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Masiero M, Spada GE, Sanchini V, Munzone E, Pietrobon R, Teixeira L, Valencia M, Machiavelli A, Fragale E, Pezzolato M, Pravettoni G. A Machine Learning Model to Predict Patients' Adherence Behavior and a Decision Support System for Patients With Metastatic Breast Cancer: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48852. [PMID: 38096002 PMCID: PMC10755656 DOI: 10.2196/48852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Adherence to oral anticancer treatments is critical in the disease trajectory of patients with breast cancer. Given the impact of nonadherence on clinical outcomes and the associated economic burden for the health care system, finding ways to increase treatment adherence is particularly relevant. OBJECTIVE The primary end point is to evaluate the effectiveness of a decision support system (DSS) and a machine learning web application in promoting adherence to oral anticancer treatments among patients with metastatic breast cancer. The secondary end point is to collect a set of new physical, psychological, social, behavioral, and quality of life predictive variables that could be used to refine the preliminary version of the machine learning model to predict patients' adherence behavior. METHODS This prospective, randomized controlled study is nested in a large-scale international project named "Enhancing therapy adherence among metastatic breast cancer patients" (Pfizer 65080791), aimed to develop a predictive model of nonadherence and associated DSS and guidelines to foster patients' engagement and therapy adherence. A web-based DSS named TREAT (treatment adherence support) was developed using a patient-driven approach, with 4 sections, that is, Section A: Metastatic Breast Cancer; Section B: Adherence to Cancer Therapies; Section C: Promoting Adherence; and Section D: My Adherence Diary. Moreover, a machine learning-based web application was developed to predict patients' risk factors of adherence to anticancer treatment, specifically pertaining to physical status and comorbid conditions, as well as short and long-term side effects. Overall, 100 patients consecutively admitted at the European Institute of Oncology (IEO) at the Division of Medical Senology will be enrolled; 50 patients with metastatic breast cancer will be exposed to the DSS and machine learning web application for 3 months (experimental group), and 50 patients will not be exposed to the intervention (control group). Each participant will fill a weekly medication diary and a set of standardized self-reports evaluating psychological and quality of life variables (Adherence Attitude Inventory, Beck Depression Inventory-II, Brief Pain Inventory, 13-item Sense of Coherence scale, Brief Italian version of Cancer Behavior Inventory, European Organization for Research and Treatment of Cancer Quality of Life 23-item Breast Cancer-specific Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 8-item Morisky Medication Adherence Scale, State-Trait Anxiety Inventory forms I and II, Big Five Inventory, and visual analogue scales evaluating risk perception). The 3 assessment time points are T0 (baseline), T1 (1 month), T2 (2 months), and T3 (3 months). This study was approved by the IEO ethics committee (R1786/22-IEO 1907). RESULTS The recruitment process started in May 2023 and is expected to conclude on December 2023. CONCLUSIONS The contribution of machine learning techniques through risk-predictive models integrated into DSS will enable medication adherence by patients with cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT06161181; https://clinicaltrials.gov/study/NCT06161181. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48852.
