There are now more oral cancer treatments than ever, highlighting the importance of patients independently taking their drugs as prescribed.
Keeping up with cancer treatments can be daunting, but is extremely important, explained Patricia Jakel, a clinical nurse specialist in the Solid Tumor Program at UCLA Medical Center.
As a breast cancer survivor herself, Jakel knows how difficult medication adherence can be. “I’m a breast cancer patient (who was) on treatment for the last four years. Oral adherence was not the best for me, so I have personal experience with it,” she said during a presentation at the 5th Annual School of Nursing Oncology Annual Meeting.
Jakel said that there can be many reasons why patients with cancer do not take their medicines as prescribed, from side effect worries to forgetfulness and “chemo brain,” which happens when cancer treatments affect a person’s memory, executive functioning, attention or ability to organize their thoughts.
“I used to be smart; I used to be really smart,” Jakel joked. “Chemo brain has really affected me. It doesn’t matter if you’re taking oral agents, (intravenous) agents or anti-estrogen agents. (Chemo brain) is really real to patients.”
Chemo brain can be curbed by brain exercises, such as crossword puzzles, though Jakel prefers to keep sharp by staying up to date on the latest developments in cancer. She also mentioned that acupuncture has helped her as well.
Jakel added that patients can use smartphone apps and alarms to remind them when to take their medicines. She remembers one patient used a phone service that made it seem that celebrities were calling.
“Every night at 9:00, President Obama would talk to her about her medication. And she thought that was just the funniest thing,” Jakel said.
But when it comes to keeping up with oral medicine regimens, chemo brain is only part of the equation. Jakel explained that about 20% to 30% of medication prescriptions are never filled, pointing toward a much bigger issue.
Many patients face cost barriers that make it difficult – or even impossible – to pay for their cancer treatments. However, there are nonprofits and programs run by drug companies that may be able to help decrease the cost.
Other patients may have psychosocial issues, like depression, anxiety or post-traumatic stress disorder, that make them not want to take their medicine. Additionally, Jakel mentioned that some people choose to stop taking their drugs as prescribed once they start feeling better. But this can lead to worse cancer outcomes and more issues down the line.
Caregivers should play a role as well.
“Make sure that education is done for the family and the caregiver,” Jakel said. “Hopefully the patient has a caregiver or a friend or family member helping them, because that’s critical for adherence.”
Patients should talk to their health care team if they are not taking their cancer treatments as prescribed. Being honest and upfront will likely lead to getting the help needed and the treatment back on track.
“Poor adherence decreases clinical benefits and overall effectiveness of the health care system,” she said. “So it not only affects the patient, but these patients who are non-adherence actually end up back in the hospital and end up with other complications.”
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