Supportive Care in Cancer

, Volume 25, Issue 6, pp 1797–1807 | Cite as

The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices

  • Teresa M. Salgado
  • Emily Mackler
  • Jane A. Severson
  • Jamie Lindsay
  • Peter Batra
  • Laura Petersen
  • Karen B. Farris
Original Article

Abstract

Purpose

The Michigan Oncology Quality Consortium (MOQC) is a continuous quality improvement collaborative seeking to improve oncology care in Michigan, including for patients taking oral chemotherapy. The aim of this study was to assess the relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics to inform future oncology care.

Methods

A multicenter cross-sectional observational study was conducted using an online survey to examine patient activation (patient activation measure, PAM), health literacy, symptom burden (Edmonton Symptom Assessment System, ESAS), confidence to self-manage side effects (fatigue, nausea, and diarrhea), and adherence to oral oncolytics. Inclusion criteria were patients taking an oral oncolytic for at least 1 month. Bivariate analyses and logistic regression were performed to evaluate relationships between the variables.

Results

A total of 125 respondents, mean (SD) age 66.2 (13.6), 57.7% female, and 95.1% Caucasian completed the survey. The mean (SD) PAM score was 65.0 (18.0). Confidence to manage fatigue, nausea, and diarrhea was associated with higher activation, and confidence to self-manage fatigue and diarrhea were associated with higher health literacy. About 30% of participants reported some level of non-adherence to oral oncolytics, and those who experienced side effects (Fisher’s exact test p = 0.033) and with shorter length of therapy (t test p = 0.027) were significantly more likely to be non-adherent.

Conclusions

These findings show that there is room for improvement across practices involved with MOQC with regard to supporting patients taking oral oncolytics. Patients will need to improve their activation levels, and oncology clinics will need to create new workflows in order to enhance self-care management ability for patients taking oral oncolytics.

