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Fareed MM, Hameed MY, Samuel E. Radiation Oncology Health Disparities in Pakistan. JCO Glob Oncol 2023; 9:e2300199. [PMID: 38127774 PMCID: PMC10752456 DOI: 10.1200/go.23.00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/18/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
This article discusses problems and potential solutions for improving radiation oncology care in Pakistan.
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Affiliation(s)
- Muhammad Mohsin Fareed
- Department of Radiation Oncology, West Virginia University Cancer Institute, Morgantown, WV
| | | | - Eileen Samuel
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY
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Koch EAT, Steeb T, Bender-Säbelkampf S, Busch D, Feustel J, Kaufmann MD, Maronna A, Meder C, Ronicke M, Toussaint F, Wellein H, Berking C, Heppt MV. Poor Adherence to Self-Applied Topical Drug Treatment Is a Common Source of Low Lesion Clearance in Patients with Actinic Keratosis-A Cross-Sectional Study. J Clin Med 2023; 12:jcm12113813. [PMID: 37298008 DOI: 10.3390/jcm12113813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Many treatments for actinic keratosis (AK) have been proven efficient in clinical trials. However, patients with AK may still experience unsatisfactory therapeutic outcomes in clinical practice. OBJECTIVES To investigate patient adherence to self-applied topical interventions for AK and to explore factors associated with adherence in a real-world setting. METHODS A cross-sectional study was conducted. Patients presenting with AK were asked to complete a self-administered questionnaire about their last topical AK treatment. RESULTS A total of 113 patients participated with a median age of 78.5 years (range 58-94). Fifty-four patients (47.8%) received topical diclofenac, ten (8.8%) imiquimod, nine (8%) 5-fluorouracil, nine (8%) 5-fluorouracil plus salicylic acid, and eight (7.1%) photodynamic therapy. The non-adherence rate was 46.9% (n = 53), and only 30.9% (n = 35) used the topical treatments according to the summary of product characteristics (SmPC). These subgroups were compared. Patients of the non-compliant group were significantly less informed about the application time of the specific topical intervention (p = 0.002) and adjusted the timeframe (p < 0.001) and application frequency of the therapy (p = 0.02) independently of their physician. Conversely, patients reporting a sufficient pre-treatment consultation (p = 0.019) generally complied with the SmPC compliance application. CONCLUSIONS A thorough pre-treatment consultation can help to increase treatment adherence and ensure lesion clearance.
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Affiliation(s)
- Elias A T Koch
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Sophia Bender-Säbelkampf
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Dorothee Busch
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Janina Feustel
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Matthias D Kaufmann
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Andreas Maronna
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Christine Meder
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Moritz Ronicke
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Frédéric Toussaint
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Hedwig Wellein
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
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Omar NE, Fahmy Soliman AI, Eshra M, Saeed T, Hamad A, Abou-Ali A. Postmarketing safety of anaplastic lymphoma kinase (ALK) inhibitors: an analysis of the FDA Adverse Event Reporting System (FAERS). ESMO Open 2021; 6:100315. [PMID: 34864500 PMCID: PMC8649649 DOI: 10.1016/j.esmoop.2021.100315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 12/24/2022] Open
Abstract
Background Inhibitors of the anaplastic lymphoma kinase (ALK) gene mutation are highly effective treatments for ALK-positive lung cancer. We conducted this pharmacovigilance analysis using the Food and Drug Administration Adverse Event Reporting System (FAERS). Patients and methods FAERS files from 2012 to 2020 were used. Reports for crizotinib, ceritinib, alectinib, brigatinib, and lorlatinib were filtered. We used the Medical Dictionary for Regulatory Activities (MedDRA version 22.1). Further, we searched for adverse events on the preferred term (PT) level based on case reports in the literature. After filtering duplicate reports, disproportionality analysis was used to detect safety signals by calculating proportional reporting ratios (PRRs), reporting odds ratios (RORs), empirical Bayesian geometric mean, and information component. Reports were considered statistically significant if the 95% confidence interval did not contain the null value. Results Within the system organ classes, significant safety signals were found, including those for crizotinib [eye disorders (PRR 2.09, ROR 2.12)], ceritinib [gastrointestinal disorders (PRR 2.19, ROR 2.41), hepatobiliary disorders (PRR 4.4, ROR 4.52), respiratory disorders (PRR 1.96, ROR 2.08)], alectinib [hepatobiliary disorders (PRR 2.60, ROR 2.63)], brigatinib [respiratory disorders (PRR 2.15, ROR 2.31)], and lorlatinib [metabolism disorders (PRR 3.34, ROR 3.53)]. For adverse events on the PT level, we found several significant signals, including pneumothorax with crizotinib (PRR 3.29, ROR 3.29), ceritinib (PRR 3.13, ROR 3.13), and alectinib (PRR 4.88, ROR 4.89); myasthenia gravis with lorlatinib (PRR 6.05, ROR 6.05); photosensitivity reactions with crizotinib (PRR 2.20, ROR 2.20), ceritinib (PRR 4.30, ROR 4.31), alectinib (PRR 20.43, ROR 20.51), and brigatinib (PRR 20.97, ROR 21.05); pulmonary arterial hypertension with brigatinib (PRR 2.92, ROR 2.92) and lorlatinib (PRR 9.2, ROR 9.24); and rectal perforation with crizotinib (PRR 7.83, ROR 7.83). All the detected safety signals were confirmed using Bayesian methods. Conclusion ALK inhibitors differed in their safety profile reports. We found several significant safety signals that matched previously published case reports, including pulmonary arterial hypertension, rectal perforation, myasthenia gravis, and photosensitivity. These signals require further regulatory investigation to determine their significance and potentially update the product labels to inform patients and clinicians. ALK inhibitors differed in their safety profile reports. We found several significant safety signals. These signals include pulmonary arterial hypertension, rectal perforation, myasthenia gravis, and photosensitivity. Further regulatory investigations are required to determine the significance of these signals and update the product labels.
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Affiliation(s)
- N E Omar
- Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
| | | | - M Eshra
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - T Saeed
- Faculty of Computer Sciences and Information Technology, Cairo University, Cairo, Egypt
| | - A Hamad
- Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Mattes MD, Suneja G, Haffty BG, Takita C, Katz MS, Ohri N, Deville C, Siker ML, Park HS. Overcoming Barriers to Radiation Oncology Access in Low-Resource Settings in the United States. Adv Radiat Oncol 2021; 6:100802. [PMID: 34693080 PMCID: PMC8515237 DOI: 10.1016/j.adro.2021.100802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022] Open
Abstract
Providing high-quality radiation therapy in medically underserved, low-resource environments can be challenging in the United States. During the American Society of Radiation Oncology 2020 Annual Meeting, the American Society for Radiation Oncology Committee on Health Equity, Diversity, and Inclusion hosted 4 radiation oncologists from both academic and community practices in an educational session. Speakers discussed creative ways to overcome barriers to equitable cancer care and outcomes for their vulnerable patient populations in both rural and urban settings. Successful tactics have included applying for state-sponsored grants, lobbying hospital leadership for equipment upgrades, implementing quality improvement programs specifically targeting the needs of the patient population, studying novel hypofractionation schedules, monitoring toxicities using wearable devices, and expanding transportation options.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah School Huntsman Cancer Institute, Salt Lake City, Utah
| | - Bruce G Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Cristiane Takita
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Matthew S Katz
- Radiation Oncology Associates, Lowell General Hospital Cancer Center, Lowell, Massachusetts
| | - Nitin Ohri
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Malika L Siker
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Henry S Park
- Department of Radiation Oncology, Yale School of Medicine, New Haven, Connecticut
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Brief relaxation training is associated with long-term endocrine therapy adherence among women with breast cancer: post hoc analysis of a randomized controlled trial. Breast Cancer Res Treat 2021; 190:79-88. [PMID: 34410568 DOI: 10.1007/s10549-021-06361-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Despite life-saving potential, many women struggle to adhere to adjuvant endocrine therapy (AET) for their breast cancer (BCa). Prior research has demonstrated that emotional distress is a barrier to AET adherence. We followed women from a trial to test the long-term effects of two 5-week post-surgical group-based stress management interventions, cognitive behavioral therapy (CBT), and relaxation training versus an attention-matched health education control, on AET adherence. METHODS We conducted a long-term follow-up (median = 8 years) of women randomized to CBT, relaxation training, or health education after surgery for stage 0-3 BCa. We measured adherence with the Endocrine Therapy Medication Usage Questionnaire (ETMUQ). First, we established factors on the ETMUQ via confirmatory factor analysis. We then used Bayesian structural equation modeling to regress these factors on study arm, controlling for age and treatments received. RESULTS Of those who completed long-term follow-up (n = 59, 44.7%), over half (n = 33; 55.9%) reported problems with adherence generally. Women receiving relaxation training (n = 15) had better adherence than those receiving health education (n = 24) on the Forgetfulness/Inconsistency [B(SE) = 0.25(0.14), p = 0.049] and Intentional Nonadherence [B(SE) = 0.31(0.14), p = 0.018] factors of the ETMUQ. Similar results were observed for those receiving relaxation training compared to CBT (n = 20): Forgetfulness/Inconsistency [B(SE) = - 0.47(0.25), p = 0.031]; Intentional Nonadherence [B(SE) = - 0.31(0.15), p = 0.027]. CONCLUSION Women receiving relaxation training were less likely to (1) forget to take their AET and (2) intentionally miss doses of AET in the long term compared to women receiving health education or CBT. This is evidence for the need of randomized trials that aim to improve adherence by incorporating theoretically based behavioral change techniques. TRIAL REGISTRATION AND DATES Trial 2R01-CA-064710 was registered March 26, 2006.
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Sun W, Reeve R, Ouellette T, Stutsky M, De Jesus R, Huffer MJ, Mougalian SS. Novel Tool to Monitor Adherence to Oral Oncolytics: A Pilot Study. JCO Clin Cancer Inform 2021; 5:701-708. [PMID: 34166064 DOI: 10.1200/cci.20.00151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Nonadherence is a significant issue in cancer care, especially as more oral therapies become available. Measuring and optimizing adherence to such therapies is challenging. In this study, we tested a novel technology that records real-time medication-taking behavior from a smart prescription bottle and can communicate with patients via text message to intervene in cases of nonadherence. METHODS We conducted a 28-patient pilot study to assess the feasibility of this technology in measuring and improving adherence in patients taking capecitabine, an oral chemotherapy agent with a complex, cyclical regimen. The study had a preintervention stage, during which patients were monitored, and an intervention stage, during which the text messaging intervention was enabled. RESULTS During preintervention, patients had an average self-adherence of 89%, and during post intervention, they had an average adherence of 90%. We defined three categories of patients by change in adherence: category 1 (> 8%), category 2 (-8% to 8%), and category 3 (< -8%). Patients in category 1 tended to live in regions with lower average household income (mean = $58,937 in US dollars [USD]) than those in category 2 (mean = $77,482 USD) and category 3 (mean = $90,972 USD). Of poststudy survey respondents, most indicated that they would want to continue using this technology and that they would recommend it to others. CONCLUSION This novel technology is able to monitor, measure, and intervene for patients taking capecitabine in real time. Adherence overall was high, and some patients appeared to benefit more from text-message interventions. Future work should focus on patients deemed high risk for nonadherence.
