Table 3 Existing interventions supporting adherence to AET in women with breast cancer
Authors | Description of Intervention | Intervention modality | AET type | Design | Key results (adherence related outcomes) | Theory that informed the intervention |
|---|---|---|---|---|---|---|
Ell et al. (2009) [73] | Written information plus structured ‘patient navigation’ phone interviews consisting of education, addressing barriers to adherence, problem solving, self-management support and emotional support. | Written information and telephone | All | 2 arm RCT- enhanced usual care (information) vs written information plus patient navigation | No significant difference; 67% vs 69% (p = 0.80). | Health Belief model and socio-cultural explanatory theory |
Yu et al. (2012) [74] | PACT materials used. Patient education (welcome pack and quarterly newsletters) with information about breast cancer and adherence. Follow up reminder calls. | Written information and telephone | Anastrozole or letrozole | Prospective, multicentre controlled observational study | No significant difference; 95.9% vs 95.8% one-year persistence rate (p = 0.95). | None reported |
Ziller et al. (2013) [75] | COMPAS study. Letter group: 8 personalized motivational reminder letters were sent over 2 years with information on topics side effects and treatment. A breast cancer information leaflet containing information on topics such as nutrition and sport. Reminder phone calls: 8 telephone calls over 2 years which used motivational interviewing to address any questions, challenges to adherence, provide information and reminders. | Written information/ telephone | AI | 3 arm RCT- usual care vs letters vs telephone calls | No significant difference in adherence in primary analysis. In post hoc analysis when pooling the intervention arms, adherence increased significantly in the intervention arms vs control (p = 0.039). | Learning theory |
Hadji et al. (2013) [76] | PACT Program: educational materials sent to participants (9 mailed letters and brochures), monthly reminders on persistence to endocrine therapy, gift items sent e.g. 7 day tablet box, pocket mirror. Educational materials included information on relevant issues such as side effects, efficacy, nutrition, communication. | Written information | Anastrozole | RCT- usual care vs written information | No significant difference in compliance at 12 months (p = 0.81). | None mentioned |
Neven et al. (2014) [77] | CARIATIDE program. PACT materials used- welcome pack and 9 letters and brochures mailed out, containing information on side effects, exercise, diet, communication. | Written information | AI | Randomized, parallel group observational study; usual care vs intervention | No significant difference in compliance between arms at 12 months (p = 0.4524). In Finland/Sweden, compliance was significantly higher in the intervention arm (p = 0.0246). | None mentioned |
Graetz et al. (2018) [79] | App: Web based app in which participants asked to record symptoms and report adherence in the past 7 days. Alerts sent to care team for any concerns. App+ reminder: Web based app in which participants asked to record symptoms and report adherence in the past 7 days. Alerts sent to care team for any concerns. Weekly reminders sent to use the app via text or email. | App and text or email | AI | Pilot RCT- app use only vs app use plus reminders to use app | Proportion of patients adherent in the experimental group (100%) was greater than control group (72.7%); p < 0.05. | None mentioned |
Heisig et al. (2015) [80] | Enhanced information leaflet and 15-minute phone calls sessions including information on the mechanisms of AET, benefits and side effects. | Written information and telephone | Any | Interventional single cohort study | Greater adherence observed at 3-month follow-up. | None mentioned |
Markopoulas et al. (2015) [78] | PACT materials. Educational materials sent to participants 9 times in 1 year, consisting of information on side effects, communication, sport, nutrition, benefits, tips on how to take AET. | Written information | Anastrozole or letrozole | RCT- standard care vs intervention | No significant difference in compliance or persistence between the groups at 12 months. | None mentioned |
Castaldi et al. (2017) [81] | Patient navigation program. Initial visit include assessment of barriers to adherence. Navigator provides reminder calls prior to follow up appointments, meets patients at outpatient appointments and on day of surgery, and a financial consultation where required. | Patient navigation | Tamoxifen and AI | Non randomized, historical care vs navigated care | 68.6% adherence in standard care vs 100% in patient navigation (p < 0.0001). | None mentioned |
Hershman et al. (2020) [82] | SMS messages sent twice weekly over 36 months. Content included overcoming barriers to medication adherence, cues to action, statements related to medication efficacy and reinforcements of the recommendation to take the medication. 40 messages repeated over intervention. | Text messaging | AI | RCT; text messages vs no text messages | No significant difference between text messages (55.55%) and no text messages (55.4%) at 36 months. | None mentioned |
Self-directed paper booklet designed in line with CBT and behaviour change theory. Included sections to modify beliefs about recurrence and the medication, to help manage side effects and to increase perceived behavioural control. | Written information | Tamoxifen | Pilot trial; no control group | Primary outcomes were feasibility and retention. Change from 100 to 91% who were non adherent after intervention. D = 0.31 for improvement of unintentionally non adherent women. | Common sense model and theory of planned behaviour | |
Bhandari et al. (2019) [84] | Prescriptions given in a 30-day bubble pack with labelled day of the week; dispensed as 1- or 3-month supply. | Medication packaging | Tamoxifen and AI’s | Single arm prospective investigational pilot study | Suggestion of improved adherence with bubble packaging (no control arm) | None mentioned |
Tan et al. (2020) [85] | Weekly SMS reminders sent on a Monday morning reading “Mdm <NAME> please be reminded to take your anti-cancer medicine as instructed by your doctor. Take one tablet once every day.”. | Text messaging | All | Open level, multi centre prospective RCT | Higher percentage of adherence in SMS (72.4%) vs standard care (59.5%) at 6 months (p = 0.034), but not at 1 year (p = 0.617). No difference in serum hormone levels. | None mentioned |
Krok-Schoen et al. (2019) [86] | Daily text message reminders focusing on initiation, continuation and adherence to prescribed dose; 14 messages repeated. Dynamic intervention in which participants complete weekly surveys on an app. Participants received feedback based on survey responses; either encouraging messages or problem solving. Physicians notified and patient has option to leave voice message and share with physician. | Text messaging and app | Tamoxifen or AI | Pilot trial; no control group | Significant improvement for self-reported medication adherence (p = 0.015), significant decreases in oestradiol, oestrogen and estrone hormone levels (p < 0.001). | None mentioned |
Labonte et al. (2020) [32] | Community based pharmacy intervention; motivational interviewing given by pharmacists in brief individual consultations. Discussions focused on mode of action of AET, side effect coping and benefits of the medication. | In person (pharmacist) | All | Intervention mapping development | N/A- development paper | Theory of planned behaviour, motivational interviewing |
Getachew et al. (2018) [87] | Breast care nurses were trained as navigators to improve patient adherence in rural Ethiopia | Breast nurse navigators | Tamoxifen | RCT | N/A- protocol abstract only | None mentioned |