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%).
Challenges with Adherence Highlight Unmet Needs
in Oncology (continued)
Non-adherence can have a large negative effect not only on patients’ physical and mental well-being, but on the healthcare system at large. Physical and mental health statuses, as well as overall quality of life, for patients in the treatment groups were derived from the validated questionnaire, SF-36v2. The oral therapy patients’ mean physical health status score was 38.8 versus 50.3 for the total U.S. adult population. However, a statistically significant difference in mental health status was observed in the three cancer patient populations depending on whether they were adherent to treatment regimens. The average U.S. adult has a mental health status score of 48.4; among the leukemia, melanoma, and NSCLC patients surveyed, that score was 49.5 for patients who were 100% adherent to their treatment versus 44.4 among patients who engaged in some sort of non-adherent behavior.
Beyond the potential impact of non-adherence on patients’ mental health status, there are potential societal implications as well, in terms of increased healthcare resource use. The NHWS data showed that leukemia, melanoma, and NSCLC patients tended to be hospitalized or visit emergency rooms more often if they were non-adherent, although these differences did not reach statistical significance, perhaps due to the small sample sizes involved. The non-adherent cancer patients reported an average of 1.18 visits to the ER and were hospitalized 0.97 times over the preceding months, compared with 0.25 ER visits and 0.42 hospitalizations for 100% adherent patients.
Because the data revealed a significant level of non-adherence among the respondent groups, an emphasis needs to be placed on improving adherence rates to maximize treatment benefit and reduce societal costs. As more oral therapies enter the market and uptake increases, adherence will become an increasingly important topic in this therapeutic area.
About the Contributors
Amir Goren, Ph.D., is Manager, Health Economics and Outcomes Research, Kantar Health; and Marco DiBonaventura, Ph.D., is Vice President, Health Outcomes, Kantar Health. Kantar Health is a leading global healthcare consulting firm and trusted advisor to many of the world’s leading pharmaceutical, biotech, and medical device and diagnostic companies. It combines evidence-based research capabilities with deep scientific, therapeutic and clinical knowledge, commercial development know-how, and brand and marketing expertise to help clients evaluate opportunities, launch products and maintain brand and market leadership.
The study’s results were drawn from the 2012 U.S. National Health and Wellness Survey (NHWS), a nationally representative, self-administered survey conducted annually. Topics covered include the health status, attitudes, behaviors and outcomes among adults 18 or older. Kantar Health conducts the NHWS in the U.S., Europe, Asia and Latin America. The survey is the largest self-reported dataset in the healthcare industry.
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