Potentially Modifiable Factors Associated with Adherence to Adjuvant Endocrine Therapy among Breast Cancer Survivors: A Systematic Review

Abstract

Adjuvant endocrine therapy (AET) reduces risk of breast cancer recurrence. However, suboptimal adherence and persistence to AET remain important clinical issues. Understanding factors associated with adherence may help inform efforts to improve use of AET as prescribed. The present systematic review examined potentially modifiable factors associated with adherence to AET in accordance with PRISMA guidelines (PROSPERO registration ID: CRD42019124200). All studies were included, whether factors were significantly associated with adherence or results were null. This review also accounted for the frequency with which a potentially modifiable factor was examined and whether univariate or multivariate models were used. This review also examined whether methodological or sample characteristics were associated with the likelihood of a factor being associated with AET adherence. A total of 68 articles were included. Potentially modifiable factors were grouped into six categories: side effects, attitudes toward AET, psychological factors, healthcare provider-related factors, sociocultural factors, and general/quality of life factors. Side effects were less likely to be associated with adherence in studies with retrospective or cross-sectional than prospective designs. Self-efficacy (psychological factor) and positive decisional balance (attitude toward AET) were the only potentially modifiable factors examined ≥10 times and associated with adherence or persistence ≥75% of the time in both univariate and multivariate models. Self-efficacy and decisional balance (i.e., weight of pros vs. cons) were the potentially modifiable factors most consistently associated with adherence, and hence may be worth focusing on as targets for interventions to improve AET adherence among breast cancer survivors.

A Survey of Potentially Modifiable Patient-Level Factors Associated with Self-Report and Objectively Measured Adherence to Adjuvant Endocrine Therapies After Breast Cancer

“…Greater self-efficacy was associated with higher self-reported adherence at baseline. This is consistent with ample literature linking self-efficacy and adherence among AET users 15 and others with chronic illness (eg, HIV/AIDS; cardiovascular, and respiratory disorders). 50 Bandura’s social cognitive theory outlines how personal factors (including cognitions such as self-efficacy), behaviour, and environmental factors all reciprocally influence each other to affect behaviour change.…”

“…It is unsurprising that side effects are relevant to adherence, as they are reportedly responsible for AET discontinuation in half of those who discontinue. 46 However, a recent systematic review reported that measures of side effects are associated with adherence or persistence in approximately half of studies that measure them, 15 suggesting that side effects alone might not reliably predict adherence. Side effects being common among AET users, 47 , 48 factors beyond side effect presence or severity, such as reaction to side effects, or having effective management strategies (such as those outlined by Franzoi et al) 49 may be relevant to understanding adherence.…”

“… 12 , 13 Reviews which also include null findings similarly endorse social support, positive decisional balance, beliefs about medications, and self-efficacy as associated with adherence; but indicate that patient–physician relationship, communication, depressive symptoms, or side effects are not consistently associated with adherence. 7 , 14 , 15 Qualitative studies highlight additional factors associated with non-adherence, such as the negative impact of side effects, prioritizing quality of life over quantity, and concerns about long-term AET use. 13 , 16 , 17 See AlOmeir et al for an excellent review of qualitative studies about AET adherence.…”

Acupuncture versus cognitive behavioral therapy for pain among cancer survivors with insomnia: an exploratory analysis of a randomized clinical trial

“…Pain and insomnia also contribute to the progression of fatigue and mental distress that further worsen symptom burden, leading to poor quality of life [8][9][10] . In breast cancer patients, pain and psychological symptoms like insomnia and depression are associated with early discontinuation and non-adherence to adjuvant hormonal therapy and, consequently, poor clinical prognosis [11][12][13][14] . In recent decades, timely and proper management of insomnia and pain has been identified as a critical element of comprehensive cancer care and several validated therapies have emerged as effective insomnia treatments 15,16 .…”

Research on the Relationship Between Self-Management Efficacy and Quality of Life for Breast Cancer Patients Receiving Endocrine Therapy

“…Endocrine therapy for breast cancer mainly reduces or clears estrogen levels in the body through some drugs or treatments, thereby inhibiting the growth of breast cancer and reducing the risk of recurrence and metastasis [5,6], which plays an important role in the comprehensive treatment of breast cancer [7]. Studies [8][9][10][11][12] show that most patients with endocrine therapy for breast cancer have experienced hot ashes, night sweats, insomnia, joint stiffness, weight gain, anxiety, depression and other symptoms, and the long treatment cycle will make patients become depressed and indifferent. Therefore, in the process of treatment and rehabilitation of patients with breast cancer endocrine therapy, it is particularly important for patients to actively participate in the management of the disease and establish an effective self-management model.…”