Impact of anxio-depressive symptoms and cognitive function on oral anticancer therapies adherence

  • Mélanie Dos SantosEmail author
  • M. Lange
  • R. Gervais
  • B. Clarisse
  • A. Capel
  • M. Barillet
  • J. M. Grellard
  • N. Heutte
  • I. Licaj
  • F. Joly
Original Article



Oral anticancer therapies have an important place in the therapeutic arsenal, but factors influencing adherence to oral treatment are poorly documented in oncology. The objective of this study was to assess the impact of anxio-depressive symptoms and cognitive functioning on oral medication adherence.


This prospective study included cancer patients initiating a first oral therapy. Before initiation of treatment, an assessment of depression, anxiety, and cognition was performed. Using self-report questionnaires, we collected information on socio-demographic conditions and the non-adherence at 1 (M1) and 3 months (M3) after the beginning of treatment.


Among 129 patients enrolled, median age was 70 years and 81% of patients were treated for metastatic cancer. Before initiating treatment, 16% and 8% of patients presented respectively depression and anxiety symptoms. Global cognitive impairment was observed in 51% of patients. Ten percent of the patients were non-adherent at M1 and 13% at M3. Depression was strongly associated with non-adherence at M1 (P = 0.046) and M3 (P = 0.014), but not anxiety. Non-adherence was associated with lower working memory (P = 0.037) and digit memory (P = 0.018) at M1 and short-term memory (P = 0.04) at M3. Patients with more than eight co-medications were more often non-adherents (P = 0.055).


Non-adherence to oral anticancer therapies was mainly associated to depression. Focusing on depressive symptoms before initiation of oral anticancer therapy could help to identify patient profiles more likely to fail self-management. Working memory, digit memory, and short-term memory also seem to play a role in non-adherence. Further studies should include a more specific population, especially according to age.


