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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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Hussain H, Fadel A, Guardiola V, Rodriguez S. A Rare Case of Non-immune Hemolytic Anemia in a Stage IV Breast Cancer Patient Treated With Capecitabine. Cureus 2022; 14:e24921. [PMID: 35698681 PMCID: PMC9187139 DOI: 10.7759/cureus.24921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/05/2022] Open
Abstract
Incremental changes in the diagnosis of breast cancer leave drastic impacts on patients. There are detrimental shifts in cost, psychological disorders in terms of depression, and morbidities. Stage IV breast cancer has a high mortality rate and was afflicting our patient who was diagnosed with metastatic breast cancer estrogen receptor/progesterone receptor (ER/PR) positive, human epidermal growth factor receptor 2 (HER-2) neo negative, and low Ki-67. Among the various management modalities and effective treatments, capecitabine was selected because of its benefits; however, there are several commonly known adverse effects when using capecitabine including non-immune hemolytic anemia, a very rare and unexpected side effect despite the many research and clinical trials performed. Immune mediate or Coombs positive hemolytic anemia was reported with the usage of capecitabine, but this patient developed Coombs negative or non-immune hemolytic anemia. Capecitabine, a form of fluoropyrimidine, hypothetically affects the erythrocyte membrane structure resulting in the destruction of these cells. Additionally, discontinuation of capecitabine in the patient led to the resolution of the condition; this made us more aware of the precise diagnosis, also considering that the bone marrow biopsy came back negative.
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Méndez Utz VE, Pérez Visñuk D, Perdigón G, de Moreno de LeBlanc A. Milk fermented by Lactobacillus casei CRL431 administered as an immune adjuvant in models of breast cancer and metastasis under chemotherapy. Appl Microbiol Biotechnol 2020; 105:327-340. [PMID: 33205285 DOI: 10.1007/s00253-020-11007-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/23/2020] [Accepted: 11/04/2020] [Indexed: 01/07/2023]
Abstract
Chemotherapy is the most common treatment for breast cancer and its metastasis; however, it affects the patients' quality of life. Previously, it was demonstrated that milk fermented by Lactobacillus casei CRL431 (probiotic fermented milk (PFM)) exerted benefits against breast cancer metastasis by modulating the immune response in a mouse model. The aim of this work was to evaluate PFM administration on the side effects of capecitabine and on its anti-tumour/anti-metastatic effects. In vitro, 4T1 breast cancer cells were treated with capecitabine in the presence of immune cells' conditioned media from mice administered with PFM. Cell viability was evaluated by MTT assay. In vivo, BALB/c mice (healthy, bearing breast cancer or with potential metastasis) were treated or not with capecitabine and administered with PFM. Blood cell counts, intestinal damages, lung histology and serum cytokines were evaluated. Results showed that capecitabine's toxicity on 4T1 cells was improved by the immune cells from mice that received PFM when the lower dose of capecitabine was evaluated. PFM reduced capecitabine side effects in all the mouse models and decreased intestinal mucositis and mortality. PFM administration to mice under chemotherapy maintained the anti-cancer/anti-metastasis effect of capecitabine with similar or decreased values for serum IL-10 and TNF-α and decreased IL-6, a cytokine related to poor prognosis in advanced cancer patients. In addition, PFM by itself reduced metastasis without side effects and improved the host's immune response. PFM has a potential to be administered as an immune adjuvant in patients under chemotherapy without affecting the treatment. KEY POINTS: • Milk fermented by L. casei CRL431 (PFM) diminished capecitabine side effects. • Capecitabine's toxicity on 4T1 cells was improved by the PFM-stimulated immune cells. • PFM maintained anti-cancer/anti-metastasis effect of capecitabine in mouse models. Graphical abstract.
