Wang Xiaofeng, Jia Ruimei, Xiang Guangcai, Zhang Deping, Wang Yi, Xu Hui
The Affiliated Taizhou People's Hospital of Nanjing Medical University Taizhou Jiangsu Province China.
Liaoning Cancer Hospital and Insititute Cancer Hospital of China Medical University Shenyang Liaoning Province China.
Health Sci Rep. 2025 Jun 18;8(6):e70934. doi: 10.1002/hsr2.70934. eCollection 2025 Jun.
Adherence to adjuvant endocrine therapy (AET) in breast cancer patients is affected by multiple factors. A number of studies were performed to find out the potential influencing factors. However, the results of these studies were not consistent. Therefore, this meta-analysis aimed to synthesize the existing evidence on influencing factors of AET adherence in breast cancer patients.
Several databases were searched for published and unpublished studies. The potential influencing factors were identified and mapped to the five dimensions of the World Health Organization (WHO) medication adherence theoretical framework. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to evaluate the influencing factors, and then meta-analysis was performed using Review Manager 5.4 software.
Thirty-seven eligible studies were included, with a total of 104,777 patients. Nineteen influencing factors were divided into five categories: patient-related factors (OR = 1.74, 95% CI: 1.55-1.96), therapy-related factors (OR = 2.13, 95% CI: 1.85-2.46), disease-related factors (OR = 1.38, 95% CI: 1.25-1.52), socioeconomic factors (OR = 1.34, 95% CI: 1.20-1.50) and health system-related factors (OR = 0.46, 95% CI: 0.26-0.81). Age < 50 years, age > 65 years, lack of knowledge about AET, side effects, without radiotherapy or chemotherapy, initial use of tamoxifen, switching AET, complementary or alternative treatment use, higher Charlson comorbidity index, taking multiple medications, depression, lower income, no medical insurance, no partner, and lack of social support were related to non-adherence. A higher level of medical support was related to good adherence.
AET adherence is influenced by multiple factors. This meta-analysis synthesizes existing evidence on influencing factors for AET adherence in breast cancer patients, offering a comprehensive overview. Governments and stakeholders should align health policy or interventions with the WHO five dimensions of medication adherence to enhance tailored AET adherence strategies.
乳腺癌患者对辅助内分泌治疗（AET）的依从性受多种因素影响。已开展多项研究以探寻潜在影响因素。然而，这些研究结果并不一致。因此，本荟萃分析旨在综合现有关于乳腺癌患者AET依从性影响因素的证据。
检索多个数据库以查找已发表和未发表的研究。确定潜在影响因素并将其映射到世界卫生组织（WHO）药物依从性理论框架的五个维度。采用比值比（OR）和95%置信区间（95%CI）评估影响因素，然后使用Review Manager 5.4软件进行荟萃分析。
纳入37项符合条件的研究，共104,777例患者。19个影响因素分为五类：患者相关因素（OR = 1.74，95%CI：1.55 - 1.96）、治疗相关因素（OR = 2.13，95%CI：1.85 - 2.46）、疾病相关因素（OR = 1.38，95%CI：1.25 - 1.52）、社会经济因素（OR = 1.34，95%CI：1.20 - 1.50）和卫生系统相关因素（OR = 0.46，95%CI：0.26 - 0.81）。年龄<50岁、年龄>65岁、对AET缺乏了解、副作用、未接受放疗或化疗、初始使用他莫昔芬、更换AET、使用补充或替代治疗、较高的查尔森合并症指数、服用多种药物、抑郁、低收入、无医疗保险、无伴侣以及缺乏社会支持与不依从相关。较高水平的医疗支持与良好依从性相关。
AET依从性受多种因素影响。本荟萃分析综合了现有关于乳腺癌患者AET依从性影响因素的证据，提供了全面概述。政府和利益相关者应使卫生政策或干预措施与WHO药物依从性的五个维度保持一致，以加强针对性的AET依从性策略。
