Barriers and facilitators of adjuvant hormone therapy adherence and persistence in women with breast cancer: a systematic review

Abstract

PurposeNonadherence to hormone therapy in breast cancer survivors is common and associated with increased risk of mortality. Consistent predictors of nonadherence and nonpersistence are yet to be identified, and little research has examined psychosocial factors that may be amenable to change through intervention. This review aimed to identify predictors of nonadherence and nonpersistence to hormone therapy in breast cancer survivors in order to inform development of an intervention to increase adherence rates.MethodsStudies published up to April 2016 were identified through MEDLINE, Embase, Web of Science, PsycINFO, CINAHL and gray literature. Studies published in English measuring associations between adherence or persistence and any predictor variables were included. Eligible studies were assessed for methodological quality, data were extracted and a narrative synthesis was conducted.ResultsSixty-one eligible articles were identified. Most studies focused on clinical and demographic factors with inconsistent results. Some evidence suggested that receiving specialist care and social support were related to increased persistence, younger age and increased number of hospitalizations were associated with nonadherence, and good patient–physician relationship and self-efficacy for taking medication were associated with better adherence. A small amount of evidence suggested that medication beliefs were associated with adherence, but more high-quality research is needed to confirm this.ConclusionSome psychosocial variables were associated with better adherence and persistence, but the results are currently tentative. Future high-quality research should be carried out to identify psychosocial determinants of nonadherence or nonpersistence that are modifiable through intervention.

The association of pharmacy fill synchronization with breast cancer endocrine therapy adherence

“…Our results are also notable given the current literature regarding the other most commonly cited barriers to adherence . According to a number of studies, side effects play a large role in nonadherence to endocrine therapy.…”

“…Our study contributes to the literature by showing several potentially remediable health delivery–related factors that play a role in nonadherence to AET. Prior studies of cancer medication delivery have primarily focused on costs . With the advent of generic alternatives to aromatase inhibitors, cost barriers actually appear to be decreasing.…”

“…Prior studies of cancer medication delivery have primarily focused on costs. 23,24 With the advent of generic alternatives to aromatase inhibitors, cost barriers actually appear to be decreasing. Several studies in the 2000s showed that out-of-pocket costs were a barrier to adherence, but recent evidence suggests that adherence improved when manufacturers released generic aromatase inhibitors in 2011.…”

Applying the theory of planned behavior to examine adjuvant endocrine therapy adherence intentions

“…The importance of self‐efficacy coincides with the meta‐analysis of adherence in chronic conditions and with Moon and colleagues' study about AET, in particular. However, a recent systematic literature review only retrieved three papers that measured self‐efficacy and found a positive association between self‐efficacy and AET adherence. Future studies should examine strategies to increase survivors' confidence in adhering to AET.…”

“…The impact of subjective norms in adherence warrants further attention. None of the 61 studies included in a recent systematic review measured subjective norms. Prescriptive norms were associated with adherence intentions in our study.…”