In the SWOG S1105 trial reported in the Journal of Clinical Oncology, Dawn L. Hershman, MD, MS, and colleagues found that a text message intervention did not reduce the rate of early discontinuation of adjuvant aromatase inhibitor therapy in postmenopausal women with early-stage breast cancer.
![Dawn L. Hershman, MD, MS](/media/14009452/38_hershman.jpg)
Dawn L. Hershman, MD, MS
Study Details
In the trial, 702 women from 40 U.S. sites were randomly assigned to receive text messaging encouraging adherence to aromatase inhibitor therapy (n = 348) or no text messaging (n = 354). Patients had been taking aromatase inhibitors for > 30 days with a planned therapy duration of ≥ 36 months. Text messages were sent twice a week over 36 months; messages included statements on overcoming barriers to adherence and medication efficacy and reinforced the recommendation to take aromatase inhibitors. Patients were assessed for adherence every 3 months by urine assay and queries regarding adherence.
The primary outcome measure was time to adherence failure, defined as urine aromatase inhibitor metabolite assays showing levels < 10 ng/mL or undetectable levels or absence of a submitted specimen.
KEY POINTS
- A text messaging intervention did not improve adherence vs no text messaging.
- Adherence failure at 3 years was 81.9% vs 85.6%.
Adherence Failure Rates
Observed adherence at 36 months was 55.5% in the intervention group vs 55.4% in the control group. No significant difference in time to adherence failure was observed, with rates of adherence failure at 3 years being 81.9% in the intervention group vs 85.6% in the control group (hazard ratio [HR] = 0.89, P = .18). Rates at 1 and 2 years were 50.9% vs 57.2% and 70.4% vs 74.4%, respectively.
No significant differences were observed in rates of patient-reported aromatase inhibitor discontinuation, with 10.4% vs 10.3% reporting discontinuation at 3 years (HR = 1.16, P = .57). No significant differences in rates of study site-reported patient discontinuation were observed, with sites reporting discontinuation in 21.9% vs 18.9% at 3 years (HR = 1.31, P = .21).
The investigators concluded, “To our knowledge, this was the first large, long-term, randomized trial of an intervention directed at improving aromatase inhibitor adherence. We found high rates of aromatase inhibitor adherence failure. Twice-weekly text reminders did not improve adherence to [therapy]…improving long-term adherence will likely require personalized and sustained behavioral interventions.”
Dr. Hershman, of Columbia University Medical Center, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by a National Institutes of Health/National Cancer Institute/Division of Cancer Prevention grant, ASCO’s Conquer Cancer Foundation, and Breast Cancer Research Foundation. For full disclosures of the study authors, visit ascopubs.org.