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Affiliation(s)
- Wendy Sun
- Yale University School of Medicine, New Haven, CT.,Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Sarah S Mougalian
- Yale University School of Medicine, New Haven, CT.,Yale Cancer Center, New Haven, CT
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Souliotis K, Peppou LE, Economou M, Marioli A, Nikolaidi S, Saridi M, Varvaras D, Paschali A, Syrigos KN. Treatment Adherence in Patients with Lung Cancer from Prospects of Patients and Physicians. Asian Pac J Cancer Prev 2021; 22:1891-1898. [PMID: 34181348 PMCID: PMC8418830 DOI: 10.31557/apjcp.2021.22.6.1891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: Adherence to treatment can be defined as the degree to which a patient’s behavior is consonant with medical or health advice he or she receive as part of his treatment regimen. The aim of this study was: 1) to measure the rate of treatment adherence to among patients with lung cancer from the prospect of both patients and physicians, 2) to measure the degree of concordance between the two prospect, and 3) to identify factors related to adherence for both prospect (patients and physicians). Materials and Methods: A total of 250 patients were included in this study. Information about socio-economic characteristics, depressive and anxiety symptoms (Hospital Anxiety and Depression scale), nicotine dependence (Fagerstrom scale), barriers to accessing care, and the level of treatment adherence was collected through interview. Physicians were enquired about disease and treatment variables as well as patients’ level of adherence. Results: From the patient perspective, only 1.2% of patients displayed poor adherence; whereas the corresponding percentage among physicians was 12.4%. The concordance between the two was low: 0.244. The correlation of measurements made on the same individual was found to be equal to 0.14. Barriers to accessing medication (O.R.=2.82, 95% C.I.: 1.01-8.09) was the only risk factor when adherence was self-rated; barriers to accessing medication (O.R.=2.45, 95% C.I.: 1.03-5.86), education equal to 12 years (O.R.=0.33, 95% C.I.: 0.13-0.82) or higher than 12 years (O.R.=0.28, 95% C.I.: 0.08-0.96), nicotine dependence (O.R.=1.41, 95% C.I. 1.17-1.69) and HADS anxiety score (O.R.=1.15, 95% C.I. 1.03-1.30) were the predictors in physicians’ rating. Conclusions: Differences in rating adherence may underpin communication gaps between patients and physicians. Systemic determinants of poor adherence should not be overlooked. A concerted effort by researchers, physicians and policy makers in defining as well as communicating adherence, while removing its barriers should be made.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social & Political Sciences, University of Peloponnese, Corinth, Greece.,School of Nursing, University of Thessaly Greece
| | - Lily E Peppou
- School of Nursing, University of Thessaly Greece.,Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece
| | - Marina Economou
- Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece.,First Department of Psychiatry, Aiginition Hospital, Medical School, Kapodistrian University of Athens, Athens, Greece
| | - Androniki Marioli
- Division of Medical Oncology, Third Department of Medicine, Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Saridi
- School of Nursing, University of Thessaly Greece
| | | | - Antonia Paschali
- Faculty of Nursing, School of Health Sciences, Department of Mental Health and Behavioral Sciences, Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos N Syrigos
- Division of Medical Oncology, Third Department of Medicine, Kapodistrian University of Athens, Athens, Greece
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Adherence to oral anticancer chemotherapies and estimation of the economic burden associated with unused medicines. Int J Clin Pharm 2020; 42:1311-1318. [PMID: 32857257 DOI: 10.1007/s11096-020-01083-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
Background The list of oral and expensive chemotherapy agents has lengthened over the last few years and has created unique medication adherence concerns. In a real-life setting, patients often do not take their medications as prescribed. This pattern is associated with poor outcomes and increased health care costs. Objectives To estimate the adherence to oral anticancer chemotherapies and to determine the economic burden of unused medicines due to patients' death. Setting Alsace (France). Method This retrospective study was carried out by using ERASME, an Insurance Healthcare database. Main outcome measures Adherence was calculated using medication possession ratio and economic impact using prescription refill data. Results 10,734 patients were treated with oral anticancer medicines (cytotoxic agents, hormonal and targeted therapies). Averaged adherence of 0.86 was observed although it varied significantly between subclasses (cytotoxic agents: 0.69 ± 0.14, hormonal therapy: 0.91 ± 0.17 and targeted therapy: 0.79 ± 0.17). 1631 patients died during the study period. The expenses related to unused chemotherapies amounted to €152,175. Conclusions Our data showed that overall adherence to oral anticancer medicines was above the acceptable limit of adherence of 80% with a marked graduation in values between cytotoxic agents, hormonal and targeted therapies. These statistical significant differences in medication possession ratio could be related to the intrinsic toxicity of the three subclasses of molecules, their tolerance and adverse effects. To limit the cost associated with unused medicines, interventions such as dispensing expensive oral anticancer chemotherapies per unit over shorter periods and not only on monthly intervals could be implement.
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Symptom Care at Home: A Comprehensive and Pragmatic PRO System Approach to Improve Cancer Symptom Care. Med Care 2020; 57 Suppl 5 Suppl 1:S66-S72. [PMID: 30531525 DOI: 10.1097/mlr.0000000000001037] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is growing recognition that systematically obtaining the patient's perspective on their health experience, using patient-reported outcomes (PRO), can be used to improve patient care in real time. Few PRO systems are designed to monitor and provide symptom management support between visits. Patients are instructed to contact providers between visits with their concerns, but they rarely do, leaving patients to cope with symptoms alone at home. We developed and tested an automated system, Symptom Care at Home (SCH), to address this gap in tracking and responding to PRO data in-between clinic visits. The purpose of this paper is to describe SCH as an example of a comprehensive PRO system that addresses unmet need for symptom support outside the clinic. METHODS FOR PRO SCORE INTERPRETATION SCH uses pragmatic, single-item measures for assessing symptoms, which are commonly used and readily interpretable for both patients and providers. We established alerting values for PRO symptom data, which was particularly important for conserving oncology providers' time in responding to daily PRO data. METHODS FOR DEVELOPING RECOMMENDATIONS FOR ACTING ON PRO RESULTS The SCH system provides automated, just-in-time self-management coaching tailored to the specific symptom pattern and severity levels reported in the daily call. In addition, the SCH system includes a provider decision support system for follow-up symptom assessment and intervention strategies. DISCUSSION SCH provides PRO monitoring, tailored automated self-management coaching, and alerts the oncology team of poorly controlled symptoms with a provider dashboard that includes evidence-based decision support for follow-up to improve individual patients' symptom care. We particularly emphasize our process for PRO selection, rationale for determining alerting thresholds, and the design of the provider dashboard and decision support. Currently, we are in the process of updating the SCH system, developing both web-based and app versions in addition to interactive voice response phone access and integrating the SCH system in the electronic health record.
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Mougalian SS, Gross CP, Hall EK. Text Messaging in Oncology: A Review of the Landscape. JCO Clin Cancer Inform 2019; 2:1-9. [PMID: 30652579 DOI: 10.1200/cci.17.00162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Text messaging via short messaging service (SMS) is a common route of communication in the United States and offers many advantages to improve health care delivery compared with other forms of mHealth. Text messaging is easy to use, is convenient, is more likely to be viewed than e-mail, and can be tailored to an individual recipient's needs. Despite evidence that patients with cancer desire more mobile-based communication, there are few examples of successful text messaging interventions in the literature. This narrative review examines the current landscape of SMS-based interventions across the continuum of cancer care, including addressing behavioral change, attendance to screening and follow-up appointments, adherence to treatment, and assessment of symptoms and quality of life. Finally, we explore some of the barriers to implementation of a successful text messaging intervention.
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Affiliation(s)
| | - Cary P Gross
- All authors: Yale University School of Medicine, New Haven, CT
| | - E Kevin Hall
- All authors: Yale University School of Medicine, New Haven, CT
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Campbell S, Suwan K, Waramit S, Aboagye EO, Hajitou A. Selective Inhibition of Histone Deacetylation in Melanoma Increases Targeted Gene Delivery by a Bacteriophage Viral Vector. Cancers (Basel) 2018; 10:E125. [PMID: 29690504 PMCID: PMC5923380 DOI: 10.3390/cancers10040125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 01/14/2023] Open
Abstract
The previously developed adeno-associated virus/phage (AAVP) vector, a hybrid between M13 bacteriophage (phage) viruses that infect bacteria only and human Adeno-Associated Virus (AAV), is a promising tool in targeted gene therapy against cancer. AAVP can be administered systemically and made tissue specific through the use of ligand-directed targeting. Cancer cells and tumor-associated blood vessels overexpress the αν integrin receptors, which are involved in tumor angiogenesis and tumor invasion. AAVP is targeted to these integrins via a double cyclic RGD4C ligand displayed on the phage capsid. Nevertheless, there remain significant host-defense hurdles to the use of AAVP in targeted gene delivery and subsequently in gene therapy. We previously reported that histone deacetylation in cancer constitutes a barrier to AAVP. Herein, to improve AAVP-mediated gene delivery to cancer cells, we combined the vector with selective adjuvant chemicals that inhibit specific histone deacetylases (HDAC). We examined the effects of the HDAC inhibitor C1A that mainly targets HDAC6 and compared this to sodium butyrate, a pan-HDAC inhibitor with broad spectrum HDAC inhibition. We tested the effects on melanoma, known for HDAC6 up-regulation, and compared this side by side with a normal human kidney HEK293 cell line. Varying concentrations were tested to determine cytotoxic levels as well as effects on AAVP gene delivery. We report that the HDAC inhibitor C1A increased AAVP-mediated transgene expression by up to ~9-fold. These findings indicate that selective HDAC inhibition is a promising adjuvant treatment for increasing the therapeutic value of AAVP.
