The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices
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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.
KeywordsAdherence 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 was obtained from all individual participants included in the study.
- 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.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.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
- 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
- 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.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.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
- 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.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
- 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
- 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
- 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