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Bandiera C, Cardoso E, Locatelli I, Zaman K, Diciolla A, Digklia A, Stravodimou A, Cristina V, Aedo-Lopez V, Dolcan A, Sarivalasis A, Bouchaab H, Pasquier J, Dotta-Celio J, Peters S, Wagner D, Csajka C, Schneider MP. A pharmacist-led interprofessional medication adherence program improved adherence to oral anticancer therapies: The OpTAT randomized controlled trial. PLoS One 2024; 19:e0304573. [PMID: 38848380 PMCID: PMC11161104 DOI: 10.1371/journal.pone.0304573] [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: 08/07/2023] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Oral anticancer therapies such as protein kinase inhibitors (PKIs) are increasingly prescribed in cancer care. We aimed to evaluate the impact of a pharmacist-led interprofessional medication adherence program (IMAP) on patient implementation (dosing history), persistence (time until premature cessation of the treatment) and adherence to 27 PKIs prescribed for various solid cancers, as well as the impact on patients' beliefs about medicines (BAM) and quality of life (QoL). METHODS Patients (n = 118) were randomized 1:1 into two arms. In the intervention arm, pharmacists supported patient adherence through monthly electronic and motivational feedback, including educational, behavioral and affective components, for 12 months. The control arm received standard care plus EM without intervention. All PKIs were delivered in electronic monitors (EMs). Medication implementation and adherence were compared between groups using generalized estimating equation models, in which relevant covariables were included; persistence was compared with Kaplan‒Meier curves. Information on all treatment interruptions was compiled for the analysis. Questionnaires to evaluate BAM and QoL were completed among patients who refused and those who accepted to participate at inclusion, 6 and 12 months post-inclusion or at study exit. RESULTS Day-by-day PKI implementation was consistently higher and statistically significant in the intervention arm (n = 58) than in the control arm (n = 60), with 98.1% and 95.0% (Δ3.1%, 95% confidence interval (CI) of the difference 2.5%; 3.7%) implementation at 6 months, respectively. The probabilities of persistence and adherence were not different between groups, and no difference was found between groups for BAM and QoL scores. No difference in BAM or QoL was found among patients who refused versus those who participated. The intervention benefited mostly men (at 6 months, Δ4.7%, 95% CI 3.4%; 6.0%), those younger than 60 years (Δ4.0%, 95% CI 3.1%; 4.9%), those who had initiated PKI more than 60 days ago before inclusion (Δ4.5%, 95% CI 3.6%; 5.4%), patients without metastasis (Δ4.5%, 95% CI 3.4%; 5.7%), those who were diagnosed with metastasis more than 2 years ago (Δ5.3%, 95% CI 4.3%; 6.4%) and those who had never used any adherence tool before inclusion (Δ3.8%, 95% CI 3.1%; 4.5%). CONCLUSIONS The IMAP, led by pharmacists in the context of an interprofessional collaborative practice, supported adherence, specifically implementation, to PKIs among patients with solid cancers. To manage adverse drug events, PKI transient interruptions are often mandated as part of a strategy for treatment and adherence optimization according to guidelines. Implementation of longer-term medication adherence interventions in the daily clinic may contribute to the improvement of progression-free survival. TRIAL REGISTRATION ClinicalTrials.gov NCT04484064.
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Affiliation(s)
- Carole Bandiera
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Evelina Cardoso
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Khalil Zaman
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonella Diciolla
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Athina Stravodimou
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valérie Cristina
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Veronica Aedo-Lopez
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ana Dolcan
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Apostolos Sarivalasis
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hasna Bouchaab
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jennifer Dotta-Celio
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Solange Peters
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dorothea Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chantal Csajka
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie Paule Schneider
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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Bruneau C, Genolini JP, Terral P. Educating patients in a French cancer treatment center: How to ensure therapy safety while reckoning patients' knowledge and power to act. PLoS One 2024; 19:e0304899. [PMID: 38843167 PMCID: PMC11156290 DOI: 10.1371/journal.pone.0304899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
In this article, we analyse how health professionals educate cancer patients to care for their condition and keep strict control over therapy safety. We study how much room for negotiation is left to patients during medical consultations so resources can still be exchanged. We pay particular attention to the trade of knowledge and powers between patients and doctors (power to act and to express oneself in an imbalanced relationship where knowledge is unequally shared). We opted for a qualitative approach with 41 interviews and several ethnological observations, first of consultations in haematology, then of pre-planned phone calls made to patients during the course of a cancer therapy follow-up scheme. The declared ambition of turning cancer patients into self-responsible patients actually re-enacts well-known procedures of control and knowledge acquisition aimed at narrowing their margin of manoeuvre for the sake of therapy safety. Even if some freedom is conceded, patients remain under the control of their medical hierarchy. Health professionals privilege two methods to keep control over patients and teach them therapy safety procedures. Which method is chosen, and how it is used, is dictated by the relationship between socially-diverse patients and health professionals. In the end, what the patient learns and the amount of control the doctor keeps over this process will depend on the distribution of power and knowledge among them, but asymmetry will always remain.
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Affiliation(s)
- Charlotte Bruneau
- Center for Research in Social Sciences, Sports and Body, University Paul Sabatier Toulouse, Toulouse, France
| | - Jean-Paul Genolini
- Center for Research in Social Sciences, Sports and Body, University Paul Sabatier Toulouse, Toulouse, France
| | - Philippe Terral
- Center for Research in Social Sciences, Sports and Body, University Paul Sabatier Toulouse, Toulouse, France
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Unal E, Cinar FI, Porucu C. Factors affecting medication adherence in patients using oral chemotherapy: A descriptive study. J Oncol Pharm Pract 2024:10781552241241059. [PMID: 38613321 DOI: 10.1177/10781552241241059] [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: 04/14/2024]
Abstract
INTRODUCTION The utilization of oral chemotherapy agents for cancer treatment has witnessed a steady rise in recent years. The pivotal determinant for the success of oral chemotherapy lies in the adherence of cancer patients to the prescribed treatment. This study aims to explore oral chemotherapy adherence and identify factors influencing medication adherence among cancer patients. METHODS A total of 103 cancer patients participated in this descriptive study. Data were collected using the Oral Chemotherapy Adherence Scale, the Turkish Translation of the Beliefs about Medicines Questionnaire (BMQ-T) and The Functional Living Index-Cancer. RESULTS Of the participants, 66% reported good adherence to oral chemotherapy. Key findings indicate that access to health services (β = -1.473, p = 0.009), cancer stage (β = -1.570, p = 0.015) and the BMQ-T subscale of General Overuse (β = .696, p = 0.041) were independent predictors of medication adherence. CONCLUSION The study observed medication non-adherence in one-third of patients undergoing oral chemotherapy. Primary contributors to non-adherence included difficulties in accessing health services, advanced cancer stage and the belief that drugs are over-recommended by doctors. These results underscore the need for a heightened focus on preventable factors, such as improving access to health services and addressing beliefs about drug overuse, to enhance medication adherence in patients receiving oral chemotherapy.
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Affiliation(s)
- Eda Unal
- Faculty of Health Sciences, Kırşehir Ahi Evran University, Kırşehir, Bağbaşı, Turkey
| | - Fatma Ilknur Cinar
- University of Health Sciences Turkey, Gülhane Faculty of Nursing, Ankara, Turkey
| | - Canan Porucu
- University of Health Sciences Turkey, Gülhane Training and Research Hospital, Ankara, Turkey
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Faurie I, Harroch E, Scotto d'Apollonia C, Corte S, Arcari C, Mohara C, Barthelemy C, Fabre MH, Boussac M, Damase-Michel C, Almudever B, Croity-Belz S, Brefel-Courbon C. Impact of therapeutic education on the evolution of social representations of medication in patients with Parkinson's disease: A quantitative and qualitative study (ETPARK REMED). Rev Neurol (Paris) 2023; 179:1086-1094. [PMID: 37633737 DOI: 10.1016/j.neurol.2023.03.026] [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: 10/21/2022] [Revised: 01/17/2023] [Accepted: 03/31/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Among the workshops of our therapeutic patient education (TPE) program, the medication workshop (TPEM workshop) is very frequently proposed to patients in view of the difficulties they encounter related to the complexity of managing antiparkinsonian treatment. Patients' appropriation of their medications could depend on their social representations. OBJECTIVES To evaluate the effect of our TPEM workshop on the social representations PD patients have of their medications and to compare it with that of another therapeutic intervention such as a talking group defined as the control group. METHODS This single-center, prospective, randomized, parallel-group study investigated the social representations of medication through a questionnaire on knowledge about antiparkinsonian medications, a questionnaire on beliefs about medication (BMQ), and a word association task. RESULTS In the TPEM group (n=16), the workshop induced significant effects over time on the knowledge questionnaire (P=0.01), BMQ specific necessity and concerns scores (P=0.04 and 0.01, respectively), necessity-concerns differential (P=0.04), and BMQ general harm (P=0.04). No significant difference was found in the talking group (n=6). Comparison of the two groups showed a significant difference of the BMQ general harm with a decrease in belief in the harmfulness of the medications in the workshop group (P=0.03). The results of the verbal association task showed a modification in the content and structure of the social representations of medication in the TPEM group. DISCUSSION The TPEM workshop helped reduce initial negative aspects of medication representations. Improved knowledge of their medication allowed patients to feel more competent and legitimate in communicating with caregivers, modifying their beliefs about medications. Indeed, the medication was perceived as less restrictive, care becoming central as shown by the emergence of the medical team in the social representations of the medication. CONCLUSION All the results show a specific beneficial effect of the TPEM workshop through an evolution of the social representations of medications, which became more positive in our PD patients.
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Affiliation(s)
- I Faurie
- Laboratoire Psychologie de la Socialisation - Développement et Travail, Maison de la Recherche, Université Toulouse - Jean-Jaurès, 31058 Toulouse cedex 9, France
| | - E Harroch
- Centre Expert Parkinson, Neurosciences Department of the University Hospital of Toulouse, CHU Purpan, 31059 Toulouse, France
| | - C Scotto d'Apollonia
- Centre Expert Parkinson, Neurosciences Department of the University Hospital of Toulouse, CHU Purpan, 31059 Toulouse, France
| | - S Corte
- Laboratoire Psychologie de la Socialisation - Développement et Travail, Maison de la Recherche, Université Toulouse - Jean-Jaurès, 31058 Toulouse cedex 9, France
| | - C Arcari
- Centre Expert Parkinson, Neurosciences Department of the University Hospital of Toulouse, CHU Purpan, 31059 Toulouse, France
| | - C Mohara
- Centre Expert Parkinson, Neurosciences Department of the University Hospital of Toulouse, CHU Purpan, 31059 Toulouse, France
| | - C Barthelemy
- Centre Expert Parkinson, Neurosciences Department of the University Hospital of Toulouse, CHU Purpan, 31059 Toulouse, France
| | - M H Fabre
- Centre Expert Parkinson, Neurosciences Department of the University Hospital of Toulouse, CHU Purpan, 31059 Toulouse, France
| | - M Boussac
- Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - C Damase-Michel
- Department of Clinical Pharmacology, Medicine Faculty of Purpan, 37, allées Jules-Guesde, 31073 Toulouse cedex, France
| | - B Almudever
- Laboratoire Psychologie de la Socialisation - Développement et Travail, Maison de la Recherche, Université Toulouse - Jean-Jaurès, 31058 Toulouse cedex 9, France
| | - S Croity-Belz
- Laboratoire Psychologie de la Socialisation - Développement et Travail, Maison de la Recherche, Université Toulouse - Jean-Jaurès, 31058 Toulouse cedex 9, France
| | - C Brefel-Courbon
- Centre Expert Parkinson, Neurosciences Department of the University Hospital of Toulouse, CHU Purpan, 31059 Toulouse, France; Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Department of Clinical Pharmacology, Medicine Faculty of Purpan, 37, allées Jules-Guesde, 31073 Toulouse cedex, France.
