(1047) Journey Mapping to Understand Oral Anticancer Medication Use in Breast Cancer

Objectives: Recent developments in cancer therapeutics have allowed increased use of Oral Anticancer Medications (OAMs), including in the treatment of breast cancer. Breast cancer is the most common cancer among women in the United States. Patients with breast cancer may face key barriers in managing their OAMs at home. These challenges can lead to sub-optimal adherence and lower the overall quality of life. Designing interventions that enhance the patient experience of OAMs use requires a deeper understanding of barriers faced by patients as they navigate their cancer care journey. The objective of this study was to identify the unmet medication management needs of patients with breast cancer receiving OAMs.

Methods: This was a qualitative study design employing the semi-structured interview technique to elicit participant thoughts and generate a patient-specific journey map characterizing the longitudinal experience of OAMs use. Participants were recruited from an outpatient breast cancer clinic in Indianapolis, Indiana. Patients were eligible for inclusion in the study if they were 18 years or older, diagnosed with breast cancer, and currently receiving OAMs. Participants completed a brief sociodemographic and health information survey and participated in a journey mapping exercise through semi-structured interviews. Interviews were conducted either in-person or remotely via Zoom, based on participant preference. For each interview, two researchers and the participant collaborated to create individual patient journey maps to generate a concise visual storyboard focused on medication use experiences related to OAMs. The journey maps enabled the establishment of a timeline, key markers of medication use, as well as specific barriers faced by patients. Individual journey maps were consolidated to generate personas representing groups of patients with related characteristics, treatment types, goals, and unmet needs.

Results: A total of 10 interviews (9 females and 1 male) were completed and recruitment is ongoing. The median age of participants was 60 years (range, 37-75). Participants were divided into two groups based on the medication types they are currently on: (1) specialty medication (palbociclib or ribociclib; n=3 patients) and (2) traditional medication (tamoxifen, anastrozole, or exemestane; n=7 patients). We defined 'Specialty' medications as those that require specialty pharmacies and 'traditional' medications as those obtainable in local community pharmacies. To represent participants across these two broad categories of medications, two personas were created. Two major themes regarding OAMs use were identified. Participants who had been prescribed specialty medications reported difficulty with navigating the insurance process during medication fills, while participants who had been prescribed traditional medication participants did not. Notably, the word “prior authorization” was not used to explain the issues they experienced. While all participants reported having side effects from their medications, sub-optimal adherence was reported among the traditional medication group only. Participants reported that they cope with side effects by either discontinuing treatment or enduring the side effects. Most participants had no or few strategies to manage their side effects. Additionally, participants mentioned needing more financial and emotional support during their treatment journey.

Conclusions: This study is ongoing. When data collection is completed (anticipated December 2023), the study is expected to provide insights into the patient experience regarding OAMs. Personas created will be applied in the design of interventions that are tailored to breast cancer patients’ needs and goals and the consolidated journey maps identify potential areas for improvement. Adequate patient education and improved tools and processes are needed to effectively manage medication side effects, which can ultimately lead to improved medication outcomes and help patients navigate their health systems.