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Identifying adherence barriers to oral endocrine therapy among breast cancer survivors

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Abstract

Purpose

Approximately 70–80% of breast cancers are hormone receptor-positive (HR+). OET, including tamoxifen and aromatase inhibitors, is considered standard adjuvant therapy for HR+ breast cancer. Despite demonstrated benefits, nearly half of patients are non-adherent and over two-thirds discontinue therapy before the recommended 5 years. Our objective was to identify and summarize literature-reported barriers associated with non-adherence/non-persistence to OET among breast cancer survivors.

Methods

A PUBMED literature search was conducted using the following terms: ‘breast cancer,’ ‘oral endocrine therapy’ or ‘Tamoxifen’ or ‘Aromatase Inhibitors,’ ‘adherence,’ or ‘barriers.’ The search was restricted to past six years. The abstracts of each result were reviewed and categorized as either patient-reported or physician-reported. All patient- and physician-reported factors that affected adherence and persistence were listed and grouped together into the three main categories: Socio-demographic and medical parameters, general psychosocial parameters, and psychosocial parameters related to OET.

Results

A total of 320 articles were identified, of which 19 met inclusion criteria. Adverse drug reactions were the most commonly reported barrier but were generally underreported among physicians. Among patient-reported barriers, common social-demographic and medical parameters were age, comorbidity, and financial status. General psychosocial variables were lack of patient–provider communication, depressive symptoms, and lack of perceived self-efficacy. Treatment toxicity was the most commonly reported psychosocial parameter related to OET.

Conclusion

The determinants of non-adherence and non-persistence are multi-dimensional and influenced by several factors. The three categories of adherence barriers should be evaluated and considered when designing future interventions to enhance OET adherence for a tailored approach.

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References

  1. Bowles EJ, Buist DS, Chubak J, Yu O, Johnson J, Chestnut J, Boudreau DM (2012) Endocrine therapy initiation from 2001 to 2008 varies by age at breast cancer diagnosis and tumor size. J Oncol Pract 8(2):113–120

    Article  PubMed  PubMed Central  Google Scholar 

  2. Salgado TM, Davis EJ, Farris KB, Fawaz S, Batra P, Henry NL (2017) Identifying socio-demographic and clinical characteristics associated with medication beliefs about aromatase inhibitors among postmenopausal women with breast cancer. Breast Cancer Res Treat 163(2):311–319

    Article  CAS  PubMed  Google Scholar 

  3. Liu Y, Malin JL, Diamant AL, Thind A, Maly RC (2013) Adherence to adjuvant hormone therapy in low-income women with breast cancer: the role of provider-patient communication. Breast Cancer Res Treat 137(3):829–836

    Article  CAS  PubMed  Google Scholar 

  4. Milata JL, Otte JL, Carpenter JS (2018) Oral endocrine therapy nonadherence, adverse effects, decisional support, and decisional needs in women with breast cancer. Cancer Nurs 41(1):E9–E18

    Article  PubMed  PubMed Central  Google Scholar 

  5. Jinih M, Relihan N, Corrigan MA, O’Reilly S, Redmond HP (2017) Extended adjuvant endocrine therapy in breast cancer: evidence and update—a review. Breast J 23(6):694–705

    Article  CAS  PubMed  Google Scholar 

  6. Stanton AL, Petrie KJ, Partridge AH (2014) Contributors to nonadherence and nonpersistence with endocrine therapy in breast cancer survivors recruited from an online research registry. Breast Cancer Res Treat 145(2):525–534

    Article  PubMed  Google Scholar 

  7. Bright EE, Petrie KJ, Partridge AH, Stanton AL (2016) Barriers to and facilitative processes of endocrine therapy adherence among women with breast cancer. Breast Cancer Res Treat 158(2):243–251

    Article  PubMed  Google Scholar 

  8. Harrow A, Dryden R, McCowan C, Radley A, Parsons M, Thompson AM, Wells M (2014) A hard pill to swallow: a qualitative study of women’s experiences of adjuvant endocrine therapy for breast cancer. BMJ Open 4(6):e005285

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brett J, Fenlon D, Boulton M, Hulbert-Williams NJ, Walter FM, Donnelly P, Lavery B, Morgan A, Morris C, Watson E (2018) Factors associated with intentional and unintentional non-adherence to adjuvant endocrine therapy following breast cancer. Eur J Cancer Care 27(1):e12601

    Article  Google Scholar 

  10. Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, Kwan M, Gomez SL, Neugut AI (2011) Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat 126(2):529–537

