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Sivakumaran K, Ginex PK, Waseem H, Belcher SM, Lagler-Clark S, LeFebvre KB, Palmer N, Pasumarthi T, Morgan RL. Domains of Structured Oral Anticancer Medication Programs: A Scoping Review. Oncol Nurs Forum 2022; 49:296-306. [PMID: 35788732 PMCID: PMC9303043 DOI: 10.1188/22.onf.296-306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PROBLEM IDENTIFICATION An interprofessional approach is necessary to support the multifactorial process of patient adherence to oral anticancer medications (OAMs). This scoping review aims to identify structured OAM programs in published literature, identify components within studies, and propose a framework for institutions developing or maintaining OAM programs. LITERATURE SEARCH Embase®, PubMed®, and CINAHL® databases were searched for studies published between January 2000 and April 2021. DATA EVALUATION Two reviewers screened studies and extracted data. Characteristics and specific domains of the OAM programs were captured. Key components of the programs were identified, and a framework was created to guide program development. SYNTHESIS Components identified among the 21 studies were education; counseling; follow-up; dedicated clinician contact; adverse event and toxicity monitoring; adherence monitoring; drug procurement, delivery, and supply; patient- and system-level cost reduction; information technology; and risk assessment. IMPLICATIONS FOR RESEARCH Based on the findings, a framework for building and evaluating OAM adherence programs is proposed. Future studies should evaluate the reliability and validity of this framework because further testing may lead to the development of additional components.
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Affiliation(s)
| | - Pamela K. Ginex
- School of Nursing, Stony Brook University with a joint appointment in the Division of Population Science at the Stony Brook Cancer Center, both in New York, and was, at the time of writing, the senior manager of evidence-based practice and inquiry at the Oncology Nursing Society in Pittsburgh, PA
| | | | - Sarah M. Belcher
- School of Nursing and Palliative Research Center at the University of Pittsburgh in Pennsylvania
| | - Sarah Lagler-Clark
- Evidence Foundation and Department of Health Research Methods, Evidence and Impact at McMaster University in Hamilton, Ontario, Canada
| | | | | | - Tejanth Pasumarthi
- Evidence Foundation and a student in the School of Interdisciplinary Science at McMaster University
| | - Rebecca L. Morgan
- Evidence Foundation and an assistant professor in the Department of Health Research Methods, Evidence and Impact at McMaster University
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Belcher SM, Mackler E, Muluneh B, Ginex PK, Anderson MK, Bettencourt E, DasGupta RK, Elliott J, Hall E, Karlin M, Kostoff D, Marshall VK, Millisor VE, Molnar M, Schneider SM, Tipton J, Yackzan S, LeFebvre KB, Sivakumaran K, Waseem H, Morgan RL. ONS Guidelines™ to Support Patient Adherence to Oral Anticancer Medications. Oncol Nurs Forum 2022; 49:279-295. [PMID: 35788731 PMCID: PMC9303042 DOI: 10.1188/22.onf.279-295] [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: 11/07/2022]
Abstract
PURPOSE This evidence-based guideline intends to support patients, clinicians, and others regarding interventions and processes to support patient adherence to oral anticancer medications (OAMs). METHODOLOGIC APPROACH A panel of healthcare professionals and patient representatives developed a clinical practice guideline to support patients taking OAMs. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology and criteria for trustworthy guidelines were followed. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. A quantitative or narrative synthesis of the evidence was completed. Certainty of the evidence was assessed using GRADE. FINDINGS The panel agreed on recommendations and suggested an adherence risk assessment, education addressing adherence, ongoing assessment, proactive follow-up, coaching, and motivational interviewing in addition to usual care. The panel suggested the implementation of a structured OAM program. IMPLICATIONS FOR NURSING As cancer treatment shifts from clinic to home settings, interventions and programs to support patients on OAMs are needed.
