Take All Your Medicine

Forty-two percent of disabled and elderly Medicare patients either reduce their drug doses or don’t fill their prescription at all because of cost, says a recent study published in the Archives of Internal Medicine. While there are no statistics specifically showing how many cancer patients may be reducing their oral medications to save money, the impact of noncompliance is starting to be seen in oncologists’ offices, and the results for patients could have dire consequences.

“In dealing with the older generation of intravenous [chemotherapy drugs], the doctor was totally in charge,” says George Demetri, MD, director of the Ludwig Center for Cancer Research at Dana-Farber Cancer Institute in Boston. “In the new world where we’re increasingly seeing expensive drugs being given to patients as pills, doctors aren’t so much in charge anymore. We depend on the patient to trust us and not be ashamed to share their concerns with us.”

While those concerns usually center on drug affordability, especially for elderly patients on fixed incomes, says Dr. Demetri, patients may also simply tire of taking medication on a regular basis and just stop taking it, not realizing the danger. Like other medications, cancer drugs only work at the prescribed dosage, so when patients skip their medicine or reduce the dosage, they dilute its potency, making the drug less effective. “We take it very seriously when tumors progress when we think a patient is taking the medicine. It’s very ominous because if the patient were taking the medicine, that would mean it isn’t working,” Dr. Demetri says.

Seeing this type of unexpected disease progression may cause physicians to make the wrong therapeutic decision, such as switching medication or recommending surgery to remove the tumors, which could have life-threatening results for the patient. “A doctor may say, ‘These tumors are getting bigger; let’s call in a surgeon to take them out,’ or worse case, the doctor may say this therapy isn’t working anymore, and recommend hospice care for the patient.”

As control of healthcare is placed more and more in the hands of the patient and out of sight of healthcare providers, it’s even more imperative that patients and doctors communicate with each other, says Dr. Demetri. “We have to recognize that this is a partnership with our patients and then make good on it.”

Dr. Demetri advises patients to talk to their doctor if the cost of medication is causing them to reduce prescription doses. Often cancer drugs are available for free through pharmaceutical patient assistance programs or Medicare drug programs (www.medicare.gov), and healthcare providers can help patients find the best program for them.