Randomized Controlled Pilot Trial of a Low-Touch Remotely-Delivered Values Intervention to Promote Adherence to Adjuvant Endocrine Therapy Among Breast Cancer Survivors
Open accessAbstract
Background: Oral anti-cancer treatments such as adjuvant endocrine therapies (AET) for breast cancer survivors are commonly used but adherence is a challenge. Few low-touch, scalable interventions exist to increase ET adherence. Purpose: To evaluate the acceptability, feasibility, and initial efficacy of a low-touch, remotely-delivered values plus AET education intervention (REACH) to promote AET adherence. Methods: A mixed-methods trial randomized 88 breast cancer survivors 1:1 to REACH or Education alone. Wisepill real-time electronic adherence monitoring tracked monthly AET adherence during a 1-month baseline through 6-month follow-up (FU) (primary outcome). Patient-reported outcomes were evaluated through 3- and 6-month FU (secondary). Multiple indices of intervention feasibility and acceptability were evaluated. Qualitative exit interviews (n = 38) further assessed participants’ perceptions of feasibility/acceptability and recommendations for intervention adaptation. Results: The trial showed strong feasibility and acceptability, with an eligible-to-enrolled rate of 85%, 100% completion of the main intervention sessions, and “good” intervention satisfaction ratings on average. For Wisepill-assessed AET adherence, REACH outperformed Education for Month 1 of FU (p = .027) and not thereafter. Participants in REACH maintained high adherence until Month 4 of FU, whereas in Education, adherence declined significantly in Month 1. Conditions did not differ in self-reported adherence, positive affective attitudes, future intentions, or necessity beliefs. REACH trended toward less negative AET attitudes than Education at 3-month FU (p = .057) reflecting improvement in REACH (p = .004) but not Education (p = .809). Exploratory moderator analyses showed that average to highly positive baseline AET affective attitudes and oncologist-patient communication each predicted higher adherence following REACH than Education; low levels did not. Participants identified recommendations to strengthen the interventions. Conclusions: REACH, a low-touch values intervention, showed good feasibility and acceptability, and initial promise in improving objectively-assessed AET adherence among breast cancer survivors (relative to education alone). Future research should target improving REACH’s tailoring and endurance.
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In breast cancer, there has been one pilot trial (N = 88) of a brief values-elicitation intervention that aimed to engender one aspect of psychological flexibility (engagement) to improve AET adherence.
“In breast cancer, there has been one pilot trial ( N = 88) of a brief values -elicitation intervention that aimed to engender one aspect of psychological flexibility (engagement) to improve AET adherence.”
From A pilot randomised controlled trial of acceptance and commitment therapy for medication decision-making and quality of life in women with breast cancer: The ACTION trial (2024) · cites this paper as [21]
The Methods report a pilot trial randomizing 88 breast cancer survivors, and the Discussion describes REACH as a brief, values-based intervention intended to promote AET adherence. The Methods also describe ACT-based exercises linking personal values to motivation for adherence. Our copy does not identify psychological flexibility or its engagement component as the intervention’s target; it states the proposed pathway in terms of attitudes toward AET and personal motivation. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThat pilot trial reported a signal of efficacy at 1 month follow-up, but not for longer-term efficacy.
“This trial reported a signal of efficacy at 1 month follow -up, but not for longer -term efficacy. 21”
This intervention included pragmatic methods for keeping women aware that taking AET is consistent with their own values.
“This intervention included pragmatic methods for keeping women aware that taking AET is consistent with their own values. 21”
The recent pilot RCT of a brief intervention informed by part of the ACT model (engagement) reported a short-term impact on adherence at 1-month follow-up.
“The recent pilot RCT of a brief intervention informed by part of the ACT model (engagement) reported a short -term impact on adherence at 1 -month follow -up. 21”
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“21 In comparison, the ACTION intervention had a focus on effective decision making in the presence of side effects.”
BackgroundMethodInfluentialInterventions to improve oral endocrine therapy adherence in breast cancer patients
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Powell, C. J., Adigwe, A., Ekezie, N., Fatima, B., Majd, Z., Collins, R., Houk, K., Patel, T., Ma, H., Shimko, R., et al. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-10247-9
Wei, W., Wang, Y., Song, A., Kang, L., & Sun, J. (2025) · Psycho-Oncologie · doi:10.18282/po4355
Arch, J. J., Uno, H., Poort, H., Slivjak, E. T., Nealis, M. S., Park, H., Wang, I., Genung, S. R., Cronin, A. M., Andorsky, D. J., et al. (2026) · BMC Cancer · doi:10.1186/s12885-026-15936-0
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Self-citation
- Authors
- Arch, J. J., Crespi, C. M., Levin, M. E., Genung, S. R., Nealis, M., Mitchell, J. L., Bright, E. E., Albright, K., Magidson, J. F., & Stanton, A. L.
- Affiliations
- University of Colorado Boulder (US)
- University of California, Los Angeles (US)
- Utah State University (US)
- Rocky Mountain Cancer Centers (US)
- University of Colorado Anschutz (US)
- University of Maryland, College Park (US)
- Corresponding author
- Arch, Joanna J
- ORCID
- Venue
- Annals of Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-03-22
- Volume
- 56
- Issue
- 8
- Pages
- 856-871
- ISSN
- 0742-5554 (ISSN-L)
- 0883-6612
- 1532-4796
- PMC
- PMC9345183
- OpenAlex
- W4221018110
- Cited by
- 34
- References
- 54
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 12 · 2023: 9 · 2022: 5
- FWCI
- 8.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Annals of Behavioral Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (R21CA218723)
- National Cancer Institute (TR002535)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- breast cancer survivors, adjuvant endocrine therapy, medication adherence, values-based intervention, electronic adherence monitoring, patient education, affective attitudes, oncologist-patient communication, intervention feasibility and acceptability
- MeSH terms
- Cancer Survivors, Breast Neoplasms, Female, Humans, Pilot Projects, Chemotherapy, Adjuvant, Medication Adherence, Acceptance and Commitment Therapy
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