From Optimistic to Overwhelmed: Exploring Health Beliefs and Barriers to Oral Anticancer Medication Adherence Among Cancer Survivors

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Zapata, Olayinka O. Shiyanbola This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8008014/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Purpose This study explored cancer survivors’ health beliefs about oral anticancer medications (OAMs) and examined how these beliefs influence adherence-related decision-making, while identifying barriers and strategies to support cancer management. Methods Twelve patients with cancer using OAMs, previously categorized into three health belief profiles, were interviewed virtually. Thematic analysis and theme mapping were used to examine the complexity of how survivors formed beliefs about cancer and OAM use. Results Survivors expressed diverse beliefs that shaped coping, adherence, and engagement with care. Three domains emerged: positive beliefs reinforcing trust in providers and treatment; negative beliefs focused on recurrence, side effects, and systemic barriers; and varied beliefs about OAMs influenced by information sources and support networks. Conclusions Survivors’ health beliefs influenced adherence and coping, underscoring the need for tailored education, communication, and support. Personalized, profile-based interventions are essential to strengthen treatment confidence and guide patient-centered survivorship care. Health beliefs Medication adherence Cancer survivorship Oral anticancer medications Patient-centered care Qualitative research Figures Figure 1 Background Cancer is a leading cause of death in the United States, with an estimated prevalence of 5.5%. 1 In 2022, approximately 18 million people were diagnosed with cancer in the U.S., and this number is anticipated to rise to 22.2 million by 2030. 2 , 3 The healthcare system allocates nearly US $ 208.9 billion annually to address this pressing issue and the cancer-related costs out-of-pocket costs are estimated at 16.2 billion from patients. 2 Nonadherence to cancer therapies significantly jeopardizes patient outcomes, with nearly half of cancer survivors failing to adhere to prescribed oral anticancer medications (OAMs). This nonadherence not only adversely affects the patients but also imposes burdens on their families and society at large. Recent studies reveal that adherence rates for certain cancer types can be as low as 33%, far below the general adherence rate of 50% observed in chronic diseases. 4 Nonadherence is associated with serious consequences, including 20% of early cancer recurrence, four times of hospitalization rates, and premature mortality. 5 – 7 Moreover, it exacerbates financial hardships, as nonadherent patients face 2.8 times out-of-pocket expenses compared to those who adhere to their OAM regimens. 2 , 8 – 10 Empirical studies increasingly indicate that negative patient beliefs have resulted in nonadherence to cancer treatment, presenting a major obstacle to effective cancer management. Common barriers to adherence to OAMs include side effects, limited disease-related knowledge, forgetfulness, reduced perceived treatment efficacy, and financial burden. 7 , 11 , 12 Systematic reviews highlight that among cancer survivors using OAMs, individual-level barriers – particularly patient beliefs – play a pivotal role and are often more amenable to targeted intervention. 12 , 13 The Extended Common-Sense Model of Self-Regulation indicates that preconceived notions about illness, including beliefs about medication, play a critical role in the decision-making process for medication use among patients with chronic disease. 14 – 18 Among cancer survivors, this process often involves balancing positive perceptions (e.g., the need for longer survival and symptom reduction) against negative perceptions (e.g., concerns about side effects and uncertainty) regarding taking OAMs. 17 , 19 – 21 When weighing the benefits and risks of taking OAMs, survivors usually engage in a deliberative process, making compromises to arrive at a final decision – whether to adhere to the treatment or modify the regimen as a mean of regaining control of their disease. 22 , 23 This decision-making process is particularly evident in individuals with advanced stages of cancer, where the uncertainty surrounding medication efficacy is weighed against the cumulative burdens experienced over time. 22 , 23 Given the complexity of how positive and negative perceptions interact in these decisions, it is essential that interventions targeting nonadherence incorporate personalized strategies to address specific barriers effectively. To explore diverse patterns of health beliefs, adopting person-centered approaches to cluster potential users into subgroups offers an innovative and alternative strategy for addressing patient-level barriers to medication adherence. Increasingly, personas are being utilized in the development of innovative health services and interventions by identifying patients’ needs, goals and challenges. 24 – 26 The process of developing personas for health interventions not only uncovers individual thought patterns but also delves deeper into patients’ experiences, including their daily routines, decision-making preferences, core values in disease management, and the need for support systems. However, few studies have thoroughly examined how individuals form their perceptions and how these perceptions influence their decision-making processes. 26 Furthermore, it is critical to identify and address patients' supportive needs for disease management while aligning these needs with their health belief patterns when designing targeted interventions. Therefore, the primary objective of this study was to explore cancer survivors’ health beliefs and examine how these beliefs influence the decision-making processes regarding the use of OAMs. Additionally, this study aimed to identify individual barriers and potential strategies to enhance medication adherence and improve overall cancer management. Methods Study Design and Procedure This qualitative study utilized stratified sampling to recruit participants based on the three health belief subgroups/profiles from the previous quantitative phase. In the quantitative phase of the parent mixed methods study, latent profile analysis identified three distinct health belief subgroups – Optimistic and adaptive , Conscious but hesitant , and Overwhelmed and unaware group, among cancer survivors taking OAMs. These subgroups were characterized by differences in beliefs about cancer and OAM use, providing the foundation for qualitative sampling to explore survivors’ lived experiences in greater depth. Additionally, purposive sampling was conducted to ensure diversity in age, cancer type, cancer stage, and treatment duration, within each subgroup, allowing for a broader range of experiences to be captured. Participants were eligible if they (1) completed the survey and provided their contact information at the end of the survey and (2) agreed to participate in the interview. This study was conducted in accordance with the ethical standards of the Declaration of Helsinki. Ethical approval was obtained from the University of Wisconsin–Madison Institutional Review Board (IRB) (Protocol ID: 2024 − 0549). Informed consent was obtained from all individual participants included in the study. Confidentiality was maintained through data de-identification, encrypted storage, and restricted access. Data Collection A semi-structured interview guide was developed based on the domains of participants’ health beliefs and questions related to medication adherence within the Extended Common-Sense Model of Self-Regulation to capture participants’ perceptions. 14 , 17 Based on the ANOVA results comparing significant subgroup differences in health beliefs and the multiple liner regression results of significant predictors of nonadherence, the final set of interview questions was selected using two criteria – f irst , health belief domains with significant subgroup differences ( p < 0.05) among the three health belief subgroups, including nine domains – Cancer Consequences, Risk of Recurrence, Emotional Representations, Coherence, Personal Control, Treatment Control, Treatment Consequences, Necessity and Concerns, and second , health belief domains identified as strong predictors ( p < 0.05) of nonadherence in the subgroup with lowest adherent ( Profile 3: Overwhelmed and Unaware group ). Two additional domains, including health literacy and comorbidities, were also added to the interview guide to explore their role in shaping participants’ experiences and to understand how and why these factors emerge as barriers to taking OAMs. Interview questions related to health literacy focused on participant experiences in understanding and utilizing health information throughout their cancer journey. Supplementary Information 1. presents the questions used in the semi-structured interviews. The initial draft of the interview guide was revised by experts with extensive experience in qualitative research and patient perceptions. Pilot testing was conducted with the first two participants, and further revisions were made based on feedback from experts and participants. The interviews were conducted by the researcher, a registered pharmacist with six years of intensive qualitative methodological training and experience in conducting qualitative studies during graduate school. In-depth, one-on-one virtual interviews were conducted via Zoom, with each interview lasting between 20–60 minutes. Recruitment continued until thematic saturation was reached, where no new concepts emerged from interviews. 27 All online interviews were audio-recorded, and the interview data were securely stored in an encrypted drive in the researcher’s office. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to ensure methodological rigor, transparency, and credibility in study design, data collection, and analysis. 28 Data Analysis Thematic analysis, guided by Braun et al., was used to explore (1) cancer survivors’ beliefs about cancer and oral anticancer medications (OAMs), (2) how their health beliefs influenced medication-taking behaviors, and (3) barriers to taking OAMs as well as strategies to support adherence for future interventions. 29 All interviews were transcribed verbatim, with personal information de-identified. The first author and a researcher with a qualitative research background conducted deductive coding of the transcripts based on predefined domains in the theoretical framework. Additionally, inductive coding was applied to identify themes not covered by the framework. The analysis proceeded iteratively, beginning with a comprehensive understanding of the transcripts through line-by-line reading and the extraction of initial codes. Subsequently, codes for each domain were compiled to identify overarching themes addressing the main research questions. In the third phase, the extracted themes were reviewed to ensure they covered all codes and to identify any overlaps. A categorization matrix and theme mapping were employed to visualize each domain of beliefs about cancer and OAMs across the health belief subgroups identified in the quantitative phase. Finally, each theme was labeled with a specific name and defined clearly. 29 To ensure the trustworthiness of the qualitative data in this study, four principles—credibility, transferability, dependability, and confirmability—guided by Lincoln and Guba were applied. 30 To establish credibility, researchers immersed themselves in the data, reading the entire transcripts for a general understanding of participants’ beliefs and conducting line-by-line coding to capture meaningful units of experience. Two independent coding of all transcripts were conducted to achieve investigator triangulation. Dependability was ensured through peer debriefing with experts who have experience with qualitative studies. This process involved confirming that the codes, themes, and interpretations aligned with the research questions during regular meetings with an expert who was not involved in the research process. Thick descriptions of the procedures, data collection, and analysis were provided in the final results to ensure transferability. Comprehensive data management was used to track all coding and theme trails using MAXQDA Version 2020. Any changes regarding research questions or procedures for data collection and analysis were documented with rationales to establish confirmability. Results Participant Demographics A total of 12 participants agreed to participate and completed the virtual interviews. The average age of participants was 64.0 years (SD = 11.2). Among them, three were male (3/12, 25%), and the majority (9/12, 75%) were White. Almost all participants (11/12) attended college or higher education and lived in urban or suburban areas. The average interview duration was 50.5 minutes (range from 15 to 96 minutes). Five out of twelve (41.7%) participants were diagnosed with breast cancer, with an average duration since diagnosis of six years (range from three months to 26 years). Half of participants were in their early stages of cancer (stage 0–2), and five had experienced cancer recurrence. Most participants were taking oral hormone therapy, with nine of them (75%) having been on OAMs for more than one year. Table 1 . lists participant demographic information Table 1 Participant Demographic Information No. Profile * Gender Age Race Education Employment Urbanicity Cancer type Cancer duration Cancer stage Recurrence Type of OAMs OAM duration Comorbidity 1 3 F 35 Black Below college Unemployed Urban Endometrial cancer 12 3 Yes Targeted therapy > 5 years 0 2 3 F 61 White Degree or above Full time Urban Breast cancer 3 3 No Hormone therapy 3–5 years 2 3 1 M 72 White Degree or above Retired Urban Colon and rectal cancer 4 3 No Don't know 1–3 years 3 4 2 F 69 White Degree or above Part time Suburban Breast cancer 0 1 No Hormone therapy < 3 months 0 5 3 F 67 White Degree or above Part time Urban Thyroid cancer 2 N/A Yes Hormone therapy 1–3 years 2 6 2 F 72 White Degree or above Full time Urban Breast cancer 26 N/A Yes Hormone therapy 3–5 years 1 7 1 F 68 White Degree or above Retired Urban Ovarian cancer 10 1 Yes Hormone therapy > 5 years 2 8 1 F 78 White Degree or above Retired Suburban Breast cancer 2 2 No Hormone therapy 1–3 years 5 9 2 F 59 White Degree or above Full time Suburban Breast cancer 9 2 No Hormone therapy 3–5 years 0 10 3 M 55 White Degree or above Disabled Suburban Colorectal cancer 2 2 No Targeted therapy 3 months − 1 year 5 11 2 M 70 Hispanic white Degree or above Unemployed Suburban Prostate cancer 1 2 No Don't know 1–3 years 5 12 2 F 62 Asian Degree or above Full time Urban Lung cancer 1 4 No Targeted therapy 3 months − 1 year 0 * Profiles were derived from latent profile analysis among cancer survivors taking OAMs: Profile 1 = Optimistic and adaptive, Profile 2 = Conscious but hesitant, and Profile 3 = Overwhelmed and unaware. Overarching Findings of Health Beliefs Among Cancer Survivors Guided by the Leventhal’s Common-Sense Model of Self-Regulation, findings related to patients' beliefs about cancer and oral anticancer medications were coded into three categories: (a) positive beliefs about cancer, including Coherence (understanding of cancer) and Personal control (b) negative beliefs about cancer, including Cancer consequences , Risk of recurrence , Emotional representations and (c) beliefs about oral anticancer medications, including Treatment control , Necessity , Treatment consequences and Concern . Figure 1 . illustrated how the themes align with health belief domains and provides a summary of each theme’s findings. The theme, subtheme, codes and supportive quotes for each category are presented in Table 2 ., Table 3 . and Table 4 . Category 1: Positive Beliefs about Cancer (Understanding of Cancer and Personal Control) Theme 1: Navigating and triangulating cancer-related information from trusted healthcare professionals, loved ones, and online platforms (Coherence, understanding of cancer) Patients described navigating cancer-related information through a process of triangulation across healthcare providers, personal networks, and online resources, which together shaped their understanding of cancer and its treatment. Trust in healthcare professionals was central, particularly for those with Optimistic and adaptive beliefs, who reported greater confidence when complex medical information was explained in clear and respectful ways, reinforcing both comprehension and trust. In contrast, patients with Overwhelmed and unaware beliefs often struggled with inconsistent messages or difficulty understanding clinical explanations, which limited trust-building with providers. Alongside professional input, many patients, especially those in the Conscious but hesitant group, relied heavily on family and friends with cancer experience, whose personal stories offered comfort and practical insights but sometimes introduced biases that required cross-checking. Online platforms also provided information and peer support, but credibility varied. Patients with Overwhelmed and unaware beliefs remained vulnerable to misinformation, even when digital communities offered benefits. Theme 2: Embracing positive thinking and staying occupied as coping strategies for managing cancer-related stress (Personal control) Patients emphasized the importance of cultivating resilience through positive thinking and structured daily routines as key strategies for coping with cancer-related stress and regaining a sense of personal control. Many described staying busy with hobbies, work, or social activities to distract from illness and maintain a sense of normalcy. Optimistic and adaptive and Conscious but hesitant survivors especially valued seeing cancer as a manageable condition rather than a death sentence. Hope in modern treatments and survival gains further reinforced this adaptive mindset, helping patients reduce feelings of