Text-based remote monitoring app cuts high-cost breast cancer visits

While a remote monitoring application offering tailored text messages did not improve adjuvant endocrine therapy (AET) adherence among women with early-stage breast cancer, it did reduce high-cost healthcare encounters without affecting quality of life, according to new research.

AET can help reduce the risk of cancer recurrence among women with early-stage, hormone receptor-positive breast cancer. AET includes drugs that block estrogen receptors, like Tamoxifen and Fulvestrant (Faslodex), drugs that lower estrogen levels, like aromatase inhibitors, and ovarian suppression treatments. However, AET is associated with adverse symptoms, which reduce adherence.

Researchers examined the efficacy of a remote symptom monitoring app in improving AET adherence and other outcomes in a study published in JAMA Network Open. The randomized clinical trial included English-speaking women with early-stage breast cancer prescribed AET at a large cancer center from November 15, 2018, to June 11, 2021.

The participants were divided into three groups:

• The enhanced usual care group, which received education about AET and treatment-related symptoms
• The app group, which received the education, as well as app access for six months and a weekly text message reminder to log into the app to report adherence and symptoms in the prior week
• The app plus feedback group, which received additional weekly tailored text messages, including educational information and encouragement related to AET adherence, AET-related symptoms, lifestyle and social support, and patient-physician communication

Of 304 study participants, 104 were assigned to the enhanced usual care group, 98 to the app group, and 102 to the app plus feedback group.

The study shows that AET adherence over one year was similar across groups: 76.6 percent for the enhanced care group, 73.4 percent for the app group, and 70.9 percent for the app plus feedback group.

However, a higher proportion of patients received symptom management in the app plus feedback group (46.1 percent) compared with the app group (36.7%) and enhanced usual care group (29.8 percent).

Additionally, after adjusting for baseline healthcare utilization levels, app plus feedback participants had significantly fewer healthcare encounters over the prior six months compared to the enhanced usual care group. Not only that, but the app plus feedback also had significantly fewer high-cost healthcare encounters and office visits than the enhanced usual care group.

The app group had similar levels of healthcare utilization, including high-cost healthcare encounters and office visits, as the enhanced usual care group.

Thus, “a remote monitoring app along with text messages did not change AET adherence but improved secondary outcomes, such as frequency of high-cost health care encounters, for women with early-stage breast cancer receiving AET,” the researchers wrote.

This is the latest example of how virtual care modalities have the potential to enhance cancer care.

A study published last month revealed that radiation oncology treatment provided via telehealth is associated with high patient satisfaction and safety. The study assessed Memorial Sloan Kettering Cancer Center’s remote radiation care model, assessing data for patients who participated between October 1, 2020, and October 31, 2022. The study included 2,817 patients, of whom 38.9 percent had metastatic disease.

Researchers found that though 764 adverse patient safety events were reported, 763 (99.9 percent) did not reach patients or caused no harm to patients. They also observed high patient satisfaction, with 97.6 percent of the 873 survey respondents rating satisfaction as good or very good across all domains. Most respondents (87.8 percent) either preferred telehealth or expressed no preference for in-person versus fully remote visits.