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Affiliation(s)
- Marianna Masiero
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gea Elena Spada
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Virginia Sanchini
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | | | | | - Elisa Fragale
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Massimo Pezzolato
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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Murphy CC, Fullington HM, Gerber DE, Bowman IA, Puligandla M, Dutcher JP, DiPaola RS, Haas NB. Adherence to oral therapies among patients with renal cell carcinoma: Post hoc analysis of the ECOG-ACRIN E2805 trial. Cancer Med 2021; 10:5917-5924. [PMID: 34405965 PMCID: PMC8419781 DOI: 10.1002/cam4.4140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND As use of oral cancer therapies increases, patient adherence has become critical when evaluating the effectiveness of therapy. In a phase III trial for renal cell carcinoma, we: (a) characterized adherence to sorafenib, sunitinib, and/or placebo and (b) identified factors associated with non-adherence. METHODS ECOG-ACRIN E2805 was a double-blind, placebo-controlled, randomized trial comparing adjuvant sorafenib or sunitinib in patients with resected primary renal cell carcinoma at high risk for recurrence. We used patient-completed pill diaries to measure adherence as the number of pills taken divided by the number of pills prescribed. Log-binomial regression was used to identify correlates of non-adherence (<80% of prescribed pills reported as taken). RESULTS Mean adherence was 90.7% among those assigned to sunitinib (n = 613) and 84.8% among those assigned to sorafenib (n = 616). Among those assigned to placebo, mean adherence was 94.9% and 92.4% to sunitinib and sorafenib placebo, respectively. Non-adherence was associated with race/ethnicity (non-Hispanic Black: prevalence ratio [PR] 2.22, 95% CI 1.63, 3.01; Hispanic: PR 1.54, 95% CI 1.05, 2.26), high volume enrollment (≥10 patients: PR 1.30, 95% CI 1.03, 1.64), treatment group (sunitinib: PR 2.24, 95% CI 1.66, 3.02; sorafenib: PR 2.37, 95% CI 1.74, 3.22), and skin rash (PR 1.36, 95% CI 1.03, 1.80). CONCLUSION Among patients participating in a randomized clinical trial, adherence to oral cancer therapies was lower compared to placebo. Adherence was also worse in racial/ethnic minorities, those experiencing toxicities, and high volume enrolling sites. Our findings highlight several challenges to address in clinical practice as use of oral therapies continues to increase. CLINICAL TRIAL REGISTRATION NUMBER This trial is registered with ClinicalTrials.gov, number NCT00326898.
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Affiliation(s)
- Caitlin C Murphy
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Hannah M Fullington
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David E Gerber
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Maneka Puligandla
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Naomi B Haas
- Division of Hematology-Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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ATF3-Induced Mammary Tumors Exhibit Molecular Features of Human Basal-Like Breast Cancer. Int J Mol Sci 2021; 22:ijms22052353. [PMID: 33652981 PMCID: PMC7956570 DOI: 10.3390/ijms22052353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 12/30/2022] Open
Abstract
Basal-like breast cancer (BLBC) is an aggressive and deadly subtype of human breast cancer that is highly metastatic, displays stem-cell like features, and has limited treatment options. Therefore, developing and characterizing preclinical mouse models with tumors that resemble BLBC is important for human therapeutic development. ATF3 is a potent oncogene that is aberrantly expressed in most human breast cancers. In the BK5.ATF3 mouse model, overexpression of ATF3 in the basal epithelial cells of the mammary gland produces tumors that are characterized by activation of the Wnt/β-catenin signaling pathway. Here, we used RNA-Seq and microRNA (miRNA) microarrays to better define the molecular features of BK5.ATF3-derived mammary tumors. These analyses showed that these tumors share many characteristics of human BLBC including reduced expression of Rb1, Esr1, and Pgr and increased expression of Erbb2, Egfr, and the genes encoding keratins 5, 6, and 17. An analysis of miRNA expression revealed reduced levels of Mir145 and Mir143, leading to the upregulation of their target genes including both the pluripotency factors Klf4 and Sox2 as well as the cancer stem-cell-related gene Kras. Finally, we show through knock-down experiments that ATF3 may directly modulate MIR145/143 expression. Taken together, our results indicate that the ATF3 mouse mammary tumor model could provide a powerful model to define the molecular mechanisms leading to BLBC, identify the factors that contribute to its aggressiveness, and, ultimately, discover specific genes and gene networks for therapeutic targeting.
