Mobile App May Be Feasible for Tracking Oral Cancer Medication Adherence

Mean percentage of missed doses increased from 29.0% at week 4 to 34.8% at week 8, then 34.2% at week 12.

Use of a medication-tracking smartphone application may be feasible, although it was not found to increase overall medication adherence in patients with breast cancer, according to results from a study on the use of the Medisafe app.

As noted in the study published in JCO Oncology Practice, oral medications shift the onus of medication administration to the patients rather than providers, often resulting in greater risk of nonadherence. The Medisafe app, which is available in English and Spanish, notifies patients when to take medication and at what dose, and patients mark each medication event as either taken or missed.

Feasibility and Satisfaction

Enrolled patients (n = 100) created accounts on the Medisafe app and received guidance on its functionality from the study team. Participants were asked to use the app for 12 weeks and to generate adherence reports every 4 weeks. The primary end point for the study was feasibility of the intervention, defined by at least 75% of participants submitting at least 50% of adherence reports.

The study reached its primary end point, with 78 patients generating more than 50% of adherence reports at the required times of weeks 4, 8, and 12. Four of the patients who did not complete intervention withdrew consent before the end of the study, and 2 patients died before study conclusion.

Satisfaction with the app as a patient-reported outcome (PRO) was one of the secondary end points, in addition to changes in self-reported nonadherence from baseline to 12 weeks. At 12 weeks, patients were asked to complete a User Version of the Mobile Application Rating Scale to assess their satisfaction with the app.

Seventy-five percent of respondents said that they would recommend the app to others, 85.4% reported that it was easy to use and clearly designed, 58.3% said that it increased their awareness of the importance of a health behavior, and 39.6% reported that it would change their own health behavior.

Adherence Outcomes

The DOSE-Nonadherence Extent and Reasons scales were used to assess adherence to oral anti-cancer drugs.

The mean percentage of missed doses for any oral medications were 29.0% at week 4, 34.8% at week 8, and 34.2% at week 12.

Rates of nonadherence increased across oral medications for cancer and other conditions. At baseline, 25.0% (n = 52) of those taking oral cancer medication and 46.3% (n = 54) of those taking non-cancer oral medications self-reported nonadherence. Postintervention rates of nonadherence were 38.5% (P = .21) and 48.1% (P = 1.0), respectively.

The difference in adherence for oral cancer medication vs oral non-cancer medication was statistically significant at baseline (P = .04). Ten patients (26.3%; n = 38) who were nonadherent at baseline reported full adherence postintervention.

For the patients who reported adherence after intervention, the most common self-reported reason for nonadherence was being busy (50.0%), followed by coming home late (30.0%), and having a long car/bus/plane ride (30.0%). Common reasons for nonadherence among those who remained nonadherent were not having symptoms (46.4%) and feeling well (53.6%).

“Given the increased use of novel [oral anti-cancer drugs], resulting in complex oral medication regimens, future research should focus on identifying and testing other intervention components targeting the diverse barriers to adherence faced by patients with cancer,” explained researchers in JCO Oncology Practice. “Trials that screen for patients with baseline nonadherence who are most likely to benefit from these interventions should be encouraged.”

Patient Characteristics

One hundred female patients were enrolled from July 2020 to February 2023 with stage I-IV breast cancer, 50 of whom were White, 17 of whom were Black, 16 of whom were Asian, and 17 of whom were of another or unknown race. The median participant age was 54.2 years (range: 29-87).

Every patient had either an active prescription for an oral cancer medication or were taking oral medication for another non-cancer chronic condition and were also receiving normal cancer treatment. Most patients (61.0%) had metastatic or unresectable breast cancer.

In total, 79.0% of patients were on oral anticancer medication, 94.0% were taking oral medication for a non-cancer condition, and 52.0% were receiving other nonoral oncologic therapies. The majority of patients who were taking oral cancer medication was also taking at least one chronic non-cancer oral medication (92.4%). Additionally, 40.5% of those taking oral cancer medication also received nonoral cancer treatment.

The most frequent oral cancer medications were endocrine therapies (64.0%), including aromatase inhibitors (55.0%) and tamoxifen (6.0%); CDK4/6 inhibitors (39.0%); and chemotherapy (10.0%).

Likewise, the most common medication types among non-cancer oral medications were antihypertensives (27.0%), other cardiovascular medications (28.0%), health maintenance/vitamin supplements (28.0%), and anti-depressant/anti-anxiety medications (21.0%).

Accessibility Considerations

Researchers noted that accessibility to racial and ethnic minorities and older patients was a consideration which was met by study results. In single-variable and multivariable analyses, no significant difference in odds of Medisafe app usage was observed by race, ethnicity, age, clinical stage, or type of medication.

“Previous studies have shown significant disparities in health-related technology use, with Black, Hispanic, and older patients less likely to use technology for health-related purposes,” wrote authors of the study. “Our findings suggests that this digital divide can be overcome with adequate training in the use of [mobile health] tools.”

Reference

Sathe C, Raghunathan R, Ulene S, et al. Use of a smartphone application to promote adherence to oral medications in patients with breast cancer. JCO Oncol Pract. 2025;21(2):199-208. doi:10.1200/OP.24.00187