HORMONO+
Adjuvant endocrine therapy in non-metastatic breast cancer: decisional issues surrounding treatment extension and strategies to improve follow-up and support for women
The primary objective is to describe the perceptions and factors influencing adherence to the proposal to extend adjuvant endocrine therapy (AET) among women with hormone-sensitive breast cancer, and to explore strategies to strengthen the follow-up and support of these women.
The secondary objectives are to:
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Describe the experience of AET among women treated for more than 5 years, and the factors influencing the decision to continue or discontinue treatment, as well as the factors influencing adherence to this extended AET.
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Explore the expectations, needs, and preferences regarding information and communication about AET extension, through the cross-referenced perspectives of patients and healthcare professionals.
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Identify innovative strategies to improve the follow-up and support of women, whether proposed by healthcare professionals or self-administered by the women themselves.
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Project period
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Main investigator
Géraldine Cazorla, Doctoral fellow
SESSTIM member(s) of the project:
Non-SESSTIM member(s) of the project
Lorène Seguin, oncologist and Magali Provansal, oncologists, Paoli-Calmettes Institute, Murielle Sevenne, patient research partner
Sponsors:
The League Against Cancer (Ligue contre le cancer, LCC), as part of the LCC-labelled teams 2024–2026
Partners:
Paoli-Calmettes Institute
Research topics:
Research question:
For several decades, adjuvant endocrine therapy (AET) taken for a period of 5 years has been part of the standard of care for the management of early-stage, hormone-sensitive breast cancer. For approximately one third of patients (more advanced stage or extensive nodal involvement), extending AET is now recommended for a total duration of 7 to 10 years in order to reduce the risks of recurrence and death. However, the optimal duration of AET remains uncertain. According to a recent review, extending aromatase inhibitor therapy beyond 7 years provides only a marginal benefit in terms of disease-free survival and overall survival rates. A meta-analysis shows that extending aromatase inhibitors beyond 5 years, while offering significant advantages in terms of disease-free survival, does not significantly improve overall survival.
Moreover, prolonged use of AET may, depending on the treatment taken, be associated with an increased risk of endometrial cancer and thromboembolic disease in the case of tamoxifen, and an increased risk of cardiotoxicity, osteoporotic fractures, and osteoporosis in the case of aromatase inhibitors. These major adverse effects add to the numerous effects recorded during the first 5 years of AET, which affect the quality of life of many patients and are the leading cause of non-adherence to treatment. In this context, the decision to extend AET beyond 5 years must weigh the absolute benefits against the additional potential risks and the adverse effects affecting women's quality of life
Method:
This research employs a qualitative methodology. An exploratory analysis of online discussion forums was conducted as a first step. A netnographic approach, inspired by ethnography and particularly well suited to exploratory research, was used. This approach enables the non-intrusive observation of users' online social interactions and experiences, thereby providing rich information on the content shared and an in-depth understanding of behaviours in digital contexts.
In a second step, semi-structured individual interviews was conducted with:
1) Healthcare professionals who prescribe or renew prescriptions for AET y in the context of hormone-dependent breast cancer.
2) Women who have been or are currently being treated with AET for 5 years or more
Research prospects:
While the factors influencing adherence to adjuvant endocrine therapy during the first five years are well documented, it remains to be examined whether these factors are also found in the still under-explored context of extended AET.
This research will contribute to filling this data gap by:
• analysing how patients and healthcare professionals communicate about extended AET and identifying potentially unmet information needs;
• qualitatively documenting perceptions of extended AET and the factors influencing adherence to this long-term treatment
Results:
The exploratory analysis of five French online discussion forums highlighted unmet information needs, uncertainties, and coping strategies among women facing the extension of adjuvant endocrine therapy. To address these challenges, clear and accessible communication on the benefit-risk balance and the management of side effects, delivered from the time of prescription onwards and at key moments along the care pathway, could promote informed decision-making, improve adherence, and preserve quality of life. With the increasing number of patients undergoing extended treatment, strengthened coordination between primary and hospital care, including follow-up by trained general practitioners and gynaecologists in connection with cancer centres, would be essential to ensure continuous care and comprehensive support. https://www.jmir.org/2025/1/e82016#ref11
By identifying strategies to personalise the support and follow-up of women and to promote adherence to extended endocrine therapy, this study could contribute to optimising the clinical benefits of this treatment
Favourable opinion from the Ethics and Research Committee of Aix-Marseille University. Reference number: 2025-02-27-01
