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Oral Cancer Chemotherapy Adherence and Adherence Assessment Tools: a Report from North Central Cancer Group Trial N0747 and a Systematic Review of the Literature

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Abstract

Oncologists are now prescribing more oral chemotherapy than ever before, thus placing the onus for taking the right dose at the right time under the right circumstances directly on the patient. This study was undertaken to understand emerging adherence issues and to explore available adherence assessment tools. This two-part study (1) examined N0747, a randomized phase II trial that tested the oral agents, sunitinib and capecitabine, in patients with metastatic esophageal cancer from an adherence standpoint, and (2) conducted a systematic review to compile and assess adherence tools that can be used in future clinical trials. First, in N0747, patients were assigned to sunitinib and capecitabine versus capecitabine; 53 chemotherapy cycles were prescribed to this 12-patient cohort. Nearly all patients denoted that they “always or almost always” took their pills as prescribed, and two patients who reported lack of full adherence suffered from grade 3+ adverse events. Surprisingly, however, over 14 cycles, 9 patients reported grade 3+ toxicity but checked “always or almost always” to describe their adherence. No relationships were observed between adherence and cancer outcomes. Secondly, 21 articles identified the following adherence tools: (1) healthcare providers’ interviews, (2) patient-reported adherence with diaries/calendars, (3) patient-completed adherence scales, (4) medication event monitoring, (5) automated voice response, (6) drug/metabolite assays, and (7) prescription databases. Of note, only the automated voice response seems capable of real-time detection of over-adherence, as observed in N0747. Oral chemotherapy adherence should be further studied, particularly from the standpoint of over-adherence.

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Authors and Affiliations

  1. Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Krishna Patel

  2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Nathan R. Foster & Jeffrey P. Meyers

  3. Library Services, Plummer Library, Mayo Clinic, Rochester, MN, USA

    Ann Farrell

  4. Illinois Oncology Research Association CCOP, Peoria, IL, USA

    Nguyet Anh Le-Lindqwister

  5. Park Nicollet Cancer Center, St. Louis Park, MN, USA

    Josy Mathew

  6. Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA

    Brian Costello & Aminah Jatoi

  7. Sanford Bismarck Medical Center, Bismarck, ND, USA

    John Reynolds

  8. 200 First Street SW, Rochester, MN, 55905, USA

    Aminah Jatoi

Authors
  1. Krishna Patel
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  2. Nathan R. Foster
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  3. Ann Farrell
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  4. Nguyet Anh Le-Lindqwister
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  5. Josy Mathew
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  6. Brian Costello
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  7. John Reynolds
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  8. Jeffrey P. Meyers
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  9. Aminah Jatoi
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Corresponding author

Correspondence to Aminah Jatoi.

Additional information

This study was conducted as a collaborative trial of the North Central Cancer Treatment Group and Mayo Clinic and was supported in part by Public Health service grants CA-25224, CA-37404, CA-35448, CA-35113, CA-35267, CA-35103, and CA-35119 from the National Cancer Institute, Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institute of Health. This study was also supported by 5K24CA131099.

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Patel, K., Foster, N.R., Farrell, A. et al. Oral Cancer Chemotherapy Adherence and Adherence Assessment Tools: a Report from North Central Cancer Group Trial N0747 and a Systematic Review of the Literature. J Canc Educ 28, 770–776 (2013). https://doi.org/10.1007/s13187-013-0511-z

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  • DOI: https://doi.org/10.1007/s13187-013-0511-z

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