Importance of endocrine treatment adherence and persistence in breast cancer survivorship: a systematic review

Finn Magnus Eliassen; Vibeke Blåfjelldal; Thomas Helland; Cathrine Fonnesbech Hjorth; Kari Hølland; Lise Lode; Bjørn Erik Bertelsen; Emiel A.M. Janssen; Gunnar Mellgren; Jan Terje Kvaløy; Håvard Søiland; Tone Hoel Lende

doi:10.1186/s12885-023-11122-8

Importance of endocrine treatment adherence and persistence in breast cancer survivorship: a systematic review

Finn Magnus Eliassen^*, Vibeke Blåfjelldal, Thomas Helland, Cathrine Fonnesbech Hjorth, Kari Hølland, Lise Lode, Bjørn Erik Bertelsen, Emiel A.M. Janssen, Gunnar Mellgren, Jan Terje Kvaløy, Håvard Søiland, Tone Hoel Lende

^*Corresponding author for this work

Department of Clinical Medicine - Department of Clinical Epidemiology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

14 Citations (Scopus)

Abstract

Purpose: Adjuvant endocrine treatment is essential for treating luminal subtypes of breast cancer, which constitute 75% of all breast malignancies. However, the detrimental side effects of treatment make it difficult for many patients to complete the guideline-required treatment. Such non-adherence may jeopardize the lifesaving ability of anti-estrogen therapy. In this systematic review, we aimed to assess the consequences of non-adherence and non-persistence from available studies meeting strict statistical and clinical criteria. Methods: A systematic literature search was performed using several databases, yielding identification of 2,026 studies. After strict selection, 14 studies were eligible for systematic review. The review included studies that examined endocrine treatment non-adherence (patients not taking treatment as prescribed) or non-persistence (patients stopping treatment prematurely), in terms of the effects on event-free survival or overall survival among women with non-metastatic breast cancer. Results: We identified 10 studies measuring the effects of endocrine treatment non-adherence and non-persistence on event-free survival. Of these studies, seven showed significantly poorer survival for the non-adherent or non-persistent patient groups, with hazard ratios (HRs) ranging from 1.39 (95% CI, 1.07 to 1.53) to 2.44 (95% CI, 1.89 to 3.14). We identified nine studies measuring the effects of endocrine treatment non-adherence and non-persistence on overall survival. Of these studies, seven demonstrated significantly reduced overall survival in the groups with non-adherence and non-persistence, with HRs ranging from 1.26 (95% CI, 1.11 to 1.43) to 2.18 (95% CI, 1.99 to 2.39). Conclusion: The present systematic review demonstrates that non-adherence and non-persistence to endocrine treatment negatively affect event-free and overall survival. Improved follow-up, with focus on adherence and persistence, is vital for improving health outcomes among patients with non-metastatic breast cancer.

Original language	English
Article number	625
Journal	BMC Cancer
Volume	23
Issue	1
Number of pages	12
ISSN	1471-2407
DOIs	https://doi.org/10.1186/s12885-023-11122-8
Publication status	Published - Dec 2023

Keywords

Adherence
Breast Cancer
Endocrine Therapy
Persistence
Survival

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10.1186/s12885-023-11122-8Licence: CC BY

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Eliassen, F. M., Blåfjelldal, V., Helland, T., Hjorth, C. F., Hølland, K., Lode, L., Bertelsen, B. E., Janssen, E. A. M., Mellgren, G., Kvaløy, J. T., Søiland, H., & Lende, T. H. (2023). Importance of endocrine treatment adherence and persistence in breast cancer survivorship: a systematic review. BMC Cancer, 23(1), Article 625. https://doi.org/10.1186/s12885-023-11122-8

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title = "Importance of endocrine treatment adherence and persistence in breast cancer survivorship: a systematic review",

abstract = "Purpose: Adjuvant endocrine treatment is essential for treating luminal subtypes of breast cancer, which constitute 75% of all breast malignancies. However, the detrimental side effects of treatment make it difficult for many patients to complete the guideline-required treatment. Such non-adherence may jeopardize the lifesaving ability of anti-estrogen therapy. In this systematic review, we aimed to assess the consequences of non-adherence and non-persistence from available studies meeting strict statistical and clinical criteria. Methods: A systematic literature search was performed using several databases, yielding identification of 2,026 studies. After strict selection, 14 studies were eligible for systematic review. The review included studies that examined endocrine treatment non-adherence (patients not taking treatment as prescribed) or non-persistence (patients stopping treatment prematurely), in terms of the effects on event-free survival or overall survival among women with non-metastatic breast cancer. Results: We identified 10 studies measuring the effects of endocrine treatment non-adherence and non-persistence on event-free survival. Of these studies, seven showed significantly poorer survival for the non-adherent or non-persistent patient groups, with hazard ratios (HRs) ranging from 1.39 (95% CI, 1.07 to 1.53) to 2.44 (95% CI, 1.89 to 3.14). We identified nine studies measuring the effects of endocrine treatment non-adherence and non-persistence on overall survival. Of these studies, seven demonstrated significantly reduced overall survival in the groups with non-adherence and non-persistence, with HRs ranging from 1.26 (95% CI, 1.11 to 1.43) to 2.18 (95% CI, 1.99 to 2.39). Conclusion: The present systematic review demonstrates that non-adherence and non-persistence to endocrine treatment negatively affect event-free and overall survival. Improved follow-up, with focus on adherence and persistence, is vital for improving health outcomes among patients with non-metastatic breast cancer.",

keywords = "Adherence, Breast Cancer, Endocrine Therapy, Persistence, Survival",

author = "Eliassen, {Finn Magnus} and Vibeke Bl{\aa}fjelldal and Thomas Helland and Hjorth, {Cathrine Fonnesbech} and Kari H{\o}lland and Lise Lode and Bertelsen, {Bj{\o}rn Erik} and Janssen, {Emiel A.M.} and Gunnar Mellgren and Kval{\o}y, {Jan Terje} and H{\aa}vard S{\o}iland and Lende, {Tone Hoel}",

