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Interventions to promote adherence to endocrine therapy among breast cancer survivors: A meta‐analysis
Author(s) -
Finitsis David J.,
Vose Brittany A.,
Mahalak Justin G.,
Salner Andrew L.
Publication year - 2019
Publication title -
psycho‐oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.41
H-Index - 137
eISSN - 1099-1611
pISSN - 1057-9249
DOI - 10.1002/pon.4959
Subject(s) - psychological intervention , medicine , breast cancer , meta analysis , cancer , oncology , adjuvant therapy , intervention (counseling) , clinical psychology , gynecology , psychiatry
Objective Adjuvant endocrine therapy (AET) significantly reduces risk of breast cancer recurrence in those patients whose tumor tests hormone (estrogen and/or progesterone) receptor positive. Many who are prescribed AET do not adhere adequately. Studies have sought to examine the effects of interventions to enhance patients' AET adherence, with strikingly mixed results. In order to reconcile a disparate literature, this paper aims to (1) quantitatively review the aggregate effect of interventions designed to optimize AET adherence within the current literature and (2) meta‐analyze these effects across studies' by intervention design. Methods Duplicate searches were conducted using multiple electronic databases as well as hand searches of recent year conference abstracts. Studies were included that (1) tested an intervention to promote AET adherence; (2) reported at least one measure of medication adherence; and (3) reported (or provided upon request) data sufficient to calculate effect size. Effect sizes were calculated using random effects models. Results Seven studies representing eight unique interventions were included. We observed an overall null effect across all interventions ( k = 8; d [95% CI] = 0.28 [−0.05, 0.61]); however, sensitivity analyses showed that interventions that used bi‐directional communication showed statistically significant effects relative to control groups within each study ( k = 4; d [95% CI] = 0.59 [0.23, 0.95]) while those relying only on providing information to the patient (one‐way communication) did not ( k = 4; d [95% CI] = −0.03 [−0.27, 0.20]). Conclusions Interventions that promote patient self‐report may improve AET adherence through enhancing patient engagement. Investigators and clinicians who wish to optimize medication adherence in this population can consider this approach.