine therapy and increase FCR among BCS. Thus, awareness of musculoskeletal pain during AI therapy should be raised and further research is required to develop multidisciplinary pain management strategies and clinical guidelines to reinforce beliefs about endocrine therapy.

주제어

표/그림 (5)

표 Table 1. General characteristics of the participants (N=123)
표 Table 2. Aromatase inhibitor continuation intention, musculoskeletal pain, fear of cancer recurrence, and beliefs about endocrine therapy (N=123)
표 Table 3. Differences in aromatase inhibitor continuation intention according to pain severity (N=123)
표 Table 4. Correlations among study variables (N=123)
표 Table 5. Factors influencing aromatase inhibitor continuation intention (N=123)

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

문제 정의

Therefore, this study aimed to identify (1) whether AI continuation intention differed according to whether patients experienced newly developed or aggravated musculoskeletal pain since taking AIs; (2) the relationships among the main variables; and (3) factors associated with AI continuation intention.

제안 방법

A five-item measure of intentions to take cardiac medication [6] was modified to evaluate AI continuation intention, with permission from the developer. For example, the item “I plan to take regular medication in the future” was modified to “I plan to continue endocrine therapy in the future.
A self-reported questionnaire including AI continuation inten- tion, musculoskeletal pain, FCR, beliefs about endocrine thera- py, and general characteristics was used. Permission to use each assessment tool was obtained from both the developers and the authors of adapted/translated versions by e-mail.
For example, the item “I plan to take regular medication in the future” was modified to “I plan to continue endocrine therapy in the future.” The five items evaluated intentional plan to take medication, intention to make an effort to take the medication, intention to persist and adhere with the medication, and the perceived possibility of taking the medication. Each item is rated on a 5-point scale (1–5), with a possible total score ranging from 5 to 25, and higher scores indicate greater intention.

대상 데이터

15 [17], and four predictors: pain severity [7, 11], pain interference [11, 18], FCR [4], and beliefs about endocrine therapy [4, 12]), based on the literature was at least 108. Considering a 20% dropout rate, questionnaires were distributed to 129 BCS and 123 completed questionnaires without missing information were included in the analyses.
September 16 to November 14, 2019. The participants were recruited via convenience sampling among patients visiting the outpatient clinic of the center for breast cancer. Based on the findings of a previous study that AI-associated musculoskeletal pain started after 6 weeks on average [16], the inclusion criteria were as follows: (1) stage I–Ⅲ breast cancer; (2) completed surgery, adjuvant chemotherapy, and radiation therapy; and (3) at least 6 weeks on AI medication [16].
This cross-sectional correlational research was conducted at a cancer center located in Goyang, Gyeonggi Province, Korea, from September 16 to November 14, 2019. The participants were recruited via convenience sampling among patients visiting the outpatient clinic of the center for breast cancer.

데이터처리

Differences in AI continuation intention according to musculoskeletal pain were examined using Welch analysis of variance. Correlations among variables were examined using Pearson correlation coefficients, and regression analysis was done to identify factors influencing AI continuation intention.

이론/모형

FCR was evaluated with the Fear of Cancer Recurrence Inven- tory-Short Form (FCRI-SF) [21] Korean version [22], which consists of nine items rated on a 5-point scale (0–4), with a possible total score range of 0 to 36 and a higher score indicating a greater FCR. A cutoff score of 13 or higher is considered clinically significant [21].
Musculoskeletal pain was evaluated with the Korean version [19] of the Brief Pain Inventory-Short Form (BPI-SF) [20]. Pain severity (four items) and pain interference (seven items) are rated on an 11-point scale (0–10), with a higher score indicating more severe pain and pain interference.

성능/효과

It consists of four subcategories: perceived control (11 items), perceived concerns (four items), perceived benefits and trust (five items), and perceived logic (two items). Each item is rated on a 4-point scale (1–4), with a possible total score range of 22 to 88, and a higher score indicates a stronger beliefs about endocrine therapy. Cronbach’s α was .
In conclusion, beliefs about endocrine therapy was a significant predictor of AI continuation intention, whereas musculoskeletal pain during AI therapy did not negatively affect AI continuation intention. The incidence of the pain and the pain se- verity, however, was high enough to require active pain management in this sample of BCS.
First, generalizability is limited as participants were recruited via convenience sampling from a single institution. Second, the discrepancy between AI continuation intention and AI adherence behavior was not evaluated. Although intentions explain behaviors to some extent, the predictability of actual AI continuation was not evaluated, as AI-taking behavior was not the focus of this study.
AI continuation intention. The regression model was statistically significant (F=95.66, p<.001), explaining 44% of AI continuation intention (Table 5).

