The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A quantitative systematic review

Leanne Fleming* (Corresponding Author), Sommer Agnew, Nicola Peddie, Megan Crawford, Diane Dixon, Iain MacPherson

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

10 Citations (Scopus)
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Background: Hormone Therapy (HT) is recommended for most women with HR-positive primary breast cancer. When taken as intended, HT reduces breast cancer recurrence by 40% and mortality by one-third. The recommended duration of treatment ranges from 5 to 10 years depending on risk of recurrence and the specific HT regimen. However, recent data indicates that rates of HT non-adherence are high and research suggests this may be due to the impact of HT side effects. The contribution of side effects to non-adherence and non-persistence behaviours has rarely been systematically explored, thereby hindering the implementation of targeted intervention strategies. Our aim is to identify, evaluate and summarise the relationship between HT side effects and patterns of adherence and persistence. Methods: Electronic searches were conducted from inception and were completed by September 2021, utilising Cochrane CENTRAL, Medline, Embase, Web of Science and PsycINFO databases. Searches included a combination of terms related to breast cancer, adherence, hormone therapy and side effects. Results: Sixty-two eligible papers were identified and study quality varied by study type. Most observational and cross-sectional studies were rated good quality, whereas most controlled intervention studies were rated fair quality. Three studies were rated poor quality. The most frequently measured side effects were pain, low mood, hot flashes, insomnia, anxiety, fatigue, weight gain, concentration/memory problems. Conclusions: This review identified a lack of consistency in the measurement of adherence and the definition of persistence across studies. The instruments used to measure side effects also varied significantly. This variation and lack of consistency makes it difficult to evaluate and summarise the role of HT side effects in HT adherence and persistence behaviour.

Original languageEnglish
Pages (from-to)63-84
Number of pages22
Early online date21 May 2022
Publication statusPublished - 1 Aug 2022

Bibliographical note

Funding Information:
This work was supported by a Chief Scientist Office Catalytic Research Grant ( CGA/19/62 ).

Data Availability Statement

Supplementary data to this article can be found online at


  • Adherence
  • Adjuvant hormone therapy
  • Aromatase inhibitor
  • Breast cancer
  • Endocrine therapy
  • Persistence
  • Quantitative
  • Side effects
  • Tamoxifen


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