Factors affecting uptake and adherence to breast cancer chemoprevention. a systematic review and meta-analysis

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1、AnnalsofOncology27:575–590,2016reviewsdoi:10.1093/annonc/mdv590Publishedonline8December2015Factorsaffectinguptakeandadherencetobreastcancerchemoprevention:asystematicreviewandmeta-analysisS.G.Smith1,2*,I.Sestak1,A.Forster2,A.Partridge3,L.Side4,M.S.Wolf5,R.Horne6,J.Wardle2&J.Cuzick

2、112WolfsonInstituteofPreventiveMedicine,QueenMaryUniversityofLondon,London;HealthBehaviourResearchCentre,UniversityCollegeLondon,London,UK;34DepartmentofMedicalOncology,Dana-FarberCancerInstitute,Boston,USA;InstituteforWomen’sHealth,UniversityCollegeLondon,London,UK;56DivisionofGe

3、neralInternalMedicine,NorthwesternUniversity,Chicago,USA;CentreforBehaviouralMedicine,UniversityCollegeLondon,London,UKReceived20October2015;accepted29November2015Background:Preventivetherapyisariskreductionoptionforwomenwhohaveanincreasedriskofbreastcancer.Theeffectivenessofpreve

4、ntivetherapytoreducebreastcancerincidencedependsonadequatelevelsofuptakeandad-herencetotherapy.Weaimedtosystematicallyreviewarticlesreportinguptakeandadherencetotherapeuticagentstopreventbreastcanceramongwomenatincreasedrisk,andidentifythepsychological,clinicalanddemographicfactor

5、saffectingtheseoutcomes.Design:SearcheswerecarriedoutinPubMed,CINAHL,EMBASEandPsychInfo,yielding3851uniquearticles.Title,abstractandfulltextscreeningleft53articles,andafurther4studieswereidentifiedfromreferencelists,givingatotalof57.ThisreviewwasprospectivelyregisteredwithPROSPERO(

6、CRD42014014957).Results:Twenty-fourarticlesreporting26studiesofuptakein21423womenwereincludedinameta-analysis.Thepooleduptakeestimatewas16.3%[95%confidenceinterval(CI)13.6–19.0],withhighheterogeneity(I2=98.9%,reviewsP<0.001).Uptakewasunaffectedbystudylocationoragent,butwassignifican

7、tlyhigherintrials[25.2%(95%CI18.3–32.2)]thaninnon-trialsettings[8.7%(95%CI6.8–10.9)](P<0.001).Factorsassociatedwithhigheruptakeincludedhavinganabnormalbiopsy,aphysicianrecommendation,higherobjectiverisk,fewerside-effectortrialconcerns,andolderage.Adherence(day-to-dayuseorpersisten

8、ce)overthefirstyearwasadequate.How