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Larbre V, Romain-Scelle N, Reymond P, Ladjouzi Y, Herledan C, Caffin AG, Baudouin A, Maire M, Maucort-Boulch D, Ranchon F, Rioufol C. Cancer outpatients during the COVID-19 pandemic: what Oncoral has to teach us about medical drug use and the perception of telemedicine. J Cancer Res Clin Oncol 2023; 149:13301-13310. [PMID: 37482585 DOI: 10.1007/s00432-023-04971-0] [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: 05/03/2023] [Accepted: 06/03/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE The COVID-19 pandemic has disrupted healthcare access and telemedicine has been widely deployed. The aim of this study is to assess the impact of this health crisis on treatment consumption and telemedicine development in outpatients treated by oral anti-cancer agents and followed by the Oncoral hospital/community multidisciplinary program where continuity care is maintained by a pharmacist/nurse pair. METHODS A prospective monocentric study was conducted among cancer patients who received Oncoral telephone follow-up during the 1st lockdown in France using a 56-item questionnaire which covered sociodemographic data, patient medication management, and telehealth. RESULTS 178 patients received Oncoral follow-up during the 1st lockdown and 67.4% responded to the questionnaire. During lockdown, 9.2% of patients took medication or CAM for fatigue, 6.7% for mood alteration, 10.8% for sleep disorder, 11.7% for stress and anxiety, and 12.5% to get more energy. Homeopathy consumption was triggered by the pandemic. Habits about getting drugs from the pharmacy changed significantly (p < 0.001), while other treatment habits did not. 83% of patients were satisfied by the telephone follow-up established, 69% would be in favor of repeating this in case of a new epidemic wave. Those most in favor of using telemedicine seemed to be the youngest (p < 0.001), with several dependent children (p < 0.007), high school degree or higher education (p = 0.023), and in work (p < 0.001). CONCLUSION Health system reorganization enables to limit the impact of the crisis on patients' drug use in oncology care. Telemedicine is a promising public health tool.
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Affiliation(s)
- V Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
- Université Lyon 1-EA 3738, CICLY, Lyon, France
| | - N Romain-Scelle
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Pierre-Bénite, France
- Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, CNRS, UMR 5558, Villeurbanne, France
| | - P Reymond
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
| | - Y Ladjouzi
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
| | - C Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
- Université Lyon 1-EA 3738, CICLY, Lyon, France
| | - A G Caffin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
| | - A Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
| | - M Maire
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
| | - D Maucort-Boulch
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Pierre-Bénite, France
| | - F Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
- Université Lyon 1-EA 3738, CICLY, Lyon, France
| | - C Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France.
- Université Lyon 1-EA 3738, CICLY, Lyon, France.
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Wang T, Ho MH, Tong MCF, Chow JCH, Voss JG, Lin CC. Effects of Patient-Reported Outcome Tracking and Health Information Provision via Remote Patient Monitoring Software on Patient Outcomes in Oncology Care: A Systematic Review and Meta-Analysis. Semin Oncol Nurs 2023; 39:151473. [PMID: 37516624 DOI: 10.1016/j.soncn.2023.151473] [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: 10/17/2022] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES The authors sought to 1) review the literature on the remote care model that uses remote patient monitoring software (RPMS) as key mechanisms in oncology care for symptom tracking and health information provision and (2) compare the remote care model to standard care in terms of health-related quality of life, symptom burden, health management self-efficacy, anxiety, and depression. DATA SOURCES The search was conducted on March 23, 2022, in the Cochrane Library, MEDLINE/PubMed, PsycINFO, and CINAHL databases. RESULTS The primary strategies for applying digital technology in remote care models are patient-reported outcomes (PRO) tracking and health information delivery. Common PRO measurements applied in the RPMS include quality of life, symptom burden, self-efficacy, anxiety, and depression. Nine randomized controlled trials testing seven RPMS interventions were examined. Compared to standard care, remote patient monitoring via RPMS was related to greater quality of life and lower physical symptom burden during cancer therapy. The RPMS incorporated into routine clinical care with nurses providing remote monitoring performed better on PRO than that not integrated. CONCLUSION The RPMS-based remote care model improves patient outcomes during cancer treatment, and it is not inferior to standard care until the RPMS function is more integrated with existing clinical care. IMPLICATIONS FOR NURSING PRACTICE Nurses are well-positioned to engage patients in self-care skills via RPMS and can play a vital role in integrating such a model of remote patient care into routine care practices.
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Affiliation(s)
- Tongyao Wang
- Research Assistant Professor, School of Nursing, LKS Faculty of Medicine, The University Hong Kong, Pokfulam, Hong Kong
| | - Mu-Hsing Ho
- Assistant Professor, School of Nursing, LKS Faculty of Medicine, The University Hong Kong, Pokfulam, Hong Kong
| | - Michael C F Tong
- Professor and Head, Graduate Division of Otorhinolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery; Director, Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR
| | - James Chung-Hang Chow
- Associate Consultant, Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Joachim G Voss
- Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chia-Chin Lin
- Head and Professor, School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
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Rotonda C, Guillemin F, Conroy T, Alleyrat C, Lefevre B, Soudant M, Tarquinio C. Validation and optimization of the French Generic Adherence for Chronic Diseases Profile (GACID-P) using classical test and item response theory. Health Qual Life Outcomes 2023; 21:49. [PMID: 37226180 DOI: 10.1186/s12955-023-02130-0] [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: 09/13/2022] [Accepted: 05/11/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The Generic Adherence for Chronic Diseases Profile is a French generic scale (GACID-P) developed to measure adherence in several disease areas such as cardiology, rheumatology, diabetes, cancer and infectiology. METHOD We aimed to study the measurement invariance of the Generic Adherence for Chronic Diseases Profile by an item response model, optimize the new instrument version from item response model and qualitative content analyses results, and validate the instrument. The metric properties of the optimized version were studied according to classical test theory and item response model analysis. RESULTS A sample of 397 patients consulting at two French hospitals (in diabetes, cardiology, rheumatology, cancerology and infectiology) and in four private practices was recruited; 314 (79%) patients also completed the questionnaire 15 days later. Factor analyses revealed four dimensions: "Forgetting to take medication", "Intention to comply with treatment", "Limitation of risk-related consumer habits" and "Healthy lifestyle". The item response model and content analyses optimized these four dimensions, regrouping 32 items in four dimensions of 25 items, including one item conditioned on tobacco use. The psychometric properties and scale calibration were satisfactory. One score per dimension was calculated as the sum of the items for the dimensions "Forgetting to take medication" and "Intention to comply with treatment" and as a weighted score according to the item response model analysis for the two other dimensions because of differential item functioning found for two items. CONCLUSION Four adherence profile scores were obtained. The instrument validity was documented by a theoretical approach and content analysis. The Generic Adherence for Chronic Diseases Profile is now available for research targeting adherence in a broad perspective.
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Affiliation(s)
- Christine Rotonda
- Université de Lorraine, Centre Pierre Janet, Metz, F-57000, France.
- Université de Lorraine, APEMAC, équipe EPSAM, Metz, F-57000, France.
| | - F Guillemin
- CHRU Nancy, Inserm, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, F-54000, France
- Université de Lorraine, APEMAC, équipe MICS, Nancy, F-54000, France
| | - T Conroy
- Université de Lorraine, APEMAC, équipe MICS, Nancy, F-54000, France
- Institut de Cancérologie de Lorraine, Department of Medical Oncology, Vandoeuvre- lès-Nancy, F-54519, France
| | - C Alleyrat
- CHRU Nancy, Inserm, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, F-54000, France
| | - B Lefevre
- Institut de Cancérologie de Lorraine, Department of Medical Oncology, Vandoeuvre- lès-Nancy, F-54519, France
- CHRU-Nancy, Université de Lorraine, Service des Maladies Infectieuses et Tropicales, Nancy, F-54000, France
| | - M Soudant
- CHRU Nancy, Inserm, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, F-54000, France
| | - C Tarquinio
- Université de Lorraine, Centre Pierre Janet, Metz, F-57000, France
- Université de Lorraine, APEMAC, équipe EPSAM, Metz, F-57000, France
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Fonda F, Cedrone S, Sartor I, Cadorin L. Outcomes of patient education in adult oncologic patients receiving oral anticancer agents: a systematic review protocol. Syst Rev 2023; 12:69. [PMID: 37081567 PMCID: PMC10120216 DOI: 10.1186/s13643-023-02229-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND A large variety of oral anticancer agents have become available and while at first glance these therapies appear to provide only benefits, patients have expressed their need for educational interventions and raised safety issues. Although both patients and providers have recognized patient education's importance, and an interplay with safety has been acknowledged, no systematic reviews of the literature that summarize all of the current evidence related to patient education's outcomes for patients who receive oral anticancer agents have been performed to date. Accordingly, this systematic review will attempt to fill the gap in the literature as well as to map (1) contents, (2) methodologies, (3) settings, (4) timing/duration, and (5) healthcare professionals involved. METHODS This protocol is being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic review will be performed. Studies that targeted eligible adult patients (≥ 18 years old) in hospital, outpatient, and home settings, and reported patient education's outcomes for those taking oral anticancer agents will be included. Searches will be conducted in PubMed/MEDLINE, CINAHL, Embase, and Scopus, and gray literature will be also sought. Two researchers will screen the search results independently and blindly in two phases: (1) title/abstract screening and (2) full-text screening using the Rayyan AI platform. An electronic data extraction form will be implemented and piloted, and then, two trained data extractors will extract the data cooperatively. Thereafter, a quality appraisal will be conducted using the Critical Appraisal Tools from The Joanna Briggs Institute. The results will be analyzed, grouped, clustered into categories, and discussed until a consensus is reached. Emerging evidence will be synthesized narratively and reported in accordance with the synthesis without meta-analysis guidelines. DISCUSSION The systematic review's results will be relevant to (1) policymakers and management at an institutional level, and (2) for clinical practice, in an evidence-based paradigm, potentially leading to a quality improvement with respect to safety and patient satisfaction. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022341797.
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Affiliation(s)
- Federico Fonda
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, 33100, Italy
| | - Sonja Cedrone
- Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, 33081, Italy
| | - Ivana Sartor
- Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, 33081, Italy
| | - Lucia Cadorin
- Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, 33081, Italy.
