Symptom Monitoring Using Patient-Report to Improve Medication Use

Official title

Symptom Monitoring Using Patient-Reported Outcomes to Optimize Medication Use

Overview

This is an intervention targeting patients at risk for non-adherence to endocrine therapy after primary treatments for hormone-positive breast cancer. In a randomized study, the study team will collect patient-reported symptoms monthly from participants through surveys. Pharmacists who specialize in cancer at the patients' hospital will give patients recommendations to help improve their symptoms and address other barriers so they can continue daily endocrine therapy medications.

Detailed description

This study will test whether oncology teams can adapt and combine models from intensive oncologic care and chronic noncancer care to support long-term oral oncologic medication adherence through better symptom monitoring and management. It will identify patients at risk of nonadherence through electronic health records and target them with a symptom monitoring and management intervention. The study will use patient-reported outcomes (PROs) to identify symptoms that may cause nonadherence and will involve clinical pharmacist-led follow-up.

Objectives:

1. Assess the impact of the intervention on adherence to oral endocrine therapy. 2. Evaluate the durability of adherence one-year post-intervention. 3. Describe the impact on symptoms and explore mechanisms for adherence improvement.

Intervention:

During the intervention phase, patients will receive symptom monitoring and pharmacist-led management based on patient-reported outcomes (PROs).

Symptom Monitoring:

1. Patients will report symptoms monthly for 12 months either online or via an interactive voice recording (IVR) system. 2. Symptoms will be assessed using PROs focusing on issues like pain, hot flashes, anxiety, and more. 3. Severe symptoms will trigger follow-up for management.

Symptom Management:

1. After the initial symptom report, patients will have a face-to-face or virtual visit with a clinical pharmacist. 2. The visit will be tailored based on patient preference and pharmacist judgment. 3. Pharmacists will discuss symptom reports, provide management recommendations, and coordinate with oncologists for prescriptions if needed. 4. All interactions will be documented in the electronic health record (EHR) for research analysis.

Control Phase:

Breast cancer patients on AET are typically seen every six months over a 5 to 10-year course, with more frequent visits if complications arise. Control group participants will continue to follow this schedule and receive an FDA document with tips for medication adherence.

Consent Process:

Informed consent will be obtained in person or remotely.

Interventions

• Behavioral Pharmacist delivered symptom monitoring and management
  Patients in the intervention phase will receive PRO-based symptom monitoring once a month and pharmacist-led management for problematic symptoms based on routine clinical care recommendations.

Primary outcome measures

• Medication adherence [Time frame: From baseline to 12 months]
• Intervention durability on medication adherence [Time frame: From 12 to 24 months]

Secondary outcome measures (12)

• Medication adherence [Time frame: From baseline to 12 months]
• Pain [Time frame: From baseline to 24 months]
• Fatigue [Time frame: From baseline to 24 months]
• Sleep [Time frame: From baseline to 24 months]
• Anxiety [Time frame: From baseline to 24 months]
• Depression [Time frame: From baseline to 24 months]
• Sexual function [Time frame: From baseline to 24 months]
• Physical functioning [Time frame: From baseline to 24 months]
• Social functioning [Time frame: From baseline to 24 months]
• Self-efficacy to manage medications [Time frame: From baseline to 24 months]
• Self-efficacy to manage symptoms [Time frame: From baseline to 24 months]
• Social support [Time frame: From baseline to 24 months]

Eligibility criteria

Inclusion criteria

• Cisgender women assigned female at birth
• Age 18 years or older
• Stage 1-3 hormone receptor-positive breast cancer

• Premenopausal patients being treated with GNRH agonist/antagonist to induce menopause are eligible
• Patients who received treatment with CDK 4/6 inhibitors are eligible
• Recommended to continue AET for ≥2 additional years after enrollment
• Low adherence defined as prescription fills with a proportion of days covered (PDC) of <80%, examined over all fills during the 2 years prior to date of eligibility review since the first AET prescription/data of AET start OR unable to calculate adherence
• Verbal fluency in English or Spanish
• Ability to understand informed consent and the willingness to sign it

Exclusion criteria

• Unable to verbalize comprehension of study or impaired decision-making
• Known distant metastatic disease
• Not receiving breast cancer care or AET prescription from provider at participating site
• Evidence that an oncology provider discontinued their AET
• Pregnant or trying to get pregnant
• Facility-administered medications (i.e., nursing home, home healthcare agency)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Crossover

Masking

Single blind

Primary purpose

Supportive care

Study locations

United States · 3 centers

• University of Illinois Chicago — Chicago
• Mayo Clinic — Rochester
• Medical College of Wisconsin — Milwaukee

Publications

• Neuner J, Weil E, Fergestrom N, Stolley M, Kamaraju S, Oxencis C, Winn A, Laud PW, Flynn KE. Feasibility of a pharmacist-led symptom monitoring and management intervention to improve breast cancer endocrine therapy adherence. J Am Pharm Assoc (2003). 2022 Jul-Aug;62(4):1321-1328.e3. doi: 10.1016/j.japh.2022.03.001. Epub 2022 Mar 5. PMID 35393248

Identifiers

NCT: NCT06765707 · PRO00051010 · 1R01CA285925-01A1

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