Highlights
- •The presence and severity of the side effects contributes to women's adherence and persistence with oral endocrine therapy.
- •Women prescribed oral endocrine therapy report insufficient information and support from healthcare professionals.
- •Primary care providers should be aware of the facilitators and barriers to adherence, and they should be knowledgeable in symptom management strategies.
Abstract
Purpose
Adjuvant endocrine therapy (AET) significantly reduces the risk of breast cancer recurrence
and mortality in women with hormone receptor (HR+) breast cancer. Despite the documented
survival benefits with AET, non-adherence and non-persistence remains a significant
problem. This systematic review of qualitative research aimed to synthesise breast
cancer patients’ experiences of adherence and persistence to oral endocrine therapy.
Methods
The ENTREQ guidelines were followed. A systematic search strategy was performed across
eleven electronic databases (Embase, Cinahl, Pubmed, Psychinfo, Proquest, Lenus, Scopus,
Web of Science, Rian.ie, EThOS e-theses online, DART Europe). Thomas and Harden's
three-stage approach to thematic analysis was undertaken on the findings of all included
studies. Confidence in the findings were reviewed using GRADE-CERQual.
Results
Twenty-four qualitative studies were included in the synthesis. Three analytic themes
were identified (We don't have an option; the side effects are worse than the disease;
help us with information and support). Adherence was often driven by women feeling
they had no option and a fear of cancer recurrence. Persistence was helped with support
and information. Non-adherence and non-persistence were associated with debilitating
side effects, inadequate information and lack of support.
Conclusions
Adherence and persistence to AET was often suboptimal among breast cancer patients.
Women commonly felt isolated and neglected as a result of insufficient information
and support from healthcare professionals. If women are to persist with AET, primary
care providers should be aware of the facilitators and barriers to adherence, and
they should be knowledgeable in symptom management strategies.
Keywords
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Article Info
Publication History
Published online: January 30, 2020
Accepted:
November 26,
2019
Received:
August 1,
2019
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
