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Dang TH, Ludlow C, Borle H, Alexander M, Wickramasinghe N, Burbury K, Jayaraman PP, Schofield P. Co-designing a motivational interviewing training platform to enhance oncology healthcare professional communication. PEC INNOVATION 2024; 5:100335. [PMID: 39257627 PMCID: PMC11385463 DOI: 10.1016/j.pecinn.2024.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 08/13/2024] [Accepted: 08/18/2024] [Indexed: 09/12/2024]
Abstract
Background Oncology healthcare professionals (HCPs) using motivational interviewing may motivate and support patients with chronic illness to adhere to medications. Research of online motivational interviewing training focusing on medication adherence in cancer is limited. Objective Co-design, develop, and preliminarily evaluate a motivational interviewing training platform (MITP) for oncology HCPs focused on medication adherence. Methods We used co-design and design science research methodology to develop and test the MITP in two phases: 1) program co-design and development and 2) interactive platform design and development. Results HCPs expressed a high demand for a practical and tailored motivational interviewing training. MITP is an online three-hour training comprising education, roleplay videos, and formative assessments. MITP was reported to be acceptable, usable, and useful by users. Innovation This study used a novel approach combining co-design and design science research methodology, and digital media to develop a flexible and acceptable online motivational interviewing training focused on medication adherence in cancer. Discussion and conclusion Applied rigorous methodology ensured the MITP was developed to address knowledge gaps and the needs of oncology HCPs for supporting patient adherence, and to be usable and useful. Study findings may inform future research on online motivational interviewing training and its potential impact on medication adherence.
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Affiliation(s)
- Thu Ha Dang
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Digital Health Cooperative Research Centre, Sydney, Australia
| | - Chris Ludlow
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | | | - Marliese Alexander
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Nilmini Wickramasinghe
- Optus Digital Health, La Trobe University, Melbourne, Victoria, Australia
- Department Health and Bio-Statistics, School of Health Sciences and Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria, Australia
- Epworth Healthcare, Victoria, Australia
| | - Kate Burbury
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Digital and Healthcare Innovation, Peter McCallum Cancer Centre, Melbourne, Victoria, Australia
- Tasmanian Health Services, Department of Health, Hobart, Tasmania, Australia
| | - Prem Prakash Jayaraman
- Factory of the Future and Digital Innovation Lab, Department of Computer Science and Software Engineering, School Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Penelope Schofield
- Optus Digital Health, La Trobe University, Melbourne, Victoria, Australia
- Department of Psychological Sciences, and Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Ucciero S, Lacarbonara F, Durante A, Torino F, Uchmanowicz I, Vellone E, Di Nitto M. Predictors of self-care in patients with cancer treated with oral anticancer agents: A systematic review. PLoS One 2024; 19:e0307838. [PMID: 39316559 PMCID: PMC11421779 DOI: 10.1371/journal.pone.0307838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/04/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND In the last two decades, the use of oral anticancer agents (OAAs) has increased in cancer patients. Despite this, patients and their caregivers face some challenging issues (side effects, drug-to-drug interactions, etc.) related to OAA administration. The three dimensions of self-care by Riegel et al., self-care maintenance (i.e., stability of patient condition), self-care monitoring (i.e., detection of side effects), and self-care management (i.e., management of side effects), may be implemented to avoid negative outcomes. However, knowledge of self-care determinants is necessary to recognise people at risk of poor self-care behaviours. AIMS Determine which are the predictors of self-care maintenance, self-care monitoring and self-care management in patients with cancer taking OAA. METHODS A systematic review with narrative synthesis was conducted. We included studies on adult patients with cancer using any kind of oral anticancer agent and describing a predictor of self-care. The search was performed on PubMed, CINAHL/PsycINFO, and Web of Science. RESULTS Of 3,061 records, 45 studies were included in this review. Forty-six predictors organised into 14 categories were identified. In general, all studies focused only on adherence, considered as a self-care maintenance component, and none of them focused on other dimensions of self-care. The predictors of OAA adherence most reported were age, side effects, and socioeconomic factors (e.g., insurance status, and annual income). CONCLUSIONS This systematic review highlighted the literature gap on the analysis of determinants of self-care behaviours in patients taking OAAs. This element could be a starting point for future research that can provide elements to support the oncology nursing research agenda, aimed at recognising patients at risk of poor self-care.
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Affiliation(s)
- Silvia Ucciero
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Federica Lacarbonara
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Angela Durante
- School of Advanced Studies Sant’Anna, Health Science Center, Pisa, Italy
| | - Francesco Torino
- Department of Systems Medicine, Medical Oncology, Tor Vergata University of Rome, Rome, Italy
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Ercole Vellone
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Marco Di Nitto
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Bernardez B, Mangues-Bafalluy I, Callejo VM, Ávila JJF, Rodríguez JAM, Aradilla MAP, Bautista MJM. Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. FARMACIA HOSPITALARIA 2024; 48:T108-T115. [PMID: 38461113 DOI: 10.1016/j.farma.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE We aimed to develop of a risk stratification model for the pharmaceutical care (PC) of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through three workshops and a pilot study. Variables were defined, grouped into four dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into three priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score =11); social and health variables and cognitive and functional status (maximum = 19); clinical and health services utilization (maximum = 25); and treatment-related (maximum = 41). From the results of applying the model to the 199 patients enrolled, the cutoff points for categorization were 28 or more points for priority 1, 16 to 27 points for priority 2 and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of 'clinical and health services utilization' and 'treatment-related'. Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
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Affiliation(s)
- Beatriz Bernardez
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, España; Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo de Farmacología, Instituto de Investigación Santiago de Compostela (IDIS), Santiago de Compostela, España.
| | - Irene Mangues-Bafalluy
- Servicio de Farmacia, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, España; Grupo de Farmacoepidemiología y Farmacodinamia, Institut de Recerca Biomèdica, IRBLleida, Lleida, España
| | - Virginia Martínez Callejo
- Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander, España
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Bernardez B, Mangues-Bafalluy I, Callejo VM, Ávila JJF, Rodríguez JAM, Aradilla MAP, Bautista MJM. Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. FARMACIA HOSPITALARIA 2024; 48:108-115. [PMID: 37884399 DOI: 10.1016/j.farma.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE We aimed to develop of a risk stratification model for the pharmaceutical care of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through 3 workshops and a pilot study. Variables were defined, grouped into 4 dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into 3 priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score=11); social and health variables and cognitive and functional status (maximum=19); clinical and health services utilization (maximum=25); and treatment-related (maximum=41). From the results of applying the model to the 199 patients enrolled, the cut-off points for categorization were 28 or more points for priority 1, 16-27 points for priority 2, and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of "clinical and health services utilization" and "treatment-related." Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
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Affiliation(s)
- Beatriz Bernardez
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago, Spain; Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Clínico, Universitario de Santiago de Compostela, Santiago, Spain; Grupo de Farmacología, Instituto de Investigación Santiago de Compostela (IDIS), Santiago, Spain.
| | - Irene Mangues-Bafalluy
- Servicio de Farmacia, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Grupo de Farmacoepidemiología y Farmacodinamia, Institut de Recerca Biomèdica, IRBLleida, Lleida, Spain
| | - Virginia Martínez Callejo
- Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Masiero M, Spada GE, Sanchini V, Munzone E, Pietrobon R, Teixeira L, Valencia M, Machiavelli A, Fragale E, Pezzolato M, Pravettoni G. A Machine Learning Model to Predict Patients' Adherence Behavior and a Decision Support System for Patients With Metastatic Breast Cancer: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48852. [PMID: 38096002 PMCID: PMC10755656 DOI: 10.2196/48852] [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: 05/09/2023] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Adherence to oral anticancer treatments is critical in the disease trajectory of patients with breast cancer. Given the impact of nonadherence on clinical outcomes and the associated economic burden for the health care system, finding ways to increase treatment adherence is particularly relevant. OBJECTIVE The primary end point is to evaluate the effectiveness of a decision support system (DSS) and a machine learning web application in promoting adherence to oral anticancer treatments among patients with metastatic breast cancer. The secondary end point is to collect a set of new physical, psychological, social, behavioral, and quality of life predictive variables that could be used to refine the preliminary version of the machine learning model to predict patients' adherence behavior. METHODS This prospective, randomized controlled study is nested in a large-scale international project named "Enhancing therapy adherence among metastatic breast cancer patients" (Pfizer 65080791), aimed to develop a predictive model of nonadherence and associated DSS and guidelines to foster patients' engagement and therapy adherence. A web-based DSS named TREAT (treatment adherence support) was developed using a patient-driven approach, with 4 sections, that is, Section A: Metastatic Breast Cancer; Section B: Adherence to Cancer Therapies; Section C: Promoting Adherence; and Section D: My Adherence Diary. Moreover, a machine learning-based web application was developed to predict patients' risk factors of adherence to anticancer treatment, specifically pertaining to physical status and comorbid conditions, as well as short and long-term side effects. Overall, 100 patients consecutively admitted at the European Institute of Oncology (IEO) at the Division of Medical Senology will be enrolled; 50 patients with metastatic breast cancer will be exposed to the DSS and machine learning web application for 3 months (experimental group), and 50 patients will not be exposed to the intervention (control group). Each participant will fill a weekly medication diary and a set of standardized self-reports evaluating psychological and quality of life variables (Adherence Attitude Inventory, Beck Depression Inventory-II, Brief Pain Inventory, 13-item Sense of Coherence scale, Brief Italian version of Cancer Behavior Inventory, European Organization for Research and Treatment of Cancer Quality of Life 23-item Breast Cancer-specific Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 8-item Morisky Medication Adherence Scale, State-Trait Anxiety Inventory forms I and II, Big Five Inventory, and visual analogue scales evaluating risk perception). The 3 assessment time points are T0 (baseline), T1 (1 month), T2 (2 months), and T3 (3 months). This study was approved by the IEO ethics committee (R1786/22-IEO 1907). RESULTS The recruitment process started in May 2023 and is expected to conclude on December 2023. CONCLUSIONS The contribution of machine learning techniques through risk-predictive models integrated into DSS will enable medication adherence by patients with cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT06161181; https://clinicaltrials.gov/study/NCT06161181. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48852.
