treatment of cancer has shifted to greater use of oral cancer agents , transferring responsibility for medication management to the patient . therapy with oral aromatase inhibitors ( ais ) like anastrozole has been shown to improve clinical outcomes for postmenopausal women with early stage breast cancer ; however , women have difficulty taking their medication for the generally prescribed five - year course . care cancer treatment prescribed to prevent recurrence , but most women receiving this treatment do not have active cancer . self - management has been defined as one 's ability to manage symptoms , treatment , physical and psychosocial consequences , and lifestyle changes that are fundamental to living with a chronic condition such as cancer . self - management for postmenopausal women with early stage breast cancer includes medication - taking with oral ai therapy , which requires women to perform activities such as identifying and counting pills , timing of pill taking , and obtaining and refilling prescriptions . qualitative inquiry provides unique information concerning the medication - taking experiences for patients with chronic disorders [ 46 ] , but little research has focused on the medication - taking experiences for patients with cancer . [ 7 , 8 ] explored the reasons patients with cancer have trouble taking their pain medication ; however , the purpose of analgesia is different from that of medication for prevention of recurrence of breast cancer . the two published studies examining medication - taking for patients with cancer have been conducted for children or adolescents with leukemia [ 9 , 10 ] , who have different issues related to medication - taking including developmental concerns such as egocentrism , concrete thinking , and parental involvement . thus , to address this gap in the literature , our purpose was to describe the medication - taking experiences of postmenopausal women with early stage breast cancer who were receiving the oral hormonal agent , anastrozole . we sought to answer the question :  what are the experiences of women who take anastrozole therapy ? we wished to learn how women with early stage breast cancer managed their anastrozole therapy daily , rather than whether or not they took it as prescribed . as such , we used qualitative description to generate a complete narrative of the medication - taking experiences of women with early stage breast cancer who are prescribed anastrozole therapy . qualitative description as a method guides analysis and interpretation of data to produce findings that are close to the data , which is appropriate when little research about a particular phenomenon exists . we accessed an existing sample and data from an ongoing study , the anastrozole use in menopausal women ( aim ) study , which examines the effect of anastrozole on cognitive function in women with early stage breast cancer (  the aim study  ) . the aim study includes postmenopausal women less than 75 years old who speak and read english and have completed at least eight years of education . women are excluded for self - reported hospitalization for psychiatric illness within the last two years , prior diagnosis of other cancers and neurologic illness ( e.g. , stroke , multiple sclerosis , dementia syndrome ) , and distant metastases . adherence to anastrozole is assessed continuously using an electronic medication event monitoring system ( mems ) ( aardex , ltd . ) . mems is a bottle cap with a microprocessor that records the date and time of each cap opening from a standard medication bottle ( i.e. , not the weight of the bottle ) . access to the aim study participants allowed us a unique opportunity to answer our research question about the experience of medication - taking and full scope of medication - taking behaviors in this sample . the university of pittsburgh institutional review board approved the  current study ,  a followup to the aim study . at the time we began our study ( 2009 ) the aim study pi sent mailings to these 47 women to determine their interest in participating in the follow - up study . interested women contacted the researcher ( kw ) , who then described the purpose of the interviews by telephone . the researcher ( kw ) performed in - depth semistructured interviews ( n = 12 ) , averaging 30 to 40 minutes in length , using an interview guide of open - ended questions adapted from two previous qualitative studies of medication - taking [ 6 , 14 ] . questions included asking women about what it was like to take anastrozole , how and why they began taking it , how it made them feel , how it was different from their previous treatments , how they took it on a typical day and the strategies they used , what they found difficult about taking anastrozole , forgetting to take it , and who helped them manage their medication . interviews conducted at a convenient private location ( n = 6 ) were shorter in duration , but not less informative , than those performed in the participant 's home ( n = 6 ) . interviews were audio - recorded with observational notes for recording of the participant 's nonverbal cues and eye contact . the following demographic and clinical data available from the aim study database were used to describe the sample . sociodemographic information was collected using the university of pittsburgh , school of nursing , center for research in chronic disorders sociodemographic questionnaire . women 's depressive symptoms were measured