About half of breast cancer patients have stopped regularly taking their adjuvant hormonal therapy after 5 years, said Dr Partridge, who specializes in cancer survivorship and breast cancer care. “If you don’t take your oral therapy correctly and as directed, it can lead to [increasingly] poor outcomes,” she says. “It can explain some of the disparities in outcomes for individuals and populations.”
Adolescents and young adults are particularly challenging when it comes to the topic of medication compliance, she noted. As in many other areas of their lives, it’s tough to get them to follow rules.
In other cases, she said, patients may think that taking a pill every other day is just as good as every day, at half the cost. Embarrassed to admit they’re financially strapped, they might not tell their doctor what they’re doing.
But even when prescriptions can be filled, some people still don’t take all their medicines as directed, Dr Partridge observed. For these individuals, the issue may be logistical, such as needing to get a babysitter or get off work to make it to the drugstore.
Edward Greeno, MD, chief of University of Minnesota Cancer Care and medical director of the school’s Masonic Cancer Clinic in Minneapolis, recalled one older patient whose arthritis kept her from opening her pill bottle. When her adult daughter was home, the woman took her medication, but when the daughter went out for the evening, the woman missed her pills — and either forgot to mention this in the clinic or was too embarrassed to disclose this information. Once Dr Greeno realized what was happening, he was able to step in and easily address the problem.
Possible Adherence Solutions
Technology offers the potential for solving many of these problems, Dr Greeno and others suggested.
Dr Greeno is testing a pill, made by Proteus Digital Health, that can detect when it is swallowed, a patient’s heart rate, and that individual’s activity level, which can provide clues that a patient isn’t feeling well. The patient wears a patch with sensors that detect when the pill gets wet in the stomach, communicates with an app on a patient’s device and, if they missed a pill, asks why. Data is uploaded so the caregiver can see it, too.
At the moment, the cancer drug has to be manually inserted into the pill by a specialty pharmacist, but if it wins approval from the US Food and Drug Administration, that process will likely be simplified, according to Dr Greeno.
“The nice thing about this technology is it actually lets us see what patients are doing,” said Dr Greeno, noting that most medication safety measures are directed at delivering therapies in hospitals, not in homes.
He said patients in the trial for the digital pill have been very open to the technology, and appeared unconcerned that it requires them to give up some privacy. For the most part, he said, “The patients we’ve [treated] so far have been grateful.”
Dr Greeno is also hoping to spread this kind of “smart pill” technology to other types of drugs — such as anti-diarrheals, which are taken as-needed — so caregivers will learn if a patient’s suffering is increasing. If they’re taking more of these types of medicines, Dr Greeno reasoned, “maybe I need to get them into clinic to evaluate how they’re doing and intervene before they end up in the emergency room.”
High-tech pills and pill bottles that encourage patient compliance are great in theory, but many remain too expensive for routine use, said Jessica Zerillo, MD, director of quality at the Cancer Center at Beth Israel Deaconess Medical Center in Boston, Massachusetts. They also don’t tell doctors why a patient isn’t adhering to their prescription.