CHICAGO — A multicenter randomized trial that employed text messaging reminders for patients undergoing aromatase inhibitor (AI) therapy found that the reminders did not improve adherence, according to study results presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting. Furthermore, the research revealed high rates of AI discontinuation, leading them to conclude that further behavioral and support interventions are needed to improve AI adherence in women with breast cancer.

“Simple bi-weekly unidirectional text messaging did not result in improved adherence based on the primary or secondary end points of our study,” said lead investigator Dawn L. Hershman, MD, FASCO, of Columbia University Medical Center in New York, New York, during her presentation.

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The researchers used time to discontinuation to measure adherence and urine biomarker for AI metabolites as their outcome measure. Adherence failure was defined as less than 10 units of urine, undetectable metabolites, or nonadherence to appointment/lack of submitted sample. Given the strictness of the primary outcome, secondary outcomes for the study included patient self-report of all endocrine therapy discontinuation, site report of all endocrine therapy discontinuation, and annual cross-sectional analysis.

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Patients were divided into 2 groups, one group received text messages (348 eligible patients) and the other group did not (354 eligible patients). Three years after registration, the researchers found that the time to adherence failure was nearly identical between the groups, with 303 events in the no text messaging arm and 283 events in the text messaging arm (hazard ratio = 0.89; 95% CI, 0.76-1.05; P =.15)

When speculating on the reason why their program may have been ineffective, Dr Hershman cited the potential that passive text messages may be insufficient due to the increase in the amount of push notifications and text messages that patients receive on a daily basis from numerous sources.

“Improving long-term adherence may require enhanced provider-patient communication, personalized sustained behavior interventions, symptom management, and support,” she concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.


Hershman DL, Unger JM, Grace  H, et al. Randomized trial of text messaging (TM) to reduce early discontinuation of aromatase inhibitor (AI) therapy in women with breast cancer: SWOG S1105. Oral presentation at: 2019 ASCO Annual Meeting; May 31 to June 4, 2019; Chicago, IL. Abstract 6516.