The Impact of Medication Side Effects on Adherence and Persistence to Hormone Therapy in Breast Cancer Survivors: A Qualitative Systematic Review and Thematic Synthesis

BACKGROUND: Hormone Therapy (HT) reduces the risk of breast cancer recurrence and mortality in breast cancer. Despite these clinical benefits, rates of HT non-adherence and non-persistence are high. Research suggests this may be due to the impact of HT side effects. However, little research has explored the individual contribution of side effects to non-adherence and non-persistence behaviours. Our aim is to review the literature on breast cancer survivors’ lived experiences of HT side effects and explore how these may be related to non-adherence and non-persistence behaviour.METHODS: Electronic searches were conducted from inception to May 2020, 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: Sixteen eligible papers were identified, and study quality was high. Data were thematically synthesised into four analytical themes, which encompassed 13 descriptive sub-themes: ‘Daily impact of side-effects’, ‘Role of Health Care Professionals’, ‘Managing HT side-effects’, and ‘Weighing up the pros and cons’.CONCLUSIONS: HT side effects significantly impact breast cancer survivor’s quality of life. A lack of support from healthcare providers leads to self-management strategies, which negatively affects adherence and persistence behaviour.