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Top Line: Less than half of women in the real world are able to completely adhere to a 5 year course of endocrine therapy.

The Study: Is there an app for that? SWOG S1105 explored the use of text-message reminders to improve adherence with adjuvant endocrine therapy. Eligible patients were taking adjuvant aromatase inhibitors for breast cancer and had been on the medication for at least a month and with at least 3 years remaining. Over 700 were randomized to receive bi-weekly text messages for 3 years. The messages offered encouragement, education about adherence, and reminders about the efficacy of treatment. Patients had urine testing every 3 months to define the primary endpoint of adherence failure (i.e. a negative urine test indicating no medication for roughly 2 weeks). The rates of adherence failure for text reminder versus no text reminder were: 51 vs 57% at 1 year, 70 vs 74% at 2 years, and 82 vs 86% at 3 years. When defining failure as 2 consecutive negative urine tests, the 3 year failure rate was 66 vs 70%. In contrast, clinician reported “discontinuation” was ~20% while patient reported discontinuation was ~10%. None of these definitions showed a difference in adherence with text reminders. Next-ditch effort: tweet reminders, preferably in all caps.

TBL: Bi-weekly educational text-message reminders do not improve the terrible real-world adherence to adjuvant endocrine therapy—more terrible than we may have ever appreciated. | Hershman, J Clin Oncol 2020