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A systematic review of interventions to improve adherence to endocrine therapy

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Abstract

Purpose

Adherence to endocrine therapy for hormone positive breast cancer is a significant problem, especially in minority populations. Further, endocrine therapy reduces recurrence and thus mortality. However, little data are available on interventions to improve adherence. The authors conducted a systematic review to examine the impact of interventions, strategies, or approaches aimed to improve endocrine therapy adherence among women with breast cancer. A secondary aim was to determine if interventions had any cultural modifications.

Methods

Two of the authors examined articles published between 2006 and 2017 from a wide variety of databases using Covidence systematic review platform.

Results

In total, 16 eligible studies met criteria for review including 4 randomized controlled trials, 4 retrospective studies, and 8 with various observational designs. Eligible studies used a broad range of definitions for adherence and measured adherence by self-report, medical records, claims data, and combinations of these. All used 80% medication possession ratio as a standard for adherence. Patient information/education was the most frequent intervention strategy but did not demonstrate a significant effect except in one study. Significant results were noted when education was combined with communication strategies.

Conclusions

Researchers need a standard definition for adherence and a reliable measure that is feasible to use in a variety of studies. While education may be a necessary component of an intervention, when used alone, it is not a sufficient approach to change behavior.

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Funding

Dr. Felder was supported by a Mentored Research Scientist Development Award to promote diversity from the National Cancer Institute of the National Institutes of Health (K01CA193667). Parker was supported by a training Grant from the Susan G. Komen® Foundation (GTDR17500160). Babatunde was supported by grant # 1F99CA22272201 from the National Cancer Institute. Heiney received partial funding for this paper from and ASPIRE grant from the Vice President of Research Office, University of South Carolina.

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Authors and Affiliations

  1. College of Nursing, School of Medicine, University of South Carolina, 1601 Greene St, Columbia, 29208, SC, USA

    Sue P. Heiney

  2. College of Nursing, University of South Carolina, Columbia, USA

    Pearman D. Parker & Jennifer M Hulett

  3. College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA

    Tisha M. Felder & Swann Arp Adams

  4. Arnold School of Public Health, University of South Carolina, Columbia, USA

    Omonefe O. Omofuma

Authors
  1. Sue P. Heiney
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  2. Pearman D. Parker
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  3. Tisha M. Felder
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  4. Swann Arp Adams
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  5. Omonefe O. Omofuma
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  6. Jennifer M Hulett
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Contributions

SH: Conceptualization and plan for this review, completed the article screening, selection, and data extraction; assisted with data synthesis and contributed to the manuscript preparation. TF: Conceptualization and plan for this review; assisted with data synthesis and contributed to the manuscript preparation. PP: Contributed to the conceptualization and plan for this review, completed the article screening, selection and data extraction; assisted with data synthesis and contributed to the manuscript preparation. OO: Completed the article screening, selection, and data extraction; assisted with data synthesis and contributed to the manuscript preparation. SA: Assisted with data synthesis and contributed to the manuscript. JH: Assisted with review and editing of the manuscript.

Corresponding author

Correspondence to Sue P. Heiney.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Heiney, S.P., Parker, P.D., Felder, T.M. et al. A systematic review of interventions to improve adherence to endocrine therapy. Breast Cancer Res Treat 173, 499–510 (2019). https://doi.org/10.1007/s10549-018-5012-7

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