Clinical practice to address tamoxifen nonadherence
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REVIEW
Clinical practice to address tamoxifen nonadherence Richard R. Love1 · Michael Baum2 · Susan M. Love3 · Andrea M. Straus4 Received: 19 June 2020 / Accepted: 1 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The primary and secondary benefits of tamoxifen as adjuvant therapy in women with hormone-receptor-positive breast cancer are substantial: a 1% decrease in the risk of death each year for 10 years with each additional year of treatment during the first 5 years. Considerable data, however, indicate that these benefits are lost to many patients because of treatment nonadherence. Nonadherence is examined within the framework of the Common-Sense Model of Self-Regulation to describe patients’ models of disease and treatment that organize their thinking and behavior, and the crucial role of the practitioner in addressing and altering these models. Common patient education and social communications about patients’ hormone-receptor-positive breast cancer and tamoxifen treatment promote an acute disease paradigm in which cancer occurs within specific locations and is either present or absent. We recommend that clinicians communicate the concepts of hormone-receptor-positive breast cancer as follows: i. a non-dichotomous systemic disorder entailing a treatment goal of homeostasis and disease quiescence and ii. a disorder undetectable by currently available tests in subclinical states. Equally important, the clinician can provide a comprehensive picture of the well-documented secondary effects of tamoxifen, noting in particular the beneficial effects. Specific action plans, grounded in individual patient understanding, can be developed and reinforced, in an ongoing process that validates and integrates patient values and goals as they change over time. Keywords Tamoxifen · Nonadherence · Patient illness representations · Patient communications · Hormone-receptorpositive breast cancer
Introduction “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.” François Voltaire. Voltaire’s judgment of our knowledge about hormonereceptor positive breast cancer and tamoxifen treatment may be overly harsh: much is known, although certainly there is more to know. His judgment of our knowledge about our patients, however, may be closer to the truth. Their
* Richard R. Love [email protected] 1
Department of Computer Science, Marquette University, Milwaukee, WI, USA
2
University College, London, UK
3
Dr. Susan Love Research Foundation, Encino, CA, USA
4
2708 Columbia Road, Madison, WI 53705, USA
common-sense misunderstanding of this disease and its treatment and the associated high rates of treatment nonadherence over time are encouraged by an apparent misalignment of patient communications with the medical understanding that underlies treatment adherence and the best clinical outcomes. Common medical care models are not patient-centric [1, p. 219]. Shared decisi
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