helplessness. Alongside emotional coping, survivors also adopted practical strategies to manage medications and overall disease burden, such as using pill organizers, alarms, or apps to support adherence, coordinating multiple health needs, and maintaining health-promoting routines like exercise and diet. Conscious but hesitant patients stood out for their vigilance in monitoring symptoms, side effects, and lab results, which offered reassurance and preparedness for medical discussions. Table 2 Theme, Subtheme, Code, Selected Subcode and Quotes for Category 1: Positive Beliefs about Cancer Theme 1: Navigating and triangulating cancer-related information from trusted professionals, loved ones and online platforms (Coherence, understanding of cancer) Subtheme Code Selected subcode and quote Developing cancer understanding and trust in cancer treatment through healthcare providers Trust in healthcare providers and the system “What's the treatment plan going to be? And I trusted in my doctors. and they're capabilities to get me through the process. ” – Participant 3, Profile 1: Optimistic and adaptive group HCPs’ role in explaining medication-related information Inconsistencies in cancer information “ The pharmacist, when he told me: It's cancer medication, there is no substitute. and I walked out into my car and just started crying and thought, why didn't anybody tell me? …” – Participant 5, Profile 3: Overwhelmed and unaware group Helped with understanding how cancer medication works in the body “ Some of it (the information about medication I’ve learned) is from my own reading, and some of it is what my doctors have told me. ” – Participant 8, Optimistic and adaptive group Strategies to help with understanding medical information Recognize patient's emotional reactions and ensure readiness for learning cancer information “They (Doctors) just they were really composed and calm , which was a really good thing, because it's needed at a time like that … they told me they knew it was really hard news to hear, so give me time to compose myself to really they let it sink in first before continuing. ” – Participant 1, Profile 3: Overwhelmed and unaware group Use plain language or graph to help with understanding “With my oncologist there were a couple of times on visits where she had. She had printed out some materials for me to become better acquainted with stuff, and some of the materials would have drawings or charts. Or whatever, and she would at least briefly , you know, explain what she was showing me.” – Participant 3, Optimistic and adaptive group Take initiative to ask HCPs questions or clarify on jargons “ (If I have questions or confusion,) I just asked them. You know they were very good. Well, they were very good at explaining things as though I didn't have a medical background . Because a lot of people don't.” – Participant 7, Optimistic and adaptive group Reling on family and friends’ experience on cancer understanding “ My husband's experiences played a very strong role into my feelings …I've lived with it for so long, except not personally in my body, but with my husband, with my mom, with my sister .” – Participant 4, Profile 2: Conscious but hesitant group Navigating and evaluating online information for support and understanding Questioning about the credibility of information online “You can find information on Google about cancer which might be wrong. So that can hinder me from and anyone else from getting the right information.” – Participant 1, Profile 3: Overwhelmed and unaware group Theme 2: Embracing positive thinking and staying occupied as coping strategies for managing cancer-related stress (Personal control) Subtheme Code Selected subcode and quote Shifting perspectives on cancer Positive thinking “ I also think keeping busy in some way , whatever it is. … You don't have to be great at whatever it is you're doing but find some interest. Get out of the world of cancer .” – Participant 4, Profile 2: Conscious but hesitant group Recognition of cancer as a manageable condition “Don't despair. There's been so much progress in treatments and keeping you healthy and keeping you alive. … It's not a death sentence. It's just an illness. Put it in perspective.” – Participant 4, Profile 2: Conscious but hesitant group Hope in modern cancer care “ It (Conquering cancer) is a work in progress … As my surgeon said, you know, 25 years ago we didn't have a whole lot of options. But look at all the progress that we've made in the last 25 years .” – Participant 8, Optimistic and adaptive group Using distraction and keeping occupied as coping strategies “ I also think keeping busy in some way , whatever it is, you know. Reading, write, keep a journal, put your thoughts down. Paint, take a painting, you know who cares what it looks like. You don't have to be perfect. You don't have to be great at whatever it is you're doing but find some interest. Get out of your, the world of cancer.” – Participant 4, Conscious but hesitant group Developed strategies to manage tasks associated with taking medication and overall disease management Setting reminders and using tools “ I set up an alarm on my cell phone … When I need to take medication, and then I have a sheet. I just write down what time I took the medication.” – Participant 12, Profile 2: Conscious but hesitant group Engagement in proactive health behaviors Maintaining a healthy lifestyle “ I think it's very important to have like a healthy lifestyle. eat healthy food. Like More vegetables like a healthy diet and the system. I think it's a very important part. you know, prevent we cannot prevent. You don't know if you can prevent by eating by, you know. But it's you know. it's good chance.” – Participant 2, Overwhelmed and unaware group Coordinated management of cancer and comorbidity “I take a lot of medications because I'm very overweight. I have arthritis. I have high blood pressure…. The cancer pill and the cancer itself are probably the least . … that would affect least. I just every once a month I do all my pills in a little box, and I make it easy for my Statin, and you know I don't feel burden from the cancer at all. ” – Participant 7, Optimistic and adaptive group Vigilance in cancer monitoring “I am pretty closely watched. I do blood work. I do scans. I did have a scare, and it ended up being nothing. But it's very scary when that the scare happened. I just. I try to be very vigilant. I'm very good about doctors appointments if they say you need to do blood work every so often. I do it every so often. I'm very good at following the orders for that, because I think that's the way to keep me alive is to watch it. ” – Participant 9, Conscious but hesitant group Category 2: Negative Beliefs about Cancer Theme 1: Experiencing severe physical symptoms, leading to increased burden and shifts in family, social dynamics, and roles (Cancer consequences) Cancer and its treatment profoundly shaped patients’ daily lives, as physical symptoms such as fatigue, nausea, pain, and changes in appearance disrupted their ability to maintain routines, social connections, and work responsibilities. These challenges were particularly pronounced among patients with Overwhelmed and unaware beliefs, who described difficulties carrying out everyday activities, withdrawing socially, and facing financial strain due to treatment costs and reduced work capacity. Changes in body image and social identity further compounded distress, while reliance on family and friends became essential for both practical and emotional support. For some, this strengthened bonds and increased feelings of connectedness. For others, especially in the Conscious but hesitant and Overwhelmed and unaware groups, it caused strain, guilt, or feelings of being a burden when support was limited or relationships grew distant. Theme 2: Navigating cancer diagnosis triggers emotional distress and increases the need for support (Emotional representations) A cancer diagnosis often initiated intense emotional distress, beginning with shock, fear, and avoidance, before gradually shifting toward acceptance and active coping as patients adjusted to their new reality. This transition varied across belief profiles: patients with Optimistic and adaptive views more readily reframed cancer as a manageable, long-term condition, while those with Overwhelmed and unaware beliefs often described confusion, fear, and difficulty processing inconsistent or delayed information. Emotional distress was further compounded by treatment side effects, such as fatigue, nausea, and hair loss, which disrupted daily life and reinforced feelings of vulnerability. Participants reported that coping with these challenges required sustained support, with family and friends offering encouragement and practical help, while cancer support groups provided a sense of solidarity and understanding. Theme 3: Perceiving some degree of recurrence risk with varied responses to its implications (Risk of recurrence) Patients commonly acknowledged the possibility of cancer recurrence, but their responses ranged from resignation to proactive resilience. Those in the Overwhelmed and unaware group often viewed recurrence as inevitable and beyond their control, leading to more passive coping. In contrast, Optimistic and adaptive patients expressed confidence in their ability to face recurrence, drawing strength from prior experiences and medical advancements. For many, the risk of recurrence remained a persistent source of anxiety, especially during follow-up scans or when experiencing unexplained symptoms. Anxiety served to influence both their vigilance in health monitoring and their efforts to maintain a sense of normalcy. Table 3 Theme, Subtheme, Code, Selected Subcode and Quotes for Category 2: Negative Beliefs about Cancer Theme 1: Experiencing severe physical symptoms, leading to increased burden and shifts in family, social dynamics and roles (Cancer consequences) Subtheme Code Selected subcode and quote Impact of cancer and treatment on daily life Physical effects Cancer effects “… I lost a couple of pounds in 2 weeks I was down to 94 …I could be out shopping and going to lunch, or something I might say, hey, I gotta go home. I want to go to bed. ” – Participant 5, Profile 3: Overwhelmed and unaware group Social effects Changes in body image and social identity “(People would think) it's important to have breasts if I go out and buy these artificial things to put on to make me look like I have breasts, you know. I'm still me, and I think that's the message that I'm like giving myself. I'm not lesser because I had my breasts removed....I see them kind of trying not to look, but noticing that I'm different, and that hurts. ” – Participant 4, Profile 2: Conscious but hesitant group Social isolation “I don't say pity parties I have to go through like, oh, you get better, or it's I will find we'll help you. We're here for you. It's like people treat me like I'm very fragile. being, which is really uncomfortable at times. So yes, I tend to avoid people. … But I have withdrawn from society a lot. ” – Participant 1, Overwhelmed and unaware group Reduced work hours and disruption “…I am not working. I would like to work and I want to work, and we need to work unless. I need to be able to keep it that way, and I need to be able to earn money.” – Participant 11, Conscious but hesitant Financial effects “It got to a point where it couldn't cover for the medication, which is really expensive. I had to use my college fund for that. Which means I haven't attended college up to now .” – Participant 1, Profile 3: Overwhelmed and unaware group Changed the dynamics with friends and family Strengthened relationship with loved ones “(During the doctor’s visit) my daughter was on the phone, and my daughter lives out of state so she couldn't be there. But she wanted to be there and insistent, mom, you have to have her let me listen to the conversation. So for that whole hour we just had a good back and forth, and I felt very comfortable going into surgery .” – Participant 8, Optimistic and adaptive group Needs for support from family and friends “ I don't really know if I know what's the best support I need, because pretty much I'm by myself in the United States. So, even though I have some friends. I have really good friends that they willing to support me, but I knew This kind of chemotherapy process is a long process, not just one day.” – Participant 12, Conscious but hesitant Theme 2: Navigating a cancer diagnosis triggers emotional distress and increases the need for support (Emotional representations) Subtheme Code Selected subcode and quote Transition from shock to active coping Trama of hearing “You Have Cancer” “The way he (doctor) talked to me it’s like… you don't have too long to live, anyway. Just enjoy your life… I was kind of shock, but I have no emotion at that point during the appointment. ” – Participant 12, Profile 2: Conscious but hesitant group Confusion and frustration from delayed cancer information “ I still didn't know it was cancer medication. (…Until) I talked to the pharmacist , …I had no idea anything was that serious and basically went out to the car and cried” – Participant 5, Profile 3: Overwhelmed and unaware group Avoidance and fear of reality “(My doctor) expecting me to go home and become as familiar with material as I felt like doing, and sometimes I didn't. Yeah, I guess there was a little part of me. It felt like if I really dug deeply into this. that I was gonna see some darkness. ” – Participant 3, Optimistic and adaptive group Feeling worried about the lack of available treatment options “I got a sense of panic. And worry, because, having something like cancer means, you might get well, you might not. So hearing that the medicine isn't working for you anymore is really tough. So I did panic at the time.” – Participant 1, Overwhelmed and unaware group Acceptance of cancer as a long-term condition in life Motivation to cope for family’s sake “ I just had to accept it. I had to… for the sake of my family. for the sake of my husband, who I had just married a few months before that (having cancer diagnosis) and I was like, and I didn't want to let him down. ” – Participant 6, Conscious but hesitant group Cancer as a long-term companion “ I would describe it as a neighbor who never bothers me. Go never causes me any trouble…And I know they're there, but they never talk to me. You know they're not unfriendly, but they're just there .” – Participant 7, Optimistic and adaptive group Living with gratitude as a survivor Shifting from receiving to giving “ I just feel very lucky, because so many people don't have the outcome that I have.... when I am healed , which I really am, I want to be one of the people who do the helping. ” – Participant 4, Profile 2: Conscious but hesitant group Emotional distress linked to medication side effects Accepted side effects as an unavoidable part of treatment “ Sometimes I'll get a little bit depressed , but I just think, in the back of my mind, you know what, this is a side effect…Take it as a grain of salt. You know if you need go, lay down and take a nap, when you get up you'll feel better, and that's a lot of times what I'll do.” – Participant 9, Conscious but hesitant group Needs for emotional support “I think that's a big part of how you get through cancer is by allowing yourself to be supported , you know, not saying I don't. I don't need any help. That's that would be a terrible decision. Because, you're building your own wall if you do that and it's not realistic, because we all need help at times .” – Participant 4, Conscious but hesitant group Received support from family and friends “I was very worried. And I think this is where and I was toxic, and my friends all said that maybe I should start taking…some anti-anxiety medication, because I just was desperate, and I just had a lot of anxiety. ... I had a lot of friends around the country, and they called me all the time so I could talk to someone every day if I needed to. I was never really alone. ” – Participant 7, Optimistic and adaptive group Emotional support from cancer support group “It's so helpful for me to participate (cancer) support group…And the good things I can do are not necessary to go in person. I can go online… people exchange information about treatment .” – Participant 2, Profile 3:Overwhelmed and unaware group Theme 3: Perceiving some degree of recurrence risk with varied responses to its implications (Risk of recurrence) Code Selected subcode and quote Perception of inevitability of recurrence “I guess it's in their gene or in their DNA. … But I'd say that's one thing I see would make the cancer come back.” – Participant 1, Profile 3: Overwhelmed and unaware group No medications were available at that time and cancer reoccurred “ There were no further drugs in those days for that particular cancer , and was like a triple negative thing. So after 5 years of going to the office first it was every few months, and then it was, you know, finally got to. It was yearly. and they said, you're fine, you're great. I thought I would never get it again. and I got it (cancer recurrence) 21 years later.” – Participant 6, Conscious but hesitant, with the history of cancer recurrence Facing the risk of cancer recurrence Confidence in facing recurrence “(Cancer) could hit again at any point. …you've got moral support from Caring Bridge [app for sharing illness stories with close friends] and all your family. … I'll deal with it again if it does .” – Participant 3, Profile 1: Optimistic and adaptive Feeling worried about recurrence “ My biggest problem with keeping myself cancer cancer-free or in remission. I’m sure I don't want to hear here that get the diagnosis. I have cancer somewhere else, because that can happen right? “ – Participant 11, Conscious but hesitant group Category 3: Beliefs about Oral Anticancer Medications Theme 1: Developing confidence in medication through various sources while acknowledging concerns about uncertain medication efficacy and medication access challenges (Treatment control vs. Concern) Patients described building confidence in their cancer medications through reassurance from healthcare providers, personal experiences, and external sources such as peer networks and online platforms. For many in the Optimistic and adaptive and Conscious but hesitant groups, medications were seen as a safeguard against recurrence, offering a sense of security and hope that cancer could be controlled with consistent treatment. In contrast, patients in the Overwhelmed and unaware group often relied more heavily on external information and the experiences of others to reinforce their trust in medication, highlighting a greater need for support in developing confidence. Despite this reliance, uncertainty about medication effectiveness persisted, as some participants doubted whether their treatment would truly protect them, viewing it as helpful but not guaranteed. Access barriers, whether financial, logistical, or tied to healthcare availability, further complicated adherence, particularly among those already struggling with limited trust or heightened vulnerability. Theme 2: Experiencing side effects, which tempered beliefs about medication’s role in recovery (Necessity vs. Treatment consequences) Patients described a conflicted relationship with oral anticancer medications, recognizing their necessity for survival while struggling with the burden of side effects. For some, persistent symptoms such as nausea or fatigue led to doubts about whether the benefits outweighed the discomfort, particularly among those in the Overwhelmed and unaware group. Despite these challenges, most patients acknowledged that discontinuing treatment was not an option, highlighting how adherence was maintained out of necessity rather than confidence, with side effects shaping both trust in medication and overall quality of life. Table 4 Theme, Subtheme, Code, Selected Subcode and Quotes for Category 3: Beliefs about Oral Anticancer Medications Theme 1: Developing confidence in medication through various sources while acknowledging concerns about uncertain efficacy and medication access challenges (Treatment control vs. Concern) Subtheme Code Selected subcode and quote Medication as a long-term safeguard Taking medication can prevent cancer from coming back “I think it (medication) is helping me. …So the chance of that type of cancer coming back, I'm sure, would be minimum because of me doing the hormone blocker. ” – Participant 9, Conscious but hesitant group Cancer is manageable with medication “The last time I went to the oncologist they told me that the studies now are showing that with my form of ovarian cancer, Letrozole has been helping other people as well , and that they are now thinking that people like me wouldn't even have to go through chemotherapy anymore because it doesn't help. So you know, I was real happy to hear that that when I first started taking it 6 years ago. They didn't really know that much about how it would help me.” – Participant 7, Optimistic and adaptive group Relied on external sources of information to develop beliefs that medication can help Learned information from cancer support group “We had talks about the cancer in general. How to manage it. What kinds of food you should avoid or you should take, and physical activities. You could do for (as) a cancer patient.” – Participant 2, Overwhelmed and unaware group Learned cancer information online “Usually (information) it's on Internet and Google. Also, talking is a doctor, who is a nutritionist also helpful to understand. What's kind of fruit. What kind of fruit and vegetables? It's good to prevent cancer (I) could ask them.. Sometimes I go to Google, ... and check from there.” – Participant 2, Overwhelmed and unaware group Lack of confidence in adhering to medication Uncertainty about treatment effectiveness Doubt about medication’s true benefits “My doctor is going to allow me to stay on it longer. Which is more formal than anything. But I want to know. Is that really going to help me? There's not nothing bad's gonna happen. But is it? Is there? Is there a positivity of staying on it longer? ” – Participant 9, Conscious but hesitant group Medication offers some level of protection without guarantees “No, no promises, I mean, no promises are made, but just what a great protection that this will be! So it was all in a positive light.” – Participant 4, Conscious but hesitant group Access to medication or healthcare services “Sometimes it's really hard to get to the physical treatment sessions, the ones where you have to go to the clinic. So sometimes I'd wake up, I'd be really weak. And that was a really big challenge, considering we live a bit far from the clinic.” – Participant 1, Overwhelmed and unaware group Not having problems in accessing medication “My medication is generic. It's tier one. I have no copay. So. No, I haven't run out of medication.” – Participant 8, Optimistic and adaptive group Theme 2: Experiencing side effects, which tempered the beliefs about medication’s role in recovery (Necessity vs. Treatment consequences) Subtheme Code Selected subcode and quote Balancing the necessity of taking medication with unflavored symptoms or side effects “Now it's because I know when I was on Tamoxifen there was a Tamoxifen Facebook support group, and everybody complained. And you know what. I'd rather be alive with a few with some minor with some side effects, than be 6 feet under. ” – Participant 9, Conscious but hesitant group Questioning the necessity of taking medications “ I have always believed that medication is there to make you better? although I would say it doesn't feel that way in this situation because I get a lot of symptoms , which make me uncomfortable like. I get nauseous like. I'm nauseous all the time I've learned to. I don't remember what it feels like to not being nauseous. ” – Participant 1, Overwhelmed and unaware group Need to take the medications to live and recover “ I think it (medication) is a very important safeguard. I mean, it's probably the most important part of my recovery.” – Participant 4, Conscious but hesitant Discussion This qualitative study, guided by Leventhal’s Common-Sense Model of Self-Regulation, explored cancer survivors’ beliefs about cancer and OAM use, revealing a diverse range of perceptions that influenced their coping strategies, medication adherence, and engagement with healthcare. While some participants exhibited optimistic and adaptive beliefs, relying on healthcare providers, structured coping mechanisms, and modern treatment advancements, others demonstrated more hesitant or overwhelmed perspectives, shaped by uncertainties about recurrence, medication side effects, and systemic barriers to healthcare access. Variations in treatment confidence, information processing, and reliance on external support networks further distinguished participants’ experiences, emphasizing the need for personalized education, enhanced communication, and tailored support systems to improve survivors’ understanding and adherence to treatment. Findings from this study illustrate the diverse sources of cancer-related information that patients utilize. While healthcare providers were often perceived as the most reliable and authoritative sources of information, reliance on informal networks and digital resources varied across patient subgroups. Survivors with Overwhelmed and unaware beliefs struggled to evaluate credibility, leaving them more vulnerable to misinformation and distrust. Their uncertainty often led them to rely on unverified online sources or personal anecdotes, increasing their vulnerability to misinformation and distrust in healthcare providers. These findings align with existing literature suggesting that cancer patients actively engage in information-seeking behaviors but may struggle with evaluating the credibility of online content. 31 Scoping reviews have also highlighted that while digital resources provide a wealth of health information, cancer patients frequently encounter challenges in distinguishing credible sources from misinformation. 32 Balancing the accessibility of digital health resources with safeguards against misinformation remains a key challenge. Healthcare providers should consider guiding patients toward reliable online sources and fostering open discussions about information credibility to support informed decision-making. Beyond traditional medical consultations, family members and peer support networks played a crucial role in shaping patients' beliefs about cancer and treatment. Previous research highlights that patients with cancer often turn to personal networks for reassurance, emotional support, and practical advice. 33 , 34 However, while firsthand experiences shared by family and friends can offer comfort, they may also introduce biases or misconceptions that influence treatment perceptions. This study found that patients in the Conscious but hesitant group relied heavily on familial advice, and cross-checking information with medical sources to mitigate potential misinformation. These findings underscore the need for structured educational and behavioral interventions that equip both patients and their support systems with accurate, comprehensible, and context-specific information about cancer management. Structural barriers and social determinants of health continue to be critical challenges in cancer care, particularly for patients in the Overwhelmed and unaware group, who often face financial constraints, transportation difficulties, and healthcare access disparities. Research highlights that patients from lower socioeconomic backgrounds, uninsured individuals, and those in rural communities are disproportionately affected by these barriers, leading to delays in diagnosis and treatment, lower adherence rates, and poorer health outcomes. 35 Limited transportation access, for example, has been identified as a major obstacle, with many patients missing critical appointments due to limited access to reliable transportation services. 36 Financial toxicity is another pressing issue, as high out-of-pocket costs force some patients to delay or forego treatment, exacerbating disparities in survival rates. 37 These findings underscore the need for healthcare policies that address the structural inequities contributing to poor cancer outcomes. Programs such as patient navigation, financial assistance initiatives, and community-based health outreach efforts have demonstrated success in bridging gaps in care by improving access to critical resources and ensuring patients receive timely treatment. 38 Family-based interventions can also further support caregivers, helping to reduce patient burden and improve both adherence and emotional well-being. 39 – 41 Ultimately, a comprehensive, multi-level approach that integrates structural support with psychosocial care is essential to reducing disparities and improving patient outcomes. 42 Strengthening collaborations between healthcare providers, social services, and policymakers can help bridge these systemic gaps and ensure that the most vulnerable cancer patients receive equitable access to care. Cancer survivors often weigh the necessity of OAMs against concerns about side effects, uncertain efficacy, and long-term risks. Findings from this study align with prior research that patients continually evaluate the trade-offs between treatment benefits and adverse effects, shaping their intention to take medications. 22 , 23 To improve adherence and reframe medication beliefs, patient-provider communication strategies should be integrated into structured educational programs, ensuring that patients receive clear, individualized information about OAMs. Evidence suggests that leveraging digital health tools, such as mobile applications, online patient portals, and telehealth consultations, can facilitate real-time provider engagement and reinforce positive treatment perceptions. 42 – 45 For the Optimistic and adaptive group, digital reminders and educational resources can sustain confidence in their regimen. Survivors with Conscious but hesitant beliefs would benefit from interactive, evidence-based platforms that allow for ongoing dialogue and reassurance from providers. For the Overwhelmed and unaware group, a more intensive approach incorporating direct counseling, symptom-tracking applications, and caregiver involvement may help reduce concerns and build confidence in treatment necessity. Future interventions should explore hybrid models that combine in-person education with digital support, ensuring that all patients, regardless of their health literacy level, have access to reliable information and structured guidance for managing their treatment effectively. Study Strengths and Limitations This study is among the first to explore how health beliefs influence cancer management, particularly treatment adherence by categorizing distinct health belief patterns. By adopting a subgroup approach, this study provides a nuanced understanding of how cancer survivors with different beliefs perceive their condition, experience challenges, and make decisions about their care. However, the small sample size within each profile may limit the generalizability of these findings. To address this, we leveraged the grouping nature of our study design to compare and synthesize insights across three distinct health belief patterns, maximizing our ability to identify variations in coping strategies and decision-making processes among cancer survivors. Despite these efforts, the study sample was predominantly White, female, and from urban or suburban areas with internet access. Given that health beliefs are shaped by social contexts and resource availability, findings should be interpreted with caution, as geographic and socioeconomic factors may influence individual perceptions. Furthermore, participants were generally more engaged in their health, potentially reflecting socially desirable responses. Some interviews were conducted with caregivers present, which may have influenced participants’ narratives. 46 To minimize the influence and enhance the quality of the responses, interviewers used probing techniques and rephrased questions to clarify responses and capture subjective experiences directly from participants. Conclusion This qualitative study explored how health beliefs shape cancer management and medication-taking behaviors among cancer survivors, identifying distinct barriers, facilitators, and coping strategies across three health belief profiles. Findings revealed that survivors in the Optimistic and adaptive group exhibited strong self-efficacy, trust in healthcare providers, and proactive coping mechanisms, allowing them to navigate medication-taking with minimal concerns. The Conscious but hesitant group engaged critically with their treatment, requiring reassurance, structured support, and ongoing monitoring to balance concerns about treatment necessity and side effects. The Overwhelmed and unaware group faced significant challenges, including greater emotional distress, a higher perceived burden of cancer and treatment, and reliance on external sources for understanding their condition. Their limited sense of control and inconsistent information-seeking behaviors contributed to higher nonadherence risks. Beyond education, interventions should address emotional distress, enhance symptom management, and ensure access to reliable information and build treatment confidence. Future research should explore how personalized adherence strategies can be integrated into oncology care while considering the social, emotional, and structural factors that shape long-term adherence. Declarations Author Contribution M.-J.W. conceived and designed the study, conducted data collection, and performed data analysis and interpretation with input from all co-authors. M.Z. contributed to data analysis and participated in consensus meetings. M.-J.W. drafted the initial manuscript. All authors reviewed, revised, and approved the final manuscript and agree to be accountable for all aspects of the work. Acknowledgement The authors thank all participants for their time and valuable contributions to this study. Data Availability The data that support the findings of this study are not publicly available due to restrictions related to participant confidentiality but are available from the corresponding author upon reasonable request. References Roser MR, H. Cancer. 2019; https://ourworldindata.org/cancer. Accessed Jan 12, 2024. American Cancer Society. Cancer Treatment & Survivorship Facts & Figures 2025. 2025; https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2025/2025-cancer-facts-and-figures-acs.pdf. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA: A Cancer Journal for Clinicians. 2025;75(1):10-45. Vyas A, Descoteaux A, Kogut S, et al. Predictors of adherence to oral anticancer medications: An analysis of 2010-2018 US nationwide claims. Journal of managed care & specialty pharmacy. 2022;28(8):831-844. Eek D, Krohe M, Mazar I, et al. Patient-reported preferences for oral versus intravenous administration for the treatment of cancer: a review of the literature. Patient preference and adherence. 2016;10:1609-1621. Ganesan P, Sagar TG, Dubashi B, et al. Nonadherence to imatinib adversely affects event free survival in chronic phase chronic myeloid leukemia. Am J Hematol. 2011;86(6):471-474. Greer JA, Amoyal N, Nisotel L, et al. A Systematic Review of Adherence to Oral Antineoplastic Therapies. Oncologist. 2016;21(3):354-376. Lu ZK, Xiong X, Brown J, Horras A, Yuan J, Li M. Impact of Cost-Related Medication Nonadherence on Economic Burdens, Productivity Loss, and Functional Abilities: Management of Cancer Survivors in Medicare. Front Pharmacol. 2021;12:706289. Mariotto AB, Enewold L, Zhao J, Zeruto CA, Yabroff KR. Medical Care Costs Associated with Cancer Survivorship in the United States. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2020;29(7):1304-1312. Wu EQ, Johnson S, Beaulieu N, et al. Healthcare resource utilization and costs associated with non-adherence to imatinib treatment in chronic myeloid leukemia patients. Curr Med Res Opin. 2010;26(1):61-69. Doshi SD, Lichtenstein MRL, Beauchemin MP, et al. Factors Associated With Patients Not Receiving Oral Anticancer Drugs. JAMA Network Open. 2022;5(10):e2236380-e2236380. Rosenberg SM, Petrie KJ, Stanton AL, Ngo L, Finnerty E, Partridge AH. Interventions to Enhance Adherence to Oral Antineoplastic Agents: A Scoping Review. Journal of the National Cancer Institute. 2020;112(5):443-465. Kaptein AA, Schoones JW, van der Meer PB, et al. Psychosocial determinants of adherence with oral anticancer treatment: 'we don't need no education'. Acta Oncol. 2021;60(1):87-95. Cameron LDLH. The self-regulation of health and illness behaviour. London; New York: Routledge; 2003. Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013;8(12):e80633. Horne R, Parham R, Driscoll R, Robinson A. Patients' attitudes to medicines and adherence to maintenance treatment in inflammatory bowel disease. Inflammatory bowel diseases. 2009;15(6):837-844. Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47(6):555-567. Horne R, Weinman J. Self-regulation and Self-management in Asthma: Exploring The Role of Illness Perceptions and Treatment Beliefs in Explaining Non-adherence to Preventer Medication. Psychology & Health. 2002;17(1):17-32. Marshall VK, Given BA. Factors Associated With Medication Beliefs in Patients With Cancer: An Integrative Review. Oncol Nurs Forum. 2018;45(4):508-526. Marshall VK, Lehto RH, Given CW, Given BA, Sikorskii A. Conceptualisation of medication beliefs among patients with advanced cancer receiving oral oncolytic agents using a theory derivation approach. Eur J Cancer Care (Engl). 2019;28(2):e12988. Timmers L, Boons CC, Moes-Ten Hove J, et al. Adherence, exposure and patients' experiences with the use of erlotinib in non-small cell lung cancer. J Cancer Res Clin Oncol. 2015;141(8):1481-1491. Marshall VK, Visovsky C, Advani P, Mussallem D, Tofthagen C. Cancer treatment-specific medication beliefs among metastatic breast cancer patients: a qualitative study. Support Care Cancer. 2022;30(8):6807-6815. Wen M-J, Hsu H-L, Chang C-L, et al. Understanding the medication experience of patients with advanced non-small cell lung cancer taking epidermal growth factor receptor-tyrosine kinase inhibitors: A phenomenological study. PLOS ONE. 2023;18(5):e0286333. Rivera E, Corte C, Steffen A, DeVon HA, Collins EG, McCabe PJ. Illness Representation and Self-Care Ability in Older Adults with Chronic Disease. Geriatrics (Basel, Switzerland). 2018;3(3). Tanaka R, Nolan RP. Psychobehavioral Profiles to Assist Tailoring of Interventions for Patients With Hypertension: Latent Profile Analysis. Journal of medical Internet research. 2018;20(5):e149. Sankar G, Djamasbi S, Dogan Telliel Y, Bajracharya AS, Amante DJ, Shi Q. Developing Personas for Designing Health Interventions. Paper presented at: HCI in Business, Government and Organizations; 2022//, 2022; Cham. Charmaz K, Belgrave LL. The SAGE Handbook of Interview Research: The Complexity of the Craft. In. 2 ed. Thousand Oaks, California: SAGE Publications, Inc.; 2012. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19(6):349-357. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101. Lincoln YS, Guba YSLEG, Guba EG, Publishing S. Naturalistic Inquiry. SAGE Publications; 1985. Kynoch K, Ramis M-A, Crowe L, Cabilan CJ, McArdle A. Information needs and information seeking behaviors of patients and families in acute healthcare settings: a scoping review. JBI Evidence Synthesis. 2019;17(6). Finney Rutten LJ, Blake KD, Greenberg-Worisek AJ, Allen SV, Moser RP, Hesse BW. Online Health Information Seeking Among US Adults: Measuring Progress Toward a Healthy People 2020 Objective. Public health reports (Washington, DC : 1974). 2019;134(6):617-625. Forsythe LP, Alfano CM, Kent EE, et al. Social support, self-efficacy for decision-making, and follow-up care use in long-term cancer survivors. Psychooncology. 2014;23(7):788-796. Lambert SD, Loiselle CG, Macdonald ME. An In-depth Exploration of Information-Seeking Behavior Among Individuals With Cancer: Part 2: Understanding Patterns of Information Disinterest and Avoidance. Cancer Nursing. 2009;32(1). Coughlin SS. Social determinants of breast cancer risk, stage, and survival. Breast Cancer Res Treat. 2019;177(3):537-548. Pringle S, Ko EM, Doherty M, Smith AJB. Addressing transportation barriers in oncology: existing programs and new solutions. Supportive Care in Cancer. 2024;32(5):317. Smith GL, Lopez-Olivo MA, Advani PG, et al. Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes. Journal of the National Comprehensive Cancer Network : JNCCN. 2019;17(10):1184-1192. Chen M, Wu VS, Falk D, Cheatham C, Cullen J, Hoehn R. Patient Navigation in Cancer Treatment: A Systematic Review. Current Oncology Reports. 2024;26(5):504-537. Mosher CE, Ott MA, Hanna N, Jalal SI, Champion VL. Coping with physical and psychological symptoms: a qualitative study of advanced lung cancer patients and their family caregivers. Supportive Care in Cancer. 2015;23(7):2053-2060. Gönderen Çakmak HS, Kapucu S. The Effect of Educational Follow-Up with the Motivational Interview Technique on Self-Efficacy and Drug Adherence in Cancer Patients Using Oral Chemotherapy Treatment: A Randomized Controlled Trial. Seminars in Oncology Nursing. 2021;37(2):151140. Wu J-R, Mark B, Knafl GJ, Dunbar SB, Chang PP, DeWalt DA. A multi-component, family-focused and literacy-sensitive intervention to improve medication adherence in patients with heart failure–A randomized controlled trial. Heart & Lung. 2019;48(6):507-514. Dang TH, Forkan ARM, Wickramasinghe N, et al. Investigation of Intervention Solutions to Enhance Adherence to Oral Anticancer Medicines in Adults: Overview of Reviews. JMIR cancer. 2022;8(2):e34833. Magalhães B, Fernandes C, Martinez-Galiano JM, Santos C. Exploring the use of Mobile applications by cancer patients undergoing chemotherapy: A scoping review. International journal of medical informatics. 2020;144:104293. Dang TH, Wickramasinghe N, Jayaraman PP, et al. Digital Solution to Support Medication Adherence and Self-Management in Patients with Cancer (SAMSON): Pilot Randomized Controlled Trial. JMIR Form Res. 2025;9:e65302. Escriva Boulley G, Leroy T, Bernetière C, Paquienseguy F, Desfriches-Doria O, Préau M. Digital health interventions to help living with cancer: A systematic review of participants' engagement and psychosocial effects. Psycho-Oncology. 2018;27(12):2677-2686. Althubaiti A. Information bias in health research: definition, pitfalls, and adjustment methods. Journal of multidisciplinary healthcare. 2016;9:211-217. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":4174559,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMapping themes to health belief domains guided by the Common Sense Model of Self-Regulation along with a summary of each theme’s findings.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8008014/v1/ec600034ddf182eda090e4b8.png"},{"id":98444170,"identity":"f7c90272-9457-401d-9ce3-89a189e66935","added_by":"auto","created_at":"2025-12-17 17:15:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8562898,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8008014/v1/9d1c0004-a9ed-48f5-a818-71d1254bd683.pdf"},{"id":97979409,"identity":"63eae553-7365-4d08-90a5-47660c7aa3b5","added_by":"auto","created_at":"2025-12-11 12:36:45","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":21100,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformation1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8008014/v1/c443101340e7d3595542bf42.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"From Optimistic to Overwhelmed: Exploring Health Beliefs and Barriers to Oral Anticancer Medication Adherence Among Cancer Survivors","fulltext":[{"header":"Background","content":"\u003cp\u003eCancer is a leading cause of death in the United States, with an estimated prevalence of 5.5%.\u003csup\u003e1\u003c/sup\u003e In 2022, approximately 18\u0026nbsp;million people were diagnosed with cancer in the U.S., and this number is anticipated to rise to 22.2\u0026nbsp;million by 2030.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The healthcare system allocates nearly US\u003cspan\u003e$\u003c/span\u003e208.9\u0026nbsp;billion annually to address this pressing issue and the cancer-related costs out-of-pocket costs are estimated at 16.2\u0026nbsp;billion from patients.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Nonadherence to cancer therapies significantly jeopardizes patient outcomes, with nearly half of cancer survivors failing to adhere to prescribed oral anticancer medications (OAMs). This nonadherence not only adversely affects the patients but also imposes burdens on their families and society at large. Recent studies reveal that adherence rates for certain cancer types can be as low as 33%, far below the general adherence rate of 50% observed in chronic diseases.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Nonadherence is associated with serious consequences, including 20% of early cancer recurrence, four times of hospitalization rates, and premature mortality.\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Moreover, it exacerbates financial hardships, as nonadherent patients face 2.8 times out-of-pocket expenses compared to those who adhere to their OAM regimens.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eEmpirical studies increasingly indicate that negative patient beliefs have resulted in nonadherence to cancer treatment, presenting a major obstacle to effective cancer management. Common barriers to adherence to OAMs include side effects, limited disease-related knowledge, forgetfulness, reduced perceived treatment efficacy, and financial burden.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Systematic reviews highlight that among cancer survivors using OAMs, individual-level barriers \u0026ndash; particularly patient beliefs \u0026ndash; play a pivotal role and are often more amenable to targeted intervention.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe Extended Common-Sense Model of Self-Regulation indicates that preconceived notions about illness, including beliefs about medication, play a critical role in the decision-making process for medication use among patients with chronic disease.\u003csup\u003e\u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Among cancer survivors, this process often involves balancing positive perceptions (e.g., the need for longer survival and symptom reduction) against negative perceptions (e.g., concerns about side effects and uncertainty) regarding taking OAMs.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e When weighing the benefits and risks of taking OAMs, survivors usually engage in a deliberative process, making compromises to arrive at a final decision \u0026ndash; whether to adhere to the treatment or modify the regimen as a mean of regaining control of their disease.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e This decision-making process is particularly evident in individuals with advanced stages of cancer, where the uncertainty surrounding medication efficacy is weighed against the cumulative burdens experienced over time.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Given the complexity of how positive and negative perceptions interact in these decisions, it is essential that interventions targeting nonadherence incorporate personalized strategies to address specific barriers effectively.\u003c/p\u003e\u003cp\u003eTo explore diverse patterns of health beliefs, adopting person-centered approaches to cluster potential users into subgroups offers an innovative and alternative strategy for addressing patient-level barriers to medication adherence. Increasingly, personas are being utilized in the development of innovative health services and interventions by identifying patients\u0026rsquo; needs, goals and challenges.\u003csup\u003e\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e The process of developing personas for health interventions not only uncovers individual thought patterns but also delves deeper into patients\u0026rsquo; experiences, including their daily routines, decision-making preferences, core values in disease management, and the need for support systems. However, few studies have thoroughly examined how individuals form their perceptions and how these perceptions influence their decision-making processes.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Furthermore, it is critical to identify and address patients' supportive needs for disease management while aligning these needs with their health belief patterns when designing targeted interventions. Therefore, the primary objective of this study was to explore cancer survivors\u0026rsquo; health beliefs and examine how these beliefs influence the decision-making processes regarding the use of OAMs. Additionally, this study aimed to identify individual barriers and potential strategies to enhance medication adherence and improve overall cancer management.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Procedure\u003c/h2\u003e\u003cp\u003eThis qualitative study utilized stratified sampling to recruit participants based on the three health belief subgroups/profiles from the previous quantitative phase. In the quantitative phase of the parent mixed methods study, latent profile analysis identified three distinct health belief subgroups \u0026ndash; \u003cem\u003eOptimistic and adaptive\u003c/em\u003e, \u003cem\u003eConscious but hesitant\u003c/em\u003e, and \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e group, among cancer survivors taking OAMs. These subgroups were characterized by differences in beliefs about cancer and OAM use, providing the foundation for qualitative sampling to explore survivors\u0026rsquo; lived experiences in greater depth. Additionally, purposive sampling was conducted to ensure diversity in age, cancer type, cancer stage, and treatment duration, within each subgroup, allowing for a broader range of experiences to be captured. Participants were eligible if they (1) completed the survey and provided their contact information at the end of the survey and (2) agreed to participate in the interview. This study was conducted in accordance with the ethical standards of the Declaration of Helsinki. Ethical approval was obtained from the University of Wisconsin\u0026ndash;Madison Institutional Review Board (IRB) (Protocol ID: 2024\u0026thinsp;\u0026minus;\u0026thinsp;0549). Informed consent was obtained from all individual participants included in the study. Confidentiality was maintained through data de-identification, encrypted storage, and restricted access.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eA semi-structured interview guide was developed based on the domains of participants\u0026rsquo; health beliefs and questions related to medication adherence within the Extended Common-Sense Model of Self-Regulation to capture participants\u0026rsquo; perceptions.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Based on the ANOVA results comparing significant subgroup differences in health beliefs and the multiple liner regression results of significant predictors of nonadherence, the final set of interview questions was selected using two criteria \u0026ndash; f\u003cem\u003eirst\u003c/em\u003e, health belief domains with significant subgroup differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) among the three health belief subgroups, including nine domains \u0026ndash; Cancer Consequences, Risk of Recurrence, Emotional Representations, Coherence, Personal Control, Treatment Control, Treatment Consequences, Necessity and Concerns, and \u003cem\u003esecond\u003c/em\u003e, health belief domains identified as strong predictors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) of nonadherence in the subgroup with lowest adherent (\u003cem\u003eProfile 3: Overwhelmed and Unaware group\u003c/em\u003e). Two additional domains, including health literacy and comorbidities, were also added to the interview guide to explore their role in shaping participants\u0026rsquo; experiences and to understand how and why these factors emerge as barriers to taking OAMs. Interview questions related to health literacy focused on participant experiences in understanding and utilizing health information throughout their cancer journey. \u003cb\u003eSupplementary Information 1.\u003c/b\u003e presents the questions used in the semi-structured interviews.\u003c/p\u003e\u003cp\u003eThe initial draft of the interview guide was revised by experts with extensive experience in qualitative research and patient perceptions. Pilot testing was conducted with the first two participants, and further revisions were made based on feedback from experts and participants. The interviews were conducted by the researcher, a registered pharmacist with six years of intensive qualitative methodological training and experience in conducting qualitative studies during graduate school. In-depth, one-on-one virtual interviews were conducted via Zoom, with each interview lasting between 20\u0026ndash;60 minutes. Recruitment continued until thematic saturation was reached, where no new concepts emerged from interviews.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e All online interviews were audio-recorded, and the interview data were securely stored in an encrypted drive in the researcher\u0026rsquo;s office. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to ensure methodological rigor, transparency, and credibility in study design, data collection, and analysis.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThematic analysis, guided by Braun et al., was used to explore (1) cancer survivors\u0026rsquo; beliefs about cancer and oral anticancer medications (OAMs), (2) how their health beliefs influenced medication-taking behaviors, and (3) barriers to taking OAMs as well as strategies to support adherence for future interventions.