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Affiliation(s)
- V E Méndez Utz
- Centro de Referencia para Lactobacilos (CERELA-CONICET), CP T4000ILC, San Miguel de Tucumán, Argentina
| | - D Pérez Visñuk
- Centro de Referencia para Lactobacilos (CERELA-CONICET), CP T4000ILC, San Miguel de Tucumán, Argentina
| | - G Perdigón
- Centro de Referencia para Lactobacilos (CERELA-CONICET), CP T4000ILC, San Miguel de Tucumán, Argentina.,Cátedra de Inmunología. Facultad de Bioquímica, Química y Farmacia. Universidad Nacional de Tucumán, San Miguel de Tucumán, Tucumán, Argentina
| | - A de Moreno de LeBlanc
- Centro de Referencia para Lactobacilos (CERELA-CONICET), CP T4000ILC, San Miguel de Tucumán, Argentina.
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Sottani C, Grignani E, Zaratin L, Santorelli D, Studioso E, Lonati D, Locatelli CA, Pastoris O, Negri S, Cottica D. A new, sensitive and versatile assay for quantitative determination of α-fluoro-β-alanine (AFBA) in human urine by using the reversed-phase ultrahigh performance-tandem mass spectrometry (rp-UHPLC-MS/MS) system. Toxicol Lett 2018; 298:164-170. [PMID: 30315949 DOI: 10.1016/j.toxlet.2018.10.007] [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: 02/04/2018] [Revised: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 11/26/2022]
Abstract
A method for the quantitation of α-fluoro-β-alanine (AFBA), the main metabolite of capecitabine (Cape) and 5-fluoruracil (5-FU), is described. Among antineoplastic drugs (ADs), 5-FU and Cape (the new oral prodrug) are the most commonly applied drugs in cancer therapy. The main objective of this study was to develop a reliable method that would be easy to run on a reversed-phase UHPLC system coupled to tandem mass spectrometry. AFBA was derivatized with Sanger's reagent to ensure complete yield of a stable 2,4 dinitrophenil-α-fluoro-β-alanine derivative. This method was based on the use of a mixed-mode anion exchange solid phase extraction enabling urinary extracts to be clear of endogenous interferences affecting quantitative results. The assay was validated in human urine according to FDA criteria with the use of a labeled internal standard (β-alanine-d4) to minimize experimental error. Good accuracy and precision were demonstrated by determining spiked urine QC samples in four consecutive days. The recovery of AFBA was between 70.0 and 82.6%, with a matrix effect that was 12.8%-18.5%. The lower limit of quantitation (LOQ) was 0.5 ng/mL with a coefficient of variation of 5.3%. This assay was successfully applied to determine the levels of this metabolite in a large number of urine samples taken from personnel who were occupationally exposed to ADs.
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Affiliation(s)
- Cristina Sottani
- Environmental Research Center, ICS MAUGERI SPA SB, Institute of Pavia, IRCCS, Pavia, Italy.
