title: A Systematic Review of Adherence to Oral Antineoplastic Therapies.
abstract: BACKGROUND
  Oral antineoplastic therapies not only improve survival but also reduce the burden of care for patients. Yet patients and clinicians face new challenges in managing adherence to these oral therapies. We conducted a systematic literature review to assess rates and correlates of adherence to oral antineoplastic therapies and interventions aimed at improving adherence.
  
  
  METHODS
  Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive literature search of the Ovid MEDLINE database from January 1, 2003 to June 30, 2015, using relevant terminology for oral antineoplastic agents. We included observational, database, and intervention studies. At least two researchers evaluated each paper to ensure accuracy of results and determine risk of bias.
  
  
  RESULTS
  We identified 927 records from the search and screened 214 abstracts. After conducting a full-text review of 167 papers, we included in the final sample 51 papers on rates/correlates of adherence to oral antineoplastic therapy and 12 papers on intervention studies to improve adherence. Rates of adherence varied widely, from 46% to 100%, depending on patient sample, medication type, follow-up period, assessment measure, and calculation of adherence. Of the intervention studies, only 1 of the randomized trials and 2 of the cohort studies showed benefit regarding adherence, with the majority suffering high risk of bias.
  
  
  CONCLUSIONS
  Although no reliable estimate of adherence to oral antineoplastic therapies can be gleaned from the literature, a substantial proportion of patients struggle to adhere to these medications as prescribed. The few intervention studies for adherence have notable methodological concerns, thereby limiting the evidence to guide practice in promoting medication adherence among patients with cancer.
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA jgreer2@mgh.harvard.edu.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Greer
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Amoyal
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Nisotel
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joel N
authors.initials: JN
authors.lastname: Fishbein
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: James
authors.initials: J
authors.lastname: MacDonald
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Stagl
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Inga
authors.initials: I
authors.lastname: Lennes
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.affiliation: University of Miami, Coral Gables, Florida, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D016903:Drug Monitoring
chemical_list: D000970:Antineoplastic Agents
keywords: Antineoplastic agents; Chemotherapy; Endocrine therapy; Medication adherence; Oral drug administration; Patient adherence