***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Non-persistence and non-compliance are common in women prescribed hormonal therapy for breast cancer , but little is known about their influence on recurrence . Methods : A nested case – control study of associations between hormonal therapy non-persistence and non-compliance and the risk of  early recurrence in women with stage I – III breast cancer was undertaken . Cases , defined as women with a breast cancer recurrence within 4 years of hormonal therapy initiation , were matched to controls ( 1 : 5 ) by tumour stage and age . Conditional logistic regression was used to examine associations between early recurrence and hormonal therapy non-persistence and non-compliance . Results : Ninety-four women with breast cancer recurrence were matched to 458 controls . Women who were non-persistent ( ⩾180 days without hormonal therapy ) had a significantly increased adjusted recurrence odds ratio ( OR ) of 2.88 ( 95%CI 1.11 , 7.46 ) compared with persistent women . There was no significant association between low compliance ( OR 1.30 ; 95 % CI 0.74 , 2.30 ) and breast cancer recurrence . Conclusion : Hormonal therapy non-persistence is associated with a significantly higher risk of early recurrence  in women with stage I – III oestrogen receptor (ER)-positive breast cancer . This finding is consistent with results from r and omized studies of hormonal therapy treatment duration and suggests that interventions to target modifiable risk factors for non-persistence are required Therapy-related adverse side effects are a main reason for non-persistence to adjuvant endocrine breast cancer therapy . This study reports frequency of drug-related adverse side effects that were so severe that a modification of the therapy was necessary . We evaluated how many patients discontinued adjuvant endocrine therapy because of these side effects ( non-persistence ) . Last , we analyzed how often a drug switch was undertaken for this reason and how often this measure led to the patient successfully continuing their endocrine therapy . Data concerning all postmenopausal breast cancer patients ( ≤80 years ) , who initiated endocrine adjuvant therapy between 1998 and 2008 in a Swiss breast center ( n = 400 ) , were analyzed . Out of these 400 women , 37 ( 9.3 % ) were defined as being non-persistent to the therapy ; out of these , 24 ( 64.9 % ) because of therapy-related side effects . About 78 patients ( 19.5 % ) suffered from severe therapy-related side effects that made a modification of therapy necessary . Out of these 78 cases , 14 patients ( 17.9 % ) stopped the therapy without attempting a drug switch ( non-persistence ) . In 64 patients ( 82.1 % ; 16 % of all women who started endocrine therapy ) , a drug switch was undertaken . Out of these 64 cases , in 52 cases ( 81.3 % ) endocrine therapy was completed after therapy modification . Patients who reported one major adverse effect were more likely to continue the endocrine therapy after a drug switch ( P = 0.048 ) compared with those who suffered from at least two different side effects . In 10 of the 64 cases ( 15.6 % ) , modification of the therapy was not successful and the patients stopped the treatment prematurely ( non-persistence ) because of ongoing side effects . In cases when therapy-related side effects occur , a drug switch is a promising step to further improve persistence and , by doing so , the outcome of breast cancer patients BACKGROUND This prospect i ve study evaluated the relationship between arthralgia and compliance during the first year of adjuvant anastrozole therapy in postmenopausal women with hormone receptor-positive early breast cancer . PATIENTS AND METHODS COMPliance and Arthralgia in Clinical Therapy ( COMPACT ) was an open-label , multicenter , noninterventional study conducted in Germany . Patients had started adjuvant anastrozole 3 - 6 months before the study start . The primary end points were arthralgia , compliance , and the relationship between compliance and arthralgia , assessed at specific time points . RESULTS Overall , 1916 patients received upfront anastrozole .  Mean arthralgia scores were increased from baseline at each visit up to 9 months . Compliance with anastrozole therapy gradually decreased over time from baseline to 9 months ( P<0.001 ) . At 9 months , investigators estimated that > 95 % of patients were compliant versus patient reports of < 70 % . There was a significant association between arthralgia mean scores and noncompliance at 6 months ( P<0.0001 ) , 9 months ( P<0.0001 ) , and overall ( P<0.0001 ) . Over time , new events or impairment of existing arthralgias were reported in 14 % ( 3 months ) , 11 % ( 6 months ) , and 9 % ( 9 months ) of patients . CONCLUSION Arthralgia is important in the clinical management of women with early breast cancer and may contribute to noncompliance and clinical