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Amanda Koire, MD, PhD




Grad Student


Brigham and Women's Hospital




Amanda Koire MD PhD, Margo Nathan MD, Philip Poorvu MD, Aleta Wiley MPH, Hadine Joffe MD MSc

Principal Investigator:

Hadine Joffe MD MSc

The impact of a web-based behavioral intervention on early treatment adherence to anti-estrogen therapy in women with hormone-receptor positive early-stage breast cancer

This work relates to gender biology and women’s health research because it assesses adherence to breast cancer treatment in a cohort of women, evaluating an intervention that targets psychological and menopausal symptoms. The cohort is composed of women, breast cancer is a disease that predominantly affects women, and the medications used by the women in the cohort alter hormone levels.


5-10 years of anti-estrogen therapy (AET; tamoxifen, aromatase inhibitors) is a critical treatment for women with early-stage HR+ breast cancer to reduce risk of recurrence. However, 30-60% women are non-adherent by 5 years, possibly related to AET-emergence side effects. This work preliminarily examines if adherence to AET is improved by implementation of a web-based Cognitive Behavioral Therapy (CBT) intervention developed for cancer patients that targets psychological and menopausal symptoms.



Women scheduled to start AET for early-stage HR+ breast cancer at the Dana Farber/Harvard Cancer Center were recruited to the ‘Finding my Way’ CBT intervention if they enrolled in an observational study monitoring well-being on AET and had at least mild depressive, insomnia, and/or somatic symptoms prior to AET initiation. Symptom scales and medication adherence information were obtained at 6 weeks and 6 months. Intervention participants (N=14) were compared to historical controls in the observational study (N=54) whose participation predated activation of the intervention but who would have met eligibility criteria.



In the intervention group, adherence improved as insomnia symptoms worsened (p=0.03) and did not change in the face of worsening hot flash-related distress (p=0.34). In contrast, in the control group, increased insomnia symptoms and hot flash-related distress worsened adherence to AET (p=0.04, p=0.11, respectively). Improvement in quality-of-life correlated with improved anxiety sensitivity in the intervention group (R2=0.71), but not in the control group (R2=0.08). Greater participation in the intervention (measured in time and log-ins) correlated with greater improvement in somatic symptoms, insomnia symptoms, hot flash-related distress, distress tolerance, and anxiety symptoms/sensitivity, but did not reach statistical significance in this pilot intervention group.



For early-stage breast cancer patients initiating AET, an online CBT intervention buffers again reductions in AET adherence even in the face of worsening AET-related side effects.

Funding: HMS Dupont Warren (MN)