title: Psychosocial factors in adjuvant hormone therapy for breast cancer: an emerging context for adherence research.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Individual patients' psychosocial characteristics and health care preferences should be considered when striving to optimize medication adherence.
authors.affiliation: Department of Psychology, The University of Iowa, E11 SSH, Iowa City, IA, 52242, USA, julia-vanliew@uiowa.edu.
authors.forename: Julia R
authors.initials: JR
authors.lastname: Van Liew
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Christensen
authors.forename: Janet S
authors.initials: JS
authors.lastname: de Moor
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D017024:Chemotherapy, Adjuvant; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D055118:Medication Adherence; D018802:Patient-Centered Care; D012944:Social Support; D017741:Survivors; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D004965:Estrogen Antagonists; D013629:Tamoxifen