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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)


Research Context