Challenges with Adherence Highlight Unmet Needs
By Amir Goren, PhD, and Marco DiBonaventura, PhD
Cancer treatment is rapidly evolving with the emergence of highly effective, oral targeted therapies. Traditionally, patients with cancer have had to visit a hospital, clinic or physician’s office to receive treatment. Although oral chemotherapy has been around for 60 years, it only became a standard treatment option with the approval of capecitabine in 1998 for metastatic breast cancer and later for colorectal cancer.
Since that time, many oral-administered chemotherapies have been FDA approved and have become standards of care. Currently, it is estimated that a third of all new cancer treatments in development are oral formulations.
The availability of oral treatments has elevated the importance of adherence, since more responsibility falls upon patients to use the treatments appropriately. Restrictions regarding the timing of administration or combination use with other medications, food, or water provide many of the challenges associated with adherence, especially among patients considered at high risk for non-adherence (e.g., those with impaired cognitive abilities, or those with comorbid conditions requiring concomitant medications).
Using data from the 2012 U.S. National Health and Wellness Survey (NHWS), a cross-sectional, representative, self-administered survey of adults in the United States (n=103), we examined the prevalence and outcomes associated with real-world non-adherence from a patient perspective among three cancer patient populations where oral therapies are the standard of care: melanoma, non-small cell lung cancer (NSCLC), and leukemia.
Across the three tumor types, 65% of respondents reported some form of non-adherent behavior (i.e., 67 out of 103 respondents). Non-adherent behaviors were reported by:
71% of leukemia patients
65% of NSCLC patients
59% of melanoma patients
Non-adherence can be intentional, such as stopping medication when a patient feels better or stopping medication when a patient feel worse; or unintentional, such as forgetting to take medication or being careless when taking medication.
Non-adherent versus adherent patients in the three selected tumor types differed significantly in a couple of ways.
Non-adherent patients were younger than adherent patients (mean: 54.3 years old vs 62.3 years old)
Non-adherent patients were less likely to be unemployed (48% vs 78%)
Although not a significant difference, non-adherent patients were twice as likely to smoke cigarettes (28% vs 14%).