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Kleineidam L, Stark M, Riedel-Heller SG, Pabst A, Schmiedek F, Streit F, Rietschel M, Klinger-König J, Grabe HJ, Erhardt A, Gelbrich G, Schmidt B, Berger K, Wagner M. The assessment of cognitive function in the German National Cohort (NAKO) - Associations of demographics and psychiatric symptoms with cognitive test performance. World J Biol Psychiatry 2023; 24:909-923. [PMID: 35175181 DOI: 10.1080/15622975.2021.2011408] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To describe the cognitive test battery of the German National Cohort (NAKO), a population-based mega cohort of 205,000 randomly selected participants, and to examine associations with demographic variables and selected psychiatric and neurological conditions. METHODS Initial data from 96,401 participants providing data on the cognitive performance measured by a brief cognitive test battery (12-word list recall task, semantic fluency, Stroop test, digit span backwards) was examined. Test results were summarised in cognitive domain scores using exploratory and confirmatory factor analyses. Associations with sociodemographic and psychiatric factors were analysed using linear regression and generalised additive models. RESULTS Cognitive test results were best represented by two domain scores reflecting memory and executive functions. Lower cognitive functions were associated with increasing age and male sex. Higher education and absence of childhood trauma were associated with better cognitive function. Moderate to severe levels of anxiety and depression, and a history of stroke, were related to lower cognitive function with a stronger effect on executive function as compared to memory. Some associations with cognition differed by German language proficiency. CONCLUSIONS The NAKO cognitive test battery and the derived cognitive domain scores for memory and executive function are sensitive measures of cognition.
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Affiliation(s)
- Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Melina Stark
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Florian Schmiedek
- Department of Education and Human Development, DIPF | Leibniz Institute for Research and Information in Education, Frankfurt am Main, Germany
- Institute of Psychology, Goethe University, Frankfurt am Main, Germany
- Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig University Giessen, Germany
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
| | - Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Wuerzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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Yang S, Park SW, Bae SJ, Ahn SG, Jeong J, Park K. Investigation of Factors Affecting Adherence to Adjuvant Hormone Therapy in Early-Stage Breast Cancer Patients: A Comprehensive Systematic Review. J Breast Cancer 2023; 26:309-333. [PMID: 37272247 PMCID: PMC10475712 DOI: 10.4048/jbc.2023.26.e22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/05/2023] [Accepted: 04/16/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE Adherence and persistence to adjuvant hormone therapy (AHT) are seldom maintained among early-stage hormone receptor-positive breast cancer (BC) survivors, despite the significant clinical benefits of long-term AHT. As the factors influencing adherence to AHT remain unclear, this study aimed to comprehensively identify such factors and classify them into specific dimensions. METHODS PubMed, Cochrane Library, Embase, PsycINFO, and CINAHL were searched for qualified articles. The search mainly focused on three components: early-stage (0-III) BC, oral AHT administration, and adherence to AHT, with keywords derived from MeSH and entry terms. The factors identified were then classified into six categories based on a modified WHO multidimensional model. RESULTS Overall, 146 studies were included; the median sample size was 651 (range, 31-40,009), and the mean age of the population was 61.5 years (standard deviation, 8.3 years). Patient- and therapy-related factors were the most frequently investigated factors. Necessity/concern beliefs and self-efficacy among patient-related factors were consistently related to better adherence than depression. Although drug side effects and medication use cannot be modified easily, a refined prescription strategy for the initiation and switching of AHT is likely to increase adherence levels. CONCLUSION An effective psychological program that encourages positive views and beliefs about medication and management strategies for each therapy may be necessary to improve adherence to AHT. Social support and a sense of belonging can be enhanced through community participation and social media for better adherence to AHT. Patient-centered communication and appropriate recommendations by physicians may be attributable to better adherence outcomes. Findings from systematically organized factors that influence adherence to AHT may contribute to the establishment of intervention strategies to benefit patients with early-stage BC to achieve optimal health.
