Investigation of Intervention Solutions to Enhance Adherence to Oral Anticancer Medicines in Adults: Overview of Reviews

Abstract

Background Adherence to anticancer medicines is critical for the success of cancer treatments; however, nonadherence remains challenging, and there is limited evidence of interventions to improve adherence to medicines in patients with cancer. Objective This overview of reviews aimed to identify and summarize available reviews of interventions to improve adherence to oral anticancer medicines in adult cancer survivors. Methods A comprehensive search of 7 electronic databases was conducted by 2 reviewers who independently conducted the study selection, quality assessment using the A Measurement Tool to Assess Systematic Reviews 2, and data extraction. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist was adapted to report the results. Results A total of 29 reviews were included in the narrative synthesis. The overall quality of the systematic reviews was low. The 4 main strategies to promote adherence were focused on education, reminders, behavior and monitoring, and multicomponent approaches. Digital technology–based interventions were reported in most reviews (27/29, 93%). A few interventions applied theories (10/29, 34%), design frameworks (2/29, 7%), or engaged stakeholders (1/29, 3%) in the development processes. The effectiveness of interventions was inconsistent between and within reviews. However, interventions using multiple strategies to promote adherence were more likely to be effective than single-strategy interventions (12/29, 41% reviews). Unidirectional communication (7/29, 24% reviews) and technology alone (11/29, 38% reviews) were not sufficient to demonstrate improvement in adherence outcomes. Nurses and pharmacists played a critical role in promoting patient adherence to oral cancer therapies, especially with the support of digital technologies (7/29, 24% reviews). Conclusions Multicomponent interventions are potentially effective in promoting patient adherence to oral anticancer medicines. The seamless integration of digital solutions with direct clinical contacts is likely to be effective in promoting adherence. Future research for developing comprehensive digital adherence interventions should be evidence-based, theory-based, and rigorously evaluated.

Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach

“…The research problem focuses on MA problems in cancer, barriers to MA, and current MA interventions and their effects. To establish problem awareness, a literature review on MA in cancer and a systematic review of current MA interventions in cancer were conducted by THD and the research team (ARMF, NW, PPJ, and PS) to define MA barriers and facilitators as well as the characteristics of effective MA interventions [ 13 ]. Besides, feedback from HCPs and patients regarding REMIND was examined thoroughly by THD and PS to define necessary changes in the next iteration (SAMSON).…”

“…Patient-related factors are the most important [ 12 ] because adherence interventions may potentially make the most impact on these factors without necessarily having systemic solutions [ 11 ]. Multicomponent interventions that involve collective adherence strategies and are tailored to patients are likely more effective than single-strategy interventions in addressing these factors and improving adherence to oral anticancer medicines [ 13 ]. Technology can help to deliver multicomponent interventions more effectively and efficiently [ 13 - 15 ] without requiring too many extra resources, which are already scarce, from the health system [ 16 ].…”

“…Literature reviews showed the potential of using technologies such as mobile solutions in promoting MA by providing patients rapid, continuous, and easy access to educational resources and symptom or side effect self-management strategies as well as facilitating direct patient-provider communication [ 11 , 15 , 17 ]. However, there is very limited evidence on how to develop mobile solutions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving MA [ 1 , 13 , 19 , 20 ].…”

Pilot Study of a Mobile Phone Chatbot for Medication Adherence and Toxicity Management Among Patients With GI Cancers on Capecitabine

“…11,12 Among patients receiving oral cancer-directed therapies, DHIs incorporating multiple components, bidirectional communication, and clinical integration are particularly effective. 13 However, despite capecitabine's complex dosing schema, no DHIs have been developed specifically for patients on this drug.…”

Are We Prepared for the CDK4/6 Revolution With HR+/HER2− Breast Cancers?: The Importance of Patient Adherence to Adjuvant Therapies

“…7 More recent analyses on aversion to AET highlight the importance of deep understanding of behavioral aspects of the patient, 9 and the need for parallel strategies to effect adaptive change. 13 A universal observation in addition to AET-induced adverse events is a general lack of appreciation of the harms inflicted by dose skipping, underscoring the need for an educational component in any intervention. 14,15 Given our interest in optimizing patient outcomes with novel cancer therapies, we undertook primary and secondary market research involving discussions with health care professionals (HCPs), and global commercial patient adherence solution developers to identify pain points and adherence motivators and barriers.…”