, Volume 19, Issue 7, pp 1009-1018,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 16 Jun 2010

Enhancing adherence to capecitabine chemotherapy by means of multidisciplinary pharmaceutical care

Abstract

Purpose

In this prospective multi-centre observational cohort study, we investigated the effect of an intensified multidisciplinary pharmaceutical care programme on the adherence of cancer patients treated with capecitabine, a prodrug of fluorouracil.

Patients and methods

Twenty-four colorectal and 24 breast cancer patients participated in this study. Patients of the control group (n = 24) received standard care, patients of the intervention group (n = 24) received intensified pharmaceutical care consisting of written and spoken information. Adherence to capecitabine chemotherapy was measured using an electronic medication event monitoring system (MEMS™).

Results

Patients in the intervention group exhibited an enhanced but not significantly different mean overall adherence compared to the control group (97.9% vs 90.5%, p = 0.069). Mean daily adherence was significantly higher in the intervention group (96.8% vs 87.2%, p = 0.029). Variability of both adherence parameters was considerably reduced when pharmaceutical care was provided. At the end of the observation period of 126 days, the probability of still being treated with capecitabine was found to be 48% in the control group and 83% in the intervention group (p = 0.019, log-rank test). The relative risk for a deviating drug intake interval, i.e. <10 or >14 instead of 12 h, in the intervention group was found to be 0.51 (95% CI, 0.46–0.56) compared with the control group (p < 0.05, Chi-square test).

Conclusions

The provision of intensified pharmaceutical care can enhance adherence to and prolong treatment with capecitabine. The results underline the importance of multidisciplinary care to assure the effectiveness of oral chemotherapy.

Relevance of the manuscript

Efficacy of an orally administered anticancer therapy depends on a high level of patient adherence. There is still a lack of strategies to assure patient adherence in this particular group of patients. This study presents a systematic and detailed analysis on patient adherence to capecitabine chemotherapy. For the first time, the impact of an intensified pharmaceutical care provision on the adherence of patients receiving oral chemotherapy has been studied.