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e All interviews were transcribed verbatim, with personal information de-identified. The first author and a researcher with a qualitative research background conducted deductive coding of the transcripts based on predefined domains in the theoretical framework. Additionally, inductive coding was applied to identify themes not covered by the framework.\u003c/p\u003e\u003cp\u003eThe analysis proceeded iteratively, beginning with a comprehensive understanding of the transcripts through line-by-line reading and the extraction of initial codes. Subsequently, codes for each domain were compiled to identify overarching themes addressing the main research questions. In the third phase, the extracted themes were reviewed to ensure they covered all codes and to identify any overlaps. A categorization matrix and theme mapping were employed to visualize each domain of beliefs about cancer and OAMs across the health belief subgroups identified in the quantitative phase. Finally, each theme was labeled with a specific name and defined clearly.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTo ensure the trustworthiness of the qualitative data in this study, four principles\u0026mdash;credibility, transferability, dependability, and confirmability\u0026mdash;guided by Lincoln and Guba were applied.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e To establish credibility, researchers immersed themselves in the data, reading the entire transcripts for a general understanding of participants\u0026rsquo; beliefs and conducting line-by-line coding to capture meaningful units of experience. Two independent coding of all transcripts were conducted to achieve investigator triangulation. Dependability was ensured through peer debriefing with experts who have experience with qualitative studies. This process involved confirming that the codes, themes, and interpretations aligned with the research questions during regular meetings with an expert who was not involved in the research process. Thick descriptions of the procedures, data collection, and analysis were provided in the final results to ensure transferability. Comprehensive data management was used to track all coding and theme trails using MAXQDA Version 2020. Any changes regarding research questions or procedures for data collection and analysis were documented with rationales to establish confirmability.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eParticipant Demographics\u003c/h2\u003e\u003cp\u003eA total of 12 participants agreed to participate and completed the virtual interviews. The average age of participants was 64.0 years (SD\u0026thinsp;=\u0026thinsp;11.2). Among them, three were male (3/12, 25%), and the majority (9/12, 75%) were White. Almost all participants (11/12) attended college or higher education and lived in urban or suburban areas. The average interview duration was 50.5 minutes (range from 15 to 96 minutes). Five out of twelve (41.7%) participants were diagnosed with breast cancer, with an average duration since diagnosis of six years (range from three months to 26 years). Half of participants were in their early stages of cancer (stage 0\u0026ndash;2), and five had experienced cancer recurrence. Most participants were taking oral hormone therapy, with nine of them (75%) having been on OAMs for more than one year. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. lists participant demographic information\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eParticipant Demographic Information\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"15\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfile\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eEmployment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUrbanicity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCancer type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eCancer duration\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eCancer stage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eRecurrence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eType of OAMs\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003eOAM\u003c/p\u003e\u003cp\u003eduration\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003eComorbidity\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBelow college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eEndometrial cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eTargeted therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFull time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBreast cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eHormone therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eColon and rectal cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eDon't know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1\u0026ndash;3 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePart time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSuburban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBreast cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eHormone therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePart time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eThyroid cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eHormone therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1\u0026ndash;3 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFull time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBreast cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eHormone therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eOvarian cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eHormone therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSuburban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBreast cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eHormone therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1\u0026ndash;3 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFull time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSuburban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBreast cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eHormone therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDisabled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSuburban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eColorectal cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eTargeted therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e3 months \u0026minus;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHispanic white\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSuburban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eProstate cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eDon't know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1\u0026ndash;3 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAsian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDegree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFull time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eLung cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eTargeted therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e3 months \u0026minus;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003e*\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eProfiles were derived from latent profile analysis among cancer survivors taking OAMs: Profile 1\u0026thinsp;=\u0026thinsp;Optimistic and adaptive, Profile 2\u0026thinsp;=\u0026thinsp;Conscious but hesitant, and Profile 3\u0026thinsp;=\u0026thinsp;Overwhelmed and unaware.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eOverarching Findings of Health Beliefs Among Cancer Survivors\u003c/h2\u003e\u003cp\u003eGuided by the Leventhal\u0026rsquo;s Common-Sense Model of Self-Regulation, findings related to patients' beliefs about cancer and oral anticancer medications were coded into three categories: (a) positive beliefs about cancer, including \u003cem\u003eCoherence\u003c/em\u003e (understanding of cancer) and \u003cem\u003ePersonal control\u003c/em\u003e (b) negative beliefs about cancer, including \u003cem\u003eCancer consequences\u003c/em\u003e, \u003cem\u003eRisk of recurrence\u003c/em\u003e, \u003cem\u003eEmotional representations\u003c/em\u003e and (c) beliefs about oral anticancer medications, including \u003cem\u003eTreatment control\u003c/em\u003e, \u003cem\u003eNecessity\u003c/em\u003e, \u003cem\u003eTreatment consequences\u003c/em\u003e and \u003cem\u003eConcern\u003c/em\u003e. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. illustrated how the themes align with health belief domains and provides a summary of each theme\u0026rsquo;s findings. The theme, subtheme, codes and supportive quotes for each category are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e., Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCategory 1: Positive Beliefs about Cancer (Understanding of Cancer and Personal Control)\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eTheme 1: Navigating and triangulating cancer-related information from trusted healthcare professionals, loved ones, and online platforms (Coherence, understanding of cancer)\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients described navigating cancer-related information through a process of triangulation across healthcare providers, personal networks, and online resources, which together shaped their understanding of cancer and its treatment. Trust in healthcare professionals was central, particularly for those with \u003cem\u003eOptimistic and adaptive\u003c/em\u003e beliefs, who reported greater confidence when complex medical information was explained in clear and respectful ways, reinforcing both comprehension and trust. In contrast, patients with \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e beliefs often struggled with inconsistent messages or difficulty understanding clinical explanations, which limited trust-building with providers. Alongside professional input, many patients, especially those in the \u003cem\u003eConscious but hesitant\u003c/em\u003e group, relied heavily on family and friends with cancer experience, whose personal stories offered comfort and practical insights but sometimes introduced biases that required cross-checking. Online platforms also provided information and peer support, but credibility varied. Patients with \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e beliefs remained vulnerable to misinformation, even when digital communities offered benefits.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: Embracing positive thinking and staying occupied as coping strategies for managing cancer-related stress (Personal control)\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients emphasized the importance of cultivating resilience through positive thinking and structured daily routines as key strategies for coping with cancer-related stress and regaining a sense of personal control. Many described staying busy with hobbies, work, or social activities to distract from illness and maintain a sense of normalcy. \u003cem\u003eOptimistic and adaptive\u003c/em\u003e and \u003cem\u003eConscious but hesitant\u003c/em\u003e survivors especially valued seeing cancer as a manageable condition rather than a death sentence. Hope in modern treatments and survival gains further reinforced this adaptive mindset, helping patients reduce feelings of helplessness. Alongside emotional coping, survivors also adopted practical strategies to manage medications and overall disease burden, such as using pill organizers, alarms, or apps to support adherence, coordinating multiple health needs, and maintaining health-promoting routines like exercise and diet. \u003cem\u003eConscious but hesitant\u003c/em\u003e patients stood out for their vigilance in monitoring symptoms, side effects, and lab results, which offered reassurance and preparedness for medical discussions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTheme, Subtheme, Code, Selected Subcode and Quotes for Category 1: Positive Beliefs about Cancer\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eTheme 1: Navigating and triangulating cancer-related information from trusted professionals, loved ones and online platforms (Coherence, understanding of cancer)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eSelected subcode and quote\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003eDeveloping cancer understanding and trust in cancer treatment through healthcare providers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrust in healthcare providers and the system\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u0026ldquo;What's the treatment plan going to be? And \u003cb\u003eI trusted in my doctors. and they're capabilities to get me through the process.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 3, Profile 1: Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHCPs\u0026rsquo; role in explaining medication-related information\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cem\u003eInconsistencies in cancer information\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eThe pharmacist, when he told me: It's cancer medication, there is no substitute.\u003c/b\u003e and I walked out into my car and just started crying and thought, \u003cb\u003ewhy didn't anybody tell me?\u003c/b\u003e\u0026hellip;\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 5, Profile 3: Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eHelped with understanding how cancer medication works in the body\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eSome of it (the information about medication I\u0026rsquo;ve learned) is from my own reading, and some of it is what my doctors have told me.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 8, Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrategies to help with understanding medical information\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cem\u003eRecognize patient's emotional reactions and ensure readiness for learning cancer information\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;They (Doctors) just they were \u003cb\u003ereally composed and calm\u003c/b\u003e, which was a really good thing, because it's needed at a time like that \u0026hellip; they told me they knew it was really hard news to hear, \u003cb\u003eso give me time to compose myself to really they let it sink in first before continuing.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 1, Profile 3: Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eUse plain language or graph to help with understanding\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;With my oncologist there were a couple of times on visits where she had. \u003cb\u003eShe had printed out some materials for me to become better acquainted with stuff, and some of the materials would have drawings or charts. Or whatever, and she would at least briefly\u003c/b\u003e, you know, explain what she was showing me.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 3, Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eTake initiative to ask HCPs questions or clarify on jargons\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003e(If I have questions or confusion,) I just asked them. You know they were very good. Well, they were very good at explaining things as though I didn't have a medical background\u003c/b\u003e. Because a lot of people don't.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 7, Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eReling on family and friends\u0026rsquo; experience on cancer understanding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eMy husband's experiences played a very strong role into my feelings\u003c/b\u003e\u0026hellip;I've lived with it for so long, except not personally in my body, \u003cb\u003ebut with my husband, with my mom, with my sister\u003c/b\u003e.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 4, Profile 2: Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNavigating and evaluating online information for support and understanding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQuestioning about the credibility of information online\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u0026ldquo;You can find \u003cb\u003einformation on Google about cancer which might be wrong. So that can hinder me from and anyone else\u003c/b\u003e from getting the right information.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 1, Profile 3: Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTheme 2: Embracing positive thinking and staying occupied as coping strategies for managing cancer-related stress (Personal control)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSubtheme\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eCode\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eSelected subcode and quote\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eShifting perspectives on cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003ePositive thinking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI also think keeping busy in some way\u003c/b\u003e, whatever it is. \u0026hellip; You don't have to be great at whatever it is you're doing but \u003cb\u003efind some interest. Get out of the world of cancer\u003c/b\u003e.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 4, Profile 2: Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eRecognition of cancer as a manageable condition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ldquo;Don't despair. \u003cb\u003eThere's been so much progress in treatments and keeping you healthy and keeping you alive. \u0026hellip; It's not a death sentence. It's just an illness.\u003c/b\u003e Put it in perspective.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 4, Profile 2: Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHope in modern cancer care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eIt (Conquering cancer) is a work in progress\u003c/b\u003e\u0026hellip; As my surgeon said, you know, 25 years ago we didn't have a whole lot of options. \u003cb\u003eBut look at all the progress that we've made in the last 25 years\u003c/b\u003e.