Text messages do not increase AI adherence for early-stage breast cancer

Aromatase inhibitors (AIs) can be prescribed for as long as 5 years for breast cancer and nonadherence can significantly increase risk of recurrence. Although studies show that text messaging (TM) reminders increase the likelihood of adherence to medications for chronic diseases, new research shows no correlation between use of the technology and AI adherence in women with early-stage breast cancer.

Long-term adherence improvements, it appears, require personalized and sustained behavioral interventions. TMs for AI should also be personalized for individual success.¹

The study, published in the Journal of Clinical Oncology, is believed to be the first large, long-term, randomized trial of an intervention to improve AI adherence. Researchers conducted the clinical trial of TM versus no TM at 40 sites in the United States.

Postmenopausal women with early-stage breast cancer taking an AI for less than 30 days with a planned duration of 36 months or less were considered eligible. Between May 2012 and September 2013, 702 patients were enrolled (348 in the TM group and 354 in no TM).

TMs were sent twice weekly over the course of 36 months and included content about overcoming barriers to medication adherence, cues to action, statements related to medication efficacy, and reiterations of AI recommendations.

Every 3 months, both groups were assessed with the primary outcome of time to adherence failure (AF), where AF was urine AI metabolite assay results as one of the following: < 10ng/mL, undetectable, or no submitted specimen.

At 36 months, observed adherence was recorded at 55% for TM and 55.4% for no TM. When researchers conducted the primary analysis, they detected no difference in time to AF by arm (3-year AF: 81.9% TM Y 85.6% No-TM; HR, 0.89 [95% CI, 0.76 to 1.05]; C=.18).

The researchers ultimately found high rates of AF and concluded that twice-weekly text reminders did not improve adherence.

References:

1.     Hershman DL, Unger JM, Hillyer GC, et al. Randomized trial of text messaging to reduce early discontinuation of adjuvant aromatase inhibitor therapy in women with early-stage breast cancer: SWOG S1105 [published online ahead of print, 2020 May 5]. J Clin Oncol. 2020; JCO1902699. doi:10.1200/JCO.19.02699