Patient Adherence Is an Important Part of Treatment

A cancer patient's survival and well-being may depend on accurate administration of oral medications. It is estimated that up to 80% of patients do not take oral oncology agents according to their doctor's instructions.1 In addition, over time, patients are less compliant to their oral cancer treatments.2 The overuse, underuse, and misuse of prescription drugs remain a major problem.1

Ensuring that cancer patients are adhering to therapy is a critical part of their treatment. Poor medication adherence can lead to1:

  • Unnecessary disease progression
  • Treatment complications
  • Reduced functional abilities
  • Lower quality of life
  • Premature death

The concept of adherence extends beyond just the objective measure of how often and to what degree a pill is taken. Adherence involves numerous health-related behaviors. The World Health Organization defines adherence as the extent to which a person's behavior, such as taking medication, following a diet, and/or executing lifestyle changes, corresponds with the agreed upon recommendations from a healthcare provider.3

Adherence is multidimensional. It is influenced by a number of interrelated factors and barriers, including: (1) social/economic factors; (2) health system factors; (3) condition-related factors; (4) therapy-related factors; and (5) patient-related factors.3

Adherence is Multidimensional

Dimensions and Barriers to Adherence

Social/Economic Factors3

  • Poor socioeconomic status/poverty
  • Low level of education/literacy
  • Unemployment
  • Lack of social support networks
  • Unstable living conditions
  • Long distance to treatment center
  • Cultural beliefs about illness
  • Family dysfunction
  • Race/age in some instances

Health System Factors3

  • Poorly developed health services
  • Inadequate reimbursement by health insurance plans
  • Poor medication distribution systems
  • Poorly trained healthcare providers
  • Overworked healthcare providers
  • Lack of feedback on performance
  • Limited consult time
  • Poor follow-up
  • Lack of community support
  • Lack of knowledge on adherence
Condition-Related Factors3

  • Severity of symptoms
  • Level of disability
  • Rate of progression
  • Severity of disease
  • Availability of psychological, social, and vocational support
  • Lack of feedback on performance
  • Comorbid conditions

Therapy-Related Factors3

  • Complex medical regimens
  • Duration of therapy
  • Previous treatment failures
  • Frequent changes in therapy
  • Immediacy of beneficial effects
  • Side effects
  • Availability of medical help for side-effect management

Patient-Related Factors3

  • Patient knowledge
  • Patient attitudes
  • Patient beliefs
  • Patient perceptions
  • Patient expectations
  • Patient follow-up appointment attendance

References: 1. Mancini R, McBride, A, Kruczynski M. Oral oncolytics: part 1—financial, adherence, and management challenges. Oncology (Williston Park). 2013;27(8):742-744, 824. 2. Greer JA, Amoyal N, Nisotel L, et al. A systematic review of adherence to oral antineoplastic therapies. Oncologist. 2016;21(3):354-376. 3. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva, Switzerland. 2003.