Academic Journal
Health Literacy and Capecitabine Adherence in a Remote Monitoring Pilot Trial for Breast Cancer: Post Hoc Exploratory Analysis.
| Τίτλος: | Health Literacy and Capecitabine Adherence in a Remote Monitoring Pilot Trial for Breast Cancer: Post Hoc Exploratory Analysis. |
|---|---|
| Συγγραφείς: | Hernandez S; Medical College of Georgia, Augusta, GA, United States., Meisel J; Winship Cancer Institute, Atlanta, GA, United States., Sadigh G; School of Medicine, Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States., Graetz I; Winship Cancer Institute, Atlanta, GA, United States.; Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States. |
| Πηγή: | JMIR formative research [JMIR Form Res] 2026 Sep 14; Vol. 10, pp. e101210. Date of Electronic Publication: 2026 Sep 14. |
| Τύπος έκδοσης: | Journal Article; Observational Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: JMIR Publications Country of Publication: Canada NLM ID: 101726394 Publication Model: Electronic Cited Medium: Internet ISSN: 2561-326X (Electronic) Linking ISSN: 2561326X NLM ISO Abbreviation: JMIR Form Res Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Toronto, ON, Canada : JMIR Publications, [2017]- |
| Ιατρικοί όροι (MeSH): | Breast Neoplasms*/drug therapy , Breast Neoplasms*/psychology , Capecitabine*/therapeutic use , Health Literacy*/statistics & numerical data , Health Literacy*/standards , Health Literacy*/methods , Medication Adherence*/psychology, Adult ; Aged ; Female ; Humans ; Middle Aged ; Adherence Interventions ; Pilot Projects ; Remote Patient Monitoring ; Randomized Controlled Trials as Topic |
| Περίληψη: | Background: Oral anticancer therapy enables convenient, home-based cancer care but can introduce adherence challenges, particularly with complex dosing schedules. Capecitabine is commonly used in breast cancer, often as adjuvant therapy or in advanced disease, and typically requires twice-daily dosing on cyclical schedules, increasing the risk of missed or incorrect doses. Low health literacy may exacerbate these difficulties, and emerging remote monitoring tools may help close this gap. Objective: In this post hoc exploratory analysis, we evaluated whether health literacy (1) was associated with capecitabine adherence and (2) modified a remote monitoring intervention's effectiveness. Methods: We conducted post hoc analyses of a 2-arm pilot trial that randomized women with breast cancer treated with capecitabine to enhanced usual care (EUC) or remote patient monitoring (RPM). Adherence was captured with a smart pill bottle, Nomi by SMRxT, that recorded dose timing and quantity. Participants in the RPM group received messages for missed or incorrect doses and weekly symptom assessments. Incorrect or missed doses and severe symptoms triggered alerts to the oncologist. Health literacy was assessed at enrollment. To evaluate moderation, we used linear regression with an interaction term (health literacy × intervention arm) predicting adherence (proportion of days). Marginal effects quantified differences in adherence by study arm and health literacy. Results: Among 28 participants (EUC, n=15 and RPM, n=13), 9 (32.1%) had lower health literacy, 16 (57.1%) identified as Black, 10 (35.7%) identified as White, and 15 (53.6%) had income below 200% of the federal poverty level. In the regression model, the health literacy × randomized group interaction did not reach statistical significance (-16.3 percentage points, 95% CI -35.5 to 2.9; P=.09). Predicted adherence among lower health literacy participants was 87.5% in the RPM group and 65.5% in the EUC group (difference: +22.1 percentage points, 95% CI 6.2-37.9; P=.008). Among participants with higher health literacy, adherence was 89.9% in the RPM group and 84.1% in the EUC group (difference: +5.7 percentage points, 95% CI -5.2 to 16.7; P=.29). Within the EUC group, predicted adherence was 18.6 percentage points lower among those with lower versus higher health literacy (95% CI -32.4 to -4.9; P=.01); within the RPM group, this difference was 2.3 percentage points lower among those with lower versus higher health literacy (95% CI -15.8 to 11.1; P=.73). Conclusions: In this post hoc exploratory analysis, the estimated difference in capecitabine adherence between the RPM and EUC groups was larger among participants with lower health literacy. Although the formal interaction test was not statistically significant, the magnitude and direction of the observed difference support further investigation of RPM as a potential approach to improve adherence among patients facing health literacy-related adherence barriers. Larger, prospectively powered studies are needed to confirm these findings and evaluate downstream clinical outcomes. (©Samuel Hernandez, Jane Meisel, Gelareh Sadigh, Ilana Graetz. Originally published in JMIR Formative Research (https://formative.jmir.org), 14.09.2026.) |
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| Contributed Indexing: | Keywords: adherence; breast cancer; capecitabine; health literacy; mHealth; mobile health; remote patient monitoring |
| Substance Nomenclature: | 6804DJ8Z9U (Capecitabine) |
| Entry Date(s): | Date Created: 20260914 Date Completed: 20260914 Latest Revision: 20261001 |
| Update Code: | 20261001 |
| PubMed Central ID: | PMC13620428 |
| DOI: | 10.2196/101210 |
| PMID: | 42735397 |
| Βάση Δεδομένων: | MEDLINE |
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