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Rosenberg AS. From mechanism to resistance - changes in the use of dexamethasone in the treatment of multiple myeloma. Leuk Lymphoma 2023; 64:283-291. [PMID: 36308022 DOI: 10.1080/10428194.2022.2136950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Glucocorticoids, including dexamethasone, have been a mainstay of treatment for multiple myeloma (MM) for decades. In current treatment protocols and NCCN clinical practice guidelines, dexamethasone is included in all phases of MM treatment as a key adjunct to novel therapies within all preferred therapy regimen, augmenting clinical response rates to these agents. The inclusion of dexamethasone in MM treatment regimens, combined with novel agents, continues to deliver good response rates. Further understanding of drug combinations and dose modifications is anticipated to enhance clinical care, mitigate toxicities and optimize outcomes. New formulations are providing the opportunity for a reduction in pill burden and potential for medication errors, whereby improving treatment adherence. Here, we summarize and discuss the role of dexamethasone in the treatment of MM, its mechanism of action and doses used, and provide a critical appraisal current evidence and its clinical implications.
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10
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Naser AY, Ofori-Asenso R, Awawdeh SA, Qadus S, Alwafi H, Liew D. Real World Adherence to and Persistence With Oral Oncolytics in Multiple Myeloma: A Systematic Review and Meta-analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:760-773. [PMID: 35764491 DOI: 10.1016/j.clml.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Oral oncolytic treatments (OOTs) have improved the prognosis of patients with multiple myeloma (MM). However, the effectiveness of these therapies is undermined by poor adherence. We aimed to characterize the real-world adherence to, and persistence with, OOTs for MM. MATERIALS AND METHODS MEDLINE, EMBASE, and the International Pharmaceutical abstracts databases were searched for relevant observational studies published in English up to November 21, 2021. This was supplemented by manual searches of abstracts from the annual meetings of the American Society of Hematology, the American Society for Clinical Oncology, and the European Hematology Association as well as screening the references of included articles. Random-effects meta-analysis was performed. RESULTS Following screening of 11,557 articles, 19 studies involving 27,129 patients in 8 countries (France, the US, Germany, Italy, the UK, Brazil, South Korea, and Belgium) prescribed OOTs (lenalidomide, thalidomide, pomalidomide, panobinostat, ixazomib, and melphalan) for MM were included. The overall pooled proportion of adherent patients was 67.9% (95% confidence interval [CI]: 57.1%-77.8%). The pooled proportion of adherent patients was higher in self-reported questionnaire-based studies compared to those using prescription/dispensing data (81.6% vs. 61.0%; P-value for difference = .08). Across 5 studies involving 15,363 patients, a pooled proportion of 35.8% (95% CI: 22.0-50.9) discontinued treatment. Factors reported to be associated with nonadherence included increasing age, higher comorbidity, polypharmacy, and a lack of social support. CONCLUSION In patients with MM, adherence to and persistence with OOTs remains suboptimal. To achieve desired clinical outcomes, interventions to improve adherence and minimize discontinuation may be warranted.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Real World Data Enabling Platform, Roche Products Ltd, Welwyn Garden City, UK.
| | - Safaa Al Awawdeh
- Department of Basic Pharmaceutical Sciences, Isra University, Amman, Jordan
| | - Sami Qadus
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Hassan Alwafi
- Faculty of Medicine, Umm Alqura University, Saudi Arabia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; The Adelaide Medical School, University of Adelaide, Adelaide, Australia
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11
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Ribeiro F, Costa-Lotufo L, Loureiro S, Pavlaki MD. Environmental Hazard of Anticancer Drugs: State of the Art and Future Perspective for Marine Organisms. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2022; 41:1793-1807. [PMID: 35622001 DOI: 10.1002/etc.5397] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/17/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
Pharmaceutical compounds represent a class of emerging contaminants present in the environment. Their intense (and increasing) use in human and veterinary medicine leads to their discharge, mainly via human excretion, into wastewater treatment plants where their removal is inefficient. A specific class of pharmaceuticals used to fight cancer, known as antineoplastic or anticancer drugs, has gained increased attention regarding their possible environmental hazard due to their pharmacological properties, which include the nonselective targeting of DNA replication mechanisms and cell division processes, potentially inducing cell apoptosis. To date, there is limited information concerning the effects of anticancer drugs and/or their metabolites in species inhabiting freshwater environments, let alone marine and estuarine compartments. In the present review, we aimed to assemble information regarding the impact that anticancer drugs have on biological traits of marine species, to identify gaps in the current environmental hazard assessment, and to make recommendations to promote an efficient environmental hazard assessment of anticancer drugs in the marine environment. Environ Toxicol Chem 2022;41:1793-1807. © 2022 SETAC.
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Affiliation(s)
- Fabianne Ribeiro
- Department of Biology, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
| | - Leticia Costa-Lotufo
- Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Susana Loureiro
- Department of Biology, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
| | - Maria D Pavlaki
- Department of Biology, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
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12
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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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13
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Maleki S, Glewis S, Fua T, Liu C, Rischin D, Alexander M, Na L, Lingaratnam S. A randomised controlled trial of clinical pharmacy intervention versus standard care to improve medication adherence in outpatients with head and neck cancer receiving radiotherapy. Support Care Cancer 2022; 30:4243-4253. [PMID: 35091845 DOI: 10.1007/s00520-021-06779-5] [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] [Received: 01/30/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient understanding of medicines information and adherence to medication instructions are important variables for ensuring optimal cancer care. This randomised controlled trial (RCT) aimed to evaluate the impact of an outpatient clinical pharmacy service on medication adherence and symptom burden in cancer patients. METHODS In this single-centre RCT, 115 patients were randomised 1:1 to a pharmacist-led pharmaceutical care program (intervention, n = 59) versus standard of care (control, n = 56) within an outpatient multidisciplinary radiotherapy clinic. The primary endpoint was medication adherence as assessed by Medication Understanding and Use Self-Efficacy (MUSE) scale and Teach-Back assessment. Secondary endpoints were patient-reported symptom burden assessed by the Edmonton Symptom Assessment Scale (ESAS). Patients were assessed at baseline (weeks 1-2) and at discharge from radiotherapy (weeks 5-7). RESULTS Polypharmacy (use of five or more medications) was observed in 26% of patients at baseline compared to 97% at discharge. Patient self-efficacy and medication adherence was higher in the intervention arm compared to the control arm, with a mean MUSE score difference of 2.70 (95% CI 1.24, 4.17) after adjustment for baseline, and a higher proportion of patients with average Teach-Back score of four or more (86% vs 14%; odds ratio (OR) 46.09, 95% CI 14.49, 146.56). The mean (SD) scores for aggregate ESAS (0-100) at discharge were 26.2 (14.0) in the intervention arm and 32.0 (15.8) in the control arm demonstrating lower overall symptom burden associated with the intervention (mean score difference adjusted for baseline - 0.52; 95% CI - 1.03, - 0.01). CONCLUSION A structured outpatient clinic pharmacy service significantly improved medication adherence and reduced overall symptom burden in patients receiving radiotherapy.
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Affiliation(s)
- Sam Maleki
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
| | - Sarah Glewis
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Tsien Fua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Chen Liu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Grattan St, Parkville Victoria, 3010, Australia
| | - Marliese Alexander
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Grattan St, Parkville Victoria, 3010, Australia
| | - Lumine Na
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Senthil Lingaratnam
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
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14
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Scholz S, Teetz L. Smart health via mHealth? Potentials of mobile health apps for improving prevention and adherence of breast cancer patients. Digit Health 2022; 8:20552076221074127. [PMID: 35096411 PMCID: PMC8796094 DOI: 10.1177/20552076221074127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/27/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Today there are several health and medical apps (mHealth) in app stores. Germany is the world's first country that introduced apps paid by the regular health insurance service. Even though breast cancer is the most common cancer in women, mHealth for breast cancer has been largely unexplored. Methods A total of 33 apps from two major mobile application marketplaces (Google Play Store/Android; App Store/iOS) have been selected for analysis. Results The app analysis shows that there are currently only 10 mHealth apps in German, which are specifically dedicated to breast cancer patients. The features of these apps fall into two categories: improvement of health literacy and indirect intervention. These apps can be used for all phases of the patient journey starting with the diagnosis. Conclusions mHealth apps have the potential to support the adherence of breast cancer patients. In order to exploit this future potential, the app quality, as well as the information about the available apps, must be urgently improved. Currently, it is very difficult both for laypersons and for doctors/other therapists to identify high-quality apps. Guidance from independent or governmental institutions would be helpful to further the digitalization in health care.
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Affiliation(s)
- Stefanie Scholz
- SRH Fuerth University of Applied Sciences, Fuerth, Bayern, Germany
| | - Laura Teetz
- Sanacorp Pharmahandel GmbH (former: Bamberg University), Bamberg, Bayern, Germany
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15
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Patients' and Nurses' Perceptions of the Effectiveness of an Oral Cancer Agent Education Process: A Mixed-Methods Study. Cancer Nurs 2021; 44:E151-E162. [PMID: 32022779 DOI: 10.1097/ncc.0000000000000790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The increase in the use of oral cancer drugs implies that nurses take on new roles for which education and support to patients and family members become fundamental for promoting therapeutic adherence. OBJECTIVE To describe the patients' and nurses' perceptions on the effectiveness of the educational process in oral cancer treatment. METHODS A mixed method with a convergent design was used. Data were collected using a questionnaire (structured according to the Multinational Association of Supportive Care in Cancer Teaching Tool for Patients Receiving Oral Agents for Cancer guidelines) and semistructured interviews with patients. Focus groups were used with the nurses. Quantitative data were analyzed with SPSS 22.0 (IBM SPSS 22.0, Armonk, New York). Qualitative data were analyzed using semantic analysis. RESULTS One hundred forty-two questionnaires were analyzed. Patients were usually informed by physicians and nurses (81%), alone (33%) or in the presence of an informal carer (29.6%). Language comprehension was high, with a significant difference between those 70 years or older (P = .04) and those younger than 70 years. From the interviews (n = 16), 3 themes were identified: emotions during communication, feeling reassured by the presence of family members and nurses, feeling welcomed and an active part of the educational process. Three themes were identified from the focus groups (n = 4): prerequisites for an effective therapeutic education, nurses' skills, and educational process barriers. CONCLUSIONS Overall, patients were satisfied with the education received. They perceived nurses as people who can help them understand the information they have received and manage their treatment and adverse effects. IMPLICATIONS FOR PRACTICE This study highlighted some important points for an effective educational process: having a nurse to refer to, technical relationship competences, joint visits with physicians, and being available by phone.
