Impact of anxio-depressive symptoms and cognitive function on oral anticancer therapies adherence
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.
KeywordsAdherence 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.
- 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
- 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
- 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
- 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
- 18.Spielberger SD (1983) Manual for the State-Trait Anxiety Inventory (STAI). Consulting Psychologists Press, Palo ALtoGoogle Scholar
- 20.Wechsler D (1997) Wechsler Adult Intelligence Scale-III. The Psychological Corporation, San AntonioGoogle Scholar
- 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
- 28.Baddeley A (2010) Working memory. Curr Biol 20(4):R136–R140Google Scholar
- 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
- 33.Lam WY, Fresco P (2015) Medication adherence measures: an overview. Biomed Res Int 217047:1–12Google Scholar
- 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