Adherence to oral chemotherapy: Challenges and opportunities

Abstract

Purpose There is very little data on the effect of combining methods to better predict and improve oral antineoplastic adherence in cancer patients. The goal of this study was to evaluate the effectiveness of an intensive pharmacist intervention at the beginning of oral antineoplastic therapy versus nurse-led control group on adherence. Methods This was a prospective, randomized, open-label controlled trial performed in a single center hematology/oncology outpatient service to compare the effectiveness of repetitive pharmacist educational intervention on adherence rates measured at four and eight weeks after prescribing oral antineoplastic medication compared to a nurse-led control group. Both groups included investigator pill counts and self-report adherence questionnaires. Results Two-hundred patients were enrolled between 2009 and 2015. Fourteen of the 101 (14%) patients in the pharmacist group and 7 (7%) of the 99 patients in the nurse-led control group dropped out ( p = 0.166). The majority of patients who remained in the study were 90–100% adherent to oral antineoplastic therapy in both groups. The pharmacist group slightly underperformed at Pill Count 2, possibly due to barriers for non-adherence. Statistically significant correlations associated with non-adherence were forgetfulness ( p = 0.009), wanting to avoid side effects ( p = 0.02), feeling depressed or overwhelmed ( p = 0.032), or falling asleep before taking medication ( p = 0.048) in both groups. Conclusion The combination of pill count and patient self-report adherence is a way of improving oral antineoplastic adherence. However, significant barriers to adherence were identified such as forgetfulness, wanting to avoid side effects, feeling depressed or overwhelmed, and falling asleep before taking medications.

Associations of Polypharmacy and Inappropriate Medications with Adverse Outcomes in Older Adults with Cancer: A Systematic Review and Meta-Analysis

“…This suggests that certain drug classes may have a disproportionate effect on outcomes and that a simple count of medications to assess PP may incorrectly assess risk. Adherence is an important predictor of clinical outcomes , and more data are needed to assess the effects of PP, PIM, and medication burden on adherence, particularly for the increasing number of oral chemotherapy agents . It is also possible that medication burden could impair patients’ ability to adhere to supportive care regimens, thereby adversely affecting outcomes, but no data specifically evaluates this hypothesis.…”

Parallel Assessment of Chemotherapy Adherence and Supportive Therapy Adherence on Occurrence and Minimization of Adverse Drug Reactions Among Cancer Patients: A Clinical-Based Observational Study

“…Bouwman et al 6 conducted a cross-sectional study where almost 50% hematological adult cancer participants claimed factors like lower age group, staying alone, and false perception of lack of social support as reasons for nonadherence to medication. Besides, an open-label randomized controlled trial conducted by Krikorian et al 7 on outpatients receiving antineoplastic drugs reports nonadherence due to falling asleep, feeling depressed, forgetfulness, and to avoid adverse effects.…”

Pricing methods in outcome-based contracting: δ6: adherence-based pricing

“…oral versus IV) and patient variables (e.g. age, forgetfulness, falling asleep) 19,20 . While such factors are important in any outcome-based contracting decision, we provided a form for model inputs selection (Supplemental Material) to enable contractors to include Table 5.…”