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 MacklerEmail author
  • Jane A. Severson
  • Jamie Lindsay
  • Peter Batra
  • Laura Petersen
  • Karen B. Farris
Original Article



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.


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.


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.


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.


Adherence Oral chemotherapy Quality improvement Self-management 



Support for the Michigan Oncology Quality Consortium (MOQC) is provided by Blue Cross and Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program. Although Blue Cross Blue Shield of Michigan and MOQC work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. Our research team is in full control of all primary data and agrees to allow the journal to review it if requested.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

The study was designated as exempt by the University of Michigan’s Institutional Review Board, as the data are part of a quality improvement initiative.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Teresa M. Salgado
    • 1
    • 2
  • Emily Mackler
    • 2
    Email author
  • 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

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