A systematic review of interventions to improve adherence to endocrine therapy
Open accessAbstract
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.
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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 [11]
The Results (Impact of Interventions to Improve ET Adherence) report that education-only interventions generally did not produce significant improvements. But they also report significant results for interventions combining education and communication and for patient navigation. The review therefore supports limited effectiveness for one common approach, not the broader claim that existing AET adherence interventions are mostly ineffective. (LLM, conf=0.83)
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”
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 [19]
The Discussion reports that the four randomized trials generally did not find statistically significant improvements in endocrine-therapy adherence, apart from a difference by country in one study. The Risk of Bias section says several trials had large samples, but the review does not establish which trials were adequately powered; that qualifier is not supported by our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAdherence 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.”
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 [25]
The Results (Impact of Interventions to Improve ET Adherence; page unavailable) identify patient education as the most frequent single strategy, and the Discussion reports that the randomized trials used education-only interventions. But education accounted for five of sixteen studies, alongside communication, navigation, and financial strategies. The paper notes limited evidence on psychosocial and behavioral factors (Introduction), but does not assess whether the interventions addressed the full range of psychological factors contributing to non-adherence. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPrevious 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.”
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- Authors
- Heiney, S. P., Parker, P. D., Felder, T. M., Adams, S. A., Omofuma, O. O., & Hulett, J. M.
- Affiliations
- University of South Carolina (US)
- Corresponding author
- Heiney, Sue P.
- ORCID
- Venue
- Breast Cancer Research and Treatment
- Published
- 2018-11-01
- Volume
- 173
- Issue
- 3
- Pages
- 499-510
- ISSN
- 0167-6806 (ISSN-L)
- 1573-7217
- PMC
- PMC7093203
- OpenAlex
- W2898642145
- Cited by
- 69
- References
- 76
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 10 · 2023: 21 · 2022: 9 · 2021: 8 · 2020: 5 · 2019: 3
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Breast Cancer Research and Treatment (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (K01CA193667)
- Susan G. Komen (GTDR17500160)
- University of South Carolina, ASPIRE grant
- 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
- endocrine therapy adherence, hormone receptor-positive breast cancer, adherence interventions, patient education, communication strategies, medication possession ratio, minority groups, cultural adaptation, adherence measurement
- MeSH terms
- Clinical Studies as Topic, Antineoplastic Combined Chemotherapy Protocols, Breast Neoplasms, Female, Humans, Treatment Outcome, Publication Bias, Antineoplastic Agents, Hormonal, Medication Adherence
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