Ilana Graetz, PhD, assistant professor in the Department of Preventive Medicine at the University of Tennessee Health Science Center, recently received a $2,021,260 R01 award from the National Institutes of Health (NIH). With her award, Dr. Graetz will examine the use of a novel web-based app designed to improve long-term use of adjuvant endocrine therapy (AET) and related adverse symptoms for women with hormone receptor-positive breast cancer.
According to the most recent Surveillance, Epidemiology, and End Results (SEER) report published annually by the National Cancer Institute, an American woman born today has about a one-in-eight chance of being diagnosed with breast cancer at some time during her life, if the current incident rate stays the same. Women with hormone receptor-positive breast cancer, the most common type of breast cancer, who participate in long-term use of AETs have a significantly reduced risk of hospitalization, cancer recurrence and mortality, and an increased quality of life.
Despite the known benefits of AETs, many breast cancer patients are nonadherent because of adverse side effects. Additionally, lower AET adherence among African-American women may be contributing to the large and expanding disparities in mortality outcomes. Real-time monitoring of treatment-related adverse symptoms and adherence has shown great potential, yet only a few interventions have aimed to improve AET adherence, and even fewer have targeted symptom management as a means to improve adherence. None have found a statistically significant improvement on adherence.
“Our proposed study will fill this research gap by testing a web-enabled app designed with the explicit goal of improving long-term AET adherence,” Dr. Graetz said. “In a small pilot trial of the study app, we found that participants who had recently initiated a new AET and received weekly reminders to use the app reported significantly higher adherence to AETs at eight weeks compared with a control group.”
The app operates via a patient’s smartphone or a web browser. It provides feedback, built-in alerts, tips and includes questions about AET adherence and adverse symptoms.
“Patient-reported symptoms will be integrated directly with the patient’s electronic health record, and concerning reports will trigger an alert to the patient’s care team in order to improve timely patient-provider communication and care outside of clinic visits,” she said. “We hypothesize that monitoring symptoms and adherence with actionable alerts and tailored feedback reports to patients will result in more effective management of symptoms, higher medication adherence, and ultimately lower recurrence and mortality.”
Dr. Graetz is optimistic regarding this study’s comprehensive design and potential impact. “Our study will provide valuable and actionable results for providers, policy makers, and insurers who strive to achieve the ‘Triple Aim’ – reduce costs, while improving health outcomes and the patient experience,” she said. The project titled, “Communication App to Manage Symptoms and Improve Adjuvant Endocrine Therapy Adherence,” will be funded through 2022.
Dr. Graetz is also the recent recipient of a $363,660 R21 NIH award, with which she is studying breast cancer disparities between African-American and Caucasian women using data from West Cancer Center, Medicare, and Tenncare claims.