Titles and Affiliations
Physician, Medical Oncology, Dana-Farber Cancer Institute
Instructor, Medicine, Harvard Medical School
Conquer Cancer, The ASCO Foundation
Dana-Farber Cancer Institute
Improving outcomes for breast cancer patients in Rwanda through symptom self-monitoring and motivational mobile text message reminders for medications.
Breast cancer is the second-most common cause of cancer deaths in Rwandan women, with a death rate of over 50 percent, compared to less than 16 percent in the United States—even though two-thirds of patients in Rwanda have cancers that are localized and potentially curable at diagnosis. Free curative breast cancer therapy is available in Rwanda for patients with localized disease, but low adherence by missing doses or prematurely stopping therapy is a major driver for the poor outcomes in these patients. Dr. Fadelu’s study will identify what barriers prevent patients from completing their therapy and will test an intervention to help remove these barriers and improve survival outcomes. In patients with ER-positive early-stage cancers, endocrine therapy after surgery—also known as adjuvant endocrine therapy (AET)—is an effective intervention to prevent cancer recurrence and prolong survival. AET are daily medications that must be continued for 5-10 years, but studies at a major cancer center in Rwanda revealed that while 87 percent of eligible patients initiated AET, over 25 percent of these patients prematurely discontinued their therapy within 2 years.
The reasons why patients are unable to adhere to their daily AET schedules are unknown for this patient population—and are especially understudied in sub-Saharan Africa (SSA). Studies in SSA for other diseases evaluated the use of behavioral interventions to improve medication adherence, and they supported several options: improving communication between patients and providers; facilitating reporting of symptoms and side-effects; and reminding patients with routine nudges to take their medications. Furthermore, text-messages and Mobile Health applications were also effectively used in SSA for chronic disease management. As part of his Conquer Cancer study, supported by BCRF, Dr. Fadelu and his team will identify the facilitators and barriers to adherence for patients receiving AET, and conduct a pilot randomized trial of motivational text-message reminders and symptom self-monitoring logs in 128 patients, to see if this improves short-term daily medication adherence and patients’ quality of life.
Temidayo Fadelu, MD, MPH has a clinical and research focus in global breast cancer and implementation science research. Originally from Nigeria, Dr. Fadelu moved to the U.S. for his undergraduate education at Baylor University. He earned his medical degree from Yale University School of Medicine and completed his training in internal medicine at the Hospital of the University of Pennsylvania. He then moved to Rwanda to serve as clinical and programmatic implementation lead for an oncology program based at Butaro Cancer Center of Excellence in rural northern Rwanda, where he coordinated several major initiatives including the implementation of pathology and palliative care services. He subsequently completed his fellowship training in medical oncology at Dana-Farber Cancer Institute, during which he also earned a master’s in public health at the Harvard T.H. Chan School of Public Health. He remains at Dana-Farber as a member of their Center for Global Cancer Medicine, where engages in implementation research projects in Rwanda and Haiti to address global inequities in breast cancer care.
BCRF Investigator Since
Conquer Cancer-Breast Cancer Research Foundation Career Development Award for Diversity, Inclusion and Breast Cancer Disparities in honor of Susan Hirschhorn and in memory of her mother, Ellen S. Hirschhorn