Skördåker A.1, Levy Berg A.2, Biguet G.2
1Bräcke diakoni, Rehabilitation Centre Sfären, Stockholm, Sweden, 2Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
Background: Breast cancer is the most common cancer in women throughout the world and is associated with long-term survival as a result of early detection and different treatments available today. Most breast cancers are hormone receptor positive and thus adjuvant endocrine therapy plays a critical role in reducing the risk of recurrence cancer. During the past two decades, several studies, carried out in various settings, have demonstrated that almost one third of the women, who received adjuvant endocrine therapy, stopped treatment prematurely. The ultimate reason for this is still unclear. Treatment induced side effects, such as pain, musculoskeletal complaints, sleep disturbances, menopausal symptoms, sexual difficulties and mood swings are some reasons why women stop taking the treatment. Still it is likely that other bodily changes or factors, such as lack of confidence in treatment effectiveness, also affects women's adherence to treatment. Further, there may be various ways of perceiving and reacting to endocrine therapy.
Purpose: The aim of the study was to explore women's perceptions and attitudes towards adjuvant endocrine therapy with special focus on bodily experiences.
Methods: A purposive sample of 14 women (between 34-75 years) who were currently taking or who recently had finished adjuvant endocrine therapy for early breast cancer, took part in individual in-depth interviews to discuss their experiences and reflections on endocrine therapy. The women were recruited from two different breast cancer centers in Sweden. A phenomenographic research approach was chosen to analyze the interviews and a pattern of categories were constructed based on the womens perceptions.
Results: Four categories of descriptions were identified; (i) a solitary matter; (ii) a habit; (iii) a lifeline and the natural extension of cancer treatment and (iv) a fact. The distinguishing structures to be found between the categories were; focus on endocrine therapy and its negative consequences or focus on the purpose of the therapy, to control cancer. These two positions provide a framework to understand the womens perception of the responsibility in maintaining adherence to endocrine therapy, the experience of time (the time span of the therapy) and the experience of the body and bodily complaints. Ultimately, these different positions are about perceiving being in control or being out of control.
Conclusion(s): The results highlight womens complex representations of endocrine therapy and their interpretation of the treatment induced side-effects. Bodily as well as existential concerns seemed to be important.
Implications: The results may play an important role to improve communication between health-care providers and women and thus prevent discontinuation of adjuvant endocrine therapy. Physiotherapists may play an important role to discuss bodily complaints and the transformed body frame of references. They can suggest interventions to ease musculoskeletal complaints and menopausal symptoms and cultivate body awareness and body reliance. This might inspire the use of the potential of the physiotherapists knowledge in cancer rehabilitation.
Funding acknowledgements: The study received no specific grant from any funding agency.
Topic: Oncology, HIV & palliative care
Ethics approval: Approved by the local research ethics committee, Stockholm. 2015/2:5
All authors, affiliations and abstracts have been published as submitted.