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16
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Souliotis K, Peppou LE, Economou M, Marioli A, Nikolaidi S, Saridi M, Varvaras D, Paschali A, Syrigos KN. Treatment Adherence in Patients with Lung Cancer from Prospects of Patients and Physicians. Asian Pac J Cancer Prev 2021; 22:1891-1898. [PMID: 34181348 PMCID: PMC8418830 DOI: 10.31557/apjcp.2021.22.6.1891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: Adherence to treatment can be defined as the degree to which a patient’s behavior is consonant with medical or health advice he or she receive as part of his treatment regimen. The aim of this study was: 1) to measure the rate of treatment adherence to among patients with lung cancer from the prospect of both patients and physicians, 2) to measure the degree of concordance between the two prospect, and 3) to identify factors related to adherence for both prospect (patients and physicians). Materials and Methods: A total of 250 patients were included in this study. Information about socio-economic characteristics, depressive and anxiety symptoms (Hospital Anxiety and Depression scale), nicotine dependence (Fagerstrom scale), barriers to accessing care, and the level of treatment adherence was collected through interview. Physicians were enquired about disease and treatment variables as well as patients’ level of adherence. Results: From the patient perspective, only 1.2% of patients displayed poor adherence; whereas the corresponding percentage among physicians was 12.4%. The concordance between the two was low: 0.244. The correlation of measurements made on the same individual was found to be equal to 0.14. Barriers to accessing medication (O.R.=2.82, 95% C.I.: 1.01-8.09) was the only risk factor when adherence was self-rated; barriers to accessing medication (O.R.=2.45, 95% C.I.: 1.03-5.86), education equal to 12 years (O.R.=0.33, 95% C.I.: 0.13-0.82) or higher than 12 years (O.R.=0.28, 95% C.I.: 0.08-0.96), nicotine dependence (O.R.=1.41, 95% C.I. 1.17-1.69) and HADS anxiety score (O.R.=1.15, 95% C.I. 1.03-1.30) were the predictors in physicians’ rating. Conclusions: Differences in rating adherence may underpin communication gaps between patients and physicians. Systemic determinants of poor adherence should not be overlooked. A concerted effort by researchers, physicians and policy makers in defining as well as communicating adherence, while removing its barriers should be made.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social & Political Sciences, University of Peloponnese, Corinth, Greece.,School of Nursing, University of Thessaly Greece
| | - Lily E Peppou
- School of Nursing, University of Thessaly Greece.,Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece
| | - Marina Economou
- Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece.,First Department of Psychiatry, Aiginition Hospital, Medical School, Kapodistrian University of Athens, Athens, Greece
| | - Androniki Marioli
- Division of Medical Oncology, Third Department of Medicine, Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Saridi
- School of Nursing, University of Thessaly Greece
| | | | - Antonia Paschali
- Faculty of Nursing, School of Health Sciences, Department of Mental Health and Behavioral Sciences, Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos N Syrigos
- Division of Medical Oncology, Third Department of Medicine, Kapodistrian University of Athens, Athens, Greece
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17
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The effect of a mobile application on treatment adherence and symptom management in patients using oral anticancer agents: A randomized controlled trial. Eur J Oncol Nurs 2021; 52:101969. [PMID: 33991868 DOI: 10.1016/j.ejon.2021.101969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE The use of mobile health technologies in the management of oral anticancer agents (OAA) can be beneficial in terms of treatment adherence and symptom management. This study was conducted to investigate the effect of a mobile application developed for patients using OAA on treatment adherence and symptom management. METHOD The study was conducted using a randomized controlled trial design, and it was carried out on 77 patients. Data were collected from the Oral Chemotherapy Adherence Scale (OCAS), and the Memorial Symptom Assessment Scale (MSAS). Data were collected at the beginning of the research, and face-to-face interviews were conducted after one, three, and six months. Patients in the intervention group were followed up for six months using the mobile application. RESULTS It was found that there was no difference between the intervention and control groups in the baseline OCAS mean scores (p > 0.05), and the mean score of the intervention group increased over the first, third- and sixth-month measurements (p < 0.05). It was found that there was no difference between the intervention and control groups in the MSAS mean scores (p > .05), and there was a decrease in the mean MSAS score of the intervention group between the third- and sixth-month follow-up (p < .05). CONCLUSION The present study results showed that the mobile application is effective in managing symptoms and increasing treatment adherence. A well-designed mobile health application that increases treatment adherence, decreases symptom severity, and supports patients' self-management could be beneficial for patients using OAA. CLINICALTRIALS. GOV IDENTIFIER NCT04626830.
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18
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Medication Experience and Adherence to Oral Chemotherapy: A Qualitative Study of Patients' and Health Professionals' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084266. [PMID: 33920570 PMCID: PMC8073288 DOI: 10.3390/ijerph18084266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
Lack of adherence constitutes one of the most important challenges in patients undergoing treatment with oral antineoplastic drugs (ANEO). Understanding cancer patients’ experiences with respect to their medication is key for optimizing adherence and therapeutic results. We aimed to assess the medication experience (ME) in patients with cancer in treatment with ANEO, to describe the barriers and facilitators related to the disease and its treatment and to compare them with the healthcare professionals’ perspectives. We carried out an exploratory qualitative study in the University Hospital of San Juan de Alicante, Spain. Three focus groups and two nominal group discussions were conducted with 23 onco-hematological patients treated with ANEO and 18 health professionals, respectively. The data were analyzed using content analyses and were eventually triangulated. The most impactful aspects in patients’ ME were the presence of adverse effects; lack of information about treatment; beliefs, needs and expectations regarding medications; social and family support; and the relationship with the health professionals. Both patients and professionals agreed on considering the negative side effects and the information about treatment as the main barriers and facilitators of adherence, respectively, although the approaches differed between both profiles. The professionals offered a more technical vision while patients prioritized the emotional burden and motivation associated with the disease and medication. This study allowed us to understand the real-life experiences of patients being treated with ANEO and explore the factors which had an impact on adherence to treatment. This understanding enables professionals to have a positive influence on patients’ behavior and provide individualized care plans. Pharmacists’ assistance is relevant to support patients’ adherence and self-management.
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19
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Kim SJ, Kang D, Park Y, Mun YC, Kim K, Kim JS, Min CK, Cho J. Impact of depression on adherence to lenalidomide plus low-dose dexamethasone in patients with relapsed or refractory myeloma. Support Care Cancer 2021; 29:4969-4977. [PMID: 33575840 DOI: 10.1007/s00520-021-06017-y] [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: 11/25/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE While continued lenalidomide and low-dose dexamethasone (Rd) treatment could improve survival outcomes for multiple myeloma (MM), the association of depression on the adherence to Rd regimen in myeloma patients has never been studied even though depression is a common symptom among MM patients. This study aims to evaluate the impact of depression prior to Rd treatment on adherence to the treatment among patients with MM. METHODS This multicenter cohort study was conducted from January 2015 to October 2018 at five tertiary hospitals in Korea. Patients who completed fewer than 4 cycles, 4-11 cycles, and more than 12 cycles were categorized as the poor adherence group (PAG), moderate adherence group (MAG), and good adherence group (GAG), respectively. RESULTS Among141 patients, 41.8% of them had depression before beginning Rd treatment and 46% of participants were in the GAG. Compared with patients in the GAG (30.3%), patients in the PAG were more likely to have depression at baseline (90.0%) and had the higher distress scores (6.35 vs. 4.28, P < 0.01). Presence of depression prior to Rd treatment was significantly associated with poor adherence (IRR = 6.67, 95% CI = 1.45, 30.61) after adjusting for age, sex, education, ECOG, ISS stage, number of previous treatments, and disease status prior to Rd treatment. CONCLUSIONS Patients with depression had a substantially high risk of poor adherence compared to patients without depression. Given that Rd treatment is mainly offered by outpatient clinics, active interventions to reduce depression should be considered for MM patients prior to Rd treatment.
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Affiliation(s)
- Seok Jin Kim
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Cancer Education Center, Samsung Comprehensive Cancer Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Park
- Divison of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Anam Hospital, Seoul, South Korea
| | - Yeung-Chul Mun
- Department of Hematology, Ewha Womans University, Seoul, South Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Chang-Ki Min
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, South Korea. .,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Cancer Education Center, Samsung Comprehensive Cancer Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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20
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Leong C, Czaykowski P, Geirnaert M, Katz A, Dragan R, Yogendran M, Raymond C. Outpatient oral anticancer agent utilization and costs in Manitoba from 2003 to 2016: a population-based study. Canadian Journal of Public Health 2021; 112:530-540. [PMID: 33471346 DOI: 10.17269/s41997-020-00464-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022]
Abstract
INTERVENTION In April 2012, the Manitoba Home Cancer Drug Program (HCDP) was introduced to allow 100% coverage for eligible oral anticancer agents (OAA) and supportive medications for Manitobans with cancer requiring these therapies. RESEARCH QUESTIONS What is the extent of use and cost of OAAs among outpatients in Manitoba from 2003/04 to 2015/16? Did the HCDP change OAA user and prescription patterns? METHODS This was a retrospective, population-based study using administrative data to measure the prevalence of drug utilization over time and the impact of HCDP on OAA use and prescriptions using generalized linear models. Manitobans with cancer who filled an OAA or supportive medication covered by HCDP from 2003/04 to 2015/16 were included. RESULTS This study included 22,393 people with cancer who filled an OAA prescription. The prevalence of OAA use increased from 222 per 100,000 to 328 per 100,000 from 2003/04 to 2015/16. Hormone therapy for breast cancer was the most common class of OAA used (increased from 154 per 100,000 to 231 per 100,000). We observed a 2.6-fold decrease in the prevalence of oral alkylating agents and a 10.7-fold increase in the prevalence of protein kinase inhibitors during the study period. The total cost of targeted OAAs per year for all Manitobans with cancer increased from $1.8 million to $19 million. CONCLUSION We observed an increase in OAA prevalence and the cost of oral targeted chemotherapy is high. Our findings underline the need for addressing these high-cost medications in future developments of a national drug program.
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Affiliation(s)
- Christine Leong
- College of Pharmacy, University of Manitoba, 219 Apotex Centre, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.
| | - Piotr Czaykowski
- CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Internal Medicine, Section of Haematology/Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Alan Katz
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | | | - Colette Raymond
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
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Visacri MB, Duarte NC, Lima TDM, de Souza RN, Cobaxo TS, Teixeira JC, Barbosa CR, Dias LP, Tavares MG, Pincinato EDC, Lima CS, Moriel P. Adverse reactions and adherence to capecitabine: A prospective study in patients with gastrointestinal cancer. J Oncol Pharm Pract 2021; 28:326-336. [PMID: 33470162 DOI: 10.1177/1078155221989420] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Capecitabine is an oral anticancer drug which can cause some adverse reactions and the great challenge for its use is to ensure the medication adherence. The aim of this study was to analyze adverse reactions and adherence to capecitabine in patients with gastrointestinal cancer. METHODS A prospective study was performed in a tertiary teaching hospital in Brazil. Outpatients undergoing capecitabine treatment for colorectal or gastric cancer were followed for three cycles of treatment. Patient demographic and clinical characteristics data were collected. Adverse reactions were analyzed using Common Terminology Criteria for Adverse Events (CTCAE) v.4. Adherence to capecitabine were evaluated using Morisky-Green and MedTake tests. Statistical analysis was conducted using Chi-square, Fisher's exact and McNemer tests. RESULTS One hundred and four patients were enrolled in this study, with a mean age was 58.5 ± 10.9 years; 51.0% were men and 51.0% Caucasian. Nausea and diarrhea were the most frequently reported adverse reactions (82.7% and 62.5%, respectively), followed by vomiting (54.8%), fatigue (54.8%), and hand-foot syndrome (53.9%). Nausea and diarrhea were also the most severe adverse reactions. Most patients were adherent to capecitabine in all cycles of treatment using the Morisky-Green test. Adherence increased significantly between cycle 1 and cycle 2 by MedTake test (p < 0.001). Some demographic and clinical characteristics were associated with adverse reactions (e.g., age and nausea, gender and nausea and vomiting) and capecitabine adherence (e.g., marital status and educational level) as well as some adverse reactions were associated with capecitabine adherence (hand-foot syndrome and nausea). CONCLUSIONS Clinical oncology pharmacists must provide patient information on the correct use of capecitabine, manage adverse reactions, and monitor adherence to treatment. Strategies to prevent non-adherence to capecitabine must be adopted to ensure the success of pharmacotherapy.
