Why Might Patients Skip Their Cancer Treatments, and How Can We Improve Compliance?

IN THIS SPECIAL ISSUE OF CURE® magazine, we ask the question: Why is medication adherence an issue for drugs that can prolong the lives of people with cancer, and even potentially cure them of disease?

It seems counterintuitive that anyone would avoid something that may save or prolong their life. The most qualified people to answer this are patients with cancer, and they have shared many valuable insights with oncologists and medical researchers over the years. Still, scientists are looking for more answers, with the aim of helping patients make the decisions most likely to lead them to good health.

Nonadherence may occur for a variety of a reasons. For some patients, it may be a result of fear, toxicities or the cost of anticancer drugs. Or it may even be a form of denial. While skipping an oral chemotherapy pill here and there to save some money or not showing up to every outpatient chemotherapy session may seem like minor acts of noncompliance, they actually can have dire consequences on a patient’s health.

Studies looking at nonadherence to specific treatments have shown that it can affect long-term outcomes. For example, a 2014 study published in the American Journal of Hematology found that patients with chronic myeloid leukemia who were prescribed the targeted drug Gleevec (imatinib) but did not take it consistently were less likely to achieve the full benefits of the therapy. Another study found that breast cancer survivors who discontinued their adjuvant hormonal therapy early, compared to those who finished the entire course, experienced lower survival rates at 10 years.

As the number of oral medications that are taken at home continues to increase and the effectiveness of these medications rises, we will see this problem of nonadherence grow.

There are several strategies that can be implemented at home by patients to stick to a medication schedule. Among these are to ask a family member or friend to send a reminder phone call or text message, use an alarm to remind yourself or simply write it down on a calendar. There are even electronic pill boxes that can remind you, track your compliance and keep your doctor’s office in the loop.

Physicians, nurses and pharmacists can also play important roles. If you experience uncomfortable side effects, tell them. They may know some way to alleviate the side effects that does not involve stopping the anticancer medication altogether. These professionals may also offer you reminder phone calls or education about your treatment, ultimately helping you stick to your regimen. Such strategies have worked well within The Oncology Specialty Pharmacy Program, which is part of the University of California Davis Comprehensive Cancer Center. The program works closely with patients to inform them about their medications, make sure they never run out of the drugs they need and answer questions about side effects. Started as a pilot program in 2013, it now helps hundreds of patients comply with their treatments.

It is most important to note that patients should never be afraid to tell the truth about any concerns they may have, especially when it comes to side effects. Open communication with physicians, nurses or pharmacists is key in all cases.

A goal of this special issue is to help you identify any challenges you are experiencing that are making it difficult for you to comply with your medical regimen, from scheduling problems to side effects to financial stress. And, of course, we hope that the guidance offered here will help you resolve those issues so that you can move forward with your treatment unhindered, and with the best chance of success.

DEBU TRIPATHY, MDEditor-in-ChiefProfessor of MedicineChair, Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer Center