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Affiliation(s)
- Seongwoo Yang
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Korea
| | - Seong Won Park
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine/Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine/Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine/Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyounghoon Park
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Korea.
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Chou CC, Chien LY, Liaw JJ, Wang CJ, Liu PY. Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women. J Clin Nurs 2021; 31:2839-2849. [PMID: 34723423 DOI: 10.1111/jocn.16106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/24/2021] [Accepted: 10/06/2021] [Indexed: 12/22/2022]
Abstract
DESIGN This study applied a cross-sectional, descriptive correlational design. AIMS AND OBJECTIVES The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. BACKGROUND Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. METHODS This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. RESULTS More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. CONCLUSIONS Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. RELEVANCE TO CLINICAL PRACTICE Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.
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Affiliation(s)
- Cheng-Chen Chou
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Yin Chien
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Jane Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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4
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Mian H, Fiala M, Wildes TM. Adherence to Lenalidomide in Older Adults With Newly Diagnosed Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:98-104.e1. [PMID: 31843543 DOI: 10.1016/j.clml.2019.09.618] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/06/2019] [Accepted: 09/29/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION One of the most common orally administered antimyeloma agents, lenalidomide, has significantly improved outcomes in multiple myeloma, including in older patients. However, despite its utilization and cost, the rates and factors related to adherence to lenalidomide in older adults with newly diagnosed multiple myeloma remain unknown. PATIENTS AND METHODS Data were collected from adults with newly diagnosed multiple myeloma over age 65 years being treated with lenalidomide therapy between the years 2007 and 2014 in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases. Adherence was measured as medication possession ratio (MPR), which was defined as the ratio of the number of days the patient had pills in their possession to the number of days in the observation period in the first year after myeloma diagnosis. MPR of < 90% was considered poor adherence. RESULTS A total of 793 patients were included in the analysis. The mean MPR in our cohort was 89.5 ± 9.3%. Overall, 38% (n = 302) of the patients were considered to have poor adherence. Factors associated with poor adherence included increasing age (adjusted odds ratio [aOR] = 1.03 per year; 95% confidence interval [CI], 1.00-1.05; P = .024), black race (aOR = 1.72; 95% CI, 1.08-2.73; P = .022), and polypharmacy (aOR = 1.04 per medication; 95% CI, 1.01-1.08; P = .008). CONCLUSION Over a third of older adults with newly diagnosed multiple myeloma were considered to have poor adherence to lenalidomide, using the MPR as a surrogate for adherence. This highlights the need to further understand factors and devise strategies to support adherence in this patient cohort.
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Affiliation(s)
- Hira Mian
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, Ontario, Canada.
| | - Mark Fiala
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Tanya M Wildes
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
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5
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Rambeau A, Beauplet B, Laviec H, Licaj I, Leconte A, Chatel C, Le Bon P, Denhaerynck J, Clarisse B, Frenkiel N, Lange M, Joly F. Prospective comparison of the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) in geriatric oncology. J Geriatr Oncol 2019; 10:235-240. [DOI: 10.1016/j.jgo.2018.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/19/2018] [Accepted: 08/01/2018] [Indexed: 12/22/2022]
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6
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Dos Santos M, Lange M, Gervais R, Clarisse B, Capel A, Barillet M, Grellard JM, Heutte N, Licaj I, Joly F. Impact of anxio-depressive symptoms and cognitive function on oral anticancer therapies adherence. Support Care Cancer 2019; 27:3573-3581. [PMID: 30690685 DOI: 10.1007/s00520-019-4644-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Oral anticancer therapies have an important place in the therapeutic arsenal, but factors influencing adherence to oral treatment are poorly documented in oncology. The objective of this study was to assess the impact of anxio-depressive symptoms and cognitive functioning on oral medication adherence. METHODS This prospective study included cancer patients initiating a first oral therapy. Before initiation of treatment, an assessment of depression, anxiety, and cognition was performed. Using self-report questionnaires, we collected information on socio-demographic conditions and the non-adherence at 1 (M1) and 3 months (M3) after the beginning of treatment. RESULTS Among 129 patients enrolled, median age was 70 years and 81% of patients were treated for metastatic cancer. Before initiating treatment, 16% and 8% of patients presented respectively depression and anxiety symptoms. Global cognitive impairment was observed in 51% of patients. Ten percent of the patients were non-adherent at M1 and 13% at M3. Depression was strongly associated with non-adherence at M1 (P = 0.046) and M3 (P = 0.014), but not anxiety. Non-adherence was associated with lower working memory (P = 0.037) and digit memory (P = 0.018) at M1 and short-term memory (P = 0.04) at M3. Patients with more than eight co-medications were more often non-adherents (P = 0.055). CONCLUSIONS Non-adherence to oral anticancer therapies was mainly associated to depression. Focusing on depressive symptoms before initiation of oral anticancer therapy could help to identify patient profiles more likely to fail self-management. Working memory, digit memory, and short-term memory also seem to play a role in non-adherence. Further studies should include a more specific population, especially according to age.