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Affiliation(s)
- Marília B Visacri
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Natalia C Duarte
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Tácio de M Lima
- Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro, Seropédica, RJ, Brazil
| | - Rafael N de Souza
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Thiago S Cobaxo
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, SP, Brazil
| | - João Cc Teixeira
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | - Lara P Dias
- Hospital de Clínicas, University of Campinas, Campinas, SP, Brazil
| | | | - Eder de C Pincinato
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Carmen Sp Lima
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Patricia Moriel
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, SP, Brazil
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22
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Bashir Q, Acosta M. Comparative Safety, Bioavailability, and Pharmacokinetics of Oral Dexamethasone, 4-mg and 20-mg Tablets, in Healthy Volunteers Under Fasting and Fed Conditions: A Randomized Open-label, 3-way Crossover Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:768-773. [DOI: 10.1016/j.clml.2020.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
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23
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Santoleri F, Romagnoli A, Costantini A. Real-life adherence in capecitabine therapy using two analysis methods and persistence after 6 months of treatment. J Oncol Pharm Pract 2020; 27:1112-1118. [PMID: 32799777 DOI: 10.1177/1078155220949634] [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] [Indexed: 01/28/2023]
Abstract
Medication adherence in the field of Oncology is crucial in therapy management and can influence the probability of achieving and maintaining efficacy over time. We conducted a cross-sectional study to evaluate adherence and persistence to oral therapy with Capecitabine, using two different calculation methods: therapy diary and indirect prescription refilling patterns. The main objective of the study was to compare the two methods of analysis and to propose a reliable adherence datum, yielded by the application of two complementary methodologies. We consequently set out to verify if data collected from therapy diaries can be superimposed to those gathered from prescription refilling patterns. Furthermore, we included data on patient-perceived quality in relation to Capecitabine therapy, as well as adverse reactions and their duration. Of 594 patients who used the study drug as of January 1, 2012, 45 completed their therapy diary. Adherence to treatment was 0.93 ± 0.10 and 0.84 ± 0.15, calculated using therapy diaries and pharmacy refill data, respectively. In terms of persistence, 53% of patients continued with treatment after six months of therapy. On a 1 to 5 scale, perceived quality was 3.31. In conclusion, when it comes to calculating adherence, it is important to preserve the objectivity of the method, which must be unencumbered by any conditioning. Regardless of the method, also considering what has already been discussed in the available literature, adherence in patients under treatment with Capecitabine, unlike persistence, is good.
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Prospective evaluation of an anti-cancer drugs management programme in a dedicated oral therapy center (DICTO programme). Med Oncol 2020; 37:69. [PMID: 32712771 PMCID: PMC7382654 DOI: 10.1007/s12032-020-01393-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/16/2020] [Indexed: 01/28/2023]
Abstract
Oral therapies have highly modified cancer patient management and changed hospital practises. We introduce a specific Oral Therapy Centre and retrospectively review information prospectively recorded by co-ordination nurses (CNs) (the DICTO programme). We describe the roles played by CNs in the management of oral cancer therapies at Limoges Dupuytren Hospital between May 2015 and June 2018. All cancers, irrespective of stage or whether oral general chemotherapy or targeted therapy was prescribed, are included. We followed up 287 patients of median age 67 years (range 26–89 years). Of these, 76% had metastases and 44% were on first-line therapy. The vast majority (88%) of their first CN contacts occurred just after physician consultation and lasted an average of 60 min. As part of follow-up, the CNs made 2719 calls (average 10 min) to patients to educate them and to verify compliance and drug tolerance. They also received 833 calls from patients (70%) or their relatives or health professionals (30%) seeking advice on management of side effects. In addition to the initial appointments, 1069 non-scheduled follow-up visits were made to assess side effects (49.2%). The CNs devoted 5 h to each patient over 3 months of treatment (i.e. 25 min/day) and, also organised scheduled hospitalisations in the department of oncology for 51% of patients. We show the interest and real-life work in a specific oral therapy centre within oncology department with the role of CNs to facilitate the global health care of the patients.
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25
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Zerbit J, Chevret S, Bernard S, Kroemer M, Ablard C, Harel S, Brice P, Madelaine I, Thieblemont C. Improved time to treatment failure and survival in ibrutinib-treated malignancies with a pharmaceutical care program: an observational cohort study. Ann Hematol 2020; 99:1615-1625. [PMID: 32483668 PMCID: PMC7316844 DOI: 10.1007/s00277-020-04045-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/15/2020] [Indexed: 01/29/2023]
Abstract
Ibrutinib treatment has been shown to increase survival in patients with B cell malignancies. Real-life data suggest a large part of discontinuations are due to toxicities, impairing ibrutinib efficacy. We aimed to assess the impact of a pharmaceutical care program on the efficacy and safety of ibrutinib. This single-center, cohort, observational study enrolled patients with B cell malignancies. Patients were either assigned to the program or to receive usual care, based on physician decision. The program was conducted by clinical pharmacists specializing in oncology and included patient education for management of toxicities, adherence monitoring, interventions to reduce drug-drug interactions, and follow-up of transition from hospital to community. Between February 2014 and May 2017, we enrolled 155 patients, including 42 (27%) who were allocated to the program group and 113 (73%) to the usual care group. The effect of the program was beneficial in terms of time to treatment failure (p = 0.0005). The 30-month progression-free and overall survivals were significantly superior in the program group (respectively p = 0.002 and p = 0.004). Grade 3 or higher adverse events occurred more frequently for patients in the usual care group (15%) than program group (8%). A pharmaceutical care program provides a personalized environment for outpatient monitoring and control of the key risks associated with oral anticancer agents. This study shows evidence that management of ibrutinib treatment by clinical pharmacists results in significant improvement in survival and better tolerance than usual care.
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Affiliation(s)
- Jeremie Zerbit
- Pharmacy Department, APHP, Saint-Louis Hospital, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics and Medical Information, APHP, Saint-Louis Hospital, Paris, France.,Paris Diderot University, Sorbonne Paris-Cité, Paris, France
| | - Sophie Bernard
- Hemato-Oncology Department, APHP, Saint-Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Marie Kroemer
- Pharmacy Department, University Hospital Center of Besançon, Besançon, France
| | | | - Stephanie Harel
- Immuno-Hematology Department, APHP, Saint-Louis Hospital, Paris, France
| | - Pauline Brice
- Hemato-Oncology Department, APHP, Saint-Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | | | - Catherine Thieblemont
- Paris Diderot University, Sorbonne Paris-Cité, Paris, France. .,Hemato-Oncology Department, APHP, Saint-Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France.
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26
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Dean LT, George M, Lee KT, Ashing K. Why individual-level interventions are not enough: Systems-level determinants of oral anticancer medication adherence. Cancer 2020; 126:3606-3612. [PMID: 32438466 PMCID: PMC7467097 DOI: 10.1002/cncr.32946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023]
Abstract
Nonadherence to oral anticancer medications (OAMs) in the United States is as low as 33% for some cancers. The reasons for nonadherence to these lifesaving medications are multifactorial, yet the majority of studies focus on patient-level factors influencing uptake and adherence. Individually based interventions to increase patient adherence have not been effective, and this warrants attention to factors at the payor, pharmaceutical, and clinical systems levels. Based on the authors' research and clinical experiences, this commentary brings fresh attention to the long-standing issue of OAM nonadherence, a growing quality-of-care issue, from a systems perspective. In this commentary, the key driving factors in pharmaceutical and payor systems (state and federal laws, payor/insurance companies, and pharmaceutical companies), clinical systems (hospitals and providers), and patient contexts that have trickle-down effects on patient adherence to OAMs are outlined. In the end, the authors' recommendations include examining the influence of laws governing OAM drug pricing, OAM supply, and provider reimbursement; reducing the need for prior authorization of long-approved OAMs; identifying cost-effective ways for providers to monitor nonadherence; examining issues of provider bias in OAM prescriptions; and further elucidating in which contexts patients are likely to be able to adhere. These recommendations offer a starting point for an examination of the chain of systems influencing patient adherence and may help to finally resolve persistently high levels of OAM nonadherence.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Marshalee George
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimberley T Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimlin Ashing
- City of Hope Comprehensive Cancer Center, Division of Health Equities, City of Hope, Duarte, California, USA
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27
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Marmorat T, Rioufol C, Ranchon F, Préau M. Encounters between medical and lay knowledge in therapeutic patient education. A qualitative study based on an oral chemotherapy program. PATIENT EDUCATION AND COUNSELING 2020; 103:537-543. [PMID: 31685357 DOI: 10.1016/j.pec.2019.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The growing number of cancer patients treated with Oral Chemotherapy (OC) at home, is prompting many healthcare centers to develop Therapeutic Patient Education (TPE) programs. This study aimed to 1) describe the different forms of knowledge shared and learned in these programs, and 2) better understand how self-care and psychosocial skills are promoted in the TPE context. METHOD This study used qualitative data from the French "ONCORAL" program. Data collection was conducted with non-participant observations. The corpus comprised 42 TPE sessions. RESULTS Analysis highlighted that TPE specifically helps patients' functional health, revealed the medical expectations and social norms that shape the patient's role, and exposed the difficulties faced by the patient when acquiring self-care skills. Self-care skills and psychosocial skills also appeared to be mutually dependent in the context of TPE. CONCLUSION TPE programs which focus more on developing medical knowledge inevitably give less importance to psychosocial skills. Yet the recognition and promotion of the latter in TPE may lead to positive coping strategies related to medical outcomes, such as adherence. PRACTICE IMPLICATION Dedicated TPE program objectives for patients undergoing oral chemotherapy should recognize not only the value of medical knowledge but also of lay knowledge.
