title: Enhancing adherence to capecitabine chemotherapy by means of multidisciplinary pharmaceutical care.
abstract: OBJECTIVE
  In this prospective multi-centre observational cohort study, we investigated the effect of an intensified multidisciplinary pharmaceutical care programme on the adherence of cancer patients treated with capecitabine, a prodrug of fluorouracil.
  
  
  METHODS
  Twenty-four colorectal and 24 breast cancer patients participated in this study. Patients of the control group (n = 24) received standard care, patients of the intervention group (n = 24) received intensified pharmaceutical care consisting of written and spoken information. Adherence to capecitabine chemotherapy was measured using an electronic medication event monitoring system (MEMS™).
  
  
  RESULTS
  Patients in the intervention group exhibited an enhanced but not significantly different mean overall adherence compared to the control group (97.9% vs 90.5%, p = 0.069). Mean daily adherence was significantly higher in the intervention group (96.8% vs 87.2%, p = 0.029). Variability of both adherence parameters was considerably reduced when pharmaceutical care was provided. At the end of the observation period of 126 days, the probability of still being treated with capecitabine was found to be 48% in the control group and 83% in the intervention group (p = 0.019, log-rank test). The relative risk for a deviating drug intake interval, i.e. <10 or >14 instead of 12 h, in the intervention group was found to be 0.51 (95% CI, 0.46-0.56) compared with the control group (p < 0.05, Chi-square test).
  
  
  CONCLUSIONS
  The provision of intensified pharmaceutical care can enhance adherence to and prolong treatment with capecitabine. The results underline the importance of multidisciplinary care to assure the effectiveness of oral chemotherapy.
authors.affiliation: Department of Clinical Pharmacy, Institute of Pharmacy, An der Immenburg 4, 53121, Bonn, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Simons
authors.forename: Susanne
authors.initials: S
authors.lastname: Ringsdorf
authors.forename: Michael
authors.initials: M
authors.lastname: Braun
authors.forename: Ulrich J
authors.initials: UJ
authors.lastname: Mey
authors.forename: Peter F
authors.initials: PF
authors.lastname: Schwindt
authors.forename: Yon D
authors.initials: YD
authors.lastname: Ko
authors.forename: Ingo
authors.initials: I
authors.lastname: Schmidt-Wolf
authors.forename: Walther
authors.initials: W
authors.lastname: Kuhn
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jaehde
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D000069287:Capecitabine; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D016001:Confidence Intervals; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D016903:Drug Monitoring
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil