As breast cancer evolves, it becomes increasingly important to consider the patient and healthcare provider perspective in therapy selection. Recently, selective estrogen receptor degraders (SERDs) have garnered attention, and may provide an alternative to intramuscular fulvestrant injections in estrogen-receptor–positive, HER2-negative, locally advanced or metastatic breast cancer. This study sought to explore patient and healthcare provider (HCP) perspectives on oral and intramuscular (IM) endocrine therapy in the same population.
This was a US-based qualitative study focused on understanding the potential benefits and burdens of next-generation oral SERDs compared with the established IM fulvestrant treatment. Researchers conducted semi-structured interviews from September 2023 to May 2024 with 22 female patients with metastatic breast cancer who had experience with oral estrogen therapy (ET) and fulvestrant within the past 3 years. The study also recruited 20 HCPs including medical oncologists and oncology nurses with experience providing oral or IM ET to ≥5 patients annually for the 3 years preceding study participation.
The interviews centered around 4 key themes: treatment preference, perceived benefits, experienced burdens, and adherence to oral and IM ET. Patients shared their personal experiences, and HCPs provided insights based on their clinical experience with the therapies. A significant majority of patients (64%) preferred oral ET, primarily because of convenience (81%), nonpainful administration (31%), and a fear of needles (19%). However, 28% of patients favored IM ET, primarily because of the simplicity of monthly administration. Patients reported that the greatest benefit of oral therapy was convenience (86%), followed by the fact they were already taking other oral medications (83%). Patients cited that the benefit of IM therapy reduced the burden of remembering to take medication (55%) and increased the efficacy of the injection (56%)
Patient-reported burdens associated with oral ET included adverse events (72%), the need to remember to take medication (86%), and having to take medication more frequently (18%). Conversely, the primary burdens of IM ET were injection-site pain (84%), anxiety (20%), and the need to travel for monthly appointments (64%). A striking contrast emerged in perceived ease of administration. Nearly all patients (92%) found adherence to oral ET easy; however, only 32% found adherence to IM ET easy.
HCP perspectives largely aligned with patient preferences, with 90% of HCPs perceiving that patients prefer oral ET. HCPs and patients recognized the convenience of oral ET and the reduced burden of remembering to take medication with IM ET. However, HCPs raised concerns about perceived burdens associated with oral ET, including financial aspects such as cost or insurance (55%), adverse events (40%), and patient compliance (30%). For IM ET, HCPs identified pain (85%) and travel requirements (70%) as key burdens. Also, HCP perspectives on the ease of administration of oral therapy relatively matched patients’ perspectives, but there was a strong disconnect when considering IM ET. This highlights a potential disconnect between provider assumptions and patient experiences.
In conclusion, the study reveals a clear preference for oral ET among patients with metastatic breast cancer who have experienced oral and IM modalities. Convenience emerged as a dominant factor driving this preference. Although injection-site pain and the need for monthly appointments were significant burdens associated with IM ET, reduced reliance on patient adherence with the IM route was seen as a benefit by patients and HCPs. The study highlights the importance of considering patient and HCP perspectives when making treatment decisions, particularly in the context of new oral SERDs entering the treatment landscape.
Speck R, Schaff S, Harding G et al. Patient and health care provider perspectives on oral versus intramuscular endocrine therapy for locally advanced or metastatic breast cancer. Presented at: San Antonio Breast Cancer Symposium. December 10-13, 2024; San Antonio, TX. Abstract SESS-1735.