Journal Article10.1002/cam4.6937
Identifying determinants of adherence to adjuvant endocrine therapy following breast cancer: A systematic review of reviews.
Adam Todd,Catherine Waldron,Lucy McGeagh,Ruth P. Norris,I.K. Bolnykh,Sarah Jane Stewart,Joanna Slodkowska-Barabasz,Zoe Moon,Caitriona Cahir,Sue Thompson,Victoria Harmer,Mary Wells,Eila Watson,Linda Sharp +13 more
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TL;DR: The evidence-base on ET adherence determinants is extensive and the determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants.
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Abstract: BACKGROUND
In oestrogen-receptor positive breast cancer, daily oral adjuvant endocrine therapy (ET) for at least 5 years significantly reduces risks of recurrence and breast cancer-specific mortality. However, many women are poorly adherent to ET. Development of effective adherence support requires comprehensive understanding of influences on adherence. We undertook an umbrella review to identify determinants of ET adherence.
METHODS
We searched PubMed, Embase, CINAHL, PsycINFO, Cochrane and PROSPERO (inception to 08/2022) to identify systematic reviews on factors influencing ET adherence. Abstracted determinants were mapped to the World Health Organization's dimensions of adherence. Reviews were quality appraised and overlap assessed.
RESULTS
Of 5732 citations screened, 17 reviews were eligible (9 quantitative primary studies; 4 qualitative primary studies; 4 qualitative or quantitative studies) including 215 primary papers. All five WHO dimensions influenced ET non-adherence: The most consistently identified non-adherence determinants were patient-related factors (e.g. lower perceived ET necessity, more treatment concerns, perceptions of ET 'cons' vs. 'pros'). Healthcare system/healthcare professional-related factors (e.g. perceived lower quality health professional interaction/relationship) were also important and, to a somewhat lesser extent, socio-economic factors (e.g. lower levels of social/economic/material support). Evidence was more mixed for medication-related and condition-related factors, but several may be relevant (e.g. experiencing side-effects, cost). Potentially modifiable factors are more influential than non-modifiable/fixed factors (e.g. patient characteristics).
CONCLUSIONS
The evidence-base on ET adherence determinants is extensive. Future empirical studies should focus on less well-researched areas and settings. The determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants.
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Citations
Women's Insights on Extended Adjuvant Endocrine Therapy for Breast Cancer: A Qualitative Online Forums Study (Preprint)
Géraldine Cazorla,Lorène Seguin,Magali Provansal,Sandrine de Montgolfier,Julien Mancini +4 more
TL;DR: This qualitative study explores French women's experiences and information needs regarding extended adjuvant endocrine therapy for breast cancer, highlighting the importance of clear, accessible information and tailored communication tools for informed decision-making and improved treatment adherence.
Adherence to adjuvant endocrine therapy including GnRH-analogues and survival: a population-based cohort study
Louise Eriksson Bergman,Alexios Matikas,Liu Xingrong,Theodoros Foukakis +3 more
Abstract: Summary Background Adjuvant endocrine therapy (AET) combining gonadotropin-releasing hormone analogues (GnRHa) with tamoxifen (TAM) or aromatase inhibitors (AI) improves survival in premenopausal women with breast cancer compared to TAM and is increasingly prescribed. However, there are concerns regarding adherence. Methods Through linkages to Swedish national healthcare registers, we conducted a population-based cohort study including women diagnosed with early, invasive, estrogen receptor-positive breast cancer, January 2007 to December 2020, in the Stockholm-Gotland region, Sweden, with at least one dispensation of oral AET (n = 16,468). Follow-up ended January 14, 2022. AET was categorized based on the first dispensed oral AET (AI or TAM) and if GnRHa had been dispensed within three months of this, into the respective combination group (GnRHa + TAM or GnRHa + AI). Adherence was defined as a medication possession ratio ≥80% over five years for oral AET and two years for GnRHa, or the shortest interval from first dispensation to recurrence, contralateral breast cancer, death, emigration, or end of follow-up, if they preceded five and two years, respectively. To study the association of type of AET and non-adherence, odds ratios (OR) were calculated using logistic regression. The association between non-adherence and invasive breast cancer-free survival (IBCFS) was studied with landmark analysis, calculating hazard ratios (HR) using the Cox proportional hazards model and flexible parametric modeling. Findings Adherence was 86% to AI, 79% to TAM, 75% to both TAM + GnRHa, and AI + GnRHa (p < 0.001). Adjusted OR for non-adherence was 1.40 (95% confidence interval (CI) 1.27–1.55) for TAM, 2.73 (95% CI 2.19–3.40) for TAM + GnRHa, and 2.92 (95% CI 2.24–3.79) for AI + GnRHa, respectively, compared to AI. Adjusted HR of IBCFS were 1.43 (95% CI 1.26–1.64) and 1.19 (95% CI 1.04–1.35) at one- and five-year landmark analysis, respectively, comparing non-adherent to adherent groups. Interpretation Adherence was lower to combination regimens than to single AET, and non-adherence was associated with poorer survival. Future prospective studies are warranted to validate these findings. Funding This work was supported by grants to TF from the Swedish Cancer Society (Cancerfonden) (grant no. 21 1800Pj), Vetenskapsrådet (grant no. 2021-03061), Cancerföreningen i Stockholm (grant no. 234073), and Region Stockholm (Stockholms Läns Landsting) (grant no. FoUI-974936).
