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Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers

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Abstract

Purpose

In the past decade, there has been an increase in the development and use of oral anti-cancer medications (OAMs), especially for breast cancer–the most prevalent cancer in women. However, adherence rates for OAMs are often suboptimal, leading to lower survival rate, increased risk of recurrence, and higher healthcare costs. Our goal was to identify potentially modifiable psychosocial facilitators and barriers that may be targeted to increase OAM adherence for breast cancer patients.

Methods

We systematically searched PubMed for studies published in the U.S. by June 15, 2016 that addressed the following: (1) OAMs for breast cancer; (2) medication adherence; and (3) at least one psychosocial aspect of adherence.

Results

Of the 1752 papers screened, 21 articles were included and analyzed. The most commonly reported motivators for adherence are patient-provider relationships (n = 11 studied, 82% reported significant association) and positive views and beliefs of medication (n = 9 studied, 89% reported significant association). We also identified consistent evidence of the impact of depression and emotions, perception of illness, concern of side effects, self-efficacy in medication management and decision making, knowledge of medication, and social support on OAM adherence.

Conclusions

Compared to traditional demographic, system, and clinical-related factors that have been well documented in the literature but are not easily changed, these cognitive, psychological, and interpersonal factors are more amendable via intervention and therefore could generate greater benefit in improving patient compliance and health outcomes. As OAMs shift treatment administration responsibility onto patients, continuous provider communication and education on illness and regimen are the keys to supporting patients’ medication behavior.

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Acknowledgement

Dr. Bosworth is supported by the VA Research Career Scientist Award (RCS 08-027); and Dr. Zullig is supported by the VA Health Services Research and Development (HSR&D) Career Development Award (CDA 13-025). The project is partially funded by Duke University Bass Connections for interdisciplinary research.

Author information

Authors and Affiliations

  1. Policy and Organizational Management Program, Duke University, 2204 Erwin Road, Durham, NC, 27705, USA

    Cheryl Lin, Rachel Clark & Pikuei Tu

  2. Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 W. Chapel Hill Street, Durham, NC, USA

    Hayden B. Bosworth & Leah L. Zullig

  3. Duke Cancer Institute, Duke University, Durham, NC, USA

    Hayden B. Bosworth & Leah L. Zullig

  4. Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA

    Hayden B. Bosworth & Leah L. Zullig

  5. School of Nursing, Duke University, Durham, NC, USA

    Hayden B. Bosworth

  6. Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA

    Hayden B. Bosworth

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  1. Cheryl Lin
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  2. Rachel Clark
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Correspondence to Cheryl Lin.

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Lin, C., Clark, R., Tu, P. et al. Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers. Breast Cancer Res Treat 165, 247–260 (2017). https://doi.org/10.1007/s10549-017-4317-2

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