What Is Your Plan to Promote Adherence to Oral Anticancer Therapies?

As an increasing number of anticancer therapies are available in oral formulations, getting patients to adhere to their prescribed treatment is becoming a growing concern. Researchers with OSI Oncology and OSI Pharmaceuticals, which manufactures erlotinib (Tarceva), an oral drug prescribed for patients with lung cancer and pancreatic cancer, presented a study at the 35^th Oncology Nursing Society annual meeting that examines the issue of adherence to oral agents.

The authors note that adherence rates to oral therapies may be “as low as 20%.” Taking a multidisciplinary approach, the study focused on knowledge, process, and responsibilities of healthcare providers in ensuring medication adherence. They performed a comprehensive review of the literature and examined data from two online surveys sponsored by OSI Pharmaceuticals. The researchers determined there is a genuine need to identify processes for improving medication adherence but that several questions must first be answered, including who is ultimately responsible for educating patients on oral therapies.

A 2009 survey conducted by ONS Edge on behalf of OSI Pharmaceuticals received responses from 281 oncology nurses, the majority of who were affiliated with academic hospitals (37%) and outpatient clinics (37%). Others worked at community hospitals (10%), a group practice (13%), a private practice (16%), or an infusion center (6%). More than 80% said they had been oncology nurses for at least 7 years, and 50% worked with a group of at least 10 nurses. The responsibility for educating patients on oral treatments fell primarily to registered nurses according to 74% of respondents. Only 48% named physicians as the responsible party. Another 66% answered APRN/PA and 16% said pharmacists.

The nurses were asked how they check for medication adherence and were permitted to give more than one response. The overwhelming majority (n = 262) said they ask. Nearly equal numbers of nurses said they have their patients diary medication use (n = 69) or count their pills (n = 68).

In a survey by the Multinational Association of Supportive Care in Cancer (MASCC), 47% of the 1115 nurses surveyed acknowledged not having any education or specific instruction on oral anticancer therapies. The nurses felt there was a lack of evidence-based guidelines on this subject and said they had limited knowledge of dosing, administration, and metabolism of oral agents that their patients were taking. They also said their facilities lacked a standardized system for educating patients on therapy adherence and they lacked tools to improve patients’ compliance with therapy. The authors identified “a need for a clear process for oral therapy and follow-up.”

Combining data from the 2009 ONS Edge survey with one conducted in 2007, the authors found that nurses are overwhelmingly the medical professionals responsible for teaching patients. At the same time, some nurses identified other parties as being responsible for this task. Without a clear process, the authors said one discipline might assume another discipline is handling this function, resulting in the patient never receiving the necessary education.

There is a need “to establish shared provider/patient perception of treatment,” the researchers concluded. They suggested defining teaching tools and adopting procedures for documenting medication adherence. The need for an interdisciplinary approach to the problem was apparent, along with greater levels of communication among the various disciplines involved in patient care.

The study made several recommendations to help nurses do more to foster patient compliance. They suggested nurses familiarize themselves with the product information sheet and learn about possible dietary and drug interactions and drug metabolism and clearance. Nurses should evaluate patients’ readiness to learn, then establish a “plan of care” and follow-up appropriately with patients. It is important to “emphasize the significance of being adherent to the plan,” said the authors. Guidelines are needed on dose reduction and discontinuation they noted. Documenting a patient’s progress was also something they felt would improve adherence.

Practices need to identify the disciplines responsible for educating patients on oral chemotherapy compliance and managing follow-up for patients taking these drugs. Practices should consider developing clinical practice guidelines and educational tools for nurses and patients.

Obviously, adherence to prescribed therapy is likely to lead to better outcomes and poor adherence is likely to lead to poorer outcomes. The OSI researchers said, “Ensuring patient adherence to oral oncology agents is your ‘Call to Action,’” and the patient and provider will benefit from instituting measures to improve medication adherence.