For roughly 80% of breast cancer survivors, treatment doesn鈥檛 end with surgery, radiation and chemotherapy. Instead, for the next five to 10 years, doctors recommend that they take medication to block sex hormones, which can fuel tumor growth and spark recurrence.
The drugs, no doubt, are life-saving: They鈥檝e been shown to cut risk of cancer recurrence by as much as half in patients with hormone receptor-positive tumors (HR+)鈥攖he most common form of breast cancer. Yet despite their promised benefits, 40% of patients stop taking them early and a third take them less frequently than directed.
New 彩民宝典 research, published this month in the 鈥�,鈥� sheds light on why that is and what doctors and the health care system can do about it.
It found that, overall, interventions can increase medication adherence by nearly 1.5 times. But some strategies work better than others.
鈥淥ur bottom-line finding is that there are strategies that do work in supporting women to take these life-extending medications, and that we as a cancer care community need to do better,鈥� said senior author Joanna Arch, a professor in the Department of Psychology and Neuroscience and member of the CU Cancer Center on the Anschutz Medical Campus.
Arch noted these so-called 鈥渁djuvant endocrine therapies,鈥� like the estrogen-blockers Tamoxifen and aromatase inhibitors, can be costly and come with a host of side effects, including weight gain, sexual side effects, joint pain, depression and sleeplessness.
鈥淚magine going from your normal estrogen activity to little or no estrogen within days. That鈥檚 what these medications do,鈥� she said. 鈥淏ut the women who take them as prescribed also have lower recurrence rates and live longer. It鈥檚 a dilemma.鈥�
As more next-generation cancer drugs, including chemotherapy agents, shift from infusions provided in a clinic to oral therapies taken at home, the medical community has grown increasingly interested in developing ways to make sure patients take their pills.
In a sweeping meta-analysis, Arch and her colleagues analyzed 25 studies representing about 368,000 women to gain insight into what works and what doesn鈥檛.听
Educational pamphlets are not enough听
The study found that cost-cutting policy changes, such as providing generic alternatives or requiring insurance companies to cover pills at the same level as infusions, consistently worked. Such 鈥渙ral parity laws鈥� have been passed in 43 states in recent years.
In one study, participants were asked to create stickers to put on their pill boxes.
Mobile apps and texts to remind patients to take their medication and psychological/coping strategies also yielded modest improvements.
The study鈥檚 findings around managing side effects were complicated: Simply educating women on side effects, via pamphlets or verbal explanations, generally failed to increase the likelihood that women took their medication as directed.
But things such as physical therapy, exercise and behavioral counseling aimed at alleviating or managing side effects often worked.
鈥淓ducation in and of itself is not enough. That is a clear finding,鈥� said Arch, suggesting that doctors write referrals to practitioners who specialize in side effects and follow up with appointment reminders. 鈥淢ost oncologists, I believe, don鈥檛 realize how low adherence is for these women. They assume that if they write the prescription, it鈥檚 being taken.鈥�
Addressing mental health is key
included in the meta-analysis was .
In it, women were asked to identify their primary motivation for taking their medication鈥攚hether it was living to see their child or grandchild grow up, pursuing their art or running a marathon someday. Via an online program, they created a sticker with a photo representing that goal, and the words 鈥淚 take this for鈥︹�� below it. Then, they stuck it on their pill box.
Participants were more likely to take their pills, at least for the first month, than those who didn鈥檛.
鈥淓ven just a tiny thing like this can help,鈥� said Arch.
Notably, very few studies looked at whether treating depression can help. Arch, aiming to fill this gap, recently launched her own pilot trial.
鈥淥ne of the most consistent predictors of not adhering to any medication is depression,鈥� she said. 鈥淒epression taps motivation.鈥�
The new 鈥淛ournal of Clinical Oncology鈥� study is the first meta-analysis to show that听interventions can be helpful, and that鈥檚 important, said Arch, because insurance companies need data to make decisions about what to cover.
But the study also showed听that the effects are relatively modest and that there is room for improvement.
Arch said she hopes the study will spark more research into novel ways to support survivors:
鈥淲e have a lot of work to do.鈥�
