Struggling to Adhere

Written By Brittany Chow

Should you be taking the medication your doctor prescribes to you? The obvious answer is ‘yes’ but in reality, it can sometimes be hard to follow the doctor’s orders. Forgetting to take your medication, having a difficult time with the side effects, or feeling like the drugs are not necessary to your health are all common reasons why people may not take their prescription medication.

One of the most important developments in breast cancer treatment over the past thirty years has been the use of hormone therapies (like Tamoxifen or an Aromatase Inhibitor) for hormone positive breast cancer. Studies have shown that hormone therapy can reduce the risk of breast cancer coming back (also called recurrence) by over half in survivors who are prescribed the drug, making it one of the best methods to prevent breast cancer from recurring 1. After completing primary cancer treatment, hormone therapy is usually prescribed to patients with hormone positive breast cancer for 5 to 10 years.

Image of several pill bottles 

Taking hormone therapy to prevent breast cancer recurrence is a long-term commitment and staying on track can be hard, especially after the first few months. Unfortunately, up to 50% of the women who are prescribed a hormone therapy medicine either stop taking it or do not take all of their pills as prescribed 2, 3, 4, putting them at higher risk for their breast cancer coming back.

In response, a group of clinicians and researchers led by Dr. Jennifer Jones, Director of Research for the Cancer Survivorship Program at Princess Margaret Cancer Centre, developed the adhERe program, a new client-focused telephone-based program to help breast cancer survivors who are struggling to take to their hormone therapy medication as recommended. They are currently pilot testing this intervention with funds received through the Canadian Breast Cancer Foundation.

The adhERe program uses an approach called Motivational Interviewing, which is a form of collaborative counselling to help people explore their health beliefs and values, and aims to strengthen their internal motivation to change their behaviour. The adERe program consists of 3 brief telephone-based sessions with trained facilitators over a period of 6 weeks. These sessions are designed to help support change within the participant’s life, while still respecting and following the individual’s personal values and beliefs.

Over the course of the adhERe pilot study, participants receive the adhERe program and are also asked to fill out questionnaires, provide pharmacy re-fill information, and give feedback on the program which will help to determine the feasibility of the study design and the acceptability of the intervention itself. The goal is to see if this brief intervention will help women with early stage breast cancer in making decisions regarding taking their medication. If the study is found to be feasible and acceptable to participants, then a larger randomized control trial may be called for in the future.

If you ever feel conflicted about taking your prescription medication, it is important to share your concerns with your health care team. Take some time to learn about any decisions regarding your medication, think about what is important to you, and talk to your health care team about your options.


The study is supported by the Canadian Breast Cancer Foundation and approved by the UHN Research Ethics Board.



1 European Breast Cancer Trial Group, Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet, 2005. 365(9472): p. 1687-717.

2 Hershman, D.L., et al., Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol, 2010. 28(27): p. 4120-8

3 Barron, T.I., et al., Early discontinuation of tamoxifen: a lesson for oncologists. Cancer, 2007. 109(5): p. 832-9.

4 Partridge, A.H., et al., Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol, 2008. 26(4): p. 556-62.