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Santoleri F, Romagnoli A, Costantini A. Real-life adherence in capecitabine therapy using two analysis methods and persistence after 6 months of treatment. J Oncol Pharm Pract 2020; 27:1112-1118. [PMID: 32799777 DOI: 10.1177/1078155220949634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Medication adherence in the field of Oncology is crucial in therapy management and can influence the probability of achieving and maintaining efficacy over time. We conducted a cross-sectional study to evaluate adherence and persistence to oral therapy with Capecitabine, using two different calculation methods: therapy diary and indirect prescription refilling patterns. The main objective of the study was to compare the two methods of analysis and to propose a reliable adherence datum, yielded by the application of two complementary methodologies. We consequently set out to verify if data collected from therapy diaries can be superimposed to those gathered from prescription refilling patterns. Furthermore, we included data on patient-perceived quality in relation to Capecitabine therapy, as well as adverse reactions and their duration. Of 594 patients who used the study drug as of January 1, 2012, 45 completed their therapy diary. Adherence to treatment was 0.93 ± 0.10 and 0.84 ± 0.15, calculated using therapy diaries and pharmacy refill data, respectively. In terms of persistence, 53% of patients continued with treatment after six months of therapy. On a 1 to 5 scale, perceived quality was 3.31. In conclusion, when it comes to calculating adherence, it is important to preserve the objectivity of the method, which must be unencumbered by any conditioning. Regardless of the method, also considering what has already been discussed in the available literature, adherence in patients under treatment with Capecitabine, unlike persistence, is good.
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Komatsu H, Yagasaki K, Yamaguchi T, Mori A, Kawano H, Minamoto N, Honma O, Tamura K. Effects of a nurse-led medication self-management programme in women with oral treatments for metastatic breast cancer: A mixed-method randomised controlled trial. Eur J Oncol Nurs 2020; 47:101780. [DOI: 10.1016/j.ejon.2020.101780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/14/2020] [Accepted: 06/04/2020] [Indexed: 01/28/2023]
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Nguyen BKH, Wu BS, Sanoff HK, Lafata JE. Patient-Oncologist Communication Regarding Oral Chemotherapy During Routine Office Visits. JCO Oncol Pract 2020; 16:e660-e667. [PMID: 32119593 PMCID: PMC7427422 DOI: 10.1200/jop.19.00550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although studies in other clinical areas have shown that patient-clinician communication can positively influence adherence to medications, little is known about how oncologists address medication counseling during routine office visits. We describe patient-oncologist office-based discussions of oral chemotherapy treatment. METHODS Transcripts of 24 patient-oncologist office visits were obtained from a national database. Patients were aged ≥ 19 years and prescribed capecitabine for colorectal cancer. We developed a structured coding worksheet using medication-counseling concepts previously identified as important to medication adherence and a grounded approach. Two coders reviewed transcripts for oncologists' provision of medication information, assessment of patients' adherence to medication, and the provision of self-management support for management of adverse effects. We assessed interrater reliability with Cohen κ statistics. We describe the counseling concepts present within patient-oncologist conversations and present illustrative quotes to describe how they were discussed. RESULTS Oncologists generally provided patients who had yet to initiate therapy comprehensive medication information; those in the midst of treatment received less information. Oncologists discussed patients' continued use of the medication (or discontinuation) among all patients who had initiated therapy (N = 18). How the patient was taking the medication (ie, therapy implementation) was less commonly discussed. Medication adverse effects were also discussed in all encounters. Self-management strategies were commonly provided, albeit mostly in response to a presenting symptom and not preemptively. Patients' use of concurrent medications, financial access to therapy, and assessments of logistical arrangements were discussed more sporadically. CONCLUSION Using audio recordings from a national sample of patient-oncologist office visits, we identified several potentially important opportunities to enhance medication counseling among patients prescribed capecitabine for the treatment of colorectal cancer.
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Affiliation(s)
- Bobbie K H Nguyen
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Benjamin S Wu
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hanna K Sanoff
- UNC Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.,UNC Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Dhellemmes A, Delmas S, Sordes F. [Therapeutic education of patients taking oral chemotherapy at home]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2018; 63:21-25. [PMID: 30551748 DOI: 10.1016/j.soin.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Oral cancer drugs make the patient more active and autonomous. They reduce the number of hospital appointments and the risk of infection. However, they result in new problems such as the management of side effects. In this context, therapeutic education is essential. The first French therapeutic education programme for patients taking oral cancer drugs at home has been set up.
