An Intervention to Improve Adherence and Management of Symptoms for Patients Prescribed Oral Chemotherapy Agents An Exploratory Study

City of Hope National Medical Center, Duarte, California (Dr Grant)
Cancer nursing (Impact Factor: 1.97). 01/2013; 36(1):18-28. DOI: 10.1097/NCC.0b013e3182551587
Source: PubMed


: Use of oral chemotherapy agents to treat cancer has increased. Patients are responsible for adhering to complex regimens while managing symptoms from adverse effects of the chemotherapy.
: This study examined an intervention to manage symptoms and adherence to oral agents.
: A 3-group pilot study determined how an Automated Voice Response (AVR) system alone (n = 40), or the AVR with strategies to manage symptoms and adherence (n = 40), or the AVR with strategies to manage adherence (n = 39) reduced symptom severity and improved adherence. Participants received a Symptom Management Toolkit, completed a baseline interview, and were randomized to receive 8 weekly AVR calls. An exit interview occurred at 10 weeks.
: Mean age was 59.6 years, with 70% female and 76% white, and 42% were nonadherent, with missed doses increasing with regimen complexity. Symptom severity declined over time in all groups. No difference was found in adherence rates, and higher adherence was related with lower symptom severity across groups.
: Adherence, a significant clinical problem, can affect efficacy of the cancer treatment. The AVR intervention alone was just as effective as the AVR plus the nurse intervention at promoting adherence and managing symptoms from adverse effects.
: Nurses need to focus on patient education by ensuring patient understanding of oral agent regimen and the need to adhere to the oral agent for efficacious cancer treatment. Nurses can promote the use of medication reminders and self-management of symptoms from adverse effects, to support adherence to the oral agent.

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    • "reased over time . For example , the adherence rate for Xeloda was 87% for cycle 1 but dropped to 78% for cycle 2 ( MacIntosh et al . 2007 ) . In the Khandelwal et al . ( 2012 ) study , the adherence was from 99% at 1 month to 64% at 3 months and 43% at 6 months . Among the most frequent intake errors was over - adherence , which ranged from 20% ( Spoelstra et al . 2013 ) to 44% ( Mayer et al . 2009 ) . Completely stopping treat - ment was rare , with a rate of 4% in the Lebovits et al . ( 1990 ) study . Finally , we have little information about the long - term effect of chemotherapy used for chronic con - ditions , such as chronic leukaemia . Indeed , Moon et al . ( 2012 ) showed that 92% of patients"
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    ABSTRACT: Since the 1990s, oral chemotherapy has been gaining ground as cancer treatment. This therapy seems to have few toxic effects and offers patients good quality of life. However, in addition to the fears the therapy might generate in patients, oral treatment raises a new issue, which, until now, has been marginal in this field: therapeutic observance or adherence. We investigated the research into adherence to oral chemotherapy among cancer patients published between 1990 and July 2013. Studies showed considerable diversity in terms of both the definition and measurement of adherence. As well, adherence to antineoplastic therapy is affected by the patient's understanding of the treatment and ability to remember information provided by the physician, treatment length and psychological distress. Our review of the few studies on adherence to anticancer drug treatment raises some questions that could be pursued in future research. In light of our findings, patients should receive 'therapy education' to help them and their support groups better understand the disease and its treatment and to achieve optimal health management and improved treatment effectiveness.
    European Journal of Cancer Care 09/2013; 23(1). DOI:10.1111/ecc.12124 · 1.56 Impact Factor
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    • "Several studies examined interventions to improve adherence to OAMs with others underway. Spoelstra et al. (2013) developed a nursing intervention to improve adherence using a Symptom Management Toolkit ® , based on a modified health belief model approach, and an automated voice response (AVR) reminder system. Participants were randomized to one of three groups: (AVR) system alone (n=40), AVR with strategies to manage symptoms and adherence (n=40), or AVR with strategies to manage adherence (n=39). "
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    ABSTRACT: The use of targeted oral anticancer medications (OAMs) is becoming increasingly prevalent in cancer care. Approximately 25-30% of the oncology drug pipeline involves oral agents and there are now over 50 OAMs approved by the Food and Drug Administration. This change represents a major shift in management of patients with cancer from directly observed, intermittent intravenous therapy to self-administered, oral chronic therapy. The increased prevalence of OAMs raises the issue of adherence in oncology, including understanding the challenges of adherence to OAMs. This review focuses on studies of adherence for patients taking molecularly targeted OAMs for breast cancer, chronic myelogenous leukemia (CML), gastrointestinal stromal tumors (GIST), non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). We then discuss barriers to adherence and studies performed to date testing interventions for improving adherence. Finally, we discuss future areas of investigation needed to define and improve adherence to OAMs in targeted therapy for cancer.
    Discovery medicine 04/2013; 15(83):231-41. · 3.63 Impact Factor
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    ABSTRACT: Oncologists are now prescribing more oral chemotherapy than ever before, thus placing the onus for taking the right dose at the right time under the right circumstances directly on the patient. This study was undertaken to understand emerging adherence issues and to explore available adherence assessment tools. This two-part study (1) examined N0747, a randomized phase II trial that tested the oral agents, sunitinib and capecitabine, in patients with metastatic esophageal cancer from an adherence standpoint, and (2) conducted a systematic review to compile and assess adherence tools that can be used in future clinical trials. First, in N0747, patients were assigned to sunitinib and capecitabine versus capecitabine; 53 chemotherapy cycles were prescribed to this 12-patient cohort. Nearly all patients denoted that they "always or almost always" took their pills as prescribed, and two patients who reported lack of full adherence suffered from grade 3+ adverse events. Surprisingly, however, over 14 cycles, 9 patients reported grade 3+ toxicity but checked "always or almost always" to describe their adherence. No relationships were observed between adherence and cancer outcomes. Secondly, 21 articles identified the following adherence tools: (1) healthcare providers' interviews, (2) patient-reported adherence with diaries/calendars, (3) patient-completed adherence scales, (4) medication event monitoring, (5) automated voice response, (6) drug/metabolite assays, and (7) prescription databases. Of note, only the automated voice response seems capable of real-time detection of over-adherence, as observed in N0747. Oral chemotherapy adherence should be further studied, particularly from the standpoint of over-adherence.
    Journal of Cancer Education 07/2013; 28(4). DOI:10.1007/s13187-013-0511-z · 1.23 Impact Factor
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