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Affiliation(s)
- Sarah M. Belcher
- School of Nursing and in the Palliative Research Center at the University of Pittsburgh in Pennsylvania
| | - Emily Mackler
- Michigan Institute for Care Management and Transformation and the Michigan Oncology Quality Consortium in Ann Arbor
| | - Benyam Muluneh
- Eshelman School of Pharmacy at the University of North Carolina in Durham
| | - Pamela K. Ginex
- School of Nursing at Stony Brook University with a joint appointment in the Division of Population Science at the Stony Brook Cancer Center, both in New York, and was, at the time of writing, the senior manager of evidence-based practice and inquiry at the Oncology Nursing Society in Pittsburgh, PA
| | | | | | | | | | - Erica Hall
- Oncology Consultants, P.A., in Houston, TX
| | | | | | | | | | - Maegan Molnar
- Waco Therapy and Holistic Wellness Services in Texas and a cancer policy and advocacy team member at the National Coalition for Cancer Survivorship in Silver Spring, MD
| | | | | | - Susan Yackzan
- Cancer Service Line at Baptist Health System in Lexington, KY
| | | | | | | | - Rebecca L. Morgan
- Evidence Foundation and an assistant professor in the Department of Health Research Methods, Evidence and Impact at McMaster University
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Tralongo P, Gebbia V, Mercadante S, Bordonaro R, Ferraù F, Barni S, Firenze A. Cancer: New Needs, New Models. Is It Time for a Community Oncologist? Another Brick in the Wall. Cancers (Basel) 2021; 13:1919. [PMID: 33923380 PMCID: PMC8071576 DOI: 10.3390/cancers13081919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/04/2021] [Accepted: 04/11/2021] [Indexed: 11/16/2022] Open
Abstract
Over the last few decades, thanks to early detection, effective drugs, and personalized treatments, the natural history of cancer has radically changed. Thanks to these advances, we have observed how survival of cancer patients has increased, becoming an ever more important goal in cancer care. Effective clinical governance of survivorship care is essential to ensure a successful transition between active and post-treatment life, identifying optimization of healthcare outcomes and quality of life for patients as the primary objectives. For these reasons, potential intervention models must consider these differences to rationalize the available resources, including economic aspects. In this perspective, analyzing the different models proposed in the literature to manage this type of patients, we focus on the possible role of the so-called "community oncologist". As a trained health professional, also focused on longevity, he could represent the right management solution in all those "intermediate" clinical conditions that arise between the hospital specialist, frequently overworked, and the general practitioner, often biased by the lack of specific expertise.
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Affiliation(s)
- Paolo Tralongo
- Medical Oncology Unit, Hospital Umberto I, RAO, 96100 Siracusa, Italy
| | - Vittorio Gebbia
- Section of Medical Oncology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy;
- Medical Oncology Unit, La Maddalena Clinic for Cancer, 90100 Palermo, Italy
- GSTU Foundation for Cancer Research, 90100 Palermo, Italy
| | - Sebastiano Mercadante
- Anesthesia and Intensive Care, Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, 90100 Palermo, Italy;
| | | | - Francesco Ferraù
- Medical Oncology Unit, San Vincenzo Hospital, 98039 Taormina, Italy;
| | - Sandro Barni
- Medical Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio, Italy;
| | - Alberto Firenze
- Risk Management Unit, AOUP P. Giaccone, University of Palermo, 90100 Palermo, Italy;
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Homcology: home chemotherapy delivery in a simultaneous care project for frail advanced cancer patients. Support Care Cancer 2020; 29:917-923. [PMID: 32533437 DOI: 10.1007/s00520-020-05569-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/05/2020] [Indexed: 12/28/2022]
Abstract
Homcology is a project that represents both an opportunity for patients who may benefit from chemotherapy so far, but present physical and social problems that prevent day-hospital access, and a model of "no-profit" contribution to the Public Health System. Our medical oncology department conducted the project from May 2014 to January 2019. We included frail patients (G-8 < 14), with advanced disease, treated with oral, subcutaneous, or parenteral biological agents, with limitations to day-hospital access, comorbidities, and at least 6-month life expectancy. A multidisciplinary team included three oncologists, four nurses, an anesthetist, a psychologist, and a physiotherapist. Satisfaction was evaluated with FAMCARE scale. A total of 188 patients (median age of 73 years, 38-87) were enrolled. Ninety percent of patients presented with metastatic disease and a median G-8 score of 8.8 (3-13.5). All of them received anticancer treatment and concomitant supportive care; 24 patients received two or more lines of treatment. The median duration of taking care was 175 days (7-1200). A median number of 254 (195-325) nursing and 164 (139-190) medical visits were performed a year, with an average of 1.9 and 1.2 visits a month per patient respectively. The median number of in-line patients was 20 (17-25). Hospitalization occurred in 18% of cases. One-third of them died at home. The others were referred to hospice. Our experience shows that the integration of home cancer treatment and supportive care is effective. Hospitalization rate is lower than data reported in the literature. Results need to be confirmed in prospective pharmacoeconomics studies.
