Randomized Controlled Pilot Trial of a Low-Touch Remotely-Delivered Values Intervention to Promote Adherence to Adjuvant Endocrine Therapy Among Breast Cancer Survivors

• Published in: Annals of behavioral medicine 2022-08, Vol.56 (8), p.856-871
• Main Authors: Arch, Joanna J, Crespi, Catherine M, Levin, Michael E, Genung, Sarah R, Nealis, Madeline, Mitchell, Jill L, Bright, Emma E, Albright, Karen, Magidson, Jessica F, Stanton, Annette L
• Format: Article
• Language: English
• Subjects: Acceptance and Commitment Therapy; Breast Neoplasms - drug therapy; Breast Neoplasms - psychology; Cancer Survivors; Chemotherapy, Adjuvant; Female; Humans; Interventions for Breast Cancer Survivors; Medication Adherence - psychology; Pilot Projects
• ISSN: 0883-6612; 1532-4796
• DOI: 10.1093/abm/kaab118

Abstract Background Oral anti-cancer treatments such as adjuvant endocrine therapies (AET) for breast cancer survivors are commonly used but adherence is a challenge. Few low-touch, scalable interventions exist to increase ET adherence. Purpose To evaluate the acceptability, feasibility, and initial efficacy of a low-touch, remotely-delivered values plus AET education intervention (REACH) to promote AET adherence. Methods A mixed-methods trial randomized 88 breast cancer survivors 1:1 to REACH or Education alone. Wisepill real-time electronic adherence monitoring tracked monthly AET adherence during a 1-month baseline through 6-month follow-up (FU) (primary outcome). Patient-reported outcomes were evaluated through 3- and 6-month FU (secondary). Multiple indices of intervention feasibility and acceptability were evaluated. Qualitative exit interviews (n = 38) further assessed participants’ perceptions of feasibility/acceptability and recommendations for intervention adaptation. Results The trial showed strong feasibility and acceptability, with an eligible-to-enrolled rate of 85%, 100% completion of the main intervention sessions, and “good” intervention satisfaction ratings on average. For Wisepill-assessed AET adherence, REACH outperformed Education for Month 1 of FU (p = .027) and not thereafter. Participants in REACH maintained high adherence until Month 4 of FU, whereas in Education, adherence declined significantly in Month 1. Conditions did not differ in self-reported adherence, positive affective attitudes, future intentions, or necessity beliefs. REACH trended toward less negative AET attitudes than Education at 3-month FU (p = .057) reflecting improvement in REACH (p = .004) but not Education (p = .809). Exploratory moderator analyses showed that average to highly positive baseline AET affective attitudes and oncologist-patient communication each predicted higher adherence following REACH than Education; low levels did not. Participants identified recommendations to strengthen the interventions. Conclusions REACH, a low-touch values intervention, showed good feasibility and acceptability, and initial promise in improving objectively-assessed AET adherence among breast cancer survivors (relative to education alone). Future research should target improving REACH’s tailoring and endurance. This study showed that having breast cancer survivors reflect on who and what they care about (their values), and design a personal values sticker for their anti-