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 8, Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUsing distraction and keeping occupied as coping strategies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI also think keeping busy in some way\u003c/b\u003e, whatever it is, you know. Reading, write, keep a journal, put your thoughts down. Paint, take a painting, you know who cares what it looks like. You don't have to be perfect. You don't have to be great at whatever it is you're doing but find some interest. Get out of your, the world of cancer.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 4, Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eDeveloped strategies to manage tasks associated with taking medication and overall disease management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eSetting reminders and using tools\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI set up an alarm on my cell phone\u003c/b\u003e\u0026hellip; When I need to take medication, and then I have a sheet. I just write down what time I took the medication.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 12, Profile 2: Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eEngagement in proactive health behaviors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eMaintaining a healthy lifestyle\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI think it's very important to have like a healthy lifestyle. eat healthy food. Like More vegetables like a healthy diet and the system. I think it's a very important part. you know, prevent we cannot prevent.\u003c/b\u003e You don't know if you can prevent by eating by, you know. But it's you know. it's good chance.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 2, Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eCoordinated management of cancer and comorbidity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ldquo;I take a lot of medications because I'm very overweight. I have arthritis. I have high blood pressure\u0026hellip;. \u003cb\u003eThe cancer pill and the cancer itself are probably the least\u003c/b\u003e. \u0026hellip; that would affect least. I just every once a month \u003cb\u003eI do all my pills in a little box, and I make it easy for my Statin, and you know I don't feel burden from the cancer at all.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 7, Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eVigilance in cancer monitoring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ldquo;I am pretty closely watched. I do blood work. I do scans. I did have a scare, and it ended up being nothing. But it's very scary when that the scare happened. I just. \u003cb\u003eI try to be very vigilant. I'm very good about doctors appointments if they say you need to do blood work every so often.\u003c/b\u003e I do it every so often. \u003cb\u003eI'm very good at following the orders for that, because I think that's the way to keep me alive is to watch it.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 9, Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eCategory 2: Negative Beliefs about Cancer\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eTheme 1: Experiencing severe physical symptoms, leading to increased burden and shifts in family, social dynamics, and roles (Cancer consequences)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCancer and its treatment profoundly shaped patients\u0026rsquo; daily lives, as physical symptoms such as fatigue, nausea, pain, and changes in appearance disrupted their ability to maintain routines, social connections, and work responsibilities. These challenges were particularly pronounced among patients with \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e beliefs, who described difficulties carrying out everyday activities, withdrawing socially, and facing financial strain due to treatment costs and reduced work capacity. Changes in body image and social identity further compounded distress, while reliance on family and friends became essential for both practical and emotional support. For some, this strengthened bonds and increased feelings of connectedness. For others, especially in the \u003cem\u003eConscious but hesitant\u003c/em\u003e and \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e groups, it caused strain, guilt, or feelings of being a burden when support was limited or relationships grew distant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: Navigating cancer diagnosis triggers emotional distress and increases the need for support (Emotional representations)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cancer diagnosis often initiated intense emotional distress, beginning with shock, fear, and avoidance, before gradually shifting toward acceptance and active coping as patients adjusted to their new reality. This transition varied across belief profiles: patients with \u003cem\u003eOptimistic and adaptive\u003c/em\u003e views more readily reframed cancer as a manageable, long-term condition, while those with \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e beliefs often described confusion, fear, and difficulty processing inconsistent or delayed information. Emotional distress was further compounded by treatment side effects, such as fatigue, nausea, and hair loss, which disrupted daily life and reinforced feelings of vulnerability. Participants reported that coping with these challenges required sustained support, with family and friends offering encouragement and practical help, while cancer support groups provided a sense of solidarity and understanding.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 3: Perceiving some degree of recurrence risk with varied responses to its implications (Risk of recurrence)\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients commonly acknowledged the possibility of cancer recurrence, but their responses ranged from resignation to proactive resilience. Those in the \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e group often viewed recurrence as inevitable and beyond their control, leading to more passive coping. In contrast, \u003cem\u003eOptimistic and adaptive\u003c/em\u003e patients expressed confidence in their ability to face recurrence, drawing strength from prior experiences and medical advancements. For many, the risk of recurrence remained a persistent source of anxiety, especially during follow-up scans or when experiencing unexplained symptoms. Anxiety served to influence both their vigilance in health monitoring and their efforts to maintain a sense of normalcy.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTheme, Subtheme, Code, Selected Subcode and Quotes for Category 2: Negative Beliefs about Cancer\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eTheme 1: Experiencing severe physical symptoms, leading to increased burden and shifts in family, social dynamics and roles (Cancer consequences)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSelected subcode and quote\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eImpact of cancer and treatment on daily life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eCancer effects\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u0026hellip; I lost a couple of pounds in 2 weeks I was down to 94 \u003cb\u003e\u0026hellip;I could be out shopping and going to lunch, or something I might say, hey, I gotta go home. I want to go to bed.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 5, Profile 3: Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSocial effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eChanges in body image and social identity\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;(People would think) it's important to have breasts if I go out and buy these artificial things to put on to make me look like I have breasts, you know. \u003cb\u003eI'm still me, and I think that's the message that I'm like giving myself. I'm not lesser because I had my breasts removed....I see them kind of trying not to look, but noticing that I'm different, and that hurts.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 4, Profile 2: Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eSocial isolation\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;I don't say pity parties I have to go through like, oh, you get better, or it's I will find we'll help you. We're here for you. \u003cb\u003eIt's like people treat me like I'm very fragile. being, which is really uncomfortable at times.\u003c/b\u003e So yes, \u003cb\u003eI tend to avoid people.\u003c/b\u003e \u0026hellip;\u003cb\u003eBut I have withdrawn from society a lot.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 1, Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eReduced work hours and disruption\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u0026hellip;I am not working. I would like to work and I want to work, and we need to work unless. I need to be able to keep it that way, and I need to be able to earn money.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 11, Conscious but hesitant\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eFinancial effects\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;It got to a point where \u003cb\u003eit couldn't cover for the medication, which is really expensive. I had to use my college fund for that. Which means I haven't attended college up to now\u003c/b\u003e.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 1, Profile 3: Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChanged the dynamics with friends and family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrengthened relationship with loved ones\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;(During the doctor\u0026rsquo;s visit) my daughter was on the phone, and my daughter lives out of state so she couldn't be there. But she wanted to be there and insistent, mom, you have to have her let me listen to the conversation. So \u003cb\u003efor that whole hour we just had a good back and forth, and I felt very comfortable going into surgery\u003c/b\u003e.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 8, Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeeds for support from family and friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI don't really know if I know what's the best support I need, because pretty much I'm by myself in the United States.\u003c/b\u003e So, even though I have some friends. I have really good friends that they willing to support me, but I knew This kind of chemotherapy process is a long process, not just one day.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 12, Conscious but hesitant\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTheme 2: Navigating a cancer diagnosis triggers emotional distress and increases the need for support (Emotional representations)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSubtheme\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eCode\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSelected subcode and quote\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eTransition from shock to active coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrama of hearing \u0026ldquo;You Have Cancer\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;The way he (doctor) talked to me it\u0026rsquo;s like\u0026hellip; you don't have too long to live, anyway. Just enjoy your life\u0026hellip; \u003cb\u003eI was kind of shock, but I have no emotion at that point during the appointment.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 12, Profile 2: Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConfusion and frustration from delayed cancer information\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI still didn't know it was cancer medication. (\u0026hellip;Until) I talked to the pharmacist\u003c/b\u003e, \u0026hellip;I had no idea anything was that serious and basically went out to the car and cried\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 5, Profile 3: Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAvoidance and fear of reality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;(My doctor) expecting me to go home and become as familiar with material as I felt like doing, and sometimes I didn't. Yeah, \u003cb\u003eI guess there was a little part of me. It felt like if I really dug deeply into this. that I was gonna see some darkness.\u003c/b\u003e\u0026rdquo; \u0026ndash; Participant 3, Optimistic and adaptive group\u003c/p\u003e\u003cp\u003e\u003cem\u003eFeeling worried about the lack of available treatment options\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;I got a sense of panic. And worry, because, \u003cb\u003ehaving something like cancer means, you might get well, you might not. So hearing that the medicine isn't working for you anymore is really tough.\u003c/b\u003e So I did panic at the time.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 1, Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcceptance of cancer as a long-term condition in life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eMotivation to cope for family\u0026rsquo;s sake\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI just had to accept it. I had to\u0026hellip; for the sake of my family.\u003c/b\u003e for the sake of my husband, who I had just married a few months before that (having cancer diagnosis) and I was like, and \u003cb\u003eI didn't want to let him down.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 6, Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eCancer as a long-term companion\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI would describe it as a neighbor who never bothers me.\u003c/b\u003e Go never causes me any trouble\u0026hellip;And I know they're there, but they never talk to me. \u003cb\u003eYou know they're not unfriendly, but they're just there\u003c/b\u003e.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 7, Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiving with gratitude as a survivor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eShifting from receiving to giving\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI just feel very lucky, because so many people don't have the outcome that I have.... when I am healed\u003c/b\u003e, which I really am, \u003cb\u003eI want to be one of the people who do the helping.\u003c/b\u003e\u0026rdquo; \u0026ndash; Participant 4, Profile 2: Conscious but hesitant group\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEmotional distress linked to medication side effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAccepted side effects as an unavoidable part of treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eSometimes I'll get a little bit depressed\u003c/b\u003e, but I just think, in the back of my mind, you know what, \u003cb\u003ethis is a side effect\u0026hellip;Take it as a grain of salt.\u003c/b\u003e You know if you need go, lay down and take a nap, when you get up you'll feel better, and that's a lot of times what I'll do.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 9, Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeeds for emotional support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I think \u003cb\u003ethat's a big part of how you get through cancer is by allowing yourself to be supported\u003c/b\u003e, you know, not saying I don't. I don't need any help. That's that would be a terrible decision. Because, \u003cb\u003eyou're building your own wall if you do that and it's not realistic, because we all need help at times\u003c/b\u003e.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 4, Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eReceived support from family and friends\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;I was very worried. And I think this is where and I was toxic, and my friends all said that maybe I should start taking\u0026hellip;some anti-anxiety medication, because I just was desperate, and I just had a lot of anxiety. ...\u003cb\u003eI had a lot of friends around the country, and they called me all the time so I could talk to someone every day if I needed to. I was never really alone.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 7, Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eEmotional support from cancer support group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;It's so helpful for me to participate (cancer) support group\u0026hellip;And the good things I can do are not necessary to go in person. I can go online\u0026hellip;\u003cb\u003epeople exchange information about treatment\u003c/b\u003e.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 2, Profile 3:Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTheme 3: Perceiving some degree of recurrence risk with varied responses to its implications (Risk of recurrence)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCode\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSelected subcode and quote\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerception of inevitability of recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u0026ldquo;I guess it's in their gene or in their DNA. \u0026hellip; But I'd say that's one thing I see would make the cancer come back.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 1, Profile 3: Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eNo medications were available at that time and cancer reoccurred\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eThere were no further drugs in those days for that particular cancer\u003c/b\u003e, and was like a triple negative thing. So after 5 years of going to the office first it was every few months, and then it was, you know, finally got to. It was yearly. and they said, you're fine, you're great. I thought I would never get it again. and I got it (cancer recurrence) 21 years later.