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Affiliation(s)
- Samuel Campbell
- Cancer Phage Therapy Laboratory, Division of Brain Sciences, Burlington Danes Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK.
| | - Keittisak Suwan
- Cancer Phage Therapy Laboratory, Division of Brain Sciences, Burlington Danes Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK.
| | - Sajee Waramit
- Cancer Phage Therapy Laboratory, Division of Brain Sciences, Burlington Danes Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK.
| | - Eric Ofori Aboagye
- Comprehensive Cancer Imaging Centre, Faculty of Medicine, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK.
| | - Amin Hajitou
- Cancer Phage Therapy Laboratory, Division of Brain Sciences, Burlington Danes Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK.
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Implementation of pharmacist consultations as part of a multidisciplinary consultation program for patients with oral anticancer agent. ACTA ACUST UNITED AC 2018. [DOI: 10.1097/op9.0000000000000003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Adjuvant hormonal therapy for early breast cancer: an epidemiologic study of medication adherence. Breast Cancer Res Treat 2018; 169:153-162. [PMID: 29362956 DOI: 10.1007/s10549-018-4676-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study was to determine the prevalence of adherence to adjuvant hormonal therapy (AHT) and to identify risk factors for medication non-adherence in clinical practice in patients with early-stage hormone receptor (HR)-positive breast cancer (BC) previously treated with chemotherapy. METHODS We carried out a cross-sectional, observational, prospective, and multicenter survey based on a structured self-report postal questionnaire (35 items investigating six areas). A sample of 474 patients was drawn from 676 patients potentially eligible. The structured and validated Morisky Medication Adherence Scale-4 items was used for measuring medication adherence. An analysis of risk factors for non-adherence to AHT was performed using a two-step approach: univariate, then multivariate analysis. RESULTS A total of 280 patients out of the 428 analyzed patients participated in the survey, yielding a response rate of 65.4% [60.9-69.9]. The prevalence of adherence to AHT was estimated at 68.6% [63.1-74.0], corresponding to a high level of adherence. Three risk factors for non-adherence to AHT were identified: > 2 medications to treat comorbidities (p-value = 0.003), age less than 65 years (p-value = 0.008), and patient management in a university hospital setting (p-value = 0.014). CONCLUSIONS Non-adherence is a common, complex, and multidimensional healthcare problem. This better understanding and knowledge of risk factors will allow healthcare providers (such as oncologists, general practitioners, pharmacists) to more easily identify patients at risk for non-adherence and help them provide appropriate information about AHT and its management, thus improving medication adherence in their patients.
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14
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Mooney K, Berry DL, Whisenant M, Sjoberg D. Improving Cancer Care Through the Patient Experience: How to Use Patient-Reported Outcomes in Clinical Practice. Am Soc Clin Oncol Educ Book 2017; 37:695-704. [PMID: 28561689 DOI: 10.1200/edbk_175418] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Poorly controlled symptoms are common and debilitating during cancer treatment and can affect functional status and quality of life, health care resource utilization, treatment adherence, and cancer survivorship. Historically, the patient experience, including symptoms during treatment, has not been tracked or documented in the patient health record. Measurement of patient-reported outcomes (PROs), including symptoms, is an essential component to cancer care focused on the illness impact to the patient and family. PROs can be useful at the individual level for monitoring and promoting symptom care both in the clinic and remotely and at the population level for aggregating population data for use in research and quality improvement initiatives. Implementation of PROs in cancer clinical care requires a carefully thought out process to overcome challenges related to integrating PROs into existing electronic health records and clinical work flow. Issues with implementing PRO collection may include making decisions about measurement tools, modes of delivery, frequency of measurement, and interpretation that are guided by a clarification of the purpose for collecting PROs. We focus on three aspects of PRO use: (1) improving care for individual patients, (2) analyzing aggregated data to improve care and outcomes overall, and (3) considerations in implementing PRO collection.
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Affiliation(s)
- Kathi Mooney
- From the University of Utah, Salt Lake City, UT; Hunstman Cancer Institute, Salt Lake City, UT; Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Donna L Berry
- From the University of Utah, Salt Lake City, UT; Hunstman Cancer Institute, Salt Lake City, UT; Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Meagan Whisenant
- From the University of Utah, Salt Lake City, UT; Hunstman Cancer Institute, Salt Lake City, UT; Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel Sjoberg
- From the University of Utah, Salt Lake City, UT; Hunstman Cancer Institute, Salt Lake City, UT; Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan Kettering Cancer Center, New York, NY
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15
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Abstract
BACKGROUND The management of elderly patients with cancer is influenced by several factors that can vary widely among aging individuals. As the proportion of elderly individuals increases, the need for specific care guidelines for this population is critical. The National Comprehensive Cancer Network (NCCN) has developed guidelines to address these factors when formulating optimal treatment regimens for elderly patients and to avoid significant toxicity and maintain their quality of life. METHODS Factors that influence the appropriate treatment choices for the elderly, such as functional status, comorbidity, polypharmacy, and the presence of anemia, are reviewed, and the guidelines developed by the NCCN for treatment elderly patients are discussed. RESULTS The guidelines address these factors when defining the goal of therapy and formulating individualized treatment approaches for the elderly to provide optimal care for these patients, avoid significant toxicity, and maintain their quality of life. CONCLUSIONS The goal of therapy must be clearly defined, whether survival, remission, cure, or palliation of symptoms. Enrollment of elderly cancer patients onto clinical trials is encouraged so the guidelines can be validated.
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Affiliation(s)
- Stuart M Lichtman
- Don Monti Division of Medical Oncology, North Shore University Hospital, Manhasset, NY 11030, USA.
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16
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Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers. Breast Cancer Res Treat 2017; 165:247-260. [DOI: 10.1007/s10549-017-4317-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/24/2017] [Indexed: 01/31/2023]
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17
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Jacobs JM, Pensak NA, Sporn NJ, MacDonald JJ, Lennes IT, Safren SA, Pirl WF, Temel JS, Greer JA. Treatment Satisfaction and Adherence to Oral Chemotherapy in Patients With Cancer. J Oncol Pract 2017; 13:e474-e485. [DOI: 10.1200/jop.2016.019729] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Although patients with cancer overwhelming prefer oral to intravenous chemotherapy, little is known about adherence to oral agents. We aimed to identify the rates and correlates of adherence in patients with diverse malignancies. Materials and Methods: Ninety patients with chronic myeloid leukemia or metastatic renal cell carcinoma, non–small-cell lung cancer, or breast cancer enrolled in this prospective, single-group, observational study of medication-taking behaviors. Adherence was measured via self-report and with an electronic pill cap (Medication Event Monitoring System cap). Patients completed surveys regarding symptom distress, mood, quality of life, cancer-specific distress, and satisfaction with clinician communication and treatment at baseline and 12-week follow-up. Results: As measured by the Medication Event Monitoring System, patients took, on average, 89.3% of their prescribed oral chemotherapy over the 12 weeks. One quarter of the sample was less than 90% adherent, and women were more adherent than men (mean difference, 9.59%; SE difference, 4.50%; 95% CI, −18.65 to −0.52; P = .039). Improvements in patient symptom distress (B = −0.79; 95% CI, −1.41 to −0.18), depressive symptoms (B = –1.57; 95% CI, –2.86 to –0.29), quality of life (B = 0.38; 95% CI ,0.07 to 0.68), satisfaction with clinician communication and treatment (B = 0.73; 95% CI, 0.49 to 0.98), and perceived burden to others (B = −1.28; 95% CI, −2.20 to −0.37) were associated with better adherence. In a multivariate model, improved treatment satisfaction (B = 0.71; 95% CI, 0.48 to 0.94) and reduced perceived burden (B = −0.92; 95% CI, −1.76 to −0.09) were the strongest indicators of better adherence. Conclusion: 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.
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Affiliation(s)
- Jamie M. Jacobs
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Nicole A. Pensak
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Nora J. Sporn
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - James J. MacDonald
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Inga T. Lennes
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Steven A. Safren
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - William F. Pirl
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Jennifer S. Temel
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Joseph A. Greer
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
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18
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Meguerditchian A, Tamblyn R, Meterissian S, Law S, Prchal J, Winslade N, Stern D. Adjuvant Endocrine Therapy in Breast Cancer: A Novel e-Health Approach in Optimizing Treatment for Seniors (OPTIMUM): A Two-Group Controlled Comparison Pilot Study. JMIR Res Protoc 2016; 5:e199. [PMID: 27821385 PMCID: PMC5118585 DOI: 10.2196/resprot.6519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 12/13/2022] Open
Abstract
Background In women with hormone receptor positive breast cancer, adjuvant endocrine therapy (AET) is associated with a significant survival advantage. Nonadherence is a particular challenge in older women, even though they stand to benefit the most from AET. Therefore, a novel eHealth tool (OPTIMUM) that integrates real-time analysis of health administrative claims data was developed to provide point-of-care decision support for clinicians. Objectives The objectives of the study are to determine the effectiveness of a patient-specific, real-time eHealth alert delivered at point-of-care in reducing rates of AET discontinuation and to understand patient-level factors related to AET discontinuation as well as to assess integration of eHealth alerts regarding deviations from best practices in administration of AET by cancer care teams. Methods A prospective, 2-group controlled comparison pilot study will be conducted at 2 urban, McGill University–affiliated hospitals, the Royal Victoria Hospital and St. Mary’s Hospital. A minimum of 43 patients per study arm will be enrolled through site-level allocation. Follow-up is 1.5 years. Health care professionals at the intervention site will have access to the eHealth tool, which will report to them in real-time medical events with known associations to AET discontinuation, an AET adherence monitor, and a discontinuation alert. Cox proportional hazard ratios with 95% confidence intervals will estimate risks of AET discontinuation. Tests for significance will be 2-sided with a significance level of P<.05. Results This protocol has been approved and funded by the Canadian Institutes of Health Research. The study will evaluate site-level differences between AET discontinuation and AET adherence and assess care team actions at the intervention site. Participant enrollment into this project is expected to start September 2016 with primary data ready to present by June 2018. Conclusion This study will offer an opportunity to verify the feasibility of integrating an eHealth tool that aims to improve the long-term management of breast cancer in a high-risk population by allowing more timely intervention to prevent or rapidly address AET discontinuation.
