Medication Adherence – Critical in Breast Cancer Treatment
By Dr. Batami Sadan
The Problems with Non-adherence to Medication
Non-adherence (also known as non-compliance) to medication regimen may affect the patient’s quality of life, cause poor health outcomes, further complications, health deterioration, untimely death, as well as financial cost1. Non-adherence is said to be intentional when the patient decides not to take the prescribed medication, often due to adverse side effects or when the treatment outcomes are not clear, poor or take a long time. Non-intentional adherence may result from forgetting to take the medication, misunderstanding the instructions, e.g. of the drug schedule or the importance of taking medication on time and for the full duration.
Non-adherence in breast cancer treatment
Non adherence in the treatment of a chronic disease, especially cancer, may have adverse clinical consequences.
Medication non adherence in patients with cancer is becoming a concern due to the increasing availability of new oral agents. In one research2 among women diagnosed with metastatic breast cancer, the most important attributes of treatments were related to effectiveness, followed by side effects. Cost related attributes were the least important.
A total of 34.8% of survey participants either discontinued their treatment or were non adherent to their treatment regimen. Forgetfulness (41.3%) and intolerance of side effects (36.5%) were the most common reasons for nonadherence. Although it is more convenient, women receiving oral chemotherapy were more likely to have significant decline in their health status. Also, among patients who ever used oral chemotherapy and those currently using oral chemotherapy, the number of non-adherent behaviors was significantly associated with a decrease in functional well-being.
In addition, non-adherence may be incorrectly attributed by clinicians as worsening condition to the lack of drug activity.
Non adherence has also been associated with an increase in physician visits, higher hospitalization rates and longer hospital stay. Also, in a setting of a formal clinical trial, non-adherence can lead to misleading results.
How can treatment improve?
Patients should be aware of the fact that taking their medications on time and for the full duration is essential to getting the full benefit of the treatment. Involving cancer patients in all aspects of decision making process has been shown to increase their motivation and adherence. Most important is the role of physicians in improving patient adherence. It requires patient-physician ongoing communication, including patient education, developing tailored made treatment regimen, regularly scheduled meeting, adherence monitoring and follow up to evaluate patients’ responses to therapy all of which may help to identify adherence issues and the resulting effect on outcomes. It also requires clinicians to listen to the patient’s needs, concerns, complaints, preferences and wishes. Poor communication between the patient and her physician with regards to the medication regimen, side effects and new possible treatments, particularly complex regimens with new side effects, may also explain the patient’s high non-adherence.
Empowering patients by using health knowledge information websites, social media and online patient networks, getting new information, comparison of patient population compliance, survival rate, etc., could encourage patients to better comply with treatment recommendations. In adition to patient education, one can find self monitoring programs, nurse visits, and telephone followups, that have shown variable effectiveness in reducing medication non adherence. However, many of these interventions are resource intensive. Tools like electronic pill dispensers may overcome those troublesome aspects and promote efficient and low cost improvement in adherence.
 Kerry L. Reynolds, et al. Endocrine Therapy for Breast Cancer: A Tough Pill to Swallow. Menopause. 2013;20 (7):714716.
 daCosta DiBonavantura, at al. Patient Preferences and Treatment Adherence among Women Diagnosed with Metastatic Breast Cancer. American Health & Drug Benefits. Oct 2014, Vol. 7 Issue 7, p386-395
 Kyle D. Checchi et al. Electronic medication packaging devices and medication adherence: A systematic review. JAMA 2014 sep 24:312(12);1237-1247