Accepted for/Published in: JMIR Cancer
Date Submitted: Jul 11, 2024
Date Accepted: Jan 15, 2025
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Efficacy of Digital Interventions on Adherence to Oral Systemic Anti-cancer Therapy Among Patients with Cancer: A Systematic Review and Meta-Analysis
ABSTRACT
Background:
Digital interventions have been increasingly applied in multidisciplinary care plans to improve medication adherence to oral systemic anti-cancer therapy (SACTs), the crucial life-saving treatments for many cancers. However, there is still a lack of consensus on the efficacy of those digital interventions.
Objective:
This systematic review and meta-analysis aimed to investigate the effectiveness of digital interventions in improving adherence to oral SACTs in patients with cancer.
Methods:
This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. The protocol has been registered at PROSPERO (no. CRD42024550203). Fully published, randomized controlled trials (RCTs) in English on adults with cancer assessing digital interventions for improving adherence to oral SACTs were retrieved from MEDLINE, EMBASE, APA PsycInfo, and CINAHL Plus up to May 31 2024. Adherence measures compared between digital intervention users and non-users were extracted. The proportions of poor adherence were synthesized using a random-effects model. The pooled results were reported as odds ratio (OR) and 95% confidence interval (95%CI). The heterogeneity was assessed with the I2 test (%). The mean difference and 95%CI were calculated from the mean adherence score and standard deviation.
Results:
This study included 13 RCTs on digital interventions for improving adherence to oral SACTs in patients with cancer. The technologies used were mobile applications (n=4), reminder systems (n=4), telephone follow-ups (n=3), and interactive multimedia platforms (n=2). Adherence was measured by surveys (n=8), relative dose intensity (n=2), pill count (n=1), self-reported missed doses (n=1), a smart pill bottle (n=1), and urine aromatase inhibitor metabolite assays (n=1). Pooled results from 11 trials showed digital technology users had a significantly lower risk of poor adherence (OR: 0.60; 95%CI: 0.47-0.77). Two studies reported positive mean differences in adherence scores comparing digital intervention users and non-users.
Conclusions:
Digital intervention users exhibited a significantly lower risk of poor oral SACTs adherence than non-users. Acknowledging individual variation and tailoring digital technologies to prioritize patient needs is essential. Clinical Trial: The protocol has been registered at PROSPERO (no. CRD42024550203).
Citation