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Affiliation(s)
- Ari Meguerditchian
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada.,Department of Oncology, McGill University, Montreal, QC, Canada.,Breast Clinic, McGill University Health Centre, Montreal, QC, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sarkis Meterissian
- Department of Surgery, McGill University, Montreal, QC, Canada.,Department of Oncology, McGill University, Montreal, QC, Canada.,Breast Clinic, McGill University Health Centre, Montreal, QC, Canada
| | - Susan Law
- Department of Family Medicine, McGill University, Montreal, QC, Canada.,Research Centre, St. Mary's Hospital, Montreal, QC, Canada
| | - Jaroslav Prchal
- Department of Oncology, McGill University, Montreal, QC, Canada.,Department of Oncology, St. Mary's Hospital Center, Montreal, QC, Canada
| | - Nancy Winslade
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Donna Stern
- Department of Oncology, St. Mary's Hospital Center, Montreal, QC, Canada
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19
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Renet S, Maritaz C, Lotz JP, Burnel S, Paubel P. [Care pathways of cancer patients: Modeling and risks analysis induced by oral anticancer drugs]. Bull Cancer 2016; 103:345-52. [PMID: 26891708 DOI: 10.1016/j.bulcan.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 11/20/2015] [Accepted: 12/04/2015] [Indexed: 11/15/2022]
Abstract
The care pathway of cancer patients is complex and therefore difficult to define. The oral anticancers (AKPO) have shown their benefits to patients and health professionals, however, the risks induced on the care pathway remain unknown. The objective of the study is to define, quantify the risks from AKPO and their effects on the care pathway (breakdown [Ds], rupture [Rt]). From the proposed care pathway model, FMEA method is used to analyze risks. For the 3 identified processes (1 monotherapy, 2 bitherapies: 2 AKPO or 1 AKPO/1 AKIV), analysis revealed an average of 91 risks, 173 Ds, 147 Rt, increased for 1 AKPO/1 AKIV therapy. The administration and delivery are the most risky steps. The lack of training and information of patients and healthcare professionals generates 80% of Ds and Rt. This model confirms the complexity, variability of the care pathway. The development of actions to improve town-hospital coordination and exchange of information is required to optimize and secure the route, confirming the objectives of "Plan Cancer 3".
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Affiliation(s)
- Sophie Renet
- Groupe hospitalier La Pitié-Salpétrière, réseau régional de cancérologie d'Île-de-France (ONCORIF), 47, boulevard de l'Hôpital, 75013 Paris, France; Hôpitaux universitaire Paris Sud, hôpital Antoine-Béclère, service de pharmacie, 92141 Clamart cedex, France.
| | - Christophe Maritaz
- Groupe hospitalier La Pitié-Salpétrière, réseau régional de cancérologie d'Île-de-France (ONCORIF), 47, boulevard de l'Hôpital, 75013 Paris, France; Groupe hospitalier Paris-Saint-Joseph, unité chimiothérapies et essais cliniques, service de pharmacie, 75014 Paris, France
| | - Jean-Pierre Lotz
- AP-HP, hôpitaux universitaires de l'Est Parisien, hôpital Tenon, service d'oncologie médicale et de thérapie cellulaire, pôle onco-hématologie, 4, rue de la Chine, 75970 Paris cedex 20, France; Université Pierre-et-Marie-Curie, institut universitaire de cancérologie, 75013 Paris, France
| | - Sylvie Burnel
- Groupe hospitalier La Pitié-Salpétrière, réseau régional de cancérologie d'Île-de-France (ONCORIF), 47, boulevard de l'Hôpital, 75013 Paris, France
| | - Pascal Paubel
- Université Paris Descartes, Sorbonne Paris Cité, institut droit et santé, Inserm UMR S 1145, faculté de pharmacie de Paris, Paris, France; Assistance publique-Hôpitaux de Paris, agence générale des équipements et produits de santé, service évaluations pharmaceutiques et bon usage, 7, rue du Fer-à-Moulin, 75005 Paris, France
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20
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Kircher SM, Meeker CR, Nimeiri H, Geynisman DM, Zafar SY, Shankaran V, de Souza J, Wong YN. The Parity Paradigm: Can Legislation Help Reduce the Cost Burden of Oral Anticancer Medications? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:88-98. [PMID: 26797241 DOI: 10.1016/j.jval.2015.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 08/14/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Abstract
Over the last decade, there has been increased development and use of oral anticancer medications, which sometimes leads to high cost sharing for patients. Drug parity laws require insurance plans to cover oral anticancer medications with the same cost sharing as intravenous/injected chemotherapy or have a capped limit on out-of-pocket costs. There are currently 36 enacted state laws (plus the District of Columbia) addressing drug parity, but no federal laws. In this policy perspective piece, we discuss the history, opportunities, and limitations of drug parity laws in oncology. We also discuss the implications of provisions of the Affordable Care Act and other proposed policy reforms on financing oral chemotherapy.
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Affiliation(s)
- Sheetal M Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Caitlin R Meeker
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Halla Nimeiri
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel M Geynisman
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | | | | | | | - Yu-Ning Wong
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
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21
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Barillet M, Prevost V, Joly F, Clarisse B. Oral antineoplastic agents: how do we care about adherence? Br J Clin Pharmacol 2015; 80:1289-302. [PMID: 26255807 DOI: 10.1111/bcp.12734] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/24/2015] [Accepted: 08/03/2015] [Indexed: 12/30/2022] Open
Abstract
AIMS Oral therapies, including hormone-based or targeted therapies, have recently taken an increasing place in cancer treatment. In this context, a state of the art of the available studies dealing with the adherence of adult patients to oral anticancer treatment is warranted. The purpose of this review is to address (i) the association between assessment methods and measured adherence, (ii) the putative factors related to adherence and (iii) new ways of improving adherence to oral cancer therapies. METHODS We conducted a literature-based narrative review of studies obtained from Pubmed using medical subject heading terms and free-text terms combining concepts related to oral anticancer medication and adherence. RESULTS The analysis is based on 48 studies published since 1990, mostly assessing hormone-based therapy in breast cancer and targeted therapies in chronic myeloid leukaemia. Various methods of adherence were reported including self-report, medication measurement or combinations of methods. Adherence rates were found to vary from 14% to 100%. Beside patient related-factors, adherence rate discrepancies were found to be dependent on the method used. Furthermore, there was no consensual definition of adherence even regarding the same methods, some of them tolerating a period of interruption during the treatment period. Finally, several studies addressing persistence found a progressive decrease in adherence with time. CONCLUSION Adherence to novel oral therapies is a major issue and further research is warranted to standardize adherence assessment in clinical studies better and to define better the most appropriate approaches to improve long term adherence in oncology practice.
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Affiliation(s)
- Marie Barillet
- Centre Hospitalier J Monod, rue Eugène Garnier BP 219, 61104, Flers cedex
| | - Virginie Prevost
- Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186, 14032, Caen Cedex 05.,INSERM U1086, Cancers et Préventions, Avenue de la Côte de Nacre, F-14000, Caen.,Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Florence Joly
- Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186, 14032, Caen Cedex 05.,INSERM U1086, Cancers et Préventions, Avenue de la Côte de Nacre, F-14000, Caen.,Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Bénédicte Clarisse
- Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
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22
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Mausbach BT, Schwab RB, Irwin SA. Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2015; 152:239-46. [PMID: 26077640 DOI: 10.1007/s10549-015-3471-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/12/2015] [Indexed: 12/21/2022]
Abstract
The purpose of this meta-analysis was to analyze the available evidence concerning the effects of depression on non-adherence to adjuvant endocrine therapy (AET) in women with breast cancer. MEDLINE and PsycInfo databases from inception through May 1, 2015 were searched using terms related to AET adherence. Articles were reviewed and selected based on predetermined selection criteria, and effect sizes from included studies were extracted. Pooled effect estimates were obtained using random-effects meta-analyses. Of the 312 articles identified, 9 met the inclusion criteria. Overall, depression was significantly associated with non-adherence to AET (Cohen's d = 0.35, 95% CI 0.19-0.52). This effect was not significantly moderated by patient age (<65 vs ≥65 years), length of study follow-up (<18 months vs ≥18 months), or method of assessing adherence (objective vs self-report). However, within these subgroups, significant effects of depression were found only for younger patients (d = 0.46; 95% CI 0.19-0.72) and in studies of shorter duration (<18 months) (d = 0.49; 95% CI 0.22-0.76). These results suggest that AET adherence may be lower among women with greater depressive symptoms, and this effect may be exacerbated in younger women during the early phases (<18 months) of AET. Management of depressive symptoms in women with breast cancer may help in enhancing adherence to AET and improve cancer treatment outcomes.
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Affiliation(s)
- Brent T Mausbach
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA,
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23
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Costas-Muniz R, Leng J, Aragones A, Ramirez J, Roberts N, Mujawar MI, Gany F. Association of socioeconomic and practical unmet needs with self-reported nonadherence to cancer treatment appointments in low-income Latino and Black cancer patients. ETHNICITY & HEALTH 2015; 21:118-28. [PMID: 25989483 PMCID: PMC4653085 DOI: 10.1080/13557858.2015.1034658] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Treatment adherence, with minimal numbers of missed appointments, is an important determinant of survival among cancer patients. This study aims to determine if unmet financial, logistic, and supportive care needs predict self-reported adherence to cancer treatment appointments of chemotherapy and/or radiation among low-income ethnic minority patients. DESIGN The sample included 1098 underserved Latino and Black patients recruited from cancer clinics in New York City through the Cancer Portal Project. Participants completed a survey which included sociodemographic, health-related questions and a needs assessment, in their preferred language. Patients' adherence to chemotherapy and/or radiation treatment appointments was assessed using a self-report. RESULTS A sample of 1098 patients (581 Latino and 517 Black cancer patients) was recruited. Forty-two Latino cancer patients (7.4%) and 78 Black cancer patients (15.5%) reported missing treatment appointments. Patients, who experienced four or more unmet needs (odds ratios [OR] = 2.02-3.36), and those with unmet housing needs (OR = 3.10-3.31), were more likely to report missing cancer treatment appointments, regardless of their ethnicity/race. Black patients with unmet supportive care (OR = 2.27) and health insurance needs (OR = 3.80) were more likely to miss appointments. Amongst Latinos, legal health-related issues (OR = 2.51) was a significant predictor of missed appointments. CONCLUSIONS Among ethnic minority cancer patients, unmet socioeconomic and supportive care needs, housing needs in particular, predicted patient-reported missed radiation, and/or chemotherapy appointments. Future research should focus on exploring the impact of practical and supportive unmet needs on adherence and development of interventions aiming to improve cancer treatment adherence.
