Effectiveness of interventions to improve cancer treatment and follow‐up care in socially disadvantaged groups

Abstract

Objective To identify and characterize the interventions that aimed to improve cancer treatment and follow‐up care in socially disadvantaged groups. To summarize the state of the art for clinicians and researchers. Methods We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Eligible studies were randomized controlled trials and quasi‐experimental studies with a control group (usual care or enhanced usual care) conducted in Organization for Economic Co‐operation and Development (OECD) member countries and published until 2016. Results Thirty‐one interventions were identified, the majority of which were conducted in the United States in patients with breast cancer. Most interventions aimed to decrease social inequalities based on ethnicity/race and/or socioeconomic level, with fewer interventions targeting inequalities based on geographical area. The most frequently assessed outcomes were quality of life (n = 20) and psychosocial factors (n = 20), followed by treatment adherence or satisfaction (n = 12,), knowledge (n = 11), pain management (n = 10), and lifestyle habits (n = 3). Conclusions The impact of interventions designed to improve cancer treatment and follow‐up care in socially disadvantages groups is multifactorial. Multicomponent‐intervention approaches and cultural adaptations are common, and their effectiveness should be evaluated in the populations of interest. More interventions are needed from outside the Unite States and in patients with cancers other than breast cancer, targeting gender or geographical inequalities and addressing key outcomes such as treatment adherence or symptom management.

Investigation of Intervention Solutions to Enhance Adherence to Oral Anticancer Medicines in Adults: Overview of Reviews

“…Most reviews included studies on all types of cancer (22/29, 76%) [ 2 , 9 - 11 , 13 , 21 , 22 , 24 , 26 - 29 , 47 - 55 , 58 ], followed by breast cancer (6/29, 21%) [ 7 , 12 , 23 , 25 , 56 , 57 ], and hematological cancer (1/29, 3%) [ 8 ]. A total of 90% (26/29) reviews [ 2 , 7 - 13 , 21 , 23 - 29 , 48 - 57 ] examined adherence interventions for disease-modifying therapies, and 10% (3/29) reviews [ 22 , 47 , 58 ] reported adherence interventions for all types of cancer treatments.…”

“…A total of 90% (26/29) reviews [ 2 , 7 - 13 , 21 , 23 - 29 , 48 - 57 ] examined adherence interventions for disease-modifying therapies, and 10% (3/29) reviews [ 22 , 47 , 58 ] reported adherence interventions for all types of cancer treatments. In total, 17% (5/29) reviews specifically focused on women [ 7 , 12 , 23 , 25 , 56 ], 7% (2/29) on adolescents and young adults [ 22 , 58 ], and 3% (1/29) on socially disadvantaged people with cancer [ 26 ]. The characteristics of the 29 studies included in this overview are presented in Multimedia Appendix 5 .…”

“…Of the 12 systematic reviews, 6 (50%) focused on examining either the efficacy [ 22 ] or the effectiveness of adherence interventions [ 9 , 12 , 21 , 24 , 25 ]. Some of the reviews specifically focused on the type of interventions (eg, nurse-led [ 51 ], pharmacist-led [ 24 ], educational [ 21 ], and technology-mediated [ 10 , 11 , 47 - 49 , 54 , 55 , 57 ]), specific settings (eg, ambulatory care setting [ 21 ]), and socially disadvantaged groups in the Organization for Economic Co-operation and Development countries [ 26 ].…”

“…All reviews, except 3 [ 47 , 49 , 51 ], reported MA improvement as a primary outcome. Some also reported medication persistence [ 23 ]; clinical outcomes, such as symptoms and adverse events [ 24 ]; hospital admission rates [ 9 ]; subclinical responses; survival time [ 8 ]; cancer-related knowledge and self-management skills [ 22 , 26 ]; and some quality-of-life indicators [ 26 ]. A total of 10% (3/29) studies [ 24 , 26 , 49 ] mentioned patient satisfaction and economic impact outcomes [ 24 ].…”

“…MA was reported as a primary outcome in all 11 narrative systematic reviews [ 2 , 7 - 9 , 12 , 21 - 24 , 26 , 27 ]. Four main strategies to promote adherence emerged from these reviews: education, reminders, behavior and monitoring, and multicomponent interventions.…”