using the beck depression inventory - ii ( bdi - ii ) . anxiety was assessed with the profile of mood states ( poms ) tension - anxiety subscale . information concerning stage of breast cancer , tumor type , radiation therapy , and chemotherapy was abstracted from the patient medical record . side effects of hormonal therapy were assessed with the breast cancer prevention trial ( bcpt ) symptom checklist [ 17 , 18 ] . bdi - ii , poms , and bcpt data from the aim study 6-month and 18-month time points ( closest to the interviews with the most complete data ) were used for the analysis . as another form of description of medication - taking of anastrozole , we categorized women according to their mems cap adherence rate : 100% adherers , good - adherers ( 9099% ) , adequate - adherers ( 8089% ) , and low - adherers ( below 80% ) . women who discontinued or who were switched to another ai by their oncologist due to toxicities were included , because therapy discontinuation is an important variation ( and perhaps consequence ) of medication - taking . the researcher ( kw ) reviewed each transcript while listening to the audiotape with observational notes for accuracy and for an understanding of the participant 's focus . all interviews were transcribed in a word document and then uploaded into atlas.ti ( 6.2.27 ) ( atlas.ti scientific software development gmbh , berlin , germany ) to manage and organize the data . we developed a timeline for each woman that outlined the timing of her breast cancer diagnosis , the start of anastrozole , and the side effects she experienced after beginning anastrozole to gain a sense of her overall experience with this treatment . probes were added about forgetting to take medication ( e.g. ,  how did you realize you forgot ?  ) , unexpected events that affected medication - taking ( e.g. , vacation / travel ) , and information received at therapy initiation ( e.g. , descriptive statistics were computed using ibm spss statistics v.20.0 ( armonk , ny ) to describe the data distributions and to characterize the study sample . we used the independent samples t - test ( or mann - whitney u - test , if data were nonnormal ) and the chi - square test of independence ( or fisher exact test , if cell sizes were sparse ) to compare women in the current study with women in the aim study to investigate whether there were any significant differences between the two groups . qualitative content analysis   was the primary method for data analysis . for each interview , the researcher ( kw ) examined the data line by line to label ( open code ) text related to the women 's medication - taking experiences , using the interview questions as a guide . matrices were constructed for comparison and pattern recognition of participant characteristics ( sociodemographic , breast cancer type and treatment , adherence level ) , side effects , depressive symptoms , and anxiety , merging qualitative data , and quantitative measures ( bcpt , bdi - ii , poms ) . numerical counts were used to characterize the strength of the main themes and subthemes within each case . in this report , we use  most  to describe occurrence of a theme in at least nine women . turning points in the analysis included the realization that medication - taking occurred despite side effect presence and severity and the pervasiveness of fear of breast cancer recurrence . sampling , interviewing , and analysis continued until we reached informational redundancy , that is , no new themes or patterns were recognized ( n = 9 ) ; at that time , we enrolled three women for further sample diversity and to confirm existing findings . no new themes emerged and we achieved informational redundancy , but we can not claim full saturation due to limited access to low - adherers and women who discontinued therapy . we implemented the following steps to assure the trustworthiness of the data , analysis , and research process . ( a ) a co - investigator ( mbh ) with expertise in qualitative methods and medication - taking research   audited the data by performing dual coding and review of the data to ensure the credibility of the analysis . ( b ) four members of a weekly group analysis meeting discussed data exemplars , coding , and analytic decisions . ( c ) four follow - up telephone interviews were performed to further clarify developing themes . for example , when several women mentioned that they had friends or relatives who were prescribed anastrozole and were no longer taking it , a follow - up question was added to further explore this experience and key informants ( i.e. , provided rich data about the selected subthemes ) were recontacted to clarify this theme . ( d ) all interview data , notes , and memos were documented using atlas.ti ( 6.2.27 ) ( atlas.ti scientific software development gmbh , berlin , germany ) software . twelve women aged 58 to 67 years were interviewed between june 2009 and april 2010 . all women were white and well educated , and were similar to the women who participated in the aim study ( 98.1% white ) ( table 1 ) . eleven women had been taking anastrozole for two and one - half to three years at the time of their interview . one woman discontinued anastrozole after six months due to arthralgias ( hip pain ) and was then switched to another ai by her oncologist . at the time of her interview women in the current study had six - month adherence levels ranging from 38.4% to 100% ( mean = 87.8% ) , which were similar to