How do you assess and encourage adherence to adjuvant hormonal therapy in early stage breast cancer patients?

Adherence is important to maximize the benefits of adjuvant therapy. Unfortunately studies that measure adherence (pill counts, bottle monitors, prescription records) suggest that many (as many as 40%) of patients discontinue therapy or take <85% of planned doses within the first 5 years. I ask open ended questions - "How often in the last month did you forget to take your pills?"  This assumes we ALL forget sometimes and gives patients permission to tell you the truth  I also ask about out of pocket cost of their drugs. Studies have found a $10 increase in out of pocket cost decreases adherence. Many patients won't ask about cost or ways to reduce cost unless we bring up the subject. Finally I ask about side effects that make them want to stop therapy.

I agree with @Dr. First Last; adherence and persistence to endocrine therapy is a challenge in the management of HR+ breast cancer. I also use open-ended questions. Careful assessment of side effects is important, as I think they are the most common cause of discontinuation of endocrine therapy. While many clinicians ask about musculoskeletal complaints and hot flashes for patients on AI's, other side effects such as insomnia and vaginal dryness/dyspareunia may be overlooked. Prompt assessment and management of these side effects may improve adherence/persistence and ultimately the outcomes of these patients.