Ask an Expert: Breast Cancer and Mobile Health Interventions with Ilana Graetz

By Shelby Crosier

Breast cancer is extremely common in the U.S. It is the second most common type of cancer and second leading cause of cancer death among women in the country.

As we enter Breast Cancer Awareness month, Ilana Graetz, PhD, associate professor of health policy and management, shares new innovations in breast cancer treatment using mobile technologies.

What challenges do people diagnosed with breast cancer face when it comes to treatment? 

People diagnosed with breast cancer often face numerous challenges, including navigating complex treatments with complicated schedules, having to rely on support from family and friends, high treatment costs, inconsistent access to care, variability in the quality of care, inadequate communication about their treatment, and having to cope with physical side effects from the cancer and its treatment.

How can oral anticancer medications help alleviate those challenges?

The use of oral anticancer medications for breast cancer has grown significantly in recent years. These therapies offer improved survival rates and reduce the burden of care by providing patients with the convenience of at-home treatment, unlike intravenous chemotherapy, which requires hospital or clinic visits.

However, this added convenience also means fewer interactions with their providers and brings the new challenges of having to manage often complex dosing schedules and adverse symptoms on their own. Forgetfulness and under-managed symptoms contribute to poorer adherence, which is a challenge for most oral anticancer medications.

Why is adherence to breast cancer treatment a concern?

Poor adherence can lead to worse survival rates, increased side effects, unnecessary changes in treatment, and higher health care costs.

For example, adjuvant endocrine therapy is one of the most common types of oral anticancer medications used as standard treatment for hormone-receptor-positive tumors, the majority of all breast cancers. When taken as prescribed, they reduce the risk of recurrence and improve survival. Current clinical guidelines recommend adjuvant endocrine therapy for at least 5 years.  However, existing studies showed that long-term adherence tends to be low with 40% discontinuing it early and 30-50% taking it less often than prescribed.

You've done work with mobile technologies, like apps, that make it easier for people to adhere to breast cancer treatment. How do those work, and why are they important?

The widespread use of mobile phones and connected devices offers a valuable new way to enhance patient engagement, improve communication with healthcare providers, and support symptom management and treatment adherence.

We recently completed a study that tested if a mobile health app could help improve endocrine therapy adherence by monitoring symptoms and providing tailored educational messages.

While the app and tailored text messages did not significantly impact 1-year adherence overall, it reduced the number of high-cost health encounters. We also found that women with lower health literacy who received the app and tailored text messages were more likely to achieve high 1-year adherence.

In another recently completed pilot trial, we tested a system to remotely monitor adherence and symptoms using a bottle that measured the timing and dose of medication use and simple text messages. The intervention resulted in higher medication adherence, improved mental health quality-of-life scores, and lowered symptom burden over 90 days.

These findings suggest that mobile health could be an effective tool to improve adherence and subsequent outcomes for different oral cancer regimens in breast cancer, and potentially other cancers that heavily rely on oral oncologic drugs.

What other opportunities do you see for mobile health and health technology to improve outcomes for breast cancer, or other cancers?

Growing evidence finds that mobile health and remote monitoring can improve health outcomes, including medication adherence, and reduce preventable high-cost care.

With new payments for remote patient monitoring introduced in 2019 and expanded during the pandemic, we need clear evidence on how to best use these tools in clinical practice. To do this, we need to create simple decision tools to identify which patients will benefit most from remote monitoring and design systems that consistently improve health outcomes.

It's also important to regularly assess the impact of these programs on health equity. We must ensure these tools can scale, keep patients engaged, and protect their data to build trust. Lastly, it's crucial to balance the benefits of remote monitoring with the time demands on clinicians and patients, and the costs to insurers.