Interventions to promote adherence to endocrine therapy among breast cancer survivors: a meta-analysis
Open accessAbstract
Objective: Adjuvant endocrine therapy (AET) significantly reduces risk of breast cancer recurrence in those patients whose tumor tests hormone (estrogen and/or progesterone) receptor positive. Many who are prescribed AET do not adhere adequately. Studies have sought to examine the effects of interventions to enhance patients' AET adherence, with strikingly mixed results. In order to reconcile a disparate literature, this paper aims to (1) quantitatively review the aggregate effect of interventions designed to optimize AET adherence within the current literature and (2) meta‐analyze these effects across studies' by intervention design. Methods: Duplicate searches were conducted using multiple electronic databases as well as hand searches of recent year conference abstracts. Studies were included that (1) tested an intervention to promote AET adherence; (2) reported at least one measure of medication adherence; and (3) reported (or provided upon request) data sufficient to calculate effect size. Effect sizes were calculated using random effects models. Results: Seven studies representing eight unique interventions were included. We observed an overall null effect across all interventions (k = 8;d[95% CI] = 0.28 [−0.05, 0.61]); however, sensitivity analyses showed that interventions that used bi‐directional communication showed statistically significant effects relative to control groups within each study (k = 4;d[95% CI] = 0.59 [0.23, 0.95]) while those relying only on providing information to the patient (one‐way communication) did not (k = 4;d[95% CI] = −0.03 [−0.27, 0.20]). Conclusions: Interventions that promote patient self‐report may improve AET adherence through enhancing patient engagement. Investigators and clinicians who wish to optimize medication adherence in this population can consider this approach.
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Existing interventions for supporting adherence to AET are mostly ineffective.
“Existing interventions for supporting adherence to AET are mostly ineffective. 3,10-12”
From A pilot randomised controlled trial of acceptance and commitment therapy for medication decision-making and quality of life in women with breast cancer: The ACTION trial (2024) · cites this paper as [12]
The Abstract reports an overall null effect across eight AET-adherence interventions, supporting the concern that existing approaches have limited effectiveness. But it also reports significant benefits for the four bidirectional interventions, while the four information-only interventions showed no significant effect. Describing the interventions as 'mostly ineffective' overlooks that distinction. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA meta-analysis of 8 adherence interventions yielded a small to moderate heterogeneous effect in favour of the interventions.
“A meta-analysis of 8 such interventions yielded a small to moderate heterogenous effect in favour of the interventions [24].”
From Acceptance and Commitment Therapy to support medication decision-making and quality of life in women with breast cancer: protocol for a pilot randomised controlled trial (2022) · cites this paper as [24]
The Results (§3.6; page not supplied) report eight interventions, a small positive average effect (d = 0.28), and substantial heterogeneity. But its confidence interval includes zero, and the paper describes the overall effect as null; the claim's unqualified statement of an effect in favour of interventions overstates the finding. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAmong adequately powered trials of AET interventions, there are few positive findings.
“Among adequately powered trials of AET interventions, there are few positive findings.18–20”
Previous adherence interventions focused on educating women to enhance adherence have proved minimally effective.
“Previous interventions focused on educating women to enhance adherence have proved minimally effective.”
Adherence interventions evaluated so far largely focused on educating patients regarding AET and did not consistently address the range of psychological factors that contribute to non-adherence.
“The interventions largely focussed on educating patients regarding AET and did not consistently address the range psychological factors that contribute to non-adherence.”
Allowing for 80% retention, 80 participants (n=10 per condition) will be randomised.
“Allowing for 80% retention (the average across eight studies20), 80 participants (n=10 per condition) will be randomised.”
From Refining and optimising a behavioural intervention to support endocrine therapy adherence (ROSETA) in UK women with breast cancer: Protocol for a pilot fractional factorial trial (2023) · cites this paper as [20]
Section 3.1 describes seven reports covering eight interventions, but does not give an average retention rate. Section 3.4 uses 80% as a threshold for medication adherence, not participant retention. Searches for retention, attrition, and an average retention rate found no passage supporting the cited 80% assumption; the proposed sample size is the citing authors’ own plan. (LLM, conf=0.73)
Experimental — accuracy not yet measured
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“A meta-analysis of 8 such interventions yielded a small to moderate heterogenous effect in favour of the interventions [24].”
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“4 12 These interventions often focus on educating women about AET.”
Background
- Authors
- Finitsis, D. J., Vose, B. A., Mahalak, J. G., & Salner, A. L.
- Affiliations
- Hartford Hospital (US)
- Corresponding author
- Finitsis, David J.
- Venue
- Psycho-Oncology
- Publisher
- Wiley
- Published
- 2018-12-28
- Volume
- 28
- Issue
- 2
- Pages
- 255-263
- ISSN
- 1057-9249 (ISSN-L)
- 1099-1611
- OpenAlex
- W2902133195
- Cited by
- 68
- References
- 56
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 11 · 2023: 19 · 2022: 16 · 2021: 4 · 2020: 9 · 2019: 1
- FWCI
- 0.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psycho-Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- medication adherence, adjuvant endocrine therapy, breast cancer survivors, patient engagement, two-way communication, patient self-report, intervention effectiveness, hormone receptor-positive breast cancer, patient-provider communication
- MeSH terms
- Cancer Survivors, Breast Neoplasms, Combined Modality Therapy, Female, Humans, Neoplasm Recurrence, Local, Receptors, Estrogen, Receptors, Progesterone, Drug Monitoring, Chemotherapy, Adjuvant, Antineoplastic Agents, Hormonal
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