The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices

Salgado, Teresa M.; Mackler, Emily; Severson, Jane Alcyne; Lindsay, Jamie; Batra, Peter; Petersen, Laura; Farris, Karen B.

doi:10.1007/s00520-017-3584-0

Cited by 41 publications

(34 citation statements)

References 45 publications

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“…With the increasing use of oral anticancer agents (OAAs), there are growing concerns around patients' non-adherence to OAAs. [1][2][3] The International Society for Pharmacoeconomics and Outcome Research defines adherence as "the degree or extent of conformity to the recommendations about day-to-day treatment by the provider with respect to the timing, dosage, and frequency". 4 Adherence to OAAs can be challenging due to certain unique characteristics of OAAs.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] In addition, OAAs are more frequently prescribed for patients with metastatic cancer rather than early stage of cancers; thus, patients' expectations for treatment outcomes and their health status may affect their adherence to OAA treatment. 1,3 There is no gold standard definition of "adequate" adherence to OAAs, but 80% is commonly used as the cutoff. 1,7,8 For molecularly targeted therapies, complete adherence (100%) may be more appropriate given that small deviations from a treatment plan may result in treatment resistance or failure.…”

Section: Introductionmentioning

confidence: 99%

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

Jiang¹,

Wickersham²,

Zhang³

et al. 2020

PPA

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Jiang¹,

Wickersham²,

Zhang³

et al. 2020

PPA

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“…Research indicates that less activated patients are less knowledgeable about their conditions, less adherent to treatment regimens, less likely to communicate concerns to providers, and less likely to recognize serious symptoms or know how to handle these symptoms when they arise. [5][6][7] Prospective studies indicate that, after controlling for demographics and chronic illness status, less activated patients are more likely to be hospitalized and to use the emergency room (ED) than are higher activated patients. 8,9 These differences have also been observed within a high-risk population.…”

Section: Introductionmentioning

confidence: 99%

Patient Activation Changes as a Potential Signal for Changes in Health Care Costs: Cohort Study of US High-Cost Patients

et al. 2018

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BACKGROUND: Programs to improve quality of care and lower costs for the highest utilizers of health services are proliferating, yet such programs have difficulty demonstrating cost savings. OBJECTIVE: In this study, we explore the degree to which changes in Patient Activation Measure (PAM) levels predict health care costs among high-risk patients. PARTICIPANTS: De-identified claims, demographic data, and serial PAM scores were analyzed on 2155 patients from multiple medical groups engaged in an existing Center for Medicare and Medicaid Innovation-funded intervention over 3 years designed to activate and improve care coordination for high-risk patients. DESIGN: In this prospective cohort study, four levels of PAM (from low to high) were used as the main predictor variable. We fit mixed linear models for log 10 of allowed charges in follow-up periods in relation to change in PAM, controlling for baseline PAM, baseline costs, age, sex, income, and baseline risk score. MAIN MEASURES: Total allowed charges were derived from claims data for the cohort. PAM scores were from a separate database managed by the local practices. KEY RESULTS: A single PAM level increase was associated with 8.3% lower follow-up costs (95% confidence interval 2.5-13.2%). CONCLUSIONS: These findings contribute to a growing evidence base that the change in PAM score could serve as an early signal indicating the impact of interventions designed for high-cost, high-needs patients.KEY WORDS: medicare; patient activation; health economics; return on investment.

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“…These regimens increase patients' BOT and lead to difficulties in medication management and subsequent regimen modifications (Trivedi et al, 2014). Such modifications may include dose changes, temporary stoppages, permanent stoppages, and adding or switching a medication (McNamara et al, 2016;Salgado et al, 2017;Verbrugghe et al, 2016). Regimen modifications can be brought on by side effects and toxicities, interactions, patient and provider decisions, or disease progression (Salgado et al, 2017).…”

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confidence: 99%

“…Such modifications may include dose changes, temporary stoppages, permanent stoppages, and adding or switching a medication (McNamara et al, 2016;Salgado et al, 2017;Verbrugghe et al, 2016). Regimen modifications can be brought on by side effects and toxicities, interactions, patient and provider decisions, or disease progression (Salgado et al, 2017). OOA regimen changes can alter the effectiveness of the medication if patients are not receiving an adequate dose or require increased rest periods.…”

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confidence: 99%

Temporary Stoppages and Burden of Treatment in Patients With Cancer

Vachon

Given

et al. 2019

ONF

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The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices

Cited by 41 publications

References 45 publications

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

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

Patient Activation Changes as a Potential Signal for Changes in Health Care Costs: Cohort Study of US High-Cost Patients

Temporary Stoppages and Burden of Treatment in Patients With Cancer

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