ASPO Abstracts
Intervention Designs to Optimize Endocrine Therapy Adherence in Breast Cancer Survivors: A Meta-analysis of Available Trials
Category: Lifestyles Behavior, Energy Balance & Chemoprevention, Behavioral Science & Health Communication
Conference Year: 2018
Abstract Body:
As secondary prevention, endocrine therapy (ET) can reduce risk of recurrence among most breast cancer survivors. For other women with genetically mediated family histories, these drugs may prevent a primary breast cancer. While efficacious in clinical trials, the effectiveness of any medication hinges upon medication adherence behavior. Many breast cancer survivors do not adhere to ET as prescribed. Researchers have trialed interventions to enhance adherence with conflicting results. The aim of this meta-analysis was to estimate the overall effect size of interventions to promote ET adherence among breast cancer survivors and test how study design moderates effect. We conducted literature searches through June 2017 using multiple electronic databases and hand searches of conference abstracts from 2015 through June 2017. Studies were included that: 1) sampled breast cancer survivors receiving ET; 2) tested an ET adherence intervention; 3) measured ET adherence; and 4) provided sufficient data to calculate effect sizes. Study information was extracted in duplicate using a standardized, piloted coding form and all effect sizes were calculated using random effects assumptions. From 1207 search results 8 interventions were included representing 1437 women with early stage breast cancer. Most (k =6) studies compared participants receiving ET against a control group; one study used a single group pre-post design. Interventions were educational in content, most (k=5) using hard copy letter format; fewer studies relied on phone (k=2) or smartphone app (k=1). Total aggregate effect size was null (d= .28; 95% CI= -.05, .61) suggesting no effect. However this model showed significant heterogeneity among individual study effect sizes (Cochrane’s Q = 55.23). Moderator analyses revealed that interventions that promoted bidirectional communication between patient and care team in their design showed enhanced effect size (d= .59; 95%CI=.23, .95) with attendant reduction in model heterogeneity (Cochrane’s Q = 25.12). Conclusion: breast cancer survivors may improve ET adherence when interventions increase opportunities for communication and engagement. Future interventions may wish to consider these design elements to optimize ET adherence in this population.
Keywords: endocrine therapy adherence breast cancer meta-analysis patient engagement