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Affiliation(s)
- Alice Dhellemmes
- Laboratoire CERPPS, Pôle 3 : Psychologie de la santé, université de Toulouse, 5, allée Antonio-Machado, 31058 Toulouse cedex 9, France.
| | - Sylvie Delmas
- Service Hospitalisation à domicile, clinique Pasteur, 45, avenue de Lombez, 31076 Toulouse cedex 3, France
| | - Florence Sordes
- Laboratoire CERPPS, Pôle 3 : Psychologie de la santé, université de Toulouse, 5, allée Antonio-Machado, 31058 Toulouse cedex 9, France
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Over-adherence to capecitabine: a potential safety issue in breast and colorectal cancer patients. Cancer Chemother Pharmacol 2018; 82:319-327. [PMID: 29948022 DOI: 10.1007/s00280-018-3612-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of the OCTO clinical study was to measure patients' adherence to capecitabine-based treatment. METHODS A cohort of ambulatory patients treated with capecitabine monotherapy for either locally advanced or metastatic, breast or colorectal cancer was monitored for 6 cycles. Adherence was assessed in all patients by self-completed questionnaires on disease, pill-count and pharmacological dosage of FBAL (metabolite of capecitabine); and in half of the cohort by electronic medication event monitoring systems (MEMS™) recording the opening times of the device. RESULTS Forty patients were enrolled between November 2008 and September 2011 and treated by capecitabine for an average of 4.75 cycles (range 1-6). Hand-foot syndrome (HFS) was the most frequently reported toxicity (35% patients), and to a lesser extent fatigue and/or asthenia (21%), nausea and/or vomiting (13%) and diarrhea (11%). In the MEMS™ cohort, 20 patients were included. Patients' adherence was excellent with very few missing occasions (23/2272 records). Close analysis of MEMS™ data revealed unexpected medication patterns, such as patients taking extra days of medication beyond planned cycle, patients taking extra doses per day and patients missing a day of dosing and "compensating" by taking extra the following day (N = 7, 18%). A trend was found between over-adherence and high-grade toxicity (grades 3 and/or 4): OR 4.74 [0.65-45.2], p = 0.13 and higher AUC (p = 0.16). There was a trend towards increased AUC of FBAL in over-adherent patients (p = 0.16). CONCLUSION Adherence to oral anticancer chemotherapy was found excellent in this population suggesting over-adherence to capecitabine and potential safety implications for outpatients' drugs.
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Hefner J, Berberich S, Lanvers E, Sanning M, Steimer AK, Kunzmann V. Patient-doctor relationship and adherence to capecitabine in outpatients of a German comprehensive cancer center. Patient Prefer Adherence 2018; 12:1875-1887. [PMID: 30288028 PMCID: PMC6159803 DOI: 10.2147/ppa.s169354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The prescribing of oral chemotherapy agents has introduced the new challenge of ensuring patients' adherence to therapy. Aspects of a close patient-doctor relationship are reported to be correlated with adherence to oral anticancer drugs, but data on capecitabine are scarce. PATIENTS AND METHODS Sixty-four outpatients with a diagnosis of cancer and prescribed capecitabine were recruited from a German Comprehensive Cancer Center. We used the Patient-Doctor Relationship Questionnaire (PDRQ-9), the Medical Adherence Rating Scale (MARS), the Beliefs about Medicines Questionnaire (BMQ), and the Satisfaction with Information about Medicines Scale (SIMS) to assess patients' perceptions and behavior. Medical data were extracted from the charts. RESULTS Non-adherence was reported by 20% of the 64 participants. The perceived quality of the patient-doctor relationship was high in general, but it did not emerge as a predictor of adherence in our survey (odds ratio [OR]=0.915, P=0.162, 95% CI=0.808-1.036). However, beliefs about medicine (OR=1.268, P<0.002; 95% CI=1.090-1.475) as well as satisfaction with information about medicine (OR=1.252, P<0.040, 95% CI=1.010-1.551) were predictors of adherence and the quality of the patient-doctor relationship was correlated with both variables (r=0.373, P=0.002 for SIMS sum score; r=0.263, P=0.036 for BMQ necessity/concern difference). Overall, adherence to capecitabine was high with a conviction that the therapy is necessary. However, concerns were expressed regarding the long-term effect of capecitabine use. Patients have unmet information needs regarding interactions of capecitabine with other medicines and the impairment of their intimate life. CONCLUSIONS In order to ensure adherence to capecitabine, our results seem to encourage the default use of modern and perhaps more impersonal means of information brokerage (eg, email, internet). However, the contents of some of patients' informational needs as well as the associations of patients' beliefs and satisfaction about the information received suggest a benefit from a trustful patient-doctor relationship.
