Center to Improve Chronic disease Outcomes through Multi-level and Multi-generational approaches Unifying Novel Interventions and Training for health EquitY (The COMMUNITY Center)

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PROJECT SUMMARY/ABSTRACT This project will contribute to reducing health disparities in patients with multiple chronic conditions by expanding the scope of our Intervention to iMProve AdherenCe equiTably (IMPACT) trial to include patients with metastatic breast cancer (MBC). The IMPACT trial is currently enrolling patients with early-stage/non-metastatic breast cancer (BC) to test whether a multicomponent intervention focused on digital and pharmaco-equity improves adherence to both cardiovascular medications and endocrine therapy (ET) for adjuvant BC treatment. Among adults with chronic illness, 30% to 50% of medications are not taken as prescribed; medication nonadherence is particularly prevalent among minorities and is associated with a higher risk of death and hospitalization, and high healthcare costs. Medication adherence has become a more salient issue in MBC care with the increased availability and efficacy of novel oral anticancer therapies such as cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). Furthermore, improvements in MBC survival outcomes have resulted in a growing tail of long-term MBC survivors at risk for aging-associated cardiovascular disease (CVD). Management of CVD risk factors is crucial as cardiovascular comorbidities are associated with poor outcomes in patients with MBC. Yet little is known about the prevalence and drivers of medication nonadherence in patients with MBC and CVD. There is also a research gap concerning adherence interventions in this patient population, especially interventions targeting adherence to multiple chronic medications. Our proposed study will harness the medication nonadherence screening and intervention tools developed through the IMPACT trial and other components of the COMMUNITY Center to address this research gap. We will conduct a retrospective cohort study to evaluate the prevalence and correlates of nonadherence to ET/CDK4/6i and CVD medications in socioeconomically diverse patients with MBC and CVD risk factors, utilizing EHR-based pharmacy fill/order data. We will also examine medication- and patient-level factors associated with nonadherence. We will conduct a pilot, single-arm trial of the adherence intervention developed in the parent IMPACT study (digital training, smartphone provision, pharmacist-led counseling tailored to patient’s adherence barriers) among 35 patients with MBC and CVD risk factors to evaluate its preliminary efficacy and acceptability in this population. Finally, we will gain a deeper understanding of the impact of social determinants of health (SDOH) on medication nonadherence through semi-structured interviews with a subset of participants to our pilot trial, leveraging the SDOH data collected with the support of a 2023 COMMUNITY Center Investigator Development Core pilot award. To our knowledge, this will be the first study focused on understanding and improving global medication adherence among patients with MBC and other chronic conditions. If successful, it could provide a roadmap for future randomized trials to equitably improve adherence and clinical outcomes in this population.