Oral Medications Pose Challenges for Cancer Treatment But There Are Strategies for Improving Patient Adherence

Over the past 10 years, convenience and patient preference have shaped the cancer pharmaceutical industry, resulting in more oral anticancer drugs than ever before.¹ Yet, with the convenience of oral medication comes the challenge of patient adherence to recommended medication regimens and the possibility of poorer patient outcomes.¹ Although what “adequate adherence” means has yet to be defined, study investigators tend to agree on a range of 80% to 95% conformity to the recommended medication regimen as being acceptable.¹

Perhaps unsurprisingly, the consequence of poor adherence to oral medications has been associated with increased mortality rates in cancer patients.² But the degree to which cancer patients as a population adhere to oral medications has been more difficult to quantify, with studies finding widely ranging adherence rates from 20% to 100%.² While the oral format of cancer medication provides a convenience to both the prescribing clinician and the patient, it also affords the patient the freedom to fulfill—or not—the recommended treatment parameters.

Investigators have studied patient adherence to oral cancer drugs to clarify some of the motives behind poor adherence in the hope of then finding solutions to this problem. Financial concerns have been cited as the main hurdle for patient adherence, and oral drugs for cancer can be particularly costly.² That costliness to patients is due, in part, to the lack of oral cancer drug coverage provided by many insurance plans, which often provide better coverage for intravenous drugs.² There have been efforts, however, to legislatively address this disparity in coverage.² Another important factor in medication adherence, education, was highlighted by a study wherein patients who were well educated about their cancer therapy had fewer disruptions to their oral medication routine.²

What is more, the study showed that pharmacist follow-ups provided patient education throughout the course of cancer therapy and, as such, revealed the critical role a pharmacist can fill in promoting oral drug adherence.² In addition, pharmacist collaboration with patient financial advocates has improved patient oral medication adherence.² Further studies have shown the importance of patient education (ie, provision of drug counseling and communication about side effects and possible drug interactions) in drug adherence; it was found that patients prefer—and are willing to pay more for—routine pharmacist guidance concerning their medication(s).²

Lastly, in the search for better ways to promote patient adherence to oral drug regimens, technology has been studied in various formats, including reminder systems such as smartphone applications and programmable pill bottle caps. It has been pointed out that here, too, pharmacists can serve as liaisons between patients, their reminder technology, and clinicians in the effort to improve oral drug adherence and, ultimately, patients’ lives.²

References

1. Ruddy K, Mayer E, Partridge A. Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin. 2009;59(1):56-66.
2. Felton MA, van Londen GJ, Marcum ZA. Medication adherence to oral cancer therapy: the promising role of the pharmacist. J Oncol Pharm Pract. 2016;22(2):378-381.