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Affiliation(s)
- Marianna Masiero
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gea Elena Spada
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Virginia Sanchini
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | | | | | - Elisa Fragale
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Massimo Pezzolato
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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Graff SL, Yan F, Abdou Y. Newly Approved and Emerging Agents in HER2-Positive Metastatic Breast Cancer. Clin Breast Cancer 2023; 23:e380-e393. [PMID: 37407378 DOI: 10.1016/j.clbc.2023.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 07/07/2023]
Abstract
Human epidermal growth factor receptor 2-positive breast cancer (HER2+ BC) is an aggressive tumor type, accounting for 15% to 20% of the approximately 300,000 new BC cases in the United States each year. The goal of this review is to discuss the evolving landscape of therapies for HER2+ metastatic BC (mBC). Targeted therapies that have been the standard of care (SOC) for HER2+ mBC for almost a decade have greatly improved patient outcomes. The SOC for the first-line treatment of HER2+ mBC continues to be HER2-targeted monoclonal antibodies (mAbs) + a taxane, but recent updates in the second-line setting favor use of a newer HER2-targeted antibody-drug conjugate (ADC), trastuzumab deruxtecan, versus the prior SOC ADC, trastuzumab emtansine. Numerous options are now available in the third line and beyond, including tyrosine kinase inhibitor (TKI) regimens, newer mAbs, and other ADCs. The optimal course of treatment for individual patients can be guided by location of metastases, prior therapies, concomitant biomarkers, and monitoring and management of adverse events. Ongoing trials will further the evolution of the HER2+ mBC treatment landscape. Furthermore, next-generation ADCs, TKIs, and classes of drugs that have not been approved for the treatment of HER2+ mBC, including immune checkpoint inhibitors and cyclin-dependent kinase 4 and 6 inhibitors, are also being evaluated for their efficacy in the first and second line. Although the influx of new drugs may complicate treatment decisions for physicians, having a multitude of options will undoubtedly further improve patient outcomes and patient-centered care.
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Affiliation(s)
- Stephanie L Graff
- Ambulatory Patient Center, Lifespan Cancer Institute, Legorreta Cancer Center at Brown University, Rhode Island Hospital, Providence, RI.
| | - Fengting Yan
- Swedish Cancer Institute, First Hill-True Family Women's Cancer Center, Seattle, WA
| | - Yara Abdou
- UNC School of Medicine, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Achieng C, Bunani N, Kagaayi J, Nuwaha F. Adherence to antiretroviral and cancer chemotherapy, and associated factors among patients with HIV-cancer co-morbidity at the Uganda Cancer Institute: a cross sectional study. BMC Public Health 2023; 23:1451. [PMID: 37507710 PMCID: PMC10386774 DOI: 10.1186/s12889-023-16387-z] [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: 07/31/2021] [Accepted: 10/17/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Human Immunodeficiency Virus is a major global public health issue affecting millions of people, and sub-Saharan Africa where Uganda lies is disproportionately affected. There has been an increase in cancer among HIV patients which has resulted into use of co-medications that sometimes affect ART and cancer chemotherapy adherence. We aimed to determine adherence to antiretroviral and cancer chemotherapy and the associated factors among patients with HIV-cancer co-morbidity at the Uganda Cancer Institute. METHODS We conducted a cross-sectional study among 200 randomly selected adult cancer patients infected with HIV and attending the Uganda cancer institute. Antiretroviral and anti-cancer chemotherapy adherence with associated factors were assessed quantitatively. We collected the data using interviewer administered semi-structured questionnaires. Modified Poisson regression with robust standard errors was used to estimate the prevalence ratios (PR) and its 95% confidence intervals (CI) for the factors associated with adherence to Antiretroviral Therapy (ART) and cancer chemotherapy. RESULTS Overall, 54% of the study participants adhered to both ART and chemotherapy, and 55% adhered to ART while 65% adhered to cancer chemotherapy. The mean age of the respondents was 42 (SD ± 11years), and a majority, 61% were males.More than half, 56.5% were married and at least 45% had attained a primary level of education. Patients with good adherence to antiretroviral therapy and chemotherapy were 54%. No knowledge of cancer stage (PR = 0.4, 95% CI = 0.3-0.6, P < 0.0001), having an AIDS defining cancer (PR = 0.7, 95% CI = 0.5-0.9, P = 0.005), ART clinic in district not near Uganda Cancer Institute (PR = 0.7,95% CI = 0.8-1.0, P = 0.027) and affordability of cancer chemotherapy (PR = 1.4, 95% CI = 1.0-1.9, P = 0.037) were associated with adherence to both ART and cancer chemotherapy. CONCLUSION Adherence to both ART and cancer chemotherapy was low. Factors significantly associated with adherence were: knowledge of the cancer stage by the patient, the type of cancer diagnosis, source of ART and affordability/ availability of medications. There is a need to provide information on the stage of cancer and adherence counseling to patients. Furthermore, Integration of HIV- cancer care will be necessary for efficient and effective care for the patients.
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Affiliation(s)
- Caroline Achieng
- Makerere University School of Public Health, Kampala, Uganda.
- Uganda Heart Institute, Kampala, Uganda.
| | - Nelson Bunani
- Makerere University School of Public Health, Kampala, Uganda
| | - Joseph Kagaayi
- Makerere University School of Public Health, Kampala, Uganda
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Fred Nuwaha
- Makerere University School of Public Health, Kampala, Uganda
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Marineau A, St-Pierre C, Lessard-Hurtubise R, David MÈ, Adam JP, Chabot I. Cyclin-dependent kinase 4/6 inhibitor treatment use in women treated for advanced breast cancer: Integrating ASCO/NCODA patient-centered standards in a community pharmacy. J Oncol Pharm Pract 2023; 29:1144-1153. [PMID: 35642282 PMCID: PMC10302375 DOI: 10.1177/10781552221102884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/25/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Outpatients treated with oral anti-cancer drugs, including selective cyclin-dependent kinase 4/6 inhibitors (CDK4/6i), may benefit from a pharmacy practice setting adapted to support proper oral anti-cancer drug monitoring. This real-world study aimed to characterize patient-centered pharmacy practice aligned with American Society of Clinical Oncology (ASCO)/National Community Oncology Dispensing Association (NCODA) standards and to describe its impact on CDK4/6i treatment use. METHODS This retrospective study included women with confirmed hormone receptor-positive/human epidermal growth factor 2 negative locally advanced or metastatic breast cancer treated with either palbociclib, abemaciclib or ribociclib combined with letrozole or fulvestrant. Pharmacists collected patient characteristics, clinical activities, and treatment patterns using data from the pharmacy chart. CDK4/6i treatment adherence rates were estimated based on medication claims data. Time-to-treatment discontinuation, a proxy for time-to-event, was assessed using the Kaplan-Meier estimate. RESULTS Of the 195 patients assessed for eligibility, 65 were included in this study. The median observation duration was 13.6 months. An average of seven pharmaceutical care activities (range 2.8-21.7) per patient was documented for each treatment cycle. The mean proportion of days covered was 89.6%. The median time-to-treatment discontinuation was estimated at 44.2 months in patients treated with CDK4/6i + letrozole and 17.0 months in patients treated with CDK4/6i + fulvestrant. The average relative dose intensity was 85%, and the benefits of treatment were maintained regardless of the relative dose intensity levels. CONCLUSION A structured patient-centered pharmacy practice model integrating the ASCO/NCODA patient-centered standards and ongoing communication with patients and healthcare providers ensure timely refills, close monitoring, and allows patients to achieve high adherence and persistence rates comparable to those reported in clinical trials.
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Affiliation(s)
| | | | | | | | - Jean-Philippe Adam
- Department of Pharmacy, Centre hospitalier de l’Université de Montréal, Montréal, Canada
- CHUM Research Center, CHUM, Montréal, Canada
| | - Isabelle Chabot
- Faculty of Pharmacy, Université de Montréal, Montréal, Canada
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9
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Corvaisier M, Duval O, Paillassa J, Hunault-Berger M, Spiesser-Robelet L. [Implementation of pharmaceutical consultations in oncohematology in a teaching hospital: Over one year outcomes]. ANNALES PHARMACEUTIQUES FRANÇAISES 2022:S0003-4509(22)00158-4. [PMID: 36513152 DOI: 10.1016/j.pharma.2022.12.001] [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: 08/19/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
The development of Oral Cancer Therapies (OAT) raises the question of the therapeutic adherence of patients, put in difficulty by the isolation of the patient in the management of treatment and adverse reactions. Accompanying processes are developing, such as Pharmaceutical Consultations (PC), whose monitoring and education objectives are multiple. The PCs and their implementation are presented here, as well as the first results at 15months. The scope of the PCs was first defined, as well as their organization and supporting documents. A patient's medication history is carried out before the PC, then analyzed. The initial PC incorporates a discussion about patient's health habits, followed by information on the OAT, which is closed by the delivery of a follow-up diary. The follow-up PCs, distributed over the course of the first year following the initiation, allow to correct the erroneous knowledge of the patient, to support him in his difficulties and to detect any adverse effects. From May 2019 to August 2020, 81.2% of the 32 patients who initiated OAT took part in CP. A pharmacotherapeutic problem is encountered in 65.4% of them and a drug interaction with alternative or complementary medicines in 62.5% of patients which consuming. The PCs developed provide new elements compared to the recommendations and provide support for patients with toxicities that weaken their medical care throughout their care pathway.