Identifying determinants of adherence to adjuvant endocrine therapy following breast cancer: A systematic review of reviews.
Adam Todd,Catherine Waldron,Lucy McGeagh,Ruth P. Norris,I.K. Bolnykh,Sarah Jane Stewart,Joanna Slodkowska-Barabasz,Zoe Moon,Caitriona Cahir,Sue Thompson,Victoria Harmer,Mary Wells,Eila Watson,Linda Sharp +13 more
TL;DR: The evidence-base on ET adherence determinants is extensive and the determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants.
Supporting women with adherence to adjuvant endocrine therapy (SWEET): feasibility study of the HT&Me intervention
Lucy McGeagh,Sarah-Jane Stewart,Ruth Norris,Mary Wells,Sue Thompson,Phil Mawson,Jo Brett,Mark Turner,Jane Wolstenholme,Helen Dakin,Peter Donnelly,Henry Cain,Farah Rehman,Sally Kum,Rob Horne,Guy Taylor,Lesley Turner,Jan Rose,Linda Sharp,Eila Watson,Adam Todd,Caitriona Cahir,Lyndsay Hughes,Brian Nicholson,Andrew Wardley,Janet Dunn,Alice Walker,Zoe Moon,Nicky Levitt,Anne Kendall,Robert Milligan,Victoria Harmer,Colin McCowan,Louise Hiller,Samuel G. Smith,Mia Porteous,Deborah Fenlon,Lucy McGeagh,Sarah-Jane Stewart,Ruth Norris,Mary Wells,Sue Thompson,Phil Mawson,Jo Brett,Mark Turner,Jane Wolstenholme,Helen Dakin,Peter Donnelly,Henry Cain,Farah Rehman,Sally Kum,Rob Horne,Guy Taylor,Lesley Turner,Jan Rose,Linda Sharp,Eila Watson,Adam Todd,Caitriona Cahir,Lyndsay Hughes,Brian Nicholson,Andrew Wardley,Janet Dunn,Alice Walker,Zoe Moon,Nicky Levitt,Anne Kendall,Robert Milligan,Victoria Harmer,Colin McCowan,Louise Hiller,Samuel G. Smith,Mia Porteous,Deborah Fenlon +73 more
Factors Influencing Adherence to Adjuvant Endocrine Therapy After Breast Cancer Surgery
Aina Johnsson,Cynthia Villarreal‐Garza +1 more
TL;DR: This study examines factors influencing adherence to adjuvant endocrine therapy in 81 women with early-stage breast cancer, finding that life satisfaction, vocational situation, and family life satisfaction positively affect adherence, while musculoskeletal and psychological side effects negatively impact adherence.
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Improving compliance and persistence to adjuvant tamoxifen and aromatase inhibitor therapy.
TL;DR: This review evaluates the available data regarding compliance and persistence with adjuvant endocrine therapies for breast cancer (tamoxifen and aromatase inhibitors) and presents strategies for improving adherence.