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Affiliation(s)
- Mélanie Dos Santos
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France. .,Department of Medicine, Hospital University, 14000, Caen, France. .,Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France. .,INSERM, U1086, ANTICIPE, 14000, Caen, France.
| | - M Lange
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
| | - R Gervais
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - B Clarisse
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - A Capel
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - M Barillet
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - J M Grellard
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - N Heutte
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
| | - I Licaj
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
| | - F Joly
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,Department of Medicine, Hospital University, 14000, Caen, France.,Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
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7
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Mislang AR, Wildes TM, Kanesvaran R, Baldini C, Holmes HM, Nightingale G, Coolbrandt A, Biganzoli L. Adherence to oral cancer therapy in older adults: The International Society of Geriatric Oncology (SIOG) taskforce recommendations. Cancer Treat Rev 2017; 57:58-66. [PMID: 28550714 DOI: 10.1016/j.ctrv.2017.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 01/08/2023]
Abstract
There is an increasing trend towards using oral systemic therapy in patients with cancer. Compared to parenteral therapy, oral cancer agents offer convenience, have similar efficacy, and are preferred by patients, consequently making its use appealing in older adults. However, adherence is required to ensure its efficacy and to avoid compromising treatment outcomes, especially when the treatment goal is curative, or in case of symptomatic/rapidly progressing disease, where dose-intensity is important. This opens a new challenge for clinicians, as optimizing patient adherence is challenging, particularly due to lack of consensus and scarcity of available clinical evidence. This manuscript aims to review the impact of age-related factors on adherence, summarize the evidence on adherence, recommend methods for selecting patients suitable for oral cancer agents, and advise monitoring interventions to promote adherence to treatment.
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Affiliation(s)
- Anna Rachelle Mislang
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato 59100, Italy; Cancer Clinical Trials Unit, Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Tanya M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Capucine Baldini
- Medical Hospital Huriez, University Lille Nord de France, Lille, France
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, TX, USA
| | - Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
| | - Annemarie Coolbrandt
- Oncology Nursing Department, University Hospitals Leuven, Leuven, Belgium; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000 Leuven, Belgium
| | - Laura Biganzoli
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato 59100, Italy.