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Rosenberg SM, Petrie KJ, Stanton AL, Ngo L, Finnerty E, Partridge AH. Interventions to Enhance Adherence to Oral Antineoplastic Agents: A Scoping Review. J Natl Cancer Inst 2020; 112:443-465. [PMID: 31899790 PMCID: PMC7225676 DOI: 10.1093/jnci/djz244] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 11/11/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As new targeted oral antineoplastic therapies have emerged in recent years, the development of effective strategies that promote optimal adherence to cancer medication regimens has become an important priority. METHODS We conducted a scoping literature review to search for English language articles published through July 15, 2019, to identify studies that reported the testing and/or evaluation of interventions to improve adherence to oral antineoplastic agents. RESULTS A total of 56 articles were selected for review. Of the studies evaluated, 14 were randomized trials. All interventions except two targeted adult patients. Thirty-three studies enrolled fewer than 100 patients. Most interventions were education- and counseling-based and centered on provision of information about the drug and strategies to manage side effects. Only eight studies used an mHealth tool and/or text messages to target nonadherence. Among studies with a comparison sample, fewer than one-half (44.7%) reported statistically significant improvements in adherence or persistence associated with the intervention; however, some pharmacist-directed programs, particularly those that integrated monitoring or routine follow-up with a provider, did demonstrate efficacy. CONCLUSION Although the development of adherence-promoting interventions for oral antineoplastic therapies has increased recently, few have been rigorously tested. The nascent literature suggests those that are pharmacist directed and use regular monitoring show promise, though additional prospective studies are needed. Study methodology, population selection, and potential challenges that may be encountered in the implementation and dissemination phases should be considered when developing new interventions to address nonadherence to oral antineoplastic treatment.
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Affiliation(s)
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Annette L Stanton
- Jonsson Comprehensive Cancer Center, Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry/Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Lan Ngo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Emma Finnerty
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Tarricone R, Cucciniello M, Armeni P, Petracca F, Desouza KC, Hall LK, Keefe D. Mobile Health Divide Between Clinicians and Patients in Cancer Care: Results From a Cross-Sectional International Survey. JMIR Mhealth Uhealth 2019; 7:e13584. [PMID: 31493318 PMCID: PMC6754682 DOI: 10.2196/13584] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022] Open
Abstract
Background Mobile technologies are increasingly being used to manage chronic diseases, including cancer, with the promise of improving the efficiency and effectiveness of care. Among the myriad of mobile technologies in health care, we have seen an explosion of mobile apps. The rapid increase in digital health apps is not paralleled by a similar trend in usage statistics by clinicians and patients. Little is known about how much and in what ways mobile health (mHealth) apps are used by clinicians and patients for cancer care, what variables affect their use of mHealth, and what patients’ and clinicians’ expectations of mHealth apps are. Objective This study aimed to describe the patient and clinician population that uses mHealth in cancer care and to provide recommendations to app developers and regulators to generally increase the use and efficacy of mHealth apps. Methods Through a cross-sectional Web-based survey, we explored the current utilization rates of mHealth in cancer care and factors that explain the differences in utilization by patients and clinicians across the United States and 5 different countries in Europe. In addition, we conducted an international workshop with more than 100 stakeholders and a roundtable with key representatives of international organizations of clinicians and patients to solicit feedback on the survey results and develop insights into mHealth app development practices. Results A total of 1033 patients and 1116 clinicians participated in the survey. The proportion of cancer patients using mHealth (294/1033, 28.46%) was far lower than that of clinicians (859/1116, 76.97%). Accounting for age and salary level, the marginal probabilities of use at means are still significantly different between the 2 groups and were 69.8% for clinicians and 38.7% for patients using the propensity score–based regression adjustment with weighting technique. Moreover, our analysis identified a gap between basic and advanced users, with a prevalent use for activities related to the automation of processes and the interaction with other individuals and a limited adoption for side-effect management and compliance monitoring in both groups. Conclusions mHealth apps can provide access to clinical and economic data that are low cost, easy to access, and personalized. The benefits can go as far as increasing patients’ chances of overall survival. However, despite its potential, evidence on the actual use of mobile technologies in cancer care is not promising. If the promise of mHealth is to be fulfilled, clinician and patient usage rates will need to converge. Ideally, cancer apps should be designed in ways that strengthen the patient-physician relationship, ease physicians’ workload, be tested for validity and effectiveness, and fit the criteria for reimbursement.