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Affiliation(s)
- Jochen Hefner
- Section of Psychosomatic Medicine, Department of Internal Medicine II, University of Wuerzburg, Bavaria, Germany,
| | - Sara Berberich
- Medical Student, Faculty of Medicine, University of Wuerzburg, Bavaria, Germany
| | - Elena Lanvers
- Intensive Care Unit, Children's Hospital of the City of Cologne, North Rhine-Westphalia, Germany
| | - Maria Sanning
- Department of Internal Medicine II, St Johannes Hospital Dortmund, North Rhine-Westphalia, Germany
| | | | - Volker Kunzmann
- Section of Clinical Oncology, Department of Internal Medicine II, University of Wuerzburg, Bavaria, Germany
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Mawhinney MW, Warden J, Stoner N. The oral education clinic: A pharmacist- and nurse-led clinic to support patients starting oral systemic anti-cancer treatments. J Oncol Pharm Pract 2017; 25:449-453. [PMID: 28841100 DOI: 10.1177/1078155217727820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the increased number of oral systemic anti-cancer treatments available, patients need to be managed safely and effectively in line with national guidance. In response to guidance in 2011, Oxford University Hospitals NHS Foundation Trust implemented an 'Oral Education Clinic'. This nurse- and pharmacist-led clinic facilitates the delivery of patient education, highlighting key safety aspects of drug administration and management, and ensures follow-up is arranged as per protocol. Patients have found this service to be effective and it has had a positive impact on the running of outpatient units, the volume of triage calls, emergency admissions and workload associated with consenting patients to an oral systemic anti-cancer treatments.
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Wu Y, Zhang D, Wu B, Quan Y, Liu D, Li Y, Zhang X. Synergistic Activity of an Antimetabolite Drug and Tyrosine Kinase Inhibitors against Breast Cancer Cells. Chem Pharm Bull (Tokyo) 2017; 65:768-775. [PMID: 28539531 DOI: 10.1248/cpb.c17-00261] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Antimetabolite drugs, including the adenosine deaminase inhibitor cladribine, have been shown to induce apoptosis in a variety of cancer cells, and have been widely used in clinical trials of various cancers in conjunction with tyrosine kinase inhibitors (TKIs). Combination treatment with cladribine and gefitinib or dasatinib is expected to have a synergistic inhibitory effect on breast cancer cell growth. Our results demonstrated that the combination treatment had synergistic activity against human breast cancer (MCF-7) cells, enhanced G2/M cell arrest and reactive oxygen species (ROS) generation, and increased the loss of mitochondrial membrane potential and cell apoptosis. In addition, the combination treatment decreased Bcl-2 expression. Our results demonstrated that cladribine in combination with gefitinib or dasatinib exerted synergistic anticancer effects on MCF-7 cells by inducing cell cycle arrest, ROS production and apoptosis through the mitochondria-mediated intrinsic pathway.
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Affiliation(s)
- Yushan Wu
- School of Life Sciences, Shandong University of Technology
| | - Dongxing Zhang
- School of Life Sciences, Shandong University of Technology
| | - Baofan Wu
- Medical Department, Heze Municipal Hospital
| | - Yuan Quan
- Hubei Key Laboratory of Agricultural Bioinformatics, College of Informatics, Huazhong Agricultural University
| | - Dongwu Liu
- School of Life Sciences, Shandong University of Technology
| | | | - Xiuzhen Zhang
- School of Life Sciences, Shandong University of Technology
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Mislang AR, Wildes TM, Kanesvaran R, Baldini C, Holmes HM, Nightingale G, Coolbrandt A, Biganzoli L. Adherence to oral cancer therapy in older adults: The International Society of Geriatric Oncology (SIOG) taskforce recommendations. Cancer Treat Rev 2017; 57:58-66. [PMID: 28550714 DOI: 10.1016/j.ctrv.2017.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 01/08/2023]
Abstract
There is an increasing trend towards using oral systemic therapy in patients with cancer. Compared to parenteral therapy, oral cancer agents offer convenience, have similar efficacy, and are preferred by patients, consequently making its use appealing in older adults. However, adherence is required to ensure its efficacy and to avoid compromising treatment outcomes, especially when the treatment goal is curative, or in case of symptomatic/rapidly progressing disease, where dose-intensity is important. This opens a new challenge for clinicians, as optimizing patient adherence is challenging, particularly due to lack of consensus and scarcity of available clinical evidence. This manuscript aims to review the impact of age-related factors on adherence, summarize the evidence on adherence, recommend methods for selecting patients suitable for oral cancer agents, and advise monitoring interventions to promote adherence to treatment.
