Self-Reported Compliance with Capecitabine: Findings from a Prospective Cohort Analysis

Abstract

Objectives: While oral anticancer treatment has increased the convenience for patients with no risk of venous access complications compared to intravenous drug administration, a high level of compliance cannot always be assumed. The aim of the present report was to evaluate real-life drug adherence in a prospective cohort analysis of patients with gastrointestinal or breast cancer treated with capecitabine-based chemotherapy. Methods: Twenty-nine Swiss oncologists recruited patients receiving capecitabine, either as monotherapy or in combination with other chemotherapeutic agents, in a prospective fashion. Patients recorded both their capecitabine intake and any adverse effects each day in patient diaries. Results: A total of 177 patients were included, 143 (81%) with gastrointestinal tumours and 34 (19%) with breast cancer. Overall, 161 patients (91%) were considered as fully compliant, while 16 patients (9%) reported some kind of compliance error. Reasons for non-compliance included forgetting to take treatment (n = 9), side effects (n = 4) and misunderstanding instructions (n = 3). Self-reported compliance was not influenced by age or Eastern Cooperative Oncology Group performance status, but there was a trend towards better compliance with capecitabine therapy if fewer adverse effects occurred (p = 0.07, simple logistic regression). Conclusions: Self-reported compliance with capecitabine-based therapy in clinical practice is high and seems to be adversely affected by side effects.

Adherence to Capecitabine Treatment and Contributing Factors among Cancer Patients in Malaysia

“…Disease progression and its influence on the daily living activities of the patients might also contribute to their adherence to cancer treatment. This study yielded similar result with the earlier two studies on adherence to oral capecitabine (Winterhalder et al, 2011;Thivat et al, 2013) by which adherence was not affected by the patients' ECOG performance status. Intriguingly, univariable analysis discovered that patients with ECOG performance status of 3 had relatively positive but insignificant correlation with adherence score compared to ECOG performance status of 2 and 1 (b= 1.53, 95%CI: -1.95, 5.01%) and this was in line with findings from Winterhalder et al (2011).…”

“…In spite of using different measurement tool for the outcome, these results were very similar with a study done by Krolop et al (2013). Other previous studies that divided adherence into binary outcome (adherent vs non adherent) also highlighted that the proportion of patients that fully adhered to oral capecitabine was mostly greater than 90% (Winterhalder et al, 2011;Thivat et al, 2013). Although cancer patients are highly motivated due to the seriousness and poor prognosis of their disease, discouragement may also occur that may ultimately result in poor adherence to their treatment.…”

“…Previous researchers have been using ranges from 80% to 95% depends on type of diseases and drugs that being studied (Ruddy et al, 2009). Two other similar studies set even higher cut-off point for adherence to capecitabine which is not less than 100% (Winterhalder et al, 2011;Bhattacharya et al, 2012), since they considered that significant deviation from the actual standard may result in significant effect on efficacy. Meanwhile, two other studies set 80% and above as being adherent (Partridge et al, 2010;Thivat et al, 2013).…”

“…As for side effects, a study conducted on 177 cancer patients in Switzerland highlighted that there was a trend towards better adherence among patients with lesser side effects (Winterhalder et al, 2011). Nonetheless, Bhattacharya and colleagues found that the number of side effects did not influence patients' adherence to their medication (Bhattacharya et al, 2012).…”

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.…”