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Affiliation(s)
- Rosanna Tarricone
- Department of Social and Political Science, Bocconi University, Milan, Italy.,Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Maria Cucciniello
- Department of Social and Political Science, Bocconi University, Milan, Italy.,Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Patrizio Armeni
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Francesco Petracca
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Kevin C Desouza
- School of Management, QUT Business School, Queensland University of Technology, Brisbane, Australia
| | - Leslie Kelly Hall
- Healthwise, Boise, ID, United States.,Engaging Patient Strategy, Boise, ID, United States
| | - Dorothy Keefe
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
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Effectiveness of a standardized patient education program on therapy-related side effects and unplanned therapy interruptions in oral cancer therapy: a cluster-randomized controlled trial. Support Care Cancer 2017; 25:3475-3483. [DOI: 10.1007/s00520-017-3770-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/30/2017] [Indexed: 01/12/2023]
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Transition journey from hospital to home in patients with cancer and their caregivers: a qualitative study. Support Care Cancer 2016; 24:4319-26. [PMID: 27178439 DOI: 10.1007/s00520-016-3269-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The National Cancer Institute Singapore initiated the NUH2 Home program in January 2014, referred to as "Caring Across the Cancer Continuum," a nurse-led cancer transitional care service (CTCS) that provides home care to patients with cancer and their caregivers. The study aimed to explore the transition experiences of patients with cancer and their caregivers. METHOD Using a purposive sampling, 12 patients with cancer and 12 caregivers were recruited. Audiotape interviews were conducted until data saturation was achieved. Each interview was transcribed verbatim, and thematic analyses were performed to extract significant themes and subthemes. RESULTS Four themes emerged from the data including (1) ongoing concerns, (2) needing timely help, (3) resuming control and normality of life, and (4) appreciating the transition care. The transition journey of patients and caregivers provided them with an ability to regain control and normality in their lives, be reassured and confident in being able to care for themselves and manage the physiological and psychological strains associated with the multiple vicissitudes associated with having cancer and its treatment while at home. CONCLUSION Our study addressed the nature, patterns, conditions, and responses to transition care. Our findings provided relevant contextual knowledge to further improve the transition care service based on the recommendations of the patients with cancer and their caregivers who first experienced the new service.
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Undesirable effects related to oral antineoplastic drugs: comparison between patients' internet narratives and a national pharmacovigilance database. Drug Saf 2015; 37:629-37. [PMID: 25027671 DOI: 10.1007/s40264-014-0203-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Internet is changing the way people learn about health and illness. Over the previous decade, the oral antineoplastic (OAN) agents have changed patient management allowing more ambulatory care. In this regard, websites could be an interesting source of data about OAN-induced adverse events (AEs). OBJECTIVE The aim of the study was to describe the characteristics of AEs, as reported on websites by patients exposed to OAN agents, and to compare these to those recorded in the French pharmacovigilance database (FPVD). METHODS We performed a retrospective study to collect AEs reported by patients in five of the best-known website forums in France over 1 year (2011). For each report, we recorded demographic data, cancer type, drug involved and AEs. The same analysis was done in the FPVD for OAN-induced adverse drug reactions (ADRs). RESULTS A total of 202 AEs were identified in website posts and 1,448 ADRs were found in the FPVD. The most cited drugs in websites were protein kinase inhibitors (n = 88, 43.5%) and hormone antagonists (n = 61, 30.2%). More musculoskeletal disorder reports were found in the patient websites compared with the FPVD (16.34 vs. 4.70%, p < 0.001). As for skin disorders, we collected fewer reports in the patient website forums than in the FPVD (13.37 vs. 22.17%, p = 0.004). AEs reported in the patient websites were less serious (n = 10, 4.95%) than ADRs recorded in the FPVD (n = 999, 68.99%) (p < 0.001). CONCLUSIONS AEs reported in the website forums are considered by patients to be relevant enough to be shared. Data from patient websites could be used as a source of data to detect AEs alongside conventional pharmacovigilance.
