Adherence to oral anticancer hormonal therapy in breast cancer patients and its relationship with treatment satisfaction: an important insight from a developing country

(2023) 23:114 Koni et al. BMC Women’s Health https://doi.org/10.1186/s12905-023-02276-5 BMC Women’s Health Open Access RESEARCH Adherence to oral anticancer hormonal therapy in breast cancer patients and its relationship with treatment satisfaction: an important insight from a developing country Amer A. Koni1,2*, Bushra A. Suwan2, Maisa A. Nazzal1, Alaa Sleem2, Aiman Daifallah2, Majd Hamed allah3, Razan Y. Odeh3 and Sa’ed H. Zyoud2,4,5 Abstract Background Hormone-positive breast cancer is the most common type and represents a burden in all countries. Treatment satisfaction might be a predictor for adherence, as higher satisfaction with medication encourages patients to adhere appropriately to the medication and, consequently, successfully achieve the treatment goals. The present study evaluated the adherence of women with hormone-positive breast cancer to oral hormonal drugs and correlated it with treatment satisfaction and other sociodemographic and clinical factors. Methods A cross-sectional design was applied. This study included two cancer centers. Data were collected from patients through face-to-face interviews and medical record reviews. The Medication Adherence Scale was adapted to assess medication adherence, and the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 was adopted to measure treatment satisfaction. Results The final analysis included 106 patients, with a mean age ± SD of 51.9 ± 1.2. Approximately 35% were hospitalized in the past year. Current hormonal therapy among cancer patients included letrozole (38.7%), tamoxifen (31.1%), exemestane (17%), and anastrozole (13.2%). The median adherence score was 5.0 [4.8–6.0], and 62.3% adhered fully to their oral hormonal drugs in the past week. The median scores of effectiveness, side effects, convenience, and global satisfaction were 66.67 [61.11.0–72.22], 75.00 [48.44–100.00], 66.67 [66.67–72.22], and 71.43 [57.14–78.57], respectively. A significantly lower adherence score was identified in patients living in camps (p = 0.020). Patients with comorbidities and those who continued on the same hormonal therapy had higher adherence scores, although they were not statistically significant. Multiple linear regression analysis showed that two domains of treatment satisfaction, side effects (p = 0.013) and global satisfaction (p = 0.018), were predictors of adherence to oral hormonal drugs. Conclusions The current study revealed a significant association between treatment satisfaction and adherence to oral hormonal therapy. We recommend creating a specialized scale to measure adherence, considering the psychosocial factors that affect hormonal anticancer medication adherence. *Correspondence: Amer A. Koni Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Koni et al. BMC Women’s Health (2023) 23:114 Page 2 of 12 Keywords Adherence, Treatment satisfaction, Oral hormonal therapy, Breast cancer, Hormone-positive, Oral anticancer Background In modern times, breast cancer is one of the most common health conditions faced by women worldwide [1]. It represents approximately 24.5% of all types of cancer in females and affects 1 in 8 women during their lifetime [1]. In Palestine, breast cancer is the most common cancer. In 2021, the number of new breast cancer cases in Palestine was 876 [2]. Based on statistics in the United States, Hormonal positive/human epidermal growth factor receptor 2 (HER2) negative breast cancer is the most common subtype and represents approximately 68% [3]. Oral hormonal anticancer drugs (i.e., tamoxifen and aromatase inhibitors) are prescribed for women with estrogenpositive and progesterone-positive breast cancer, with a highly satisfactory result after using these treatments [4]. It is often started as an adjuvant treatment following surgery/radiotherapy/chemotherapy or a combination of these therapies and given for 5 to 10 years [5]. It can also be given as a neo-adjuvant [5]. In a systematic review, the adherence rate to adjuvant hormonal therapy was approximately 66% [6]. Furthermore, it was found that more than half of breast cancer patients had nonadherent behavior to their treatment [7]. This percentage is close to that in Arabic nations, where Saudi Arabia reported a 69% adherence rate to antihormonal therapy [8]. Depression, older age, comorbidities, younger age, and side effects were associated with lower adherence. However, therapy with aromatase inhibitors, received chemotherapy, and prior medication use were associated with improved adherence [6]. In addition, it was found that adherence to hormone therapy increases disease-free survival [9]. Nevertheless, adherence to endocrine treatment decreased with years of therapy [10]. A previous study proved that satisfaction with oral anticancer drugs substantially affects adherence [11]. Breast cancer is a notable burden in all countries, and its incidence is high [12]. Suppose a cancer patient follows the treatment plan and adheres to the medications directed by his physician. In that case, it improves the survival rate and decreases the likelihood of recurrence [13]. Patient satisfaction with treatment is the key that encourages him to adhere to medications and successfully achieve short- and long-term results [11]. However, treatment satisfaction assessment helps healthcare professionals know the exact level of their patient’s satisfaction with a specific drug and subsequently modify the treatment plan or find other solutions. This study will be the foundation for other projects that aim to evaluate adherence and treatment satisfaction in different cancer populations or with other therapies. There are limited reports on endocrine therapy adherence and treatment satisfaction in Palestine. Therefore, this study aims to determine the adherence rate and study factors associated with adherence. Methods Study design and (...truncated)