outcomes . CLINICAL TRIALSGOV IDENTIFIER NCT00857012 Background There is an important gap between the implication s of clinical research evidence and the routine clinical practice of healthcare professionals . Because individual decisions are often central to adoption of a clinical -related behaviour , more information about the cognitive mechanisms underlying behaviours is needed to improve behaviour change interventions targeting healthcare professionals . The aim of this study was to systematic ally review the published scientific literature about factors influencing health professionals ' behaviours based on social cognitive theories . These theories refer to theories where individual cognitions/thoughts are viewed as processes intervening between observable stimuli and responses in real world situations . Methods We search ed psycINFO , MEDLINE , EMBASE , CIHNAL , Index to theses , PROQUEST dissertations and theses and Current Contents for articles published in English only . We included studies that aim ed to predict healthcare professionals ' intentions and behaviours with a clear specification of relying on a social cognitive theory . Information on percent of explained variance ( R2 ) was used to compute the overall frequency-weighted mean R2 to evaluate the efficacy of prediction in several context s and according to different method ological aspects . The cognitive factors most consistently associated with prediction of healthcare professionals ' intention and behaviours were documented . Results Seventy eight studies met the inclusion criteria . Among these studies , 72 provided information on the determinants of intention and 16 prospect i ve studies provided information on the determinants of behaviour . The theory most often used as reference was the Theory of Reasoned Action ( TRA ) or its extension the Theory of Planned Behaviour ( TPB ) . An overall frequency-weighted mean R2 of 0.31 was observed for the prediction of behaviour ; 0.59 for the prediction of intention . A number of moderators influenced the efficacy of prediction ; frequency-weighted mean R2 varied from 0.001 to 0.58 for behaviour and 0.19 to 0.81 for intention . Conclusion Our results suggest that the TPB appears to be an appropriate theory to predict behaviour whereas other theories better capture the dynamic underlying intention . In addition , given the variations in efficacy of prediction , special care should be given to method ological issues , especially to better define the context of behaviour performance Little is known about the cognitive factors associated with adherence to antiestrogen therapy . Our objective was to investigate the association between domain-specific cognitive function and adherence among women in a clinical prevention trial of oral antiestrogen therapies .  We performed a secondary analysis of Co-STAR , an ancillary study of the STAR breast cancer prevention trial in which postmenopausal women at increased breast cancer risk were r and omized to tamoxifen or raloxifene . Co-STAR enrolled nondemented participants ≥65 years old to compare treatment effects on cognition . The cognitive battery assessed global cognitive function ( Modified Mini-Mental State Exam ) , and specific cognitive domains of verbal knowledge , verbal fluency , figural memory , verbal memory , attention and working memory , spatial ability , and fine motor speed . Adherence was defined by a ratio of actual time taking therapy per protocol ≥80 % of expected time . Logistic regression was used to evaluate the association between cognitive test scores and adherence to therapy . The mean age of the 1,331 Co-STAR participants was 67.2 ± 4.3 years . Mean 3MS score was 95.1 ( 4.7 ) and 14 % were nonadherent . In adjusted analyses , the odds of nonadherence were lower for those with better scores on verbal memory [ OR ( 95 % confidence interval ) : 0.75 ( 0.62–0.92 ) ] . Larger relative deficits in verbal memory compared with verbal fluency were also associated with nonadherence [ 1.28 ( 1.08–1.51 ) ] . Among nondemented older women , subtle differences in memory performance were associated with medication adherence . Differential performance across cognitive domains may help identify persons at greater risk for poor adherence . Cancer Prev Res ; 7(1 ) ; 161–8 . © 2013 AACR Context Flexible sigmoidoscopy and colonoscopy are important screening tools for colon cancer , but many patients miss scheduled appointments for these procedures . Contribution In a large health care system in Philadelphia , 62 % of 11 803 patients attended scheduled colon studies .  