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Agboola S, Flanagan C, Searl M, Elfiky A, Kvedar J, Jethwani K. Improving outcomes in cancer patients on oral anti-cancer medications using a novel mobile phone-based intervention: study design of a randomized controlled trial. JMIR Res Protoc 2014; 3:e79. [PMID: 25537463 PMCID: PMC4296099 DOI: 10.2196/resprot.4041] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/29/2014] [Indexed: 12/18/2022] Open
Abstract
Background The widespread and increasing use of oral anti-cancer medications has been ushered in by a rapidly increasing understanding of cancer pathophysiology. Furthermore, their popular ease of administration and potential cost savings has highlighted their central position in the health care system as a whole. These facts have heightened appreciation of the unique challenges associated with the use of oral anti-cancer medications; especially in the long-term use of these medications and the associated side effects that may impede optimal adherence to their use. Therefore, we developed ChemOtheRapy Assistant, CORA, a personalized mobile phone–based self-management application to help cancer patients on oral anti-cancer medications. Objective Our objective is to evaluate the effect of CORA on adherence to oral anti-cancer medications and other clinically relevant outcomes in the management of patients with renal and prostate cancer. Methods The study will be implemented as a 2-parallel group randomized controlled trial in 104 patients with renal or prostate cancer on oral anti-cancer medications over a 3-month study period. The intervention group will use CORA in addition to usual care for self-management while the control group will continue care as usual. Medication adherence will be measured objectively by a Medication Event Monitoring System device and is defined as the percentage of prescribed doses taken. We will also assess the effect of the intervention on cancer-related symptoms measured by the MD Anderson Symptom Inventory and unplanned hospital utilizations. Other outcomes that will be measured at study start, midpoint, and endpoint are health-related quality of life, cancer-related fatigue, and anxiety. Group differences in medication adherence will be examined by t tests or by non-parametric Mann-Whitney tests if the data are not normally distributed. Logistic regression will be used to identify potential predictors of adherence. Results We expect to have results for this study before the end of 2016. Conclusions This novel mobile phone–enabled, multimodal self-management and educational intervention could lead to improvements in clinical outcomes and serve as a foundation for future mHealth research in improving outcomes for patients on oral anti-cancer medications.
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Affiliation(s)
- Stephen Agboola
- Partners Healthcare Center for Connected Health, Boston, MA, United States.
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de Almeida MH, Fogliatto L, Couto D. Importance of adherence to BCR-ABL tyrosine-kinase inhibitors in the treatment of chronic myeloid leukemia. Rev Bras Hematol Hemoter 2014; 36:54-9. [PMID: 24624037 PMCID: PMC3948667 DOI: 10.5581/1516-8484.20140014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 08/19/2013] [Indexed: 01/02/2023] Open
Abstract
Treatment of chronic myeloid leukemia with BCR-ABL tyrosine kinase inhibitors requires full adherence in order to maximize the likelihood of achieving optimal responses, and to minimize healthcare costs. In this article, we review some of the methods available for assessing compliance, the main consequences of nonadherence on treatment outcomes, major factors commonly associated with poor compliance, a few successful measures for improving adherence and the most accepted recommendations for proactively managing adverse events.
