title: Self-reported adherence to oral cancer therapy: relationships with symptom distress, depression, and personal characteristics.
abstract: BACKGROUND
  Therapeutic cancer chemotherapy is most successful when complete dosing is achieved. Because many newer therapeutic agents are oral and self-administered by the patient, adherence is a concern. The purpose of our analysis was to explore relationships between adherence, patient characteristics, and barriers to adherence.
  
  
  METHODS
  This secondary analysis utilized self-reported data from a randomized trial of self-care management conducted at two cancer centers in the US. Symptom distress was measured using the 15-item Symptom Distress Scale (SDS-15) and depression with the Patient Health Questionnaire-9 (PHQ-9). Adherence to oral medication was self-reported using the 8-item Morisky Medication Adherence Scale (MMAS-8). Measures were collected via Web-based, study-specific software ~8 weeks after treatment start date. Odds of low/medium adherence (score <8) were explored using univariate logistic regression. Given the number of factors and possible relationships among factors, a classification tree was built in lieu of a multivariable logistic regression model.
  
  
  RESULTS
  Of the eligible participants enrolled, 77 were on oral therapy and 70 had an MMAS score. Forty-nine (70%) reported a high adherence score (=8). Higher odds of low/medium adherence were associated with greater symptom distress (P=0.09), more depression (P=0.05), chemotherapy vs hormonal oral medication (P=0.03), being female (P=0.02), and being randomized to the control group in the parent trial (P=0.09). Conversely, high adherence was associated with working (P=0.08), being married/partnered (P=0.004), and being older (P=0.02). Factors identified as significantly related to low/medium adherence from the univariate logistic regression analyses were supported by the classification tree results.
  
  
  CONCLUSIONS
  Nonadherence to therapeutic oral medications in patients with cancer was associated with being unmarried/unpartnered, symptom distress, younger age, not working, and female sex. These findings may help to identify patients at risk for nonadherence and for whom supportive interventions to enhance adherence may be needed.
authors.affiliation: Phyllis F Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA ; Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, MA, USA ; Department of Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Berry
authors.affiliation: Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Traci M
authors.initials: TM
authors.lastname: Blonquist
authors.affiliation: Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA ; Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Fangxin
authors.initials: F
authors.lastname: Hong
authors.affiliation: Phyllis F Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Halpenny
authors.affiliation: Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, MA, USA ; Department of Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Ann H
authors.initials: AH
authors.lastname: Partridge
keywords: logistic regression; patient-centered technology; recursive partitioning; self-management