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Affiliation(s)
- Rosario Costas-Muniz
- Memorial Sloan Kettering Cancer Center Immigrant Health & Cancer Disparities Service Department of Psychiatry & Behavioral Sciences 300 E 66th St. 15th Fl, New York, NY 10065
| | - Jennifer Leng
- Memorial Sloan Kettering Cancer Center Immigrant Health & Cancer Disparities Service Department of Psychiatry & Behavioral Sciences 300 E 66th St. 15th Fl, New York, NY 10065
| | - Abraham Aragones
- Memorial Sloan Kettering Cancer Center Immigrant Health & Cancer Disparities Service Department of Psychiatry & Behavioral Sciences 300 E 66th St. 15th Fl, New York, NY 10065
| | - Julia Ramirez
- Memorial Sloan Kettering Cancer Center Immigrant Health & Cancer Disparities Service Department of Psychiatry & Behavioral Sciences 300 E 66th St. 15th Fl, New York, NY 10065
| | - Nicole Roberts
- Memorial Sloan Kettering Cancer Center Immigrant Health & Cancer Disparities Service Department of Psychiatry & Behavioral Sciences 300 E 66th St. 15th Fl, New York, NY 10065
| | - Mohammed Imran Mujawar
- Memorial Sloan Kettering Cancer Center Immigrant Health & Cancer Disparities Service Department of Psychiatry & Behavioral Sciences 300 E 66th St. 15th Fl, New York, NY 10065
| | - Francesca Gany
- Memorial Sloan Kettering Cancer Center Immigrant Health & Cancer Disparities Service Department of Psychiatry & Behavioral Sciences 300 E 66th St. 15th Fl, New York, NY 10065
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24
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Holle LM, Puri S, Clement JM. Physician–pharmacist collaboration for oral chemotherapy monitoring: Insights from an academic genitourinary oncology practice. J Oncol Pharm Pract 2015; 22:511-6. [DOI: 10.1177/1078155215581524] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Oral chemotherapy is being routinely used in metastatic castrate-resistant prostate and renal cell cancer. Although convenient, these drugs require monitoring for adherence, toxicity, and drug interactions to maximize outcomes. Oncology pharmacists have the training and expertise that place them in an optimal position to collaboratively provide medication therapy management. Methods A board-certified oncology pharmacist, working in collaboration with a medical oncologist, initiated an oral chemotherapy–monitoring program. The pharmacist provided education, completed medication therapy management; monitored for adherence and toxicity; and recommended treatment of toxicity and supportive care issues. Patient encounters included one of the following: collaboration with medical oncologist visit, pharmacist visit, or telephone or email follow-up between visits. Results From December 2012 to May 2014, the pharmacist had 123 encounters with 20 patients with either metastatic prostate ( n = 17) or renal cell cancer ( n = 3). All patients were males (median age 80 years). Most encounters were clinic visits, in collaboration with physician visit or alone (52%); 36% were telephone encounters, and 11.3% were email follow-ups. Medication-related problems were identified in 25% of the 315 assessments made. Problems included: adverse drug reactions, 40%; inappropriate therapy, 20%; and noncompliance, 18%. Recommendations included: modification of laboratory monitoring, 25%; cancer or non-cancer therapy modification, 12%; drug discontinuation, 6.9%. Non-cancer therapy-related drug information and coordination of care accounted for 30% of recommendations. Conclusion Our program led to identification of a number of potentially clinically significant issues for patients on oral chemotherapy and demonstrated the benefit of the pharmacist in the multidisciplinary team to assist in addressing them.
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Affiliation(s)
- Lisa M Holle
- Department of Pharmacy Practice, UConn School of Pharmacy, Storrs, CT, USA
| | - Sonam Puri
- Department of Internal Medicine, UConn, Farmington, CT, USA
| | - Jessica M Clement
- Carole and Ray Neag Comprehensive Cancer Center, UConn Health, Farmington, CT, USA
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Larizza MA, Dooley MJ, Stewart K, Kong DCM. Factors Influencing Adherence to Molecular Therapies in Haematology-Oncology Outpatients. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2006.tb00584.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Kay Stewart
- Department of Pharmacy Practice; Monash University
| | - David CM Kong
- Department of Pharmacy Practice; Monash University; Parkville Victoria
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Wells JS, Strickland OL, Dalton JA, Freeman S. Adherence to intravenous chemotherapy in African American and white women with early-stage breast cancer. Cancer Nurs 2015; 38:89-98. [PMID: 24831041 PMCID: PMC4232488 DOI: 10.1097/ncc.0000000000000139] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Adherence to intravenous chemotherapy offers survival and recurrence-free benefits for women diagnosed with early-stage breast cancer. However, previous studies have found that African American women are more likely to discontinue intravenous chemotherapy early, thus shortening their survival. Yet the existence of racial differences and predictors of adherence to chemotherapy treatment between African American and white women are largely understudied or inconsistent. OBJECTIVE The purposes of this study were to examine factors that influence the decision to adhere to chemotherapy in African American and white women diagnosed with early-stage breast cancer and to test for racial differences that may exist in this sample. INTERVENTIONS/METHODS The study recruited a convenience sample of 99 African American and white women. Factors examined were sociodemographic variables (age, race, access to healthcare), social support, religious coping, chemotherapy adverse effects, depression, breast cancer knowledge, health beliefs, cancer fatalism, and days from diagnosis to treatment. Data analyses included logistic regression modeling. RESULTS No racial differences in adherence to intravenous chemotherapy between African American and white women were found (χ = 2.627, P = .10). Days to treatment (odds ratio [OR], 0.982, P = .058), health insurance (OR, 0.121; P = .016), change in depression (OR, 0.935; P = .118), and symptom severity (OR, 0.950; P = .038) were independently associated with nonadherence to chemotherapy. CONCLUSIONS This study provides emerging evidence of factors that may be potentially modified with interventions at the clinical setting. IMPLICATIONS FOR PRACTICE The findings can be used to spearhead future intervention studies that improve treatment decision making to chemotherapy adherence.
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Affiliation(s)
- Jessica S Wells
- Author Affiliations: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Drs Wells, Dalton, and Freeman); and Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami (Dr Strickland)
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Costas-Muniz R, Leng J, Diamond L, Aragones A, Ramirez J, Gany F. Psychosocial correlates of appointment keeping in immigrant cancer patients. J Psychosoc Oncol 2015; 33:107-23. [PMID: 25574581 DOI: 10.1080/07347332.2014.992084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study aims to determine the psychosocial correlates of self-reported adherence to cancer treatment appointments and treatment delays and interruptions. The sample included 622 immigrant cancer patients from New York City. Patients completed a survey that included sociodemographic and health-related questions, questions assessing missed appointments and delays/or interruptions, and quality of life and depression scales. After controlling for sociodemographic characteristics, having a positive depression screen and poor physical and emotional well-being were significant predictors of missed appointments and delays and/or interruptions of treatment. Non-adherence to treatment appointments in immigrant cancer patients is a complex outcome related to important modifiable or treatable factors.
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Affiliation(s)
- Rosario Costas-Muniz
- a Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Immigrant Health & Cancer Disparities Service , New York , NY , USA
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Berry DL, Blonquist TM, Hong F, Halpenny B, Partridge AH. Self-reported adherence to oral cancer therapy: relationships with symptom distress, depression, and personal characteristics. Patient Prefer Adherence 2015; 9:1587-92. [PMID: 26604712 PMCID: PMC4639537 DOI: 10.2147/ppa.s91534] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Therapeutic cancer chemotherapy is most successful when complete dosing is achieved. Because many newer therapeutic agents are oral and self-administered by the patient, adherence is a concern. The purpose of our analysis was to explore relationships between adherence, patient characteristics, and barriers to adherence. METHODS This secondary analysis utilized self-reported data from a randomized trial of self-care management conducted at two cancer centers in the US. Symptom distress was measured using the 15-item Symptom Distress Scale (SDS-15) and depression with the Patient Health Questionnaire-9 (PHQ-9). Adherence to oral medication was self-reported using the 8-item Morisky Medication Adherence Scale (MMAS-8). Measures were collected via Web-based, study-specific software ~8 weeks after treatment start date. Odds of low/medium adherence (score <8) were explored using univariate logistic regression. Given the number of factors and possible relationships among factors, a classification tree was built in lieu of a multivariable logistic regression model. RESULTS Of the eligible participants enrolled, 77 were on oral therapy and 70 had an MMAS score. Forty-nine (70%) reported a high adherence score (=8). Higher odds of low/medium adherence were associated with greater symptom distress (P=0.09), more depression (P=0.05), chemotherapy vs hormonal oral medication (P=0.03), being female (P=0.02), and being randomized to the control group in the parent trial (P=0.09). Conversely, high adherence was associated with working (P=0.08), being married/partnered (P=0.004), and being older (P=0.02). Factors identified as significantly related to low/medium adherence from the univariate logistic regression analyses were supported by the classification tree results. CONCLUSION Nonadherence to therapeutic oral medications in patients with cancer was associated with being unmarried/unpartnered, symptom distress, younger age, not working, and female sex. These findings may help to identify patients at risk for nonadherence and for whom supportive interventions to enhance adherence may be needed.
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Affiliation(s)
- Donna L Berry
- Phyllis F Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
- Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Correspondence: Donna L Berry, Phyllis F Cantor Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, LW-518, Boston, MA 02115, USA, Tel +1 617 632 1909, Fax +1 617 582 8550, Email
| | - Traci M Blonquist
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Barbara Halpenny
- Phyllis F Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann H Partridge
- Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Bender CM, Gentry AL, Brufsky AM, Casillo FE, Cohen SM, Dailey MM, Donovan HS, Dunbar-Jacob J, Jankowitz RC, Rosenzweig MQ, Sherwood PR, Sereika SM. Influence of patient and treatment factors on adherence to adjuvant endocrine therapy in breast cancer. Oncol Nurs Forum 2014; 41:274-85. [PMID: 24769592 DOI: 10.1188/14.onf.274-285] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To comprehensively assess the patient and illness or treatment factors that may predict nonadherence to adjuvant endocrine therapy and to explore whether an interaction occurs between these factors in women with breast cancer. DESIGN Repeated-measures design. SETTING The Outpatient Services of the Women's Cancer Program at the University of Pittsburgh Cancer Institute and participants' homes. SAMPLE 91 women with early-stage breast cancer who received endocrine therapy. METHODS Adherence was assessed continuously for the first 18 months of endocrine therapy. Patient and illness or treatment factors were assessed at four time points (Time 1 to Time 4). Time 1 (baseline) was within two weeks prior to the initiation of endocrine therapy. Times 2-4 occurred at six-month intervals, as many as 18 months after Time 1. MAIN RESEARCH VARIABLES Adherence, patient factors, and illness or treatment factors. FINDINGS Adherence to endocrine therapy declined significantly during the first 18 months of treatment in women with breast cancer. The presence of negative mood and symptoms before starting treatment predicted nonadherence to endocrine therapy over time. Perceptions of financial hardship, symptoms, disease stage, and more complex medication regimens intensified the effect of negative mood on adherence over time. CONCLUSIONS Women with breast cancer may be at risk for nonadherence to prescribed endocrine therapy if they experience depression or anxiety and symptoms prior to initiating therapy. IMPLICATIONS FOR NURSING Oncology nurses should be alert to women with breast cancer who are depressed or anxious or who are experiencing symptoms. Management of negative mood and symptoms may result in better adherence.
