title: Barriers and facilitators of adjuvant hormone therapy adherence and persistence in women with breast cancer: a systematic review.
abstract: OBJECTIVE
  Nonadherence to hormone therapy in breast cancer survivors is common and associated with increased risk of mortality. Consistent predictors of nonadherence and nonpersistence are yet to be identified, and little research has examined psychosocial factors that may be amenable to change through intervention. This review aimed to identify predictors of nonadherence and nonpersistence to hormone therapy in breast cancer survivors in order to inform development of an intervention to increase adherence rates.
  
  
  METHODS
  Studies published up to April 2016 were identified through MEDLINE, Embase, Web of Science, PsycINFO, CINAHL and gray literature. Studies published in English measuring associations between adherence or persistence and any predictor variables were included. Eligible studies were assessed for methodological quality, data were extracted and a narrative synthesis was conducted.
  
  
  RESULTS
  Sixty-one eligible articles were identified. Most studies focused on clinical and demographic factors with inconsistent results. Some evidence suggested that receiving specialist care and social support were related to increased persistence, younger age and increased number of hospitalizations were associated with nonadherence, and good patient-physician relationship and self-efficacy for taking medication were associated with better adherence. A small amount of evidence suggested that medication beliefs were associated with adherence, but more high-quality research is needed to confirm this.
  
  
  CONCLUSIONS
  Some psychosocial variables were associated with better adherence and persistence, but the results are currently tentative. Future high-quality research should be carried out to identify psychosocial determinants of nonadherence or nonpersistence that are modifiable through intervention.
authors.affiliation: Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Moon
authors.affiliation: Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Rona
authors.initials: R
authors.lastname: Moss-Morris
authors.affiliation: Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Myra S
authors.initials: MS
authors.lastname: Hunter
authors.affiliation: Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Carlisle
authors.affiliation: Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Lyndsay D
authors.initials: LD
authors.lastname: Hughes
keywords: adherence; breast cancer; hormone therapy; persistence