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. 2016 Aug;16(4):247-255.e3.
doi: 10.1016/j.clbc.2016.03.006. Epub 2016 Mar 31.

Behavioral Interventions to Enhance Adherence to Hormone Therapy in Breast Cancer Survivors: A Systematic Literature Review

Alejandra Hurtado-de-Mendoza  1 , Mark L Cabling  2 , Tania Lobo  1 , Chiranjeev Dash  1 , Vanessa B Sheppard  1
Affiliations

Behavioral Interventions to Enhance Adherence to Hormone Therapy in Breast Cancer Survivors: A Systematic Literature Review

Alejandra Hurtado-de-Mendoza et al. Clin Breast Cancer. 2016 Aug.

Abstract

Adjuvant hormone therapy contributes to reductions in recurrence and mortality for women with hormone receptor-positive breast cancer. However, adherence to hormone therapy is suboptimal. This is the first systematic literature review examining interventions aimed at improving hormone therapy adherence. Researchers followed the PRISMA guidelines. PubMed-Medline, CINAHL, PsychInfo, Ovid-Medline, and EMBASE were searched for behavioral interventions that aimed to enhance adherence to adjuvant hormone therapy in breast cancer survivors. A total of 376 articles were screened for eligibility. Five articles met the study criteria. All interventions presented adherence outcomes after 1-year follow-up. None significantly enhanced adherence compared to the usual care in the primary analysis (odds ratios ranged from 1.03 to 2.06 for adherence and from 1.11 to 1.18 for persistence). All studies targeted patients, and only 3 studies included postmenopausal breast cancer patients. Three tested the same intervention consisting of educational materials. Only one was conducted in the United States. Only one reported participants' ethnicity. Overall, it was unclear whether the studies contained bias. The use of different terminology and operationalization of adherence made comparisons challenging. Interventions to improve adherence to adjuvant hormone therapy in US breast cancer populations that include survivors who are ethnically diverse, premenopausal, and receiving tamoxifen therapy are necessary to inform future interventions. Adoption of consistent adherence definitions/measurements will provide a clearer framework to consolidate aggregate findings. Given the limited efficacy of tested interventions, it is important to engage oncologists and researchers to develop approaches that target different components associated with hormone therapy adherence, such as doctor-patient communication or social support.

Keywords: Breast neoplasm; Clinical trials; Compliance; Patients; Systemic therapy.

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Conflict of interest statement

Conflicts of interest: none

Figures

Figure 1
Figure 1. Literature Review Method
See this image and copyright information in PMC

References

    1. Siegel R, Ma J, Zou Z, et al. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29. - PubMed
    1. Keen JC, Davidson NE. The biology of breast carcinoma. Cancer. 2003;97:825–833. - PubMed
    1. Allison KH. Molecular pathology of breast cancer: What a pathologist needs to know. Am J Clin Pathol. 2012;138:770–780. - PubMed
    1. Davies C, Pan H, Godwin J, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381:805–816. - PMC - PubMed
    1. Hershman DL, Shao T, Kushi LH, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011;126:529–537. - PMC - PubMed

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