Although participants in a recent study exhibited higher rates of non-adherence following the intervention, those who initially reported non-adherence demonstrated some improvement in adherence levels.
The feasibility of a smartphone-based medication-tracking application was explored in patients with breast cancer, though findings indicated no overall improvement in medication adherence, according to results from a study on the Medisafe app.
As highlighted in research published in JCO Oncology Practice, oral medications place the responsibility of administration on patients rather than healthcare providers, increasing the risk of non-adherence. The Medisafe app, available in both English and Spanish, sends reminders regarding dosage schedules, enabling patients to log whether they have taken or missed their medication.
Feasibility and User Satisfaction
A total of 100 patients were enrolled in the study, creating individual accounts on the Medisafe app with guidance from the research team. Participants were required to utilise the app for 12 weeks, generating adherence reports every four weeks. The primary objective was to determine the feasibility of the intervention, with success defined as at least 75% of participants submitting a minimum of 50% of adherence reports.
This target was achieved, as 78 patients successfully generated reports at weeks 4, 8, and 12. Four participants withdrew consent before the study’s conclusion, while two passed away during the study period.
Patient satisfaction with the app was evaluated as a secondary endpoint, alongside changes in self-reported non-adherence from baseline to week 12. At the conclusion of the study, participants completed the User Version of the Mobile Application Rating Scale to assess their satisfaction with the app.
Findings revealed that 75% of respondents would recommend the app to others, 85.4% found it user-friendly and well-designed, 58.3% reported an increased awareness of the importance of health-related behaviours, and 39.6% indicated that it had positively influenced their personal health behaviours.
Adherence Outcomes
To assess adherence levels to oral anti-cancer medications, researchers utilised the DOSE-Nonadherence Extent and Reasons scales.
The mean percentage of missed doses across all oral medications was 29.0% at week 4, 34.8% at week 8, and 34.2% at week 12.
Non-adherence rates increased for both oral cancer medications and other prescription drugs. At baseline, 25.0% (n = 52) of patients taking oral cancer medication and 46.3% (n = 54) of those on non-cancer oral medications reported non-adherence. Post-intervention, these rates rose to 38.5% (P = .21) and 48.1% (P = 1.0), respectively.
The difference in adherence levels between oral cancer and non-cancer medication was statistically significant at baseline (P = .04). Notably, 10 patients (26.3%; n = 38) who were previously non-adherent reported full adherence after the intervention.
Among those who became adherent post-intervention, the most frequently cited reasons for previous non-adherence included being busy (50.0%), returning home late (30.0%), and long commutes (30.0%). Conversely, common reasons for continued non-adherence were the absence of symptoms (46.4%) and feeling well (53.6%).
“Given the increasing use of novel [oral anti-cancer drugs] and the resulting complexity of oral medication regimens, future research should aim to identify and test additional intervention strategies targeting the diverse barriers to adherence faced by cancer patients,” the study authors noted. “Trials that screen for baseline non-adherence among patients who may benefit most from such interventions should be prioritised.”
Patient Demographics and Medication Use
The study included 100 female patients with stage I-IV breast cancer, enrolled between July 2020 and February 2023. The median age was 54.2 years (range: 29-87). Of these, 50 were White, 17 were Black, 16 were Asian, and 17 identified as another or unknown race.
Each participant had an active prescription for either an oral cancer medication or a non-cancer chronic condition and was receiving standard oncological treatment. A majority (61.0%) had metastatic or unresectable breast cancer.
Among participants, 79.0% were prescribed oral anti-cancer medications, 94.0% were on oral medications for non-cancer conditions, and 52.0% were undergoing additional non-oral oncologic therapies. Nearly all patients taking oral cancer medications (92.4%) were also managing at least one chronic condition with oral medication. Additionally, 40.5% of oral cancer patients received concurrent non-oral cancer treatment.
The most commonly prescribed oral cancer medications included endocrine therapies (64.0%), such as aromatase inhibitors (55.0%) and tamoxifen (6.0%), CDK4/6 inhibitors (39.0%), and chemotherapy agents (10.0%).
Among non-cancer medications, the most frequently prescribed drug classes were antihypertensives (27.0%), other cardiovascular medications (28.0%), health maintenance/vitamin supplements (28.0%), and antidepressant/anti-anxiety medications (21.0%).
Accessibility and Digital Health Disparities
Researchers examined potential disparities in app usage across racial, ethnic, and age groups, as well as differences based on clinical stage and type of medication prescribed. Findings indicated no significant variation in odds of Medisafe app utilisation based on these factors.
“Previous studies have demonstrated significant disparities in the adoption of health-related technologies, with Black, Hispanic, and older patients less likely to engage with digital health tools,” the authors stated. “Our results suggest that these gaps can be mitigated through appropriate training and support in using [mobile health] applications.”
Implications for Future Research
While the Medisafe app did not significantly improve adherence across all participants, it showed potential as a tool for specific subgroups, particularly those with baseline non-adherence. Future studies should consider combining mobile technology with personalised adherence strategies, such as behavioural counselling, telehealth interventions, or pharmacist-led medication management programmes.
As the landscape of oral cancer treatment continues to evolve, integrating digital health solutions alongside tailored support systems may offer a more comprehensive approach to improving adherence and patient outcomes.