Adherence and Patients' Attitudes to Oral Anticancer Drugs: A Prospective Series of 201 Patients Focusing on Targeted Therapies

Abstract

Objectives: Patient adherence is a challenge in oncology and hematology practice. Hormone therapy data in breast cancer suggest insufficient adherence and poor persistence. Limited data are available for targeted therapies (TT) including tyrosine kinase and mammalian target of rapamycin inhibitors. Methods: We performed a prospective survey using a 15-item questionnaire in patients with solid tumors and hematologic malignancies receiving oral anticancer therapy. Treatment duration, setting (adjuvant vs. metastatic), cancer type, age, and comedication were recorded. Results: 201 patients (median age 65.5 years) participated, 102 with TT and 99 with hormone therapy or chemotherapy (HC). The median time of drug intake was 11.0 months. Written information was more frequently given to TT patients (68.6 vs. 23.2%, p < 0.0001). TT and HC patients showed equal adherence to therapy (72.5 vs. 69.6%, p = n.s.) despite TT patients experiencing more side effects (p < 0.0001) and taking more concomitant oral medication (p = 0.0042). Forgotten doses were the leading cause of nonadherence in HC patients (83%, as compared to 54% in the TT group), whereas dose reduction by the patient was higher in the TT group (32 vs. 17%). Conclusions: Despite advances in providing information to patients leading to better adherence among TT patients, efforts towards better patient education are warranted including dedicated staff for monitoring outpatient anticancer oral therapy.

Oral antineoplastic agents: how do we care about adherence?

“…Self‐report has been used for adherence assessment to hormone therapy, chemotherapy or molecular targeted therapy especially in breast cancer patients (Table ). Adherence rates ranged from 38 to 97%.…”

Factors Influencing Oral Adherence: Qualitative Metasummary and Triangulation With Quantitative Evidence

“…Forgetfulness Negative association with adherence: Gater et al, 2012;Sawesi et al, 2014;Verbrugge et al, 2013 Negative association with adherence: Atkins & Fallowfield, 2006;Barthélémy et al, 2014;Bhattacharya, 2012;DiBonaventura et al, 2014;Grunfeld et al, 2005;Larizza et al, 2006;Wu et al, 2014 Negative association with adherence: Eliasson et al, 2011 Lifestyle fit Lack of lifestyle fit had negative association with adherence: Puts et al, 2014;Sawesi et al, 2014 Lack of lifestyle fit had negative association with adherence: Larizza et al, 2006 Lack of lifestyle fit had a negative association with adherence and a good lifestyle fit had a positive association with adherence: Eliasson et al, 2011 Medication knowledge…”

“…Negative association with adherence: Gater et al, 2012;Puts et al, 2014;Sawesi et al, 2014;Verbrugghe et al, 2013 Mixed findings: Mathes et al, 2014 Having no side effects or effectively managed side effects had positive association with adherence: Kahn et al, 2007 No association with adherence by patient report. Doctors reported side effects had a positive influence on adherence: Font et al, 2012 Negative association with adherence: Bender et al, 2014;Bhattacharya, 2012;DiBonaventura et al, 2014;Grunfeld et al, 2005;Kahn et al, 2007;Larizza et al, 2006;Noens et al, 2009;Ruddy et al, 2012;Wu et al, 2014 No association with adherence: Barthélémy et al, 2014 Negative association with adherence: Eliasson et al, 2011; Social support…”

Practice Patterns for Prophylaxis and Treatment of Venous Thromboembolism in German Cancer Patients

“…Another issue with NOACs was the number of comedications. This is important not only because of potential interactions between NOACs and anticancer agents but also because oncologists are very aware of decreasing adherence when they prescribe more oral medications [43]. …”