Improving Adherence to Oral Cancer Therapy in Clinical Practice

Abstract

Adherence to oral chemotherapy regimens maximizes their effectiveness and minimizes any potential toxicities. Factors specifically related to the treatment, patient, and health care provider may influence medication adherence. Treatment‐related factors include the complexity of the regimen, the cost of therapy, the possibility of side effects, and the delay in treatment benefits. Meanwhile, patients may not have an adequate support system or an understanding of the need for the medication, and providers may not fully succeed in communicating the importance of adherence and the types of side effects that may occur. Nonadherence may lead to an increased risk of toxicity, decreased effectiveness, and increased utilization of health care resources. Although various methods for measuring adherence are available, self‐reporting is the most widely used. Studies describing adherence in a broad range of cancers are reviewed. Treatment of chronic myeloid leukemia has been revolutionized by the development of oral tyrosine kinase inhibitors that are highly effective in managing the disease when taken consistently. However, nonadherence is relatively common and can lead to reduced rates of response and increased medical costs. Similar effects of nonadherence on outcome and cost have also been observed in patients with various other hematologic malignancies and solid tumors. Interventions to improve adherence to oral chemotherapy regimens include communication about the importance of adherence and the potential consequences of nonadherence, simplification of the patient's medication schedule (if possible), and inclusion of a caregiver or family member in the conversation. Written materials should always be provided to accompany verbal instructions. This review summarizes factors influencing medication adherence, impact of nonadherence on patient outcomes, methods for measuring adherence, previous studies of nonadherence in patients with cancer, common barriers to access, and interventions to improve adherence in the community setting.

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

“…This is consistent with prior studies of oral cytotoxic chemotherapies 25 where the severity of a malignant diagnosis and its potential to lead to significant morbidity and mortality may cause patients to comply with medical advice, including taking their medications as prescribed. This is further supported by our observation that groups conventionally expected to be relatively noncompliant, such as patients with advanced age and polypharmacy 25, did not actually experience higher rates of treatment delays when compared to their counterparts. Interestingly, individuals with stage II disease were more likely than those with stage III disease to be noncompliant.…”

“…Cancer patients are particularly vulnerable to oral drug noncompliance because many are elderly and predisposed to polypharmacy due to the need to take concomitant medications to manage other comorbidities 24, 25. Compliance is further hindered by systemic therapy drugs that often have significant toxicities or complicated dosing schedules (e.g., 2 weeks on and 1 week off) 26, 27, 28.…”

Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study (Preprint)

“…These issues are further compounded by the fact that many patients are elderly with a median age at onset of 69 years [14]. Finally, all patients with low health literacy, cognitive decline or forgetfulness, more symptoms, and those without an involved support system who is knowledgeable regarding the medication may be at increased risk for poor medication adherence [15].…”

Educational pamphlets on health: a reception study

“…The World Health Organization (WHO) is concerned with the advancing number of patients with chronic diseases and the extent of the age of affected individuals, and so has recommended the establishment of educational processes that excel in generating knowledge, autonomy and management capacity for the healthcare of these individuals (4)(5)(6) .…”