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Affiliation(s)
| | - Amanda L Gentry
- Department of Health and Community Systems, School of Medicine
| | | | - Frances E Casillo
- Department of Acute and Tertiary Care, Office of Community Partnerships
| | - Susan M Cohen
- Department of Acute and Tertiary Care, Office of Community Partnerships
| | - Meredith M Dailey
- Department of Acute and Tertiary Care, Office of Community Partnerships
| | - Heidi S Donovan
- Department of Acute and Tertiary Care, Office of Community Partnerships
| | | | | | | | - Paula R Sherwood
- Department of Acute and Tertiary Care at the School of Nursing, University of Pittsburgh in Pennsylvania
| | - Susan M Sereika
- Center for Research and Evaluation, University of Pittsburgh in Pennsylvania
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Kavookjian J, Wittayanukorn S. Interventions for adherence with oral chemotherapy in hematological malignancies: A systematic review. Res Social Adm Pharm 2014; 11:303-14. [PMID: 25262600 DOI: 10.1016/j.sapharm.2014.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Poor adherence to treatment for chronic diseases including some hematological malignancies impedes health outcomes and increases costs. Oral chemotherapy is an emerging trend that raises concern about nonadherence problems in these targeted patients. OBJECTIVES This systematic literature review explores evidence and gaps in the literature regarding interventions to enhance adherence with prescribed oral chemotherapy in patients with hematological malignancies. METHODS Searches of databases and abstracts from conferences were performed for 1987 to January 2013 using a modified Cochrane method. Studies measuring interventions to improve adherence alone or together with clinical, humanistic, and economic outcomes were included. Assessment of methodological quality was performed for each retained study. RESULTS The literature search generated 6 studies that met inclusion criteria. Four of these reported a statistically significant increase in the adherence outcome, compared with baseline. Tailored and educational interventions were widely used among the retained studies. Post-intervention adherence rates were 41-96.1%; intervention groups yielded higher rates than comparison groups. Two studies reported statistically significant improvement in clinical outcomes (cytogenetic response and survival time). One study reported that severity of illness was associated with survival time but not with adherence. Studies that used both tailored and educational interventions showed significant relationship between adherence and clinical outcomes; however, the study that used dosage simplification did not. None of the studies explored humanistic or economic outcomes. CONCLUSIONS Interventions to improve adherence with oral chemotherapies in hematological malignancies remain limited. Though they were heterogeneous in nature, interventions tested in the retained studies suggested a positive impact on the adherence outcome; some established a significant relationship between adherence and clinical outcomes. The results yielded limited evidences regarding characteristics of a specific intervention, but supported a general structure for methods to improve adherence and other outcomes in real-life settings. Further rigorous methodological studies are needed to fully examine impact on adherence and clinical outcomes.
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Affiliation(s)
- Jan Kavookjian
- Health Outcomes Research & Policy, Harrison School of Pharmacy, Auburn University, AL, USA.
| | - Saranrat Wittayanukorn
- Health Outcomes Research & Policy, Harrison School of Pharmacy, Auburn University, AL, USA
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Kimura M, Usami E, Iwai M, Nakao T, Yoshimura T, Mori H, Sugiyama T, Teramachi H. Oral anticancer agent medication adherence by outpatients. Oncol Lett 2014; 8:2318-2324. [PMID: 25295117 PMCID: PMC4186627 DOI: 10.3892/ol.2014.2480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 08/01/2014] [Indexed: 01/28/2023] Open
Abstract
In the present study, medication adherence and factors affecting adherence were examined in patients taking oral anticancer agents. In June 2013, 172 outpatients who had been prescribed oral anticancer agents by Ogaki Municipal Hospital (Ogaki, Gifu, Japan) completed a questionnaire survey, with answers rated on a five-point Likert scale. The factors that affect medication adherence were evaluated using a customer satisfaction (CS) analysis. For patients with good and insufficient adherence to medication, the median ages were 66 years (range, 21–85 years) and 73 years (range, 30–90 years), respectively (P=0.0004), while the median dosing time was 131 days (range, 3–3,585 days) and 219 days (24–3,465 days), respectively (P=0.0447). In 36.0% (62 out of 172) of the cases, there was insufficient medication adherence; 64.5% of those cases (40 out of 62) showed good medication compliance (4–5 point rating score). However, these patients did not fully understand the effects or side-effects of the drugs, giving a score of three points or less. The percentage of patients with good medication compliance was 87.2% (150 out of 172). Through the CS analysis, three items, the interest in the drug, the desire to consult about the drug and the condition of the patient, were extracted as items for improvement. Overall, the medication compliance of the patients taking the oral anticancer agents was good, but the medication adherence was insufficient. To improve medication adherence, a better understanding of the effectiveness and necessity of drugs and their side-effects is required. In addition, the interest of patients in their medication should be encouraged and intervention should be tailored to the condition of the patient. These steps should lead to improved medication adherence.
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Affiliation(s)
- Michio Kimura
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Eiseki Usami
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Mina Iwai
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Toshiya Nakao
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Tomoaki Yoshimura
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Hiromi Mori
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Tadashi Sugiyama
- Laboratory of Clinical Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Hitomi Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
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Adherence influencing factors in patients taking oral anticancer agents: A systematic review. Cancer Epidemiol 2014; 38:214-26. [DOI: 10.1016/j.canep.2014.03.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 01/26/2023]
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Perini G, Grigoletti L, Hanife B, Biggeri A, Tansella M, Amaddeo F. Cancer mortality among psychiatric patients treated in a community-based system of care: a 25-year case register study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:693-701. [PMID: 24092521 DOI: 10.1007/s00127-013-0765-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 09/17/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE Cancer mortality data allow assessing, at the same time, the risk of developing the disease and the quality of care provided to patients after the oncologic diagnosis. This study explores the risk of death caused by a single tumor site in a psychiatric population treated in a community-based psychiatric service. METHODS All patients with an ICD-10 psychiatric diagnosis, seeking care in 1982-2006 (25 years), were included. Data were drawn from the South Verona Psychiatric Case Register (PCR). Mortality and cause of death were ascertained using different procedures and sources. Standardized mortality ratios (SMRs) were used to compare the observed number of deaths with the expected number using as reference a population in the Veneto region. RESULTS Having been admitted to the hospital (SMR = 1.32), having a short interval from registration (1.52), having a diagnosis of alcoholism (2.03), and being a middle-aged male (1.83) were factors showing an increased risk of death from cancer. Increased SMRs were found for cancer of the oral cavity (22.93), lymphoma, leukemias, Hodgkin's lymphoma (8.01), and central nervous system (CNS) and cranial nerve tumors (4.75). The SMR decreased for stomach tumors (0.49). Patients with alcoholism (5.90 for larynx), affective disorders (20.00 for lymphomas), and personality disorders (28.00 for SNC) were found to be exposed to a high risk of cancer death in specific sites. CONCLUSIONS Psychiatric patients showed different patterns of site-specific cancer mortality when compared with the general population. The 20-fold higher risk of dying from hematological neoplasms needs further investigation. Chronic use of phenothiazines could be involved in the relative protection from stomach and prostate cancer found in psychiatric patients.
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Affiliation(s)
- Giovanni Perini
- Section of Psychiatry and Section of Clinical Psychology, Department of Public Health and Community Medicine, Policlinico GB Rossi, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
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Bender CM, Gentry AL, Brufsky AM, Casillo FE, Cohen SM, Dailey MM, Donovan HS, Dunbar-Jacob J, Jankowitz RC, Rosenzweig MQ, Sherwood PR, Sereika SM. Influence of patient and treatment factors on adherence to adjuvant endocrine therapy in breast cancer. Oncol Nurs Forum 2014. [PMID: 24769592 DOI: 10.1188/14.onf.274-285.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To comprehensively assess the patient and illness or treatment factors that may predict nonadherence to adjuvant endocrine therapy and to explore whether an interaction occurs between these factors in women with breast cancer. DESIGN Repeated-measures design. SETTING The Outpatient Services of the Women's Cancer Program at the University of Pittsburgh Cancer Institute and participants' homes. SAMPLE 91 women with early-stage breast cancer who received endocrine therapy. METHODS Adherence was assessed continuously for the first 18 months of endocrine therapy. Patient and illness or treatment factors were assessed at four time points (Time 1 to Time 4). Time 1 (baseline) was within two weeks prior to the initiation of endocrine therapy. Times 2-4 occurred at six-month intervals, as many as 18 months after Time 1. MAIN RESEARCH VARIABLES Adherence, patient factors, and illness or treatment factors. FINDINGS Adherence to endocrine therapy declined significantly during the first 18 months of treatment in women with breast cancer. The presence of negative mood and symptoms before starting treatment predicted nonadherence to endocrine therapy over time. Perceptions of financial hardship, symptoms, disease stage, and more complex medication regimens intensified the effect of negative mood on adherence over time. CONCLUSIONS Women with breast cancer may be at risk for nonadherence to prescribed endocrine therapy if they experience depression or anxiety and symptoms prior to initiating therapy. IMPLICATIONS FOR NURSING Oncology nurses should be alert to women with breast cancer who are depressed or anxious or who are experiencing symptoms. Management of negative mood and symptoms may result in better adherence.