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Affiliation(s)
- M Corvaisier
- Département de pharmacie, Faculté de Santé, Université d'Angers, Angers, France; Laboratoire de Psychologie des Pays de la Loire EA4638, Université d'Angers, Angers, France; Pharmacie à Usage Intérieur, Centre Hospitalier Universitaire, Angers, France.
| | - O Duval
- Département de pharmacie, Faculté de Santé, Université d'Angers, Angers, France; Maladies du sang, Centre Hospitalier Universitaire, Angers, France; MINT (Inserm U1066 CNRS 6021), Université d'Angers, Angers, France
| | - J Paillassa
- Maladies du sang, Centre Hospitalier Universitaire, Angers, France
| | - M Hunault-Berger
- Maladies du sang, Centre Hospitalier Universitaire, Angers, France; Inserm, CNRS, CRCI2NA (UMR_S 892 CNRS 6299 CRCNA), SFR ICAT, 49000, FHU GOAL, Université d'Angers, Université de Nantes, Angers, France; Département de médecine, Faculté de Santé, Université d'Angers, Angers, France
| | - L Spiesser-Robelet
- Département de pharmacie, Faculté de Santé, Université d'Angers, Angers, France; Pharmacie à Usage Intérieur, Centre Hospitalier Universitaire, Angers, France; Laboratoire des Éducations et Pratiques de Santé EA3412, Université Sorbonne Paris Nord, Bobigny, France
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10
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Joret R, Matti N, Beck M, Michel B. Medication adherence and persistence among patients with non-small cell lung cancer receiving tyrosine kinase inhibitors and estimation of the economic burden associated with the unused medicines. J Oncol Pharm Pract 2022; 28:1120-1129. [PMID: 33896267 DOI: 10.1177/10781552211012452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is a leading cause of cancer deaths. Its treatment includes specific oral tyrosine kinases inhibitors (TKIs). OBJECTIVES To estimate adherence and persistence among patients receiving TKIs and to assess the economic burden of the unused medicines in Alsace (France). METHOD This retrospective study was carried out using the Insurance Healthcare database. MAIN OUTCOME MEASURES Adherence was calculated using medication possession ratio (MPR), persistence using estimated level of persistence with therapy (ELPT) and economic impact using prescription refill data. RESULTS 242 patients were receiving TKIs. The most common TKIs prescribed were erlotinib (75.6%, n = 183) and crizotinib (12.8%, n = 31). Total of 149 patients were included in the adherence analysis. Overall MPR was 0.98. 180 patients were included in the persistence analysis. Almost half of patients had stopped treatment at 60 days and only 38.3% (n = 69) were still persistent with the therapy at 120 days. The expenses related to unused TKIs amounted to €356,392 and were related majorly to treatment discontinuation followed by overlapping refills, patient deaths and dose- or drug-switching, respectively. CONCLUSIONS Our data indicated overall adherence medicines above the acceptable limit of 0.80 but also pointed out a significant decline in persistence over time. The resulting economic losses justify the need for physicians and pharmacists to closely monitor their patients to ensure continuity of treatment. To limit the cost associated with unused medicines, interventions such as app-based monitoring, dispensing TKIs per unit over shorter periods and not only on monthly intervals could be implemented.
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Affiliation(s)
| | - Nazish Matti
- Department of Pharmacy, Quaid-e-Azam University, Islamabad, Pakistan
- Faculty of Pharmacy, University of Strasbourg, Strasbourg, France
| | - Morgane Beck
- Agence Régionale de Santé Grand Est, Strasbourg, France
| | - Bruno Michel
- OMEDIT Grand EST, Strasbourg, France
- Faculty of Pharmacy, University of Strasbourg, Strasbourg, France
- Department of Pharmacy, University Hospital of Strasbourg, Strasbourg, France
- Laboratory of Neuro-Cardiovascular Pharmacology and Toxicology UR7296, University of Strasbourg, Strasbourg, France
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11
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Kaye DR, Wilson LE, Greiner MA, Spees LP, Pritchard JE, Zhang T, Pollack CE, George D, Scales CD, Baggett CD, Gross CP, Leapman MS, Wheeler SB, Dinan MA. Patient, provider, and hospital factors associated with oral anti-neoplastic agent initiation and adherence in older patients with metastatic renal cell carcinoma. J Geriatr Oncol 2022; 13:614-623. [PMID: 35125336 PMCID: PMC9232903 DOI: 10.1016/j.jgo.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/16/2021] [Accepted: 01/13/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Oral anti-neoplastic agents (OAAs) for metastatic renal cell carcinoma (mRCC) are associated with increased cancer-specific survival. However, racial disparities in survival persist and older adults have the lowest rates of cancer-specific survival. Research from other cancers demonstrates specialty access is associated with high-quality cancer care, but older adults receive cancer treatment less often than younger adults. We therefore examined whether patient, provider, and hospital characteristics were associated with OAA initiation, adherence, and cancer-specific survival after initiation and whether race, ethnicity, and/or age was associated with an increased likelihood of seeing a medical oncologist for diagnosis of mRCC. PATIENTS AND METHODS We used Surveillance, Epidemiology, and End Results (SEER)Medicare data to identify patients ≥65 years of age who were diagnosed with mRCC from 2007 to 2015 and enrolled in Medicare Part D. Insurance claims were used to identify receipt of OAAs within twelve months of metastatic diagnosis, calculate proportion of days covered, and to identify the primary cancer provider and hospital. We examined provider and hospital characteristics associated with OAA initiation, adherence, and all-cause mortality after OAA initiation. RESULTS We identified 2792 patients who met inclusion criteria. Increased OAA initiation was associated with access to a medical oncologist. Patients were less likely to begin OAA treatment if their primary oncologic provider was a urologist (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.49-0.77). Provider/hospital characteristics were not associated with differences in OAA adherence or mortality. Patients who started sorafenib (odds ratio [OR] 0.50; 95% CI 0.29-0.86), were older (aged >81 OR 0.56; 95% CI 0.34-0.92), and those living in high poverty ZIP codes (OR 0.48; 95% CI 0.29-0.80) were less likely to adhere to OAA treatment. Furthermore, provider characteristics did not account for differences in mortality once an OAA was initiated. Last, only age > 81 years was statistically and clinically associated with a decreased relative risk of seeing a medical oncologist (risk ratio [RR] 0.87; CI 0.82-0.92). CONCLUSION Provider/hospital factors, specifically, being seen by a medical oncologist for mRCC diagnosis, are associated with OAA initiation. Older patients were less likely to see a medical oncologist; however, race and/or ethnicity was not associated with differences in seeing a medical oncologist. Patient factors are more critical to OAA adherence and mortality after OAA initiation than provider/hospital factors.
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Affiliation(s)
- Deborah R Kaye
- Department of Surgery (Urology), Duke University School of Medicine, Durham, NC, United States of America; Duke-Margolis Policy Center, Duke University School of Medicine, Durham, NC, United States of America; Duke Cancer Institute, Durham, NC, United States of America
| | - Lauren E Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, United States of America
| | - Jessica E Pritchard
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Tian Zhang
- Duke Cancer Institute, Durham, NC, United States of America; Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Daniel George
- Duke Cancer Institute, Durham, NC, United States of America; Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Charles D Scales
- Department of Surgery (Urology), Duke University School of Medicine, Durham, NC, United States of America; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Chris D Baggett
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, United States of America; Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, United States of America
| | - Cary P Gross
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT, United States of America
| | - Michael S Leapman
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT, United States of America; Department of Urology, Yale School of Medicine, New Haven, CT, United States of America
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, United States of America
| | - Michaela A Dinan
- Department of Urology, Yale School of Medicine, New Haven, CT, United States of America.
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12
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Self-care behaviors in patients with cancer treated with oral anticancer agents: a systematic review. Support Care Cancer 2022; 30:8465-8483. [PMID: 35639188 DOI: 10.1007/s00520-022-07166-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Continuous progress in cancer care has led to its increased use in oral anticancer agents that are easily managed by patients at home with fewer costs and hospitalizations. However, correct self-care behaviors are needed for the safe use of these medications. This review aimed to synthesize studies on self-care behaviors in patients treated with oral anticancer agents. METHODS This systematic review used a convergent qualitative synthesis design for mixed studies. Studies on adult patients with cancer using any kind of oral anticancer agent and describing self-care maintenance, self-care monitoring, and/or self-care management behaviors were searched on PubMed, EMBASE, and CINAHL. After data extraction, the findings were retained for qualitative synthesis. FINDINGS Of 3419 records, 19 studies were included in this review. From the qualitative synthesis, all the retrieved behaviors were synthesized in the three self-care dimensions. Five themes and 18 subthemes were identified. Self-care maintenance included "adherence to the medications" and "prevention." Self-care monitoring consisted of "health surveillance and recognition of illness changes." Self-care management included "seeking help" and "autonomous management of side effects." Overall, most of the behaviors described focused only on adherence. CONCLUSION The findings of this systematic review could guide future studies on self-care and drive future interventions aimed at improving self-care in this vulnerable population. Nurses and other healthcare professionals should provide self-care support to patients taking oral anticancer agents. In particular, they should promote behaviors aimed at improving well-being, preserving health, or managing side effects.