후속연구

Although FCR in this study was higher than found in a previous study, it had no effect on AI continuation intention, which may be related to the high level of beliefs about endocrine therapy found in this study. Since it has been noted that FCR plays a role in endocrine therapy continuation among BCS with low levels of beliefs about endocrine therapy [4], further research should explore this inter- play.
Second, the evaluation of the relationship of musculoskeletal pain to AI continuation intention in a Korean population is also significant, since data indicating low AI adherence have been published from other countries, but the relevance of those findings to nursing practice in Korea has not been clear. This study’s finding can improve clinicians’ understanding of musculoskeletal pain during AI therapy and can be used to develop nursing interventions for musculoskeletal pain management and improving endocrine therapy continuation intention.
Although previous studies [7, 18] of AI (non)adherence focused on behavior rather than intention, an accurate identification of BCS who are indecisive about AI continuation would be helpful for preventing premature discontinuation and encouraging BCS to complete the therapy during the recommended period. Thus, further research should develop valid tools evaluating intention to continue endocrine therapy and seek to identify vulnerable populations. In addition, the discrepancy between intention and behavior may be relevant.
Although intention to take medication is a predictor of medication adherence [6], actual behavior can differ. Thus, other factors should be considered when using intention as a predictor of behavior, and further studies with a longitudinal design are required to evaluate the predictive power of intention on adherence in the context of endocrine therapy with AI.

참고문헌 (29)

1 Emanuel G Henson KE Broggio J Charman J Horgan K Dodwell D Endocrine therapy in the years following a diagnosis of breast cancer: a proof of concept study using the primary care prescription database linked to cancer registration data Cancer Epidemiol 2019 61 185 189 10.1016/j.canep.2019.04.012 31126816

상세보기
2 Xing P Dong H Liu Q Yao F Xu Y Chen B Impact of persistence on survival of patients with breast cancer treated with endocrine therapy in Northeast China: a prospective study Oncotarget 2017 8 60 102499 102510 10.18632/oncotarget.18454 29254265

상세보기
3 Beryl LL Rendle KA Halley MC Gillespie KA May SG Glover J Mapping the decision-making process for adjuvant endocrine therapy for breast cancer: the role of decisional resolve Med Decis Making 2017 37 1 79 90 10.1177/0272989X16640488 27053528

상세보기
4 Lambert LK Balneaves LG Howard AF Chia SK Gotay CC Understanding adjuvant endocrine therapy persistence in breast Cancer survivors BMC Cancer 2018 18 1 732 10.1186/s12885-018-4644-7 29996816

상세보기
5 Corter AL Broom R Porter D Harvey V Findlay M Predicting nonadherence to adjuvant endocrine therapy in women with early stage breast cancer Psychooncology 2018 27 9 2096 2103 10.1002/pon.4771 29776011

상세보기
6 Pakpour AH Gellert P Asefzadeh S Updegraff JA Molloy GJ Sniehotta FF Intention and planning predicting medication adherence following coronary artery bypass graft surgery J Psychosom Res 2014 77 4 287 295 10.1016/j.jpsychores.2014.07.001 25280826

상세보기
7 Chim K Xie SX Stricker CT Li QS Gross R Farrar JT Joint pain severity predicts premature discontinuation of aromatase inhibitors in breast cancer survivors BMC Cancer 2013 13 401 10.1186/1471-2407-13-401 24004677

상세보기
8 Lombard JM Zdenkowski N Wells K Beckmore C Reaby L Forbes JF Aromatase inhibitor induced musculoskeletal syndrome: a significant problem with limited treatment options Support Care Cancer 2016 24 5 2139 2146 10.1007/s00520-015-3001-5 26556210

상세보기
9 Park JY Lee SK Bae SY Kim J Kim MK Kil WH Aromatase inhibitor-associated musculoskeletal symptoms: incidence and associated factors J Korean Surg Soc 2013 85 5 205 211 10.4174/jkss.2013.85.5.205 24266010

상세보기
10 Kim TH Kang JW Lee TH Therapeutic options for aromatase inhibitor-associated arthralgia in breast cancer survivors: A systematic review of systematic reviews, evidence mapping, and network meta-analysis Maturitas 2018 118 29 37 10.1016/j.maturitas.2018.09.005 30415752

상세보기
11 Cahir C Dombrowski SU Kelly CM Kennedy MJ Bennett K Sharp L Women’s experiences of hormonal therapy for breast cancer: exploring influences on medication-taking behaviour Support Care Cancer 2015 23 11 3115 3130 10.1007/s00520-015-2685-x 25744290