    Article  CAS  PubMed  Google Scholar 

  11. Makubate B, Donnan PT, Dewar JA, Thompson AM, McCowan C (2013) Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer 108(7):1515–1524

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Tinari N, Fanizza C, Romero M, Gambale E, Moscetti L, Vaccaro A, Seminara P, Longo F, Gori S, Vici P et al (2015) Identification of subgroups of early breast cancer patients at high risk of nonadherence to adjuvant hormone therapy: results of an Italian survey. Clin Breast Cancer 15(2):e131–e137

    Article  PubMed  Google Scholar 

  13. Luschin G, Habersack M (2014) Oral information about side effects of endocrine therapy for early breast cancer patients at initial consultation and first follow-up visit: an online survey. Health Commun 29(4):421–426

    Article  PubMed  Google Scholar 

  14. Milata JL, Otte JL, Carpenter JS (2016) Oral endocrine therapy nonadherence, adverse effects, decisional support, and decisional needs in women with breast cancer. Cancer Nurs 41:E9–E18

    Article  Google Scholar 

  15. Ekinci E, Nathoo S, Korattyil T, Vadhariya A, Zaghloul HA, Niravath PA, Abughosh SM, Trivedi MV (2018) Interventions to improve endocrine therapy adherence in breast cancer survivors: what is the evidence? J Cancer Surviv 12:348–356

    Article  PubMed  Google Scholar 

  16. Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW (2012) Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat 134(2):459–478

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Moon Z, Moss-Morris R, Hunter MS, Carlisle S, Hughes LD (2017) Barriers and facilitators of adjuvant hormone therapy adherence and persistence in women with breast cancer: a systematic review. Patient Prefer Adherence 11:305–322

    Article  PubMed  PubMed Central  Google Scholar 

  18. Font R, Espinas JA, Gil-Gil M, Barnadas A, Ojeda B, Tusquets I, Segui MA, Margeli M, Arcusa A, Prat A et al (2012) Prescription refill, patient self-report and physician report in assessing adherence to oral endocrine therapy in early breast cancer patients: a retrospective cohort study in Catalonia, Spain. Br J Cancer 107(8):1249–1256

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Karmakar M, Pinto SL, Jordan TR, Mohamed I, Holiday-Goodman M (2017) Predicting adherence to aromatase inhibitor therapy among breast cancer survivors: an application of the protection motivation theory. Breast Cancer (Auckl) 11:1178223417694520

    PubMed Central  Google Scholar 

  20. Cluze C, Rey D, Huiart L, BenDiane MK, Bouhnik AD, Berenger C, Carrieri MP, Giorgi R (2012) Adjuvant endocrine therapy with tamoxifen in young women with breast cancer: determinants of interruptions vary over time. Ann Oncol 23(4):882–890

    Article  CAS  PubMed  Google Scholar 

  21. Freedman RA, Revette AC, Hershman DL, Silva K, Sporn NJ, Gagne JJ, Kouri EM, Keating NL (2017) Understanding breast cancer knowledge and barriers to treatment adherence: a qualitative study among breast cancer survivors. Biores Open Access 6(1):159–168

    Article  PubMed  PubMed Central  Google Scholar 

  22. Cahir C, Dombrowski SU, Kelly CM, Kennedy MJ, Bennett K, Sharp L (2015) Women’s experiences of hormonal therapy for breast cancer: exploring influences on medication-taking behaviour. Support Care Cancer 23(11):3115–3130

    Article  PubMed  Google Scholar 

  23. Aiello Bowles EJ, Boudreau DM, Chubak J, Yu O, Fujii M, Chestnut J, Buist DS (2012) Patient-reported discontinuation of endocrine therapy and related adverse effects among women with early-stage breast cancer. J Oncol Pract 8(6):e149–e157

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gallicchio L, Calhoun C, Helzlsouer K (2017) A prospective study of aromatase inhibitor therapy initiation and self-reported side effects. Support Care Cancer 25(9):2697–2705

    Article  PubMed  Google Scholar 

  25. Bluethmann SM, Murphy CC, Tiro JA, Mollica MA, Vernon SW, Bartholomew LK (2017) Deconstructing decisions to initiate, maintain, or discontinue adjuvant endocrine therapy in breast cancer survivors: a mixed-methods study. Oncol Nurs Forum 44(3):E101–E110

    Article  PubMed  PubMed Central  Google Scholar 

  26. Brier MJ, Chambless DL, Gross R, Chen J, Mao JJ (2017) Perceived barriers to treatment predict adherence to aromatase inhibitors among breast cancer survivors. Cancer 123(1):169–176