women participating in the aim study ( mean = 88.1% ) . in their interviews , the women shared their perceptions about anastrozole (  what i think  ) , their experiences with side effects and side effect severity (  how it makes me feel  ) , and their day - to - day self - management of anastrozole (  what i do  ) . these three main topical categories describe the women 's engagement in self - management of anastrozole and represent key dimensions of self - management in this early phase of breast cancer survivorship . these categories involved an overarching belief in the importance of anastrozole , as well as an imperative to take it . we found that though the women 's side effect experiences were significant , only one woman stopped taking anastrozole due to side effects . the women 's descriptions of their day - to - day medication - taking experiences with anastrozole included barriers and facilitators to taking anastrozole daily . all women assigned a sense of the value , purpose , or importance to anastrozole that offset other challenges associated with managing anastrozole , including side effect severity . the importance of anastrozole was defined as a woman 's awareness or beliefs about therapy , the value , benefit , or relative worth of taking anastrozole , and her commitment or motivation to take anastrozole . most women remained motivated to take anastrozole despite the side effects they experienced : i still take it . ... if i thought that the medication was going to make me have early- onset dementia , i would think about it more , and i do know there 've been some thoughts about that , but i still take it . i do n't want to , ( lowers tone ) get breast cancer again , so , i take it . ... if i thought that the medication was going to make me have early- onset dementia , i would think about it more , and i do know there 've been some thoughts about that , but i still take it . i do n't want to , ( lowers tone ) get breast cancer again , so , i take it . when discussing their beliefs and motivation to take anastrozole , most women used imagery rather than the term  cancer recurrence  : another took it to keep  loose cells [ from ] travelling where they should n't . another woman said ,  that 's very important , that pill ... i want to live ... i want to stay healthy . one participant with 100% adherence described a heightened consciousness about the role of anastrozole : i was conscious of saying ,  okay , do your job in there , arimidex.  ... it was a funny thing . i did n't experience that in the first year and maybe only because i was experiencing those other things [ side effects ] . but , there was this short period of time where i 'd take my water , drink it down and say , okay , do your thing , arimidex , get in there , kill any cells that you see ...  i was conscious of saying ,  okay , do your job in there , arimidex.  ... it was a funny thing . i did n't experience that in the first year and maybe only because i was experiencing those other things [ side effects ] . but , there was this short period of time where i 'd take my water , drink it down and say , okay , do your thing , arimidex , get in there , kill any cells that you see ...  conversely to the above description , two women indicated that it was  no big deal  to take or to miss a dose of anastrozole , presumably meaning that missing one dose would not harm her overall outcome.so i think if you 're taking arimidex over years , they 're [ adrenal glands ] not going to all of a sudden , if you miss one , they 're not going to all of a sudden get back going again when they 've been put to sleep as ... for as long as they have been ... i mean if you skipped a whole month ... or even a whole week ... that might be a different story ... ' cause then they 'd start getting their act back together . so i think if you 're taking arimidex over years , they 're [ adrenal glands ] not going to all of a sudden , if you miss one , they 're not going to all of a sudden get back going again when they 've been put to sleep as ... for as long as they have been ... i mean if you skipped a whole month ... or even a whole week ... that might be a different story ... ' cause then they 'd start getting their act back together . although all women were motivated to take anastrozole and recognized its value , some interviews suggested tension between the desire to prevent cancer recurrence and uncertainty about taking anastrozole . this woman 's comments further revealed ambiguity regarding the value of the medication in preventing cancer recurrence : to me , the benefit of not getting cancer , whether it 's breast or some other site , is certainly more advantageous than putting up with a little bit of wrinkles or some other problem ... but on the other hand , you wonder . to me , the benefit of not getting cancer , whether it 's breast or some other site , is certainly more advantageous than putting up with a little bit of wrinkles or some other problem ... but on the other hand , you wonder . women further indicated that there was a necessity or obligation to take anastrozole that went beyond their belief in its importance . this treatment imperative included her commitment to the program and  wanting to get to the finish line . i want to complete the program as is ,  or externally motivated from a relative , a friend , or a health care provider ,  my mom ... would push me to take it and say  you need to continue on this . several women mentioned an