Elements Of Oral Chemotherapy Compliance

Cancer treatments are evolving, and there is a shift toward chemotherapy that patients self-administer at home, with an emphasis on oral medications. In 2010, authors published in the Clinical Journal of Oncology Nursing expected use of oral chemotherapy treatments “to more than double in the next several years” and one 2014 estimate assessed that about a quarter of treatments in the research pipeline were oral medications. 

At-home oral chemotherapy has created opportunities in the form of convenience and ease of administration, but it also presents new challenges; specifically, the risk of patient non-compliance with prescribed treatment regimens.

Varieties of chemotherapy

The types of chemotherapy differ by the specific drug used and its method of delivery, the latter of which include intrathecal, intraperitoneal, intra-arterial, intravenous (IV), injection, topical, and oral administration.



These treatments are delivered in a wide range of doses, frequencies, and settings. And while many forms of chemotherapy are still exclusively delivered in a clinical setting, “pills, intravenous chemo, IV antibiotics … subcutaneous injections” can be managed at home by the patient. Self-administration makes it all the more essential that a patient is educated about the treatment and engaged in following the prescribed regimen.

A review in Oncology assessed that the “move to oral self-administration” has caused “a critical shift in responsibility of management from the provider to patient.” And a review of research literature in the Journal of the National Cancer Institute made the case simply: “Oral chemotherapy can be effective only if adherence is optimized.”

Issues with patient adherence to oral chemo

Steve D’Amato, RPh, BCOP, reviewed the factors of non-adherence and their effects in “Improving Patient Adherence with Oral Chemotherapy” published in Oncology Issues. The practical impact of noncompliance included increased visits to a physician, more and longer hospitalizations, decreased patient satisfaction, a poor physician-patient relationship, and, crucially, compromised disease outcomes. 

D’Amato listed the following drivers of non-adherence:

  • Presence of cognitive impairment
  • Presence of psychological problems, especially depression
  • Treatment of asymptomatic disease
  • Inadequate follow-up or discharge planning
  • Adverse effects of medication
  • Patient’s lack of belief in the benefits of treatment
  • Patient’s lack of insight into the illness
  • Missed appointments
  • Poor provider-patient relationship
  • Presence of barriers to medications or care
  • Complexity of treatment
  • Cost of medication, co-payment, or both

At least six of these issues (bolded) can be directly addressed with effective education, which is something that healthcare marketers can decidedly influence. And this education cuts two ways: Providers must be educated about the factors in patient non-compliance, while patients and their families need to understand their disease, its treatments, and how adherence affects the course of their condition.

“Comprehensive patient and family education has been shown to enhance adherence to oral chemotherapy,” concluded D’Amato. 

The right media for patient education

Of course, much of the responsibility to educate patients falls to physicians, and a positive provider-patient relationship is a key factor in adherence. But there is an information gap; a 2014 survey of oral chemotherapy patients revealed that only 68% of respondents thought that “their practices offered adequate patient education materials.” Materials created by healthcare marketers can help facilitate both the patient-provider relationship and fulfill this need for sufficient information. 

Specifically, educational materials should provide practical information that addresses “the dose, frequency, timing of dosing, what to do if a dose is omitted, side effects and symptom management, and what to do if an adverse effect is encountered,” according to D’Amato.

In addition, written materials should explain “the importance of adherence” and the consequences of failing to follow the prescribed regimen. Practical aids, such as “pillboxes, calendars, diaries, alarms, and other tools” can aid in adherence. Finally, effective materials must outline how to safely use the drug at home, including how to protect family members from exposure.

The treatment of cancer is changing, and self-administered treatments are a significant part of this change. But the medical community must adapt its patient education efforts to ensure that outcomes are not compromised — and healthcare marketers are uniquely positioned to meet this need.

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