The Impact of Medication Side Effects on Adherence and Persistence to Hormone Therapy in Breast Cancer Survivors: A Qualitative Systematic Review and Thematic Synthesis

Overview

Journal Breast

Publisher Elsevier

Specialties Endocrinology
Oncology

Date 2021 May 28

PMID 34049260

Citations 34

Authors

Nicola Peddie

Sommer Agnew

Megan Crawford

Diane Dixon

Iain MacPherson

Leanne Fleming

Affiliations

Soon will be listed here.

Abstract

Background: Hormone Therapy (HT) reduces the risk of breast cancer recurrence and mortality in women with breast cancer. Despite these clinical benefits, rates of HT non-adherence and non-persistence are high. Research suggests this may be due to the impact of HT side effects. However, little research has explored the individual contribution of side effects to non-adherence and non-persistence behaviours, thereby hindering the implementation of targeted intervention strategies. Our aim is to review the published literature on breast cancer survivors' lived experiences of HT side effects and explore how these may be related to non-adherence and non-persistence behaviour.

Methods: Electronic searches were conducted from inception to May 2020, utilising Cochrane CENTRAL, Medline, Embase, Web of Science and PsycINFO databases. Searches included a combination of terms related to breast cancer, adherence, hormone therapy and side effects.

Results: Sixteen eligible papers were identified, and study quality was high. Data were thematically synthesised into four analytical themes, which encompassed 13 descriptive sub-themes: 'Daily impact of side-effects', 'Role of Health Care Professionals', 'Managing HT side-effects', and 'Weighing up the pros and cons'.

Conclusions: HT side effects significantly impact breast cancer survivor's quality of life. A lack of support from healthcare providers leads to self-management strategies, which negatively affects adherence and persistence behaviour.

Citing Articles

The impact of sleep on breast cancer-specific mortality: a Mendelian randomisation study.

Hayes B, Fleming L, Mahmoud O, Martin R, Lawlor D, Robinson T BMC Cancer. 2025; 25(1):357.

PMID: 40011859 PMC: 11863467. DOI: 10.1186/s12885-025-13681-4.

Digital and nurse-led support intervention in primary care during the first year after curative intent treatment for breast or prostate cancer: study protocol of two cluster randomised controlled pilot trials.

Langius-Eklof A, Craftman A, Gellerstedt L, Kelmendi N, Rooth K, Gustavell T BMJ Open. 2025; 15(2):e090848.

PMID: 39986997 PMC: 11848687. DOI: 10.1136/bmjopen-2024-090848.

Perspectives of Women with Breast Cancer and Healthcare Providers Participating in an Adherence-Enhancing Program for Adjuvant Endocrine Therapy: A Qualitative Study.

Turcotte V, Guillaumie L, Lemay M, Dionne A, Lemieux J, Labbe A Curr Oncol. 2025; 32(1).

PMID: 39851961 PMC: 11764025. DOI: 10.3390/curroncol32010045.

Effect of depression and empowerment on medication adherence in patients with breast cancer: a descriptive survey.

Jeong S, Kim E BMC Nurs. 2025; 24(1):47.

PMID: 39806337 PMC: 11731554. DOI: 10.1186/s12912-024-02680-8.

Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana.

Wester J, Wagner R, Motladiile B, Nkele I, Chinyepi N, Makhema M JCO Glob Oncol. 2024; 10:e2400180.

PMID: 39666914 PMC: 11684513. DOI: 10.1200/GO.24.00180.

References

Cheng H, Sit J, Cheng K . A qualitative insight into self-management experience among Chinese breast cancer survivors. Psychooncology. 2016; 26(7):1044-1049. DOI: 10.1002/pon.4279. View

Heisig S, Shedden-Mora M, von Blanckenburg P, Schuricht F, Rief W, Albert U . Informing women with breast cancer about endocrine therapy: effects on knowledge and adherence. Psychooncology. 2014; 24(2):130-7. DOI: 10.1002/pon.3611. View

Bourmaud A, Rousset V, Regnier-Denois V, Collard O, Jacquin J, Merrouche Y . Improving Adherence to Adjuvant Endocrine Therapy in Breast Cancer Through a Therapeutic Educational Approach: A Feasibility Study . Oncol Nurs Forum. 2016; 43(3):E94-E103. DOI: 10.1188/16.ONF.E94-E103. View

Hershman D, Kushi L, Shao T, Buono D, Kershenbaum A, Tsai W . Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol. 2010; 28(27):4120-8. PMC: 2953970. DOI: 10.1200/JCO.2009.25.9655. View