imperative to take anastrozole based  on doctor 's orders . he told me that i 'd have to take it , and so i took it . women were told by their health care provider ( hcp ) to take anastrozole daily , but they were they given no other instructions . the women expressed willingness to discuss their side effects with their oncologist or hcp ; however , they were rarely asked about their experiences . in some cases furthermore , when some women desired specific information about anastrozole , such as what time of day to take the medication , they asked their pharmacist ( or chemist ) . for all women , the opening question ( tell me about your experience taking anastrozole  ) led without prompting to a description of the side effects of anastrozole . all women immediately described challenges with hot flashes and associated sleep disturbances , arthralgias , fatigue , female things  , weight gain or loss , and struggles with forgetfulness or memory loss , regardless of their mems cap adherence level . the women described the timing of when side effects occurred in relation to starting anastrozole ( e.g. , within a few months or right away ) , the time of day the side effects occurred , and the duration of the side effects ( e.g. , lasting a few minutes ) . they described how the side effects affected their daily life or altered their lifestyle , characterization ( e.g. ,  like a torch  ) , frequency ( e.g. , occurring every few hours ) , and their attribution that the side effect was due to anastrozole , another therapy , or a process such as aging . one woman experiencing menopausal - like symptoms stated that anastrozole  threw me back into menopause . another woman characterized her hot flashes : overall it feels like a torch ... the chest area and face and forehead ; my forehead 's like soaking wet now ... they come on real fast and last about a minute or two ... during the night i might wake up it seems every two hours ... like at midnight , two o'clock , four o'clock , six o'clock , and you know it wakes me up and sometimes i ca n't go back to sleep so that is an additional problem . overall it feels like a torch ... the chest area and face and forehead ; my forehead 's like soaking wet now ... they come on real fast and last about a minute or two ... during the night i might wake up it seems every two hours ... like at midnight , two o'clock , four o'clock , six o'clock , and you know it wakes me up and sometimes i ca n't go back to sleep so that is an additional problem . one woman who took anastrozole in combination with chemotherapy described how she felt about her experiences with memory problems : the only thing i do have a problem with , and i have noticed it , is my memory . now i 'm remembering a lot of things ... today , talking to you , but if somebody said , well , i told you that yesterday ,  or  do n't you remember i ...   i ca n't remember . i mean i had a bad memory before ( laughs ) ... but it , it is worse . it is , it is worse . the only thing i do have a problem with , and i have noticed it , is my memory . now i 'm remembering a lot of things ... today , talking to you , but if somebody said ,  well , i told you that yesterday ,  or  do n't you remember i ...   i ca n't remember . i mean i had a bad memory before ( laughs ) ... but it , it is worse . the woman who discontinued ai therapy due to hip pain described the related uncertainty of the underlying cause of her pain : i think once you have cancer you start to think ,  is this mets to the bone , or is this mets somewhere else ... or is it a side effect from the medication  when i take medication , i try not to read the side effects unless i 'm having problems and then i go to the side effects and say , but when i started ... in my hips , and it was at night and i was having trouble sleeping , i just decided that ... this [ anastrozole ] was n't for me . is this mets to the bone , or is this mets somewhere else ... or is it a side effect from the medication  when i take medication , i try not to read the side effects unless i 'm having problems and then i go to the side effects and say , but when i started ... in my hips , and it was at night and i was having trouble sleeping , i just decided that ... this [ anastrozole ] was n't for me . to further explore the problem of the women 's side effects and side effect severity , we constructed profiles of side effects for each participant by combining those side effects reported in interviews with information from the bdi - ii , poms , and bcpt ( table 2 ) . participants reported three to six side effects ; most women ( n = 10 ) reported five or more side effects . low - adherers  reported the same type and number of side effects as the two 100% adherers . the woman who discontinued ai therapy due to side effect severity was classified as a  good  adherer and reported the same five side effects as the other women . women expressed varying levels of depressive symptoms and anxiety when completing the bdi - ii and poms surveys ; however , only one woman expressed these symptoms during her interview , and her scores did not indicate depression or anxiety . this mixed data analysis revealed no patterns between symptom number , type , and severity and adherence category . generally , women used pharmaceuticals ( e.g. , antidepressants ) , physical therapy , or other daily management or compensation strategies to alleviate the side effects they experienced . for example , one woman avoided or limited