Simple text reminders do not improve breast cancer hormone therapy adherence

PORTLAND, OR – Text message reminders are not a silver bullet when it comes to overcoming the long-standing challenge of ensuring that breast cancer patients continue to take aromatase inhibitors, pills to treat hormone-sensitive cancers that are prescribed for as long as five years.

Aromatase inhibitors (AIs) are one of the most common treatments for breast cancer, with tens of thousands of post-menopausal women prescribed the drugs each year to fight hormone-sensitive breast cancers, which make up about 80 percent of all breast cancers. AIs stop the production of estrogen, essentially starving hormone receptor-positive breast cancer cells, and patients must take them for months or years. Side effects are common, with about half of patients reporting bone pain. Headaches, nausea, and hot flashes are common. Quitting AI treatment can be dangerous. Those who do are at increased risk for their breast cancer returning.

SWOG Cancer Research Network Vice Chair Dawn Hershman, MD, director of the Breast Cancer Program at NewYork-Presbyterian and Columbia University Irving Medical Center’s Herbert Irving Comprehensive Cancer Center, wanted to find out whether a relatively new form of medication reminder – texts – would encourage more women to keep up their AI regimen.

In new study results out now in the Journal of Clinical Oncology, Hershman shows they did not.

Her SWOG study is the first large, long-term, randomized trial to test any intervention aimed at directly improving AI adherence. Founded in 1956, SWOG is a cancer clinical trials network funded by the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), and a member of the oldest and largest publicly-funded research network in the nation.

To conduct her trial, Hershman and her team enrolled 724 post-menopausal women with early-stage breast cancer into the study from 40 SWOG sites across the United States. Every woman had been taking AIs for at least a month, and would continue to take the pills at least 36 months under their doctors’ orders. Of the women enrolled, 348 received brief, twice-weekly text messages reminding them to take their medication or reminding them of the benefits of taking their medication. Another 354 did not receive the texts. Patients and physicians both reported on drug adherence – and women even took routine urine tests to screen for AI biomarkers. After 36 months, there was no difference between the two groups. The percentage of women who remained AI adherent was 55 percent – the same number for both groups, no matter how adherence was measured.

Hershman, who presented preliminary results of her study at the 2019 ASCO annual meeting, said the take-home message is not that text messages are ineffective tools in the fight for cancer drug adherence. Rather, generic, one-way text messages are not the answer.

“Persuading patients to take AIs, or any long-term cancer drug, will likely require a more personalized approach, one that includes many interventions and supportive efforts to provide relief from symptoms and also provide encouragement and support for patients,” Hershman said. “Texts alone don’t do the trick.”

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Hershman’s study was funded by the National Institutes of Health through National Cancer Institute grant award CA189974 and in part by the Conquer Cancer Foundation and the Breast Cancer Research Foundation.

Hershman’s team included Joseph Unger, PhD, of the SWOG Statistics and Data Management Center and the Fred Hutchinson Cancer Research Center; Grace Clarke Hillyer of Columbia University Medical Center; Anna Moseley, MS, of the SWOG Statistics and Data Management Center and the Fred Hutch; Kathryn B. Arnold, MS, of the SWOG Statistics and Data Management Center and the Fred Hutch; Shaker R. Dakhil, MD, of the Cancer Center of Kansas/Wichita NCORP; Benjamin T. Esparaz, MD, of Cancer Care Specialists of Central Illinois/Heartland NCORP; Ming C. Kuan, MD, of Kaiser Permanente Northern California/Kaiser Permanente NCORP; Mark L. Graham II, MD, of Waverly Hematology Oncology/Southeast Clinical Oncology NCORP; Douglas M. Lackowski, MD, of Kaiser Permanente Interstate Medical Office/Northwest NCORP; William J. Edenfield, MD, of Greenville Health System/NCORP of the Carolinas; Zoneedy R. Dayao, MD, of University of New Mexico Cancer Center/New Mexico Minority Underserved NCORP; N. Lynn Henry, MD, of University of Michigan; Julie R. Gralow, MD, of Seattle Cancer Care Alliance and University of Washington; Scott D. Ramsey, MD, PhD, of Fred Hutch; and Alfred I. Neugut, MD, of Columbia University Medical Center.

SWOG Cancer Research Network is part of the National Cancer Institute’s National Clinical Trials Network and the NCI Community Oncology Research Program, and is part of the oldest and largest publicly-funded cancer research network in the nation. SWOG has nearly 12,000 members in 47 states and six foreign countries who design and conduct clinical trials to improve the lives of people with cancer. SWOG trials have led to the approval of 14 cancer drugs, changed more than 100 standards of cancer care, and saved more than 3 million years of human life. Learn more at swog.org.