Paper Info
Title
The therapy is making me sick: how online portal communications between breast cancer patients and physicians indicate medication discontinuation.
Abstract
Objective: Online platforms have created a variety of opportunities for breast patients to discuss their hormonal therapy, a long-term adjuvant treatment to reduce the chance of breast cancer occurrence and mortality. The goal of this investigation is to ascertain the extent to which the messages breast cancer patients communicated through an online portal can indicate their potential for discontinuing hormonal therapy. Materials and Methods: We studied the de-identified electronic medical records of 1106 breast cancer patients who were prescribed hormonal therapy at Vanderbilt University Medical Center over a 12-year period. We designed a data-driven approach to investigate patients' patterns of messaging with healthcare providers, the topics they communicated, and the extent to which these messaging behaviors associate with the likelihood that a patient will discontinue a prescribed 5-year regimen of therapy. Results: The results indicates that messaging rate over time [hazard ratio (HR) = 1.373, P = 0.002], mentions of side effects (HR = 1.214, P = 0.006), and surgery-related topics (HR = 1.170, P = 0.034) were associated with increased risk of early medication discontinuation. In contrast, seeking professional suggestions (HR = 0.766, P = 0.002), expressing gratitude to healthcare providers (HR = 0.872, P = 0.044), and mentions of drugs used to treat side effects (HR = 0.807, P = 0.013) were associated with decreased risk of medication discontinuation. Discussion and Conclusion: This investigation suggests that patient-generated content can inform the study of health-related behaviors. Given that approximately 50% of breast cancer patients do not complete a course of hormonal therapy as described, the identification of factors associated with medication discontinuation can facilitate real-time interventions to prevent early discontinuation.
Year
DOI
Venue
2018
10.1093/jamia/ocy118
JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION
Keywords
Field
DocType
patient portals,medication discontinuation,hormonal therapy,hierarchical clustering,survival analysis
Breast cancer,Knowledge management,Medication Discontinuation,Intensive care medicine,Medicine
Journal
Volume
Issue
ISSN
25
11
1067-5027
Citations 
PageRank 
References 
0
0.34
9
Authors
6
Name
Order
Citations
PageRank
Zhijun Yin178837.97
Morgan Harrell200.34
Jeremy Warner34311.61
Qingxia Chen4153.70
Daniel Fabbri52312.03
Bradley Malin61302113.97