A Tailored Medication Adherence-Promotion Intervention for Adolescents and Young Adults with Cancer

Up to 60% of adolescents and young adults (AYAs) with cancer are non-adherent to cancer treatment medications and thus at an increased likelihood of experiencing poor health outcomes like relapse and death. Improving adherence has the potential to improve health outcomes among AYAs with cancer but interventions that address the challenges this population faces to adhering to a medication regimen are lacking. AYAs with cancer endorse a range of challenges to taking their medication (e.g., forgetting, lack of motivation) that vary widely across individuals. We hypothesize that improving adherence will require a personalized intervention capable of teaching AYAs the specific behavior change techniques (BCTs) they need to overcome their challenges to adherence. To test this hypothesis, we developed SUMMIT (SUpporting Medication Management with Individualized Treatment). SUMMIT is the first tailored adherence-promotion intervention designed specifically for AYAs with cancer and directly aligns with the NCI’s special interest in “personalized approaches to improve adherence” (NOT-OD-24-146). Preliminary data from our NCI R21-funded pilot trial support SUMMIT’s feasibility, acceptability, and usability and suggest it has the potential to improve medication adherence. Now, the aim of this R01 is to advance the NCI’s goal of “testing of interventions addressing… treatment adherence” (PAR-24-072) by evaluating the efficacy of SUMMIT as compared to uniform standard of care via a randomized clinical trial. We will recruit AYAs receiving care from pediatric and adult hospitals and will randomize 160 AYAs from these sites to SUMMIT or uniform standard of care. AYAs will use an electronic adherence monitoring device to store their medication and we will use these data to evaluate the hypothesis that SUMMIT results in greater improvements in electronically-monitored medication adherence than uniform standard of care. We will also conduct secondary analyses to evaluate potential group differences in quality of life and outpatient encounters and exploratory analyses to identify obstacles and facilitators to scaling-up and spreading SUMMIT.