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Satisfaction and Adherence to Oral Chemotherapy
J Oncol Pract; ePub 2017 Apr 11; Jacobs, et al
Patients who said they were satisfied with oral chemotherapy treatment and felt they were not a burden to others were more adherent to it, according to a prospective, single-group, observational study involving 90 individuals.
Participants had chronic myeloid leukemia, metastatic renal cell carcinoma, lung cancer, or breast cancer. Investigators evaluated medication adherence via self-report and with an electronic pill cap, and assessed surveys administered at baseline and 12 weeks later. Among the results:
- Patients took ~90% of their prescribed oral chemotherapy.
- One-fourth of patients were <90% adherent.
- Women were more adherent than men.
- Improved patient symptom distress, depressive symptoms, quality of life, and satisfaction with clinician communication and treatment were linked with better adherence, as was reduced perceived burden to others.
- Multivariate analysis revealed that improved treatment satisfaction and reduced perceived burden most strongly indicated better adherence.
Jacobs J, Pensak N, Sporn N, et al. Treatment satisfaction and adherence to oral chemotherapy in patients with cancer. [Published online ahead of print April 11, 2017]. J Oncol Pract. doi:10.1200/JOP.2016.019729.
Over the last decade, one of the most dramatic changes in the field of oncology has been the rapid development of new oral anticancer medications. Recent reports suggest that oral anticancer agents account for 25% of the current oncology pipeline. Patient preference for oral chemotherapy has been a main driver for its growth. The reasons patients prefer oral chemotherapy are varied and include convenience, challenges with IV access and needles, and the ability to spend more time outside of clinic.1 However, as with any oral medication, adherence becomes a central issue. According to a study on adherence to oral antineoplastic therapy, “suboptimal adherence may prove to be the greatest barrier to the effective use of oral agents.”2 Non-adherence can contribute to unnecessary diagnostic testing, unnecessary hospitalizations and emergency department visits, and unnecessary changes in regimens. The patient-provider bond is also jeopardized by non-adherence as it fractures the trust necessary for these relationships to function.
This study adds to our understanding of factors related to adherence. A quarter of the patients were found to be poorly adherent, using a 90% cutoff for poor adherence. Better adherence was most robustly predicted by patient satisfaction with clinician communication and treatment. While a single-group, non-randomized, observational study, this research illuminates potential interventions for improving patient adherence to oral anticancer medications. For example, the authors propose that provider-focused interventions that teach “empathic listening, effectively engaging the patient in decision making, and explaining the rationale for treatment and potential adverse effects” could make strides in achieving better adherence and would be consistent with a patient-centered care model. As we shift more of cancer care out of the clinic and hospital and into the home, research will be critical in developing the interventions necessary to ensure effective patient care.
—Bobby Daly, MD, MBA