Weekly text message reminders did not increase patient adherence to adjuvant aromatase inhibitor (AI) therapy according to results from a randomized, clinical trial published in the American Society of Clinical Oncology.

At 40 sites in the United States, 724 postmenopausal women with early-stage hormone-sensitive breast cancer on an AI treatment were recruited between 2012 and 2013. Study participants were randomly assigned to receive text messages (n=348) or not (n=354). The messages were sent twice a week for 36 months. The text content included cues to action, discussed medication efficacy, and reminded patients to take their AI.

At the study conclusion, no difference in adherence was observed in the text message group (55.5%) compared with the no text message group (55.4%). Self-reported 3-year time-to-adherence failure was 10.4% vs 10.3% and site-reported rates were 21.9% vs 18.9% for the text and no text groups, respectively.

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The overall adherence rates declined over time from 73.5% at 12 months, 62.3% at 24 months, and 55.4% at 36 months. These rates did not significantly differ between the study treatments. An overall hazard ratio of adherence failure was calculated as 0.89 (95% CI, 0.76-1.05).

A limitation of this study is that the investigators were unable to differentiate between missed appointments and nonadherence, perhaps exaggerating the nonadherence rates.

The study authors concluded that adherence was not altered by a twice-a-week text message routine, and that a more personalized intervention may be needed to increase patient compliance to AI therapy.


Hershman DL, Unger JM, Clarke Hillyer G, et al. Randomized trial of text messaging to reduce early discontinuation of adjuvant aromatase inhibitor therapy in women with early-stage breast cancer: SWOG S1105 [published online May 5, 2020]. J Clin Oncol. doi:10.1200/JCO.19.02699