Oral Chemotherapy, A Tough Pill To Swallow: A Systematic Review

Abstract

<p>As patients begin to receive more oral chemotherapies in the place of the traditional parenteral therapies, the responsibility for treatment falls on the shoulders of patients and their caregivers. The responsibility for the “five rights” of medication administration, which include the- right drug, right dose, right time, right route, and right patient are being transferred to patients and care givers. This places patients at risk for medications errors. Patients and care providers assume responsibility for medication administration, often with little or no healthcare education. As the number of patients being prescribed chemotherapies continues to increase, an emphasis on education as well as adherence to therapy should be emphasized. Multiple barriers exist, that negatively affect a people’s ability to adhere with prescribed treatment. A systematic review was conducted to identify the most prevalent barriers to nonadherence in this patient population. The Preferred Reporting Items for Systematic Reviews (PRISMA) checklist and flowchart were utilized to extrapolate, analyze, and synthesize the date. Common themes were identified and organized into three main categories: patient-related factors, system-related factors, and nurse and provider-related factors. The most prevalent were analyzed in further detail which revealed there were multi-factorial causes of nonadherence to oral chemotherapies. Under the patient-related heading, adverse effects and toxicities as well as forgetfulness were seen most commonly in the literature. Within the theme of systemrelated both regimen complexity and financial causes were found, whereas under nurse and provider-related patient education and frequency and length of follow up were most common. The advanced practice nurse (APN) is in the prime position to help counter-act these barriers to adherence. This systematic review served to help identify common causes of nonadherence to patients’ oral chemotherapeutic agents as prescribed.</p>

Oral Antikanser İlaç Kulanan Kanser Hastalarında Telefon ile Yapılan İzlemin İlaç Uyumuna Etkisi: Sistematik Derleme

“…Bu durumda da araştırmaların verdiği uyum oranlarını karşılaştırmak ve yöntemin etkisi hakkında yorum yapmak güçleşmektedir. Yapılan çalışmalar ilaç uyumunun ölçülmesi için direkt yöntemin; direkt gözlem ve serum ilaç seviyesi olduğunu, indirekt yöntemin: ilaç sayma, mikroelekronik izlem sistemi, kayıt doldurma olduğunu ve subjektif yöntem olarak: hasta cevabı ve günlükler olduğunu göstermektedir [33][34][35] kullanımının yaygın ve ucuz olduğunu, fakat hastalar tarafından sonuçların kolayca saptırılabileceği ve abartabileceği bir yöntem olduğunu vurgulamaktadır. Bundan dolayı hasta uyumunu doğru değerlendirmediğini düşünmemekteler 34 .…”

Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions

“…Regarding healthcare system-related factors in the oncology field, a direct association between a poor patient-healthcare provider relationship to a lack of treatment adherence was shown [67,68]. Moreover, non-adherence was associated with short follow-up visits for cancer patients [56,69,70]. Supply problems of community pharmacies were also shown to be related to poor adherence [63].…”

“…Given that these studies included small sample sizes, the experts in oncology decided to exclude them from the final selection of factors, as these may not be representative or generalizable. The presence of mental health problems (including depression, anxiety, stress, previous antidepressant use, cognitive symptoms, and cancer-specific psychological distress) has been reported as a key factor in determining a patient's adherent behavior [56,58,60,69,70,75,[77][78][79][80][81][82][83][84]. This factor was shown to be independent of the cancer type or other patients' characteristics.…”

“…Treatment duration [56,60,70,96,98,115,118,119] Socioeconomic factors linked to poor adherence have been found. For instance, in two breast cancer studies (one with European patients and another with American patients), single women with breast cancer were shown to have lower adherence to adjuvant endocrine therapy than non-single women [54,55].…”

“…Another factor that has been shown to determine non-adherence is the difficulty in symptom control, and in some cases, the frustration that comes with it [92]. The most important unintentional factor related to non-adherence is forgetfulness, which has been shown to be responsible for low adherence in various types of cancer [56,62,65,66,69,70,86,[93][94][95][96][97][98]. Adherence in itself is a habit, and various unhealthy habits, in particular, smoking and alcohol consumption, correlate with a lack of adherence [56,62,85,99].…”