Keywords

Adherence Oral chemotherapy Quality improvement Self-management 

References

  1. 1.
    Bedell CH (2003) A changing paradigm for cancer treatment: the advent of new oral chemotherapy agents. Clin J Oncol Nurs 7:5–9CrossRefPubMedGoogle Scholar
  2. 2.
    Khandelwal N, Duncan I, Ahmed T, Rubinstein E, Pegus C (2011) Impact of clinical oral chemotherapy program on wastage and hospitalizations. Am J Manag Care 17:e169–e173PubMedGoogle Scholar
  3. 3.
    Weingart SN, Brown E, Bach PB, Eng K, Johnson SA, Kuzel TM, Langbaum TS, Leedy RD, Muller RJ, Newcomer LN, O'Brien S, Reinke D, Rubino M, Saltz L, Walters RS (2008) NCCN task force report: oral chemotherapy. J Natl Compr Cancer Netw 6(Suppl 3):S1–14Google Scholar
  4. 4.
    Schwartz RN, Eng KJ, Frieze DA, Gosselin TK, Griffith N, Seung AH, Hinkel JM, Johnson PE, Johnson SA, Li EC, Szabatura AH, Wong MK (2010) NCCN task force report: specialty pharmacy. J Natl Compr Cancer Netw 8(Suppl 4):S1–12Google Scholar
  5. 5.
    Goodin S, Griffith N, Chen B, Chuk K, Daouphars M, Doreau C, Patel RA, Schwartz R, Tames MJ, Terkola R, Vadnais B, Wright D, Meier K (2011) Safe handling of oral chemotherapeutic agents in clinical practice: recommendations from an international pharmacy panel. J Oncol Pract 7:7–12CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Zerillo JA, Pham TH, Kadlubek P, Severson JA, Mackler E, Jacobson JO, Blayney DW (2015) Administration of oral chemotherapy: results from three rounds of the quality oncology practice initiative. J Oncol Pract 11:e255–e262CrossRefPubMedGoogle Scholar
  7. 7.
    Kidd LA (2014) Consequences, control and appraisal: cues and barriers to engaging in self-management among people affected by colorectal cancer—a secondary analysis of qualitative data. Health Expect 17:565–578CrossRefPubMedGoogle Scholar
  8. 8.
    Greene J, Hibbard JH (2012) Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med 27:520–526CrossRefPubMedGoogle Scholar
  9. 9.
    Kinney RL, Lemon SC, Person SD, Pagoto SL, Saczynski JS (2015) The association between patient activation and medication adherence, hospitalization, and emergency room utilization in patients with chronic illnesses: a systematic review. Patient Educ Couns 98:545–552CrossRefPubMedGoogle Scholar
  10. 10.
    Mosen DM, Schmittdiel J, Hibbard J, Sobel D, Remmers C, Bellows J (2007) Is patient activation associated with outcomes of care for adults with chronic conditions? J Ambul Care Manage 30:21–29CrossRefPubMedGoogle Scholar
  11. 11.
    Katz ML, Fisher JL, Fleming K, Paskett ED (2012) Patient activation increases colorectal cancer screening rates: a randomized trial among low-income minority patients. Cancer Epidemiol Biomark Prev 21:45–52CrossRefGoogle Scholar
  12. 12.
    Foulon V, Schoffski P, Wolter P (2011) Patient adherence to oral anticancer drugs: an emerging issue in modern oncology. Acta Clin Belg 66:85–96PubMedGoogle Scholar
  13. 13.
    Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, Dobbels F, Fargher E, Morrison V, Lewek P, Matyjaszczyk M, Mshelia C, Clyne W, Aronson JK, Urquhart J (2012) A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol 73:691–705CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Ruddy K, Mayer E, Partridge A (2009) Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin 59:56–66CrossRefPubMedGoogle Scholar
  15. 15.
    Huang WC, Chen CY, Lin SJ, Chang CS (2016) Medication adherence to oral anticancer drugs: systematic review. Expert Rev Anticancer Ther 16:423–432CrossRefPubMedGoogle Scholar
  16. 16.
    Greer JA, Amoyal N, Nisotel L, Fishbein JN, MacDonald J, Stagl J, Lennes I, Temel JS, Safren SA, Pirl WF (2016) A systematic review of adherence to oral antineoplastic therapies. Oncologist 21:354–376CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    McCue DA, Lohr LK, Pick AM (2014) Improving adherence to oral cancer therapy in clinical practice. Pharmacotherapy 34:481–494CrossRefPubMedGoogle Scholar
  18. 18.
    Marin D, Bazeos A, Mahon FX, Eliasson L, Milojkovic D, Bua M, Apperley JF, Szydlo R, Desai R, Kozlowski K, Paliompeis C, Latham V, Foroni L, Molimard M, Reid A, Rezvani K, de Lavallade H, Guallar C, Goldman J, Khorashad JS (2010) Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol 28:2381–2388CrossRefPubMedGoogle Scholar
  19. 19.
    Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, Kwan M, Gomez SL, Neugut AI (2011) Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat 126:529–537CrossRefPubMedGoogle Scholar
  20. 20.
    Darkow T, Henk HJ, Thomas SK, Feng W, Baladi JF, Goldberg GA, Hatfield A, Cortes J (2007) Treatment interruptions and non-adherence with imatinib and associated healthcare costs: a retrospective analysis among managed care patients with chronic myelogenous leukaemia. PharmacoEconomics 25:481–496CrossRefPubMedGoogle Scholar
  21. 21.
    Roop JC, Wu HS (2014) Current practice patterns for oral chemotherapy: results of a national survey. Oncol Nurs Forum 41:185–194CrossRefPubMedGoogle Scholar
  22. 22.
    Bourmaud A, Pacaut C, Melis A, Tinquaut F, Magne N, Merrouche Y, Chauvin F (2014) Is oral chemotherapy prescription safe for patients? A cross-sectional survey. Ann Oncol 25:500–504CrossRefPubMedGoogle Scholar
  23. 23.
