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Barriers and facilitators of adjuvant hormone therapy adherence and persistence in women with breast cancer: a systematic review

Authors Moon Z, Moss-Morris R, Hunter MS, Carlisle S, Hughes LD

Received 4 November 2016

Accepted for publication 11 January 2017

Published 23 February 2017 Volume 2017:11 Pages 305—322


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Zoe Moon, Rona Moss-Morris, Myra S Hunter, Sophie Carlisle, Lyndsay D Hughes

Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

Nonadherence to hormone therapy in breast cancer survivors is common and associated with increased risk of mortality. Consistent predictors of nonadherence and nonpersistence are yet to be identified, and little research has examined psychosocial factors that may be amenable to change through intervention. This review aimed to identify predictors of nonadherence and nonpersistence to hormone therapy in breast cancer survivors in order to inform development of an intervention to increase adherence rates.
Methods: Studies published up to April 2016 were identified through MEDLINE, Embase, Web of Science, PsycINFO, CINAHL and gray literature. Studies published in English measuring associations between adherence or persistence and any predictor variables were included. Eligible studies were assessed for methodological quality, data were extracted and a narrative synthesis was conducted.
Results: Sixty-one eligible articles were identified. Most studies focused on clinical and demographic factors with inconsistent results. Some evidence suggested that receiving specialist care and social support were related to increased persistence, younger age and increased number of hospitalizations were associated with nonadherence, and good patient–physician relationship and self-efficacy for taking medication were associated with better adherence. A small amount of evidence suggested that medication beliefs were associated with adherence, but more high-quality research is needed to confirm this.
Conclusion: Some psychosocial variables were associated with better adherence and persistence, but the results are currently tentative. Future high-quality research should be carried out to identify psychosocial determinants of nonadherence or nonpersistence that are modifiable through intervention.

breast cancer, adherence, persistence, hormone therapy

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