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Johnson LA. Factors influencing oral adherence: qualitative metasummary and triangulation with quantitative evidence. Clin J Oncol Nurs 2017; 19:6-30. [PMID: 26030389 DOI: 10.1188/15.s1.cjon.6-30] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Concern about adherence to oral agents among patients with cancer has grown as more oral agents are being used for cancer treatment. Knowledge of common factors that facilitate or inhibit adherence to oral medication regimens can be beneficial to clinicians in identifying patients at risk for nonadherence, in planning care to address barriers to adherence, and in educating patients about ways to improve adherence. OBJECTIVES The focus of this review is to synthesize the evidence about factors that influence adherence and identify implications for practice. METHODS Literature was searched via PubMed and CINAHL®. Evidence regarding factors influencing adherence was synthesized using a metasummary of qualitative research and triangulated with findings from quantitative research. FINDINGS Forty-four factors influencing adherence were identified from 159 research studies of patients with and without cancer. Factors associated with adherence in oncology and non-oncology cases included provider relations, side effects, forgetfulness, beliefs about medication necessity, establishing routines for taking medication, social support, ability to fit medications in lifestyle, cost, and medication knowledge. Among patients with cancer, depression and negative expectations of results also were shown to have a negative relationship to adherence.
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A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS One 2017; 12:e0170651. [PMID: 28166234 PMCID: PMC5293218 DOI: 10.1371/journal.pone.0170651] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022] Open
Abstract
Background Adherence to medication is vital for disease management while simultaneously reducing healthcare expenditure. Older persons with cognitive impairment (CI) are at risk for non-adherence as cognitive processes are needed to manage medications. This systematic review focuses on the relationship between medication non-adherence and specific cognitive domains in persons with CI, and explores determinants of medication non-adherence. When available, relationships and factors are compared with cognitively intact populations. Methods A seven database systematic search of studies published between 1 January 1949–31 December 2015 examining medication non-adherence in community dwelling persons with CI or dementia was conducted. Articles reporting medication non-adherence in people with CI or dementia in the community, with or without caregiver supports were eligible for inclusion. Papers reporting adherence to treatments in cognitively intact populations, populations from hospital or institutional settings, for non-prescribed medication or those describing dementia as a factor predicting medication non-adherence were excluded. Data on study and population characteristics, research design, data sources and analysis, specific cognitive domains, non-adherence prevalence, measurement of adherence, salient findings, factors associated with adherence and strategies to improve medication adherence were extracted. Study limitations included inconsistencies between data sources and definitions, resulting in a loss of fidelity in the value and comprehensiveness of data, as well as exclusion of non-pharmacological treatments and regimens. Findings Fifteen studies met inclusion criteria. Adherence among CI subjects ranged from 10.7%-38% with better rates of adherence in non-CI individuals. Medication non-adherence definitions varied considerably. New-learning, memory and executive functioning were associated with improved adherence and formed the focus of most studies. Multiple factors were identified as modulators of non-adherence. Conclusion This review highlights a gap in knowledge on how specific cognitive domains contribute to medication non-adherence amongst CI populations, and demonstrates the current focus is limited to two domains: memory and executive functioning.
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Smith SG, Sestak I, Forster A, Partridge A, Side L, Wolf MS, Horne R, Wardle J, Cuzick J. Factors affecting uptake and adherence to breast cancer chemoprevention: a systematic review and meta-analysis. Ann Oncol 2016; 27:575-90. [PMID: 26646754 PMCID: PMC4803450 DOI: 10.1093/annonc/mdv590] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/29/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Preventive therapy is a risk reduction option for women who have an increased risk of breast cancer. The effectiveness of preventive therapy to reduce breast cancer incidence depends on adequate levels of uptake and adherence to therapy. We aimed to systematically review articles reporting uptake and adherence to therapeutic agents to prevent breast cancer among women at increased risk, and identify the psychological, clinical and demographic factors affecting these outcomes. DESIGN Searches were carried out in PubMed, CINAHL, EMBASE and PsychInfo, yielding 3851 unique articles. Title, abstract and full text screening left 53 articles, and a further 4 studies were identified from reference lists, giving a total of 57. This review was prospectively registered with PROSPERO (CRD42014014957). RESULTS Twenty-four articles reporting 26 studies of uptake in 21 423 women were included in a meta-analysis. The pooled uptake estimate was 16.3% [95% confidence interval (CI) 13.6-19.0], with high heterogeneity (I(2) = 98.9%, P < 0.001). Uptake was unaffected by study location or agent, but was significantly higher in trials [25.2% (95% CI 18.3-32.2)] than in non-trial settings [8.7% (95% CI 6.8-10.9)] (P < 0.001). Factors associated with higher uptake included having an abnormal biopsy, a physician recommendation, higher objective risk, fewer side-effect or trial concerns, and older age. Adherence (day-to-day use or persistence) over the first year was adequate. However, only one study reported a persistence of ≥ 80% by 5 years. Factors associated with lower adherence included allocation to tamoxifen (versus placebo or raloxifene), depression, smoking and older age. Risk of breast cancer was discussed in all qualitative studies. CONCLUSION Uptake of therapeutic agents for the prevention of breast cancer is low, and long-term persistence is often insufficient for women to experience the full preventive effect. Uptake is higher in trials, suggesting further work should focus on implementing preventive therapy within routine care.
