It seems like a reasonable assumption that anyone with a life-threatening illness would reliably take their medications for that ailment. And yet, people with cancer are no better at staying adherent to their prescriptions than those with heart disease or other serious illnesses — with anywhere from 20% to 80% of patients with cancer improperly taking their medications, or avoiding them altogether, according to Ann Partridge, MD, MPH, who is an oncologist at the Dana-Farber Cancer Institute and a professor at Harvard University in Boston, Massachusetts.
There are many reasons patients skip medications — from psychological to physical, to toxic costs or toxic side effects. “How people feel about their drugs, their health beliefs, the potential side effects, the cost, the logistics, the fear of the disease — it’s all these trade-offs people make — either consciously or unconsciously — about taking their medicine,” Dr Partridge told Cancer Therapy Advisor.
The problem is growing as more and more drugs are delivered orally and taken at home, rather than infused in the hospital setting, where a nurse and a pharmacist would check that the patient is getting the right medication and dosage.
Today, about half of the drugs used to treat breast cancer are oral therapies that patients take at home, estimates Debasish (Debu) Tripathy, MD, professor and chair of the department of breast medical oncology at The University of Texas MD Anderson Cancer Center in Houston.
“The number of drugs that are given by IV is still much larger than [the number of] oral drugs,” he said, “But when you multiply it by the number of people who are on [oral] drugs, like hormonal therapy for breast cancer, it’s millions of patients as opposed to thousands [who] are on the IV drug.”
This is great for patients who may have to spend less time getting hours-long infusions, but also puts more burden on them to ensure they’ve been given the proper medication and that they take it as prescribed. And, the doctor and health care system must communicate well enough with the patient to identify and help solve problems with compliance, Dr Tripathy said.
So, Drs Partridge, Tripathy, and others are trying to develop creative ways to get patients to take medications appropriately — in some cases, through the use of technology, in others, by relying on good, old-fashioned medical care. Sometimes, clinicians harness a combination of both approaches.
From patient surveys, Dr Tripathy said he thinks that about one-quarter to one-third of noncompliance is due to medication cost or resource issues, such as not having easy access to a drugstore; one-third is due to side effects of the medications; and one-third is due to forgetfulness.
The issues may also be different depending on whether a patient is in an acute stage of disease, has just been diagnosed, or has already been coping with a chronic illness for an extended period of time.
Dana-Farber, for instance, provides education to every patient who takes home chemotherapy drugs, making sure they understand how much to take, that taking more than what has been prescribed isn’t a good idea, and how to properly dispose of any unused medication, said Dr Partridge. But “when the casseroles go away,” as Dr Partridge put it, it becomes more difficult for a patient to stick with a medication that may cause side effects. Remaining adherent to therapy may also serve as a daily — and unwelcome — reminder to patients of their illness.