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Affiliation(s)
| | - Laura Fogliatto
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Dulce Couto
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
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Bordonaro S, Romano F, Lanteri E, Cappuccio F, Indorato R, Butera A, D’Angelo A, Ferraù F, Tralongo P. Effect of a structured, active, home-based cancer-treatment program for the management of patients on oral chemotherapy. Patient Prefer Adherence 2014; 8:917-23. [PMID: 25028540 PMCID: PMC4077854 DOI: 10.2147/ppa.s62666] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The advent of oral chemotherapy agents has had a strong impact on several aspects of the management of cancer patients, including survival rates, health-care expenditure, and health-related quality of life. However, access to care and adherence to oral chemotherapy are central to optimal outcomes. PATIENTS AND METHODS In this multicenter observational study, we assessed the effect of the "Active Home Care" initiative - a structured, active, home-based cancer-treatment program - on quality of life, health-care utilization, and patient adherence and satisfaction using self-administered questionnaires. Sixty-two patients treated with oral chemotherapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate) were enrolled in the program. Weekly home visits were scheduled, each one with a trained nurse who delivered the home-based chemotherapy and reviewed patients' compliance and treatment toxicity. An oncologist evaluated patients and modified the dosage of oral chemotherapy based on toxicity reported during the previous cycle at bi-weekly visits. RESULTS A total of 460 home visits were performed between April 2012 and February 2013. The Active Home Care initiative was associated with significant improvements in physical functioning and symptoms, and reductions in the access to cancer facilities. Satisfaction with oral chemotherapy and care received was high. All patients reported having taken their medications according to their prescription, and no patient reported difficulties in managing the oral chemotherapy regimen. CONCLUSION The Active Home Care program was associated with improvements in the quality of life of patients and caregivers, better adherence to treatment, and the effective management of therapy and cancer-related symptoms. Home-based cancer treatment may also optimize the utilization of health-care resources.
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Affiliation(s)
- S Bordonaro
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - F Romano
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - E Lanteri
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - F Cappuccio
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - R Indorato
- Medical Oncology Unit, S Giovanni di Dio Hospital, Agrigento, Italy
| | - A Butera
- Medical Oncology Unit, S Giovanni di Dio Hospital, Agrigento, Italy
| | - A D’Angelo
- Medical Oncology Unit, S Vincenzo Hospital, Taormina, Italy
| | - F Ferraù
- Medical Oncology Unit, S Vincenzo Hospital, Taormina, Italy
| | - P Tralongo
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
- Correspondence: Paolo Tralongo, Medical Oncology Unit, Umberto I Hospital, RAO, Siracusa, Italy, Tel +39 9 3172 4542, Email
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Patel K, Foster NR, Farrell A, Le-Lindqwister NA, Mathew J, Costello B, Reynolds J, Meyers JP, Jatoi A. Oral cancer chemotherapy adherence and adherence assessment tools: a report from North Central Cancer Group Trial N0747 and a systematic review of the literature. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:770-776. [PMID: 23872949 PMCID: PMC3815511 DOI: 10.1007/s13187-013-0511-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Oncologists are now prescribing more oral chemotherapy than ever before, thus placing the onus for taking the right dose at the right time under the right circumstances directly on the patient. This study was undertaken to understand emerging adherence issues and to explore available adherence assessment tools. This two-part study (1) examined N0747, a randomized phase II trial that tested the oral agents, sunitinib and capecitabine, in patients with metastatic esophageal cancer from an adherence standpoint, and (2) conducted a systematic review to compile and assess adherence tools that can be used in future clinical trials. First, in N0747, patients were assigned to sunitinib and capecitabine versus capecitabine; 53 chemotherapy cycles were prescribed to this 12-patient cohort. Nearly all patients denoted that they "always or almost always" took their pills as prescribed, and two patients who reported lack of full adherence suffered from grade 3+ adverse events. Surprisingly, however, over 14 cycles, 9 patients reported grade 3+ toxicity but checked "always or almost always" to describe their adherence. No relationships were observed between adherence and cancer outcomes. Secondly, 21 articles identified the following adherence tools: (1) healthcare providers' interviews, (2) patient-reported adherence with diaries/calendars, (3) patient-completed adherence scales, (4) medication event monitoring, (5) automated voice response, (6) drug/metabolite assays, and (7) prescription databases. Of note, only the automated voice response seems capable of real-time detection of over-adherence, as observed in N0747. Oral chemotherapy adherence should be further studied, particularly from the standpoint of over-adherence.
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Affiliation(s)
- Krishna Patel
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
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