Text Message Reminders Do Not Improve Aromatase Inhibitor Adherence, New Study Finds

Text message reminders do not improve adherence to aromatase inhibitors, a new study from Dawn Hershman, MD, MS and colleagues at SWOG finds. Text message reminders is a strategy often used in impacting health behaviors, and has been shown to improve patients’ compliance in taking other chronic medications. For aromatase inhibitors, however, the strategy fell short.

Aromatase inhibitors (AIs) are one of the most common treatments for hormone receptor-positive breast cancer. These drugs stop the production of estrogen, working to starve breast cancer cells that depend on estrogen for their survival. An essential part of a breast cancer regimen, these drugs unfortunately have unwanted side effects like bone pain, headaches, nausea, and hot flashes. Many women stop taking their medications or skip doses, which can have dangerous implications for their health, including a higher risk for their breast cancer returning.

This trial is the first large, long-term randomized trial of an intervention designed to improve AI adherence. Patients were randomized into two groups, one that received a text message twice a week for 36 months and one that did not. The team analyzed adherence in a number of ways, including urine tests, patient self-reported discontinuation, and site-reported discontinuation of hormone therapy, but found that that adherence was not improved in the group receiving text message reminders.

“No matter how we defined adherence, there was absolutely no difference between the two intervention arms," says Dr. Hershman, co-leader of the Cancer Population Sciences Program at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia University Irving Medical Center.

With the onslaught of electronic information that most people receive daily, Dr. Hershman suggests that desensitization to media like text messages may be partly to blame.

“It is possible that text messages are too routine or mundane to trigger a behavioral change like taking AIs,” says Dr. Hershman. “It seems that to overcome non-adherence to AIs – a drug with more than a few unwanted side effects – we need more personalized behavioral interventions, like direct communication between providers and patients and better symptom management.”

The team is planning an additional study evaluating a telehealth-based intervention to improve medication adherence.