Breast Cancer Research and Treatment

, Volume 167, Issue 3, pp 615–633 | Cite as

Patient-reported factors associated with adherence to adjuvant endocrine therapy after breast cancer: an integrative review

  • Leah K. LambertEmail author
  • Lynda G. Balneaves
  • A. Fuchsia Howard
  • Carolyn C. Gotay



Adjuvant endocrine therapy (AET) significantly reduces recurrence and mortality in women with breast cancer (BrCa). Despite the efficacy of AET in improving BrCa outcomes, up to 50% of women do not adhere to prescribed AET regimens. While numerous demographic and clinical predictors influence adherence and persistence, few studies have identified the patient-reported factors that influence AET adherence and persistence.


The aim was to examine the patient-reported personal, social, and structural factors influencing BrCa survivors’ adherence and persistence with AET.


An integrative review was undertaken wherein PubMed, Medline, CINAHL, Embase, and PsycINFO databases were searched using keyword descriptors and database subject headings. Inclusion criteria included quantitative or qualitative peer-reviewed studies written in English that assessed AET adherence and/or persistence through objective measurement or self-report and included patient-reported factors found to influence adherence and/or persistence. The data extracted from eligible studies were entered into a matrix, and systematically compared and iteratively analyzed using relational autonomy as an organizing theoretical framework.


A total of 43 manuscripts (9 qualitative and 34 quantitative) were reviewed. Several personal, social, and structural factors were identified that influenced AET adherence and persistence, including side effects, necessity beliefs, self-efficacy, the patient–healthcare provider relationship, social support, and continuity of follow-up care.


An increasing number of studies have focused on identifying the patient-reported factors that influence AET adherence and persistence. This review highlights important personal, social, and structural factors that act as facilitators and barriers in adhering to and persisting with long-term AET. Acknowledging and addressing these factors is key to providing women with the care needed to improve suboptimal adherence and persistence.


Breast cancer Adjuvant endocrine therapy Medication adherence Medication persistence Integrative review Cancer survivorship Patient-reported outcomes 



Adjuvant endocrine therapy


Aromatase inhibitor


Breast cancer


Healthcare provider


Quality of life



LKL was supported by a University of British Columbia Four-Year Fellowship and a CIHR Psychosocial Oncology Research Training (PORT) Fellowship.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Leah K. Lambert
    • 1
    Email author
  • Lynda G. Balneaves
    • 2
  • A. Fuchsia Howard
    • 1
  • Carolyn C. Gotay
    • 3
  1. 1.School of NursingUniversity of British ColumbiaVancouverCanada
  2. 2.College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for NursingUniversity of ManitobaWinnipegCanada
  3. 3.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada

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