    Article  CAS  PubMed  Google Scholar 

  27. Wheeler SB, Roberts MC, Bloom D, Reeder-Hayes KE, Espada M, Peppercorn J, Golin CE, Earp JA (2016) Oncology providers’ perspectives on endocrine therapy prescribing and management. Patient Prefer Adher 10:2007–2019

    Article  Google Scholar 

  28. Samuel CA, Turner K, Donovan HAS, Beckjord E, Cardy A, Dew MA, van Londen GJ (2017) Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management. Support Care Cancer 25(12):3723–3731

    Article  PubMed  PubMed Central  Google Scholar 

  29. Brier MJ, Chambless D, Gross R, Su HI, DeMichele A, Mao JJ (2015) Association between self-report adherence measures and oestrogen suppression among breast cancer survivors on aromatase inhibitors. Eur J Cancer 51(14):1890–1896

    Article  CAS  PubMed  Google Scholar 

  30. Lambert LK, Balneaves LG, Howard AF, Gotay CC (2018) Patient-reported factors associated with adherence to adjuvant endocrine therapy after breast cancer: an integrative review. Breast Cancer Res Treat 167(3):615–633

    Article  PubMed  Google Scholar 

  31. Archer DF, Dupont CM, Constantine GD, Pickar JH, Olivier S, Study I (2009) Desvenlafaxine for the treatment of vasomotor symptoms associated with menopause: a double-blind, randomized, placebo-controlled trial of efficacy and safety. Am J Obstet Gynecol 200(3):238–e238

    Article  CAS  Google Scholar 

  32. Bertelli G, Venturini M, Del Mastro L, Bergaglio M, Sismondi P, Biglia N, Venturini S, Porcile G, Pronzato P, Costantini M et al (2002) Intramuscular depot medroxyprogesterone versus oral megestrol for the control of postmenopausal hot flashes in breast cancer patients: a randomized study. Ann Oncol 13(6):883–888

    Article  CAS  PubMed  Google Scholar 

  33. Miller WR, Rollnick S (2009) Ten things that motivational interviewing is not. Behav Cogn Psychother 37(2):129–140

    Article  PubMed  Google Scholar 

  34. Velasquez MSK, Dodrill C, Kan L (2005) The transtheoretical model as a framework for developing substance abuse interventions. J Addict Nurs 16:31–40

    Article  Google Scholar 

  35. Christie D, Channon S (2014) The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: a clinical review. Diabetes Obes Metab 16(5):381–387

    Article  CAS  PubMed  Google Scholar 

  36. Abughosh S, Wang X, Serna O, Esse T, Mann A, Masilamani S, Holstad MM, Essien EJ, Fleming M (2017) A motivational interviewing intervention by pharmacy students to improve medication adherence. J Manag Care Spec Pharm 23(5):549–560

    PubMed  Google Scholar 

  37. DiIorio C, McCarty F, Resnicow K, McDonnell Holstad M, Soet J, Yeager K, Sharma SM, Morisky DE, Lundberg B (2008) Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study. AIDS Care 20(3):273–283

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Ogedegbe G, Chaplin W, Schoenthaler A, Statman D, Berger D, Richardson T, Phillips E, Spencer J, Allegrante JP (2008) A practice-based trial of motivational interviewing and adherence in hypertensive African Americans. Am J Hypertens 21(10):1137–1143

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Departments of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, 4849 Calhoun Road, Houston, TX, 77204-5047, USA

    Rutugandha Paranjpe & Susan Abughosh

  2. University of Houston, College of Pharmacy, 4849 Calhoun Road, Houston, TX, 77204-5047, USA

    Grace John

  3. Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, 4849 Calhoun Road, Houston, TX, 77204-5047, USA

    Meghana Trivedi

  4. Pharmacological and Pharmaceutical Sciences, University of Houston, College of Pharmacy, 4849 Calhoun Road, Houston, TX, 77204-5047, USA

    Meghana Trivedi

Authors
  1. Rutugandha Paranjpe
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  2. Grace John
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  4. Susan Abughosh
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Corresponding author

Correspondence to Susan Abughosh.

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Rutugandha Paranjpe declares that she has no conflict of interest. Grace John declares that she has no conflict of interest. Meghana Trivedi declares that she has no conflict of interest. Susan Abughosh declares that she has no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors. Hence, it does not need any human consent.

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Paranjpe, R., John, G., Trivedi, M. et al. Identifying adherence barriers to oral endocrine therapy among breast cancer survivors. Breast Cancer Res Treat 174, 297–305 (2019). https://doi.org/10.1007/s10549-018-05073-z

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  • DOI: https://doi.org/10.1007/s10549-018-05073-z

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