In a systematic review and meta-analysis reported in the Journal of Clinical Oncology, Bright et al found that interventions to promote adjuvant endocrine therapy adherence in breast cancer survivors were successful overall compared with control conditions, although some interventions appeared to be more effective than others.
Study Details
Studies that examined an intervention for promoting adjuvant endocrine therapy adherence were included in the systematic review. Studies included in the meta-analysis were those that examined a measure of adjuvant endocrine therapy adherence (compliance or persistence beyond initiation) and provided sufficient information to calculate an effect size.
Key Findings
A total of 33 unique studies representing 375,951 patients met inclusion criteria for the systematic review.
Interventions that educated patients on managing side effects mostly failed to improve adjuvant endocrine therapy adherence. However, health system policy changes that reduced the costs of adjuvant endocrine therapy consistently improved adherence. Variable efficacy in improving adherence was observed with interventions such as medication reminders, communication, and psychological/coping strategies. For example, four of seven studies evaluating the efficacy of medication reminders showed significantly improved adherence. Two additional studies—one seeking to increase positive affective attitudes toward adjuvant endocrine therapy and one using cognitive behavioral therapy techniques to teach adaptive coping skills with an emphasis on reducing cancer-related stressors—showed significantly improved adherence.
A total of 25 of the studies representing 367,873 patients met inclusion criteria for the meta-analysis. The investigators found that adherence interventions overall significantly improved the likelihood of treatment adherence vs study-specified control conditions (odds ratio = 1.412, 95% confidence interval [CI] = 1.183–1.682, P = .0001). In subgroup analyses, no significant differences in effect sizes were observed according to study design (randomized controlled trial vs other), study publication year, directionality of the intervention (unidirectional vs bidirectional contact), or individual intervention type.
The investigators concluded: “To our knowledge, this is the first known meta-analysis to demonstrate a significant effect for interventions to promote adjuvant endocrine therapy 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.”
Joanna J. Arch, PhD, of the Department of Psychology and Neuroscience, University of Colorado Boulder, is the corresponding author of the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
