Impact of web application support versus standard management on adherence with adjuvant hormone therapy in patients treated for breast cancer: the WEBAPPAC study

BACKGROUND

Non-metastatic breast cancer treatment is mainly based on surgery, with or without chemotherapy, radiotherapy and/or hormone therapy. To reduce the risk of hormone receptor positive (HR+) disease recurrence, hormone therapy is prescribed for at least 5 years. It may induce adverse drug reactions (ADRs) as joint pain, sexual dysfunction, weight increase, fatigue, mood disorders and vasomotor symptoms. Around 30-40% of patients withhold hormone therapy within 5 years after initiation. Based on encouraging results of mobile health in patient follow-up, we developed a web-application addressed for breast cancer patients initiating adjuvant hormonal therapy and aimed to assess its impact on hormone therapy adherence, ADRs management, and health-related quality of life.

METHODS

The WEBAPPAC trial is a randomized, open-label, prospective, single-center phase 3 study aiming to assess the interest of a web-application support as compared to standard management among breast cancer patients initiating hormone therapy. The main endpoint is the proportion of patients with hormone therapy adherence failure within 18 months after treatment start, in each arm. Eligible patients will be 1:1 randomized between the WEBAPPAC web-application support (experimental arm,) or standard support (control arm), with stratification on type of hormone therapy (Aromatase inhibitor or Tamoxifen). We plan to enroll 438 patients overall. Failure to hormone therapy will be assessed using the Morisky 8-item self-questionnaire (MMSA8), patient adherence logbook, and medical consultations. Secondary outcomes include hormone therapy adherence at 6 months, pain (Visual Analogue Scale and Brief Pain Inventory), quality of life (EORTC QLQ-C30 and BR23 self-questionnaires), anxiety and depression (Hospital and Depression Scale), and return to work and/or daily activities. The user experience with the WEBAPPAC web-application will be assessed using the System Usability Scale (SUS) questionnaire.

DISCUSSION

Hormone therapy discontinuation or adherence failure in breast cancer patients may be indirectly related to an increased risk of recurrence. A better control of medication adherence, through the detection of side effects and some proposed actions trying to reduce them, appears therefore essential to limit the risk of disease recurrence. The WEBAPPAC web-application thus aims better monitoring and allowing higher level of responsiveness in case of ADRs, thus improving treatment adherence.

TRIAL REGISTRATION

NCT04554927, registered September 18, 2020.

PROTOCOL VERSION

Version 2.1 dated from December 21, 2021.

Abstract P4-12-05: Benefit of multidisciplinary consultation at initiation of oral antineoplastic agents in metastatic breast cancer patients

INTRODUCTION: The management of cancer patients changed in the recent years with increased in the number of oral antineoplastic agents (OANA) prescriptions. Recent guidelines encouraged improvement of information and patient education, and the coordination between health care professionals to secure and optimize the management of these drugs. To cope with current recommendations, a multidisciplinary consultation (MDC) for initiation of OANA was initiated at François Baclesse comprehensive cancer center in Caen, France. OBJECTIVE: The aim of this study was to evaluate the benefit of the MDC before the initiation OANA in patients with metastatic breast cancer. MDC consisted of a medical oncologist, hospital pharmacist, and oncology nurse consultations. Primary endpoint was the rate of hospitalizations. Secondary endpoints were treatment discontinuation and of adverse events rate. MATERIALS AND METHODS: We conducted a retrospective single center study comparing patients receiving MDC to the population with a single medical visit. RESULTS: A total of 482 patients were included in this study between January 2017 and December 2019 (329 patients had only a consultation with a medical oncologist before initiation of OANA and 153 had the MDC). A statistically significant decrease in the rate of hospitalizations for toxicity was found in the group of patients with MDC 3.9% (n=6) vs 18.5% (n = 61) in the group without MDC (p < 0.001). A significant decrease in treatment interruption rate for toxicity was found in the group of patients with MDC 11% (n = 16) vs 26% (n=86) (p < 0.001). Adverse events rate was not statistically significant between the two groups CONCLUSION: A statistically significant decrease in hospitalizations and rate of treatment interruption for toxicity was observed after initiation of MDC in patients with a metastatic breast cancer treated with an OANA. This process should be generalized for a better security in the management of the OANA.

Citation Format: Adeline Morel, Margaux Jacobs, Angelique Da Silva, Djelila Allouache, Ioana Hrab, Carine Segura, Maud Villemin, Clémence Boscher, Alison Johnson, Charlotte Ceintre, Rose-Marie Charles, François Lahaye, Justine Lequesne, Fabienne Divanon, Christelle Levy, Georges Emile. Benefit of multidisciplinary consultation at initiation of oral antineoplastic agents in metastatic breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-05.