Enhancing Adherence to Adjuvant Endocrine Therapy

Breast cancer is the most common cancer diagnosed in females and is the second leading cause of death behind lung cancer. In 2020, an estimated 320,000 new cases of either invasive or non-invasive breast cancer will be diagnosed in women.¹

Treatment advancements have increased breast cancer survivorship. Oncologists prescribe adjuvant endocrine therapy (AET), tamoxifen, or aromatase inhibitors, for women with hormone-sensitive breast cancer to reduce recurrence and mortality. Researchers have evidence that AET reduces recurrence rates, but therapy is prescribed for 5-10 years—allowing for suboptimal adherence for many women.

Clinicians developed and evaluated 4 previous interventions to enhance AET adherence but found inconclusive results. Some limitations behind these studies may explain the inconclusiveness:

• Interventions weren’t based on identification of potentially modifiable psychosocial factors influencing AET adherence
• They mainly relied on written educational materials/reminders
• None of the 4 reported using a structured approach for intervention development, implementation and evaluation

The journal Research in Social and Administrative Pharmacy published the results on the development of the PAcHA program, a community pharmacy-based intervention, in February 2020. This program was used to enhance AET adherence, and the article focused on the process of developing the intervention.²

Clinicians can prescribe AET for 30-day periods, creating frequent patient encounters with community pharmacists—and allowing for a potential role in enhancing AET adherence. Pharmacists’ access to medication claims can help them detect nonadherence, and suggest strategies to enhance it.

On the downside, community pharmacists report they feel untrained and poorly equipped to monitor oral medication in oncology.

Intervention Mappin (IM), a 6 step-by-step approach to guide development and evaluation of complex behavioral interventions in health promotion, guided the PAcHA program. Previous AET adherence-enhancing interventions attempts have proven ineffective. Using a structured approach like IM has the possibility to increase success rates for efficacy and implementation of interventions targeting adherence.

If proven effective, the step-by-step IM approach may potentially optimize AET benefits among women with breast cancer and address pharmacists' needs for better monitoring of oral anticancer therapies.²

Improving patient adherence to AET will continue to reduce breast cancer recurrences and mortality rates.

Samuel Breiner is a 2021 PharmD Candidate, the University of Connecticut in Storrs.

REFERENCES

• U.S. Breast Cancer Statistics. BreastCancer.org. https://www.breastcancer.org/symptoms/understand_bc/statistics Updated January 27, 2020. Accessed May 2, 2020.
• Labonté M, Guillaumie L, Dionne A, et.al. Development of a community pharmacy-based intervention to enhance adherence to adjuvant endocrine therapy among breast cancer survivors guided by the Intervention Mapping approach [published online ahead of print, 2020 Feb 12]. Res Social Adm Pharm. 2020; S1551-7411(19)30530-3. doi: 10.1016/j.sapharm.2020.02.004.