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13
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Quaschning K, Koerner M, Wirtz MA. Analyzing the effects of barriers to and facilitators of medication adherence among patients with cardiometabolic diseases: a structural equation modeling approach. BMC Health Serv Res 2022; 22:588. [PMID: 35501793 PMCID: PMC9063142 DOI: 10.1186/s12913-022-07987-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background Based on the theoretical model of medication adherence (WHO, 2003), the aims of the study were (1) to develop and test a theory-based multidimensional model for the predictive power of barriers to and facilitators of medication adherence and (2) to identify the mediating effects of barriers to medication adherence on drug-related patient outcomes (barrier “MedAd- “: forget; facilitator “MedAd + ”: regular intake). Methods Within a cross-sectional study entitled “Increasing medication adherence to improve patient safety in cardiological rehabilitation (PaSiMed)”, the model was evaluated in structural analytical terms based on data collected online of N = 225 patients with cardiometabolic diseases. The revised “Freiburg questionnaire on medication adherence (FF-MedAd-R)" was used to measure the latent constructs (e.g., facilitator: communication; barrier: reservations).” Results The structural equation model proved to exhibit an appropriate data fit (RMSEA: .05; CFI: .92). For all first-order facilitators of medication adherence, a high proportion of variance (62–94%) could be explained by the second-order factor “Physician–patient relationship (PPR)”. All paths from “PPR” to the constructs depicting barriers to medication adherence showed significant negative effects. Facilitators (“MedAd + ”) and barriers (“MedAd-”) accounted for 20% and 12% of the variance, respectively, in global items of medication adherence. Whereas “Carelessness” showed a full mediation for “MedAd-”, ‘‘Reservations’’ showed a partial mediation for “MedAd + ”. Conclusions “PPR” is an important predictor of patient medication adherence. The results underline the importance of a trustful physician–patient relationship in reducing barriers and enhancing medication adherence. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07987-3.
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Affiliation(s)
- Katharina Quaschning
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, 79104, Freiburg, Germany.
| | - Mirjam Koerner
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, 79104, Freiburg, Germany
| | - Markus Antonius Wirtz
- Department of Research Methods in the Health Sciences, Institute of Everyday Culture, Sports and Health, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany
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14
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Di Nitto M, Sollazzo F, Biagioli V, Torino F, Alvaro R, Vellone E, Durante A. Self-care behaviours in older adults treated with oral anticancer agents: A qualitative descriptive study. Eur J Oncol Nurs 2022; 58:102139. [DOI: 10.1016/j.ejon.2022.102139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/22/2022] [Accepted: 04/03/2022] [Indexed: 11/04/2022]
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15
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Chun DS, Hicks B, Hinton SP, Funk MJ, Gooden K, Keil AP, Tan HJ, Stürmer T, Lund JL. Comparison of Approaches for Measuring Adherence and Persistence to Oral Oncologic Therapies in Patients Diagnosed with Metastatic Renal Cell Carcinoma. Cancer Epidemiol Biomarkers Prev 2022; 31:893-899. [PMID: 35064061 DOI: 10.1158/1055-9965.epi-21-0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/28/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adherence and persistence studies face several methodologic difficulties, including short-term mortality. We compared approaches to quantify adherence and persistence to first line (1L) oral targeted therapy (TT) in patients diagnosed with metastatic renal cell carcinoma (mRCC). METHODS Patients with mRCC ages 66 years or more who initiated TTs within 4 months of diagnosis were identified in the Surveillance, Epidemiology, and End Results Medicare-linked database (2007-2015). Adherence [proportion of days covered (PDC) >80%] was calculated using (i) PDC with a fixed 6-month denominator including then excluding patients who died within the 6 months and (ii) PDC with a denominator measuring time on treatment. Risk of nonpersistence was obtained by censoring death or treating death as a competing risk using cumulative incidence functions. RESULTS Among 485 patients with mRCC initiating a 1L oral TT (sunitinib, 64%; pazopanib, 25%; other, 11%), 40% died within 6 months. Adherence was higher after restricting to patients who survived (60%) compared with including those patients and assigning zero days covered after death (47%). Risk of nonpersistence was higher when censoring patients at death, 0.91 [95% confidence interval (CI), 0.88-0.94], compared with treating death as a competing risk, 0.75 (95% CI, 0.71-0.79). CONCLUSIONS Different approaches to handling death resulted in different adherence and persistence estimates in the metastatic setting. Future studies should explicitly report the proportion of patient deaths over time and explore appropriate methods to account for death as competing risk. IMPACT Use of several approaches can provide a more comprehensive picture of medication-taking behavior in the metastatic setting where death is a major competing risk.
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Affiliation(s)
- Danielle S Chun
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Blánaid Hicks
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Sharon Peacock Hinton
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Michele Jonsson Funk
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Kyna Gooden
- Bristol Meyers Squibb, Princeton Pike, New Jersey
| | - Alexander P Keil
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Hung-Jui Tan
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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16
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Saint-Ghislain M, Levenbruck C, Bellesoeur A. Adverse events of targeted therapies approved for women's cancers. Int J Womens Dermatol 2022; 7:552-559. [PMID: 35024412 PMCID: PMC8721120 DOI: 10.1016/j.ijwd.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/14/2022] Open
Abstract
Breast cancer and gynecologic cancers affect >3 million women worldwide each year. With advances in precision medicine, a growing number of targeted therapies have been approved recently, and new therapeutic classes have emerged, including cell cycle inhibitors for hormone receptor positive breast cancer, antibody drug conjugate for human epidermal growth factor receptor 2 positive and triple negative breast cancer, and poly-ADP-ribose polymerase inhibitors for ovarian cancer. This article focuses first on the challenges for health care systems to address the specificities of each emerging targeted therapy and new issues raised by oral antitumor treatments, including individualization of prescriptions, drug–drug interaction assessment, pharmaceutical counseling, patient education, and outpatient management. Then, we provide an overview of the main adverse effects of targeted therapies approved for breast and gynecologic cancers, such as hematologic toxicity of cyclin-dependent kinase 4/6 inhibitors and poly-ADP-ribose polymerase inhibitors, metabolic disorders of phosphatidylinositol-3-kinase/Akt/mammalian target of rapamycin inhibitors, and cardiovascular toxicity of agents targeting human epidermal growth factor receptor 2.
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Affiliation(s)
| | | | - Audrey Bellesoeur
- Medical Oncology Department, Institut Curie, Paris, France.,Pharmacy Department, Institut Curie, Paris, France.,Radiopharmacology Department, Institut Curie, Saint-Cloud, France
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17
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Gönderen Çakmak HS, Kapucu S. The Effect of Educational Follow-Up with the Motivational Interview Technique on Self-Efficacy and Drug Adherence in Cancer Patients Using Oral Chemotherapy Treatment: A Randomized Controlled Trial. Semin Oncol Nurs 2021; 37:151140. [PMID: 33766423 DOI: 10.1016/j.soncn.2021.151140] [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: 07/20/2020] [Revised: 01/20/2021] [Accepted: 01/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed to determine the effect of educational follow-up with the motivational interview technique on drug adherence and self-efficacy in patients with cancer using at least one oral chemotherapy drug. DATA SOURCES A total of 80 patients with cancer were randomly allocated to the intervention group or the control group. Educational follow-up with the motivational interview technique was applied to the patients with phone calls during weeks 1, 3, 6, and 9. Patients in the intervention and control groups were evaluated during both the first interview and at week 12 using a questionnaire, the medication adherence self-efficacy scale (MASES), and oral chemotherapy adherence scale (OCAS). CONCLUSION At the end of the study, the level of drug adherence and self-efficacy of patients who received educational follow-up with the motivational interview technique by phone call increased significantly (P < .001). Additionally, the level of drug self-efficacy of patients increased (P < .001). IMPLICATIONS FOR NURSING PRACTICE This study emphasizes treatment compliance problems of patients with cancer using oral chemotherapy. Designed with communication techniques that will be added to our counseling process, interventions can allow nurses to use their time effectively.
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Affiliation(s)
| | - Sevgisun Kapucu
- Faculty of Nursing, Internal Medicine Nursing Department, Hacettepe University, Ankara, Turkey
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18
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Quaschning K, Körner M. [Faciliators and Barriers of Medication Adherence of Rehabilitants with Cardiovascular Diseases - A Qualitative Survey]. REHABILITATION 2020; 60:37-44. [PMID: 33152780 DOI: 10.1055/a-1242-9562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The medication adherence of people with chronic diseases is often deficient. The present study investigated facilitators and barriers of the implementation of prescribed medication among rehabilitants with cardiological diseases in medical rehabilitation. METHODS In total, 22 rehabilitants with cardiological diseases in medical rehabilitation were interviewed by means of a guided interview. All interviews were digitally recorded and literally translated. The analysis of the interviews was software-based (MAXQDA 12) according to the comprehensive content-analytic approach of Mayring. The main categories (barriers/facilitators) were deductively and the subcategories inductively developed. RESULTS In total, 698 passages were coded in 22 documents, on average 32 per interview (SD=13.2, range 12-65). The 370 entries in the main category barriers are divided into 13 subcategories (e. g. carelessness, lack of information, reservations, burdens, forgetfulness). The 328 statements given in the main category facilitators could be allocated to 14 subcategories (e. g. individual strategies, knowledge, aids, patient insight into the necessity of treatment, communication). CONCLUSION The findings suggest that a lack of medication adherence can be improved, in particular through individualized multi-level barrier management.