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Affiliation(s)
- S G Smith
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London Health Behaviour Research Centre, University College London, London, UK
| | - I Sestak
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London
| | - A Forster
- Health Behaviour Research Centre, University College London, London, UK
| | - A Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - L Side
- Institute for Women's Health, University College London, London, UK
| | - M S Wolf
- Division of General Internal Medicine, Northwestern University, Chicago, USA
| | - R Horne
- Centre for Behavioural Medicine, University College London, London, UK
| | - J Wardle
- Health Behaviour Research Centre, University College London, London, UK
| | - J Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London
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11
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Greer JA, Amoyal N, Nisotel L, Fishbein JN, MacDonald J, Stagl J, Lennes I, Temel JS, Safren SA, Pirl WF. A Systematic Review of Adherence to Oral Antineoplastic Therapies. Oncologist 2016; 21:354-76. [PMID: 26921292 DOI: 10.1634/theoncologist.2015-0405] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/08/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Oral antineoplastic therapies not only improve survival but also reduce the burden of care for patients. Yet patients and clinicians face new challenges in managing adherence to these oral therapies. We conducted a systematic literature review to assess rates and correlates of adherence to oral antineoplastic therapies and interventions aimed at improving adherence. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive literature search of the Ovid MEDLINE database from January 1, 2003 to June 30, 2015, using relevant terminology for oral antineoplastic agents. We included observational, database, and intervention studies. At least two researchers evaluated each paper to ensure accuracy of results and determine risk of bias. RESULTS We identified 927 records from the search and screened 214 abstracts. After conducting a full-text review of 167 papers, we included in the final sample 51 papers on rates/correlates of adherence to oral antineoplastic therapy and 12 papers on intervention studies to improve adherence. Rates of adherence varied widely, from 46% to 100%, depending on patient sample, medication type, follow-up period, assessment measure, and calculation of adherence. Of the intervention studies, only 1 of the randomized trials and 2 of the cohort studies showed benefit regarding adherence, with the majority suffering high risk of bias. CONCLUSIONS Although no reliable estimate of adherence to oral antineoplastic therapies can be gleaned from the literature, a substantial proportion of patients struggle to adhere to these medications as prescribed. The few intervention studies for adherence have notable methodological concerns, thereby limiting the evidence to guide practice in promoting medication adherence among patients with cancer.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Amoyal
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Nisotel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joel N Fishbein
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James MacDonald
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie Stagl
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Inga Lennes
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - William F Pirl
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Le Rhun E, Delbeuck X, Lefeuvre-Plesse C, Kramar A, Skrobala E, Pasquier F, Bonneterre J. A phase III randomized multicenter trial evaluating cognition in post-menopausal breast cancer patients receiving adjuvant hormonotherapy. Breast Cancer Res Treat 2015; 152:569-80. [DOI: 10.1007/s10549-015-3493-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/02/2015] [Indexed: 12/29/2022]
