Sudanese Pharmacists' Knowledge, Attitudes, Practices, and Barriers Regarding Breast Cancer Endocrine Therapy: A Cross- Sectional Survey

Breast cancer represents one of the most frequent causes of morbidity and mortality in Sudan, and late diagnosis, lack of access to specialist care, and socioeconomic factors limit the results of its treatment. Endocrine therapy, which includes the use of tamoxifen, letrozole, and anastrozole, is of vital importance for treating hormone-receptor-positive breast cancer. However, their proper use depends on pharmacists' activities, which should include counselling, ensuring adherence, monitoring adverse effects and interactions, and identifying treatment problems.

In the current cross-sectional study, the knowledge, attitude, practice, and barriers of Sudanese pharmacists toward breast cancer pharmacotherapy were studied using a questionnaire survey method. The structured, self-administered online questionnaire was distributed across Sudan. Descriptive and inferential statistical methods were used, including the binary logistic regression, which helped to reveal the independent predictors of good knowledge, favorable attitudes, and practice. The significance level was established to be p < 0.05.

A total of 405 Sudanese pharmacists filled out the questionnaire. Most respondents were females (65.9%), aged from 26 to 30 years old (44.0%), had a bachelor's degree in pharmacy (70.9%), and worked in community pharmacies (75.3%). Overall, 52.6% showed good knowledge, 50.1% had a positive attitude, and 50.1% reported good practice concerning tamoxifen, letrozole, and anastrozole. Knowledge was significantly associated with job type (p = 0.002), and practice depended on job type (p = 0.001) and participation in educational programs and workshops (p < 0.001). Also, knowledge was significantly associated with practice (p < 0.001). Multivariable analysis revealed that pharmacists with more than 10 years of work experience had higher odds of good knowledge than those with less than 5 years of experience (OR = 3.095, 95% CI: 1.188-8.064; p = 0.021), while clinical pharmacists had higher odds of good knowledge than those who did not report clinical pharmacy work (OR = 2.827, 95% CI: 1.006-7.942; p = 0.049). No examined factors were significantly associated with positive attitude. Attendance at an educational program was associated with higher odds of good practice (OR = 3.546, 95% CI: 2.240-5.612; p < 0.001).

Moderate knowledge and practice in combination with a favorable attitude toward breast cancer endocrine therapy were revealed among Sudanese pharmacists. Job type and education in oncology represent the main predictors of pharmacists' practice, highlighting the need for structured continuing education and stronger pharmacist integration into multidisciplinary cancer care.