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Behavioral Interventions Demonstrate Improved Long-Term Adherence to Adjuvant Endocrine Therapy Among Women with HR-Positive Breast Cancer

Conference Correspondent 

Adjuvant endocrine therapy is a widely accepted treatment for patients with HR-positive breast cancers. However, a significant number of patients do not maintain the required therapeutic regimen for the duration required to adequately treat early-stage disease. Although diverse limitations to adherence likely exist, emotional distress has been shown to be a major contributor. An estimated 20% to 40% of patients with breast cancer suffer from high levels of emotional distress and only a small fraction may be referred for a mental health consultation. Therefore, appropriate interventions are necessary to improve emotional health in this patient population.

Investigators examined two 5-week post-surgery group–based stress management interventions: cognitive behavioral therapy and relaxation training. A health education program served as the control for comparison to cognitive behavioral therapy and relaxation training. Adherence to adjuvant endocrine therapy at long-term follow-up (average, 8 years post-surgery) was compared across the 3 groups. The majority of study participants were approximately aged 54.81 years, white (41.5%) and Hispanic (42.2%), partnered (62.2%) with stage I (57.0%) or stage II (25.9%) HR-positive disease.

At long-term follow-up (44.7% of original study cohort), approximately 50.8% described problems with adherence to treatment over the 8-year study period, including change in routine (28.80%), being away from home (23.70%), sick or side effects (23.70%), fell asleep (18.60%), and felt the treatment was harmful (18.60%). Women in the relaxation training group (n = 15) had significantly better adherence compared with women in the cognitive behavioral therapy group (n = 20) on the factor measuring forgetfulness/inconsistency (P = .001) and slightly better adherence on intentional nonadherence (P = .062). No significant difference was observed when comparing relaxation training or cognitive behavioral therapy with health education.

Researchers conclude that patients receiving relaxation training were less likely to forget to take their medication or intentionally miss doses of adjuvant endocrine therapy compared with women receiving cognitive behavioral therapy. However, both interventions fared better than the health education program alone, suggesting some type of psychological assistance might improve long-term adherence to adjuvant endocrine therapy. The investigators note further investigation into the mechanism activated by relaxation training is needed.

Source: Ream M, Walsh EA, Jacobs JM, et al. Brief relaxation training effects on long-term endocrine therapy adherence among women with breast cancer. American Society of Clinical Oncology Virtual Meeting; June 4-8, 2021. Abstract 12061.

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