Veering Off Course: Addressing Challenges in Chemotherapy and Radiation Adherence

Patients often face challenges in adhering to infused chemotherapy or radiation, but many obstacles can be resolved.
Fear. Finances. Logistical obstacles. These are just some of the reasons health professionals hear to explain why their patients with cancer don’t adhere to their treatments. While the importance of following a treatment plan might seem obvious, some of the challenges patients face can make their commitment to that idea decidedly murkier.

Take Desiree Walker, for example.

Walker, 54, was diagnosed with breast cancer for the second time at age 47 (she was 38 at first diagnosis). After a bilateral mastectomy, Walker says, her oncologist recommended an infused chemotherapy regimen of carboplatin and docetaxel, along with a series of infused treatments of the targeted therapy Herceptin (trastuzumab) — plus the hormonal drug tamoxifen — to combat her aggressive HER2-positive cancer. Walker, an advocate for patients with cancer and a support group facilitator who travels to national and international conferences, knew how important it was to adhere to the treatment plan her oncologist had laid out for her. But then life happened.

Walker was laid off from her job prior to her second diagnosis. “As a cancer survivor, I knew how important insurance was. So I opted for COBRA,” she says.

She began chemotherapy and Herceptin treatments as scheduled, but then life happened again. She developed reduced heart function shortly after beginning Herceptin. Her oncologist said this was not unusual and stopped the targeted therapy until her cardiologist cleared her to resume and complete the treatment under close monitoring.

“I finished chemotherapy on time, but still had to finish the Herceptin,” Walker says. “What normally would have taken a year ended up taking a year and a half. During that time, I got a letter informing me that my COBRA was running out.”

She appealed to both her former employer and the insurance company, but was told there would be no exception. So she made the difficult choice to stop the Herceptin treatment for six weeks as she tried to work through her insurance issues. Her oncologist understood her struggles, but was uncomfortable with not following treatment protocol — particularly because Walker’s cancer was a recurrence.

“It was eye-opening for me. As informed as I was about many things, I wasn’t prepared for this experience,” Walker says. She ultimately reached out to an estranged family member, who assisted her with finishing her treatment.

Patients who don’t adhere to infused chemotherapy or radiation therapy treatments typically fall into a few categories. There are those who want and intend to adhere to treatment, but face practical challenges, such as a lack of transportation or child care, financial problems, or family or other issues that prevent them from doing so. But there are also patients who struggle with fear, or with feeling overwhelmed or hopeless. Finally, there are patients who don’t agree with the treatment plans their oncologists have outlined, don’t see the big-picture value of treatment or want to try alternative therapies.


“It isn’t uncommon for issues of cost to get in the way of treatment,” says Victoria Puzo, M.S.W., L.M.S.W., a licensed oncology social worker and coordinator of online support group programs with the New York City-based patient support organization CancerCare. “Even with insurance, co-pays related to treatment can affect whether somebody adheres.”

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