“I think technology can be powerful to help address some of the issues, but I think you can’t have a [technological] [solution] that fixes everything,” Dr Zerillo said. “We also have to have processes in place to manage [the] data from the technology.”

In a January 2018 review in JAMA Oncology, Dr Zerillo and her colleagues showed that telephone-based monitoring by a nurse or pharmacist three days after patients start their oral chemotherapy reduces the toxic effects of the drugs.1 “There are data that suggest that electronic outreach and connections to patients while they’re at home could have a great impact,” she said.

Dr Tripathy agreed. “Interacting with the patient from afar, or even sending a text message where the patient can respond, ‘Yes,’ ‘No,’ or ‘I’m having trouble,’ or ‘I’d like to talk’ — these things can enhance what we’re doing now.”


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But there’s not yet enough research on the most effective ways to influence patient behaviors more broadly, Dr Partridge said. Probably the best solution will be to use multiple approaches and tailor them to each patient’s needs, she added. A patient aged 85 years who struggles to remember to take their pills and to open the pill bottle will need a different solution than a teenager who just wants to lead a normal life.

And there will always be patients who intentionally mislead doctors about whether they’re taking their medication.

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But taking a medication is also an adult patient’s choice to make, Dr Tripathy said. In some women on hormonal therapy for breast cancer, for instance, taking medication might reduce their recurrence risk from an already-low 5% to a little more than 2%. If patients are suffering from debilitating side effects that Dr Tripathy is sure are related to treatment with the drug, he said he thinks it’s reasonable for patients to decide to stop therapy.

“I think it’s very important early on to establish the kind of relationship with the patient where they trust that you will listen and be sympathetic to their concerns — that you won’t just wave it off and say, ‘nope you’ve got to take it for 5 years; too bad.’”

Patients who are informed about risks and who actively decide to take a medication may be more likely to stick with a regimen for longer than those who were simply instructed that they should comply with the program, said Dr Partridge, who is currently investigating the validity of this hypothesis.

Partridge believes another way to reduce the problem of noncompliance is by improving therapies so that they’ll cause fewer side effects. For instance, she’s currently researching new medications for menopausal symptoms such as hot flashes, and strategies like exercise that individuals can employ to better cope with the weight gain that can appear as a result of hormonal treatments.

She’s also applying for a grant that would allow her to provide a real-time coaching tool to help patients manage cancer-related symptoms like fatigue, hot flashes, and the emotional challenges of survivorship. “If you’re getting trusted information in real time, you may be more likely to try it,” she said.

And the most basic steps may be the most effective. Dr Tripathy said that he unearths many problems with drug adherence simply by getting his patients to trust him and talk to him.

“Sometimes it involves talking to our patients and listening to our patients,” he added. “It’s as simple as that.”

Reference

  1. Zerillo JA, Goldenberg BA, Kotesh RR, Tewari AK, Jacobson JO, Krzyzanowska MK. Interventions to improve oral chemotherapy safety and quality: a systematic review. JAMA Oncol. 2018;4(1):105–117.