In order for oral anticancer drugs to work and prevent remission, patients have to take the medications as prescribed. But adherence is a problem for some, including many women with breast cancer taking endocrine therapy. Nonadherence can be impacted by a wide range of factors and behaviors, ranging from age to social support to the patient-physician relationship. And so, when it comes to a solution that will help address nonadherence, there likely won't be a one-size-fits all fix.
It's a topic that Kathryn Ruddy, MD, a medical oncologist at Mayo Clinic, addresses in an editorial she coauthored in the Journal of Clinical Oncology that was published online ahead of print (2020; doi: 10.1200/JCO.20.00778). Furthermore, she says there is likely a place for technology in these solutions, but they'll need to be somewhat tailored to the specific patient group they're intending to help.
"Because more than a million women around the world are diagnosed with hormonally sensitive breast cancer each year, it is important that we continue to study ways to improve adherence to endocrine therapy, taking into account patient preferences and individualized barriers to adherence and tailoring technological solutions to these concerns and values," the editorial notes.
Couple all of those points with the fact that the global COVID-19 pandemic has moved more health care to virtual spaces than ever before (and increased interest in adopting such strategies). The time is ripe for more interventions, in particular ones that harness the efficiency and convenience of technology, Ruddy and her coauthor note in the editorial. There are also important takeaways to learn from unsuccessful trials.
In an interview with Oncology Times, Ruddy discussed the editorial and the role of technology in these types of solutions for improving therapy adherence in patients with cancer.
1 In what ways might the shift to virtual health care delivery in response to the COVID-19 health crisis increase people's interest in smart technology solutions in ways that improve their care?
"The COVID-19 pandemic forced us to very quickly shift much of the health care that we previously provided in person to be by phone or video instead (to reduce the risk of transmission). I suspect that some of the changes in our care have been popular and successful enough to be here to stay. Because technological tools that connect patients with clinicians have been critical to these efforts, interest in smart technology will only grow over the months and years to come."
2 You explain in the editorial that a few recent examples of studies that have looked at the efficacy of certain solutions have found that these tools haven't improved outcomes when it comes to endocrine therapy adherence-including one study that investigated effectiveness of a text messaging intervention in postmenopausal women with estrogen-responsive breast cancer-yet that those negative results don't mean that no such interventions would help (J Clin Oncol 2020; DOI: 10.1200/JCO.19.02699; Hershman, et al). What can we learn from those negative results and what type of research should be done going ahead?
"Future studies of technological solutions may be more successful if they target patients who are at baseline both heavy users of that technology and at high risk of non-adherence.
"I believe that there are opportunities to harness technology to improve treatment adherence in new ways. One example might be via a mobile application that also offers users appealing educational and inspirational content to enhance engagement and improve quality of life. The incorporation of games, social connectivity, and other entertaining elements might increase the likelihood that people use the tool."
3 So what's the bottom line that practicing oncologists and cancer care providers should know about this issue and the potential for technological solutions to help with treatment adherence going ahead?
"In recent years, as the number of effective oral therapies for cancer has exploded, figuring out ways to optimize adherence has become even more important throughout oncology.
"Although the study published by Dr. Hershman and colleagues did not find that a text messaging intervention improved endocrine therapy adherence in postmenopausal women, efforts to improve adherence remain important across an ever-widening variety of cancers, and there is potential for future research to identify smart tech solutions that do improve adherence in specific populations."