Importance of endocrine treatment adherence and persistence in breast cancer survivorship: a systematic review.

PURPOSE: Adjuvant endocrine treatment is essential for treating luminal subtypes of breast cancer, which constitute 75% of all breast malignancies. However, the detrimental side effects of treatment make it difficult for many patients to complete the guideline-required treatment. Such non-adherence may jeopardize the lifesaving ability of anti-estrogen therapy. In this systematic review, we aimed to assess the consequences of non-adherence and non-persistence from available studies meeting strict statistical and clinical criteria. METHODS: A systematic literature search was performed using several databases, yielding identification of 2,026 studies. After strict selection, 14 studies were eligible for systematic review. The review included studies that examined endocrine treatment non-adherence (patients not taking treatment as prescribed) or non-persistence (patients stopping treatment prematurely), in terms of the effects on event-free survival or overall survival among women with non-metastatic breast cancer. RESULTS: We identified 10 studies measuring the effects of endocrine treatment non-adherence and non-persistence on event-free survival. Of these studies, seven showed significantly poorer survival for the non-adherent or non-persistent patient groups, with hazard ratios (HRs) ranging from 1.39 (95% CI, 1.07 to 1.53) to 2.44 (95% CI, 1.89 to 3.14). We identified nine studies measuring the effects of endocrine treatment non-adherence and non-persistence on overall survival. Of these studies, seven demonstrated significantly reduced overall survival in the groups with non-adherence and non-persistence, with HRs ranging from 1.26 (95% CI, 1.11 to 1.43) to 2.18 (95% CI, 1.99 to 2.39). CONCLUSION: The present systematic review demonstrates that non-adherence and non-persistence to endocrine treatment negatively affect event-free and overall survival. Improved follow-up, with focus on adherence and persistence, is vital for improving health outcomes among patients with non-metastatic breast cancer.

Treatment and clinical outcome in patients with idiopathic normal pressure hydrocephalus--a systematic review.

INTRODUCTION: Treatment of idiopathic normal pressure hydrocephalus (iNPH) is challenging. It is well known that patients with iNPH experience short-term symptom relief after shunt implantation, but the long-term effect of shunting has yielded diverging results. The objective of the present study was to review the literature and to investigate the diagnostics, treatment and outcome of patients with iNPH after shunt treatment. METHODS: A PubMed search was performed and 430 articles were identified. The search was further limited to humans, language (English and Norwegian) and publication dates after 1990. A total of 343 articles were retrieved, and 43 of these articles were found to be applicable to the research question and were therefore screened. A total of ten articles were discarded after reviewing their abstracts as the articles were not relevant to the question of interest. Another ten articles were identified from the reference lists of the initial articles which yielded a total of 43 relevant articles. The main reason for exclusion of articles was a lack of match between the articles' search criteria and the research question herein. RESULTS: Approximately 40% of the studies were prospective. The overall success rate from surgical treatment varied from 30% to 90%. Direct comparison was hampered by the lack of a common protocol regarding symptoms and outcome. Factors suggestive of a good outcome were early diagnosis, gait disturbance as the predominant preoperative complaint, and a positive response to cerebrospinal fluid dynamic tests. CONCLUSION: Shunting remains the preferred treatment, but endoscopic third ventriculostomy is reported as a possible alternative in some studies.