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

Ilana Graetz; Samuel Hernandez; Xin Hu; Rebecca A. Krukowski; Janeane N. Anderson; Teresa M. Waters; Edward Stepanski; Gregory A. Vidal; Lee S. Schwartzberg

doi:10.1016/j.breast.2025.104552

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

Ilana Graetz, Samuel Hernandez, Xin Hu, Rebecca A. Krukowski, Janeane N. Anderson, Teresa M. Waters, Edward Stepanski, Gregory A. Vidal, Lee S. Schwartzberg

Health Management, Economics, & Policy

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English (US)
Article number	104552
Journal	Breast
Volume	83
DOIs	https://doi.org/10.1016/j.breast.2025.104552
State	Published - Oct 2025

Keywords

Adherence
Breast cancer
Endocrine therapy
Health literacy
mHealth

ASJC Scopus subject areas

Surgery
Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.breast.2025.104552

Cite this

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

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",

author = "Ilana Graetz and Samuel Hernandez and Xin Hu and Krukowski, \{Rebecca A.\} and Anderson, \{Janeane N.\} and Waters, \{Teresa M.\} and Edward Stepanski and Vidal, \{Gregory A.\} and Schwartzberg, \{Lee S.\}",

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year = "2025",

month = oct,

doi = "10.1016/j.breast.2025.104552",

language = "English (US)",

volume = "83",

journal = "Breast",

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T1 - Addressing health literacy gaps in adjuvant endocrine therapy adherence

T2 - Post hoc insights from a randomized remote monitoring trial

AU - Graetz, Ilana

AU - Hernandez, Samuel

AU - Hu, Xin

AU - Krukowski, Rebecca A.

AU - Anderson, Janeane N.

AU - Waters, Teresa M.

AU - Stepanski, Edward

AU - Vidal, Gregory A.

AU - Schwartzberg, Lee S.

PY - 2025/10

Y1 - 2025/10

N2 - 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.

AB - 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.

KW - Adherence

KW - Breast cancer

KW - Endocrine therapy

KW - Health literacy

KW - mHealth

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U2 - 10.1016/j.breast.2025.104552

DO - 10.1016/j.breast.2025.104552

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AN - SCOPUS:105012476954

SN - 0960-9776

VL - 83

JO - Breast

JF - Breast

M1 - 104552

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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