Encouraging CDK4/6 Adherence Through Emotional Awareness

EP: 1.How CDK4/6 Inhibitors Enable More Personalized Treatment in HR+ mBC

EP: 2.CDK4/6 Inhibition Customizes Frontline HR+, HER2- mBC Treatment

EP: 3.Routine Helps Patients With Breast Cancer on CDK4/6 Inhibitors Gain Independence

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EP: 4.Encouraging CDK4/6 Adherence Through Emotional Awareness

Understanding the emotional aspects behind treatment adherence can help make it clearer to patients with cancer what their role in the management of their adverse effects (AEs) is, said Kimberly Podsada, BSN, RN, MSN, NP-C, CNS.

In an interview with Oncology Nursing News after a Case-Based Roundtable, Podsada, a nurse practitioner at the University of California San Diego, touched on the responsibility of patients to play an active part in managing AEs. As she explained, the “minefield of emotions” that patients with a cancer diagnosis experience can prevent them from focusing on the day-to-day methods in which their care is their responsibility, specifically as it relates to patients with hormone receptor (HR)–positive metastatic breast cancer receiving CDK4/6 inhibitors.

Podsada emphasized that this is in area providers in the roundtable discussion agreed they are “all trying to find that 1 thing that’s going to make a difference.” However, Podsada said, setting up a realistic expectation with patients from the start of treatment along with overcommunicating and documenting patient expectations can help patients keep track of their responsibilities throughout treatment.

Additionally, Podsada mentioned that it can be helpful to explain to patients that AEs will be difficult at first and get better with time and diligence.

Transcript

We’re all trying to find that 1 thing that’s going to make a difference for adherence and comfort. How do we make this more comfortable for the patient, engage them in this process, and have accountability that they need to be involved in this as well?

We can’t do all the work for them. We need them to get on board with: “This is how we want to treat you because of these long-term benefits, but we really need you to do these things up front.” The realistic expectations conversation up front is so important.

We’re navigating this minefield of emotion from the individual: “I have kids. I don’t want to die. I want to see my kids graduate college and get married and have their own kids. I’m the only one who is taking care of my elderly parents. Who will take care of them if I die?”

The mind goes in many different directions, so it’s very challenging sometimes to get patients back to the present and have conversations like: “This is what we strongly recommend, and it’s going to give you the best long-term benefit. You’re not dying right now, and this medication is going to help.”

For a realistic expectation conversation, it’s something like: “You’re going to have side effects. You’re not going to have every side effect, but we still need to find out what your side effects are going to be. Side effects tend to get more tolerable and manageable over time if you work with us and communicate with us to manage your symptoms. There are symptoms we can help you control, and then there are symptoms you have to control.”

Setting up that conversation expressing that is not going to be easy, especially upfront, but it gets better, is important. Some of it is their mind is full of the “what ifs” and fear, and that’s understandable. I [explain] a lot of things. I put a lot of things in writing. I call them in a couple of weeks to check on them. It’s getting over that hump of those first 3 to 6 months, and then things become a pattern and a routine.

This transcript has been edited for clarity and conciseness.