For roughly 80% of breast cancer survivors, treatment doesn’t end with surgery, radiation and chemotherapy. As a substitute, for the subsequent five to 10 years, doctors recommend that they take medication to dam sex hormones, which might fuel tumor growth and spark reoccurrence.

The drugs are life-saving: They have been shown to chop risk of cancer reoccurrence by as much as half in patients with hormone receptor-positive tumors (HR+)-;probably the most common type of breast cancer. Yet despite their promised advantages, 40% of patients stop taking them early and a 3rd take them less often than directed.

Recent CU Boulder research, published this month within the Journal of Clinical Oncology, sheds light on why that’s and what doctors and the health care system can do about it.

It found that, overall, interventions can increase medication adherence by nearly 1.5 times. But some strategies work higher than others.

Our bottom-line finding is that there are strategies that do work in supporting women to take these life-extending medications, and that we as a cancer care community must do higher.”

Joanna Arch, senior writer, professor within the Department of Psychology and Neuroscience and member of the CU Cancer Center on the Anschutz Medical Campus

Arch noted these so-called “adjuvant endocrine therapies,” just like the estrogen-blockers Tamoxifen and aromatase inhibitors, could be costly and are available with a number of uncomfortable side effects, including weight gain, sexual uncomfortable side effects, joint pain, depression and sleeplessness.

“Imagine going out of your normal estrogen activity to little or no estrogen inside days. That is what these medications do,” she said. “But the ladies who take them as prescribed even have lower reoccurrence rates and live longer. It is a dilemma.”

As more next-generation cancer drugs, including chemotherapy agents, shift from infusions provided in a clinic to oral therapies taken at home, the medical community has grown increasingly keen on developing ways to ensure that patients take their pills.

In a sweeping meta-analysis, Arch and her colleagues analyzed 25 studies representing about 368,000 women to realize insight into what works and what doesn’t.

Educational pamphlets will not be enough

The study found that cost-cutting policy changes, reminiscent of providing generic alternatives or requiring insurance firms to cover pills at the identical level as infusions, consistently worked. Such “oral parity laws” have been passed in 43 states lately.

In a single study, participants were asked to create stickers to placed on their pill boxes.

Mobile apps and texts to remind patients to take their medication and psychological/coping strategies also yielded modest improvements.

The study’s findings around managing uncomfortable side effects were complicated: Simply educating women on uncomfortable side effects, via pamphlets or verbal explanations, generally didn’t increase the likelihood that ladies took their medication as directed.

But things reminiscent of physical therapy, exercise and behavioral counseling aimed toward alleviating or managing uncomfortable side effects often worked.

“Education in and of itself just isn’t enough. That could be a clear finding,” said Arch, suggesting that doctors write referrals to practitioners who concentrate on uncomfortable side effects and follow up with appointment reminders. “Most oncologists, I feel, do not realize how low adherence is for these women. They assume that in the event that they write the prescription, it’s being taken.”

Addressing mental health is essential

One study included within the meta-analysis was Arch’s own.

In it, women were asked to discover their primary motivation for taking their medication-;whether it was living to see their child or grandchild grow up, pursuing their art or running a marathon someday. Via a web-based program, they created a sticker with a photograph representing that goal, and the words “I take this for…” below it. Then, they stuck it on their pill box.

Participants were more more likely to take their pills, no less than for the primary month, than those that didn’t.

“Even only a tiny thing like this might help,” said Arch.

Notably, only a few studies checked out whether treating depression might help. Arch, aiming to fill this gap, recently launched her own pilot trial.

“Probably the most consistent predictors of not adhering to any medication is depression,” she said. “Depression taps motivation.”

The brand new Journal of Clinical Oncology study is the primary meta-analysis to point out that interventions could be helpful, and that is necessary, said Arch, because insurance firms need data to make decisions about what to cover.

However the study also showed that the consequences are relatively modest and that there may be room for improvement.

Arch said she hopes the study will spark more research into novel ways to support survivors:

“We’ve numerous work to do.”

Source:

University of Colorado at Boulder

Journal reference:

Vibrant, E. E., et al. (2023) A Systematic Review and Meta-Evaluation of Interventions to Promote Adjuvant Endocrine Therapy Adherence Amongst Breast Cancer Survivors. Journal of Clinical Oncology. doi.org/10.1200/JCO.23.00697.