by Sandra L. Spoelstra, Michigan State University College of Nursing, East Lansing, United States.
Patients with cancer miss as much as one third of the prescribed doses of oral anti-cancer agents required for treatment of their disease. Even more disconcerting is that within the next three years, 25% of cancer treatment will be delivered in pill form. This shift in the treatment paradigm will result in increased care in the home, placing greater responsibility on patients. Barriers to oral agent adherence for patients include no or limited coverage for the medication, complex dosing regimens, difficulty obtaining the prescription, running out of the prescription, forgetting to take the pills, skipping or stopping because they believed the medication was not working or because it created symptoms from side effects, and not seeking help from others. Often, the more adherent patients are to oral chemotherapy agents, the more likely they are to experience symptoms. Patients prescribed oral agents have indicated titrating doses as they were unable to tolerate symptoms occurring as a side effect of the cancer treatment. Thus, prompt and aggressive management of symptoms becomes vital to managing adherence at home. Furthermore, pharmacy literature suggests a narrow therapeutic index for cancer therapy, increasing the importance of oral agent adherence, as non-adherence may affect time to disease progression and mortality. The therapeutic outcome for patients taking oral agents depends heavily on the ability of patients to adhere to the prescribed regimen. Healthcare research has not conclusively identified effective interventions to promote medication adherence. Chemotherapy classes are a common part of care for patients receiving IV treatment. However, training for patients on oral agents is underdeveloped, and needs to include adherence, monitoring and reporting of symptoms from side effects and toxicities, coordination of changes in dosing if altered or stopped, and management of insurance coverage and drug delivery. Oncology nurses must take the lead in structuring care settings that promote patient behavior to attain optimal adherence. Oncology nurses can help patients and their families understand what they are responsible for in many ways. The number of cancer patients who receive oral agents in pill form is increasing, and oncology nurses can lead the way enabling patients to adhere to and complete their cancer treatment.
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