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BACKGROUND Globally, breast cancer has been identified as the most common cancer among women. The clinical efficacy of adjuvant oral antiestrogen therapy-including tamoxifen and aromatase inhibitors-has been proven to be clinically efficacious for breast cancer survivors. However, medication adherence for these therapies remains suboptimal among breast cancer survivors. OBJECTIVE The aim of this study was to evaluate the effect of a reminder intervention-a smart pill bottle paired with the Pillsy mobile application-on medication adherence, medication self-efficacy, and depression, among breast cancer survivors who were undergoing oral antiestrogen therapy. METHODS This study is a randomized controlled trial. Sixty-one women were allocated to an experimental group (n = 31) and the control group (n = 30). The experimental group received the reminder intervention of a smart pill bottle for 4 weeks. Study outcomes were identified as medication adherence, medication self-efficacy, and depression. RESULTS Fifty-seven women completed the follow-up measurement. Significant differences in favor of the experimental group were noted for medication adherence (P = .004) and medication self-efficacy (P = .004). There was no statistically significant difference between the 2 groups with regard to depression (P = .057). CONCLUSIONS Reminder intervention using smart pill bottles was effective in improving medication adherence and medication self-efficacy among breast cancer survivors undergoing oral antiestrogen therapy. IMPLICATIONS FOR PRACTICE A smart pill bottle method of intervention can be a useful reminder strategy to improve medication adherence among breast cancer survivors.

Background Recognition of the importance of self-management (SM) for breast cancer survivors (BCSs) is increasing, but evidence from investigations of their needs focusing on SM is limited. Objectives The aim of this study was to explore the SM needs of BCSs who had completed treatment. Methods Using a qualitative study design, we interviewed a focus group of 20 BCSs who underwent cancer therapy (mean time since diagnosis 3.4 years) at a university hospital in South Korea. Data were analyzed via conventional content analysis. Results The focus group interviews revealed 10 subthemes that we organized into 5 themes about the posttreatment SM needs of BCSs: (1) symptom management needs, (2) emotional management needs, (3) information acquisition needs, (4) need for a relationship with healthcare providers, and (5) adaptation needs. Specifically, participants needed to acquire SM skills to relieve symptoms (eg, peripheral neuropathy, insomnia), deal with emotional problems (eg, fear of recurrence, anxiety, depression), and adapt to changes due to cancer treatment (eg, body image, lifestyle, and role changes). In particular, participants expressed a substantial need for a constructive relationship with healthcare providers who, by respecting and communicating with them, would help empower them. Participants placed a high value on building self-confidence for successful SM. Conclusions Our findings can contribute to the development of breast cancer survivorship care plans by emphasizing posttreatment SM. Implications for practice Future SM support intervention for BCSs after treatment should focus on training SM skills, enhancing the survivor-provider relationship, and building survivor self-confidence.

BACKGROUND Self-efficacy has become the target outcome of many self-management interventions for cancer survivors. However, no measurement is available that can be used to measure cancer-specific self-efficacy in Korea. OBJECTIVE The aim of this study was to cross-culturally evaluate the reliability and validity of a Korean version of the Cancer Survivors' Self-Efficacy Scale (CSSES-K). METHODS We translated the original version of the CSSES (11 items) and created a Korean version. We then conducted a validation study with 204 cancer survivors who had completed their primary treatment. We conducted psychometric evaluation using item analysis, factorial construct validity (exploratory factor analysis and confirmative factor analysis), hypothesis testing construct validity, and internal consistency reliability (Cronbach's α). RESULTS Exploratory factor analysis revealed 2 subscales for which model fitting was appropriate-"self-efficacy for managing health problems" (5 items) and "self-efficacy for seeking help and support" (5 items). Hypothesis testing construct validity was confirmed showing significant moderate correlations between the CSSES-K and general self-efficacy (r = 0.511, P < .001), anxiety (r = -0.596, P < .001), depression (r = -0.554, P < .001), and health-related quality of life (r = 0.586, P < .001). The internal consistency of the CSSES-K of total scale and subscales was high (Cronbach's α = .86-.92). CONCLUSIONS The results supported that the CSSES-K was valid and reliable in measuring self-efficacy among Korean cancer survivors after cancer treatment. IMPLICATIONS FOR PRACTICE Our findings suggest that the CSSES-K can be effectively used for measuring self-efficacy in Korean cancer survivors.

