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

Abstract

Adjuvant hormonal therapy contributes to reductions in recurrence and mortality for women with hormone receptor positive breast cancer. However, adherence to hormonal therapy is suboptimal. This is the first systematic literature review examining interventions aimed at improving hormonal 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 hormonal therapy in breast cancer survivors. There were 376 manuscripts screened for eligibility. Five articles met criteria. All interventions presented adherence outcomes after one-year follow-up. None significantly enhanced adherence compared to the usual care in the primary analysis (OR ranged from 1.03 to 2.06 for adherence and from 1.11 – 1.18 for persistence). All targeted patients and three only included post-menopausal breast cancer patients. Three tested the same intervention consisting of educational materials. Only one was conducted in the US. 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 hormonal therapy in US breast cancer populations that includes survivors who are ethnically diverse, premenopausal, and taking tamoxifen 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 academics to develop approaches that target different components associated with hormonal therapy adherence, such as doctor-patient communication or social support.

The association of pharmacy fill synchronization with breast cancer endocrine therapy adherence

“…Differences between physicians and patients in perceptions of medicines may also pose important barriers to adherence: patients in 1 large AET study reported that an important barrier to continuing AET was "I was not sure if it (the medication) was helping," 35 and a meta-analysis of 5 randomized studies showed that educational interventions to address such issues had little impact on adherence. 36 Our study, therefore, adds a potential new target to otherwise disappointing efforts to improve adherence to oral cancer medications. A few studies outside oncology have examined whether improving synchronization can improve adherence.…”

Applying the theory of planned behavior to examine adjuvant endocrine therapy adherence intentions

“…38 Assessing emotions towards AET in clinical practice could be an efficient strategy to identify women who may be less likely to adhere to AET. 30 Given the lack of success of most AET adherence interventions, 9 findings from this study can inform future interventions to target untapped psychosocial factors to enhance adherence to AET and survivorship.…”

“…Because psychosocial factors are modifiable, they are promising intervention targets. Interventions that promote AET adherence are limited . Utilizing conceptual models to examine the relationship between psychosocial factors and adherence increases their potential for informing the development of successful interventions .…”

Deconstructing Decisions to Initiate, Maintain, or Discontinue Adjuvant Endocrine Therapy in Breast Cancer Survivors: A Mixed-Methods Study

“…Few interventions have been found to be effective for managing side effects for the duration of therapy. Some evidence suggests that tailored patient counseling, particularly for older adult survivors, may be initially beneficial to promoting adherence (Hugtenburg, Timmers, Elders, Vervloet, & van Dijk, 2013); however, in general, clinical interventions for medication adherence have not included behavioral approaches beyond reminder systems (Easthall, Song, & Bhattacharya, 2013; Hurtado-de-Mendoza, Cabling, Lobo, Dash, & Sheppard, 2016). Increasing knowledge of side effects, communicating the benefits of the prescribed medication to improve adherence motivation, and identifying opportunities to resolve barriers to medication use (such as side effects) have been highlighted in reviews as critical components in a long-term adherence model in clinical practice (Accordino & Hershman, 2013; DiMatteo, Haskard-Zolnierek, & Martin, 2012).…”