Investigating factors associated with hormonal therapy adherence in breast cancer survivors: a systematic review

Abstract

Background: This review aimed to identify predictors of non-adherence and non-persistence to hormonal therapy in breast cancer survivors, in order to inform development of an intervention to increase adherence rates. Methods: Included studies measured associations between adherence or persistence and predictor variables. Studies were identified by searching electronic databases and reviewing grey literature. Eligible studies were assessed for methodological quality, data was extracted and a narrative synthesis of the results was conducted. Findings: The search identified 54 papers. The majority of research focused on clinical and demographic factors and found inconsistent results. The most consistent results showed that receiving specialist care, having more prescription medications and fewer hospitalisations often were related to increased adherence and persistence. Very little research investigated potentially modifiable factors. There was a small amount of evidence to suggest that medication beliefs were associated with adherence, but more high quality research is needed to confirm this. Discussion: In order to increase adherence rates, and reduce rates of cancer recurrence and mortality, future research needs to identify psychosocial predictors of non-adherence which are amenable to change.