Enhancing adherence to capecitabine chemotherapy by means of multidisciplinary pharmaceutical care

Abstract

PurposeIn this prospective multi-centre observational cohort study, we investigated the effect of an intensified multidisciplinary pharmaceutical care programme on the adherence of cancer patients treated with capecitabine, a prodrug of fluorouracil.Patients and methodsTwenty-four colorectal and 24 breast cancer patients participated in this study. Patients of the control group (n = 24) received standard care, patients of the intervention group (n = 24) received intensified pharmaceutical care consisting of written and spoken information. Adherence to capecitabine chemotherapy was measured using an electronic medication event monitoring system (MEMS™).ResultsPatients in the intervention group exhibited an enhanced but not significantly different mean overall adherence compared to the control group (97.9% vs 90.5%, p = 0.069). Mean daily adherence was significantly higher in the intervention group (96.8% vs 87.2%, p = 0.029). Variability of both adherence parameters was considerably reduced when pharmaceutical care was provided. At the end of the observation period of 126 days, the probability of still being treated with capecitabine was found to be 48% in the control group and 83% in the intervention group (p = 0.019, log-rank test). The relative risk for a deviating drug intake interval, i.e. <10 or >14 instead of 12 h, in the intervention group was found to be 0.51 (95% CI, 0.46–0.56) compared with the control group (p < 0.05, Chi-square test).ConclusionsThe provision of intensified pharmaceutical care can enhance adherence to and prolong treatment with capecitabine. The results underline the importance of multidisciplinary care to assure the effectiveness of oral chemotherapy.

A Systematic Review of Adherence to Oral Antineoplastic Therapies

“…In one of the cohort studies, Gebbia et al [48] showed that a treatment monitoring program for patients with advanced non-small cell lung cancer was associated with significantly higher rates of adherence to second-line erlotinib (as measured by both patient self-report [p 5 .042] and pill count [p 5 .002]) and disease control (p 5 .037) relative to a retrospective standard care control group. Finally, Simons et al [50] showed that intensified multidisciplinary pharmaceutical care was associated with significantly higher mean daily adherence rates to oral capecitabine in a small cohort of patients with colorectal and breast cancer compared with a control group that received standard care (p 5 .029). However, overall adherence for the observational period in this study was only marginally significantly different between cohorts (p 5 .069).…”

“…One randomized, three-arm trial did show differences in adherence, favoring the intervention groups, when the investigators conducted a post hoc pooled analysis comparing both interventions to the control group [47]. The remaining investigations included two single-group studies (i.e., a feasibility pilot study [46] and a randomized crossover study [53]) and five investigations of nonrandomized observational cohorts with control groups [42,[48][49][50][51]. Of these investigations, only two nonrandomized cohort studies showed a significant benefit of their respective interventions for adherence to oral antineoplastic therapy relative to their control groups.…”

“…In a total of 12 studies ( [44][45][46][47], treatment monitoring [48], pharmacy-based programs [42,49,50], counseling programs [51,52], prefilled pill boxes [53], and automated voice response systems [54]. Five of these studies were randomized trials, none of which demonstrated significant differences between the intervention and control groups with respect to their primary adherence outcomes [44,45,47,52,54].…”

Usefulness of a pharmacist outpatient service for S-1 adjuvant chemotherapy in patients with gastric cancer

“…For cancer chemotherapy, hospital pharmacists in medical teams are part of a pharmacist outpatient service, and such services have improved the quality of medical care and patient QOL (8)(9)(10)(11)(12)(13)(14)(15). However, few facilities have offered pharmacist outpatient services to patients undergoing monotherapy with oral anti-cancer agents prior to examination by a physician.…”

Compliance with adjuvant capecitabine in patients with stage II and III colon cancer: comparison of administrative versus medical record data

“…The majority of studies on medication compliance in oncology have focused on oral hormonal therapies in breast cancer 5, 6, 11, 12, 13 even though oral drugs are also frequently used in other cancers 14, 15, 16, 17. In colon cancer, the oral 5‐fluorouracil prodrug known as capecitabine is a commonly prescribed component in a large number of systemic therapy regimens 18, 19, but it has received relatively little focus to date 20, 21, 22, 23. Patients prescribed capecitabine may be at risk of not filling the initial prescription (noninitiation), failing to take the medication as prescribed (nonadherence), or continuing with the drug only temporarily (early discontinuation or nonpersistence) 20, 22.…”