her activities , while another wrote down tasks or names to remember them . the woman with  summertime blues described her frustration with word - finding problems and how she compensated : i've worked with lots of women , and we all say ( laughter ) estrogen , the menopausal breakdown . but , i have days when i just ... ca n't remember things like names or specific words for thoughts ... and i 'm usually really good . but , i just have days when i ca n't , and i 'm not as articulate ... i just finished helping with the summer camp and we had about 18 college counselors ... i remembered all their names , and once in a while i 'd completely blank ... but i had a notebook , i had my cheat sheet . i 've worked with lots of women , and we all say ( laughter ) estrogen , the menopausal breakdown . but , i have days when i just ... ca n't remember things like names or specific words for thoughts ... and i 'm usually really good . but , i just have days when i ca n't , and i 'm not as articulate ... i just finished helping with the summer camp and we had about 18 college counselors ... i remembered all their names , and once in a while i 'd completely blank ... but i had a notebook , i had my cheat sheet . all women described in detail the actual hand - to - hand , tangible characteristics of taking anastrozole . however , when anastrozole was packaged in blister packs for a short time ( e.g. , a few months ) , the women expressed extreme difficulty and irritation with opening the blister pack . one woman who received two three - month supplies of anastrozole packaged in blister packs described how the packaging affected her daily medication - taking of anastrozole : ... my husband had to get them out ... ( laughter ) maybe they found that out ... but i 'll tell you that was the only time that i considered stopping . because i have arthritis in my hands ... and they 're old hands ... it was very , very difficult . i could n't put it through , you know , so i tried to use a penknife , i tried to flip up the little foil thing ... and sometimes i 'd try to slice off the bubbles like this . ( laughter ) maybe they found that out ... but i 'll tell you that was the only time that i considered stopping . because i have arthritis in my hands ... and they 're old hands ... it was very , very difficult . i could n't put it through , you know , so i tried to use a penknife , i tried to flip up the little foil thing ... and sometimes i 'd try to slice off the bubbles like this . central to self - management of anastrozole for all of the women was the routinization or integration of anastrozole into their everyday lives as anastrozole - taking became a consistent , accepted , or habitual medication self - management practice . they described timing anastrozole administration with meals or other medications , associating it with a visual cue ( e.g. , seeing the bottle on the window sill ) , a central location ( e.g. , kitchen ) , or a storage strategy ( e.g. , weekly pill minder ) . women stated that participation in the aim study helped to routinize their medication - taking practice . most ( n = 11 ) were already taking other prescription medications , vitamins , or supplements and incorporated anastrozole within their established routine . associated with routinization was remembering / forgetting to take anastrozole and their realization , reaction , and strategies for taking anastrozole after forgetting a dose : i was in that aim study and i had the little bottle , and i swear i took it every day , but there was a few times when she ( study nurse ) put it on the little machine to see that i had missed it a few times . now last night i went to bed and i remembered about 1:00 [ am ] and i came down the steps and took it . i was in that aim study and i had the little bottle , and i swear i took it every day , but there was a few times when she ( study nurse ) put it on the little machine to see that i had missed it a few times . now last night i went to bed and i remembered about 1:00 [ am ] and i came down the steps and took it . frequently , remembering was linked to a certain time of day or a storage strategy , such as a weekly pill container . for example , one woman stated she did not forget to take her anastrozole  cause i take it with my morning vitamin , my calcium , and fish oil . another woman described : when i started it , that 's when i put into my day [ pill minder ] ... i 've had no trouble remembering to take it , and that seems to be a good time [ after supper ] since its after my work day , except when i have a meeting , i do n't forget . when i started it , that 's when i put into my day [ pill minder ] ... i 've had no trouble remembering to take it , and that seems to be a good time [ after supper ] since its after my work day , except when i have a meeting , i do n't forget . although women felt they remembered to take anastrozole , over half stated they occasionally missed a dose , only realizing it when noticing the pill was still in the container or her pocket , or when the mems cap was downloaded . both low adhering women discussed the management of their missed doses in a similar manner . sometimes i might play the 12 hour shuffle if i know i did n't take it the night before ... maybe i 'll take it in the morning , and then at bedtime , so it 's probably putting two in one day , but trying to spread them apart , so it 's not quite the same . sometimes i might play the 12 hour shuffle if i know i did n't take it the night before ... maybe i 'll take it in the morning , and then at bedtime , so it 's probably putting two in one day , but trying to spread them apart , so it 's not quite the same . some women described medication - taking as a social or a  mutual medication - taking  experience , referring to taking anastrozole at the same time a spouse or other family member took their own medications . several women mentioned that they had friends or relatives who were prescribed anastrozole and were no longer taking it , but they denied that this deterred them from taking their own anastrozole . solitary  experience in which no one can or needs to help with taking anastrozole . a woman who lived alone stated ,  i just have to do it .  