Use of a web-based app to improve breast cancer symptom management and adherence for aromatase inhibitors: a randomized controlled feasibility trial

Abstract

Purpose: For postmenopausal women with hormone receptor-positive breast cancer, long-term use of aromatase inhibitors (AIs) significantly reduces the risk of cancer recurrence and improves survival. Still, many patients are nonadherent due to adverse side effects. We conducted a pilot randomized controlled trial to test the use of a web-based application (app) designed with and without weekly reminders for patients to report real-time symptoms and AI use outside of clinic visits with built-in alerts to patients' oncology providers. Our goal was to improve symptom burden and medication adherence.

Methods: Forty-four women with early-stage breast cancer and a new AI prescription were randomized to either an App+Reminder (weekly reminders to use app) or an App (no reminders) group. Pre- and post-assessment data were collected from all participants.

Results: Participants in the App+Reminder group had higher weekly app usage rate (74 vs. 38%, p < 0.05) during the intervention and reported higher AI adherence at 8 weeks (100 vs. 72%, p < 0.05). Symptom burden increase was higher for the App group compared to the App+Reminder group but did not reach statistical significance.

Conclusions: Weekly reminders to use a web-based app to report AI adherence and treatment-related symptoms demonstrated feasibility and improved short-term AI adherence, which may reduce symptom burden for women with breast cancer and a new AI prescription.

Implications for cancer survivors: If short-term gains in adherence persist, this low-cost intervention could improve survival outcomes for women with breast cancer. A larger, long-term study should examine if AI adherence and symptom burden improvements persist for a 5-year treatment period.

Trial registration: ClinicalTrials.gov NCT02957526.

Keywords: Aromatase inhibitor; Health; Hormone-receptor positive breast cancer; Patient reported outcomes; Randomized controlled trial.

Figures

Figure 1

CONSORT Flowchart

Figure 2

Screenshot Examples from the Study App

Figure 3

Change in Symptom Burden Note: The dotted line represents the expected change for App+Reminder participants if they had the same trajectory as App only participants. The difference-in-difference (DID) is equal to the difference from baseline to follow-up for the App group minus the difference from baseline to follow-up for the App+Reminder group.