Patient Messaging Content Associated with Initiating Hormonal Therapy after a Breast Cancer Diagnosis

Hormonal therapy is an effective, but challenging, long-term treatment for patients with hormone-receptor-positive breast cancer. Raising the rate of patients who initiate therapy may be possible by characterizing the factors that influence a patient's decision. We hypothesized that online patient portal messages convey such factors. To investigate this hypothesis, we focused on breast cancer patients who were prescribed hormonal therapy at Vanderbilt University Medical Center and sent messages through the portal between diagnosis and therapy initiation. We first conducted a topic modeling analysis to generate the main themes of portal messages. We subsequently applied survival analysis to learn the association between the factors conveyed in messages, in term of semantic word groups, and the time elapsed from diagnosis to therapy initiation. We found that consulting with healthcare providers increased the probability of therapy initiation, while mentions of symptoms or negative emotions exhibited a reduced probability.