Adherence to oral anticancer chemotherapy: What influences patients’ over or non-adherence? Analysis of the OCTO study through quantitative–qualitative methods

Abstract

BackgroundNumerous oral anticancer chemotherapies are available. Non-adherence or over-adherence to these chemotherapies can lead to lowered efficacy and increased risk of adverse events. The objective of this study was to identify patients’ adherence profiles using a qualitative–quantitative method.MethodsA capecitabine treatment was initiated for 38 patients with advanced breast or colorectal cancer. At inclusion, information on patients’ beliefs was reported using a questionnaire. Later, Information on patients’ relation to treatment was obtained from a sub-group during an interview with a sociologist. Questionnaires were analyzed using Multiple Classification Analysis to cluster patients. Treatment adherence was evaluated by an electronic medication event monitoring systems (MEMS caps) and then correlated with patient clusters. Interviews were analyzed to complete and explain results.Results38 patients were enrolled between 2008 and 2011 and completed the questionnaire. Twenty had adherence measured with MEMS caps all along treatment. Between 4 and 6 months after inclusion, 16 patients were interviewed. Patient profile B (retired, with a regular life, surrounded by a relative’s attention to drug adherence, with a low educational level) was statistically associated with adequate adherence (p = 0.049). A tendency for lower adherence was observed among more highly educated patients with an irregular, active life (NS). All patients taking capecitabine demonstrated a risk of over-adherence, potentiating side effects.ConclusionsThese encouraging primary results suggest that further studies should be undertaken and that educational programs tailored to patient profiles should be evaluated to enhance adherence for those who need it and to empower all patients to manage treatment side effects.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1231-8) contains supplementary material, which is available to authorized users.

Patient–doctor relationship and adherence to capecitabine in outpatients of a German comprehensive cancer center

“… 20 We are therefore not able to expand the literature on this issue of increasing relevance. 20 – 22 Finally, future studies may also benefit from measuring changes of patients’ perceptions and adherence over time, as we only adopted a cross-sectional design. Longitudinal studies may reveal significant associations at certain timepoints, ie, at the beginning of treatment.…”

“… 8 – 19 Even less is known about the risk of over-adherence in patients receiving capecitabine. 20 – 22 Although the numbers generally appear to be satisfying, even a small variation of adherence may result in adverse clinical consequences. 14 , 20 – 23 …”

<p>Conditions for the Implementation of a Patient Education Program Dedicated to Cancer Patients Treated by Oral Anticancer Therapy</p>

“…25 Bourmaud et al have shown that patients treated with oral anticancer therapies are asking for tailored educational interventions, driven by their healthcare providers. 26 It is therefore an opportunity to put the patient back at the heart of care, in the institution, by modifying professional Thought software and returning to a symmetrical care-care relationship. Everyone will be able to recognize and take advantage of the expertise of the other: the expert patient in his or her construction, based on his or her experiences and experience; the expert caregiver in his or her care-taking practice.…”

Medication adherence: A practical measurement selection guide using case studies

“…She searches the scientific literature and discovers several studies using electronic monitoring systems to assess adherence to oral chemotherapy regimens and hormonal therapy for breast cancer [26–28]. The monitors are expensive, but Dr. Jones determines that the cost is justified – there is a high correlation between electronic monitoring adherence estimates and clinical outcomes for many conditions.…”