{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:03:31Z","timestamp":1790831011985,"version":"4.1.0"},"reference-count":79,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"10","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n            <jats:title>PURPOSE<\/jats:title>\n            <jats:p>Breast cancer (BC) is the most common female cancer worldwide, and the burden is increasing across sub-Saharan Africa. For women with hormone receptor\u2013positive (HR+) cancers, endocrine therapy (ET) taken for 5-10 years can reduce the risk of recurrence by half. We explored experiences with ET and barriers to utilization among survivors in Botswana.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS<\/jats:title>\n            <jats:p>We recruited women with nonmetastatic disease from a survivorship cohort who had undergone mastectomy within 1-5 years for semi-structured interviews to explore experiences with treatment. This thematic content analysis focused on ET, so the sample included women with HR+ cancer who should have received ET and HR\u2212 women who reported taking ET.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS<\/jats:title>\n            <jats:p>We analyzed interviews with 19 women (mean age 54 years, 42% stage I\/II, 58% stage III). Three key themes were identified: (1) limited provider counseling, (2) challenges refilling prescriptions at public pharmacies, and (3) high medication and transportation costs associated with private pharmacies. Subthemes included immunohistochemistry result communication, lack of knowledge, frequent public pharmacy stockouts, inconvenient prescription refill policies, and medication switching and discontinuation, especially among participants with low socioeconomic positions (SEPs). Women's persistence, SEP, and financial support facilitated refills. Although some experienced side effects, they were not a common reason for discontinuation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION<\/jats:title>\n            <jats:p>BC survivors in Botswana face multilevel barriers to accessing and adhering to ET. Provider and health system improvements are needed to effectively communicate ET importance and increase access to consistently available and affordable medication.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1200\/go.24.00180","type":"journal-article","created":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T20:59:17Z","timestamp":1734037157000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":7,"title":["Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9607-8982","authenticated-orcid":true,"given":"James R.","family":"Wester","sequence":"first","affiliation":[{"name":"Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8019-5041","authenticated-orcid":true,"given":"Rachel B.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bosa","family":"Motladiile","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Nkele","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4866-4418","authenticated-orcid":true,"given":"Nkhabe","family":"Chinyepi","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Botswana, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moeketsi J.","family":"Makhema","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3726-9527","authenticated-orcid":true,"given":"Tara M.","family":"Friebel-Klingner","sequence":"additional","affiliation":[{"name":"Rutgers Global Health Institute, New Brunswick, NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6401-3722","authenticated-orcid":true,"given":"Peter","family":"Vuylsteke","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Botswana, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5384-9716","authenticated-orcid":true,"given":"Shahin","family":"Lockman","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, Botswana"},{"name":"Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA"},{"name":"Department of Medicine, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8487-9731","authenticated-orcid":true,"given":"Scott","family":"Dryden-Peterson","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, Botswana"},{"name":"Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA"},{"name":"Department of Medicine, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1017-3832","authenticated-orcid":true,"given":"Racquel E.","family":"Kohler","sequence":"additional","affiliation":[{"name":"Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ"},{"name":"Botswana Harvard Health Partnership, Princess Marina Hospital, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_3_7_3_2","volume-title":"Global Cancer Observatory: Cancer Today, Africa","author":"Ferlay J","year":"2024","unstructured":"Ferlay J, Ervik M, Lam F, et al: Global Cancer Observatory: Cancer Today, Africa. 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