Randomized trial of a smartphone mobile app for adherence to oral chemotherapy.

Abstract

230 Background: As patients with cancer are increasingly prescribed oral chemotherapy, they share greater responsibility for ensuring adherence and monitoring side effects. The aim of this study was to test the effect of a smartphone mobile app to improve adherence and symptom management in patients prescribed oral chemotherapy. Methods: From 2/15 to 12/16, 181 patients with diverse cancers prescribed oral chemotherapy at an urban cancer center were randomized to receive either the smartphone mobile app or standard care. The mobile app included a medication treatment plan with alerts, symptom reporting module, education library, and cancer-specific resources. The primary outcome was adherence, measured by electronic pill cap (MEMS) and self-report (Morisky Medication Adherence Scale; MMAS). To assess symptoms, mood, and quality of life, participants completed the MD Anderson Symptom Inventory, Hospital Anxiety & Depression Scale (HADS); and Functional Assessment of Cancer Therapy-General (FACT-G) at baseline and 12 weeks. General linear models were used to assess intervention effects on patient outcomes. Results: Study groups did not differ across outcome measures from baseline to week 12, except patients in the mobile app group had less of a reduction in social well-being (FACT-G) over time (Mean Diff = 1.67, 95% CI = -3.12, -0.21, p = .025). Secondary analyses showed that baseline adherence (MMAS) and anxiety (HADS) were moderators of intervention effects on self-reported and electronically monitored adherence. Among patients who reported adherence problems, those assigned to the mobile app had better average MEMS adherence (Mean Diff = -22.30, 95% CI = -42.82, -1.78, p = .034) compared to standard care. Similarly, among patients with higher baseline anxiety, those in the mobile app group had better average MEMS adherence (Mean Diff = -16.08, 95% CI = -31.74, -0.41, p = .044) and reported fewer adherence problems on the MMAS at 12 weeks (4.3% vs 32%, OR = 0.06, 95% CI = 0.003, 0.96, p = .047) compared to standard care. Conclusions: A patient-centered, smartphone mobile app designed to improve adherence to oral chemotherapy may be especially useful for patients with certain risk factors, such as those struggling with adherence or anxiety. Clinical trial information: NCT02157519.