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Affiliation(s)
- Katharina Quaschning
- Medizinische Fakultät, Medizinische Psychologie und Medizinische Soziologie, Albert-Ludwigs-Universität Freiburg
| | - Mirjam Körner
- Medizinische Fakultät, Medizinische Psychologie und Medizinische Soziologie, Albert-Ludwigs-Universität Freiburg
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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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Rosentreter J, Alt J, Fried M, Chakupurakal G, Stratmann J, Krämer I. Multi-center observational study on the adherence, quality of life, and adverse events in lung cancer patients treated with tyrosine kinase inhibitors. J Oncol Pharm Pract 2020; 27:1147-1158. [PMID: 32746691 DOI: 10.1177/1078155220946381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cancer patients tend to prefer oral instead of parenteral chemotherapy. To date, there is little evidence on the medication adherence in cancer patients. We investigated medication adherence to tyrosine kinase inhibitors in patients suffering from non-small cell lung cancer. METHODS Tyrosine kinase inhibitor adherence was measured electronically by MEMS® (medication event monitoring system) over at least six months. Adherence rates were calculated in terms of Dosing Compliance, Timing Compliance, Taking Compliance, and Drug Holidays. Patients were dichotomized as adherent when Dosing Compliance and Timing Compliance were ≥80%, Taking Compliance ranged between 90 and 110%, and <1 Drug Holiday was registered. Quality of life was assessed by two questionnaires (EORTC QLQ-C30 version 3.0, EORTC QLQ-LC13) at three time points. Adverse drug events were reported via patient diaries. RESULTS Out of 32 patients enrolled, data from 23 patients were evaluable. Median Dosing Compliance, Taking Compliance, and Timing Compliance adherence rates of tyrosine kinase inhibitor intake amounted to 100%, 98%, and 99%, respectively; Drug Holidays were observed in three patients. Four patients were dichotomized as non-adherent. Three of them had a twice-daily tyrosine kinase inhibitor regimen. Median quality of life scores amounted to 67 (max. 100) and remained unchanged over the study period. Fatigue and rash were the most frequently reported adverse drug events. CONCLUSION Medication adherence of non-small cell lung cancer patients treated with tyrosine kinase inhibitors was extraordinarily high and is likely to support the effectiveness of tyrosine kinase inhibitor treatment and a good quality of life over a long period of time. Adherence facilitating information and education is especially relevant for patients taking tyrosine kinase inhibitors in a twice-daily regimen.
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Affiliation(s)
- Jelena Rosentreter
- Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen Alt
- Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marius Fried
- Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Jan Stratmann
- Department of Internal Medicine II (Hematology, Oncology), Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Irene Krämer
- Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Medeiros KS, Queiroz JF, Monteiro MN, Costa WA, Cobucci RN, Stransky B, Gonçalves AK. Impact of mobile applications on adherence to cancer treatment: a systematic review and meta-analysis protocol. BMJ Open 2019; 9:e027246. [PMID: 31699713 PMCID: PMC6858102 DOI: 10.1136/bmjopen-2018-027246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/14/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The number of patients taking oral chemotherapy is increasing around the world. It is essential to maximise the adherence to oral chemotherapy to improve the overall survival and life expectancy of the patients. In this systematic review and meta-analysis, we aim to evaluate the effectiveness of mobile applications in improving the adherence to oral chemotherapy and adjuvant hormonal therapy in cancer survivors. METHODS AND ANALYSIS MEDLINE, Embase, LILACS, clinicaltrials.gov, Scopus and the Cochrane Central Register of Controlled Trials will be searched for randomised or quasi-experimental studies published between January 2009 and July 2019. This systematic review and meta-analysis will include studies investigating the use of mobile applications by cancer survivors to aid adherence to oral chemotherapy and adjuvant hormonal therapy. Patient education, reminder tools, calendars, pillboxes and electronic reminders will not be evaluated. The primary outcome will be the improvement in adherence to anticancer drugs. The secondary outcomes will be an improvement in the overall survival and life expectancy, improved quality of life and control of cancer-related symptoms. Three independent reviewers will select the studies and extract data from the original publications. The risk-of-bias will be assessed using the Cochrane risk-of-bias tool. Data synthesis will be performed using the Review Manager software (RevMan V.5.2.3). To assess heterogeneity, we will compute the I2 statistics. Additionally, a quantitative synthesis will be performed if the included studies are sufficiently homogenous. ETHICS AND DISSEMINATION This study will be a review of the published data, and thus, ethical approval is not required. Findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018102172.
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Affiliation(s)
- Kleyton Santos Medeiros
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Janice França Queiroz
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | | | | | - Beatriz Stransky
- Universidade Federal do Rio Grande do Norte, Centro de Tecnologia, Natal, Brazil
| | - Ana Katherine Gonçalves
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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Brincat A, Bonanno PV, Stewart D, Weidmann AE. Patients' lived experiences with antineoplastic medicines for the management of malignant solid tumours: A systematic review. Res Social Adm Pharm 2019; 16:450-463. [PMID: 31311718 DOI: 10.1016/j.sapharm.2019.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/23/2019] [Accepted: 06/29/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Antineoplastic medicines affect the patients' physical and psychosocial well-being posing challenges for patients, caregivers and healthcare professionals. However, little is known about the patients' lived experience with medicines (PLEM) for antineoplastic treatment. It is the lived experience that gives meaning to each individual's perception of a particular phenomenon which is influenced by internal and external factors relevant to the individual. OBJECTIVES To critically appraise, synthesise and present the available evidence of patients' lived experience with antineoplastic medicines prescribed for the management of malignant solid tumours. METHOD A systematic literature search was conducted in six electronic databases for articles published in English with no date restrictions. The search terms were related to beliefs, practice and burden in relation to patient, antineoplastic medicines, tumours and lived experience. Study selection, quality assessment and data extraction were performed independently by 2 reviewers. Research findings were analysed using narrative and meta-synthesis approaches. RESULTS The search retrieved 31,004 articles with only 10 studies satisfying the inclusion and exclusion criteria. These studies were published between 2005 and 2016 in Europe (n = 6), America (n = 3) and Asia (n = 1). Nine themes were identified to contribute to the patients' lived experience with antineoplastic medicines. These were (a) influence from family members, healthcare professionals, media and culture, (b) general attitude towards medicine, (c) accepting medicine, (d) modifying or altering medicine regimen or dose, (e) medicine characteristics, (f) medicine routine, (g) medicine adverse events, (h) medicine and social burden and (i) healthcare associated medicine burden. Patients tend to undergo a continuous process of reinterpretations of their experience with medicines throughout their treatment journey. CONCLUSION The use of antineoplastic medicines has a profound effect on the patients' lives. Further longitudinal in-depth studies are required to provide deeper insight into PLEM and support patients in their treatment journey.
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Affiliation(s)
- Alison Brincat
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, United Kingdom.
| | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, United Kingdom.
| | - Derek Stewart
- Qatar University Health and College of Pharmacy, Qatar University, Doha, Qatar.
| | - Anita E Weidmann
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, United Kingdom.
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Birand N, Boşnak AS, Diker Ö, Abdikarim A, Başgut B. The role of the pharmacist in improving medication beliefs and adherence in cancer patients. J Oncol Pharm Pract 2019; 25:1916-1926. [PMID: 30786821 DOI: 10.1177/1078155219831377] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple factors have been reported to affect adherence to medication, including beliefs about medicines, while specifically tailored pharmaceutical care services for patients may improve adherence. The aim was to assess the impact of counselling by an oncology pharmacist on patients' medication adherence and beliefs. METHODS An interventional prospective study was performed in the oncology department at a tertiary hospital in Northern Cyprus from November 2017 to April 2018. The Beliefs about Medicines Questionnaire was used to evaluate the balance between beliefs about necessity and concerns and medication beliefs before and after an educational intervention. The Morisky Green Levine Test 2018 was used to evaluate adherence. RESULTS In total, 81 patients (65.4% females; mean age: 59.1 ± 11.34 years; 34.6% hypertensive; 19.8% with diabetes) were analysed before and after receiving counselling from an oncology pharmacist. Pharmacist education significantly enhanced the mean patient necessity-concern balance scores by two-fold (MT0(baseline) = -3.1 ± 8.6; MT1(posteducation) =3.0 ± 7.3; p < 0.0001), with patients who received counselling for the first time experiencing the greatest benefit. Multivariate analysis showed that patients who had a negative balance between their beliefs about the necessity of the medication and their concerns were less likely to adhere to the medication (0.138 (0.025-0.772)). CONCLUSION Counselling by an oncology pharmacist was effective in decreasing patient concerns and increasing their understanding of the necessity of the medication, thus enhancing their adherence and consequently improving the care they received.
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Affiliation(s)
- Nevzat Birand
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, North Cyprus, Turkey
| | | | - Ömer Diker
- Department of Medical Oncology, Near East Hospital, North Cyprus, Turkey
| | - Abdi Abdikarim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, North Cyprus, Turkey
| | - Bilgen Başgut
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, North Cyprus, Turkey
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24
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Ali EE, Chan SSL, Poh HY, Susanto YA, Suganya T, Leow JL, Pang CK, Chew L, Yap KYL. Design Considerations in the Development of App-Based Oral Anticancer Medication Management Systems: a Qualitative Evaluation of Pharmacists' and Patients' Perspectives. J Med Syst 2019; 43:63. [PMID: 30726518 DOI: 10.1007/s10916-019-1168-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/15/2019] [Indexed: 12/23/2022]
Abstract
Smartphone apps can potentially help in enhancing oral anticancer medication (OAM) adherence. Patient adoption and efficacy of such apps depends on inclusion of user-centred and evidence-based features. The objective of this study was to identify important design considerations from the perspectives of patients taking OAMs, caregivers and oncology pharmacists. The study employed a qualitative study design. Data were collected using in-depth interviews with patients (n = 15), caregivers (n = 3) and pharmacists (n = 16). Interviews were audio-recorded, transcribed verbatim and inductive thematic analysis approach was used in data analysis. Monitoring medication-related problems, medication information, replacement of or integration with current systems and accessibility of app content on devices other than smartphones were the key themes identified in the analysis. Flexible input methods for monitored data, glanceability of monitored reports/information, near real-time adherence enhancing and symptom management interventions and customisable reminder options were design considerations identified under the monitoring medication-related problems theme. Participants suggested the provision of focused and easily understandable medication information with a potential for personalisation. Integration of app-based adherence systems with patients' electronic medical records with added mechanisms for alerts in the dispensing system was also suggested as a key design requirement to improve quality of patient care and facilitate adoption by clinicians. Finally, smartphones were the most favoured platform with optional accessibility of app content on other devices. In conclusion, important design considerations were identified through a user-centred design approach. The findings will help developers and clinicians in the design of new app-based systems and evaluation of existing ones.