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Affiliation(s)
- Anna Rachelle Mislang
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato 59100, Italy; Cancer Clinical Trials Unit, Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Tanya M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Capucine Baldini
- Medical Hospital Huriez, University Lille Nord de France, Lille, France
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, TX, USA
| | - Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
| | - Annemarie Coolbrandt
- Oncology Nursing Department, University Hospitals Leuven, Leuven, Belgium; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000 Leuven, Belgium
| | - Laura Biganzoli
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato 59100, Italy.
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Timmers L, Boons CCLM, Mangnus D, Van de Ven PM, Van den Berg PH, Beeker A, Swart EL, Honeywell RJ, Peters GJ, Boven E, Hugtenburg JG. Adherence and Patients' Experiences with the Use of Capecitabine in Daily Practice. Front Pharmacol 2016; 7:310. [PMID: 27708578 PMCID: PMC5030243 DOI: 10.3389/fphar.2016.00310] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 08/30/2016] [Indexed: 12/15/2022] Open
Abstract
Introduction: Capecitabine is a widely prescribed oral anticancer agent. We studied medication adherence and explored its use in daily practice from a patients' perspective. Patients and Methods: Patients (n = 92) starting capecitabine were followed up to five 3-week cycles. Adherence was assessed using a pill count, pharmacy data and dosing information from the patients' medical file. Self-reported adherence was measured using the Medication Adherence Report Scale (MARS). At baseline and during week 2 of cycles 1, 3, and 5, patients filled out questionnaires about quality of life, symptoms, attitude toward medicines and disease and use in daily practice. Simultaneously, blood samples were taken to determine the area under the curve (AUC) of 5′-deoxy-5-fluorouridine (5′-DFUR), 5-fluorouracil (5-FU), and α-fluoro-β-alanine (FBAL) by a population pharmacokinetic model. Associations between AUCs and patient-reported symptoms were tested for cycles 3 and 5. Results: Most patients (84/92; 91%) had an adherence rate of ≥95 and ≤ 105%. The percentage of patients reporting any non-adherence behavior measured with MARS increased from 16% at cycle 1 to 29% at cycle 5. Symptoms were reported frequently and the dosing regimen was adjusted by the physician at least once in 62% of patients. In multivariate analysis the probability of an adjustment increased with the number of co-medication (OR 1.19, 95% CI: 1.03–1.39) and a stronger emotional response to the disease (OR 1.32, 95% CI: 1.10–1.59). The AUC of 5′-DFUR was associated with weight loss (OR 1.10, 95% CI: 1.01–1.19), AUC of FBAL with hand-foot syndrome (OR 0.90, 95% CI: 0.83–0.99), rhinorrhea (OR 1.21, 95% CI: 1.03–1.42 weight loss (OR 1.09, 95% CI: 1.00–1.20) and depression (OR 0.90, 95% CI: 0.82–0.99). Side effects were reported by one third of patients as the reason to discontinue treatment. Conclusion: Adherence to capecitabine was generally high. Nevertheless, adherence measured with MARS decreased over time Adherence management to support implementation of correct capecitabine use is specifically relevant in longer term treatment. In addition, it appears that adverse event management is important to support persistence. With the extending armamentarium of oral targeted anticancer agents and prolonged treatment duration, we expect the issue of medication adherence of increasing importance in oncology.