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Affiliation(s)
- Thibaud Marmorat
- Social Psychology Research Group (EA 4163 GRePS), Lyon 2 University, Lyon University, Lyon, France.
| | - Catherine Rioufol
- Parmacy Department, Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils of Lyon, Pierre-Bénite, France; Université Lyon 1, EMR 3738, Lyon, France
| | - Florence Ranchon
- Parmacy Department, Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils of Lyon, Pierre-Bénite, France; Université Lyon 1, EMR 3738, Lyon, France
| | - Marie Préau
- Social Psychology Research Group (EA 4163 GRePS), Lyon 2 University, Lyon University, Lyon, France
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Improvement in adherence to Capecitabine and Lapatinib by way of a therapeutic education program. Support Care Cancer 2019; 28:3313-3322. [PMID: 31758323 DOI: 10.1007/s00520-019-05144-x] [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: 05/06/2019] [Accepted: 10/21/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE A patient non-adherence with oral anticancer agents is a well-recognized barrier to effective treatment. The aim of this prospective study was to evaluate the efficacy of a therapeutic education program among non-adherent patients treated with Capecitabine alone or associated with Lapatinib. METHODS Sixty-five cancer patients were enrolled. Among them, 55 participated in the first observational phase of the study, measuring adherence using electronic MEMS pillboxes (medication event monitoring system). An adherence score was assessed in the form of a composite adherence score including intake dose and intake intervals. Ten non-adherent patients (adherence score < 80%) were included in the intervention phase of the study and were enrolled on a therapeutic education program. The efficacy of the program was evaluated on the basis of an improvement in adherence scores. We also studied factors influencing adherence. RESULTS The average adherence score was 83.6 ± 15.7% in the overall population. Forty-one patients were adherent (adherence score > 80%) and 14 patients were non-adherent (adherence score < 80%). The therapeutic education program for non-adherent patients (n = 10) increased their adherence score by 17.8% and led 60% of these patients to become adherent. The number of toxicities during the first cycles was a predictive factor for non-adherence. CONCLUSION This study showed an improvement in adherence to Capecitabine ± Lapatinib among non-adherent patients by way of a therapeutic education program.
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N Heck J, A Null A. Frequency of appropriate lab monitoring of oral chemotherapy in an outpatient setting. J Oncol Pharm Pract 2019; 26:1097-1102. [PMID: 31684819 DOI: 10.1177/1078155219882077] [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: 11/17/2022]
Abstract
PURPOSE The aim of this study is to understand the frequency of appropriate laboratory monitoring of oral chemotherapy at the Eastern Colorado Health Care System (ECHCS) compared to recommendations set forth in the 2012 Veterans Health Administration (VHA) Guidance on Dispensing and Monitoring of Oral Chemotherapy. METHODS This study is a retrospective chart review of patients who have received a subset of oral chemotherapy drugs at ECHCS. Patients 18 to 89 years of age with an active cancer diagnosis who initiated therapy at ECHCS between September 1, 2010 and August 31, 2014 were included in the study. Initial and subsequent prescription fill dates, appropriate labs as defined by VHA guidance and baseline and follow-up lab monitoring dates, and appropriate labs as defined by VHA guidance were collected for up to 12 cycles of chemotherapy per patient. Baseline labs were defined as within three months of the first prescription fill date, and follow-up labs were defined as within seven days of subsequent prescription fill dates. RESULTS Results are presented as complete, partial, or incomplete and as attempt or no attempt at monitoring according to the VHA guidance recommendations. There was 100% attempt at laboratory monitoring at baseline; however, there was a decline in attempt and complete follow-up monitoring overall as well as for drugs that require special monitoring. CONCLUSION Based on recommendations from the 2012 VHA Guidance on Dispensing and Monitoring Oral Chemotherapy, data presented here demonstrate that ECHCS could benefit from improved lab monitoring in order to ensure safe and effective use of oral chemotherapies. These results provide a unique opportunity to consider the potential role of clinical pharmacists in monitoring and management of patients receiving oral chemotherapies as well as patient and provider education regarding the importance of appropriate lab monitoring.
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Affiliation(s)
- Jessica N Heck
- VA Eastern Colorado Health Care System, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Aaron A Null
- VA Eastern Colorado Health Care System, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
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Vachon E, Given B, Given C, Dunn S. Temporary Stoppages and Burden of Treatment in Patients With Cancer. Oncol Nurs Forum 2019; 46:E135-E144. [PMID: 31424460 DOI: 10.1188/19.onf.e135-e144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine the effect of burden of treatment and multimorbidity on the relationship between baseline characteristics and oral oncolytic agent (OOA) temporary stoppages. SAMPLE & SETTING 272 patients newly prescribed OOAs at six National Cancer Institute-designated comprehensive cancer centers. METHODS & VARIABLES Patients were randomly assigned to an adherence and symptom management group or a usual care/control group. Temporary OOA stoppages, symptom interference, OOA regimen complexity, and multimorbidities were explored. Data were collected at four-week intervals for 12 weeks. RESULTS Burden of treatment variables and multimorbidity had no significant effect on OOA temporary stoppages. Women and those prescribed kinase inhibitors were significantly more likely to experience a temporary stoppage. IMPLICATIONS FOR NURSING Oncology nurses are in a crucial position to educate patients on self-management of OOAs and symptoms. Nurses should be aware of patients who may be more susceptible to severe symptoms, including those with multimorbidities. Future research is needed to better understand OOA stoppages and factors associated with preventing stoppages.
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Kinnaer L, Decoene E, Van Hecke A, Foulon V. Collaborative network to take responsibility for oral anticancer therapy (CONTACT): Study‐protocol investigating the impact of a care pathway. J Adv Nurs 2019; 75:3726-3739. [DOI: 10.1111/jan.14157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/21/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Lise‐Marie Kinnaer
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences KU Leuven Leuven Belgium
| | - Elsie Decoene
- Department of Oncology Ghent University Hospital Ghent Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Department of Nursing Ghent University Hospital Ghent Belgium
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences KU Leuven Leuven Belgium
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Key elements for the education and counselling of patients treated with oral anticancer drugs. Eur J Oncol Nurs 2019; 41:173-194. [PMID: 31358251 DOI: 10.1016/j.ejon.2019.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/22/2019] [Accepted: 06/29/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE The process of education and counselling of patients treated with oral anticancer drugs, aimed to achieve adequate self-management, involves different stakeholders (i.e. physicians, oncology nurses, pharmacists) from primary and secondary care. However, currently no guiding principles exist on how to organize and perform education and counselling for these patients. Therefore, the purpose of this study was to develop and build consensus on key elements for the education and counselling in patients on oral anticancer drugs. METHODS A multi-method approach combining a literature search, semi-structured interviews with patients and healthcare professionals, and input from experts were used to develop an initial list of key elements. Subsequently, consensus was built in a two-round Delphi-study, involving patients and healthcare professionals from primary and secondary care. Key elements were retained if at least 80% of respondents in all groups considered the element as important or if in at least one group 90% consensus was reached. RESULTS The initial list contained 110 key elements, divided in 7 themes: coordination of care, patient contacts: style and content, medication counselling at the start of the treatment and during follow-up, psychosocial support, and involvement of family and friends. After the first Delphi round, 80% consensus was reached for 23 elements; 6 new key elements were added. After the second round, 80% consensus was reached for 51 out of 116 elements; 31 elements were added following the 90%-rule, yielding a list of 82 elements. CONCLUSION The final list of 82 key elements, obtained in this study, could be used to develop clinical pathways that guide adequate education and counselling of patients on oral anticancer drugs. Due to the open description, the implementation of these elements can be adapted to the specific context and composition of the oncology team.
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Eldeib HK, Abbassi MM, Hussein MM, Salem SE, Sabry NA. The Effect of Telephone-Based Follow-Up on Adherence, Efficacy, and Toxicity of Oral Capecitabine-Based Chemotherapy. Telemed J E Health 2019; 25:462-470. [DOI: 10.1089/tmj.2018.0077] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Hend K. Eldeib
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Maggie M. Abbassi
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Marwa M. Hussein
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Salem E. Salem
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nirmeen A. Sabry
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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McKay R, Mills H, Werner L, Choudhury A, Choueiri T, Jacobus S, Pace A, Polacek L, Pomerantz M, Prisby J, Sweeney C, Walsh M, Taplin ME. Evaluating a Video-Based, Personalized Webpage in Genitourinary Oncology Clinical Trials: A Phase 2 Randomized Trial. J Med Internet Res 2019; 21:e12044. [PMID: 31045501 PMCID: PMC6538310 DOI: 10.2196/12044] [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: 08/27/2018] [Revised: 12/08/2018] [Accepted: 12/31/2018] [Indexed: 01/22/2023] Open
Abstract
Background The pace of drug discovery and approvals has led to expanding treatments for cancer patients. Although extensive research exists regarding barriers to enrollment in oncology clinical trials, there are limited studies evaluating processes to optimize patient education, oral anticancer therapy administration, and adherence for patients enrolled in clinical trials. In this study, we assess the feasibility of a video-based, personalized webpage for patients enrolled in genitourinary oncology clinical trials involving 1 or more oral anticancer therapy. Objective The primary objective of this trial was to assess the differences in the number of patient-initiated violations in the intervention arm compared with a control arm over 4 treatment cycles. Secondary objectives included patient satisfaction, frequently asked questions by patients on the intervention arm, patient-initiated calls to study team members, and patient-reported stress levels. Methods Eligible patients enrolling on a therapeutic clinical trial for a genitourinary malignancy were randomized 2:1 to the intervention arm or control arm. Patients randomized to the intervention arm received access to a video-based, personalized webpage, which included videos of patients’ own clinic encounters with their providers, instructional videos on medication administration and side effects, and electronic versions of educational documents. Results A total of 99 patients were enrolled (89 were evaluable; 66 completed 4 cycles). In total, 71% (40/56) of patients in the intervention arm had 1 or more patient-initiated violation compared with 70% (23/33) in the control arm. There was no difference in the total number of violations across 4 cycles between the 2 arms (estimate=−0.0939, 95% CI−0.6295 to 0.4418, P value=.73). Median baseline satisfaction scores for the intervention and control arms were 72 and 73, respectively, indicating high levels of patient satisfaction in both arms. Median baseline patient-reported stress levels were 10 and 13 for the intervention and control arms, respectively, indicating low stress levels in both arms at baseline. Conclusions This study is among the first to evaluate a video-based, personalized webpage that provides patients with educational videos and video recordings of clinical trial appointments. Despite not meeting the primary endpoint of reduced patient-initiated violations, this study demonstrates the feasibility of a video-based, personalized webpage in clinical trials. Future research assessing this tool might be better suited for realms outside of clinical trials and might consider the use of an endpoint that assesses patient-reported outcomes directly. A major limitation of this study was the lack of prior data for estimating the null hypothesis in this population.