상세보기
12 Lee JY Min YH Relationships between determinants of adjuvant endocrine therapy adherence in breast cancer BMC Womens Health 2018 18 1 48 10.1186/s12905-018-0522-3 29551094

상세보기
13 Hall DL Lennes IT Pirl WF Friedman ER Park ER Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors Support Care Cancer 2017 25 5 1401 1407 10.1007/s00520-016-3533-3 27966025

상세보기
14 Lopez C Charles C Rouby P Boinon D Laurent S Rey A Relations between arthralgia and fear of recurrence: results of a cross-sectional study of breast cancer patients treated with adjuvant aromatase inhibitors therapy Support Care Cancer 2015 23 12 3581 3588 10.1007/s00520-015-2722-9 25894881

상세보기
15 Salgado TM Davis EJ Farris KB Fawaz S Batra P Henry NL Identifying socio-demographic and clinical characteristics associated with medication beliefs about aromatase inhibitors among postmenopausal women with breast cancer Breast Cancer Res Treat 2017 163 2 311 319 10.1007/s10549-017-4177-9 28251384

상세보기
16 Castel LD Hartmann KE Mayer IA Saville BR Alvarez J Boomershine CS Time course of arthralgia among women initiating aromatase inhibitor therapy and a postmenopausal comparison group in a prospective cohort Cancer 2013 119 13 2375 2382 10.1002/cncr.28016 23575918

상세보기
17 Lee YH Jeong IS Factors influencing medication adherence to oral anticancer drugs Asian Oncol Nurs 2013 13 4 201 209 10.5388/aon.213.13.4.201
18 Kadakia KC Snyder CF Kidwell KM Seewald NJ Flockhart DA Skaar TC Patient-reported outcomes and early discontinuation in aromatase inhibitor-treated postmenopausal women with early stage breast cancer Oncologist 2016 21 5 539 546 10.1634/theoncologist.2015-0349 27009936

상세보기
19 Yun YH Mendoza TR Heo DS Yoo T Heo BY Park HA Development of a cancer pain assessment tool in Korea: a validation study of a Korean version of the brief pain inventory Oncology 2004 66 6 439 444 https://doi.org/10.1159/000079497. PMID: 15452372 15452372
20 Cleeland CS Ryan KM Pain assessment: global use of the Brief Pain Inventory Ann Acad Med Singap 1994 23 2 129 138 8080219

상세보기
21 Simard S Savard J Screening and comorbidity of clinical levels of fear of cancer recurrence J Cancer Surviv 2015 9 3 481 491 10.1007/s11764-015-0424-4 25603948

상세보기
22 Shin J Goo A Ko H Kim JH Lim SU Lee HK Simard S Validation study for the korean version of Fear of Cancer Recurrence Inventory J Korean Med Sci 2017 32 11 1792 1799 10.3346/jkms.2017.32.11.1792 28960031

상세보기
23 Simard S Savard J Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence Support Care Cancer 2009 17 3 241 251 10.1007/s00520-008-0444-y 18414902

상세보기
24 Kim SH Development of an adjuvant endocrine therapy beliefs scale for breast cancer survivors [dissertation] Seoul Yonsei University 2019 215
25 Shim HY Park M Kim HJ Kyung HS Shin JY Physical activity status by pain severity in patients with knee osteoarthritis: a nationwide study in Korea BMC Musculoskelet Disord 2018 19 1 380 10.1186/s12891-018-2301-6 30342512

상세보기
26 Cleeland CS The brief pain inventory user guide Houston (TX) MD Anderson Cancer Center 2009
27 Heisig SR Shedden-Mora MC von Blanckenburg P Rief W Witzel I Albert US What do women with breast cancer expect from their treatment? Correlates of negative treatment expectations about endocrine therapy Psychooncology 2016 25 12 1485 1492 10.1002/pon.4089 26913587

상세보기
28 Boonstra A van Zadelhoff J Timmer-Bonte A Ottevanger PB Beurskens CH van Laarhoven HW Arthralgia during aromatase inhibitor treatment in early breast cancer patients: prevalence, impact, and recognition by healthcare providers Cancer Nurs 2013 36 1 52 59 10.1097/NCC.0b013e31824a7e18 22495502

상세보기
29 de Mendoza AH Cabling M Dilawari A Turner JW Fernández N Henderson A Providers’ perspectives on adherence to hormonal therapy in breast cancer survivors. is there a role for the Digital Health Feedback System? Health Technol (Berl) 2019 9 2 175 184 10.1007/s12553-018-0267-x 31448187

상세보기

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증