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Mausbach BT, Schwab RB, Irwin SA. Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2015; 152:239-46. [PMID: 26077640 DOI: 10.1007/s10549-015-3471-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/12/2015] [Indexed: 12/21/2022]
Abstract
The purpose of this meta-analysis was to analyze the available evidence concerning the effects of depression on non-adherence to adjuvant endocrine therapy (AET) in women with breast cancer. MEDLINE and PsycInfo databases from inception through May 1, 2015 were searched using terms related to AET adherence. Articles were reviewed and selected based on predetermined selection criteria, and effect sizes from included studies were extracted. Pooled effect estimates were obtained using random-effects meta-analyses. Of the 312 articles identified, 9 met the inclusion criteria. Overall, depression was significantly associated with non-adherence to AET (Cohen's d = 0.35, 95% CI 0.19-0.52). This effect was not significantly moderated by patient age (<65 vs ≥65 years), length of study follow-up (<18 months vs ≥18 months), or method of assessing adherence (objective vs self-report). However, within these subgroups, significant effects of depression were found only for younger patients (d = 0.46; 95% CI 0.19-0.72) and in studies of shorter duration (<18 months) (d = 0.49; 95% CI 0.22-0.76). These results suggest that AET adherence may be lower among women with greater depressive symptoms, and this effect may be exacerbated in younger women during the early phases (<18 months) of AET. Management of depressive symptoms in women with breast cancer may help in enhancing adherence to AET and improve cancer treatment outcomes.
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Affiliation(s)
- Brent T Mausbach
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA,
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Gorini A, Mazzocco K, Gandini S, Munzone E, McVie G, Pravettoni G. Development and psychometric testing of a breast cancer patient-profiling questionnaire. BREAST CANCER-TARGETS AND THERAPY 2015; 7:133-46. [PMID: 26064067 PMCID: PMC4457218 DOI: 10.2147/bctt.s80014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction The advent of “personalized medicine” has been driven by technological advances in genomics. Concentration at the subcellular level of a patient’s cancer cells has meant inevitably that the “person” has been overlooked. For this reason, we think there is an urgent need to develop a truly personalized approach focusing on each patient as an individual, assessing his/her unique mental dimensions and tailoring interventions to his/her individual needs and preferences. The aim of this study was to develop and test the psychometric properties of the ALGA-Breast Cancer (ALGA-BC), a new multidimensional questionnaire that assesses the breast cancer patient’s physical and mental characteristics in order to provide physicians, prior to the consultation, with a patient’s profile that is supposed to facilitate subsequent communication, interaction, and information delivery between the doctor and the patient. Methods The specific validation processes used were: content and face validity, construct validity using factor analysis, reliability and internal consistency using test–retest reliability, and Cronbach’s alpha correlation coefficient. The exploratory analysis included 100 primary breast cancer patients and 730 healthy subjects. Results The exploratory factor analysis revealed eight key factors: global self-rated health, perceived physical health, anxiety, self-efficacy, cognitive closure, memory, body image, and sexual life. Test–retest reliability and internal consistency were good. Comparing patients with a sample of healthy subjects, we also observed a general ability of the ALGA-BC questionnaire to discriminate between the two. Conclusion The ALGA-BC questionnaire with 29 items is a valid instrument with which to obtain a patient’s profile that is supposed to help physicians achieve meaningful personalized care which supplements biological and genetic analyses.
