Bidirectional Text Messaging to Monitor Endocrine Therapy Adherence and Patient-Reported Outcomes in Breast Cancer

Abstract

Introduction Up to 40% of patients with breast cancer may not adhere to adjuvant endocrine therapy. Therapy-related adverse effects (AEs) are important contributors to nonadherence. We developed a bidirectional text-message application, BETA-Text, that simultaneously tracks adherence, records symptoms, and alerts the clinical team. Patients and Methods We piloted our intervention in 100 patients. The intervention consisted of text messages to which patients responded for 3 months: daily, evaluating adherence; weekly, evaluating medication-related AEs; and monthly, regarding barriers to adherence. Concerning responses prompted a telephone call from a clinic nurse. The primary objective was to assess patient acceptance of this intervention using self-reported surveys. To compare participants with the general population at our institution, we assessed 100 consecutively treated patients as historical controls using medical record review. Results We approached 141 consecutive patients, 100 (71%) of whom agreed to participate and 89 of whom completed the intervention. A majority of patients reported that the intervention was easy to use (98%) and helpful in taking their medication (96%). Four patients discontinued therapy before 3 months, and 93% of patients who continued therapy took ≥ 80% of their medication. The frequency of AEs reported by participants via text was higher than that reported in clinical trials: hot flashes (72%), arthralgias (53%), and vaginal symptoms (35%). Approximately 39% of patients reported one or more severe AE that prompted an alert to the provider team to call the patient. Conclusion A daily bidirectional text-messaging system can monitor adherence and identify AEs and other barriers to adherence in real time without inconveniencing patients. AEs of endocrine therapy, as detected using this texting approach, are more prevalent than reported in clinical trials.

How patients experience endocrine therapy for breast cancer: an online survey of side effects, adherence, and medical team support

“…We demonstrate that social media can be effective in rapidly obtaining large numbers of patient responses regarding care issues. Similar to previous studies [1,7,10,[17][18][19][34][35][36][37][38][39], our results demonstrate that most patients (91%) who take ET experience related side effects, and one-third discontinue treatment early. Our findings suggest that online patient communities can be a valuable tool for identifying variables that influence breast cancer patients' adherence to ET.…”

Comparing a Mobile Phone Automated System With a Paper and Email Data Collection System: Substudy Within a Randomized Controlled Trial

“…Our study supports previous studies which showed that SMS messaging could improve treatment adherence and was acceptable to participants [ 16 , 19 , 27 ]. Despite concerns about long-term attrition in previous studies [ 28 ], the MPAS results showed that even with a decrease in response rates over time, the response rates were consistently higher than the PEDC rates over the same period, possibly because of better engagement among the users.…”

The Potential for mHealth Interventions to Support Women with Breast Cancer after Active Treatment

“…endpoints (Job, Spark, Fjeldsoe, Eakin, & Reeves, 2017;Mougalian et al, 2017), providing support that these programs may be beneficial long-term. Long term (12-24 month) randomised controlled trials are needed to provide evidence of continued participant engagement and benefit.…”