Adherence to Oral Anticancer Medications Among Women With Breast Cancer in Africa: A Scoping Review

Abstract

PURPOSE Oral anticancer medications (OAMs) improve treatment outcomes and survival in women with breast cancer (BC). However, adherence to OAM therapy remains suboptimal. This scoping review provides evidence of adherence to OAMs among African women with BC. METHODS We searched four databases and gray literature, using guidance from the Joanna Briggs Institute. Thirteen studies on adherence rates, determinants, and interventions were included. NVivo 12 software was used to perform thematic analysis of the included studies. The determinants (barriers and facilitators) associated with adherence were analyzed according to the five dimensions of the WHO multidimensional adherence model. RESULTS Most studies (n = 11, 85%) focused on endocrine medication. Depending on the definition, measurements, and assessment period, the nonadherence rates ranged from 4.3% to 65.4% for endocrine medications, 80.9% for cytotoxic chemotherapies, and 32.7% for combined medications. The significant barriers associated with adherence include Islamic religion, concurrent comorbidities, mastectomy, anastrozole treatment, side effects, unawareness of treatment insurance coverage, and seeking treatment from traditional healers. Thorough therapeutic communication regarding treatment, neoadjuvant chemotherapy, and adequate social support significantly facilitate adherence. A randomized controlled trial of breast nursing interventions reported improved patient adherence. CONCLUSION The evidence mapped from studies that evaluated OAM adherence in women with BC indicates that nonadherence to OAMs is common. Applying context-specific standardized measures to assess adherence and facilitators or strategies targeting the identified barriers can optimize adherence and treatment outcomes. Effective interventions to improve adherence are limited. Therefore, further empirical and interventional studies in Africa are required to enhance the evidence.

Outcomes in breast cancer—does ethnicity matter?

“…The significant barriers identified were Islamic religion, comorbidities, mastectomy, anastrozole treatment, side-effects, unawareness of medical insurance coverage, and seeking treatment from traditional healers. 46 The African Breast Cancer–Disparities in Outcomes prospective cohort study conducted in sub-Saharan Africa reported that surgery with multimodality treatment was initiated in only a minority of patients with localized BC, and a majority of women did not complete local or systemic therapy as indicated clinically. 47 Such important statistics are unfortunately not available from many areas of the world.…”

Association between culture and the preference for, and perceptions of, 11 routes of medicine administration: A survey in 21 countries and regions

“…Culture is known to partly shape health attributions, health beliefs and health behaviours, leading to a diversity in belief systems about healing among cultural groups. 13 Cultural background also informs beliefs about medication, such as beliefs about the benefits and dangers of medicines, 14 drug efficacy, 15 and affects behaviours, such as, adherence to medication 15 , 16 , 17 including prescription drugs. 18 Religious concerns has had a long history 19 and can lead to discontinuation of medication, when medicine components are considered prohibited, 20 such as certain animal-derived products, 21 or during observances such as the Ramadan fasting period.…”

Barriers and Facilitators of Adherence to Oral Anticancer Medications Among Women with Breast Cancer: A Qualitative Study

“…1,2 The common modalities for breast cancer treatment include surgery, chemotherapy and radiotherapy. 3 Traditional chemotherapy has mainly been administered intravenously when the patient presents to an outpatient infusion centre or The review 23 revealed that few observational studies from Nigeria [26][27][28] assessed factors influencing adherence to OAMs among women with BC. Financial difficulties, medication costs, younger age, and feeling well after starting chemotherapy contributed to poor adherence to OAMs.…”