another stated , ... i do n't think he [ husband ] thinks about me taking my medication at all . our purpose was to describe the medication - taking experiences of postmenopausal women with early stage breast cancer who were receiving anastrozole therapy . the women 's engagement in the self - management of anastrozole involved a predominant belief in the importance of anastrozole , as well as an imperative to take it . we found that though their side effect experiences were significant , the women remained motivated to take anastrozole ; only one woman stopped taking anastrozole due to side effects . all medication - taking practices were facilitated by routinization that was interconnected with remember / forgetting to take anastrozole and a storage strategy ( e.g. , pill minder ) . some women noted a mutual medication - taking experience with their spouse , but most felt that taking anastrozole was something they had to manage alone . little research has addressed motivation to take oral ai therapy for women with breast cancer . for example , the atac trialists ' group   found that fewer women withdrew from therapy with anastrozole when compared to tamoxifen , but the reasons for discontinuation were not reported . in a qualitative comparison of 13 stroke patients who were classified as high- and low - adherers , chambers and colleagues   found that both groups reported intentional and nonintentional adherence . although some low - adherers in chambers '   study reported occasionally skipping a medication , stability of a medication routine and beliefs about medication were central themes describing medication self - management in our sample . pound and colleagues   discussed in a metasynthesis of qualitative studies of lay medication - taking experiences that little research focuses on men and women who reject their medications or take their medications without questioning . our results suggest that some women who take anastrozole without question may do so because they believe in the medication 's value and importance . furthermore , the use of imagery and personification in many of the women 's speech is additional evidence of the value and power that the women assigned to anastrozole . the side effects the women reported were consistent with reports of menopausal symptoms induced by breast cancer treatment [ 26 , 27 ] , as well as with previous qualitative research describing women 's experiences with hot flashes , the impact of hot flashes on daily life , and the higher priority that women placed on breast cancer treatment over menopausal symptoms [ 2830 ] . garreau and colleagues   found that women receiving ais switched therapy more often ( 47.5% ) than those taking tamoxifen ( 37% ) . sedjo and devine   found that 30% of women discontinued ai therapy ; of those , 84% discontinued due to side effects . given these findings , we would have expected women in the current study to describe switching or discontinuing ai therapy more often , but 11 of 12 women indicated that side effects did not deter them from taking anastrozole . the fact that the women who were lower - adherers reported the same type and number of side effects as women who were 100% adherers is interesting and suggests that side effects related to ai therapy are significant to women midway through treatment . the impact of side effects on the medication - taking process with ai therapy for breast cancer prevention requires further examination . it is possible that completion of the bcpt , poms , and bdi ii surveys may have primed the women to describe the side effects that they felt were the most important , most persistent , and/or most present . the manner in which women logistically and socially managed anastrozole therapy was consistent with research examining medication - taking for patients with chronic conditions [ 4 , 6 , 32 , 33 ] ; however , in our study , mutual - medication taking went beyond social support or reminding or assisting patients with their medications . rather , it included a partnership with a spouse in the physical taking of anastrozole that was part of her daily routine . furthermore , self - management of medications often involves coordination between the patient and the health care team , but in the current study , the women received little in the way of instructions concerning medication use , side effects , and daily management of anastrozole . this suggests that patient - provider communication and information provision are potentially unmet important needs for women taking anastrozole therapy . the most significant limitation in the current study is the potential influence of participation in the aim study . the women who participated in the interviews were neither nave to