Increasing Adherence to Adjuvant Hormone Therapy Among Patients With Breast Cancer: A Smart Phone App-Based Pilot Study

Abstract

Purpose:This study tested the feasibility and efficacy of using a text-based intervention to increase initiation, decrease discontinuation, and improve adherence as prescribed to adjuvant hormone therapy (AHT) among hyphenate post-menopausal breast cancer survivors.Methods:The 3-month intervention consisted of daily text message reminders to take medication, coupled with a dynamic (eg, feedback on progress) tailored intervention using weekly interactive surveys delivered by a smartphone app. Five clinic sites within the Alliance for Clinical Trials in Oncology participated. Hormone levels were measured prior to AHT initiation and at study exit.Results:Of the 39 patients recruited to the pilot study, 27 (69.2%) completed all study requirements (completed both the baseline and the exit surveys, both blood draws, and did not miss more than 2 weekly surveys). Significant improvements were observed pre- to postintervention for self-reported medication adherence (P = .015), mental health functioning (P = .007), and perceived stress (P = .04). Significant decreases in estradiol, estrogen, and estrone hormone levels were observed from baseline to study exit (P < .001), indicating the accuracy of self-reported AHT adherence. Participants (91.9%) and physicians (100%) agreed that participant participation in the intervention was beneficial.Conclusions:The results of this pilot study established the general feasibility and efficacy of an app-based intervention to support patient AHT adherence. Larger controlled, randomized trials are needed to examine the effectiveness of the app-based intervention in improving AHT and quality of life among breast cancer survivors.

Text Messaging in Cancer-Supportive Care: A Systematic Review

“…The electronic database search identified a total of 4449 studies, out of which 18 studies involving 5821 patients were included in the final qualitative synthesis ( Figure 1 ). Of the included studies, 9 (50%) were randomized trials [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] and 9 (50%) were non-randomized interventional/observational studies [ 11 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] ( Table 1 , Table S3 ). Sixteen of 18 studies (89%) were conducted in high-income countries (HICs) [ 11 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 ], the majority ( n = 11) in the United States [ 11 , 26 , 28 , 29 , 33 , 34 , 35 , 36 , 38 , 40 , 41 ].…”

“…Of the included studies, 9 (50%) were randomized trials [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] and 9 (50%) were non-randomized interventional/observational studies [ 11 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] ( Table 1 , Table S3 ). Sixteen of 18 studies (89%) were conducted in high-income countries (HICs) [ 11 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 ], the majority ( n = 11) in the United States [ 11 , 26 , 28 , 29 , 33 , 34 , 35 , 36 , 38 , 40 , 41 ]. Two studies (11%) were conducted in low- and middle-income countries (LMICs), both in Brazil [ 30 , 39 ].…”

“…Ten studies included patients with any cancer [ 26 , 27 , 30 , 32 , 33 , 34 , 36 , 39 , 41 , 42 ], while the remaining eight focused on specific cancer types (breast n = 4 [ 11 , 29 , 31 , 38 ], lung n = 2 [ 35 , 37 ], endometrial n = 1 [ 28 ], chronic myeloid leukemia n = 1 [ 40 ]) as seen in Table 1 . One study included patients with late-stage cancer only (stage III–IV lung) [ 35 ] and three studies included patients with early stage cancer only [ 11 , 29 , 38 ], while the remainder did not use staging as part of their inclusion criteria. Further, 13 studies focused on patients in periods of active treatment [ 11 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 ], while 4 studies focused on patients during their survivorship phase [ 26 , 27 , 28 , 42 ] and 1 did not specify [ 35 ].…”

“…One study included patients with late-stage cancer only (stage III–IV lung) [ 35 ] and three studies included patients with early stage cancer only [ 11 , 29 , 38 ], while the remainder did not use staging as part of their inclusion criteria. Further, 13 studies focused on patients in periods of active treatment [ 11 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 ], while 4 studies focused on patients during their survivorship phase [ 26 , 27 , 28 , 42 ] and 1 did not specify [ 35 ]. The total sample sizes at baseline ranged from 14 [ 39 ] to 3429 participants [ 41 ].…”

“…Text-based communication can complement other internet-based communication methods [ 11 ]. Employing internet-based communication as a sole method of communication may exacerbate quality of care inequities, as many patients with cancer have limited Internet access [ 12 ].…”