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Affiliation(s)
- Eskinder Eshetu Ali
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Sharlene Si Ling Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Huan Yu Poh
- Department of Electrical and Computer Engineering, Faculty of Engineering, National University of Singapore, Block E4, Level 5, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Yosua Amadeus Susanto
- Department of Electrical and Computer Engineering, Faculty of Engineering, National University of Singapore, Block E4, Level 5, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Thendral Suganya
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Jo Lene Leow
- Department of Pharmacy, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Chee Khiang Pang
- Department of Electrical and Computer Engineering, Faculty of Engineering, National University of Singapore, Block E4, Level 5, 4 Engineering Drive 3, Singapore, 117583, Singapore
- Engineering Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 138683, Singapore
| | - Lita Chew
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Kevin Yi-Lwern Yap
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, 3086, Victoria, Australia.
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25
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Qualitative study of patients with metastatic prostate cancer to adherence of hormone therapy. Eur J Oncol Nurs 2019; 38:8-12. [DOI: 10.1016/j.ejon.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/25/2018] [Accepted: 11/11/2018] [Indexed: 11/21/2022]
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26
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Dos Santos M, Lange M, Gervais R, Clarisse B, Capel A, Barillet M, Grellard JM, Heutte N, Licaj I, Joly F. Impact of anxio-depressive symptoms and cognitive function on oral anticancer therapies adherence. Support Care Cancer 2019; 27:3573-3581. [PMID: 30690685 DOI: 10.1007/s00520-019-4644-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Oral anticancer therapies have an important place in the therapeutic arsenal, but factors influencing adherence to oral treatment are poorly documented in oncology. The objective of this study was to assess the impact of anxio-depressive symptoms and cognitive functioning on oral medication adherence. METHODS This prospective study included cancer patients initiating a first oral therapy. Before initiation of treatment, an assessment of depression, anxiety, and cognition was performed. Using self-report questionnaires, we collected information on socio-demographic conditions and the non-adherence at 1 (M1) and 3 months (M3) after the beginning of treatment. RESULTS Among 129 patients enrolled, median age was 70 years and 81% of patients were treated for metastatic cancer. Before initiating treatment, 16% and 8% of patients presented respectively depression and anxiety symptoms. Global cognitive impairment was observed in 51% of patients. Ten percent of the patients were non-adherent at M1 and 13% at M3. Depression was strongly associated with non-adherence at M1 (P = 0.046) and M3 (P = 0.014), but not anxiety. Non-adherence was associated with lower working memory (P = 0.037) and digit memory (P = 0.018) at M1 and short-term memory (P = 0.04) at M3. Patients with more than eight co-medications were more often non-adherents (P = 0.055). CONCLUSIONS Non-adherence to oral anticancer therapies was mainly associated to depression. Focusing on depressive symptoms before initiation of oral anticancer therapy could help to identify patient profiles more likely to fail self-management. Working memory, digit memory, and short-term memory also seem to play a role in non-adherence. Further studies should include a more specific population, especially according to age.
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Affiliation(s)
- Mélanie Dos Santos
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France. .,Department of Medicine, Hospital University, 14000, Caen, France. .,Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France. .,INSERM, U1086, ANTICIPE, 14000, Caen, France.
| | - M Lange
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
| | - R Gervais
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - B Clarisse
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - A Capel
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - M Barillet
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - J M Grellard
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - N Heutte
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
| | - I Licaj
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
| | - F Joly
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,Department of Medicine, Hospital University, 14000, Caen, France.,Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
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27
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Schneider MP, Achtari Jeanneret L, Chevaux B, Backes C, Wagner AD, Bugnon O, Luthi F, Locatelli I. A Novel Approach to Better Characterize Medication Adherence in Oral Anticancer Treatments. Front Pharmacol 2019; 9:1567. [PMID: 30761009 PMCID: PMC6361826 DOI: 10.3389/fphar.2018.01567] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/24/2018] [Indexed: 01/28/2023] Open
Abstract
Purpose: This study aims to describe a 12-month medication adherence with oral anticancer medications (OAMs) in a routine care medication adherence program, and to better characterize non-persistence. Patients and methods:In this observational, one-centered, longitudinal study, medication adherence was monitored electronically while patients were taking part in a medication adherence program for 12 months or until treatment stop. Patients were >18 years and starting or taking one of the following OAMs: letrozole, exemestane, imatinib, sunitinib, capecitabine, or temozolomide. Non-persistence was defined as any premature treatment interruption due to patient's unilateral decision or to a medical decision because of adverse effects. The Kaplan Meier survival function estimate was used to characterize persistence, and Generalized Estimating Equations (GEE) were adopted to fit implementation. Statistical analyses were performed using the R software package. Results: Forty-three outpatients with various tumor entities were enrolled. Reasons for quitting the medication adherence program and/or OAM medication were characterized as OAM discontinuation due to adverse effects or toxicity (n = 5), planned OAM completion time (n = 10), OAM failure (cancer relapse) (n = 5) and non-compliance to the adherence program (n = 3). In persistent patients, the implementation rates were high (from 98% at baseline to 97% at 12 months). The probability of being persistent at 12 months was estimated at 85%. Conclusion: A better characterization of both persistence and implementation to OAMs in real life settings is crucial for understanding and optimizing medication adherence to OAMs. The complex identification of non-persistence underlines the need to carefully and prospectively assess OAM interruption or treatment switch reasons. The GEE analysis for describing implementation to OAMs will allow researchers and professionals to take advantage of the richness of longitudinal real-time data, to avoid reducing such data through thresholds and to put them into perspective with OAM blood levels.
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Affiliation(s)
- Marie Paule Schneider
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.,Community pharmacy, Department of Ambulatory Care and Primary Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Bernard Chevaux
- Etablissements Hospitaliers du Nord Vaudois (eHnv), Yverdon-les-Bains, Switzerland
| | - Claudine Backes
- Community pharmacy, Department of Ambulatory Care and Primary Medicine, University of Lausanne, Lausanne, Switzerland
| | - Anna Dorothea Wagner
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.,Community pharmacy, Department of Ambulatory Care and Primary Medicine, University of Lausanne, Lausanne, Switzerland
| | - François Luthi
- Hirslanden SA Lausanne, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Isabella Locatelli
- Department of Ambulatory Care and Primary Medicine, University of Lausanne, Lausanne, Switzerland
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Kawakami K, Wakatsuki T, Soejima A, Kobayashi K, Yokokawa T, Aoyama T, Suzuki K, Suenaga M, Yamaguchi K, Inoue A, Machida Y, Hama T. Factors Associated With Regorafenib Adherence With Metastatic Colorectal Cancer. Patient Prefer Adherence 2019; 13:1745-1750. [PMID: 31686792 PMCID: PMC6800560 DOI: 10.2147/ppa.s217835] [Citation(s) in RCA: 9] [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] [Received: 06/02/2019] [Accepted: 09/21/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Regorafenib is an oral multikinase inhibitor for the treatment of metastatic colorectal cancer (mCRC). The clinical factors that may affect adherence to regorafenib remain unclear. The aim of this study was to evaluate adherence to regorafenib with mCRC and to identify factors that might affect adherence to regorafenib. METHODS A total of 108 consecutively enrolled Japanese patients with mCRC received regorafenib. Adherence was measured by pharmacists using pill counts and a self-reported treatment diary for patients at a pharmaceutical outpatient clinic. The median relative dose intensities of regorafenib and the factors adversely affecting adherence were retrospectively surveyed. Logistic regression analysis was then performed using patient socio-demographic factors and clinical factors. RESULTS A total of 96 patients were included in the analysis. The median adherence rate was 61.7% in the first cycle. The median relative dose intensity was 57.1%. The most common reason for non-adherence was a hand-foot-skin reaction (35.6%). On multivariate analysis, increased non-adherence to regorafenib was significantly associated with sex (female) [odds ratio (OR) = 4.36; 95% confidence interval (CI): 1.43-13.22, p = 0.01]. DISCUSSION Hand-foot-skin reactions and female sex were associated with lower adherence to regorafenib. Since these factors could be associated with lower adherence to regorafenib, it would be useful to consider these factors when assessing adherence.
