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Exploring the factors influencing adherence to oral anticancer drugs in patients with digestive cancer: a qualitative study.

ABSTRACT:

Purpose

The aim of this study was to explore the beliefs, perceptions and representations of patients in order to identify the determinants of oral anticancer drugs adherence and to take action in current practice to improve patient support in digestive oncology.

Methods

We constructed a semi-directed interview guide which aimed to explore the patient's relationship with medication, their health history, their experiences at the time of the announcement of treatment, their confidence, their fears, their motivations to adhere to their treatment and the constraints linked to their treatment. The data were analysed and discussed using a thematic approach.

Results

Seventeen patients agreed to participate in the study. The median age was 60 years. Ten patients had colorectal cancer, 3 patients had hepatocellular carcinoma, 3 patients had gastrointestinal stromal tumour and 1 patient had neuroendocrine pancreatic tumour. We identified five categories of factors influencing adherence: demographic and socioeconomic, disease-related, treatment-related, care system-related, and patient representation and pathways' factors. A majority of patients emphasised the importance of family support in the adherence process and the convenience of per os treatment compared to other intravenous treatments. However, several negative determinants emerged such as the toxicity of the treatment, fears of forgetting to take the medication, difficulties with the galenic formulation and negative beliefs of the family.

Conclusion

This study demonstrates the need to address the different dimensions of the patient in order to understand his or her behaviour with regard to adherence and to identify the levers for improvement.

SUBMITTER: Nizet P

PROVIDER: S-EPMC8794904 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundAdherence is a crucial point for the successful treatment of a hepatitis-C virus infection. Studies have shown that especially adherence to ribavirin is important.The objective of this systematic review was to identify factors that influence adherence in hepatitis-C infected patients taking regimes that containing ribavirin.MethodsA systematic literature search was performed in Medline and Embase in March 2014 without limits for publication date. Titles and abstracts and in case of relevance, full-texts were screened according to predefined inclusion criteria. The risk of bias was assessed. Both process steps were carried out independently by two reviewers. Relevant data on study characteristics and results were extracted in standardized tables by one reviewer and checked by a second. Data were synthesized in a narrative way using a standardized procedure.ResultsNine relevant studies were identified. The number of analyzed patients ranged between 12 and 5706 patients. The study quality was moderate. Especially the risk of bias regarding the measurement of influencing factors was mostly unclear."Psychiatric disorders" (N?=?5) and having to take "higher doses of ribavirin" (N?=?3) showed a negative influence on adherence. In contrast, a "HIV co-infection" (N?=?2) and the "hemoglobin level" (N?=?2) were associated with a positive influence on adherence. Furthermore, there is the tendency that male patients are more adherent than female patients (N?=?6). "Alcohol consumption" (N?=?2), "education", "employment status", "ethnic group","hepatitis-C virus RNA" (N?=?4), "genotype" (N?=?5), "metavir activity" (N?=?1) and "weight" (N?=?3) showed mostly no effect on adherence. Although, some studies showed statistically significant results for "age", "drug use" , "genotype", "medication dose interferon", and "treatment experience" the effect is unclear because effect directions were partly conflicting.The other factors were heterogeneous regarding the effect direction and/or statistical significance.ConclusionThere are some factors that seem to show an influence on adherence. However, due to the heterogeneity (e.g. patient characteristics, regimes, settings, countries) no general conclusions can be made. The results should rather be considered as indications for factors that can have an influence on adherence in hepatitis-C infected patients taking regimes that containing ribavirin.