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Affiliation(s)
| | - Amanda L Gentry
- Department of Health and Community Systems, School of Medicine
| | | | - Frances E Casillo
- Department of Acute and Tertiary Care, Office of Community Partnerships
| | - Susan M Cohen
- Department of Acute and Tertiary Care, Office of Community Partnerships
| | - Meredith M Dailey
- Department of Acute and Tertiary Care, Office of Community Partnerships
| | - Heidi S Donovan
- Department of Acute and Tertiary Care, Office of Community Partnerships
| | | | | | | | - Paula R Sherwood
- Department of Acute and Tertiary Care at the School of Nursing, University of Pittsburgh in Pennsylvania
| | - Susan M Sereika
- Center for Research and Evaluation, University of Pittsburgh in Pennsylvania
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Fangand CY, Schnoll RA. Impact of psychological distress on outcomes in cancer patients. Expert Rev Pharmacoecon Outcomes Res 2014; 2:495-506. [DOI: 10.1586/14737167.2.5.495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bordonaro S, Romano F, Lanteri E, Cappuccio F, Indorato R, Butera A, D’Angelo A, Ferraù F, Tralongo P. Effect of a structured, active, home-based cancer-treatment program for the management of patients on oral chemotherapy. Patient Prefer Adherence 2014; 8:917-23. [PMID: 25028540 PMCID: PMC4077854 DOI: 10.2147/ppa.s62666] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The advent of oral chemotherapy agents has had a strong impact on several aspects of the management of cancer patients, including survival rates, health-care expenditure, and health-related quality of life. However, access to care and adherence to oral chemotherapy are central to optimal outcomes. PATIENTS AND METHODS In this multicenter observational study, we assessed the effect of the "Active Home Care" initiative - a structured, active, home-based cancer-treatment program - on quality of life, health-care utilization, and patient adherence and satisfaction using self-administered questionnaires. Sixty-two patients treated with oral chemotherapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate) were enrolled in the program. Weekly home visits were scheduled, each one with a trained nurse who delivered the home-based chemotherapy and reviewed patients' compliance and treatment toxicity. An oncologist evaluated patients and modified the dosage of oral chemotherapy based on toxicity reported during the previous cycle at bi-weekly visits. RESULTS A total of 460 home visits were performed between April 2012 and February 2013. The Active Home Care initiative was associated with significant improvements in physical functioning and symptoms, and reductions in the access to cancer facilities. Satisfaction with oral chemotherapy and care received was high. All patients reported having taken their medications according to their prescription, and no patient reported difficulties in managing the oral chemotherapy regimen. CONCLUSION The Active Home Care program was associated with improvements in the quality of life of patients and caregivers, better adherence to treatment, and the effective management of therapy and cancer-related symptoms. Home-based cancer treatment may also optimize the utilization of health-care resources.
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Affiliation(s)
- S Bordonaro
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - F Romano
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - E Lanteri
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - F Cappuccio
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - R Indorato
- Medical Oncology Unit, S Giovanni di Dio Hospital, Agrigento, Italy
| | - A Butera
- Medical Oncology Unit, S Giovanni di Dio Hospital, Agrigento, Italy
| | - A D’Angelo
- Medical Oncology Unit, S Vincenzo Hospital, Taormina, Italy
| | - F Ferraù
- Medical Oncology Unit, S Vincenzo Hospital, Taormina, Italy
| | - P Tralongo
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
- Correspondence: Paolo Tralongo, Medical Oncology Unit, Umberto I Hospital, RAO, Siracusa, Italy, Tel +39 9 3172 4542, Email
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Walter T, Wang L, Chuk K, Ng P, Tannock IF, Krzyzanowska MK. Assessing adherence to oral chemotherapy using different measurement methods: Lessons learned from capecitabine. J Oncol Pharm Pract 2013; 20:249-56. [DOI: 10.1177/1078155213501100] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Purpose Adherence to oral medication is important in oncology. Few studies have evaluated adherence with cancer agents such as capecitabine, which is given on a complicated schedule. Furthermore, little guidance exists regarding the best methods for monitoring adherence with oral cancer drugs. The purpose of our study was to evaluate adherence to capecitabine using several accepted measures. Patients and methods Patients treated with capecitabine for gastrointestinal cancers were included in this prospective cohort study. Adherence was evaluated during two consecutive cycles of capecitabine using three assessment methods: self-report, pill count, and use of a microelectronic monitoring system. The primary endpoint was proportion of patients adherent to capecitabine (>80% of adherence according to the three methods of measurement); the secondary objective was to compare the three methods of measurement. Results Nineteen patients were accrued to this study. Further accrual was stopped after the first planned analysis, because 18 and 19 patients were adherent by self-report and pill count, respectively. The overall adherence rates were 99, 100, and 61% with self-report, pill count, and microelectronic monitoring system cap, respectively. Ten (53%) patients were classified as nonadherent (<80% of adherence according to at least one method of measurement), but four of them transferred their pills into another medication container suggesting that measurement of adherence using microelectronic monitoring system technology may not be useful. Conclusion While we did not identify a major adherence issue with capecitabine in our study, it provides insight into problems associated with measurement of adherence in oncology and suggests that combining measures of adherence maximizes accuracy.
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Affiliation(s)
- Thomas Walter
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Hospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Médicale, Lyon, France
| | - Lisa Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Karen Chuk
- Department of Pharmacy, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Pamela Ng
- Department of Pharmacy, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ian F Tannock
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada
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Pretreatment predictors of short-term nonadherence to oral hormonal therapy for women with breast cancer. Nurs Res 2013; 62:243-51. [PMID: 23817282 DOI: 10.1097/nnr.0b013e318298fd70] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adjuvant treatment with oral hormonal therapy improves clinical outcomes for breast cancer, but women have difficulty adhering to the 5-year regimen. OBJECTIVE The aim of this study was to explore pretreatment predictors of short-term nonadherence to oral hormonal therapy for women with early-stage breast cancer from the pretreatment assessment to 6 months after initiation of hormonal therapy. METHODS A secondary analysis was performed using data collected from 198 women enrolled in one of two longitudinal studies. Nonadherence was defined as the percentage of prescribed doses of hormonal therapy not taken during the first 6 months of therapy measured using electronic medication event monitoring. Information on predictor variables was measured at pretreatment using self-report and medical record review. Linear regression analysis was performed to examine associations between predictor variables and 6-month nonadherence in a bivariate manner to first identify candidate predictors variables at p < .20 and then multivariately considering candidate predictors identified through stepwise and backward elimination regression methods. RESULTS Participants were White (98.3%), well educated (M = 15.0; SD = 2.9 years of schooling), and on average, 59.1 years old (SD = 7.5 years old). Mean nonadherence was 11.3%. Stepwise and backward elimination modeling algorithms identified a similar set of predictors associated with 6-month nonadherence and explained 13.0% of the variance (adjusted R = .11, standard error of the estimate = 0.28). Ductal carcinoma in situ tumor type (p = .004) and higher weight concern scores (p = .003) were associated with nonadherence. DISCUSSION The findings suggest that additional examinations of associations of tumor type and symptom burden with nonadherence are indicated.
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Determinants and associated factors influencing medication adherence and persistence to oral anticancer drugs: a systematic review. Cancer Treat Rev 2013; 39:610-21. [PMID: 23428230 DOI: 10.1016/j.ctrv.2012.12.014] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS The use of oral anticancer drugs has increased in modern oncology treatment. The move from intravenous treatments towards oral anticancer drugs has increased the patients' own responsibility to take oral anticancer drugs as being prescribed. High rates of non-adherence to oral anticancer drugs have been reported. A systematic literature review was conducted to gain insight into determinants and associated factors of non-adherence and non-persistence in patients taking oral anticancer therapy. REVIEW METHODS PubMed, Cochrane, Web of Science and Cinahl were systematically searched for studies focusing on determinants and associated factors of medication non-adherence and non-persistence to oral anticancer drugs. The methodological quality of the included studies was assessed by two independent reviewers. No studies were excluded based on the quality assessment. RESULTS Twenty-five studies were included and systematically reviewed. The quality of the studies was moderate. Associated factors influencing medication non-adherence and non-persistence to oral anticancer drugs are multifactorial and interrelated. Older and younger age, and the influence of therapy related side effects were found to be predominant factors. CONCLUSION Non-adherence and non-persistence to oral anticancer drug therapy are complex phenomena. More qualitative research is needed to facilitate the development of patient tailored complex interventions by exploring patients' needs and underlying processes influencing medication non-adherence and non-persistence to oral anticancer drugs.
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Thivat E, Van Praagh I, Belliere A, Mouret-Reynier MA, Kwiatkowski F, Durando X, Mahammedi H, Dillies AF, Chollet P, Chevrier R. Adherence with oral oncologic treatment in cancer patients: interest of an adherence score of all dosing errors. Oncology 2012; 84:67-74. [PMID: 23128040 DOI: 10.1159/000342087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/13/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE Patient nonadherence to oral antineoplastic therapy is a well-recognized barrier to effective treatment. In order to identify patients who may need additional support to become adherent, it is important to have a useful tool that takes into account all the parameters of adherence to prescription. The aim of this prospective study was to evaluate adherence of oral antineoplastic agents and to investigate two calculation methods of adherence score. PATIENTS AND METHODS Twenty-nine cancer patients were enrolled in this study. Fourteen were treated by capecitabine and 15 patients by aromatase inhibitors. Adherence was measured using a medication event monitoring system and adherence score was calculated by a usual method and a composite adherence score that takes into account missed doses and also intake interval errors (between 2 doses and between meals). RESULTS Across the 6-month evaluation period, average adherence was 95% with the standard calculation (capecitabine group: 89%; aromatase inhibitor group: 99%) versus 83% with the composite index (capecitabine group: 62%; aromatase inhibitor group: 99%) (p = 0.030). The composite calculation permits to highlight more nonadherent patients (29.6 vs. 7.4%), particularly in the capecitabine group (73 vs. 18%, p = 0.001). We report 2 cases identified as nonadherent with composite adherence rate. CONCLUSION The composite adherence score permits to better evaluate adherence to prescription and to identify barriers to adherence and persistence.
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Affiliation(s)
- E Thivat
- Division of Clinical Research, Centre Jean Perrin, Clermont-Ferrand, France
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Font R, Espinas JA, Gil-Gil M, Barnadas A, Ojeda B, Tusquets I, Segui MA, Margelí M, Arcusa A, Prat A, Garcia M, Borras JM. Prescription refill, patient self-report and physician report in assessing adherence to oral endocrine therapy in early breast cancer patients: a retrospective cohort study in Catalonia, Spain. Br J Cancer 2012; 107:1249-56. [PMID: 22955858 PMCID: PMC3494419 DOI: 10.1038/bjc.2012.389] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AIMS To compare different methods in order to assess adherence and persistence with oral endocrine therapy in women diagnosed with breast cancer (BC) in Catalonia. MATERIALS AND METHODS This study covered all women newly diagnosed with stage I, II or IIIa BC and positive hormone receptors at six hospitals in Catalonia (Spain) in 2004. Adherence was assessed on the basis of physician report and patient self-report using a telephone questionnaire. Persistence was measured by refill prescriptions. We used the Kappa index to compare adherence measures and logistic regression to evaluate adherence-related risk factors. RESULTS The study covered a total of 692 women. Adherence ranged from 92% (self-report) to 94.7% (physician report), depending on the measure used; persistence was 74.7% at 5 years of follow-up. Low concordance between measures was observed (Kappa range: 0.018-0.267). Patients aged 50-74 years showed higher adherence than those aged <50 years. Adherence was also associated with: adjuvant chemotherapy and sequential hormonal therapy. CONCLUSIONS Concordance between the different measures was remarkably low, indicating the need for further research. Adherence is an issue in the management of BC patients taking oral drugs, and should be assessed in clinical practice.
