2. Methodology Buehler’s background Corruption of GT studies
Major characteristic – Process
Interviews with open ended questions
Further questions we should ask
Analysis began after 1st interview
Interviews will continue until no new data

3. Study Topic
Rural women with breast cancer who were unable to continue taking an Aromatase Inhibiter (AI) because of medication side effects.

4. Rural components of community’s response
Lack of anonymity – Everyone knows everyone and “their business”
Concern for valued Insider developing breast cancer
Caring for our own

5. Illness Trajectory Diagnosis  biopsy  treatment Surgery Radiation
Chemotherapy
Aromatase inhibitor (AI)

6. Aromatase Inhibitor Action
Estrogen production
“Estrogen synthesis is primarily sited peripherally in adipose tissue, muscle and breast tissue, rather than in the ovaries as in premenopausal women. In terms of inhibiting production, the most specific effects are best achieved by blocking the last step in biosynthesis, the conversion of androgens to estrogens by the heme-containing enzyme, aromatase.”
“This type of association provides exquisite potency for and specificity against the aromatase enzyme” Miller, W. R. Semin Oncol Aug;30(4 Suppl 14):3-11.

7. Side Effects: seen in literature & our larger study purpose
Pain
Fatigue
Sleep Disturbance
Distress

8. Elements of Distress Emotional Depression
Extreme irritability (wanting to lash out or lashing out at others – Loss of control)
Distorted reality (“Felt like drug is taking over”)
Extreme anxiety (“Feeling overwhelmed”)

9. Elements of Distress
Cognitive
Not identified in early studies of AI’s

10. Additional Findings Minimizing, by staff as well as by patients
All subjects initially attributed side effects from AI to other factors such as aging, radiation, cancer
Subjects talked of information regarding possible side effects being withheld from them.
Patient/physician conflict regarding medication

11. Additional Findings
Strategies
Disease management
Treatment management

12. Additional Findings Timing
Typically an AI is started while the pt is still receiving radiation
For patients who have difficulties, physicians suggest a 1 week drug holiday to see if side effects decrease.

13. Additional Findings
Risk-Benefit ratio

14. Nursing Implications
Educate patients about possible side effects and ways to manage
Assist patients in communicating their experiences effectively with their physicians to enhance treatment efficacy. We think this is a rich area for further study.
Lay network

15. QUESTIONS