Improving medication adherence with adjuvant aromatase inhibitor in women with breast cancer: A randomised controlled trial to evaluate the effect of short message service (SMS) reminder

Abstract

Background Medication adherence is crucial for improving clinical outcomes in the treatment of patients. We evaluate the effect of short message service (SMS) reminder on medication adherence and serum hormones in patients with breast cancer on aromatase inhibitors. Methods An open-label, multi-centre, prospective randomised controlled trial of SMS versus Standard Care was conducted. Medication adherence was assessed via self-report using the Simplified Medication Adherence Questionnaire at baseline, 6 month, and 1 year. Androstenedione, estradiol, and estrone were measured at baseline and 1 year. The χ 2 test and mixed effects logistic regression was performed to compare medication adherence between groups. Difference in androstenedione and estrone levels were assessed using analysis of covariance, whereas χ 2 test and logistic regression was used for estradiol. Analysis was based on intention-to-treat. Results A total of 244 patients were randomised to receive weekly SMS reminder ( n = 123) or Standard Care ( n = 121) between May 2015 and December 2018. The odds of adherence was higher at 6-month in SMS (OR = 1.78, 95% CI 1.04–3.05, p = 0.034), and not significantly different at 1-year (OR = 1.15, 95% CI: 0.67–1.96 p = 0.617). Mixed effects logistic regression analysis showed higher odds of adherence in SMS over the 1-year period (OR = 2.35, 95% CI: 1.01–5.49, p = 0.048). There was no difference in serum hormone levels between groups. Conclusion SMS reminder improved medication adherence in the short-term but had no effect on serum hormones levels in the longer term. Future studies could investigate the use of tailored SMS intervention according to patient preference to improve its sustainability.

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.…”

“…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 ].…”

“…Sixteen studies assessed text-based communication interventions used solely for supportive care purposes, such as medication adherence, appointment reminders, weight loss, physical activity motivation, and self-management education [ 11 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 39 , 40 , 41 , 42 ]. The remaining two studies used text-based communication for supportive care as well as for symptom monitoring (i.e., tracking symptoms experienced by patients) [ 37 , 38 ].…”