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Affiliation(s)
- Lonneke Timmers
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center Amsterdam, Netherlands
| | - Christel C L M Boons
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center Amsterdam, Netherlands
| | - Dirk Mangnus
- Department of Pharmacy, Slingeland Ziekenhuis Doetinchem, Netherlands
| | - Peter M Van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands
| | | | - Aart Beeker
- Department of Internal Medicine, Spaarne Hospital Hoofddorp, Netherlands
| | - Eleonora L Swart
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center Amsterdam, Netherlands
| | - Richard J Honeywell
- Department of Medical Oncology, VU University Medical Center Amsterdam, Netherlands
| | - Godefridus J Peters
- Department of Medical Oncology, VU University Medical Center Amsterdam, Netherlands
| | - Epie Boven
- Department of Medical Oncology, VU University Medical Center Amsterdam, Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, VU University Medical CenterAmsterdam, Netherlands; The EMGO Institute for Health and Care Research, VU University Medical CenterAmsterdam, Netherlands
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14
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Wu D, Yan J, Sun P, Xu K, Li S, Yang H, Li H. Comparative analysis of the interaction of capecitabine and gefitinib with human serum albumin using 19 F nuclear magnetic resonance-based approach. J Pharm Biomed Anal 2016; 129:15-20. [DOI: 10.1016/j.jpba.2016.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/01/2016] [Accepted: 06/19/2016] [Indexed: 01/20/2023]
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15
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Validation d’un questionnaire mesurant l’adhérence et les compétences de gestion des effets secondaires chez des patients traités par capécitabine. Bull Cancer 2016; 103:241-51. [DOI: 10.1016/j.bulcan.2016.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 12/03/2015] [Accepted: 01/11/2016] [Indexed: 12/27/2022]
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16
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Greer JA, Amoyal N, Nisotel L, Fishbein JN, MacDonald J, Stagl J, Lennes I, Temel JS, Safren SA, Pirl WF. A Systematic Review of Adherence to Oral Antineoplastic Therapies. Oncologist 2016; 21:354-76. [PMID: 26921292 DOI: 10.1634/theoncologist.2015-0405] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/08/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Oral antineoplastic therapies not only improve survival but also reduce the burden of care for patients. Yet patients and clinicians face new challenges in managing adherence to these oral therapies. We conducted a systematic literature review to assess rates and correlates of adherence to oral antineoplastic therapies and interventions aimed at improving adherence. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive literature search of the Ovid MEDLINE database from January 1, 2003 to June 30, 2015, using relevant terminology for oral antineoplastic agents. We included observational, database, and intervention studies. At least two researchers evaluated each paper to ensure accuracy of results and determine risk of bias. RESULTS We identified 927 records from the search and screened 214 abstracts. After conducting a full-text review of 167 papers, we included in the final sample 51 papers on rates/correlates of adherence to oral antineoplastic therapy and 12 papers on intervention studies to improve adherence. Rates of adherence varied widely, from 46% to 100%, depending on patient sample, medication type, follow-up period, assessment measure, and calculation of adherence. Of the intervention studies, only 1 of the randomized trials and 2 of the cohort studies showed benefit regarding adherence, with the majority suffering high risk of bias. CONCLUSIONS Although no reliable estimate of adherence to oral antineoplastic therapies can be gleaned from the literature, a substantial proportion of patients struggle to adhere to these medications as prescribed. The few intervention studies for adherence have notable methodological concerns, thereby limiting the evidence to guide practice in promoting medication adherence among patients with cancer.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Amoyal
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Nisotel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joel N Fishbein
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James MacDonald
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie Stagl
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Inga Lennes
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - William F Pirl
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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17
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Barillet M, Prevost V, Joly F, Clarisse B. Oral antineoplastic agents: how do we care about adherence? Br J Clin Pharmacol 2015; 80:1289-302. [PMID: 26255807 DOI: 10.1111/bcp.12734] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/24/2015] [Accepted: 08/03/2015] [Indexed: 12/30/2022] Open
Abstract
AIMS Oral therapies, including hormone-based or targeted therapies, have recently taken an increasing place in cancer treatment. In this context, a state of the art of the available studies dealing with the adherence of adult patients to oral anticancer treatment is warranted. The purpose of this review is to address (i) the association between assessment methods and measured adherence, (ii) the putative factors related to adherence and (iii) new ways of improving adherence to oral cancer therapies. METHODS We conducted a literature-based narrative review of studies obtained from Pubmed using medical subject heading terms and free-text terms combining concepts related to oral anticancer medication and adherence. RESULTS The analysis is based on 48 studies published since 1990, mostly assessing hormone-based therapy in breast cancer and targeted therapies in chronic myeloid leukaemia. Various methods of adherence were reported including self-report, medication measurement or combinations of methods. Adherence rates were found to vary from 14% to 100%. Beside patient related-factors, adherence rate discrepancies were found to be dependent on the method used. Furthermore, there was no consensual definition of adherence even regarding the same methods, some of them tolerating a period of interruption during the treatment period. Finally, several studies addressing persistence found a progressive decrease in adherence with time. CONCLUSION Adherence to novel oral therapies is a major issue and further research is warranted to standardize adherence assessment in clinical studies better and to define better the most appropriate approaches to improve long term adherence in oncology practice.
