Factors influencing oncologists’ prescribing hormonal therapy in women with breast cancer: a qualitative study in Córdoba, Argentina

• Main Author: Yolanda Eraso
• Format: Article
• Language: English
• Published: BMC 2019-02-01
• Series: International Journal for Equity in Health
• Subjects: Breast cancer; Hormonal therapy; Oncologists’ prescribing; Health system provider; Gender; Inequalities
• Online Access: http://link.springer.com/article/10.1186/s12939-019-0936-z

Abstract Background Hormonal therapy is an integral component for breast cancer treatment in women with oestrogen receptor positive tumours in early-stage and advanced cases of the disease. Little is known about what factors influence oncologists’ prescribing practices, especially non-biological factors, although this information may have important implications for understanding inequalities in health care quality and outcomes. This paper presents findings from research on factors influencing oncologists’ prescribing hormonal therapy for women with early and advanced cases of breast cancer in the city of Córdoba, Argentina. Methods A qualitative study using in-depth, semi-structured interviews with 16 oncologists was conducted. A stratified purposive sampling was used to recruit female and male participants and working at 3 health subsystems (private, social security, public). Data was analysed using the Framework approach. Results According to the respondents, factors influencing prescribing practices of hormonal therapy are varied. Women’s socio-economic status (poverty and wealth) and their level of health literacy can affect oncologists’ prescribing practices. Overall, in comparison to male, female oncologists reported more awareness of patients’ needs, more involvement in communicating drug side-effects, and in offering treatment options in private health settings. The 3 health subsystems provided a differential access to drugs and lines of hormonal treatment, which ranged from a limited availability in the public sector, to administrative restrictions imposed by the social security system, and to a lesser extent, the private sector. This happened in the backdrop of national legislation covering oncological treatments and drugs free of charge. Conclusions Addressing prescribing practices for hormonal therapy as a distinct type of breast cancer treatment (chronic care) is fundamental in the understanding of breast cancer care and can shed light on inequalities in treatments. Identifying the underlying care gaps in the prescription of hormonal therapy can help in the design of tailored interventions.