research nor to anastrozole adherence , which may have affected their responses . we interviewed all women who responded to the mailings , but most of the women were already successful in self - management of anastrozole . women may have had difficulty recalling their early experiences taking anastrozole , or they may have been primed to discuss side effects due to the recent completion of the aim study surveys . although the women we interviewed were representative of the women who took anastrozole in the aim study , they may not represent postmenopausal women with early stage breast cancer in the general population . racial / ethnic disparities in treatment may affect self - management of medication and should be investigated . qualitative description allows one to fully describe a particular phenomenon ; however , our sampling strategy did not allow us to obtain a complete picture of the women 's process of taking anastrozole . in the current study , the women were approximately midway through their five - year course of therapy ; therefore , they may have been more established in their medication - taking routines and less likely to discontinue anastrozole therapy . interviewing women at earlier points in their treatment may help elicit the full scope of how side effects of hormonal therapies affect medication - taking . while we reached information redundancy in our sample , we did not saturate with regard to those who were low - adherers or who had stopped ai therapy . we were able to interview one participant who had discontinued anastrozole due to hip pain ; however , we may have missed women at the beginning of their treatment who discontinued or were switched to other ais . nonetheless , our results provide a snapshot of the way some women at approximately the midpoint of their hormonal therapy manage their medications , and thus may inform interventions that would aid them in completing the full five years of anastrozole therapy . the women 's experiences suggest several implications for clinical practice concerning medication self - management . given that women were offered minimal information about taking anastrozole therapy , provision of information about anastrozole , its side effects , and how and when to take it may be beneficial , beginning with the first clinic visit with ongoing reassessment at subsequent clinic visits . second , while most women indicated they experienced similar side effects , the trajectory of those side effects differed among the women . this suggests that ongoing side effect assessment by the health care team is needed even after therapy is well established . finally , questions focusing on the patient 's medication - taking experiences as a whole , rather than an overall verbal assessment of adherence , may prompt further discussion , including why they do or do not take their medication . our study offers a unique perspective into the medication - taking experiences of some postmenopausal women with early stage breast cancer who were midway through a course of anastrozole who were successful at self - management of anastrozole therapy . while reports examining the end result of self - management of medication ( adherence ) have been published , reports of research explaining how women view their experiences taking oral hormonal therapy are lacking . our results help explain why some women , regardless of their measured adherence level , take anastrozole therapy without question and continue despite the side effects of anastrozole . next steps should include investigations of medication - taking about : ( a ) women who are low - adherers to ai therapy ; ( b ) socioeconomically and ethnically diverse patient samples ; ( c ) potential differences between pre- and postmenopausal women , particularly side effect severity and medication - taking ; ( d ) effects of medication - taking on clinical outcomes ; and , ( e ) women with breast cancer taking oral targeted therapies .
the oral hormonal agent anastrozole improves clinical outcomes for women with breast cancer , but women have difficulty taking it for the five - year course . 
 the unique medication - taking experiences related to self - management of anastrozole therapy for women with early stage breast cancer are not known . 
 our purpose was to describe the medication - taking experiences for postmenopausal women with early stage breast cancer who were prescribed a course of anastrozole therapy . 
 twelve women aged 58 to 67 years , midway through therapy , participated in audio - recorded interviews . 
 women 's medication - taking experiences involved a belief in their importance and an imperative to take anastrozole . 
 we found that women 's side effect experiences , particularly menopausal symptoms , were significant , but only one woman stopped anastrozole due to side effects . 
 medication - taking included routinization interconnected with remembering / forgetting and a storage strategy . 
 some women noted a mutual medication - taking experience with their spouse , but most felt taking anastrozole was something they had to do alone . 
 our results provide insight into the way some women with early stage breast cancer manage their hormonal therapy at approximately the midpoint of treatment . 
 next steps should include examinations of patient - provider communication , potential medication - taking differences between pre- and postmenopausal women , and the effects of medication - taking on clinical outcomes .