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Affiliation(s)
- Kazuyoshi Kawakami
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-Ku, Tokyo135-8550, Japan
- Correspondence: Kazuyoshi Kawakami The Japanese Foundation for Cancer Research, Cancer Institute Hospital, Depatment of Pharmacy, 3-8-31 Ariake Koto-ku, Tokyo135-8550, Japan Email
| | - Takeru Wakatsuki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-Ku, Tokyo135-8550, Japan
| | - Azusa Soejima
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-Ku, Tokyo135-8550, Japan
| | - Kazuo Kobayashi
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-Ku, Tokyo135-8550, Japan
| | - Takashi Yokokawa
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-Ku, Tokyo135-8550, Japan
| | - Takeshi Aoyama
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-Ku, Tokyo135-8550, Japan
| | - Kenichi Suzuki
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-Ku, Tokyo135-8550, Japan
| | - Mitsukuni Suenaga
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-Ku, Tokyo135-8550, Japan
| | - Kensei Yamaguchi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-Ku, Tokyo135-8550, Japan
| | - Ayaka Inoue
- Section for Practical Education, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-Ku, Tokyo142-8501, Japan
| | - Yoshiaki Machida
- Section for Practical Education, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-Ku, Tokyo142-8501, Japan
| | - Toshihiro Hama
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-Ku, Tokyo135-8550, Japan
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Asfaw AA, Yan CH, Sweiss K, Wirth S, Ramirez VH, Patel PR, Sharp LK. Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study. JMIR Cancer 2018; 4:e12. [PMID: 30425032 PMCID: PMC6256103 DOI: 10.2196/cancer.9918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/02/2018] [Accepted: 09/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background Many recently approved medications to manage multiple myeloma (MM) are oral, require supportive medications to prevent adverse effects, and are taken under complex schedules. Medication adherence is a concern; however, little attention has been directed toward understanding adherence in MM or associated barriers and facilitators. Advanced sensored medication devices (SMDs) offer opportunities to intervene; however, acceptability among patients with MM, particularly African American patients, is untested. Objective This study aimed to explore patients’ (1) perceptions of their health before MM including experiences with chronic medications, (2) perceptions of adherence barriers and facilitators, and (3) attitudes toward using SMDs. Methods An in-person, semistructured, qualitative interview was conducted with a convenience sample of patients being treated for MM. Patients were recruited from within an urban, minority-serving, academic medical center that had an established cancer center. A standardized interview guide included questions targeting medication use, attitudes, adherence, barriers, and facilitators. Demographics included the use of cell phone technology. Patients were shown 2 different pill bottles with sensor technology—Medication Event Monitoring System and the SMRxT bottle. After receiving information on the transmission ability of the bottles, patients were asked to discuss their reactions and concerns with the idea of using such a device. Medical records were reviewed to capture information on medication and diagnoses. The interviews were audio-recorded and transcribed. Interviews were independently coded by 2 members of the team with a third member providing guidance. Results A total of 20 patients with a mean age of 56 years (median=59 years; range=29-71 years) participated in this study and 80% (16/20) were African American. In addition, 18 (90%, 18/20) owned a smartphone and 85% (17/20) were comfortable using the internet, text messaging, and cell phone apps. The average number of medications reported per patient was 13 medications (median=10; range=3-24). Moreover, 14 (70%, 14/20) patients reported missed doses for a range of reasons such as fatigue, feeling ill, a busy schedule, forgetting, or side effects. Interest in using an SMD ranged from great interest to complete lack of interest. Examples of concerns related to the SMDs included privacy issues, potential added cost, and the size of the bottle (ie, too large). Despite the concerns, 60% (12/20) of the patients expressed interest in trying a bottle in the future. Conclusions Results identified numerous patient-reported barriers and facilitators to missed doses of oral anticancer therapy. Many appear to be potentially mutable if uncovered and addressed. SMDs may allow for capture of these data. Although patients expressed concerns with SMDs, most remained willing to use one. A feasibility trial with SMDs is planned.
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Affiliation(s)
- Alemseged Ayele Asfaw
- Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Connie H Yan
- Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Karen Sweiss
- Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Scott Wirth
- Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Victor H Ramirez
- College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Pritesh R Patel
- Department of Medicine, Section of Hematology/Oncology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Lisa K Sharp
- Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
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Hong SJ, Li EC, Matusiak LM, Schumock GT. Spending on Antineoplastic Agents in the United States, 2011 to 2016. J Oncol Pract 2018; 14:JOP1800069. [PMID: 30226791 DOI: 10.1200/jop.18.00069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Recent cancer drug approvals are lauded as being more effective with relatively fewer adverse effects, but these treatments come with a great cost to the US health care system. There is little information on recent trends in actual antineoplastic expenditures representative of the whole US health care system or by sector. Therefore, the objective of this study was to describe antineoplastic expenditures in the United States by year and sector. METHODS: This was a retrospective, cross-sectional study of IQVIA (formerly QuintilesIMS) National Sales Perspective data for the period of January 1, 2011, to December 31, 2016. Actual expenditures were totaled by health care sector and calendar year, then adjusted for medical-cost inflation to 2016 dollars. Growth was calculated as the percentage increase from the previous year. RESULTS: Total expenditures of antineoplastic agents across all channels grew from $26.8 billion in 2011 to $42.1 billion in 2016. Antineoplastic spending increased 12.2% in 2016 (compared with the previous year), followed by 15.6% in 2015, 13.4% in 2014, 6.3% in 2013, and 0.4% in 2012. Throughout the study period, 96.5% of total antineoplastic expenditures occurred within clinics, mail-order pharmacies, nonfederal hospitals, and retail pharmacies. CONCLUSION: Antineoplastic expenditures are expected to increase because of continuing development and approval of costly targeted cancer therapies. Cost containment and utilization management strategies must be balanced so as not to restrict access or disrupt innovation. Future policies should focus on ensuring safe and appropriate use of antineoplastics while balancing long-term drug costs.
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Affiliation(s)
- Samuel J Hong
- University of Illinois at Chicago, Chicago, IL; Sandoz, Princeton, NJ; and Plymouth Meeting, PA
| | - Edward C Li
- University of Illinois at Chicago, Chicago, IL; Sandoz, Princeton, NJ; and Plymouth Meeting, PA
| | - Linda M Matusiak
- University of Illinois at Chicago, Chicago, IL; Sandoz, Princeton, NJ; and Plymouth Meeting, PA
| | - Glen T Schumock
- University of Illinois at Chicago, Chicago, IL; Sandoz, Princeton, NJ; and Plymouth Meeting, PA
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de Chevigny A, Chatron C, Morvillez L, Prevost V, Chédru-Legros V. Validation d’un guide d’entretien pour le suivi des patients traités par chimiothérapie orale. ACTUALITES PHARMACEUTIQUES 2018. [DOI: 10.1016/j.actpha.2018.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Over-adherence to capecitabine: a potential safety issue in breast and colorectal cancer patients. Cancer Chemother Pharmacol 2018; 82:319-327. [PMID: 29948022 DOI: 10.1007/s00280-018-3612-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of the OCTO clinical study was to measure patients' adherence to capecitabine-based treatment. METHODS A cohort of ambulatory patients treated with capecitabine monotherapy for either locally advanced or metastatic, breast or colorectal cancer was monitored for 6 cycles. Adherence was assessed in all patients by self-completed questionnaires on disease, pill-count and pharmacological dosage of FBAL (metabolite of capecitabine); and in half of the cohort by electronic medication event monitoring systems (MEMS™) recording the opening times of the device. RESULTS Forty patients were enrolled between November 2008 and September 2011 and treated by capecitabine for an average of 4.75 cycles (range 1-6). Hand-foot syndrome (HFS) was the most frequently reported toxicity (35% patients), and to a lesser extent fatigue and/or asthenia (21%), nausea and/or vomiting (13%) and diarrhea (11%). In the MEMS™ cohort, 20 patients were included. Patients' adherence was excellent with very few missing occasions (23/2272 records). Close analysis of MEMS™ data revealed unexpected medication patterns, such as patients taking extra days of medication beyond planned cycle, patients taking extra doses per day and patients missing a day of dosing and "compensating" by taking extra the following day (N = 7, 18%). A trend was found between over-adherence and high-grade toxicity (grades 3 and/or 4): OR 4.74 [0.65-45.2], p = 0.13 and higher AUC (p = 0.16). There was a trend towards increased AUC of FBAL in over-adherent patients (p = 0.16). CONCLUSION Adherence to oral anticancer chemotherapy was found excellent in this population suggesting over-adherence to capecitabine and potential safety implications for outpatients' drugs.
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Eşkazan AE. Evolving treatment strategies in CML - moving from early and deep molecular responses to TKI discontinuation and treatment-free remission: is there a need for longer-term trial outcomes? Br J Clin Pharmacol 2018; 84:1635-1638. [PMID: 29862545 DOI: 10.1111/bcp.13637] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Kav S. Oral Agents in Cancer Treatment: Meeting the Patients' Needs to Ensure Medication Adherence. Asia Pac J Oncol Nurs 2017; 4:273-274. [PMID: 28966953 PMCID: PMC5559935 DOI: 10.4103/apjon.apjon_49_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sultan Kav, is a Professor at Baskent University, Faculty of Health Sciences Department of Nursing in Ankara, Turkey. She received her Bachelor of Nursing, Master, and PhD degrees from Hacettepe University School of Nursing in Ankara, Turkey. She has over 25 years experiences in oncology nursing; she is an active member of national and international organizations, namely, Turkish Oncology Nursing Association (TONA), International Society of Nurses in Cancer Care (ISNCC), European Oncology Nursing Society (EONS), ONS, and Multinational Association of Supportive Care in Cancer (MASCC). She was served on ISNCC and EONS Board and former president of EONS. She was the principal investigator of several studies of the education of patients receiving oral cancer agents, which led to develop “The MASCC Teaching Tool for Patients Receiving Oral Agents for Cancer MASCC Oral Agents Teaching Tool (MOATT)©” and the MOATT© User Guide. She is the recipient of the 2010 ONS International Award for Contributions to Cancer Care; before this, she has received MASCC Young Investigator Award in 2004 and MASCC Best Young Investigator Award for her research study “Patient Education and Follow-up for Oral Chemotherapy Treatment in Turkey” in 2005.