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Affiliation(s)
- Rana McKay
- University of California San Diego, La Jolla, CA, United States
| | - Hannah Mills
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Lillian Werner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Atish Choudhury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Toni Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Susanna Jacobus
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Amanda Pace
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Laura Polacek
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mark Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Judith Prisby
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Meghara Walsh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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Cransac A, Aho S, Chretien ML, Giroud M, Caillot D, Boulin M. Adherence to immunomodulatory drugs in patients with multiple myeloma. PLoS One 2019; 14:e0214446. [PMID: 30917164 PMCID: PMC6436707 DOI: 10.1371/journal.pone.0214446] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 03/13/2019] [Indexed: 01/08/2023] Open
Abstract
Background Immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide; IMID) are widely used in the treatment of multiple myeloma patients. To date, few data are available on IMID adherence in multiple myeloma patients. The aim of our study was to evaluate IMID adherence and to compare two indirect methods to measure IMID adherence in multiple myeloma patients: a specific questionnaire and the medication possession ratio (MPR). Another aim was to explore this specific questionnaire for the assessment of IMID adherence in multiple myeloma patients. Methods All consecutive multiple myeloma patients, with at least two consecutive dispensations of thalidomide, lenalidomide or pomalidomide in our hospital were included in this prospective study. IMID adherence was measured using a specific questionnaire and the medication possession ratio. Relationship between the questionnaire scores and variables of interest was evaluated by multiple linear regression with a robust variance estimator. Findings Sixty-three patients were included in our study. The mean questionnaire score was 8.2±1.2 and the mean medication possession ratio value was 0.97±0.06. A total of 76% of patients were considered adherent according to the questionnaire (i.e. score ≥ 8), 94% according to the medication possession ratio (i.e. MPR ≥ 0.90), and 70% according to the questionnaire and the medication possession ratio. No statistically significant linear association was observed between the questionnaire score and any variables of interest including medication possession ratio. All Cronbach’s alpha were relatively low (range 0.0342–0.2443), showing a low correlation of the different questions with the questionnaire score. Conclusions Our study is the first prospective study evaluating IMID adherence in multiple myeloma patients in real life. The high adherence to IMIDs reported here, regardless of the drug, is encouraging considering the efficacy, toxicity and elevated cost of IMIDs. The specific questionnaire should be used with caution to evaluate IMID adherence.
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Affiliation(s)
- Amélie Cransac
- Department of Pharmacy, Dijon University Hospital and LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| | - Serge Aho
- Hospital Epidemiology and Infection Control Department, University Hospital, Dijon, France
| | - Marie-Lorraine Chretien
- Department of Clinical Hematology, University Hospital and SAPHIIR-UMR 1231, University of Burgundy & Franche Comté, Dijon, France
| | - Maurice Giroud
- Department of Neurology, Dijon University Hospital and LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| | - Denis Caillot
- Department of Clinical Hematology, University Hospital, Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, Dijon University Hospital and EPICAD LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
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Nagy A, Rahman OA, Abdullah H, Negida A. Do we Need Maintenance Chemotherapy in Advanced NSCLC in the Era of Immune and Targeted Therapy? CURRENT CANCER THERAPY REVIEWS 2019. [DOI: 10.2174/1573394714666180417160205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background:
Although well established for the effective management of hematologic
cancers, maintenance chemotherapy has only been recently incorportated as a treatment paradigm
for advanced non–small-cell lung cancer. Maintenance chemotherapy aims to prolong a clinically
favorable response state achieved after finishing induction therapy which is usually predefined in
number before startng treatment. There are 2 modalities for maintenance therapy; continuation
maintenance (involving a non-platinum component which was a part of the induction protocol or a
targeted agent) and switch maintenance therapy (utilizing a new agent which was not a part of the
induction regimen).
Methods:
The purpose of this article is to review the role of maintenance therapy in the treatment
of advanced Non-Small Cell Lung Cancer (NSCLC) and provide a brief overview about induction
chemotherapy in NSCLC to address the basis of maintenance therapy as a treatment option. We
will also compare the impact of maintenance chemotherapy with the now evolving role of
immunotherapy in NSCLC.
Results:
There have been 4 maintenance studies to date showing prolonged PFS and OS with statistical
significance. However, Three out of the four studies (ECOG4599, JMEN, and PARAMOUNT)
did not report tumor molecular analysis. As regard Immunotherapy, current data is in
favour of strongly an increasing role for immunotherapy in NSCLC.
Conclusion:
Maintenance therapy in NSCLC continues to be an important therapeutic line to improve
outcome in patients with metastatic and recurrent disease.
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Affiliation(s)
- Ahmed Nagy
- Department of Clinical Oncology and Nuclear Medicine, Ain Shams University, Cairo, Egypt
| | - Omar Abdel Rahman
- Department of Clinical Oncology and Nuclear Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Abdullah
- Department of Clinical Oncology, Mit Ghamr Cancer Center, Mit Al Faramawi, Mit Ghamr, Egypt
| | - Ahmed Negida
- Faculty of Medicine, Agazig University, Cairo, Egypt
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Crawford SY, Boyd AD, Nayak AK, Venepalli NK, Cuellar S, Wirth SM, Hsu GIH. Patient-centered design in developing a mobile application for oral anticancer medications. J Am Pharm Assoc (2003) 2019; 59:S86-S95.e1. [PMID: 30745188 DOI: 10.1016/j.japh.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To develop and test the usability and feasibility of a customizable mobile application (app) designed to help educate patients about their oral anticancer medications (OAMs) and regimens. SETTING Outpatient cancer center and oncology pharmacy for urban, Midwestern academic health system. PRACTICE DESCRIPTION Clinically-supervised educational intervention to support patients learning about OAMs. PRACTICE INNOVATION With input from patient partners, our interdisciplinary team designed the first known tablet-based educational app that can interface with a patient's electronic medical record. The app is based on learning style and adherence theories and is customizable for individually prescribed OAMs. The app can accommodate multiple learning styles through text at 6th-grade reading level, pictures, animations, and audio voiceovers. Functionalities include interactive educational modules on 11 OAMs and case-based patient stories on common barriers to OAM adherence. EVALUATION Early phase testing provided the opportunity to observe the user interface with the app and app functionality. Data were summarized descriptively from observations and comments of patient subjects. RESULTS Thirty patient subjects provided input-19 in phase 1 usability testing and 11 in phase 2 feasibility testing. Comments provided by patient subjects during usability testing were largely positive. Responses included self-identification with patient stories, usefulness of drug information, preferences for text messages, and app limitations (e.g., perceived generational digital divide in technology use and potential patient inability to receive text messages). Using their feedback, modifications were made to the prototype app. Responses in feasibility testing demonstrated the app's usefulness across a wide range of ages. Highest opinion ratings on app usefulness were stated by patients who were newer to OAM therapy. CONCLUSION User feedback suggests the potential benefit of the app as a tool to help patients with cancer, particularly after the first months for those starting new OAM regimens. Processes and lessons learned are transferable to other settings.
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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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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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Shelby RA, Dorfman CS, Bosworth HB, Keefe F, Sutton L, Owen L, Corsino L, Erkanli A, Reed SD, Arthur SS, Somers T, Barrett N, Huettel S, Gonzalez JM, Kimmick G. Testing a behavioral intervention to improve adherence to adjuvant endocrine therapy (AET). Contemp Clin Trials 2019; 76:120-131. [PMID: 30472215 PMCID: PMC6346744 DOI: 10.1016/j.cct.2018.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023]
Abstract
Adjuvant endocrine therapy (AET) is used to prevent recurrence and reduce mortality for women with hormone receptor positive breast cancer. Poor adherence to AET is a significant problem and contributes to increased medical costs and mortality. A variety of problematic symptoms associated with AET are related to non-adherence and early discontinuation of treatment. The goal of this study is to test a novel, telephone-based coping skills training that teaches patients adherence skills and techniques for coping with problematic symptoms (CST-AET). Adherence to AET will be assessed in real-time for 18 months using wireless smart pill bottles. Symptom interference (i.e., pain, vasomotor symptoms, sleep problems, vaginal dryness) and cost-effectiveness of the intervention protocol will be examined as secondary outcomes. Participants (N = 400) will be recruited from a tertiary care medical center or community clinics in medically underserved or rural areas. Participants will be randomized to receive CST-AET or a general health education intervention (comparison condition). CST-AET includes ten nurse-delivered calls delivered over 6 months. CST-AET provides systematic training in coping skills for managing symptoms that interfere with adherence. Interactive voice messaging provides reinforcement for skills use and adherence that is tailored based on real-time adherence data from the wireless smart pill bottles. Given the high rates of non-adherence and recent recommendations that women remain on AET for 10 years, we describe a timely trial. If effective, the CST-AET protocol may not only reduce the burden of AET use but also lead to cost-effective changes in clinical care and improve breast cancer outcomes. Trials registration: ClinicalTrials.gov, NCT02707471, registered 3/3/2016.
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Affiliation(s)
- Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Hayden B Bosworth
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States; Department of Population Health Sciences, Duke University, Durham, NC, United States; Department of Medicine, Duke University, Durham, NC, United States.
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Linda Sutton
- Duke Cancer Network, Duke University, Durham, NC, United States.
| | - Lynda Owen
- Duke Cancer Network, Duke University, Durham, NC, United States.
| | - Leonor Corsino
- Division of Endocrinology, Duke University, Durham, NC, United States.
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States.
| | - Shelby D Reed
- Department of Population Health Sciences, Duke University, Durham, NC, United States; Department of Medicine, Duke University, Durham, NC, United States.
| | - Sarah S Arthur
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Nadine Barrett
- Office of Health Equity and Disparities, Duke Cancer Institute, Duke University, Durham, NC, United States.
| | - Scott Huettel
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States.
| | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University, Durham, NC, United States.
| | - Gretchen Kimmick
- Division of Medical Oncology, Duke University, Durham, NC, United States.
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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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Sikorskii A, Given CW, Given BA, Vachon E, Krauss JC, Rosenzweig M, McCorkle R, Champion VL, Banik A, Majumder A. An Automated Intervention Did Not Improve Adherence to Oral Oncolytic Agents While Managing Symptoms: Results From a Two-Arm Randomized Controlled Trial. J Pain Symptom Manage 2018; 56:727-735. [PMID: 30096441 PMCID: PMC7646373 DOI: 10.1016/j.jpainsymman.2018.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 01/28/2023]
Abstract
CONTEXT An increasing number of oral cancer treatments require patient adherence and symptom self-management. OBJECTIVES The report presents the effects of a medication reminder and symptom management intervention directed at patients initiating new oral oncolytic agents. METHODS Patients (N = 272) were recruited at six comprehensive cancer centers, interviewed over the telephone after oral agent initiation, and randomized to either standard care or a medication reminder and symptom management intervention. In the intervention arm, the automated system called patients daily to remind them about taking their medications and weekly to assess 18 symptoms and refer patients to a printed Medication Management and Symptom Management Toolkit. Severity of 18 symptoms was also assessed during telephone interviews at Week 4 (midintervention), Week 8 (postintervention), and Week 12 (follow-up). Adherence was measured using the relative dose intensity, the ratio of dose taken by patient out of dose prescribed by the oncologist, and assessed using pill counts at Weeks 4, 8, and 12 and prescribing information from medical records. RESULTS The relative dose intensity was high and did not differ by trial arm. Symptom severity was significantly lower (P < 0.01) in the experimental arm at Week 8 but not at Weeks 4 or 12. CONCLUSION Adherence may be less of a problem than originally anticipated, and intervention was not efficacious possibly because of already high rates of patient adherence to oral oncolytic medication during first 12 weeks. Longer follow-up in future research may identify subgroups of patients who need interventions to sustain adherence.