| | - Elena Grignani
- Environmental Research Center, ICS MAUGERI SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
| | - Laura Zaratin
- Environmental Reasearch Center, ICS Maugeri SPA SB, Institute of Padova, Italy
| | - Donatella Santorelli
- Environmental Research Center, ICS MAUGERI SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
| | - Emanuele Studioso
- Environmental Research Center, ICS MAUGERI SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
| | - Davide Lonati
- Poison Control Center and National Toxicology Information Center, IRCCS Maugeri Foundation Hospital, Pavia, Italy
| | - Carlo A Locatelli
- Poison Control Center and National Toxicology Information Center, IRCCS Maugeri Foundation Hospital, Pavia, Italy
| | - Ornella Pastoris
- Department of Forensic Medicine, Pharmacology and Toxicology, University of Pavia, Pavia, Italy
| | - Sara Negri
- Environmental Research Center, ICS MAUGERI SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
| | - Danilo Cottica
- Environmental Research Center, ICS MAUGERI SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
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Pandey S, Swamy SMV, Gupta A, Koli A, Patel S, Maulvi F, Vyas B. Multiple response optimisation of processing and formulation parameters of pH sensitive sustained release pellets of capecitabine for targeting colon. J Microencapsul 2018; 35:259-271. [DOI: 10.1080/02652048.2018.1465138] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sonia Pandey
- Maliba Pharmacy College, Uka Tarsadia University, Surat, India
| | | | - Arti Gupta
- Maliba Pharmacy College, Uka Tarsadia University, Surat, India
| | - Akshay Koli
- Maliba Pharmacy College, Uka Tarsadia University, Surat, India
| | - Swagat Patel
- Maliba Pharmacy College, Uka Tarsadia University, Surat, India
| | - Furqan Maulvi
- Maliba Pharmacy College, Uka Tarsadia University, Surat, India
| | - Bhavin Vyas
- Maliba Pharmacy College, Uka Tarsadia University, Surat, India
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Hefner J, Berberich S, Lanvers E, Sanning M, Steimer AK, Kunzmann V. Patient-doctor relationship and adherence to capecitabine in outpatients of a German comprehensive cancer center. Patient Prefer Adherence 2018; 12:1875-1887. [PMID: 30288028 PMCID: PMC6159803 DOI: 10.2147/ppa.s169354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The prescribing of oral chemotherapy agents has introduced the new challenge of ensuring patients' adherence to therapy. Aspects of a close patient-doctor relationship are reported to be correlated with adherence to oral anticancer drugs, but data on capecitabine are scarce. PATIENTS AND METHODS Sixty-four outpatients with a diagnosis of cancer and prescribed capecitabine were recruited from a German Comprehensive Cancer Center. We used the Patient-Doctor Relationship Questionnaire (PDRQ-9), the Medical Adherence Rating Scale (MARS), the Beliefs about Medicines Questionnaire (BMQ), and the Satisfaction with Information about Medicines Scale (SIMS) to assess patients' perceptions and behavior. Medical data were extracted from the charts. RESULTS Non-adherence was reported by 20% of the 64 participants. The perceived quality of the patient-doctor relationship was high in general, but it did not emerge as a predictor of adherence in our survey (odds ratio [OR]=0.915, P=0.162, 95% CI=0.808-1.036). However, beliefs about medicine (OR=1.268, P<0.002; 95% CI=1.090-1.475) as well as satisfaction with information about medicine (OR=1.252, P<0.040, 95% CI=1.010-1.551) were predictors of adherence and the quality of the patient-doctor relationship was correlated with both variables (r=0.373, P=0.002 for SIMS sum score; r=0.263, P=0.036 for BMQ necessity/concern difference). Overall, adherence to capecitabine was high with a conviction that the therapy is necessary. However, concerns were expressed regarding the long-term effect of capecitabine use. Patients have unmet information needs regarding interactions of capecitabine with other medicines and the impairment of their intimate life. CONCLUSIONS In order to ensure adherence to capecitabine, our results seem to encourage the default use of modern and perhaps more impersonal means of information brokerage (eg, email, internet). However, the contents of some of patients' informational needs as well as the associations of patients' beliefs and satisfaction about the information received suggest a benefit from a trustful patient-doctor relationship.
