In a single-center study reported in the Journal of Oncology Practice, Jacobs et al found that improved satisfaction with clinician communication and treatment was the strongest predictor of treatment adherence in patients receiving oral anticancer medication.
The prospective study included 88 patients (50 women) with chronic myeloid leukemia or metastatic renal cell carcinoma, non–small cell lung cancer (NSCLC), or breast cancer recruited from the cancer outpatient clinic at a major medical center in Boston from March 2011 to November 2012. Patients had been prescribed an oral tyrosine kinase inhibitor, endocrine therapy, or capecitabine at least 2 weeks before enrollment.
Adherence was measured via self-report and with an electronic pill cap (Medication Event Monitoring System cap). Patients completed surveys on symptom distress, mood, quality of life, cancer-specific distress, and satisfaction with clinician communication and treatment at baseline and at 12 weeks; adherence was analyzed by changes in these measures. Poor adherence was defined as adherence < 90%.
Pill cap data were available for 82 patients. Mean adherence was 89%, with 24% of patients having 100% adherence and 26% having adherence < 90%; adherence was < 90% for 35% of 23 patients with metastatic renal cell carcinoma, 35% for 16 patients with chronic myeloid leukemia, 17% for 22 patients with metastatic breast cancer, and 13% for 21 patients with metastatic NSCLC. Women were more adherent than men (mean 93% vs 84%, P = .039).
Better pill cap adherence was associated with reduced symptom distress (P = .012), reduced depressive symptoms (P = .017), improved quality of life (P = .015), reduced perceived burden to friends and family (P = .006), and improved satisfaction with clinician communication and treatment (P < .001); the latter factor accounted for 33% of the variance in adherence. A multivariate model that explained 41% of adherence variance showed improved treatment satisfaction was the strongest predictor of adherence (P < .001); perceived burden to family and friends also remained a significant predictor (P = .03), whereas changes in symptom distress, depressive symptoms, and quality of life were no longer significantly associated with adherence.
The investigators concluded: “Women and patients who reported increased treatment satisfaction and reduced burden to others were more adherent to oral chemotherapy. Interventions that help patients improve communication with clinicians and reduce burden may optimize oral chemotherapy adherence.”
The study was supported by Massachusetts General Hospital Cancer Center.
Jamie M. Jacobs, PhD, of Massachusetts General Hospital Cancer Center, is the corresponding author of the Journal of Oncology Practice article.
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