Among patients who kept more than 85 % or fewer than 66 % of their scheduled visits with physicians in the past 2 years , 70 % and 52 % , respectively , attended the colon study appointment . Implication s Patients who frequently miss scheduled appointments with their physicians will probably miss appointments for sigmoidoscopy and colonoscopy . The Editors Experts have endorsed periodic direct visualization of the colorectum to screen for colorectal cancer ( 1 , 2 ) . However , in 2001 the Behavioral Risk Factor Surveillance System found that less than half of eligible persons ( 48 % ) 50 years of age or older had had colonoscopy or flexible sigmoidoscopy  ( 3 ) . Endoscopic studies of the colorectum are particularly taxing for patients because they require substantial preparation , as well as keeping the appointment . We hypothesized that patients who were generally nonadherent to physician visits would also be less likely to keep their appointments for colon studies . Computerized scheduling data can now be used to evaluate patients ' appointment-keeping behavior . These data may help to identify patients in greatest need of interventions to improve adherence to colonoscopy and flexible sigmoidoscopy . Methods Study Sample We used the University of Pennsylvania Health System 's ambulatory scheduling and billing system ( IDX Systems Corp. , Burlington , Vermont ) to identify all patients with flexible sigmoidoscopy or colonoscopy ( colon study ) scheduled by a primary care practice from June 1999 through November 2001 . To focus on the first colon study , we considered only patients without a previous colon study since the scheduling system began in December 1997 . Referring primary care practice s ranged from large urban clinics and physician practice s to small suburban physician practice s. Sites performing these endoscopic procedures used various approaches to remind patients about scheduled studies , but there were several commonalities . All sites reminded patients by telephone before the procedure and mailed brochures about the preparation and the procedure . Patients who canceled their appointments could reschedule them immediately . Primary care physicians were not routinely notified when patients did not keep colon study appointments , but the scheduling system would have indicated this . Outcome Variables Our primary outcome was having arrived at the colon study appointment compared with cancellation or not showing up . For both the colon study appointment and physician visits , the patient was judged to have kept an appointment if a cancellation was followed by an arrival within 1 day . Among those patients who did not arrive but rescheduled within 6 months , our secondary outcome was arrival at the second appointment . We used the scheduling information from the IDX system  from January 2000 through August 2002 to examine the disposition of follow-up colon studies . Primary Predictor Variable We examined all scheduled physician visits to both primary care and subspecialty physicians in the health system up to 2 years before the first colon study appointment to define physician visit adherence . Physician visit adherence was measured as the proportion of all scheduled physician appointments within 2 years preceding the first colon study appointment  that had an arrived status . Study participants had a median of 13 scheduled visits to health system providers over a 2-year period ( interquartile range , 7 to 25 visits ) , and the median proportion of visits that were kept was 75 % ( interquartile range , 65 % to 86 % ) . We created variables for quartiles of scheduled visits in the study time frame . Other Study Variables Because Asian and Hispanic persons made up only 4 % of the sample , they were analyzed with white persons . Insurance type was classified as Medicare , Medicaid , commercial , or other ( self-pay or unknown ) . From the 2000 U.S. Census , we determined the median household income associated with the ZIP code of each patient 's residence . Missing data for race or ethnicity ( n = 1033 ) , ZIP code ( n = 10 ) , and median household income information for the ZIP code ( n = 310 ) was imputed by using multiple imputation ( 4 ) in the SAS procedures PROC MI and PROC MIANALYZE ( SAS Institute , Inc. , Cary , North Carolina ) . We created an indicator for a chronic medical condition identified by 2 occurrences of coded diagnoses on inpatient or outpatient encounters : hypertension , diabetes mellitus , chronic obstructive heart disease , chronic bronchitis , asthma , coronary artery disease , congestive heart failure , peripheral vascular disease , cancer ( lung , breast , uterus , prostate , or ovarian ) , and renal failure ( available upon request ) . We also created an indicator for at least 2 occurrences of coded diagnoses for any chronic gastrointestinal conditions ( available upon request ) . The 23 practice s ( primarily gastroenterology 
    Output:
    
There is some evidence that the domains Beliefs about Capabilities , Behaviour Regulation and Social Influences influence hormonal therapy MTB .
PRACTICE IMPLICATION S Further research is needed to develop effective interventions to improve hormonal therapy MTB