Patient perspectives on the barriers associated with medication adherence to oral chemotherapy

Appropriate use of oral chemotherapy is a challenge for patients and clinicians. The purpose of this study was to analyze cancer patients' use of oral chemotherapies and identify opportunities to improve adherence.

We developed a 30-question survey to address frequency and reasons for reducing/skipping doses; sources of information for oral chemotherapy use; perceived importance of food-drug effects; and ease of understanding labeling directions.

Ninety-three patients taking oral chemotherapies with chronic myeloid leukemia, renal cell carcinoma, breast cancer, and colorectal cancer completed the survey. This was a well-educated population with 69% (n = 62) having completed some college; 51% (n = 47) female and 59% (n = 54) older than 50 years of age. Thirty percent of patients reported forgetting to take their oral chemotherapy at least "sometimes". Younger patients (<50 vs. ≥50, p = 0.002), shorter treatment duration (<6 vs. ≥6 months p = 0.03), or with chronic myeloid leukemia (vs. other diagnoses, p = 0.015) forget to take their oral chemotherapy at higher rates. Twenty-three percent (n = 21) indicated they intentionally skipped their oral chemotherapies and 38% (n = 8) of those did not inform their physicians. Forty-one percent (n = 28) taking drugs with significant food-drug effects did not think about their last meal before taking their oral chemotherapy and 80% (n = 55) did not understand the potential interactions. Additionally, 39% (n = 36/92) never looked at labeling and 15% (n = 14/91) had difficulty understanding label directions.

There are three main barriers associated with appropriate use of oral chemotherapies: misunderstanding about the timing of drug with food; stopping drug without informing physicians; and difficulty understanding labeling directions. A multipronged approach is needed to optimize communication of directions for optimal oral chemotherapy use.

Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners. 2016 Jan 28 [Epub ahead of print]

Benyam Muluneh, Allison Deal, Maurice D Alexander, Meredith D Keisler, Janell M Markey, Jennifer M Neal, Stephen Bernard, John Valgus, Lynn G Dressler

Department of Pharmacy, University of North Carolina Medical Center ., Lineberger Comprehensive Cancer Center, University of North Carolina., Department of Pharmacy, University of North Carolina Medical Center., School of Pharmacy, Virginia Commonwealth University., School of Medicine, University of North Carolina., Eshelman School of Pharmacy, University of North Carolina.