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Affiliation(s)
- Jochen Hefner
- Section of Psychosomatic Medicine, Department of Internal Medicine II, University of Wuerzburg, Bavaria, Germany,
| | - Sara Berberich
- Medical Student, Faculty of Medicine, University of Wuerzburg, Bavaria, Germany
| | - Elena Lanvers
- Intensive Care Unit, Children's Hospital of the City of Cologne, North Rhine-Westphalia, Germany
| | - Maria Sanning
- Department of Internal Medicine II, St Johannes Hospital Dortmund, North Rhine-Westphalia, Germany
| | | | - Volker Kunzmann
- Section of Clinical Oncology, Department of Internal Medicine II, University of Wuerzburg, Bavaria, Germany
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Timmers L, Boons CCLM, Mangnus D, Van de Ven PM, Van den Berg PH, Beeker A, Swart EL, Honeywell RJ, Peters GJ, Boven E, Hugtenburg JG. Adherence and Patients' Experiences with the Use of Capecitabine in Daily Practice. Front Pharmacol 2016; 7:310. [PMID: 27708578 PMCID: PMC5030243 DOI: 10.3389/fphar.2016.00310] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 08/30/2016] [Indexed: 12/15/2022] Open
Abstract
Introduction: Capecitabine is a widely prescribed oral anticancer agent. We studied medication adherence and explored its use in daily practice from a patients' perspective. Patients and Methods: Patients (n = 92) starting capecitabine were followed up to five 3-week cycles. Adherence was assessed using a pill count, pharmacy data and dosing information from the patients' medical file. Self-reported adherence was measured using the Medication Adherence Report Scale (MARS). At baseline and during week 2 of cycles 1, 3, and 5, patients filled out questionnaires about quality of life, symptoms, attitude toward medicines and disease and use in daily practice. Simultaneously, blood samples were taken to determine the area under the curve (AUC) of 5′-deoxy-5-fluorouridine (5′-DFUR), 5-fluorouracil (5-FU), and α-fluoro-β-alanine (FBAL) by a population pharmacokinetic model. Associations between AUCs and patient-reported symptoms were tested for cycles 3 and 5. Results: Most patients (84/92; 91%) had an adherence rate of ≥95 and ≤ 105%. The percentage of patients reporting any non-adherence behavior measured with MARS increased from 16% at cycle 1 to 29% at cycle 5. Symptoms were reported frequently and the dosing regimen was adjusted by the physician at least once in 62% of patients. In multivariate analysis the probability of an adjustment increased with the number of co-medication (OR 1.19, 95% CI: 1.03–1.39) and a stronger emotional response to the disease (OR 1.32, 95% CI: 1.10–1.59). The AUC of 5′-DFUR was associated with weight loss (OR 1.10, 95% CI: 1.01–1.19), AUC of FBAL with hand-foot syndrome (OR 0.90, 95% CI: 0.83–0.99), rhinorrhea (OR 1.21, 95% CI: 1.03–1.42 weight loss (OR 1.09, 95% CI: 1.00–1.20) and depression (OR 0.90, 95% CI: 0.82–0.99). Side effects were reported by one third of patients as the reason to discontinue treatment. Conclusion: Adherence to capecitabine was generally high. Nevertheless, adherence measured with MARS decreased over time Adherence management to support implementation of correct capecitabine use is specifically relevant in longer term treatment. In addition, it appears that adverse event management is important to support persistence. With the extending armamentarium of oral targeted anticancer agents and prolonged treatment duration, we expect the issue of medication adherence of increasing importance in oncology.
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Affiliation(s)
- Lonneke Timmers
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center Amsterdam, Netherlands
| | - Christel C L M Boons
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center Amsterdam, Netherlands
| | - Dirk Mangnus
- Department of Pharmacy, Slingeland Ziekenhuis Doetinchem, Netherlands
| | - Peter M Van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands
| | | | - Aart Beeker
- Department of Internal Medicine, Spaarne Hospital Hoofddorp, Netherlands
| | - Eleonora L Swart
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center Amsterdam, Netherlands
| | - Richard J Honeywell
- Department of Medical Oncology, VU University Medical Center Amsterdam, Netherlands
| | - Godefridus J Peters
- Department of Medical Oncology, VU University Medical Center Amsterdam, Netherlands
| | - Epie Boven
- Department of Medical Oncology, VU University Medical Center Amsterdam, Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, VU University Medical CenterAmsterdam, Netherlands; The EMGO Institute for Health and Care Research, VU University Medical CenterAmsterdam, Netherlands
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Over compliance with capecitabine oral chemotherapy. Int J Clin Pharm 2014; 36:271-3. [PMID: 24532364 DOI: 10.1007/s11096-014-9921-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 02/06/2014] [Indexed: 01/28/2023]
Abstract
CASE A case study of a patient who over complied with adjuvant capecitabine monotherapy on several occasions is described. The patient suffered worsening side effects, predominantly palmar plantar erythrodysesthesia which resulted in dose reduction and delay. The patient had disregarded advice to stop taking the capecitabine as he perceived it as "important to fight his cancer". The patient refused review with a psychologist. CONCLUSION There is a lack of evidence regarding the issue of over compliance. Pharmacists should consider discussing patient's attitudes towards taking their medication and its importance to them in treating their cancer. Tools that are used to assess non-compliance could be utilised to identify patients who over comply. Further research is required to gain further understanding of the psychological factors behind patient's decisions to over comply with treatment.