Adherence Cancer Depression Anxiety Cognitive function 



The authors would like to thank all patients who generously participated in this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H, Forman D, Bray F (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403CrossRefGoogle Scholar
  2. 2.
    Benjamin L, Maroun R, Maurel F, Bardoulat I, Ricarte C (2015) Patterns of use of oral anticancer treatments in France: a retrospective analysis of cancer treatments given orally from 2004 to 2012 (Re-ACTOR study). Curr Med Res Opin 31(2):323–332CrossRefGoogle Scholar
  3. 3.
    O'Neill VJ, Twelves CJ (2002) Oral cancer treatment: developments in chemotherapy and beyond. Br J Cancer 87(9):933–937CrossRefGoogle Scholar
  4. 4.
    Bedell CH (2003) A changing paradigm for cancer treatment: the advent of new oral chemotherapy agents. Clin J Oncol Nurs 7(6 Suppl):5–9CrossRefGoogle Scholar
  5. 5.
    Mastroianni CM, Viscomi C, Ceniti S, de Simone R, Filice A, Gadaleta Caldarola G, Infusino S, Manfredi C, Rea A, Sandomenico C, Turano S, Serranò F, Condemi G, Cortese C, Prantera T, Palazzo S (2008) Preferences of patients with advanced colorectal cancer for treatment with oral or intravenous chemotherapy. Patient 1(3):181–187CrossRefGoogle Scholar
  6. 6.
    Liu G, Franssen E, Fitch MI, Warner E (1997) Patient preferences for oral versus intravenous palliative chemotherapy. J Clin Oncol 15(1):110–115CrossRefGoogle Scholar
  7. 7.
    Ruddy K, Mayer E, Partridge A (2009) Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin 59(1):56–66CrossRefGoogle Scholar
  8. 8.
    Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353:487–497CrossRefGoogle Scholar
  9. 9.
    Barillet M, Prevost V, Joly F, Clarisse B (2015) Oral antineoplastic agents: how do we care about adherence? Br J Clin Pharmacol 80(6):1289–1302CrossRefGoogle Scholar
  10. 10.
    Bender CM, Gentry AL, Brufsky AM, Casillo FE, Cohen SM, Dailey MM, Donovan HS, Dunbar-Jacob J, Jankowitz RC, Rosenzweig MQ, Sherwood PR, Sereika SM (2014) Influence of patient and treatment factors on adherence to adjuvant endocrine therapy in breast cancer. Oncol Nurs Forum 41(3):274–285CrossRefGoogle Scholar
  11. 11.
    Lin C, Clark R, Tu P, Bosworth HB, Zullig LL (2017) Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers. Breast Cancer Res Treat 165(2):247–260CrossRefGoogle Scholar
  12. 12.
    Sedjo RL, Devine S (2011) Predictors of non-adherence to aromatase inhibitors among commercially insured women with breast cancer. Breast Cancer Res Treat 125(1):191–200CrossRefGoogle Scholar
  13. 13.
    Lange M, Heutte N, Rigal O et al (2016) Decline of cognitive functions in elderly localized breast cancer patients after adjuvant treatment. Oncologist 21(11):1337–1348Google Scholar
  14. 14.
    Ahles TA, Root JC, Ryan EL (2012) Cancer and cancer treatment-associated cognitive change: an update on the state of the science. J Clin Oncol 30(30):3675–3686CrossRefGoogle Scholar
  15. 15.
    Klepin HD, Geiger AM, Bandos H, Costantino JP, Rapp SR, Sink KM, Lawrence JA, Atkinson HH, Espeland MA (2014) Cognitive factors associated with adherence to oral antiestrogen therapy: results from the cognition in the study of tamoxifen and raloxifene (Co-STAR) study. Cancer Prev Res (Phila) 7(1):161–168CrossRefGoogle Scholar
  16. 16.
    Chesney MA, Ickovics JR, Chambers DB et al (2000) Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS Care 12:255–266CrossRefGoogle Scholar
  17. 17.
    Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRefGoogle Scholar
  18. 18.
    Spielberger SD (1983) Manual for the State-Trait Anxiety Inventory (STAI). Consulting Psychologists Press, Palo ALtoGoogle Scholar
  19. 19.
    Nasreddine ZS, Phillips NA, Bédirian V et al (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699CrossRefGoogle Scholar
  20. 20.
    Wechsler D (1997) Wechsler Adult Intelligence Scale-III. The Psychological Corporation, San AntonioGoogle Scholar
  21. 21.
    Reitan R (1958) Validity of trail making tests as an indicator of organic brain damage. Percept Motor Skills 8:271–276CrossRefGoogle Scholar
  22. 22.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186CrossRefGoogle Scholar
  23. 23.
    Rodda J, Walker Z, Carter J (2011) Depression in older adults. BMJ 343:d5219CrossRefGoogle Scholar
  24. 24.
    Potter GG, McQuoid DR, Whitson HE, Steffens DC (2016) Physical frailty in late-life depression is associated with deficits in speed-dependent executive functions. Int J Geriatr Psychiatry 31:466–474CrossRefGoogle Scholar
  25. 25.
    Kenis C, Bron D, Libert Y, Decoster L, van Puyvelde K, Scalliet P, Cornette P, Pepersack T, Luce S, Langenaeken C, Rasschaert M, Allepaerts S, van Rijswijk R, Milisen K, Flamaing J, Lobelle JP, Wildiers H (2013) Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study. Ann Oncol 24(5):1306–1312CrossRefGoogle Scholar
  26. 26.
    Hamaker ME, Schiphorst AH, ten Bokkel Huinink D, Schaar C, van Munster BC (2014) The effect of a geriatric evaluation on treatment decisions for older cancer patients - a systematic review. Acta Oncol 53(3):289–296CrossRefGoogle Scholar
  27. 27.
    Stilley CS, Bender CM, Dunbar-Jacob J, Sereika S, Ryan CM (2010) The impact of cognitive function on medication management: three studies. Health Psychol 29(1):50–55CrossRefGoogle Scholar
  28. 28.
    Baddeley A (2010) Working memory. Curr Biol 20(4):R136–R140Google Scholar
  29. 29.
    Ghidei L, Simone MJ, Salow MJ, Zimmerman KM, Paquin AM, Skarf LM, Kostas TRM, Rudolph JL (2013) Aging, antiretrovirals, and adherence: a meta analysis of adherence among older HIV-infected individuals. Drugs Aging 30(10):809–819CrossRefGoogle Scholar
  30. 30.
    Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, Stefaniak M (2004) Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS 18(Suppl 1):19–25CrossRefGoogle Scholar
  31. 31.
    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(6):481–496CrossRefGoogle Scholar
  32. 32.
    Del Prete S, Cennamo G, Leo L et al (2017) Adherence and safety of regorafenib for patients with metastatic colorectal cancer: observational real-life study. Future Oncol 13(5):415–423CrossRefGoogle Scholar
  33. 33.
    Lam WY, Fresco P (2015) Medication adherence measures: an overview. Biomed Res Int 217047:1–12Google Scholar
  34. 34.
    Lange M, Heutte N, Rigal O, Noal S, Kurtz JE, Lévy C, Allouache D, Rieux C, Lefel J, Clarisse B, Veyret C, Barthélémy P, Longato N, Castel H, Eustache F, Giffard B, Joly F (2016) Decline in cognitive function in older adults with early-stage breast cancer after adjuvant treatment. Oncologist 21(11):1337–1348CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinical Research Department, Centre François BaclesseCaenFrance
  2. 2.Department of MedicineHospital UniversityCaenFrance
  3. 3.Department of Medical Oncology, Centre François BaclesseCaenFrance
  4. 4.INSERM, U1086, ANTICIPECaenFrance

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