Overview of the Challenges Related to Oral Agents for Cancer and Their Impact on Adherence

Tipton, Janelle

doi:10.1188/15.s1.cjon.37-40

Cited by 28 publications

(22 citation statements)

References 20 publications

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“…It is estimated that approximately 25-30% of all chemotherapeutic agents currently undergoing clinical trials are now by oral route of administration, and this number is expected to grow (Tipton, 2015). While oral therapies are often more convenient for patients, there are several important factors regarding adherence or compliance with treatment that should be taken into consideration.…”

Section: Background/statement Of the Problemmentioning

confidence: 99%

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

Corrente

2016

Preprint

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<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>

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Section: Background/statement Of the Problemmentioning

confidence: 99%

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

Corrente

2016

Preprint

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“…This population will typically have less frequent oncology visits than patients receiving chemotherapy infusions, leading to reduced opportunities to discuss adverse drug events and other elements of care. 11 These data may inform future strategies to increase reporting and enabling well-coordinated patient care.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of patients reporting adverse drug reactions to health care providers during oral targeted cancer treatment

Monestime¹,

Page²,

Jordan³

et al. 2021

Journal of the American Pharmacists Association

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Background: Pharmacovigilance is a critical component to facilitate clinicians' decision-making to alter or discontinue therapy. However, self-administration of oral targeted therapy (OTT) requires fewer clinical visits than parenteral infusions, potentially leading to an increase in the underreporting of adverse drug reactions (ADRs). Objective(s): To identify factors associated with patients reporting ADRs to their health care provider (HCP) and to identify the prevalence of unreported ADRs while on OTT. Methods: Patients aged 18 years who received care from a community oncology clinic and newly prescribed an OTT between August 1, 2018, and October 31, 2018, were included. Sixmonthly follow-up calls were conducted by the pharmacy staff to assess for gradable ADRsd validated by the NCI Common Terminology Criteria for Adverse Eventsdand ungradable ADRs. Descriptive analysis was used to analyze the prevalence of unreporting ADRs, and a multivariate logistic regression model was utilized to evaluate predictors of reporting ADRs to an HCP. Predictors included sociodemographic factors, severity of ADRs, insurance type, pharmacy setting, type of OTT, and the number of prescribed medications Results: Of the 76 patients analyzed, the mean age was 63.32 ±11.55 years, 84.2% were women, 68.8% were non-Hispanic white, and 76.3% had breast cancer. During the follow-up calls, 306 ADRs were identified and 22.2% were not previously reported to an HCP. Of the unreported gradable ADRs, 63.2% were grade 1, 19.3% were grade 2, and 17.5% were grade 3. We found that for every 1-year increase in age, there was a 5% decrease in the likelihood of reporting ADRs (95% confidence interval ¼ 0.91e0.99), and men were 11.4 times more likely to report ADRs (95% confidence interval ¼ 1.29e100.8). Conclusion: Follow-up calls served as an outlet to collect pharmacovigilance data by identifying over 20% of unreported ADRs to HCPs, in which over one-third were moderate to severe. However, future studies are needed to further understand the statistically significant differences found in under-reporting for women and the older population.

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“…First, OAs have complicated dosing regimens involving combined therapies, complex cycling and regimens that change over the course of treatment depending on how the patient tolerates the medication. Second, OAs often cause adverse events and aversive symptoms and carry associated toxicities that may require medication interruptions and/or stoppages (Shimada et al, ; Tipton, ). Unlike traditional cancer treatments, which are administered in supervised settings, patients are self‐managing adverse events of OA medication at home without the close observation of oncology professionals (Hess et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…and/or stoppages (Shimada et al, 2014;Tipton, 2015). Unlike traditional cancer treatments, which are administered in supervised settings, patients are self-managing adverse events of OA medication at home without the close observation of oncology professionals (Hess et al, 2017).…”

mentioning

confidence: 99%

Conceptualisation of medication beliefs among patients with advanced cancer receiving oral oncolytic agents using a theory derivation approach

et al. 2019

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Objective This paper describes a derived model that provides a conceptual framework for understanding medication beliefs among patients with advanced cancer receiving oral oncolytic agents. Methods Theory derivation was used to (a) examine the phenomenon of medication beliefs in cross‐disciplinary research; (b) select a parent theory for derivation; (c) identify parent theory concepts and/or structure to use in derivation; and (d) redefine parent theory concepts and structure to create a derived model. Results Medication beliefs are shaped by previous experiences, including cognitive and emotional factors, past health and illness encounters, and medication‐taking behaviours. Medication beliefs are defined within a larger mental model of illness representation for which medication was prescribed. Individuals independently hold both positive and negative medication beliefs at the same time. This distinction is critical to understanding how dichotomous components of medication beliefs change over time as they are influenced by varying treatment‐related factors. Conclusion This paper contributes to conceptual knowledge regarding the phenomenon of medication beliefs and their impact on health behaviour. Findings can support oncology interventions to improve patient outcomes including medication adherence.

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Overview of the Challenges Related to Oral Agents for Cancer and Their Impact on Adherence

Cited by 28 publications

References 20 publications

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

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

Prevalence and predictors of patients reporting adverse drug reactions to health care providers during oral targeted cancer treatment

Conceptualisation of medication beliefs among patients with advanced cancer receiving oral oncolytic agents using a theory derivation approach

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