Patient–doctor relationship and adherence to capecitabine in outpatients of a German comprehensive cancer center

Abstract

PurposeThe prescribing of oral chemotherapy agents has introduced the new challenge of ensuring patients’ adherence to therapy. Aspects of a close patient–doctor relationship are reported to be correlated with adherence to oral anticancer drugs, but data on capecitabine are scarce.Patients and methodsSixty-four outpatients with a diagnosis of cancer and prescribed capecitabine were recruited from a German Comprehensive Cancer Center. We used the Patient–Doctor Relationship Questionnaire (PDRQ-9), the Medical Adherence Rating Scale (MARS), the Beliefs about Medicines Questionnaire (BMQ), and the Satisfaction with Information about Medicines Scale (SIMS) to assess patients’ perceptions and behavior. Medical data were extracted from the charts.ResultsNon-adherence was reported by 20% of the 64 participants. The perceived quality of the patient–doctor relationship was high in general, but it did not emerge as a predictor of adherence in our survey (odds ratio [OR]=0.915, P=0.162, 95% CI=0.808–1.036). However, beliefs about medicine (OR=1.268, P<0.002; 95% CI=1.090–1.475) as well as satisfaction with information about medicine (OR=1.252, P<0.040, 95% CI=1.010–1.551) were predictors of adherence and the quality of the patient–doctor relationship was correlated with both variables (r=0.373, P=0.002 for SIMS sum score; r=0.263, P=0.036 for BMQ necessity/concern difference). Overall, adherence to capecitabine was high with a conviction that the therapy is necessary. However, concerns were expressed regarding the long-term effect of capecitabine use. Patients have unmet information needs regarding interactions of capecitabine with other medicines and the impairment of their intimate life.ConclusionsIn order to ensure adherence to capecitabine, our results seem to encourage the default use of modern and perhaps more impersonal means of information brokerage (eg, email, internet). However, the contents of some of patients’ informational needs as well as the associations of patients’ beliefs and satisfaction about the information received suggest a benefit from a trustful patient–doctor relationship.

Parents’ satisfaction with information received on psychotropic drugs used by adolescents in a Mental Health Unit

“… 8 – 10 , 18 – 21 Klewitz et al 8 researched the necessary information about immunosuppressants for 440 kidney transplant patients over 15 years of age and found that 46.1% of respondents were dissatisfied with the information in the item “Potential problems” and 26.7% with the item “Action and usage”. A similar pattern of results was found in people with bipolar disorder, 22 systemic lupus erythematosus, 18 using antineoplastic agents 19 , 20 or antiretrovirals 16 and other conditions. 9 , 10 People often do not take their medications due to ignorance regarding its purposes or to lack of information, especially about potential drug-related problems, 18 , 19 as seen in the current study.…”

“…A similar pattern of results was found in people with bipolar disorder, 22 systemic lupus erythematosus, 18 using antineoplastic agents 19 , 20 or antiretrovirals 16 and other conditions. 9 , 10 People often do not take their medications due to ignorance regarding its purposes or to lack of information, especially about potential drug-related problems, 18 , 19 as seen in the current study. The perception of professionals about the quality of the information they provide is often at variance with the perception of patients or their caregivers.…”

“… 30 Concerns or beliefs regarding adverse effects can negatively interfere with medication adherence, even promoting intentional non-adherence. 19 Zhang et al, 18 in a cross-sectional study with 210 patients with systemic lupus erythematosus conducted in China, revealed that talking about adverse effects can reduce feelings of anxiety caused by lack of knowledge about the effects of the drug and improve the quality of life of people who use them. Therefore, informing about adverse effects can reduce the chances of intentional non-adherence.…”

Psychosocial determinants of adherence with oral anticancer treatment: ‘we don’t need no education’

“…[5]): more importantly appear to be determinants that are part of the Extended Common Sense Model, i.e. illness perceptions, medication beliefs, coping and more or less stable personality characteristics such as anxiety and depression [24,25,29,31,32,35,38,39]. Earlier, more or less comparable reviews published similar results (e.g.…”

Real-life adherence in capecitabine therapy using two analysis methods and persistence after 6 months of treatment

“…18 Considering the particular dose scheme of capecitabine, the clinician's actions are of fundamental importance for patients to fully understand the correct methods of administration and, regardless of possible side effects and disease progression, to maintain high adherence levels over time. 19 Concerning the importance of the doctor-patient relationship, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) emphasizes the patient centrality, in defining adherence to treatment, since patients are found to maintain adherence to treatment when adequately informed by the prescribing clinician. 20,21 Depending on the methods used to calculate adherence, previous studies reported compliance rates for capecitabine therapy ranging from 67.9% to 98%.…”