Many patients fail to properly take oral chemo, leading to complications

As the use of oral chemotherapy continues to rise, researchers from Michigan State University have discovered many patients fail to properly take the cancer-fighting medication, a significant clinical problem that can result in complications and premature death.

That lack of adherence needs to be addressed by the health care community, said College of Nursing researcher Barbara Given, who led the study that is published in the May edition of Seminars in Oncology Nursing.

"Given the increasing use of oral chemotherapy in treating cancer, patient adherence is critical to successful outcomes," said Given, associate dean for research for the college. "Health care providers need to monitor and facilitate adherence by identifying barriers and implementing strategies to overcome them."

During the past decade, the use of oral cancer-fighting medication is transforming how oncology care is delivered, Given said: About 10 percent of cancer chemotherapy is provided to patients orally, and the National Comprehensive Cancer Network predicts that by 2013, the rate will increase to 25 percent.

"This phenomenon shifts the care from a safe, controlled process in hospitals or clinics to patients' homes where adherence becomes the patient's and family's responsibility," she said.

While patients benefit by avoiding trips to clinics and hospitals, complex dosing regimens and side effects are challenging to manage – and poor adherence may lead to disease progression and premature death.

As part of the study, Given and her team identified the barriers that prevent optimal adherence, looking at factors ranging from age, race and gender to health literacy, social support, cost and how much communication there exists between health providers and patients.

Part of the overall problem, Given added, is that measuring and studying adherence to oral medications is difficult because patients are aware of being observed, and patients may adhere more than the average patient who is receiving the same therapy.

"Future research needs to develop better methods for measurement and intervention," she said. "We need to better understand what factors determine patients' adherence. Nurses play a crucial role in promoting adherence and will be key in adopting new treatment plans to help patients."

Given's research was funded by two grants from the Oncology Nursing Society Foundation.

The May edition of Seminars in Oncology Nursing, of which Given was a guest editor, focuses entirely on oral medications in treating cancer. Other MSU researchers with articles in the journal include Sandra Spoelstra, an assistant professor with the College of Nursing and a 2010 Ph.D. graduate, and Bill Given, a professor in the College of Human Medicine.

Spoelstra, also a co-author on Barbara Given's article on the challenges of taking oral chemotherapy, worked with Bill Given on papers focusing on how to best measure adherence to oral medications as well as the policy implications of such drugs.