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Horne R, Chapman SCE, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One 2013; 8:e80633. [PMID: 24312488 PMCID: PMC3846635 DOI: 10.1371/journal.pone.0080633] [Citation(s) in RCA: 717] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/04/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it. OBJECTIVE To assess the utility of the NCF in explaining nonadherence to prescribed medicines. DATA SOURCES We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles. STUDY ELIGIBILITY CRITERIA Studies using the Beliefs about Medicines Questionnaire (BMQ) to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication. PARTICIPANTS Patients with long-term conditions. STUDY APPRAISAL AND SYNTHESIS METHODS Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models. RESULTS We identified 3777 studies, of which 94 (N = 25,072) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used. LIMITATIONS Few prospective longitudinal studies using objective adherence measures were identified. CONCLUSIONS The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in treatment decisions and support optimal adherence to appropriate prescriptions.
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Affiliation(s)
- Rob Horne
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Sarah C. E. Chapman
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Rhian Parham
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Alastair Forbes
- Department of Internal Medicine, University College Hospital, London, United Kingdom
| | - Vanessa Cooper
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
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Walter T, Wang L, Chuk K, Ng P, Tannock IF, Krzyzanowska MK. Assessing adherence to oral chemotherapy using different measurement methods: Lessons learned from capecitabine. J Oncol Pharm Pract 2013; 20:249-56. [DOI: 10.1177/1078155213501100] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Purpose Adherence to oral medication is important in oncology. Few studies have evaluated adherence with cancer agents such as capecitabine, which is given on a complicated schedule. Furthermore, little guidance exists regarding the best methods for monitoring adherence with oral cancer drugs. The purpose of our study was to evaluate adherence to capecitabine using several accepted measures. Patients and methods Patients treated with capecitabine for gastrointestinal cancers were included in this prospective cohort study. Adherence was evaluated during two consecutive cycles of capecitabine using three assessment methods: self-report, pill count, and use of a microelectronic monitoring system. The primary endpoint was proportion of patients adherent to capecitabine (>80% of adherence according to the three methods of measurement); the secondary objective was to compare the three methods of measurement. Results Nineteen patients were accrued to this study. Further accrual was stopped after the first planned analysis, because 18 and 19 patients were adherent by self-report and pill count, respectively. The overall adherence rates were 99, 100, and 61% with self-report, pill count, and microelectronic monitoring system cap, respectively. Ten (53%) patients were classified as nonadherent (<80% of adherence according to at least one method of measurement), but four of them transferred their pills into another medication container suggesting that measurement of adherence using microelectronic monitoring system technology may not be useful. Conclusion While we did not identify a major adherence issue with capecitabine in our study, it provides insight into problems associated with measurement of adherence in oncology and suggests that combining measures of adherence maximizes accuracy.
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Affiliation(s)
- Thomas Walter
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Hospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Médicale, Lyon, France
| | - Lisa Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Karen Chuk
- Department of Pharmacy, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Pamela Ng
- Department of Pharmacy, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ian F Tannock
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada
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