Development and Refinement of a Telehealth Intervention for Symptom Management, Distress, and Adherence to Adjuvant Endo
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Development and Refinement of a Telehealth Intervention for Symptom Management, Distress, and Adherence to Adjuvant Endocrine Therapy after Breast Cancer Jamie M. Jacobs1,2 · Emily A. Walsh1,3 · Chelsea S. Rapoport1 · Michael H. Antoni3 · Elyse R. Park1,2 · Kathryn Post1,2 · Amy Comander4,5 · Jeffrey Peppercorn4,5 · Steven A. Safren3 · Jennifer S. Temel4,5 · Joseph A. Greer1,2 Accepted: 1 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Adjuvant endocrine therapy (AET) prevents recurrence after early stage, hormone sensitive breast cancer; however, adherence to AET is suboptimal, and efficacious interventions are severely lacking. Barriers to adherence are well established; however, interventions, thus, far have failed to produce meaningful changes in adherence and have generally not followed guiding principles of psychosocial intervention development. The purpose of this paper is to describe the iterative development, using the National Institutes of Health Stage Model for Behavioral Intervention Development, of an evidence-based, patient-centered, telehealth intervention to enhance adherence, improve symptom management, and reduce distress for patients taking AET after breast cancer, with a focus on (1) a small open pilot study which informed modifications and refinement of the intervention based on quantitative and qualitative patient feedback about feasibility and acceptability and (2) the underlying theoretical and empirical rationale for each component of the finalized intervention. Clinical implications and directions for future research are discussed. Keywords Hormonal therapy · Breast cancer · Symptom management · Adherence · Distress · Cognitive-behavioral intervention
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10880-020-09750-4) contains supplementary material, which is available to authorized users. * Jamie M. Jacobs [email protected] 1
Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Yawkey, Suite 10B, Boston, MA 02114, USA
2
Department of Psychiatry, Harvard Medical School, Boston, MA, USA
3
Department of Psychology, University of Miami, Coral Gables, FL, USA
4
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
5
Department of Medicine, Harvard Medical School, Boston, MA, USA
Approximately, 60–75% of early-stage breast malignancies are hormone sensitive (i.e., hormone receptor-positive) and treated with adjuvant endocrine therapy (AET), a critical component of recurrence prevention during survivorship (Burstein, Lacchetti, & Griggs, 2018). While breast cancer cells that are hormone receptor-positive use estrogen and/or progesterone to grow and spread, AET reduces the risk of cancer recurrence by lowering estrogen levels in the body or by blocking estrogen from acting on these breast cancer cells. Thus, AET in the form of tamoxifen (blocks estrogen receptors on breast cancer cells) or an aromatase inhibitor (AI; sto
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