title: Patient perspectives on the barriers associated with medication adherence to oral chemotherapy.
abstract: Purpose Appropriate use of oral chemotherapy is a challenge for patients and clinicians. The purpose of this study was to analyze cancer patients' use of oral chemotherapies and identify opportunities to improve adherence. Methods We developed a 30-question survey to address frequency and reasons for reducing/skipping doses; sources of information for oral chemotherapy use; perceived importance of food-drug effects; and ease of understanding labeling directions. Results Ninety-three patients taking oral chemotherapies with chronic myeloid leukemia, renal cell carcinoma, breast cancer, and colorectal cancer completed the survey. This was a well-educated population with 69% (n = 62) having completed some college; 51% (n = 47) female and 59% (n = 54) older than 50 years of age. Thirty percent of patients reported forgetting to take their oral chemotherapy at least "sometimes". Younger patients (<50 vs. ≥50, p = 0.002), shorter treatment duration (<6 vs. ≥6 months p = 0.03), or with chronic myeloid leukemia (vs. other diagnoses, p = 0.015) forget to take their oral chemotherapy at higher rates. Twenty-three percent (n = 21) indicated they intentionally skipped their oral chemotherapies and 38% (n = 8) of those did not inform their physicians. Forty-one percent (n = 28) taking drugs with significant food-drug effects did not think about their last meal before taking their oral chemotherapy and 80% (n = 55) did not understand the potential interactions. Additionally, 39% (n = 36/92) never looked at labeling and 15% (n = 14/91) had difficulty understanding label directions. Conclusion There are three main barriers associated with appropriate use of oral chemotherapies: misunderstanding about the timing of drug with food; stopping drug without informing physicians; and difficulty understanding labeling directions. A multipronged approach is needed to optimize communication of directions for optimal oral chemotherapy use.
authors.affiliation: 1 Department of Pharmacy, University of North Carolina Medical Center.|2 Eshelman School of Pharmacy, University of North Carolina.
authors.forename: Benyam
authors.initials: B
authors.lastname: Muluneh
authors.affiliation: 3 Lineberger Comprehensive Cancer Center, University of North Carolina.
authors.forename: Allison
authors.initials: A
authors.lastname: Deal
authors.affiliation: 1 Department of Pharmacy, University of North Carolina Medical Center.|2 Eshelman School of Pharmacy, University of North Carolina.
authors.forename: Maurice D
authors.initials: MD
authors.lastname: Alexander
authors.affiliation: 1 Department of Pharmacy, University of North Carolina Medical Center.|2 Eshelman School of Pharmacy, University of North Carolina.
authors.forename: Meredith D
authors.initials: MD
authors.lastname: Keisler
authors.affiliation: 3 Lineberger Comprehensive Cancer Center, University of North Carolina.
authors.forename: Janell M
authors.initials: JM
authors.lastname: Markey
authors.affiliation: 4 School of Pharmacy, Virginia Commonwealth University.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Neal
authors.affiliation: 5 School of Medicine, University of North Carolina.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.affiliation: 1 Department of Pharmacy, University of North Carolina Medical Center.|2 Eshelman School of Pharmacy, University of North Carolina.|3 Lineberger Comprehensive Cancer Center, University of North Carolina.
authors.forename: John
authors.initials: J
authors.lastname: Valgus
authors.affiliation: 2 Eshelman School of Pharmacy, University of North Carolina.|6 Fullerton Genetics Center, Mission Health Systems.
authors.forename: Lynn G
authors.initials: LG
authors.lastname: Dressler
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D015179:Colorectal Neoplasms / Q000188:drug therapy; D004348:Drug Labeling; D005260:Female; D018565:Food-Drug Interactions; D006801:Humans; D033182:Intention; D007680:Kidney Neoplasms / Q000188:drug therapy; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy; D008297:Male; D055118:Medication Adherence; D008568:Memory; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents
keywords: Oral chemotherapy; adherence; compliance