Tomlinson D, Diorio C, Beyene J, Sung L . Effect of exercise on cancer-related fatigue: a meta-analysis. Am J Phys Med Rehabil. 2014; 93(8):675-86. DOI: 10.1097/PHM.0000000000000083. View

Cahir C, Guinan E, Dombrowski S, Sharp L, Bennett K . Identifying the determinants of adjuvant hormonal therapy medication taking behaviour in women with stages I-III breast cancer: A systematic review and meta-analysis. Patient Educ Couns. 2015; . DOI: 10.1016/j.pec.2015.05.013. View

Ahlstedt Karlsson S, Wallengren C, Olofsson Bagge R, Henoch I . "It is not just any pill"-Women's experiences of endocrine therapy after breast cancer surgery. Eur J Cancer Care (Engl). 2019; 28(3):e13009. DOI: 10.1111/ecc.13009. View

Johnson J, Rash J, Campbell T, Savard J, Gehrman P, Perlis M . A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev. 2015; 27:20-8. DOI: 10.1016/j.smrv.2015.07.001. View

Weaver K, Camacho F, Hwang W, Anderson R, Kimmick G . Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women. Am J Clin Oncol. 2012; 36(2):181-7. PMC: 3355198. DOI: 10.1097/COC.0b013e3182436ec1. View

10.

Bluethmann S, Murphy C, Tiro J, Mollica M, Vernon S, Bartholomew L . Deconstructing Decisions to Initiate, Maintain, or Discontinue Adjuvant Endocrine Therapy in Breast Cancer Survivors: A Mixed-Methods Study. Oncol Nurs Forum. 2017; 44(3):E101-E110. PMC: 5507080. DOI: 10.1188/17.ONF.E101-E110. View

11.

Kyvernitakis I, Ziller V, Hars O, Bauer M, Kalder M, Hadji P . Prevalence of menopausal symptoms and their influence on adherence in women with breast cancer. Climacteric. 2013; 17(3):252-9. DOI: 10.3109/13697137.2013.819327. View

12.

Humphries B, Collins S, Guillaumie L, Lemieux J, Dionne A, Provencher L . Women's Beliefs on Early Adherence to Adjuvant Endocrine Therapy for Breast Cancer: A Theory-Based Qualitative Study to Guide the Development of Community Pharmacist Interventions. Pharmacy (Basel). 2018; 6(2). PMC: 6024955. DOI: 10.3390/pharmacy6020053. View

13.

Tong A, Flemming K, Mcinnes E, Oliver S, Craig J . Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012; 12:181. PMC: 3552766. DOI: 10.1186/1471-2288-12-181. View

14.

Clancy C, Lynch J, OConnor P, Dowling M . Breast cancer patients' experiences of adherence and persistence to oral endocrine therapy: A qualitative evidence synthesis. Eur J Oncol Nurs. 2020; 44:101706. DOI: 10.1016/j.ejon.2019.101706. View

15.

Brett J, Boulton M, Fenlon D, Hulbert-Williams N, Walter F, Donnelly P . Adjuvant endocrine therapy after breast cancer: a qualitative study of factors associated with adherence. Patient Prefer Adherence. 2018; 12:291-300. PMC: 5819578. DOI: 10.2147/PPA.S145784. View

16.

Street Jr R, Makoul G, Arora N, Epstein R . How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009; 74(3):295-301. DOI: 10.1016/j.pec.2008.11.015. View

17.

Harrow A, Dryden R, McCowan C, Radley A, Parsons M, Thompson A . A hard pill to swallow: a qualitative study of women's experiences of adjuvant endocrine therapy for breast cancer. BMJ Open. 2014; 4(6):e005285. PMC: 4067895. DOI: 10.1136/bmjopen-2014-005285. View

18.

Wells K, Pan T, Vazquez-Otero C, Ung D, Ustjanauskas A, Munoz D . Barriers and facilitators to endocrine therapy adherence among underserved hormone-receptor-positive breast cancer survivors: a qualitative study. Support Care Cancer. 2016; 24(10):4123-30. PMC: 4995114. DOI: 10.1007/s00520-016-3229-8. View

19.

Lambert L, Balneaves L, Howard A, Gotay C . Patient-reported factors associated with adherence to adjuvant endocrine therapy after breast cancer: an integrative review. Breast Cancer Res Treat. 2017; 167(3):615-633. DOI: 10.1007/s10549-017-4561-5. View

20.

Liu Y, Malin J, Diamant A, Thind A, Maly R . Adherence to adjuvant hormone therapy in low-income women with breast cancer: the role of provider-patient communication. Breast Cancer Res Treat. 2012; 137(3):829-36. PMC: 3553239. DOI: 10.1007/s10549-012-2387-8. View