We can’t assume that patients will adhere to their oral chemotherapy regimen. They often need support to remain compliant.
—Susan M. Schneider, PhD, RN, AOCN, ACNS-BC, FAAN
In a study testing the effectiveness of three strategies to improve oral chemotherapy adherence, tailored coaching was beneficial for some patients, reducing barriers to adherence, reported Susan M. Schneider, PhD, RN, AOCN, ACNS-BC, FAAN, Associate Professor and Director of Oncology Nursing Specialty at the Duke University School of Nursing, Durham, North Carolina, at the recent Oncology Nurses Society Annual Congress in Washington, DC.1 However, the differences between the study’s control and experimental groups were not significant.
Patients with cancer prefer oral medications but do not always follow treatment instructions. Lack of understanding, inadequate support, and treatment-related side effects are leading reasons patients do not take their medication. Those who do adhere to their chemotherapy regimen have less recurrence and better long-term quality of life.
“We can’t assume that patients will adhere to their oral chemotherapy regimen,” Dr. Schneider said. “They often need support to remain compliant. And helping patients tolerate oral chemotherapy regimens is critical to their survival.”
Overcoming Personal Barriers
Dr. Schneider and her colleagues designed a program based on a self-regulatory model of adherence. Patient knowledge, behavioral skills, and support system are considered. Strategies are then conceived to overcome each patient’s personal barriers.
The clinical trial examined the adherence rates of 48 adults started on a new oral chemotherapeutic agent. The patients were diagnosed with a range of cancers: breast, colorectal, renal cell, hepatocellular carcinoma, multiple myeloma, or chronic leukemia. The majority of patients were Caucasian. The average age was 60 years old. Most patients were female with some college education. No correlation was found between adherence rates and age, gender, or depression.
The control group received standard chemotherapy education, whereas the experimental group received an assessment and tailored intervention delivered by an advanced practice nurse over the telephone in addition to the standard chemotherapy education. At 2 and 4 months, patient adherence rates were measured in both groups using self-reporting and pharmacy fill rates. Chi-squared tests were used to analyze the data.
“The differences between the intervention group and the control group suggest that for some participants, the tailored coaching intervention was beneficial in promoting adherence,” Dr. Schneider said.
At both the 2- and 4-month landmarks, by self-reporting, the intervention group showed greater adherence than the control group: 91% and 95% vs 80% and 82%. According to pharmacy refill data, however, adherence rates were lower: 80% and 74% vs 65% and 69%. Unexpectedly, the study found that system barriers, such as late pharmacy deliveries and lack of coordination by providers, interfered with adherence in 10% of participants.
The study was funded by the National Cancer Institute, and the Duke group has submitted a follow-up proposal for funding. This new study would utilize a variety of coaching and electronic approaches to monitor medication adherence and symptom management. ■
Disclosure: Dr. Schneider reported no potential conflicts of interest.
1. Schneider SM, et al: Tailored intervention protocol for oral chemotherapy adherence. Oncology Nursing Society Annual Congress. Presented April 26, 2013.