Making a Connection: Staying in Touch for Better Anticancer Drug Adherence

By staying in touch, nurses and pharmacists can help patients successfully adhere to oral anticancer treatments that they take at home.
KAREN ROBERTS sticks with her
anticancer regimen by keeping
her medications organized in a
pillbox and taking them at the
same time every day. - PHOTO BY BOB RIVES
KAREN ROBERTS sticks with her anticancer regimen by keeping her medications organized in a pillbox and taking them at the same time every day. - PHOTO BY BOB RIVES
Every night, before going to bed, Karen Roberts, of Washington, D.C., reaches for her pill container on her night table and takes eight pills prescribed by her doctors. They include Arimidex (anastrozole), an aromatase inhibitor to help keep her breast cancer at bay, and Effexor (venlafaxine), an antidepressant that has proven to be effective against night sweats, a common side effect of Arimidex. This simple routine has kept Roberts, who is in her late 50s, on track, or adherent, with her medication regimen.

Adherence is commonly understood to mean taking medications as prescribed on a regular basis, including following instructions concerning timing and dosage. Although adherence has become a way of life for Roberts, numerous studies have shown that many cancer patients struggle to follow the rules, even as the use of oral, take-at-home anticancer drugs becomes more common. Estimates vary considerably as to the extent of the problem; a comprehensive review of the literature published in the Oncologist in 2016 placed adherence at between 46 and 100 percent. Most of the findings are based on self-reports from patients and caregivers, the use of electronic pill-counting devices, and medical claims data — all approaches that have their inherent flaws. Despite the best efforts of researchers, the bottom line is that it’s extremely difficult to know the precise level of nonadherence.

In some cases, bending the rules even a little bit may be too much. Studies looking at nonadherence to specific treatments have shown that it can affect long-term outcomes. For example, a 2011 study published in the American Journal of Hematology found that patients with chronic myeloid leukemia who did not take Gleevec (imatinib) consistently were less likely to achieve the full benefits of the therapy. In another study, breast cancer survivors who discontinued their adjuvant (post-treatment, or maintenance) hormonal therapy early, compared with those who finished the entire course, showed lower survival rates at 10 years.

Although these findings raise red flags about problems related to nonadherence, it is also clear that oral anticancer medications are here to stay. According to many clinicians, approximately one-third of all cancer patients are now taking oral medications, and more than 25 percent of 400 anticancer drugs currently being investigated are oral agents. The proportion of drugs that are oral is growing, and these run the gamut from chemotherapy to immunotherapy to targeted treatments.

“Oral anticancer medications are the wave of the future,” says Ann O’Mara, Ph.D., R.N., M.P.H., head of palliative care in the Division of Cancer Prevention at the National Cancer Institute. “Patients prefer them, and for good reason. With intravenous chemotherapy, they had to go to the clinic one, two or three days every two, three or four weeks to receive intravenous chemotherapy, a regimen that took over their lives. Now, many patients can take their medication as a pill, in the comfort of their homes.”

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