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Psychosocial Factors Related to Treatment Adherence

Posted 7/16/2014

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  We know that five years of an anti-estrogen/hormonal therapy (tamoxifen or one of the AIs) reduces recurrence. For most women with ER positive breast cancers, the risk reduction from one of these treatments is equal to the risk reduction from chemotherapy. Meaning: If a woman, after surgery, has a 20% chance of recurrence based on the characteristics of her tumor, chemotherapy can cut that risk by 50%--bringing the recurrence risk down to 10%. Adding an AI for five years (and, we all know, increasingly it is ten years) cuts the remaining risk by 50%--bringing her recurrence risk down to 5%. That is a whole lot better than the 20% she began with!

  For women who do not need chemotherapy, the anti-estrogen treatment reduces their absolute risk by the same 50%. Also very good!

  We also know that there is a major problem with adherence to this regimen. All of the reasons for many women's non-compliance with daily pills for at least five years are not very well understood. It is clear that cost is often an issue, as are side effects, denial, and just plain wishing that this all were over. This study from the Journal of Cancer Survivorship is the first, to my knowledge, to explore other psychosocial issues that may impact adherence. I found it really interesting and hope that you do, too. Here is the abstract. If you want the whole article, email me, and I will send it along:

Psychosocial factors in adjuvant hormone therapy for breast
cancer: an emerging context for adherence research
Julia R. Van Liew & Alan J. Christensen &
Janet S. de Moor

Abstract
Purpose For patients with hormone receptor positive breast
cancer, survivorship entails prolonged self-management of
adjuvant treatment in the form of daily hormone therapy.
Although sustained daily adherence across the 5-year course
of therapy is associated with improved recurrence-free
survival outcomes, adherence is suboptimal and many
women discontinue hormone therapy prematurely. Factors
associated with breast cancer survivors’ nonadherence and
nonpersistence are not comprehensively understood. Furthermore,
psychosocial variables have only received limited research
attention, despite their documented relationships with
adherence in other chronic illness populations.
Methods A systematic literature review identified 14 studies
that analyzed relationships between psychosocial factors and
breast cancer survivors’ adherence and/or persistence with
adjuvant hormone therapy.
Results Although identified relationships were complex and
at times inconsistent, salient conclusions emerged. Interpersonal
factors, in the form of positive social support and
patient-centered interactions with medical providers, as well
as intrapersonal factors, such as anxiety and beliefs about the
relative benefits of medication use, were reliably associated
with better adherence and persistence. Depression did not

demonstrate the negative impact on adherence that has been
observed in other medical populations. No relationships between
quality of life and adherence were identified.
Conclusions Adjuvant hormone therapy appears to be a
unique context for medication adherence, which warrants further
attention and more rigorous analysis in future research.
Implications for Cancer Survivors Individual patients’ psychosocial
characteristics and health care preferences should be
considered when striving to optimize medication adherence.

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