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

Breast Cancer Research and Treatment volume 167, pages 615–633 (2018)Cite this article

Abstract

Background

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.

Purpose

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

Methods

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.

Results

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.

Conclusions

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.

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Fig. 1

Abbreviations

AET:

Adjuvant endocrine therapy

AI:

Aromatase inhibitor

BrCa:

Breast cancer

HCP:

Healthcare provider

QOL:

Quality of life

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Acknowledgements

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

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Affiliations

  1. School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada

    Leah K. Lambert & A. Fuchsia Howard

  2. College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada

    Lynda G. Balneaves

  3. School of Population and Public Health, University of British Columbia, V2206 East Mall, Vancouver, BC, V6T 1Z3, Canada

    Carolyn C. Gotay

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Lambert, L.K., Balneaves, L.G., Howard, A.F. et al. Patient-reported factors associated with adherence to adjuvant endocrine therapy after breast cancer: an integrative review. Breast Cancer Res Treat 167, 615–633 (2018). https://doi.org/10.1007/s10549-017-4561-5

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Keywords

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