Potentially modifiable factors associated with adherence to adjuvant endocrine therapy among breast cancer survivors: a systematic review
Open accessAbstract
Adjuvant endocrine therapy (AET) reduces risk of breast cancer recurrence. However, suboptimal adherence and persistence to AET remain important clinical issues. Understanding factors associated with adherence may help inform efforts to improve use of AET as prescribed. The present systematic review examined potentially modifiable factors associated with adherence to AET in accordance with PRISMA guidelines (PROSPERO registration ID: CRD42019124200). All studies were included, whether factors were significantly associated with adherence or results were null. This review also accounted for the frequency with which a potentially modifiable factor was examined and whether univariate or multivariate models were used. This review also examined whether methodological or sample characteristics were associated with the likelihood of a factor being associated with AET adherence. A total of 68 articles were included. Potentially modifiable factors were grouped into six categories: side effects, attitudes toward AET, psychological factors, healthcare provider-related factors, sociocultural factors, and general/quality of life factors. Side effects were less likely to be associated with adherence in studies with retrospective or cross-sectional than prospective designs. Self-efficacy (psychological factor) and positive decisional balance (attitude toward AET) were the only potentially modifiable factors examined ≥10 times and associated with adherence or persistence ≥75% of the time in both univariate and multivariate models. Self-efficacy and decisional balance (i.e., weight of pros vs. cons) were the potentially modifiable factors most consistently associated with adherence, and hence may be worth focusing on as targets for interventions to improve AET adherence among breast cancer survivors.
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Several modifiable factors are associated with AET adherence, and four of the strongest determinants were selected as intervention targets.
“We identified several modifiable factors associated with AET adherence,27–30 selecting four of the strongest determinants as intervention targets.17”
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Cited by
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Arch, J. J., Crespi, C. M., Levin, M. E., Genung, S. R., Nealis, M., Mitchell, J. L., Bright, E. E., Albright, K., Magidson, J. F., & Stanton, A. L. (2022) · Annals of Behavioral Medicine · doi:10.1093/abm/kaab118 · Cited by 34 · see citing works
Smith, S. G., Green, S. M. C., Ellison, R., Foy, R., Graham, C. D., Mason, E., French, D. P., Hall, L. H., Wilkes, H., McNaught, E., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-069971 · Cited by 20 · see citing works
- Authors
- Toivonen, K., Williamson, T., Carlson, L., Walker, L., & Campbell, T.
- Affiliations
- University of Calgary (CA)
- Corresponding author
- Campbell, Tavis
- Venue
- Cancers
- Publisher
- MDPI AG
- Published
- 2020-12-31
- Volume
- 13
- Issue
- 1
- Pages
- 107
- ISSN
- 2072-6694 (ISSN-L)
- PMC
- PMC7794693
- OpenAlex
- W3115995788
- Cited by
- 77
- References
- 112
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 15 · 2023: 20 · 2022: 15 · 2021: 2
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Cancers (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of Calgary
- Alberta Cancer Foundation
- Killam Trusts
- Alberta Innovates
- Canadian Institutes of Health Research
- 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, self-efficacy, decisional balance, adverse effects, treatment attitudes, psychological factors, sociocultural factors, quality of life
About these checks
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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