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month = dec,

doi = "10.1186/s12885-023-11122-8",

language = "English",

volume = "23",

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Importance of endocrine treatment adherence and persistence in breast cancer survivorship: a systematic review. / Eliassen, Finn Magnus; Blåfjelldal, Vibeke; Helland, Thomas et al.
In: BMC Cancer, Vol. 23, No. 1, 625, 12.2023.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Importance of endocrine treatment adherence and persistence in breast cancer survivorship

T2 - a systematic review

AU - Eliassen, Finn Magnus

AU - Blåfjelldal, Vibeke

AU - Helland, Thomas

AU - Hjorth, Cathrine Fonnesbech

AU - Hølland, Kari

AU - Lode, Lise

AU - Bertelsen, Bjørn Erik

AU - Janssen, Emiel A.M.

AU - Mellgren, Gunnar

AU - Kvaløy, Jan Terje

AU - Søiland, Håvard

AU - Lende, Tone Hoel

PY - 2023/12

Y1 - 2023/12

N2 - Purpose: Adjuvant endocrine treatment is essential for treating luminal subtypes of breast cancer, which constitute 75% of all breast malignancies. However, the detrimental side effects of treatment make it difficult for many patients to complete the guideline-required treatment. Such non-adherence may jeopardize the lifesaving ability of anti-estrogen therapy. In this systematic review, we aimed to assess the consequences of non-adherence and non-persistence from available studies meeting strict statistical and clinical criteria. Methods: A systematic literature search was performed using several databases, yielding identification of 2,026 studies. After strict selection, 14 studies were eligible for systematic review. The review included studies that examined endocrine treatment non-adherence (patients not taking treatment as prescribed) or non-persistence (patients stopping treatment prematurely), in terms of the effects on event-free survival or overall survival among women with non-metastatic breast cancer. Results: We identified 10 studies measuring the effects of endocrine treatment non-adherence and non-persistence on event-free survival. Of these studies, seven showed significantly poorer survival for the non-adherent or non-persistent patient groups, with hazard ratios (HRs) ranging from 1.39 (95% CI, 1.07 to 1.53) to 2.44 (95% CI, 1.89 to 3.14). We identified nine studies measuring the effects of endocrine treatment non-adherence and non-persistence on overall survival. Of these studies, seven demonstrated significantly reduced overall survival in the groups with non-adherence and non-persistence, with HRs ranging from 1.26 (95% CI, 1.11 to 1.43) to 2.18 (95% CI, 1.99 to 2.39). Conclusion: The present systematic review demonstrates that non-adherence and non-persistence to endocrine treatment negatively affect event-free and overall survival. Improved follow-up, with focus on adherence and persistence, is vital for improving health outcomes among patients with non-metastatic breast cancer.

AB - Purpose: Adjuvant endocrine treatment is essential for treating luminal subtypes of breast cancer, which constitute 75% of all breast malignancies. However, the detrimental side effects of treatment make it difficult for many patients to complete the guideline-required treatment. Such non-adherence may jeopardize the lifesaving ability of anti-estrogen therapy. In this systematic review, we aimed to assess the consequences of non-adherence and non-persistence from available studies meeting strict statistical and clinical criteria. Methods: A systematic literature search was performed using several databases, yielding identification of 2,026 studies. After strict selection, 14 studies were eligible for systematic review. The review included studies that examined endocrine treatment non-adherence (patients not taking treatment as prescribed) or non-persistence (patients stopping treatment prematurely), in terms of the effects on event-free survival or overall survival among women with non-metastatic breast cancer. Results: We identified 10 studies measuring the effects of endocrine treatment non-adherence and non-persistence on event-free survival. Of these studies, seven showed significantly poorer survival for the non-adherent or non-persistent patient groups, with hazard ratios (HRs) ranging from 1.39 (95% CI, 1.07 to 1.53) to 2.44 (95% CI, 1.89 to 3.14). We identified nine studies measuring the effects of endocrine treatment non-adherence and non-persistence on overall survival. Of these studies, seven demonstrated significantly reduced overall survival in the groups with non-adherence and non-persistence, with HRs ranging from 1.26 (95% CI, 1.11 to 1.43) to 2.18 (95% CI, 1.99 to 2.39). Conclusion: The present systematic review demonstrates that non-adherence and non-persistence to endocrine treatment negatively affect event-free and overall survival. Improved follow-up, with focus on adherence and persistence, is vital for improving health outcomes among patients with non-metastatic breast cancer.

KW - Adherence

KW - Breast Cancer

KW - Endocrine Therapy

KW - Persistence

KW - Survival

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Importance of endocrine treatment adherence and persistence in breast cancer survivorship: a systematic review

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