Gli strumenti di misura dell’aderenza alla terapia endocrina nel paziente con tumore alla mammella

Many factors contribute to the failure of an adjuvant therapy, perhaps one of the most important is the adhesion to the treatment. The topic of oral consumption of medicines generated a vast literature and considerable controversies. The complexity of the topic is based on the fact that terms such as compliance, adherence and concordance are commonly used as synonymous related on the consumption of medicines. Patients do not adhere to the prescribed therapy for several reasons, and each of them needs to be analyzed and managed in order to give to the patient the best clinical benefit. Evaluation of treatment adherence is, thus, a major issue in breast cancer care. The assessment of long term adherent behavior, however, is methodologically challenging. Studies have yielded inconclusive results indicating adherence rates between 20% and 100% across different phases of antineoplastic treatment. This variability of non-adherence rates found in the literature has been suggested to be attributed to heterogeneous study designs as well as inconsistencies in methodological approaches. There is currently no Gold Standard of adherence measurement available. Current evidence indicates that the patterns of findings on adherence might result more from the methods used to study them than from the underlying conceptual principles. The first part of the article will explain some of the key controversies inherent in the terminology. In the second part the measure instruments of adherence, which need to be used in the clinical practice will be presented.