Randomized Trial of Text Messaging to Reduce Early Discontinuation of Adjuvant Aromatase Inhibitor Therapy in Women With Early-Stage Breast Cancer: SWOG S1105

Abstract

PURPOSE Nonadherence to aromatase inhibitors (AIs) for breast cancer is common and increases the risk of recurrence. Text messaging increases adherence to medications for chronic conditions. METHODS We conducted a randomized clinical trial of text messaging (TM) versus no text messaging (No-TM) at 40 sites in the United States. Eligible patients were postmenopausal women with early-stage breast cancer taking an AI for > 30 days with a planned duration of ≥ 36 months. Test messages were sent twice a week over 36 months. Content themes focused on overcoming barriers to medication adherence and included cues to action, statements related to medication efficacy, and reinforcements of the recommendation to take AIs. Both groups were assessed every 3 months. The primary outcome was time to adherence failure (AF), where AF was defined as urine AI metabolite assay results satisfying one of the following: < 10 ng/mL, undetectable, or no submitted specimen. A stratified log-rank test was conducted. Multiple sensitivity analyses were performed. RESULTS In total, 724 patients were registered between May 2012 and September 2013, among whom,702 patients (348 in the text-messaging arm and 354 in the no–text-messaging arm) were eligible at baseline. Observed adherence at 36 months was 55.5% for TM and 55.4% for No-TM. The primary analysis showed no difference in time to AF by arm (3-year AF: 81.9% TM v 85.6% No-TM; HR, 0.89 [95% CI, 0.76 to 1.05]; P = .18). Multiple time to AF sensitivity analyses showed similar nonsignificant results. Three-year self-reported time to AF (10.4% v 10.3%; HR, 1.16 [95% CI, 0.69 to 1.98]; P = .57) and site-reported time to AF (21.9% v 18.9%; HR, 1.31 [95% CI, 0.86 to 2.01]; P = .21) also did not differ by arm. CONCLUSION To our knowledge, this was the first large, long-term, randomized trial of an intervention directed at improving AI adherence. We found high rates of AI AF. Twice-weekly text reminders did not improve adherence to AIs. Improving long-term adherence will likely require personalized and sustained behavioral interventions.

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

“…Patients and their medical team members might have differing perspectives on the definition of a "well-tolerated" medication and on measures of quality of life [52,53], but efforts must be made to better understand the patient's point of view. There are a variety of conceptual framework models such as decision support and needs, symptom management, symptom experience, self-management, and patient activation [31,[53][54][55][56]] that can be applied to improve adherence [57,58]. For example, a recent pilot program demonstrated that patient activation did not improve oral oncolytic adherence; however, patients who completed the program did report increased confidence in their ability to self-manage symptoms and seek help when experiencing side effects [55].…”

Effect of Collaborative Review of Electronic Patient-Reported Outcomes for Shared Reporting in Breast Cancer Patients: Descriptive Comparative Study

“…As mentioned, neither version of the app was equipped to send questionnaires, and calls from nurse specialists were not intended. We can only speculate regarding how far occasional push notifications, ample choice of symptoms, and listing of frequently selected "favorites" or "last used" symptoms might have influenced patients' motivation and input selection, as unfortunately, we did not include these variables in our end-of-study assessment [18,19]. However, the increasingly careful symptom recording provided by ePROs, along with improved symptom management in routine outpatient care, demonstrated a reduction in both unplanned hospitalizations and disease burden [2].…”

The Case for Brachytherapy: Why It Deserves a Renaissance

“…The phase II Triumph-T trial showed excellent local tumor control (albeit short median follow up) and breast cosmesis using a 3-fraction breast brachytherapy technique, and a similar 4-fraction regimen had excellent cosmesis with no locoregional recurrences at 6 years (37, 39). Furthermore, in elderly patients, single fraction regimens have also demonstrated excellent oncologic outcomes (40), and a recent study comparing PBI to PBI plus endocrine therapy or endocrine therapy alone in women over the age of 70 with low-risk, hormone-J o u r n a l P r e -p r o o f positive early-stage breast cancer demonstrated that PBI was superior when compliance with endocrine therapy was poor (41) and tested compliance interventions have demonstrated no improvement (42,43).…”

“… 37 , 39 Furthermore, in elderly patients, single-fraction regimens have also demonstrated excellent oncologic outcomes, 40 and a recent study comparing PBI with PBI + hormone therapy or hormone therapy alone in women age >70 years with low-risk, hormone-positive, early stage breast cancer demonstrated that PBI was superior when compliance with hormone therapy was poor, 41 and tested compliance interventions have demonstrated no improvement. 42 , 43 …”