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Affiliation(s)
- Alessandra Gorini
- Department of Health Science, University of Milan, Milan, Italy ; European Institute of Oncology, Milan, Italy
| | - Ketti Mazzocco
- Department of Health Science, University of Milan, Milan, Italy ; European Institute of Oncology, Milan, Italy
| | | | | | | | - Gabriella Pravettoni
- Department of Health Science, University of Milan, Milan, Italy ; European Institute of Oncology, Milan, Italy
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Cahir C, Guinan E, Dombrowski SU, Sharp L, Bennett K. Identifying the determinants of adjuvant hormonal therapy medication taking behaviour in women with stages I-III breast cancer: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)00234-7. [PMID: 26054455 DOI: 10.1016/j.pec.2015.05.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/05/2015] [Accepted: 05/14/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to identify the modifiable determinants of adjuvant hormonal therapy medication taking behaviour (MTB) in women with stage I-III breast cancer in clinical practice settings. METHODS We searched PubMed EMBASE, PsycINFO and CINAHL for articles investigating determinants of adjuvant hormonal therapy. Potentially modifiable determinants were identified and mapped to the 14 domains of the Theoretical Domains Framework (TDF), an integrative framework of theories of behavioural change. Meta-analysis was used to calculate pooled odds ratios for selected determinants. RESULTS Potentially modifiable determinants were identified in 42 studies and mapped to 9 TDF domains. In meta-analysis treatment side-effects (Domain: Beliefs about Capabilities) and follow-up care with a general practitioner (vs. oncologist) (Social Influences) were significantly negatively associated with persistence (p<0.001) and number of medications (Behaviour Regulation) was significantly positively associated with persistence (p<0.003). Studies did not examine several domains (including Beliefs about Consequences, Intentions, Goals, Social Identity, Emotion and Knowledge) which have been reported to influence MTB in other disease groups. CONCLUSIONS There is some evidence that the domains Beliefs about Capabilities, Behaviour Regulation and Social Influences influence hormonal therapy MTB. PRACTICE IMPLICATIONS Further research is needed to develop effective interventions to improve hormonal therapy MTB.
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Affiliation(s)
- Caitriona Cahir
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Ireland and Economic and Social Research Institute, Dublin 2, Ireland,.
| | - Emer Guinan
- Discipline of Physiotherapy, Trinity College Dublin, Ireland
| | | | - Linda Sharp
- National Cancer Registry Ireland, Cork, Ireland
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Ireland
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Defrancesco M, Sperner-Unterweger B. [Diagnosis and therapy of cognitive deficits in oncology patients]. DER NERVENARZT 2015; 86:282-290. [PMID: 25676924 DOI: 10.1007/s00115-014-4155-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Improvements in the diagnostics and therapy of almost all types of cancer have extended the survival rates and average life expectancies of oncology patients. As a result the assessment of cognitive deficits is becoming much more important not only in cancer diagnostics but also in the disease-free period following treatment. Various cognitive deficits can occur in patients with intracranial as well as extracranial malignancies. These deficits can be caused by tumor or treatment-related factors. Previous studies have shown that cognitive deficits may negatively influence the quality of life, therapy adherence, prognosis and mortality of patients. Currently, standardized specially designed cognitive tests for oncology patients are lacking; nevertheless, neurocognitive assessment should become an integral element in the diagnostic procedure as well as in the therapeutic process of these patients. An increasing number of studies are currently evaluating pharmacological and non-pharmacological strategies to treat or prevent cognitive deficits; however, recommendations for daily clinical use are still lacking.
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Affiliation(s)
- M Defrancesco
- Universitätsklinik für Allgemeine und Sozialpsychiatrie, Department für Psychiatrie und Psychotherapie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich,
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Kasi PM, Ruddy KJ. Factors influencing treatment adherence and discontinuation in women with breast cancer. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.14.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Although all aspects of breast cancer care rely to some extent on patient behaviors, the endocrine therapies, which are orally administered at home, are the most impacted by nonadherence and nonpersistence. A variety of issues can interfere with a breast cancer patient's adherence and persistence including the following: sociodemographic factors; healthcare team and system-related factors (such as inadequate visit time and poor medication distribution services); condition-related factors (such as prognosis); therapy-related factors (such as side effects); and patient-related factors (such as attitudes, beliefs, perceptions, and expectations). In our review, we describe evidence regarding the most powerful factors mediating adherence and persistence in breast cancer patients, and explore potential interventions to reduce nonadherence and nonpersistence, primarily based on data in patients taking adjuvant endocrine therapy.
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Affiliation(s)
| | - Kathryn J Ruddy
- Division of Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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