| Aims1. To investigate the rate of adherence and persistence to hormonal therapy for breast cancer patients.2. To analyze the influential factors of persistence and adherence to hormonal therapy for breast cancer patients.3. To evaluate the effect of nurse-led individualized follow-up on medication adherence and quality of life of breast cancer patients with adjuvant hormonal therapy.Methods1. Literatures published before March2012were searched in the following databases:Cochrane Library, JBI Database of Systematic Reviews, Nursing Consult, MEDLINE, Embase, Pubmed, Web of Knowledge, Chinese Biological Medical Literature Database(CBM), and WanFang Dissertation Database. Survey, cohort study, case-control study, and randomized controlled trials were included. The quality of studies was critically appraised and data were extracted by three reviewers independently. Content analysis was conducted for the24eligible studies.2. Medical records of274women who were diagnosed with hormone-sensitive breast cancer and received surgery in Shanghai Cancer Hospital Fudan University in2006were identified and reviewed. All of their hormonal therapy prescriptions and dates of refill from2006to2012were retrospectively extracted by two researchers. Cox proportional hazards regression models was used to analyze factors associated with discontinuation3. In-depth interviews were conducted to health care professionals and patients with hormonal therapy to explore their perception about persistence and adherence to hormonal therapy and influential factors. 4. Randomized controlled trial on effect of nurse-led individualized follow-up on medication adherence and quality of life of51breast cancer patients with hormonal therapy were evaluated with six months follow-up.Results1. A total of24studies were included (14cohort studies,9surveys, and1RCT) in the systematic review. Sample size ranged from26to13593. Sixty-four to ninety-four percents of breast cancer patients took at least one prescription in the physician’s recommendation. Ten to nineteen percents of patients discontinued hormonal therapy (prescription gap>180days) at the first year. Among the continuous users in five-year therapy,31%～54%of them were non-adherent. Extreme age (≥65or <45years) and comorbidities (higher Charlson Comorbidity Index) were main exposures to discontinuation.2. For retrospective part of this study, the mean duration of hormonal therapy was34.6±21.7months. Over the5-year period,83(30.3%) patients never discontinued the hormonal therapy. Of the191(69.7%) patients who discontinued their hormonal therapy,87(45.5%) restarted. The annual medication possession ratio of the83patients who never discontinued hormonal therapy were0.94±0.11、0.90±0.14、0.93±0.09.0.89±0.13,and0.80±0.20respectively. Women taking Tamoxifen had the higher risk of discontinuation than Aromatase Inhibitors (OR=2.94). Women who never replace hormonal therapy prescription had more risk of discontinuation.3. The results of in-depth interviews for breast cancer experts showed that the balance between side effects and efficacy was the key point of adherence for breast cancer patients. The awareness on importance of hormonal therapy was insufficient among breast cancer patients. Lack of dynamic monitoring indicators and channels to communicate with health professionals were the most significant influence on the adherence to hormonal therapy.4. After6months nurse-led individualized follow-up, the medication possession ration and scores of endocrine symptom subscale of patients in intervention group were significant higher than patients in control group. Night sweat, hectic fever, and weight gain were significantly improved in intervention group.Conclusion1. Medication adherence to hormonal therapy for breast cancer patients should be improved urgently. Randomized controlled study was sorely lacking in exploring the effective measures to enhance the medication adherence of breast cancer women with hormonal therapy.2. Medication adherence to breast cancer patients with adjuvant hormonal therapy was polarization in Shanghai. Particular attention should be paid to the persistence of hormonal therapy for breast cancer patients.3. More focus must be attracted on patients with Tamoxifen and take effective measures to ensure the availability of hormonal therapy drugs.4. Main factors associated with medication adherence included lack of awareness of importance of hormonal therapy, severe side effect, and relationship between patients and health care professionals. Individualized and continuous follow-up models should be explored.5. Nurse-led individualized follow-up could significantly enhance the rate of adherence and endocrine symptom during the first six month of hormonal therapy for breast cancer patients. |
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