Stick with the program

Cancer researcher documents value of pill to prevent cancer's return

Tisha Felder was a social worker in Washington, D.C., when her best friend’s mother died of breast cancer. Felder knew the statistics that showed African-American women were less likely to be diagnosed with breast cancer but more likely to die from it.

Having lived through it with her friend, she could not shake the sadness. She talked with her father, telling him how bad she felt.

“All he said was ‘What are you going to do about it?’ ” Felder says.

At that moment, Felder says, she began her quest to improve the outcomes.

“I felt a calling to do something about these disparities,” says Felder, a native of Easley, S.C., and a researcher with a joint appointment in USC’s College of Nursing and the Cancer Prevention and Control Program in the Arnold School of Public Health.

She recently received funding from the National Cancer Institute to identify and test intervention strategies to improve adherence to hormonal therapy among disadvantaged breast cancer survivors who experience excess rates of breast cancer mortality.

“It’s one pill a day for up to 10 years,” Felder says. “But there are side effects, and the worst of those often happen in the first year. The irony is the worse the side effects are, the more effective the treatment seems to be.”

It is those side effects, which mimic menopause symptoms like hot flashes and vaginal dryness, that can lead women to stop taking the medicine within the first year.

Eventually, Felder says, the side effects lessen. So getting women through that first year is key. Her research began with interviews with health care providers across South Carolina, and now Felder is in the “data crunching” part of that phase.

Next up are interviews with patients themselves. The target group is women who have completed other breast cancer treatments (e.g., surgery, chemotherapy), are now cancer-free and have been put on hormonal therapy to prevent recurrence. Felder’s study will focus on women with Medicaid coverage.

“Research shows that Medicaid patients have worse outcomes than other patients, and for black Medicaid patients, the outcomes are even worse,” she says.

The goal is to have at least 30 participants to help researchers develop and pilot test intervention strategies to improve use of the hormonal treatment.

“Our hypothesis is that we have to address issues beyond the patient; we have to look at their support systems, their partners and providers,” she says.

As part of her field research, Felder shadowed different oncologists and saw a wide variation in the bedside manner and rapport with patients. Providers’ attitudes, she says, can affect the way a patient views continued therapy and ultimately how well she sticks with it.

As part of the award from the National Cancer Institute, Felder will be mentored by an interdisciplinary team of cancer disparities experts from the University of South Carolina: Ronit Elk and Sue Heiney from the College of Nursing, Daniela Friedman and James Hébert from the Arnold School of Public Health and Marvella Ford from the Medical University of South Carolina.

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