A systematic review of interventions to improve adherence to endocrine therapy

• Published in: Breast cancer research and treatment Vol. 173; no. 3; pp. 499 - 510
• Main Authors: Heiney, Sue P., Parker, Pearman D., Felder, Tisha M., Adams, Swann Arp, Omofuma, Omonefe O., Hulett, Jennifer M
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2019; Springer; Springer Nature B.V
• Subjects: Antineoplastic Agents, Hormonal - administration & dosage; Antineoplastic Agents, Hormonal - adverse effects; Antineoplastic Agents, Hormonal - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast cancer; Breast Neoplasms - metabolism; Breast Neoplasms - therapy; Cancer; Cancer research; Clinical Studies as Topic; Clinical trials; Education; Endocrine therapy; Female; Health aspects; Hormones; Humans; Medical records; Medical schools; Medication Adherence; Medicine; Medicine & Public Health; Mortality; Oncology; Patient compliance; Publication Bias; Review; Systematic review; Treatment Outcome; Adherence; Endocrine therapy; Systematic review; Breast cancer; Interventions
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-018-5012-7

Purpose
Adherence to endocrine therapy for hormone positive breast cancer is a significant problem, especially in minority populations. Further, endocrine therapy reduces recurrence and thus mortality. However, little data are available on interventions to improve adherence. The authors conducted a systematic review to examine the impact of interventions, strategies, or approaches aimed to improve endocrine therapy adherence among women with breast cancer. A secondary aim was to determine if interventions had any cultural modifications.
Methods
Two of the authors examined articles published between 2006 and 2017 from a wide variety of databases using Covidence systematic review platform.
Results
In total, 16 eligible studies met criteria for review including 4 randomized controlled trials, 4 retrospective studies, and 8 with various observational designs. Eligible studies used a broad range of definitions for adherence and measured adherence by self-report, medical records, claims data, and combinations of these. All used 80% medication possession ratio as a standard for adherence. Patient information/education was the most frequent intervention strategy but did not demonstrate a significant effect except in one study. Significant results were noted when education was combined with communication strategies.
Conclusions
Researchers need a standard definition for adherence and a reliable measure that is feasible to use in a variety of studies. While education may be a necessary component of an intervention, when used alone, it is not a sufficient approach to change behavior.