Medication Reminder Application to Improve Medication Adherence in Women with Breast Cancer

Improvements in screening and treatment options in the past few decades have led to declining breast cancer mortality rates. As survival after breast cancer diagnosis increases, cardiovascular disease (CVD) has now become the leading cause of death in breast cancer patients, especially among older women. Despite the growing risk of death due to CVD, adherence to medications for chronic non-breast cancer conditions (diabetes, hypertension, high cholesterol) decreases after the first year of treatment. Of concern, Non-adherence to medications for cardiovascular conditions following a diagnosis of breast cancer is associated with an increased risk of a subsequent cardiac event such as a heart attack. In addition, patients with CVDs risk factors at the time of diagnosis have more hospitalizations and higher costs of care during their breast cancer treatment. Also of major concern, non-adherence to medications for chronic conditions is associated with non-adherence to hormonal therapy for breast cancer, which can increase the risk of breast cancer recurrence and death from breast cancer. Less is known about adherence to antineoplastic agents among patients with advanced disease. Recently, investigators have turned to Medication Reminder Applications (Med_App) to improve medication adherence. Medisafe is an app that can be used on a phone or tablet to help manage medications by sending daily reminders by text, email or push notification depending on preferences. The app shows not only which medication the patient should take, but also the reasoning for it. It tracks medication use, saves and analyzes usage history. For this proposal we will conduct two prospective trials to assess the efficacy and feasibility of Medisafe in improving adherence to both oral anticancer therapy and adherence to medications for chronic conditions in a diverse cohort of 150 patients with early stage breast cancer (AIM 1) and 75 patients with metastatic breast cancer (AIM 2). We will determine the effect of the assisted implementation of a Medication Assistance App on global medication adherence (ie adherence to all medications). We will evaluate self-reported adherence, medication refills, and downstream effects of medication compliance. We will also measure engagement and acceptance of the application in both English speaking and Spanish speaking women. If successful, results from this work will inform the optimal intervention delivery methods for a large multicenter randomized trial. Improving the delivery of known effective therapies has great potential to reduce the number of deaths in women with breast cancer.