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 6, Conscious but hesitant, with the history of cancer recurrence\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacing the risk of cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cem\u003eConfidence in facing recurrence\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;(Cancer) could hit again at any point. \u0026hellip;you've got moral support from Caring Bridge [app for sharing illness stories with close friends] and all your family. \u0026hellip;\u003cem\u003eI'll deal with it again if it does\u003c/em\u003e.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 3, Profile 1: Optimistic and adaptive\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eFeeling worried about recurrence\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eMy biggest problem with keeping myself cancer cancer-free or in remission.\u003c/b\u003e I\u0026rsquo;m sure I don't want to hear here that get the diagnosis. I have cancer somewhere else, because that can happen right? \u0026ldquo; \u003cem\u003e\u0026ndash; Participant 11, Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eCategory 3: Beliefs about Oral Anticancer Medications\u003c/h2\u003e\u003cp\u003e\u003cb\u003eTheme 1: Developing confidence in medication through various sources while acknowledging concerns about uncertain medication efficacy and medication access challenges (Treatment control vs. Concern)\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients described building confidence in their cancer medications through reassurance from healthcare providers, personal experiences, and external sources such as peer networks and online platforms. For many in the \u003cem\u003eOptimistic and adaptive\u003c/em\u003e and \u003cem\u003eConscious but hesitant\u003c/em\u003e groups, medications were seen as a safeguard against recurrence, offering a sense of security and hope that cancer could be controlled with consistent treatment. In contrast, patients in the \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e group often relied more heavily on external information and the experiences of others to reinforce their trust in medication, highlighting a greater need for support in developing confidence. Despite this reliance, uncertainty about medication effectiveness persisted, as some participants doubted whether their treatment would truly protect them, viewing it as helpful but not guaranteed. Access barriers, whether financial, logistical, or tied to healthcare availability, further complicated adherence, particularly among those already struggling with limited trust or heightened vulnerability.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: Experiencing side effects, which tempered beliefs about medication\u0026rsquo;s role in recovery (Necessity vs. Treatment consequences)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Patients described a conflicted relationship with oral anticancer medications, recognizing their necessity for survival while struggling with the burden of side effects. For some, persistent symptoms such as nausea or fatigue led to doubts about whether the benefits outweighed the discomfort, particularly among those in the \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e group. Despite these challenges, most patients acknowledged that discontinuing treatment was not an option, highlighting how adherence was maintained out of necessity rather than confidence, with side effects shaping both trust in medication and overall quality of life.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTheme, Subtheme, Code, Selected Subcode and Quotes for Category 3: Beliefs about Oral Anticancer Medications\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eTheme 1: Developing confidence in medication through various sources while acknowledging concerns about uncertain efficacy and medication access challenges (Treatment control vs. Concern)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSelected subcode and quote\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003eMedication as a long-term safeguard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTaking medication can prevent cancer from coming back\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;I think it (medication) is helping me. \u0026hellip;So \u003cb\u003ethe chance of that type of cancer coming back, I'm sure, would be minimum because of me doing the hormone blocker.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 9, Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCancer is manageable with medication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;The last time I went to the oncologist they told me that the studies now are showing that with \u003cb\u003emy form of ovarian cancer, Letrozole has been helping other people as well\u003c/b\u003e, and that they are now thinking that people like me wouldn't even have to go through chemotherapy anymore because it doesn't help. So you know, I was real happy to hear that that when I first started taking it 6 years ago. They didn't really know that much about how it would help me.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 7, Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRelied on external sources of information to develop beliefs that medication can help\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eLearned information from cancer support group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;We had talks about the cancer in general. How to manage it. What kinds of food you should avoid or you should take, and physical activities. You could do for (as) a cancer patient.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 2, Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eLearned cancer information online\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;Usually (information) it's on Internet and Google. Also, talking is a doctor, who is a nutritionist also helpful to understand. What's kind of fruit. What kind of fruit and vegetables? It's good to prevent cancer (I) could ask them.. Sometimes I go to Google, ... and check from there.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 2, Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eLack of confidence in adhering to medication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUncertainty about treatment effectiveness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eDoubt about medication\u0026rsquo;s true benefits\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;My doctor is going to allow me to stay on it longer. Which is more formal than anything. \u003cb\u003eBut I want to know. Is that really going to help me?\u003c/b\u003e There's not nothing bad's gonna happen. But is it? Is there? \u003cb\u003eIs there a positivity of staying on it longer?\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 9, Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eMedication offers some level of protection without guarantees\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;No, no promises, I mean, no promises are made, but just what a great protection that this will be! So it was all in a positive light.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 4, Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAccess to medication or healthcare services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Sometimes it's really hard to get to the physical treatment sessions, the ones where you have to go to the clinic. So sometimes I'd wake up, I'd be really weak. And that was a really big challenge, considering we live a bit far from the clinic.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 1, Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eNot having problems in accessing medication\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;My medication is generic. It's tier one. I have no copay. So. No, I haven't run out of medication.\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 8, Optimistic and adaptive group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTheme 2: Experiencing side effects, which tempered the beliefs about medication\u0026rsquo;s role in recovery (Necessity vs. Treatment consequences)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSubtheme\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eCode\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eSelected subcode and quote\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eBalancing the necessity of taking medication with unflavored symptoms or side effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u0026ldquo;Now it's because I know when I was on Tamoxifen there was a Tamoxifen Facebook support group, and everybody complained. And you know what. \u003cb\u003eI'd rather be alive with a few with some minor with some side effects, than be 6 feet under.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 9, Conscious but hesitant group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eQuestioning the necessity of taking medications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI have always believed that medication is there to make you better? although I would say it doesn't feel that way in this situation because I get a lot of symptoms\u003c/b\u003e, which make me uncomfortable like. I get nauseous like. I'm nauseous all the time I've learned to. \u003cb\u003eI don't remember what it feels like to not being nauseous.\u003c/b\u003e\u0026rdquo; \u003cem\u003e\u0026ndash; Participant 1, Overwhelmed and unaware group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNeed to take the medications to live and recover\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;\u003cb\u003eI think it (medication) is a very important safeguard.\u003c/b\u003e I mean, it's probably the most important part of my recovery.\u0026rdquo; \u0026ndash; Participant 4, Conscious but hesitant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study, guided by Leventhal\u0026rsquo;s Common-Sense Model of Self-Regulation, explored cancer survivors\u0026rsquo; beliefs about cancer and OAM use, revealing a diverse range of perceptions that influenced their coping strategies, medication adherence, and engagement with healthcare. While some participants exhibited optimistic and adaptive beliefs, relying on healthcare providers, structured coping mechanisms, and modern treatment advancements, others demonstrated more hesitant or overwhelmed perspectives, shaped by uncertainties about recurrence, medication side effects, and systemic barriers to healthcare access. Variations in treatment confidence, information processing, and reliance on external support networks further distinguished participants\u0026rsquo; experiences, emphasizing the need for personalized education, enhanced communication, and tailored support systems to improve survivors\u0026rsquo; understanding and adherence to treatment.\u003c/p\u003e\u003cp\u003eFindings from this study illustrate the diverse sources of cancer-related information that patients utilize. While healthcare providers were often perceived as the most reliable and authoritative sources of information, reliance on informal networks and digital resources varied across patient subgroups. Survivors with \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e beliefs struggled to evaluate credibility, leaving them more vulnerable to misinformation and distrust. Their uncertainty often led them to rely on unverified online sources or personal anecdotes, increasing their vulnerability to misinformation and distrust in healthcare providers. These findings align with existing literature suggesting that cancer patients actively engage in information-seeking behaviors but may struggle with evaluating the credibility of online content.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Scoping reviews have also highlighted that while digital resources provide a wealth of health information, cancer patients frequently encounter challenges in distinguishing credible sources from misinformation.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e Balancing the accessibility of digital health resources with safeguards against misinformation remains a key challenge. Healthcare providers should consider guiding patients toward reliable online sources and fostering open discussions about information credibility to support informed decision-making.\u003c/p\u003e\u003cp\u003eBeyond traditional medical consultations, family members and peer support networks played a crucial role in shaping patients' beliefs about cancer and treatment. Previous research highlights that patients with cancer often turn to personal networks for reassurance, emotional support, and practical advice.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e However, while firsthand experiences shared by family and friends can offer comfort, they may also introduce biases or misconceptions that influence treatment perceptions. This study found that patients in the \u003cem\u003eConscious but hesitant\u003c/em\u003e group relied heavily on familial advice, and cross-checking information with medical sources to mitigate potential misinformation. These findings underscore the need for structured educational and behavioral interventions that equip both patients and their support systems with accurate, comprehensible, and context-specific information about cancer management.\u003c/p\u003e\u003cp\u003eStructural barriers and social determinants of health continue to be critical challenges in cancer care, particularly for patients in the \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e group, who often face financial constraints, transportation difficulties, and healthcare access disparities. Research highlights that patients from lower socioeconomic backgrounds, uninsured individuals, and those in rural communities are disproportionately affected by these barriers, leading to delays in diagnosis and treatment, lower adherence rates, and poorer health outcomes.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Limited transportation access, for example, has been identified as a major obstacle, with many patients missing critical appointments due to limited access to reliable transportation services.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Financial toxicity is another pressing issue, as high out-of-pocket costs force some patients to delay or forego treatment, exacerbating disparities in survival rates.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e These findings underscore the need for healthcare policies that address the structural inequities contributing to poor cancer outcomes. Programs such as patient navigation, financial assistance initiatives, and community-based health outreach efforts have demonstrated success in bridging gaps in care by improving access to critical resources and ensuring patients receive timely treatment.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e Family-based interventions can also further support caregivers, helping to reduce patient burden and improve both adherence and emotional well-being.\u003csup\u003e\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e Ultimately, a comprehensive, multi-level approach that integrates structural support with psychosocial care is essential to reducing disparities and improving patient outcomes.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e Strengthening collaborations between healthcare providers, social services, and policymakers can help bridge these systemic gaps and ensure that the most vulnerable cancer patients receive equitable access to care.\u003c/p\u003e\u003cp\u003eCancer survivors often weigh the necessity of OAMs against concerns about side effects, uncertain efficacy, and long-term risks. Findings from this study align with prior research that patients continually evaluate the trade-offs between treatment benefits and adverse effects, shaping their intention to take medications.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e To improve adherence and reframe medication beliefs, patient-provider communication strategies should be integrated into structured educational programs, ensuring that patients receive clear, individualized information about OAMs. Evidence suggests that leveraging digital health tools, such as mobile applications, online patient portals, and telehealth consultations, can facilitate real-time provider engagement and reinforce positive treatment perceptions.\u003csup\u003e\u003cspan additionalcitationids=\"CR43 CR44\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e For the \u003cem\u003eOptimistic and adaptive\u003c/em\u003e group, digital reminders and educational resources can sustain confidence in their regimen. Survivors with \u003cem\u003eConscious but hesitant\u003c/em\u003e beliefs would benefit from interactive, evidence-based platforms that allow for ongoing dialogue and reassurance from providers. For the \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e group, a more intensive approach incorporating direct counseling, symptom-tracking applications, and caregiver involvement may help reduce concerns and build confidence in treatment necessity. Future interventions should explore hybrid models that combine in-person education with digital support, ensuring that all patients, regardless of their health literacy level, have access to reliable information and structured guidance for managing their treatment effectively.