Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review

Abstract

Background Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). This systematic review aims to: 1) determine the prevalence of adherence and persistence to adjuvant hormonal therapy among breast cancer survivors in clinical practice, and 2) identify correlates of adherence and persistence. Methods We searched Medline, PubMed, PsycINFO, and CINAHL for studies that measured rates and/or correlates of adherence and/or persistence to adjuvant hormonal therapy. Studies were reviewed in a multi-step process: 1) the lead author screened titles and abstracts of all potentially eligible studies; 2) each coauthor reviewed a random 5% sample of abstracts; and 3) two sets of coauthors each reviewed half of all “maybe” abstracts. Any disagreements were discussed until consensus was reached. Results Twenty nine studies met inclusion criteria. Prevalence of adherence ranged from 41–72% and discontinuation (i.e., nonpersistence) ranged from 31–73%, measured at the end of 5 years of treatment. Extremes of age (older or younger), increasing out-of-pocket costs, follow-up care with a general practitioner (vs. oncologist), higher CYP2D6 activity, switching from one form of therapy to another, and treatment side effects were negatively associated with adherence and/or persistence. Taking more medications at baseline, referral to an oncologist, and earlier year at diagnosis were positively associated with adherence and/or persistence. Conclusions/Implications Adherence and persistence to adjuvant hormonal therapy among breast cancer survivors is suboptimal. Many of the correlates of adherence and persistence studied to date are not modifiable. Our review reveals a critical need for further research on modifiable factors associated with adherence to adjuvant hormonal therapy, and the development of behavioral interventions to improve adherence in this population.

Fatores associados à adesão e à persistência na hormonioterapia em mulheres com câncer de mama

“…Such results, similarly to those found by other authors 2,23,24 , confirm that even though adherence to adjuvant hormonal therapy is, in general, high (70 -80%), there is a progressive increase of the non-persistent patients in the treatment throughout time.…”

“…Evidence shows that most of the patients, after completing the "initial" phase of treatment (i.e. surgery, chemotherapy and radiotherapy), do not continue using the oncologist figure as his/her main care provider, which makes the maintenance of hormonal therapy more difficult 2,36,37 . Reasons for therapy discontinuation may change throughout the treatment; therefore, the professional must understand them to overcome them, by emphasizing the importance of its follow-up to patients 38 .…”

“…Studies show that using such drugs to treat breast cancer at early stages may decrease the risk of recurrence and mortality to 15 years and, therefore, it is recommended as a preventive measurement in 75 to 80% of the disease cases 1,2 . In addition, considering that oral medications are used, hormonal therapy may also provide better quality of life to ill subjects with more feeling of control on the therapeutics and less interference in social life 3 .…”

“…Therefore, adherence and persistence should be separately defined and measured to characterize the medication intake in a broader manner, thus providing more understanding on this conduct 8,9 . It is known that adherence and persistence may be influenced by several factors related to the patient, such as treatment, health services, beliefs, and life habits 2,10 . The performance of researches able to measure such phenomena and to portray them in a defined context represents an important strategy for comparing, understanding and producing evidence for health services and professionals to promote the success of the employed therapy, the improvement of patient's quality of life and, finally, the reduction of mortality 2,10,11 .…”

Atrial Fibrillation and Cor Triatriatum Sinister: A Case Report

“…97,98,433 Despite the strong documentation of the effectiveness of AET, it is both surprising and disappointing to note the incredibly high rates of noncompliance to a 5-year regimen, which range from 30% to 70%. 434 Less than 80% compliance at 2.5 years has been associated with increased mortality. 14 Nearly 25% of patients discontinue AET within the first year, and 50% become noncompliant by Year 4, 433,435 despite multiple trials that have shown higher recurrence rates and decreased survival.…”