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Br J Gen Pract. 2017 Jun;67(659):e414-e427. doi: 10.3399/bjgp17X689377. Epub 2017 Feb 13.

Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs' attitudes.

Author information

1
Institute of Health Sciences, University of Leeds, Leeds, and Wolfson Institute of Preventive Medicine, Queen Mary University of London, London.
2
Institute of Health Sciences, University of Leeds, Leeds.
3
Institute of Epidemiology and Healthcare; Institute for Women's Health, University College London, London.
4
Center for Population and Development Studies, Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA.
5
Division of Medical Oncology, Ospedali Galliera, Genoa, and Wolfson Institute of Preventive Medicine, Queen Mary University of London, London.
6
Department of Cancer Studies, University of Leicester, Leicester.
7
Institute for Women's Health, University College London, London.
8
Wolfson Institute of Preventive Medicine, Queen Mary University of London, London.

Abstract

BACKGROUND:

The cancer strategy for England (2015-2020) recommends GPs prescribe tamoxifen for breast cancer primary prevention among women at increased risk.

AIM:

To investigate GPs' attitudes towards prescribing tamoxifen.

DESIGN AND SETTING:

In an online survey, GPs in England, Northern Ireland, and Wales (n = 928) were randomised using a 2 × 2 between-subjects design to read one of four vignettes describing a healthy patient seeking a tamoxifen prescription.

METHOD:

In the vignette, the hypothetical patient's breast cancer risk (moderate versus high) and the clinician initiating the prescription (GP prescriber versus secondary care clinician [SCC] prescriber) were manipulated in a 1:1:1:1 ratio. Outcomes were willingness to prescribe, comfort discussing harms and benefits, comfort managing the patient, factors affecting the prescribing decision, and awareness of tamoxifen and the National Institute for Health and Care Excellence (NICE) guideline CG164.

RESULTS:

Half (51.7%) of the GPs knew tamoxifen can reduce breast cancer risk, and one-quarter (24.1%) were aware of NICE guideline CG164. Responders asked to initiate prescribing (GP prescriber) were less willing to prescribe tamoxifen than those continuing a prescription initiated in secondary care (SCC prescriber) (68.9% versus 84.6%, P<0.001). The GP prescribers reported less comfort discussing tamoxifen (53.4% versus 62.5%, P = 0.01). GPs willing to prescribe were more likely to be aware of the NICE guideline (P = 0.039) and to have acknowledged the benefits of tamoxifen (P<0.001), and were less likely to have considered its off-licence status (P<0.001).

CONCLUSION:

Initiating tamoxifen prescriptions for preventive therapy in secondary care before asking GPs to continue the patient's care may overcome some prescribing barriers.

KEYWORDS:

breast cancer; chemoprevention; general practice; preventive therapy; primary care; tamoxifen

PMID:
28193617
PMCID:
PMC5442957
DOI:
10.3399/bjgp17X689377
[Indexed for MEDLINE]
Free PMC Article

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