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStudy Strengths and Limitations\u003c/h2\u003e\u003cp\u003eThis study is among the first to explore how health beliefs influence cancer management, particularly treatment adherence by categorizing distinct health belief patterns. By adopting a subgroup approach, this study provides a nuanced understanding of how cancer survivors with different beliefs perceive their condition, experience challenges, and make decisions about their care. However, the small sample size within each profile may limit the generalizability of these findings. To address this, we leveraged the grouping nature of our study design to compare and synthesize insights across three distinct health belief patterns, maximizing our ability to identify variations in coping strategies and decision-making processes among cancer survivors. Despite these efforts, the study sample was predominantly White, female, and from urban or suburban areas with internet access. Given that health beliefs are shaped by social contexts and resource availability, findings should be interpreted with caution, as geographic and socioeconomic factors may influence individual perceptions. Furthermore, participants were generally more engaged in their health, potentially reflecting socially desirable responses. Some interviews were conducted with caregivers present, which may have influenced participants\u0026rsquo; narratives.\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e To minimize the influence and enhance the quality of the responses, interviewers used probing techniques and rephrased questions to clarify responses and capture subjective experiences directly from participants.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis qualitative study explored how health beliefs shape cancer management and medication-taking behaviors among cancer survivors, identifying distinct barriers, facilitators, and coping strategies across three health belief profiles. Findings revealed that survivors in the \u003cem\u003eOptimistic and adaptive\u003c/em\u003e group exhibited strong self-efficacy, trust in healthcare providers, and proactive coping mechanisms, allowing them to navigate medication-taking with minimal concerns. The \u003cem\u003eConscious but hesitant\u003c/em\u003e group engaged critically with their treatment, requiring reassurance, structured support, and ongoing monitoring to balance concerns about treatment necessity and side effects. The \u003cem\u003eOverwhelmed and unaware\u003c/em\u003e group faced significant challenges, including greater emotional distress, a higher perceived burden of cancer and treatment, and reliance on external sources for understanding their condition. Their limited sense of control and inconsistent information-seeking behaviors contributed to higher nonadherence risks. Beyond education, interventions should address emotional distress, enhance symptom management, and ensure access to reliable information and build treatment confidence. Future research should explore how personalized adherence strategies can be integrated into oncology care while considering the social, emotional, and structural factors that shape long-term adherence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.-J.W. conceived and designed the study, conducted data collection, and performed data analysis and interpretation with input from all co-authors. M.Z. contributed to data analysis and participated in consensus meetings. M.-J.W. drafted the initial manuscript. All authors reviewed, revised, and approved the final manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank all participants for their time and valuable contributions to this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are not publicly available due to restrictions related to participant confidentiality but are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eRoser MR, H. Cancer. 2019; https://ourworldindata.org/cancer. Accessed Jan 12, 2024.\u003c/li\u003e\n \u003cli\u003eAmerican Cancer Society. Cancer Treatment \u0026amp; Survivorship Facts \u0026amp; Figures 2025. 2025; https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2025/2025-cancer-facts-and-figures-acs.pdf.\u003c/li\u003e\n \u003cli\u003eSiegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. \u003cem\u003eCA: A Cancer Journal for Clinicians.\u0026nbsp;\u003c/em\u003e2025;75(1):10-45.\u003c/li\u003e\n \u003cli\u003eVyas A, Descoteaux A, Kogut S, et al. Predictors of adherence to oral anticancer medications: An analysis of 2010-2018 US nationwide claims. \u003cem\u003eJournal of managed care \u0026amp; specialty pharmacy.\u0026nbsp;\u003c/em\u003e2022;28(8):831-844.\u003c/li\u003e\n \u003cli\u003eEek D, Krohe M, Mazar I, et al. Patient-reported preferences for oral versus intravenous administration for the treatment of cancer: a review of the literature. \u003cem\u003ePatient preference and adherence.\u0026nbsp;\u003c/em\u003e2016;10:1609-1621.\u003c/li\u003e\n \u003cli\u003eGanesan P, Sagar TG, Dubashi B, et al. Nonadherence to imatinib adversely affects event free survival in chronic phase chronic myeloid leukemia. \u003cem\u003eAm J Hematol.\u0026nbsp;\u003c/em\u003e2011;86(6):471-474.\u003c/li\u003e\n \u003cli\u003eGreer JA, Amoyal N, Nisotel L, et al. A Systematic Review of Adherence to Oral Antineoplastic Therapies. \u003cem\u003eOncologist.\u0026nbsp;\u003c/em\u003e2016;21(3):354-376.\u003c/li\u003e\n \u003cli\u003eLu ZK, Xiong X, Brown J, Horras A, Yuan J, Li M. Impact of Cost-Related Medication Nonadherence on Economic Burdens, Productivity Loss, and Functional Abilities: Management of Cancer Survivors in Medicare. \u003cem\u003eFront Pharmacol.\u0026nbsp;\u003c/em\u003e2021;12:706289.\u003c/li\u003e\n \u003cli\u003eMariotto AB, Enewold L, Zhao J, Zeruto CA, Yabroff KR. Medical Care Costs Associated with Cancer Survivorship in the United States. \u003cem\u003eCancer epidemiology, biomarkers \u0026amp; prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.\u0026nbsp;\u003c/em\u003e2020;29(7):1304-1312.\u003c/li\u003e\n \u003cli\u003eWu EQ, Johnson S, Beaulieu N, et al. Healthcare resource utilization and costs associated with non-adherence to imatinib treatment in chronic myeloid leukemia patients. \u003cem\u003eCurr Med Res Opin.\u0026nbsp;\u003c/em\u003e2010;26(1):61-69.\u003c/li\u003e\n \u003cli\u003eDoshi SD, Lichtenstein MRL, Beauchemin MP, et al. Factors Associated With Patients Not Receiving Oral Anticancer Drugs. \u003cem\u003eJAMA Network Open.\u0026nbsp;\u003c/em\u003e2022;5(10):e2236380-e2236380.\u003c/li\u003e\n \u003cli\u003eRosenberg SM, Petrie KJ, Stanton AL, Ngo L, Finnerty E, Partridge AH. Interventions to Enhance Adherence to Oral Antineoplastic Agents: A Scoping Review. \u003cem\u003eJournal of the National Cancer Institute.\u0026nbsp;\u003c/em\u003e2020;112(5):443-465.\u003c/li\u003e\n \u003cli\u003eKaptein AA, Schoones JW, van der Meer PB, et al. Psychosocial determinants of adherence with oral anticancer treatment: \u0026apos;we don\u0026apos;t need no education\u0026apos;. \u003cem\u003eActa Oncol.\u0026nbsp;\u003c/em\u003e2021;60(1):87-95.\u003c/li\u003e\n \u003cli\u003eCameron LDLH. \u003cem\u003eThe self-regulation of health and illness behaviour.\u003c/em\u003e London; New York: Routledge; 2003.\u003c/li\u003e\n \u003cli\u003eHorne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients\u0026apos; adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. \u003cem\u003ePLoS One.\u0026nbsp;\u003c/em\u003e2013;8(12):e80633.\u003c/li\u003e\n \u003cli\u003eHorne R, Parham R, Driscoll R, Robinson A. Patients\u0026apos; attitudes to medicines and adherence to maintenance treatment in inflammatory bowel disease. \u003cem\u003eInflammatory bowel diseases.\u0026nbsp;\u003c/em\u003e2009;15(6):837-844.\u003c/li\u003e\n \u003cli\u003eHorne R, Weinman J. Patients\u0026apos; beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. \u003cem\u003eJ Psychosom Res.\u0026nbsp;\u003c/em\u003e1999;47(6):555-567.\u003c/li\u003e\n \u003cli\u003eHorne R, Weinman J. Self-regulation and Self-management in Asthma: Exploring The Role of Illness Perceptions and Treatment Beliefs in Explaining Non-adherence to Preventer Medication. \u003cem\u003ePsychology \u0026amp; Health.\u0026nbsp;\u003c/em\u003e2002;17(1):17-32.\u003c/li\u003e\n \u003cli\u003eMarshall VK, Given BA. Factors Associated With Medication Beliefs in Patients With Cancer: An Integrative Review. \u003cem\u003eOncol Nurs Forum.\u0026nbsp;\u003c/em\u003e2018;45(4):508-526.\u003c/li\u003e\n \u003cli\u003eMarshall VK, Lehto RH, Given CW, Given BA, Sikorskii A. Conceptualisation of medication beliefs among patients with advanced cancer receiving oral oncolytic agents using a theory derivation approach. \u003cem\u003eEur J Cancer Care (Engl).\u0026nbsp;\u003c/em\u003e2019;28(2):e12988.\u003c/li\u003e\n \u003cli\u003eTimmers L, Boons CC, Moes-Ten Hove J, et al. Adherence, exposure and patients\u0026apos; experiences with the use of erlotinib in non-small cell lung cancer. \u003cem\u003eJ Cancer Res Clin Oncol.\u0026nbsp;\u003c/em\u003e2015;141(8):1481-1491.\u003c/li\u003e\n \u003cli\u003eMarshall VK, Visovsky C, Advani P, Mussallem D, Tofthagen C. Cancer treatment-specific medication beliefs among metastatic breast cancer patients: a qualitative study. \u003cem\u003eSupport Care Cancer.\u0026nbsp;\u003c/em\u003e2022;30(8):6807-6815.\u003c/li\u003e\n \u003cli\u003eWen M-J, Hsu H-L, Chang C-L, et al. Understanding the medication experience of patients with advanced non-small cell lung cancer taking epidermal growth factor receptor-tyrosine kinase inhibitors: A phenomenological study. \u003cem\u003ePLOS ONE.\u0026nbsp;\u003c/em\u003e2023;18(5):e0286333.\u003c/li\u003e\n \u003cli\u003eRivera E, Corte C, Steffen A, DeVon HA, Collins EG, McCabe PJ. Illness Representation and Self-Care Ability in Older Adults with Chronic Disease. \u003cem\u003eGeriatrics (Basel, Switzerland).\u0026nbsp;\u003c/em\u003e2018;3(3).\u003c/li\u003e\n \u003cli\u003eTanaka R, Nolan RP. Psychobehavioral Profiles to Assist Tailoring of Interventions for Patients With Hypertension: Latent Profile Analysis. \u003cem\u003eJournal of medical Internet research.\u0026nbsp;\u003c/em\u003e2018;20(5):e149.\u003c/li\u003e\n \u003cli\u003eSankar G, Djamasbi S, Dogan Telliel Y, Bajracharya AS, Amante DJ, Shi Q. Developing Personas for Designing Health Interventions. Paper presented at: HCI in Business, Government and Organizations; 2022//, 2022; Cham.\u003c/li\u003e\n \u003cli\u003eCharmaz K, Belgrave LL. The SAGE Handbook of Interview Research: The Complexity of the Craft. In. 2 ed. Thousand Oaks, California: SAGE Publications, Inc.; 2012.\u003c/li\u003e\n \u003cli\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. \u003cem\u003eInternational Journal for Quality in Health Care.\u0026nbsp;\u003c/em\u003e2007;19(6):349-357.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. \u003cem\u003eQualitative Research in Psychology.\u0026nbsp;\u003c/em\u003e2006;3(2):77-101.\u003c/li\u003e\n \u003cli\u003eLincoln YS, Guba YSLEG, Guba EG, Publishing S. \u003cem\u003eNaturalistic Inquiry.\u003c/em\u003e SAGE Publications; 1985.\u003c/li\u003e\n \u003cli\u003eKynoch K, Ramis M-A, Crowe L, Cabilan CJ, McArdle A. Information needs and information seeking behaviors of patients and families in acute healthcare settings: a scoping review. \u003cem\u003eJBI Evidence Synthesis.\u0026nbsp;\u003c/em\u003e2019;17(6).\u003c/li\u003e\n \u003cli\u003eFinney Rutten LJ, Blake KD, Greenberg-Worisek AJ, Allen SV, Moser RP, Hesse BW. Online Health Information Seeking Among US Adults: Measuring Progress Toward a Healthy People 2020 Objective. \u003cem\u003ePublic health reports (Washington, DC : 1974).\u0026nbsp;\u003c/em\u003e2019;134(6):617-625.\u003c/li\u003e\n \u003cli\u003eForsythe LP, Alfano CM, Kent EE, et al. Social support, self-efficacy for decision-making, and follow-up care use in long-term cancer survivors. \u003cem\u003ePsychooncology.\u0026nbsp;\u003c/em\u003e2014;23(7):788-796.\u003c/li\u003e\n \u003cli\u003eLambert SD, Loiselle CG, Macdonald ME. An In-depth Exploration of Information-Seeking Behavior Among Individuals With Cancer: Part 2: Understanding Patterns of Information Disinterest and Avoidance. \u003cem\u003eCancer Nursing.\u0026nbsp;\u003c/em\u003e2009;32(1).\u003c/li\u003e\n \u003cli\u003eCoughlin SS. Social determinants of breast cancer risk, stage, and survival. \u003cem\u003eBreast Cancer Res Treat.\u0026nbsp;\u003c/em\u003e2019;177(3):537-548.\u003c/li\u003e\n \u003cli\u003ePringle S, Ko EM, Doherty M, Smith AJB. Addressing transportation barriers in oncology: existing programs and new solutions. \u003cem\u003eSupportive Care in Cancer.\u0026nbsp;\u003c/em\u003e2024;32(5):317.\u003c/li\u003e\n \u003cli\u003eSmith GL, Lopez-Olivo MA, Advani PG, et al. Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes. \u003cem\u003eJournal of the National Comprehensive Cancer Network : JNCCN.\u0026nbsp;\u003c/em\u003e2019;17(10):1184-1192.\u003c/li\u003e\n \u003cli\u003eChen M, Wu VS, Falk D, Cheatham C, Cullen J, Hoehn R. Patient Navigation in Cancer Treatment: A Systematic Review. \u003cem\u003eCurrent Oncology Reports.\u0026nbsp;\u003c/em\u003e2024;26(5):504-537.\u003c/li\u003e\n \u003cli\u003eMosher CE, Ott MA, Hanna N, Jalal SI, Champion VL. Coping with physical and psychological symptoms: a qualitative study of advanced lung cancer patients and their family caregivers. \u003cem\u003eSupportive Care in Cancer.\u0026nbsp;\u003c/em\u003e2015;23(7):2053-2060.\u003c/li\u003e\n \u003cli\u003eG\u0026ouml;nderen \u0026Ccedil;akmak HS, Kapucu S. The Effect of Educational Follow-Up with the Motivational Interview Technique on Self-Efficacy and Drug Adherence in Cancer Patients Using Oral Chemotherapy Treatment: A Randomized Controlled Trial. \u003cem\u003eSeminars in Oncology Nursing.\u0026nbsp;\u003c/em\u003e2021;37(2):151140.\u003c/li\u003e\n \u003cli\u003eWu J-R, Mark B, Knafl GJ, Dunbar SB, Chang PP, DeWalt DA. A multi-component, family-focused and literacy-sensitive intervention to improve medication adherence in patients with heart failure\u0026ndash;A randomized controlled trial. \u003cem\u003eHeart \u0026amp; Lung.\u0026nbsp;\u003c/em\u003e2019;48(6):507-514.\u003c/li\u003e\n \u003cli\u003eDang TH, Forkan ARM, Wickramasinghe N, et al. Investigation of Intervention Solutions to Enhance Adherence to Oral Anticancer Medicines in Adults: Overview of Reviews. \u003cem\u003eJMIR cancer.\u0026nbsp;\u003c/em\u003e2022;8(2):e34833.\u003c/li\u003e\n \u003cli\u003eMagalh\u0026atilde;es B, Fernandes C, Martinez-Galiano JM, Santos C. Exploring the use of Mobile applications by cancer patients undergoing chemotherapy: A scoping review. \u003cem\u003eInternational journal of medical informatics.\u0026nbsp;\u003c/em\u003e2020;144:104293.\u003c/li\u003e\n \u003cli\u003eDang TH, Wickramasinghe N, Jayaraman PP, et al. Digital Solution to Support Medication Adherence and Self-Management in Patients with Cancer (SAMSON): Pilot Randomized Controlled Trial. \u003cem\u003eJMIR Form Res.\u0026nbsp;\u003c/em\u003e2025;9:e65302.\u003c/li\u003e\n \u003cli\u003eEscriva Boulley G, Leroy T, Berneti\u0026egrave;re C, Paquienseguy F, Desfriches-Doria O, Pr\u0026eacute;au M. Digital health interventions to help living with cancer: A systematic review of participants\u0026apos; engagement and psychosocial effects. \u003cem\u003ePsycho-Oncology.\u0026nbsp;\u003c/em\u003e2018;27(12):2677-2686.\u003c/li\u003e\n \u003cli\u003eAlthubaiti A. Information bias in health research: definition, pitfalls, and adjustment methods. \u003cem\u003eJournal of multidisciplinary healthcare.\u0026nbsp;\u003c/em\u003e2016;9:211-217.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Health beliefs, Medication adherence, Cancer survivorship, Oral anticancer medications, Patient-centered care, Qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-8008014/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8008014/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eThis study explored cancer survivors\u0026rsquo; health beliefs about oral anticancer medications (OAMs) and examined how these beliefs influence adherence-related decision-making, while identifying barriers and strategies to support cancer management.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eTwelve patients with cancer using OAMs, previously categorized into three health belief profiles, were interviewed virtually. Thematic analysis and theme mapping were used to examine the complexity of how survivors formed beliefs about cancer and OAM use.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSurvivors expressed diverse beliefs that shaped coping, adherence, and engagement with care. Three domains emerged: positive beliefs reinforcing trust in providers and treatment; negative beliefs focused on recurrence, side effects, and systemic barriers; and varied beliefs about OAMs influenced by information sources and support networks.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eSurvivors\u0026rsquo; health beliefs influenced adherence and coping, underscoring the need for tailored education, communication, and support. Personalized, profile-based interventions are essential to strengthen treatment confidence and guide patient-centered survivorship care.\u003c/p\u003e","manuscriptTitle":"From Optimistic to Overwhelmed: Exploring Health Beliefs and Barriers to Oral Anticancer Medication Adherence Among Cancer Survivors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 12:36:35","doi":"10.21203/rs.3.rs-8008014/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-28T23:00:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T16:02:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-15T09:15:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"104619530938588273365007246670235339688","date":"2026-03-13T01:52:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97117714088972720657686907787647936840","date":"2026-03-03T08:43:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-08T20:09:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-08T20:07:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-14T00:26:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2025-11-01T21:57:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"14675d56-377e-45d1-8808-2912e87d8885","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T21:53:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 12:36:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8008014","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8008014","identity":"rs-8008014","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}