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A Feasibility Study of a Pro-Based, Clinical Pharmacist-Led Symptom Monitoring and Management Intervention To Improve Adherence to Breast Cancer Adjuvant Endocrine Therapy


 Background Adjuvant endocrine therapy (AET) for breast cancer reduces mortality, but one-third to one-half of patients discontinue it early or are nonadherent. We developed a pilot single-site study of patients with evidence of early nonadherence to AET to assess the feasibility of a novel intervention targeting symptom and medication management.Methods: Subjects with prescription fill records showing nonadherence were enrolled in a single arm, clinical pharmacist-led, pre-post feasibility study. Automated reminders were sent by email or text with a link to symptom monitoring assessments weekly for 1 month and monthly until 6 months. Clinical oncology pharmacists used guideline-based symptom management and other medication management tools to support adherence and ameliorate symptoms reported on the assessments. Patient-reported outcome assessments included physical, mental, and social health domains, and self-efficacy to manage symptoms and medications. Feasibility outcomes included completion of symptom reports and pharmacist recommendations.Results Of nineteen nonadherent patients who completed initial assessments, 18 completed all final study procedures, with 14 completing assessments and no patient missing > three. All 18 patients reported at least one of three symptom types, and the majority reported attempting pharmacist recommendations. Patient-reported measures of physical, mental and social health, as well as self-efficacy improved, and 44% of the patients became adherent.Conclusions: An intervention to utilize pharmacists in an oncology practice systematically monitor and manage symptoms shows promise to reduce symptoms, enhance support and self-efficacy, and improve adherence to AET. Implications for Cancer Survivors: If future larger studies confirm these pilot findings, the intervention could improve patient symptoms and adherence.