By 2022, there will be nearly 4 million breast cancer survivors in the USA. Adherence to long-term
endocrine therapy is crucial for survivors of hormone receptor-positive breast cancer prescribed these daily
medications to prevent cancer recurrence. Despite the life-saving benefits of these medications, rates of
adherence are low. Medication-taking behavior is simultaneously influenced by multiscale factors, including
personal and environmental factors, and a patient's other behavioral patterns. Despite advances in smart
and connected health, there have been few attempts to develop and deliver personalized interventions for
medication adherence. Existing technology-based interventions focus on cognitive reasons for non-adherence
to medications experienced by some people (e.g., forgetting), but fail to account for interactions
between cognitive factors and other types of factors (i.e., environmental, behavioral) that contribute to
adherence. Furthermore, few technology-driven interventions have been assessed for efficacy in
supporting medication adherence. Tools to understand interactions between multiscale factors and the
effect that personalized interventions have on these factors would ultimately improve medication
adherence. This 3-phase project will overcome these fundamental scientific barriers by developing and
employing a Multiscale Modeling and Intervention (MMI) system. First, a system consisting of sensor-rich
smartphones, wireless medication event monitoring systems (MEMS), wireless beacons, and wearable
sensors that collect in situ data on medication adherence, will be developed to provide continuous, noninvasive
adherence assessment and multiscale monitoring of factors. Second, the MMI system will be
deployed to breast cancer survivors to model relationships between adherence and multiscale factors,
identify patterns associated with medication-taking behavior, and develop interventions. Third, a proof-of-concept
for MMI will be demonstrated through a human subjects study, with subjects receiving multiscale
interventions. The proposed research has significant public health implications as it is expected to increase
our understanding of medication adherence in breast cancer survivors, thus providing a general framework
that will be applicable to oral chemotherapy use across multiple cancers.
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