Lack of adherence to orally administered drug regimens is a problem that deserves attention.
The Spring issue of CURE addresses our growing awareness of an important downside of orally administered cancer therapies — the surprisingly low levels of adherence and compliance. In this day and age, with the availability of newer targeted drugs that can be more effective and cause fewer side effects than chemotherapy, one questions why compliance would be a problem.
This is a notable issue, given the fact that we are seeing yearly rises in the proportion of oncologic medications that are taken by mouth. However, as the field of research on this topic has matured, we are getting estimates of adherence to oral cancer therapies in the paltry range of 50 percent. This number is much lower than experts would have expected from measures of compliance obtained in clinical trial data, but in the real world, many factors conspire to lead patients to skip, reduce doses of, or altogether stop their cancer medications. There is a spectrum of reasons for this, from side effects to costs to the common tendency to exhibit some degree of denial about having a cancer diagnosis. Any given patient may experience one or several of these, but the end result can be a short-changing of the treatment plan intention.
We have, for the most part, welcomed the trend to develop more targeted drugs that are generally less toxic. A side benefit has resulted: Many of them are “bioavailable,” meaning that they are absorbed into the body through the gastrointestinal tract, resulting in fewer visits to the clinic and allowing patients to avoid the infusion center.
In this issue, we review what is driving noncompliance and how this problem may attenuate treatment benefits, and even, in some cases, potential cures. Innovative tools are being developed to encourage patients to keep up with their medications. Some are simple reminders, while others are sophisticated approaches to minimizing side effects.
Both strategies will be important in motivating and facilitating compliance — and CURE is aiming to do its part, as well, by sharing information about this issue as it becomes available.
DEBU TRIPATHY, MDEditor-in-ChiefProfessor of MedicineChair, Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer Center