A Systematic Review and Meta-Analysis of Interventions to Promote Adjuvant Endocrine Therapy Adherence Among Breast Cancer Survivors

Bright, Emma E.; Finkelstein, Lauren B.; Nealis, Madeline S.; Genung, Sarah R.; Wrigley, Jordan; Gu, Heng Chao J.; Schmiege, Sarah J.; Arch, Joanna J.

doi:10.1200/jco.23.00697

Cited by 74Medication Adherence and ComplianceCancer survivorship and careBreast Cancer Treatment Studies

A Systematic Review and Meta-Analysis of Interventions to Promote Adjuvant Endocrine Therapy Adherence Among Breast Cancer Survivors

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Bright, Emma E., Finkelstein, Lauren B., Nealis, Madeline S., Genung, Sarah R., Wrigley, Jordan, Gu, Heng Chao J., Schmiege, Sarah J., Arch, Joanna J.·2023·Journal of Clinical Oncology

DOI 10.1200/jco.23.00697PMC PMC10553065

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Abstract

PURPOSE: Adjuvant endocrine therapy (AET) adherence among breast cancer survivors is often suboptimal, leading to higher cancer recurrence and mortality. Intervention studies to promote AET adherence have burgeoned, more than doubling in number since this literature was last reviewed. The current aim is to provide an up-to-date systematic review and meta-analysis of interventions to enhance AET adherence and to identify strengths and limitations of existing interventions to inform future research and clinical care. METHODS: Systematic searches were conducted in three electronic databases. Studies were included in the systematic review if they examined an intervention for promoting AET adherence among breast cancer survivors. Studies were further included in the meta-analyses if they examined a measure of AET adherence (defined as compliance or persistence beyond initiation) and reported (or provided upon request) sufficient information to calculate an effect size. RESULTS: Of 5,045 unique records, 33 unique studies representing 375,951 women met inclusion criteria for the systematic review. Interventions that educated patients about how to manage side effects generally failed to improve AET adherence, whereas policy changes that lowered AET costs consistently improved adherence. Medication reminders, communication, and psychological/coping strategies showed varied efficacy. Of the 33 studies that met the inclusion criteria for the systematic review, 25 studies representing 367,873 women met inclusion criteria for the meta-analysis. The meta-analysis showed statistically significant effects of the adherence interventions overall relative to study-specified control conditions (number of studies [k] = 25; odds ratio, 1.412; 95% CI, 1.183 to 1.682; P = .0001). Subgroup analyses showed that there were no statistically significant differences in effect sizes by study design (randomized controlled trial v other), publication year, directionality of the intervention (unidirectional v bidirectional contact), or intervention type. CONCLUSION: To our knowledge, this is the first known meta-analysis to demonstrate a significant effect for interventions to promote AET adherence. The systematic review revealed that lowering medication costs and a subgroup of psychosocial and reminder interventions showed the most promise, informing future research, policy, and clinical directions.

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Existing interventions for supporting adherence to AET often focus on educating women about AET.
“These interventions often focus on educating women about AET. 13”
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 [13]

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Authors: Bright, E. E., Finkelstein, L. B., Nealis, M. S., Genung, S. R., Wrigley, J., Gu, H. C. J., Schmiege, S. J., & Arch, J. J.
Affiliations: University of Colorado Boulder (US)
Colorado School of Public Health (US)
ORCID: Bright, Emma E.
Finkelstein, Lauren B.
Nealis, Madeline S.
Genung, Sarah R.
Wrigley, Jordan
Gu, Heng Chao J.
Schmiege, Sarah J.
Arch, Joanna J.
Venue: Journal of Clinical Oncology
Publisher: American Society of Clinical Oncology (ASCO)
Published: 2023-10-01
Volume: 41
Issue: 28
Pages: 4548-4561
ISSN: 0732-183X (ISSN-L)
1527-7755
DOI: 10.1200/jco.23.00697
PMC: PMC10553065
OpenAlex: W4385488031
Cited by: 74
References: 69
Citations by year: 2026: 22 · 2025: 26 · 2024: 25 · 2023: 1
FWCI: 3.44
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Journal of Clinical Oncology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Comprehensive Cancer Network
Genentech
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, medication adherence, breast cancer survivors, adherence interventions, drug cost reduction, medication reminders, psychosocial interventions, coping strategies, patient education, side effect management, treatment persistence
MeSH terms: Cancer Survivors, Adaptation, Psychological, Breast Neoplasms, Female, Humans, Chemotherapy, Adjuvant, Medication Adherence

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A Systematic Review and Meta-Analysis of Interventions to Promote Adjuvant Endocrine Therapy Adherence Among Breast Cancer Survivors

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