Digital interventions may help cancer patients stick to their meds

Digital interventions such as mobile apps, reminder systems, and wearable devices, among others, may be a useful tool in ensuring patients adhere to their oral systemic anticancer therapy, according to a systematic review and meta-analysis.

Pooled data from 11 randomized controlled trials (RCTs) showed that the use of digital interventions was associated with a significantly lower likelihood of poor adherence to oral systemic anticancer therapy compared with nonuse (odds ratio [OR], 0.60, 95 percent confidence interval [CI], 0.47–0.77; I²=73.1 percent). [JMIR Cancer 2025;11:e64208]

In two studies wherein adherence scale scores were calculated, the differences in the scores favoured digital intervention use over nonuse (mean difference, 1.10 in study 1 and 7.86 in study 2; p<0.01 for both).

“However, due to considerable heterogeneity (I²=73.1 percent), it is difficult to make a definitive conclusion from the pooled results about the effect of digital interventions upon adherence to oral anticancer therapy,” the investigators noted.

Adherence boosters

“Medication adherence is crucial in oncology therapy, yet low adherence rates, as low as 14 percent for some cancer regimens, significantly impact patient health outcomes and strain healthcare systems and budgets,” according to the investigators. [JMIR Cancer 2024;10:e46979]

They pointed out that nonadherence to oral anticancer therapy could be driven by issues such as complicated regimens, insufficient monitoring, poor communication, a lack of community support, mental health concerns, drug efficacy views, adverse effects, and financial load.

“Digital tools such as apps, text messages, mobile games, phone calls, and multimedia interactive information technologies have been used to increase medical adherence… The efficacy of [these] tools can be attributed to various factors, for example, providing instructional resources, dosage aids, engagement with healthcare providers, digital medicine, self-monitoring, and quickly implementable technical methods,” the investigators said. [Expert Opin Drug Saf 2020;19:735-746]

However, social inequality poses challenges to digital tool adoption, they continued. “For instance, older adults are less likely to use the web or smartphones, and individuals with lower incomes face greater barriers to web access. This inequality results in disparities in access to digital tools and hampers the implementation of digital interventions in healthcare.” [Int J Equity Health 2023;22:249]

As such, the investigators highlighted the importance of educational campaigns to raise awareness and provide training on digital tools while also challenging stereotypes about older adults’ technological capabilities and reinforcing patients’ confidence in maintaining their privacy when using such interventions.

“Efforts should focus on minimizing the threshold and difficulties associated with using digital tools and ensuring accessibility and ease of implementation for patients of all ages. Investigating patients’ preferences for digital interventions could also increase usage rates,” they noted.

The investigators called for additional research to explore optimal timing and frequency for implementing digital interventions in order to prevent “alert fatigue.” Additionally, quantitative findings may be complemented by qualitative studies, which delve deeper into the experiences of digital intervention users in real-world therapeutic settings, they said.

The 13 studies included in the meta-analysis were published between 2016 and 2024 and conducted in the United States, South Korea, France, Egypt, Finland, Australia, Colombia, Singapore, and Turkey. The technologies used were mobile apps, reminder systems, telephone follow-ups, and interactive multimedia platforms. Adherence was measured using surveys, relative dose intensity, pill count, self-reported missed doses, a smart pill bottle, and urine aromatase inhibitor metabolite assays.

Risks of bias were primarily related to randomization, missing outcome data, and outcome measurement, including nonblinded randomization, subjective patient-reported data, difficulties in distinguishing between missed appointments, and actual medication nonadherence.