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Affiliation(s)
| | | | | | - Eric Vachon
- Michigan State University, East Lansing, Michigan, USA
| | | | | | | | | | - Asish Banik
- Michigan State University, East Lansing, Michigan, USA
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Challenges to the design and testing supportive interventions for cancer patients treated with oral oncolytic agents. Support Care Cancer 2018; 26:3975-3977. [PMID: 30136026 DOI: 10.1007/s00520-018-4414-8] [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: 11/13/2017] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
Conducting research into supportive care for patients as they initiate treatment with oral oncolytic agents poses numerous new challenges. Some of these medications have very complex dosing schedules and produce symptoms that patients need to manage at home with less reliance on oncology clinicians. We describe lessons learned from a multi-site trial designed to improve adherence to these medications and self-management of symptoms among patients newly prescribed oral oncolytic agents. Identifying these challenges can assist researchers to improve the integrity of their future supportive care trials.
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Maleki S, Alexander M, Fua T, Liu C, Rischin D, Lingaratnam S. A systematic review of the impact of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies. J Oncol Pharm Pract 2018; 25:130-139. [PMID: 29938594 DOI: 10.1177/1078155218783814] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients receiving anticancer therapies are frequently prescribed complex and high-risk medication regimens, which at times can result in medication misadventures. The objective of this review was to assess the effect of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies, including patients undergoing radiotherapy. METHODS A systematic review of original publications indexed in EMBASE, MEDLINE and Cochrane Library from June 2007 to June 2017. Eligible studies evaluated outpatient pharmacy clinic services for cancer patients and reported at least one medication-related quantitative outcome measure. Two authors independently reviewed full-text articles for inclusion, then extracted data and performed quality and risk of bias assessments. RESULTS Of 908 identified publications, 13 met predefined eligibility criteria; 1 randomised control trial, 2 controlled cohort studies and 10 uncontrolled before-after studies. Many excluded studies described outpatient pharmacy services but lacked medication-related outcomes. All included studies had informative practice model designs, with interventions for drug-related problems including drug dose optimisation ( n = 8), reduced drug interaction ( n = 6) and adverse drug reaction reporting ( n = 3). Most studies ( n = 11) reported on symptom improvement, commonly nausea ( n = 7) and pain ( n = 5). Of four studies in radiotherapy cohorts, pharmacist involvement was associated with improved symptoms, satisfaction and wellbeing scores. CONCLUSION Few studies have objectively assessed outpatient pharmacy cancer services, even fewer in the radiotherapy settings. Although the results support these services, significant heterogeneity and bias in the study designs prohibit robust conclusions and further controlled trials are required.
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Affiliation(s)
- Sam Maleki
- 1 Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Marliese Alexander
- 1 Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Tsien Fua
- 2 Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Chen Liu
- 2 Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Danny Rischin
- 3 Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Senthil Lingaratnam
- 1 Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
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Adherence to Oral Anticancer Medications: Evolving Interprofessional Roles and Pharmacist Workforce Considerations. PHARMACY 2018. [PMID: 29518017 PMCID: PMC5874562 DOI: 10.3390/pharmacy6010023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Interprofessional care is exhibited in outpatient oncology practices where practitioners from a myriad of specialties (e.g., oncology, nursing, pharmacy, health informatics and others) work collectively with patients to enhance therapeutic outcomes and minimize adverse effects. Historically, most ambulatory-based anticancer medication therapies have been administrated in infusion clinics or physician offices. Oral anticancer medications (OAMs) have become increasingly prevalent and preferred by patients for use in residential or other non-clinic settings. Self-administration of OAMs represents a significant shift in the management of cancer care and role responsibilities for patients and clinicians. While patients have a greater sense of empowerment and convenience when taking OAMs, adherence is a greater challenge than with intravenous therapies. This paper proposes use of a qualitative systems evaluation, based on theoretical frameworks for interdisciplinary team collaboration and systems science, to examine the social interactionism involved with the use of intravenous anticancer treatments and OAMs (as treatment technologies) by describing patient, organizational, and social systems considerations in communication, care, control, and context (i.e., Kaplan’s 4Cs). This conceptualization can help the healthcare system prepare for substantial workforce changes in cancer management, including increased utilization of oncology pharmacists.
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Li Q, Liu Z, Kolli S, Wetz K, Griffith N, Poi MJ. Stability of extemporaneous erlotinib, lapatinib, and imatinib oral suspensions. Am J Health Syst Pharm 2018; 73:1331-7. [PMID: 27543577 DOI: 10.2146/ajhp150581] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The stability of extemporaneously prepared erlotinib, lapatinib, and imatinib oral liquid dosage forms using two commercially available vehicles when stored at 4 and 25 °C was evaluated. METHODS Three batches of extemporaneous oral suspensions were prepared for each drug. Erlotinib and lapatinib tablets were crushed and mixed in a 1:1 mixture of Ora-Plus:Ora-Sweet solution to yield 10- and 50-mg/mL suspensions, respectively. Imatinib tablets were crushed and mixed in Ora-Sweet solution to yield a 40-mg/mL suspension. Suspensions were stored in amber plastic bottles, and samples from each bottle were obtained on days 0, 1, 3, 7, 14, and 28. RESULTS Erlotinib 10-mg/mL and lapatinib 50-mg/mL oral suspensions in a 1:1 mixture of Ora-Plus and Ora-Sweet retained at least 90% of their initial concentration throughout the 28-day study when stored at 25 °C. Visual inspection revealed notable viscosity changes in the erlotinib and lapatinib suspensions stored at 4 °C for 7 days and beyond. The viscosity of these preparations increased with time and was particularly evident with the erlotinib suspension, which exhibited a puddinglike texture. Imatinib 40-mg/mL oral suspension in Ora-Sweet appeared stable for up to 14 days when stored at both 25 and 4 °C. CONCLUSION Erlotinib 10-mg/mL and lapatinib 50-mg/mL oral suspensions prepared from commercially available tablets were stable for at least 28 days when prepared in a 1:1 mixture of Ora-Plus:Ora-Sweet at 25 °C. Imatinib 40-mg/mL oral suspension prepared from commercially available tablets was stable for up to 14 days when prepared in Ora-Sweet and stored at 25 and 4 °C.
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Affiliation(s)
- Quan Li
- Department of Pharmacy, James Comprehensive Cancer Hospital and Richard Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, OH
| | - Zhaoying Liu
- College of Veterinary Medicine, Hunan Agricultural University, Hunan, China
| | | | - Karen Wetz
- Department of Pharmacy, Ohio State University Wexner Medical Center, Columbus, OH
| | - Niesha Griffith
- Department of Pharmacy, James Comprehensive Cancer Hospital and Richard Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, OH
| | - Ming J Poi
- Division of Pharmacy Practice and Science, College of Pharmacy, Ohio State University, Columbus, OHDepartment of Pharmacy, James Comprehensive Cancer Hospital and Richard Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, OH.
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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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Colombo LRP, Aguiar PM, Lima TM, Storpirtis S. The effects of pharmacist interventions on adult outpatients with cancer: A systematic review. J Clin Pharm Ther 2017; 42:414-424. [DOI: 10.1111/jcpt.12562] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/24/2017] [Indexed: 12/29/2022]
Affiliation(s)
- L. R. P. Colombo
- Department of Pharmacy; University of São Paulo; São Paulo Brazil
| | - P. M. Aguiar
- Department of Pharmacy; University of São Paulo; São Paulo Brazil
| | - T. M. Lima
- Department of Pharmacy; University of São Paulo; São Paulo Brazil
| | - S. Storpirtis
- Department of Pharmacy; University of São Paulo; São Paulo Brazil
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Engle JA, Traynor AM, Campbell TC, Wisinski KB, LoConte N, Liu G, Wilding G, Kolesar JM. Assessment of adherence and relative dose intensity with oral chemotherapy in oncology clinical trials at an academic medical center. J Oncol Pharm Pract 2017; 24:348-353. [PMID: 28457192 DOI: 10.1177/1078155217704989] [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] [Indexed: 11/16/2022]
Abstract
Background/Aims Oral chemotherapy is increasingly utilized leaving the patient responsible for self-administering an often complex regimen where adverse effects are common. Non-adherence and reduced relative dose intensity are both associated with poorer outcomes in the community setting but are rarely reported in clinical trials. The purpose of this study is to quantify adherence and relative dose intensity in oncology clinical trials and to determine patient and study related factors that influence adherence and relative dose intensity. Methods Patients were identified from non-industry-funded clinical trials conducted between 1 January 2009 and 31 March 2013 at the University of Wisconsin Carbone Cancer Center. Data were extracted from primary research records. Descriptive statistics and linear regression modeling was performed using SAS 9.4. Results A total of 17 clinical trials and 266 subjects were included. Mean adherence was greater than 97% for the first eight cycles. Mean relative dose intensity was less than 90% for the first cycle and declined over time. Male gender, a performance status of 1 or 2, metastatic disease, and traveling more than 90 miles to reach the cancer center were associated with higher relative dose intensity. Conclusions Patients with cancer enrolled in clinical trials are highly adherent but unlikely to achieve protocol specified relative dose intensity. Given that determining the phase II dose is the primary endpoint of phase I trials, incorporating relative dose intensity into this determination should be considered.
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Affiliation(s)
- Jeff A Engle
- 1 School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Anne M Traynor
- 2 Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Toby C Campbell
- 2 Carbone Cancer Center, University of Wisconsin, Madison, WI, USA.,3 School of Nursing, University of Wisconsin, Madison, WI, USA
| | - Kari B Wisinski
- 2 Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Noelle LoConte
- 2 Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Glenn Liu
- 2 Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - George Wilding
- 4 MD Anderson Cancer Center, The University of Texas MD, Houston, TX, USA
| | - Jill M Kolesar
- 5 College of Pharmacy, University of Kentucky, Lexington, KY, USA
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Spoelstra SL, Rittenberg CN. Assessment and measurement of medication adherence: oral agents for cancer. Clin J Oncol Nurs 2017; 19:47-52. [PMID: 26030393 DOI: 10.1188/15.s1.cjon.47-52] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinicians are challenged to find ways to assess and measure adherence to oral agents for cancer (OACs). OBJECTIVES The purpose of this article is to report on available ways to assess and measure medication adherence by patients with cancer. METHODS Tools examined include the Morisky Medication Adherence Scale (MMAS) and the Adherence Estimator, which are able to predict risk of nonadherence. Adherence Starts With Knowledge (ASK®)-12 and the Brief Adherence Rating Scale (BARS) are likely to be effective for predicting nonadherence and measuring adherence rates. FINDINGS Additional research needs to focus on the testing of reliable and valid tools that are sensitive and specific to patients with cancer who are prescribed OACs. The authors found that the MMAS and Adherence Estimator tools may be useful at predicting risk of medication nonadherence, and the ASK-12 and BARS may be useful for measuring rates of adherence. Tools could be modified to a specific clinical setting and used in a standardized format so that nurses can assess risk of medication nonadherence and measure adherence rates of OACs.
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