<p>Side Effects, Self-Management Activities, and Adherence to Oral Anticancer Agents</p>

Abstract

Purpose: There are growing concerns about patients' adherence to oral anticancer agents (OAAs), and the need for patients to engage in self-management of OAA-related side effects. We assessed associations among adherence, severity of side effects, and effectiveness of self-management of side effects in patients taking capecitabine. Methods: Adherence to capecitabine at 6 weeks was measured by the Medication Event Monitoring System among 50 patients with gastrointestinal cancers. Severity of side effects related to capecitabine and effectiveness of self-management of side effects were captured using the Modified Self-Care Diary at the time of enrollment and weekly for 6 weeks. Spearman's correlation, Mann-Whitney U-tests, and multiple linear regression were conducted, p<0.05. Results: Overall mean adherence rate was 85.4±14.1%. Adherence rate was not significantly correlated to the mean severity of total side effects at any time point and was correlated with the mean effectiveness of self-management of total side effects only at week 2 (rho=0.29, p=0.04). However, adherence rate was associated with the mean severity of one specific side effect, diarrhea, at 6 weeks (rho=0.36, p=0.01) and marginally correlated to the mean effectiveness of self-management of diarrhea at 6 weeks (rho=0.28, p=0.05). Mean severity of diarrhea at 6 weeks was an independent predictor of adherence rate (b=4.97, p=0.01), with the control of age (b=0.52, p=0.002), number of outpatient medications (b=1.12, p=0.007), health literacy (b=2.53, p=0.04), diagnosis of colorectal cancer (b=11.6, p=0.03), and capecitabine in combination with other chemotherapies (b=16.8, p=0.001) in the model. Conclusion: This pilot study suggests ongoing examination of both severity and effectiveness of self-management of side effects in future studies of adherence to OAAs is merited. There is a need for future studies with larger sample sizes that explore the complex relationships among adherence, severity of side effects, and effectiveness of self-management of side effects in OAA therapy.

The role of health literacy in cancer care: A mixed studies systematic review

“…Four studies, of which one was higher quality [21], explored the association between health literacy and oral medication adherence. Adherence to general medications [71], specific oral chemotherapy (capecitabine) [21], and to various anti-cancer medications, including hormonal and targeted treatments [51,66] was assessed. Higher health literacy was associated with higher levels of adherence in three studies of up to 100 participants [21,51,71].…”

“…Adherence to general medications [71], specific oral chemotherapy (capecitabine) [21], and to various anti-cancer medications, including hormonal and targeted treatments [51,66] was assessed. Higher health literacy was associated with higher levels of adherence in three studies of up to 100 participants [21,51,71]. One study of patients with gynaecological cancers (N = 100) did not report a significant association, though it was not powered to detect predictors of non-adherence [66].…”

“…One study of patients with gynaecological cancers (N = 100) did not report a significant association, though it was not powered to detect predictors of non-adherence [66]. All but one study [21] relied on self-report.…”

Enhancing Safety via Medication Self-Management and Timely Reporting

“…Although the measurement of capecitabine self-management using the adopted Measure of Drug Self-Management [15] might not be comprehensive enough to cover all six steps from Fill to Sustain, this pilot study did reveal the association between capecitabine self-management and patient experiences with and concerns of side effects, as well as their perceived abilities to manage them. To understand patient side effect self-reporting behaviors, a post-study of the same cohort, researchers phone interviewed 36 patients [14]. The results indicated that twothirds of patients (n=24) had called their doctors or nurses regarding capecitabine treatment related problems.…”

Tolerance to oral anticancer agent treatment in older adults with cancer: A secondary analysis of data from EHRs and a pilot study of patient-reported outcomes

“…EHR data from the remaining 47 patients were included in this combined data analysis. The pilot study was an observational, single-group study that collected patient-reported side effects through telephone calls from 50 adult patients who were diagnosed with gastrointestinal (GI) cancers and had taken capecitabine for at least two cycles [12]. The nal combined dataset consisted of 97 adult patients who were taking capecitabine in 2016-2017.…”