Remote Monitoring and Self-Efficacy: Implications for Breast Cancer Survivorship Outcomes.

Abstract

Objectives: To examine whether self-efficacy in managing symptoms is associated with symptom burden and adjuvant endocrine therapy (AET) adherence among women with early-stage breast cancer and whether self-efficacy modifies the effects of a remote monitoring intervention.

Study design: Post hoc analysis of a randomized trial evaluating app-based remote monitoring of self-reported symptoms and adherence for women prescribed AET.

Methods: Participants were randomly assigned to enhanced usual care (EUC), app only (weekly remote monitoring), or app plus feedback (with weekly tailored supportive text messages). Outcomes included 12-month symptom burden (Functional Assessment of Cancer Therapy-Endocrine Subscale [FACT-ES]) and adherence (≥ 80% of expected doses recorded using a connected pillbox). Multivariable regression evaluated associations of the PROMIS (Patient-Reported Outcomes Measurement Information System) Self-Efficacy for Managing Symptoms T score with symptom burden and adherence as well as differential intervention effects by self-efficacy level.

Results: Among 264 participants (mean age, 58.5 years; 64% White, 32% Black), mean (SD) baseline self-efficacy exceeded the normative mean of 50 (54.2 [9.9]). Higher self-efficacy was associated with lower symptom burden (eg, higher FACT-ES score: 0.6; 95% CI, 0.3-0.8) and greater odds of adherence (OR, 1.1; 95% CI, 1.0-1.1). Adherence benefits were greater at lower self-efficacy levels (eg, at a score of 30, 52.7% were adherent in app + feedback vs 17.8% in EUC; +34.9 percentage points; 95% CI, 1.0-68.9; P  = .04), with effects diminishing and becoming nonsignificant at higher self-efficacy levels.

Conclusions: Without additional support, breast cancer survivors with low self-efficacy had poorer symptom control and lower adherence. Remote symptom monitoring with tailored messaging was most effective among women with lower self-efficacy levels, highlighting the need for screening and targeted interventions for patients most likely to benefit.