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Affiliation(s)
- Sultan Kav
- Department of Nursing, Faculty of Health Sciences, Baskent University, Ankara, Turkey
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Tokdemir G, Kav S. The Effect of Structured Education to Patients Receiving Oral Agents for Cancer Treatment on Medication Adherence and Self-efficacy. Asia Pac J Oncol Nurs 2017; 4:290-298. [PMID: 28966956 PMCID: PMC5559938 DOI: 10.4103/apjon.apjon_35_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/24/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study was conducted to examine the effect of structured education on medication adherence and self-efficacy through the use of the MASCC Oral Agent Teaching Tool (MOATT) for patients receiving oral agents for cancer treatment. METHODS This quasi-experimental study has been conducted at two hospitals; 41 patients were included in the study. Data were obtained using a questionnaire, medication adherence self-efficacy scale (MASES), memorial symptom assessment scale, and a follow-up form (diary). Patients were educated through the use of the MOATT at a scheduled time; drug-specific information was provided along with a treatment scheme and follow-up diary. Phone interviews were completed 1 and 2 weeks after the educational session. At the next treatment cycle, the patients completed the same questionnaires. RESULTS Majority of the patients were receiving capecitabine (90.2%; n = 37) as an oral agent for breast (51.2%; n = 21) and stomach cancer (24.6%; n = 10) treatment. About 90.2% of patients (n = 37) stated that they did not forget to take their medication and experienced medication-related side effects (78%; n = 32). The total score of MASES was increased after the education (66.39 vs. 71.04, P < 0.05). CONCLUSIONS It was shown that individual education with the MOATT and follow-up for patients receiving oral agents for cancer treatment increased patient medication adherence self-efficacy.
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Affiliation(s)
- Gamze Tokdemir
- Department of Nursing, Başkent University Ankara Hospital, Ankara, Turkey
| | - Sultan Kav
- Department of Nursing, Faculty of Health Sciences, Başkent University, Ankara, Turkey
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Oral Chemotherapy in Patients with Hematological Malignancies-Care Process, Pharmacoeconomic and Policy Implications. Curr Hematol Malig Rep 2017; 11:288-94. [PMID: 27086140 DOI: 10.1007/s11899-016-0325-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with hematologic malignancies are increasing being prescribed oral anticancer medications (OAMs) and/or biologics. These newer targeted OAMs are associated with a host of practical and pharmacoeconomic implications for patients and healthcare providers. Issues such as safety, procurement challenges, and the need for proactive involvement of all stakeholders to optimize adherence for successful use of these agents are increasingly being recognized. The current reactive model is negatively impacting the patient experience through delays in care, financial toxicity, and decreased safety. It also impacts the healthcare providers in the form of lost revenue and staff burnout due to labor-intensive procurement and patient financial assistance burdens. In this review, we describe some of the issues identified and discuss potential strategies to improve patient access, minimize healthcare burden, and review current policy initiatives and patient advocacy efforts to reduce financial toxicity.
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Stokes M, Reyes C, Xia Y, Alas V, Goertz HP, Boulanger L. Impact of pharmacy channel on adherence to oral oncolytics. BMC Health Serv Res 2017; 17:414. [PMID: 28629454 PMCID: PMC5477418 DOI: 10.1186/s12913-017-2373-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 06/09/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Oral chemotherapy is increasingly prescribed to treat cancer. Despite its benefits, concerns have been raised regarding adherence to therapy. The study objective was to compare and measure adherence, persistence, and abandonment in patients filling prescriptions in traditional retail (TR) versus specialty pharmacy (SP) channels. METHODS Using a retrospective cohort design, we selected newly treated patients aged ≥18 years with a prescription for erlotinib, capecitabine, or imatinib during 2007-2011 from a Medco population of both United States commercial and Medicare health plans. Patients were classified according to pharmacy channel providing the medication. Abandonment was defined as a reversal following initial approval of the index prescription claim with no additional paid claims for agent within 90 days of reversal. Patients were considered adherent if the proportion of days covered between the date of the first and last oral prescription was ≥80%. RESULTS In our retrospective cohort, 11,972 filled their prescriptions within the SP channel, and 30,394 filled their prescriptions within the TR channels, respectively. The SP channel had the highest proportion of adherent patients compared with TR (71.6% vs. 56.4%, P < .001). Abandonment of the initial prescription was low with overall rates of only 1.7%. In multivariate models controlling for demographic characteristics, index oncolytic, days of supply, and copay, SP channel (relative to TR) was significantly associated with lower rates of abandonment and increased adherence. CONCLUSIONS Pharmacy channel may be influential on abandonment and adherence. Lower rates of abandonment and higher rates of adherence were observed among SP patients versus TR.
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Affiliation(s)
| | | | - Yu Xia
- Evidera, Lexington, MA USA
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Hirao C, Mikoshiba N, Shibuta T, Yamahana R, Kawakami A, Tateishi R, Yamaguchi H, Koike K, Yamamoto-Mitani N. Adherence to oral chemotherapy medications among gastroenterological cancer patients visiting an outpatient clinic. Jpn J Clin Oncol 2017. [DOI: 10.1093/jjco/hyx087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Chieko Hirao
- Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Naoko Mikoshiba
- Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Tomomi Shibuta
- Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Reiko Yamahana
- Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Aki Kawakami
- Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Hironori Yamaguchi
- Department of Clinical Oncology, Jichi Medical University, Tochigi, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
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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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Font R, Espinas J, Layos L, Martinez Villacampa M, Capdevila J, Tobeña M, Pisa A, Pericay C, Lezcano C, Fort E, Cardona I, Berga N, Solà J, Borras J. Adherence to capecitabine in preoperative treatment of stage II and III rectal cancer: do we need to worry? Ann Oncol 2017; 28:831-835. [DOI: 10.1093/annonc/mdx006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Farber HW, Gin-Sing W. Practical considerations for therapies targeting the prostacyclin pathway. Eur Respir Rev 2016; 25:418-430. [PMID: 27903664 PMCID: PMC9487556 DOI: 10.1183/16000617.0083-2016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/23/2016] [Indexed: 12/03/2022] Open
Abstract
Therapies that target the prostacyclin pathway play a key role in the treatment of both early- and late-stage pulmonary arterial hypertension, and provide significant clinical benefits for patients. A number of agents have been approved, which are administered via intravenous, subcutaneous, inhaled or oral routes. The use of these therapies is associated with practical challenges, relating to the need for up-titration and their routes of administration. We discuss here a number of measures that can be taken to support patients and healthcare professionals in order to address the complexities of using these therapies and to encourage compliance. Providing patients with timely information and education, together with practical advice on managing their medication and associated equipment, assists patients with day-to-day management of therapy. Referral to patient associations and support groups can be of further benefit. With an effective management plan and an experienced multidisciplinary team, the use of therapies that target the prostacyclin pathway can be optimised. Practical support for patients and HCPs to facilitate the use of therapies that target the PGI2 pathway in PAHhttp://ow.ly/468S305Dl6m
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Senerchia AA, Macedo CR, Ferman S, Scopinaro M, Cacciavillano W, Boldrini E, Lins de Moraes VL, Rey G, de Oliveira CT, Castillo L, Almeida MT, Borsato ML, Lima E, Lustosa D, Barreto JH, El-Jaick T, Aguiar S, Brunetto A, Greggiani L, Cogo-Moreira H, Atallah A, Petrilli AS. Results of a randomized, prospective clinical trial evaluating metronomic chemotherapy in nonmetastatic patients with high-grade, operable osteosarcomas of the extremities: A report from the Latin American Group of Osteosarcoma Treatment. Cancer 2016; 123:1003-1010. [PMID: 28263383 DOI: 10.1002/cncr.30411] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Metronomic chemotherapy (MC) consists of the administration of a low dose of chemotherapy on a daily or weekly basis without a long break to achieve an antitumoral effect through an antiangiogenic effect or stimulation of the immune system. The potential effect of MC with continuous oral cyclophosphamide and methotrexate in patients with high-grade operable osteosarcomas (OSTs) of the extremities was investigated. METHODS Patients with high-grade OSTs who were 30 years old or younger were eligible for registration at diagnosis. Eligibility for randomization included 1) nonmetastatic disease and 2) complete resection of the primary tumor. The study design included a backbone of 10 weeks of preoperative therapy with methotrexate, adriamycin, and platinum (MAP). After surgery, patients were randomized between 2 arms to complete 31 weeks of MAP or receive 73 weeks of MC after MAP. The primary endpoint was event-free survival (EFS) from randomization. RESULTS There were 422 nonmetastatic patients registered (May 2006 to July 2013) from 27 sites in 3 countries (Brazil, Argentina and Uruguay), and 296 were randomized to MAP plus MC (n = 139) or MAP alone (n = 157). At 5 years, the EFS cumulative proportions surviving in the MAP-MC group and the MAP-alone group were 61% (standard error [SE], 0.5%) and 64% (SE, 0.5%), respectively, and they were not statistically different (Wilcoxon [Gehan] statistic = 0.724; P =.395). The multivariate analysis showed that necrosis grades 1 and 2, tumor size, and amputation were associated with shorter EFS. CONCLUSIONS According to the current follow-up, EFS with MAP plus MC is not statistically superior to EFS with MAP alone in patients with high-grade, resectable OSTs of the extremities. Cancer 2017;123:1003-10. © 2016 American Cancer Society.
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Affiliation(s)
- Andreza A Senerchia
- Institute of Pediatric Oncology/Support Group for Adolescents and Children With Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Carla Renata Macedo
- Institute of Pediatric Oncology/Support Group for Adolescents and Children With Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Sima Ferman
- National Cancer Institute, Rio de Janeiro, Brazil
| | - Marcelo Scopinaro
- Hospital de Pediatria SAMIC-Professor Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Walter Cacciavillano
- Hospital de Pediatria SAMIC-Professor Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | | | - Guadalupe Rey
- R. Gutierrez Children's Hospital, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio Sergio Petrilli
- Institute of Pediatric Oncology/Support Group for Adolescents and Children With Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
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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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