Breast Cancer Research and Treatment

, Volume 174, Issue 2, pp 297–305 | Cite as

Identifying adherence barriers to oral endocrine therapy among breast cancer survivors

  • Rutugandha Paranjpe
  • Grace John
  • Meghana Trivedi
  • Susan AbughoshEmail author



Approximately 70–80% of breast cancers are hormone receptor-positive (HR+). OET, including tamoxifen and aromatase inhibitors, is considered standard adjuvant therapy for HR+ breast cancer. Despite demonstrated benefits, nearly half of patients are non-adherent and over two-thirds discontinue therapy before the recommended 5 years. Our objective was to identify and summarize literature-reported barriers associated with non-adherence/non-persistence to OET among breast cancer survivors.


A PUBMED literature search was conducted using the following terms: ‘breast cancer,’ ‘oral endocrine therapy’ or ‘Tamoxifen’ or ‘Aromatase Inhibitors,’ ‘adherence,’ or ‘barriers.’ The search was restricted to past six years. The abstracts of each result were reviewed and categorized as either patient-reported or physician-reported. All patient- and physician-reported factors that affected adherence and persistence were listed and grouped together into the three main categories: Socio-demographic and medical parameters, general psychosocial parameters, and psychosocial parameters related to OET.


A total of 320 articles were identified, of which 19 met inclusion criteria. Adverse drug reactions were the most commonly reported barrier but were generally underreported among physicians. Among patient-reported barriers, common social-demographic and medical parameters were age, comorbidity, and financial status. General psychosocial variables were lack of patient–provider communication, depressive symptoms, and lack of perceived self-efficacy. Treatment toxicity was the most commonly reported psychosocial parameter related to OET.


The determinants of non-adherence and non-persistence are multi-dimensional and influenced by several factors. The three categories of adherence barriers should be evaluated and considered when designing future interventions to enhance OET adherence for a tailored approach.


Breast cancer Oral endocrine therapy Barriers Adherence 




Compliance with ethical standards

Conflict of interest

Rutugandha Paranjpe declares that she has no conflict of interest. Grace John declares that she has no conflict of interest. Meghana Trivedi declares that she has no conflict of interest. Susan Abughosh declares that she has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Hence, it does not need any human consent.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Rutugandha Paranjpe
    • 1
  • Grace John
    • 2
  • Meghana Trivedi
    • 3
    • 4
  • Susan Abughosh
    • 1
    Email author
  1. 1.Departments of Pharmaceutical Health Outcomes and PolicyUniversity of Houston, College of PharmacyHoustonUSA
  2. 2.University of Houston, College of PharmacyHoustonUSA
  3. 3.Pharmacy Practice and Translational ResearchUniversity of Houston, College of PharmacyHoustonUSA
  4. 4.Pharmacological and Pharmaceutical SciencesUniversity of Houston, College of PharmacyHoustonUSA

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