Addressing health literacy gaps in adjuvant endocrine therapy adherence: Post hoc insights from a randomized remote monitoring trial

Breast. 2025 Oct:83:104552. doi: 10.1016/j.breast.2025.104552. Epub 2025 Aug 5.

Abstract

Adjuvant endocrine therapy (AET) improves survival in hormone receptor-positive breast cancer, yet adherence is often lower among individuals with limited health literacy. This post hoc analysis of the THRIVE trial examined whether health literacy modified the effectiveness of two remote monitoring interventions (App-only and App + Feedback) versus enhanced usual care (EUC) on 12-month AET adherence (≥80 % of prescribed doses via connected pillbox). Among participants with lower health literacy, adherence was higher with App + Feedback than EUC (80.0 % vs. 42.1 %, p = 0.03), with no significant differences among those with higher health literacy. Tailored digital interventions may support adherence among patients with limited health literacy. TRIAL: ClinicalTrial.gov identifier NCT03592771.

Keywords: Adherence; Breast cancer; Endocrine therapy; Health literacy; mHealth.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents, Hormonal* / therapeutic use
  • Breast Neoplasms* / drug therapy
  • Chemotherapy, Adjuvant
  • Female
  • Health Literacy* / statistics & numerical data
  • Humans
  • Medication Adherence* / psychology
  • Middle Aged
  • Mobile Applications
  • Tamoxifen / therapeutic use
  • Telemedicine

Substances

  • Antineoplastic Agents, Hormonal
  • Tamoxifen

Associated data

  • ClinicalTrials.gov/NCT03592771