    Weingart SN, Flug J, Brouillard D, Morway L, Partridge A, Bartel S, Shulman LN, Connor M (2007) Oral chemotherapy safety practices at US cancer centres: questionnaire survey. BMJ 334:407CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Hibbard JH, Mahoney ER, Stockard J, Tusler M (2005) Development and testing of a short form of the patient activation measure. Health Serv Res 40:1918–1930CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Hibbard JH, Stockard J, Mahoney ER, Tusler M (2004) Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 39:1005–1026CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Watanabe SM, Nekolaichuk CL, Beaumont C (2012) The Edmonton Symptom Assessment System, a proposed tool for distress screening in cancer patients: development and refinement. Psychooncology 21:977–985CrossRefPubMedGoogle Scholar
  27. 27.
    Severson JA, Mackler E, Marini B, Blayney DW (2014) Association of high symptom burden with oral oncolytic agents. J Clin Oncol 32:(suppl 31; abstr 177)Google Scholar
  28. 28.
    Feldman BJ, Fredericksen RJ, Crane PK, Safren SA, Mugavero MJ, Willig JH, Simoni JM, Wilson IB, Saag MS, Kitahata MM, Crane HM (2013) Evaluation of the single-item self-rating adherence scale for use in routine clinical care of people living with HIV. AIDS Behav 17:307–318CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, Wilson IB (2008) Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav 12:86–94CrossRefPubMedGoogle Scholar
  30. 30.
    Unni EJ, Farris KB (2015) Development of a new scale to measure self-reported medication nonadherence. Res Social Adm Pharm 11:e133–e143CrossRefPubMedGoogle Scholar
  31. 31.
    Peterson PN, Shetterly SM, Clarke CL, Bekelman DB, Chan PS, Allen LA, Matlock DD, Magid DJ, Masoudi FA (2011) Health literacy and outcomes among patients with heart failure. JAMA 305:1695–1701CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Chew LD, Bradley KA, Boyko EJ (2004) Brief questions to identify patients with inadequate health literacy. Fam Med 36:588–594PubMedGoogle Scholar
  33. 33.
    DeSalvo KB, Fisher WP, Tran K, Bloser N, Merrill W, Peabody J (2006) Assessing measurement properties of two single-item general health measures. Qual Life Res 15:191–201CrossRefPubMedGoogle Scholar
  34. 34.
    Bassan F, Peter F, Houbre B, Brennstuhl MJ, Costantini M, Speyer E, Tarquinio C (2014) Adherence to oral antineoplastic agents by cancer patients: definition and literature review. Eur J Cancer Care (Engl) 23:22–35CrossRefGoogle Scholar
  35. 35.
    Mathes T, Pieper D, Antoine SL, Eikermann M (2014) Adherence influencing factors in patients taking oral anticancer agents: a systematic review. Cancer Epidemiol 38:214–226CrossRefPubMedGoogle Scholar
  36. 36.
    Verbrugghe M, Verhaeghe S, Lauwaert K, Beeckman D, Van Hecke A (2013) Determinants and associated factors influencing medication adherence and persistence to oral anticancer drugs: a systematic review. Cancer Treat Rev 39:610–621CrossRefPubMedGoogle Scholar
  37. 37.
    Noens L, van Lierde MA, De Bock R, Verhoef G, Zachee P, Berneman Z, Martiat P, Mineur P, Van Eygen K, MacDonald K, De Geest S, Albrecht T, Abraham I (2009) Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood 113:5401–5411CrossRefPubMedGoogle Scholar
  38. 38.
    Marques P, Pierin A (2008) Factors that affect cancer patient compliance to oral antineoplastic therapy. Acta Paul Enferm 21:323–329CrossRefGoogle Scholar
  39. 39.
    Hendriks M, Rademakers J (2014) Relationships between patient activation, disease-specific knowledge and health outcomes among people with diabetes; a survey study. BMC Health Serv Res 14:393CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Sheikh S, Hendry P, Kalynych C, Owensby B, Johnson J, Kraemer DF, Carden D (2016) Assessing patient activation and health literacy in the ED. Am J Emerg Med 34:93–96CrossRefPubMedGoogle Scholar
  41. 41.
    Smith SG, Curtis LM, Wardle J, von Wagner C, Wolf MS (2013) Skill set or mind set? Associations between health literacy, patient activation and health. PLoS One 8:e74373CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Eichler C, Pia M, Sibylle M, Sauerwald A, Friedrich W, Warm M (2015) Cognitive behavioral therapy in breast cancer patients—a feasibility study of an 8 week intervention for tumor associated fatigue treatment. Asian Pac J Cancer Prev 16:1063–1067CrossRefPubMedGoogle Scholar
  43. 43.
    Berry DL, Blumenstein BA, Halpenny B, Wolpin S, Fann JR, Austin-Seymour M, Bush N, Karras BT, Lober WB, McCorkle R (2011) Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial. J Clin Oncol 29:1029–1035CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Spoelstra SL, Given BA, Given CW, Grant M, Sikorskii A, You M, Decker V (2013) An intervention to improve adherence and management of symptoms for patients prescribed oral chemotherapy agents: an exploratory study. Cancer Nurs 36:18–28CrossRefPubMedGoogle Scholar
  45. 45.
    Arthurs G, Simpson J, Brown A, Kyaw O, Shyrier S, Concert CM (2015) The effectiveness of therapeutic patient education on adherence to oral anti-cancer medicines in adult cancer patients in ambulatory care settings: a systematic review. JBI Database System Rev Implement Rep 13:244–292PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Teresa M. Salgado
    • 1
    • 2
  • Emily Mackler
    • 2
  • Jane A. Severson
    • 2
  • Jamie Lindsay
    • 2
  • Peter Batra
    • 1
  • Laura Petersen
    • 2
  • Karen B. Farris
    • 1
    • 2
  1. 1.University of Michigan College of PharmacyAnn ArborUSA
  2. 2.Michigan Oncology Quality ConsortiumUniversity of MichiganAnn ArborUSA

Personalised recommendations