Adhering to Adjuvant Endocrine Therapy after Breast Cancer: What’s the Problem?

Abstract

Background: Breast cancer is a major cause of premature mortality in Canadian women. The use of adjuvant endocrine therapy (AET) has dramatically reduced breast cancer recurrence and mortality. Although AET has made a radical difference in breast cancer outcomes, a remarkable 50% of women do not take their prescribed AET regimens as recommended. Purpose: An overview of AET adherence and its impact on breast cancer survivors will be discussed. Gaps in the AET adherence literature will be outlined and a proposed plan of research will be offered. Methods: An integrative review of the literature was undertaken to explore AET non-adherence in breast cancer survivors. Findings: The AET adherence literature has predominately focused on identifying demographic and clinical predictors of non-adherence. As a result, a significant gap exists regarding why an alarming number of women do not adhere to AET. Few studies have attempted to address AET non-adherence that incorporate the perspectives of breast cancer survivors and health-care providers (HCPs). Implications: If effective strategies for targeting suboptimal adherence are to be developed, it is essential that we look beyond the demographic and clinical predictors of non-adherence and conduct an in-depth exploration of the interrelationships between the personal, social and structural factors influencing AET adherence. An understanding of breast cancer survivors’ and HCPs’ experiences and preferences related to AET is an imperative first step in identifying and prioritizing strategies that hold real promise for improving adherence rates and ultimately reducing the risk of breast cancer recurrence.