Medical and Psychosocial Associates of Nonadherence in Adolescents With Cancer

Abstract

The current study examined adherence to medication regimens among adolescents with cancer by applying the Pediatric Self-Management Model. Adolescents and their parents reported on adherence to medication, reasons for nonadherence, and patient-, family-, and community-level psychosocial variables. Adolescent- and parent-reported adherence were significantly correlated, with about half of the sample reporting perfect adherence. The majority reported “just forgot” as the most common reason for missed medication. Patient-, family-, and community-level variables were examined as predictors of adherence. With regard to individual factors, adolescents who endorsed perfect adherence reported a greater proportion of future-orientated goals and spent fewer days in outpatient clinic visits. For family factors, adolescents who endorsed perfect adherence reported greater social support from their family and were more likely to have a second caregiver who they perceived as overprotective. The community-level variable (social support from friends) tested did not emerge as a predictor of adherence. The results of this study provide direction for intervention efforts to target adolescent goals and family support in order to increase adolescent adherence to cancer treatment regimens.

Assessing Medication Adherence as a Standard of Care in Pediatric Oncology

“…Anticipatory guidance including a discussion of common barriers to adherence, previous experiences taking medication, and strategies to improve medication adherence should be provided immediately prior to the transfer of self‐management responsibilities to the patient and/or family and whenever there is a change in the medication regimen . Children and adolescents with cancer and their families describe multiple barriers to medication adherence that can be addressed with behavioral intervention including forgetting, being away from home when doses are due, difficulty in swallowing pills, taste of medications, and not feeling well . Observational studies suggest that interventions targeting family support and patient psychosocial functioning (i.e., depressive symptoms) may improve adherence.…”

“…Children and adolescents with cancer and their families describe multiple barriers to medication adherence that can be addressed with behavioral intervention including forgetting, being away from home when doses are due, difficulty in swallowing pills, taste of medications, and not feeling well . Observational studies suggest that interventions targeting family support and patient psychosocial functioning (i.e., depressive symptoms) may improve adherence. As behavioral and multicomponent interventions providing such guidance are more effective in improving medication adherence than educational interventions alone and have been shown to improve self‐efficacy, cancer‐related knowledge, and adherence, clinicians are encouraged to consider partnering with relevant disciplines (i.e., psychology, social work, and child life) to develop procedures for assessing barriers and delivering behavioral interventions as appropriate.…”

Medication adherence decision-making among adolescents and young adults with cancer

“…Mechanisms listed on the cards included those supported by previous studies of adherence among AYAs (i.e., Hullmann et al, 2014) and adherence decision-making (i.e., Sung et al, 2003) (see Table 3). In addition, AYAs were provided with a stack of blank cards and asked to create a card for any mechanism that impacted adherence decision-making not listed on a previous card (e.g., “my husband’s support”).…”

“…The few studies examining this question have identified broad constructs including deficits in information (i.e., lack of medication knowledge), limited family social support, and psychosocial difficulties (i.e., depressive symptoms) that predict non-adherence among AYAs with cancer (Hullmann, Brumley, & Schwartz, 2014; Kennard et al, 2004; Tebbi et al, 1986). While these studies identify predictors of adherence behavior, the use of broad measures and single point assessments of adherence prevent conclusions as to the mechanisms that account for these relationships (Quittner, Modi, Lemanek, Ievers-Landis, & Rapoff, 2008).…”

Development of the Pediatric Neuro-Oncology Rating of Treatment Intensity (PNORTI)

“…Treatment intensity is relevant given that it might be related to other important variables of interest, including school attendance, family functioning, patient or family member distress [3] and survivor health-related quality of life [4, 5]. Additionally, it is often important to establish that treatment intensity is not related to certain variables, such as fatigue [6], physical activity [7] or adherence to medical regimens [8]. While treatment intensity may be related to the level of risk for late effects, they are not necessarily directly related.…”