Background Cancer treatment-induced bone loss is an important long-term effect in breast cancer survivors, but evidence regarding lifestyle interventions for preventing cancer treatment-induced bone loss is lacking. Objective The aim of this study was to investigate the feasibility, safety, and effects of a 6-month combined home-based exercise and calcium and vitamin D supplements (EX + SUPP) intervention compared with calcium and vitamin D supplements alone (SUPP) on bone health of osteopenic breast cancer survivors. Methods In this pilot randomized controlled trial, we enrolled 43 women with breast cancer who were diagnosed as osteopenic through bone mineral density screening. Women were randomly assigned to the EX + SUPP group (n = 23) or the SUPP group (n = 20). Results The rates of participant retention (90.7%) and of counseling calls delivered to the EX + SUPP group (90.3%) were high. The average exercise adherence rate was 69.5% for weight-bearing exercise and 48.5% for resistance exercise. The EX + SUPP group reported no injuries or adverse events. Despite positive findings of adherence and safety, no significant group differences were observed for bone mineral density, bone turnover marker, or physical performance. Conclusions A home-based exercise program for bone health among osteopenic breast cancer survivors is feasible and safe. There was no significant additive effect of exercise on bone outcomes under the conditions studied, however, suggesting the need for a larger trial. Implications for practice Effective exercise intervention may require more intensive components such as higher loading forces and longer duration for improving bone health among this population.

Background Cancer treatment-induced bone loss has important long-term effects in prostate cancer survivors (PCSs) receiving androgen deprivation therapy (ADT), but little is known about preventive interventions. Objective The aim of this study was to examine the feasibility and preliminary effectiveness of a 6-month home-based exercise intervention in PCSs. Methods In this pilot, randomized controlled trial, 51 men (mean age, 70.8 years) were randomized to a 6-month home-based exercise intervention for preventing osteoporosis group (n = 26) or an exercise placebo intervention of stretching exercise group (n = 25). Primary outcomes were bone mineral density and bone turnover markers. Secondary outcomes were physical performance (level of physical activity, muscle strength, and balance) and health-related quality of life. Results The patient retention rate for 6 months was 80.4%. The mean adherence rate was 84.7% for weight-bearing exercise and 64.8% for resistance exercise. No adverse events during the study period were reported. Although primary outcomes did not differ significantly between the 2 groups, the home-based exercise intervention for preventing osteoporosis group demonstrated significantly greater increased muscle strength than the stretching exercise group. Conclusions A home-based exercise program is relatively feasible and safe and may improve muscle strength but not bone outcomes. Implications for practice Given the importance of preventing cancer treatment-induced bone loss among PCSs receiving ADT, a home-based exercise intervention can be considered, but further trials with a larger sample are required to determine its effect for bone outcomes.

Background At the time of diagnosis, patients with cancer are highly exposed to the risk of psychological morbidity. The effects of psychosocial intervention for newly diagnosed cancer patients have not been extensively studied. Objective The objective of this study was to test the effects of a dyadic peer support intervention on self-efficacy, anxiety, depression, and mental adjustment among newly diagnosed breast cancer patients in Korea. Methods This study used a randomized controlled trial design. One hundred twenty-nine patients were recruited within 1 month of diagnosis with breast cancer in the National Cancer Center in Korea. The study participants were randomly assigned to either experimental (n = 64) or control (n = 65) group. The experimental group underwent dyadic peer support intervention during the 6 weeks after surgery. The control group received the usual care. Results There was a significant difference in changes in self-efficacy for self-management of breast cancer between the experimental and control groups; however, no significant changes were observed in anxiety, depression, and mental adjustment between the 2 groups. Conclusions A 6-week dyadic peer support intervention was feasible and effective for increasing self-efficacy for self-management among newly diagnosed breast cancer patients in Korea. However, this intervention did not improve other psychological outcomes. Implications for practice Oncology nurses are optimally positioned to promote adjustment in patients with cancer. Trained peer support partners, supervised by skilled nurses, may be useful in improving self-efficacy of patients newly diagnosed with breast cancer.