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Affiliation(s)
- R Font
- Catalonian Cancer Strategy Unit, Department of Health, Catalonian Regional Authority, L'Hospitalet de Llobregat, Barcelona, Spain
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Wood L. A review on adherence management in patients on oral cancer therapies. Eur J Oncol Nurs 2012; 16:432-8. [DOI: 10.1016/j.ejon.2011.10.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 09/30/2011] [Accepted: 10/02/2011] [Indexed: 12/27/2022]
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Sommers RM, Miller K, Berry DL. Feasibility Pilot on Medication Adherence and Knowledge in Ambulatory Patients With Gastrointestinal Cancer. Oncol Nurs Forum 2012; 39:E373-9. [DOI: 10.1188/12.onf.e373-e379] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Raborn ML, Pelletier EM, Smith DB, Reyes CM. Patient Out-of-Pocket Payments for Oral Oncolytics: Results From a 2009 US Claims Data Analysis. J Oncol Pract 2012; 8:9s-15s. [PMID: 22942827 PMCID: PMC3348605 DOI: 10.1200/jop.2011.000516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oral oncolytics are an increasingly important treatment option for cancer. These agents often fall within the pharmacy benefit, with the potential for increased out-of-pocket (OOP) cost burden for patients. The purpose of this study was to evaluate patient OOP payments for oral oncolytic therapies in US managed care plans. MATERIALS AND METHODS Patients age ≥ 18 years who received one of 21 oral oncolytics were identified in 2009 US claims; the first oral therapy was the index therapy. OOP payments were calculated as the allowed amount (dollar amount a health plan allows for a therapy, including member liability) minus the paid amount (dollar amount paid by a health plan). Patient characteristics were provided, and per-claim OOP payments were evaluated for each of the 21 therapies in aggregate and stratified by payer type and index therapy. RESULTS A total of 6,094 patients who received at least one oral oncolytic therapy were identified. Mean age was 53 years; 54% were women; 77% had a commercial payer; prevalent cancer diagnoses included breast, colorectal, glioblastoma, and lung. Mean OOP payments were highest for dasatinib ($527; median, $36) and lowest for cyclophosphamide ($15; median, $10). Medicare Risk patients had higher mean OOP payments for most therapies compared with commercial, Medicaid, and self-insured patients. CONCLUSION Among 21 oral oncolytics, average OOP cost ranged from $15 to > $500. These results confirm previous findings showing OOP payments differing widely among oral oncolytic options. As cost for therapy becomes a greater part of treatment decisions, an understanding of patient OOP cost will be critical in informing choices.
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Affiliation(s)
- Martin L. Raborn
- Genentech, South San Francisco, CA; and IMS Health, Watertown, MA
| | | | - Daniel B. Smith
- Genentech, South San Francisco, CA; and IMS Health, Watertown, MA
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Brown JC, Huedo-Medina TB, Pescatello LS, Ryan SM, Pescatello SM, Moker E, LaCroix JM, Ferrer RA, Johnson BT. The efficacy of exercise in reducing depressive symptoms among cancer survivors: a meta-analysis. PLoS One 2012; 7:e30955. [PMID: 22303474 PMCID: PMC3267760 DOI: 10.1371/journal.pone.0030955] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 12/27/2011] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The purpose of this meta-analysis was to examine the efficacy of exercise to reduce depressive symptoms among cancer survivors. In addition, we examined the extent to which exercise dose and clinical characteristics of cancer survivors influence the relationship between exercise and reductions in depressive symptoms. METHODS We conducted a systematic search identifying randomized controlled trials of exercise interventions among adult cancer survivors, examining depressive symptoms as an outcome. We calculated effect sizes for each study and performed weighted multiple regression moderator analysis. RESULTS We identified 40 exercise interventions including 2,929 cancer survivors. Diverse groups of cancer survivors were examined in seven exercise interventions; breast cancer survivors were examined in 26; prostate cancer, leukemia, and lymphoma were examined in two; and colorectal cancer in one. Cancer survivors who completed an exercise intervention reduced depression more than controls, d(+) = -0.13 (95% CI: -0.26, -0.01). Increases in weekly volume of aerobic exercise reduced depressive symptoms in dose-response fashion (β = -0.24, p = 0.03), a pattern evident only in higher quality trials. Exercise reduced depressive symptoms most when exercise sessions were supervised (β = -0.26, p = 0.01) and when cancer survivors were between 47-62 yr (β = 0.27, p = 0.01). CONCLUSION Exercise training provides a small overall reduction in depressive symptoms among cancer survivors but one that increased in dose-response fashion with weekly volume of aerobic exercise in high quality trials. Depressive symptoms were reduced to the greatest degree among breast cancer survivors, among cancer survivors aged between 47-62 yr, or when exercise sessions were supervised.
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Affiliation(s)
- Justin C Brown
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
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Gebbia V, Bellavia G, Ferraù F, Valerio MR. Adherence, compliance and persistence to oral antineoplastic therapy: a review focused on chemotherapeutic and biologic agents. Expert Opin Drug Saf 2011; 11 Suppl 1:S49-59. [PMID: 22149481 DOI: 10.1517/14740338.2011.645803] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION To date, orally administered chemotherapy and biologic agents represent a significant percentage of all antineoplastic treatments in several types of cancer, which are most likely to increase in the near future. In this scenario, the issue of adherence and persistence to oral therapy is a key issue since poor compliance to oral antineoplastic treatments may negatively influence patients' clinical outcomes and, in turn, cause an increase in costs, number of hospitalizations and time spent in the hospital. AREAS COVERED The issue of adherence to new oral chemotherapeutic and/or biologic agents has not been deeply evaluated and data published in medical literature are quite scarce. Adherence is a multidimensional phenomenon, which may be influenced by patient- and health-care provider-related factors, anticancer therapy itself, education and socioeconomic aspects. Patients' selection plays, therefore, a key role in maximizing adherence and persistence to oral therapies. Treating health-care practitioners should first evaluate patient reliability to avoid prescribing oral treatments to patients with socioeconomic and medical conditions, which may predict poor adherence. EXPERT OPINION Adherence and persistence to new oral biologic agents, which are linked to several side effects and whose use is constantly widening, should represent a main endpoint of clinical research in the nearest future.
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Affiliation(s)
- Vittorio Gebbia
- UO Oncologia Medica, La Maddalena, Università di Palermo, Palermo, Italy.
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Given BA, Spoelstra SL, Grant M. The challenges of oral agents as antineoplastic treatments. Semin Oncol Nurs 2011; 27:93-103. [PMID: 21514479 DOI: 10.1016/j.soncn.2011.02.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Given the increasing use of oral antineoplastic agents in cancer management, patient adherence is critical to successful treatment outcomes. This article reviews the scope of the problem and issues of adherence to oral antineoplastic agents. DATA SOURCES Research-based and other articles, newsletters, and conference presentations. CONCLUSION Suboptimal adherence to oral antineoplastic agents is a significant clinical problem that may result in disease or treatment complications, adjustment in treatment regimen, disease progression, and premature death. IMPLICATIONS FOR NURSING PRACTICE Healthcare providers need to monitor and facilitate adherence by identifying barriers and implementing strategies to assure adherence, and therefore, improve clinical outcomes.
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Affiliation(s)
- Barbara A Given
- Michigan State University, College of Nursing, East Lansing, MI 48824, USA.
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Schneider SM, Hess K, Gosselin T. Interventions to promote adherence with oral agents. Semin Oncol Nurs 2011; 27:133-41. [PMID: 21514482 DOI: 10.1016/j.soncn.2011.02.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The advent of oral therapies has dramatically changed the landscape of cancer therapy. Yet the degree to which patients actually take the prescribed agents as ordered remains unknown. This article outlines the challenges that oral chemotherapy agents present to both patients and providers and suggests interventions for promoting adherence. DATA SOURCES Published articles and web resources. CONCLUSION Barriers and facilitators to medication adherence are reviewed and interventions to promote medication adherence are presented. Strategies that include patient education and symptom management can promote adherence. IMPLICATIONS FOR NURSING PRACTICE Maximizing adherence to oral chemotherapy agents can have many positive outcomes, but most important is improvement in overall survival and life expectancy. Other outcomes include improved safety and quality of life. Patients risk improper dosing and an increase in disease recurrence when there is nonadherence with medications. Correct dosing, education, and symptom management are all critical to ensuring adherence. Nursing interventions that incorporate education, early symptom identification, and reminder prompts can improve outcomes.
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Affiliation(s)
- Susan M Schneider
- Duke University School of Nursing, DUMC 3322, Durham, NC 27710, USA.
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Abstract
The maintenance phase of treatment for childhood acute lymphoblastic leukemia is characterized by daily oral chemotherapy dose-adjusted on the basis of toxicity, monitored by regular (1 to 2 weekly) blood counts. A traditional approach is undertaking this at out-patient clinics. A home maintenance program was commenced to reduce visits to hospital and associated family disruption. The program organizes blood tests arranged to be taken at or near the patients' home. The results are examined by a pharmacist and specialist nurse; changes in therapy are communicated by telephone call and written confirmation. Hospital attendance is reduced to monthly visits. To assess the program, tablet counting and before-and-after audits of parental satisfaction were undertaken. Results of the first 2 years are presented. Preliminary analysis to identify predictors of nonadherence was performed. Fifty families were included in the evaluation. There were no critical incidents. Poor adherence rates in the initial 3-month period (overall 24%) improved after increased support and advice were offered to 78%. Increasing age was correlated with good adherence (r=0.37, P=0.02). Partnership status of the child's caretakers was strongly associated with adherence (14% of poor adhering patients had caretakers in stable partnerships, compared with 87% of good adhering patients, P<0.01).
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