Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review
Open accessAbstract
Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). This systematic review aims to: (1) determine the prevalence of adherence and persistence to adjuvant hormonal therapy among breast cancer survivors in clinical practice, and (2) identify correlates of adherence and persistence. We searched Medline, PubMed, PsycINFO, and CINAHL for studies that measured rates and/or correlates of adherence and/or persistence to adjuvant hormonal therapy. Studies were reviewed in a multi-step process: (1) the lead author screened titles and abstracts of all potentially eligible studies; (2) each coauthor reviewed a random 5 % sample of abstracts; and (3) two sets of coauthors each reviewed half of all “maybe” abstracts. Any disagreements were discussed until consensus was reached. Twenty-nine studies met inclusion criteria. Prevalence of adherence ranged from 41 to 72 % and discontinuation (i.e., nonpersistence) ranged from 31 to 73 %, measured at the end of 5 years of treatment. Extremes of age (older or younger), increasing out-of-pocket costs, follow-up care with a general practitioner (vs. oncologist), higher CYP2D6 activity, switching from one form of therapy to another, and treatment side effects were negatively associated with adherence and/or persistence. Taking more medications at baseline, referral to an oncologist, and earlier year at diagnosis were positively associated with adherence and/or persistence. Adherence and persistence to adjuvant hormonal therapy among breast cancer survivors is suboptimal. Many of the correlates of adherence and persistence studied to date are not modifiable. Our review reveals a critical need for further research on modifiable factors associated with adherence to adjuvant hormonal therapy, and the development of behavioral interventions to improve adherence in this population.
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A meta-analysis reported that 31%-73% of breast cancer survivors are adherent to AET.
“A meta-analysis reported 31%–73% of breast cancer survivors are adherent to AET,10”
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 [10]
The Results section reports adherence rates of 41–88% for tamoxifen, 50–91% for aromatase inhibitors, and 46–100% for studies combining therapies. The Discussion identifies 31–73% as the range for treatment discontinuation in clinical practice, not adherence. The source describes itself as a systematic review, not a meta-analysis. (LLM, conf=0.94)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredUp to three-quarters of women prescribed adjuvant endocrine therapy take less than 80% of prescribed therapy.
“However, non-adherence is common with up to three-quarters of women prescribed adjuvant endocrine therapy (HT) taking < 80% of prescribed therapy and similar proportions discontinuing prematurely [4].”
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 [4]
The Results section defines adherence most often as a medication possession ratio of at least 80%. Its Prevalence of Adherence and Discontinuation subsection reports adherence as low as 41%, implying nonadherence of up to 59%—not three-quarters. The same subsection reports discontinuation of up to 73%, which supports the citing sentence’s separate point about premature discontinuation. Page numbers are not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA number of barriers to medication use have been reported in this setting, including medication side-effects, psychological distress and a lack of social support.
“A number of barriers to medication use have been reported in this setting, including medication side-effects, psychological distress and a lack of social support [4, 15].”
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 [4]
The Discussion reports treatment side effects as barriers to continued therapy, and the Results link low social support with discontinuation. Neither section identifies psychological distress as a barrier to medication use; searches for that term and related wording did not locate support in our copy. Page numbers were not available. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNon-adherence to adjuvant endocrine therapy (AET) in women with breast cancer is common.
“Non -adherence to adjuvant endocrine therapy (AET) in women with breast cancer is common and associated with medication side -effects and distress.”
Medication side-effects affect adherence to adjuvant endocrine therapy.
“Adherence to adjuvant endocrine therapy is affected by medication side-effects and associated distress.”
Similar proportions of women prescribed adjuvant endocrine therapy discontinue prematurely.
“However, non-adherence is common with up to three-quarters of women prescribed adjuvant endocrine therapy (HT) taking < 80% of prescribed therapy and similar proportions discontinuing prematurely [4].”
Non-adherence to AET is a major problem among women with breast cancer.
“Non-adherence to AET is a major problem among women with breast cancer [4]”
Between 31% and 73% of breast cancer survivors discontinue adjuvant hormonal therapy in clinical practice.
“Despite these benefits, between 31-73% of survivors discontinue adjuvant hormonal therapy in clinical practice,6 thereby reducing treatment efficacy.7-10”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [6]
Few interventions have been developed to improve adjuvant hormonal therapy adherence.
“However, few interventions have been developed to improve adjuvant hormonal therapy adherence.6”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [6]
Patient variables, social support, patient-provider communication, and healthcare factors such as cost are associated with adherence to systemic therapies in breast cancer survivors.
“Patient variables (e.g., age), social support, patient-provider communication, and healthcare factors (e.g., cost) have been associated with breast cancer survivor adherence to systemic therapies.6, 16-18”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [6]
Adherence to adjuvant hormonal therapy is suboptimal.
“However, adherence to hormonal therapy is suboptimal.”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [6]
Hormonal treatment-related side effects such as hot flashes and osteoporosis are one of the main reasons for discontinuation.
“While hormonal treatment related side effects such as hot flashes and osteoporosis42 represent one of the main reasons for discontinuation,6 none of the retrieved interventions had an explicit focus on side effects.”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [6]
Studies have shown that adherence is problematic in both older and younger women similarly.
“Although studies have shown that adherence is problematic in both older and younger women similarly,6 the reasons for discontinuation or barriers to adherence may be different between the two groups.”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [6]
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- Authors
- Murphy, C. C., Bartholomew, L. K., Carpentier, M. Y., Bluethmann, S. M., & Vernon, S. W.
- Affiliations
- The University of Texas Health Science Center at Houston (US)
- Corresponding author
- Murphy, Caitlin C.
- Venue
- Breast Cancer Research and Treatment
- Published
- 2012-06-12
- Volume
- 134
- Issue
- 2
- Pages
- 459-478
- ISSN
- 0167-6806 (ISSN-L)
- 1573-7217
- PMC
- PMC3607286
- OpenAlex
- W1987753117
- Semantic Scholar
- 92816b1cff05e88d3955bfa52d7d9c9f3eafb040
- Cited by
- 708
- References
- 85
- Citations by year
- 2026: 32 · 2025: 63 · 2024: 59 · 2023: 67 · 2022: 71 · 2021: 59 · 2020: 60 · 2019: 54 · 2018: 41 · 2017: 64 · 2016: 33 · 2015: 38 · 2014: 32 · 2013: 34 · 2012: 1
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Breast Cancer Research and Treatment (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (R25CA057712, R01CA112223, K07CA140159)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Keywords
- adjuvant endocrine therapy, breast cancer survivors, medication adherence, treatment persistence, tamoxifen, aromatase inhibitors, hormone receptor-positive breast cancer, out-of-pocket costs, treatment side effects, behavioral interventions
- MeSH terms
- Breast Neoplasms, Clinical Trials as Topic, Female, Humans, Neoplasms, Hormone-Dependent, Chemotherapy, Adjuvant, Survivors, Antineoplastic Agents, Hormonal, Medication Adherence
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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