Automated telephone reminders: Potential to improve adherence to adjuvant hormonal therapy among patients with breast cancer.

Abstract

297 Background: As the U.S. population ages and life expectancy lengthens, the number of new estrogen receptor positive (ER+) breast cancer (bca) cases is expected to grow substantially from the current 150,000/year. Numerous studies show that adjuvant hormonal therapy (AHT) dramatically reduces bca recurrence (by 50%) and mortality (by 30%) among ER+ women. Daily treatment for 5 years is the recommended therapy. Yet, reports of under-utilization are alarming, ranging from 30% to more than 50%. Methods: We examined utilization of AHT among members of Kaiser Permanente Southern California, a nonprofit prepaid health care organization serving 3.6 million socio-economically diverse members. We identified 10,827 women diagnosed with bca between 2000 and 2007 from the plan’s SEER-affiliated cancer registry who were eligible for AHT. We used automated pharmacy records to assess uptake and utilization of AHT (primarily tamoxifen (TAM) and aromatase inhibitors (AIs)). Results: In this insured population, we found 14% of eligible bca survivors did not begin AHT. Among women who started AHT, over 30% had sub-optimal adherence defined as a medication possession ratio <80%. Discontinuation of AHT, defined as >90 days without medication, began in year 1 (7%) and reached 25% by year 5. To address this threat to quality bca care, the health plan recently initiated an innovative automated telephone reminder (ATR) system among women who filled at least 1 prescription for TAM. Each month, ATR calls are made to about 125 women >18 years, who are overdue between 2 and 6 weeks for a refill, and who have not developed intolerance to TAM or switched to an AI. To date, ATR calls have generated no or few complaints. Next steps include evaluation of the impact of the system on adherence to TAM and, subsequently, AIs, and incorporation of electronic prompts to clinical staff for follow-up with non-responders. Conclusions: Monitoring and intervention for improving adherence to AHT needs to begin at initiation and continue across the 5 years of recommended therapy. AVR can reach large numbers of bca survivors and may have the potential to ensure they receive optimal benefit from these life-saving treatments.