Five to 10 years of adjuvant endocrine therapy (ET) for early stage hormone receptor- positive (HR+) breast cancer is associated with significant reductions in recurrence and death. Despite these proven benefits, up to 40% of patients are non-adherent (take it irregularly) or discontinue ET early. Patients who discontinue adjuvant ET early often do so soon after initiation, with published 12-month discontinuation rates of approximately 20%. Side effects are often cited as the reason for early discontinuation. Data indicate that symptoms present at the time of initiation of adjuvant ET or that emerge soon thereafter are associated with early discontinuation. Ongoing symptom monitoring through collection of electronic patient reported outcomes (ePRO) offers the opportunity for early identification of symptoms and appropriate intervention. We aim to implement serial ePRO collection for patients initiating adjuvant ET for early stage HR+ breast cancer at Johns Hopkins clinical sites. Severe or worsening scores on ePRO measures assessing common symptoms during adjuvant ET will trigger an alert to the clinical team. We will develop evidence-based pathways to guide management of these symptoms. The overall goal of this project is to evaluate whether implementation of symptom assessment through collection of ePRO early during the course of adjuvant ET along with timely management of symptoms according to standardized clinical pathways will reduce the early discontinuation rate of adjuvant ET compared to the historical discontinuation rate.
Reducing Discontinuation Rate of Adjuvant Endocrine Therapy through Symptom Monitoring and Management
Johns Hopkins University
2017 Clinical Pathways in Breast Cancer