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Affiliation(s)
- Marie Barillet
- Centre Hospitalier J Monod, rue Eugène Garnier BP 219, 61104, Flers cedex
| | - Virginie Prevost
- Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186, 14032, Caen Cedex 05.,INSERM U1086, Cancers et Préventions, Avenue de la Côte de Nacre, F-14000, Caen.,Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Florence Joly
- Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186, 14032, Caen Cedex 05.,INSERM U1086, Cancers et Préventions, Avenue de la Côte de Nacre, F-14000, Caen.,Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Bénédicte Clarisse
- Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
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18
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Bourmaud A, Henin E, Tinquaut F, Regnier V, Hamant C, Colomban O, You B, Ranchon F, Guitton J, Girard P, Freyer G, Tod M, Rioufol C, Trillet-Lenoir V, Chauvin F. Adherence to oral anticancer chemotherapy: What influences patients' over or non-adherence? Analysis of the OCTO study through quantitative-qualitative methods. BMC Res Notes 2015; 8:291. [PMID: 26142140 PMCID: PMC4490730 DOI: 10.1186/s13104-015-1231-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/15/2015] [Indexed: 12/20/2022] Open
Abstract
Background Numerous oral anticancer chemotherapies are available. Non-adherence or over-adherence to these chemotherapies can lead to lowered efficacy and increased risk of adverse events. The objective of this study was to identify patients’ adherence profiles using a qualitative–quantitative method. Methods A capecitabine treatment was initiated for 38 patients with advanced breast or colorectal cancer. At inclusion, information on patients’ beliefs was reported using a questionnaire. Later, Information on patients’ relation to treatment was obtained from a sub-group during an interview with a sociologist. Questionnaires were analyzed using Multiple Classification Analysis to cluster patients. Treatment adherence was evaluated by an electronic medication event monitoring systems (MEMS caps) and then correlated with patient clusters. Interviews were analyzed to complete and explain results. Results 38 patients were enrolled between 2008 and 2011 and completed the questionnaire. Twenty had adherence measured with MEMS caps all along treatment. Between 4 and 6 months after inclusion, 16 patients were interviewed. Patient profile B (retired, with a regular life, surrounded by a relative’s attention to drug adherence, with a low educational level) was statistically associated with adequate adherence (p = 0.049). A tendency for lower adherence was observed among more highly educated patients with an irregular, active life (NS). All patients taking capecitabine demonstrated a risk of over-adherence, potentiating side effects. Conclusions These encouraging primary results suggest that further studies should be undertaken and that educational programs tailored to patient profiles should be evaluated to enhance adherence for those who need it and to empower all patients to manage treatment side effects. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1231-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aurélie Bourmaud
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institut, Inserm, CIC1408, 108 bis avenue A. Raimond, 42 270, Saint Priest en Jarez, France.
| | - Emilie Henin
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France.
| | - Fabien Tinquaut
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institut, Inserm, CIC1408, 108 bis avenue A. Raimond, 42 270, Saint Priest en Jarez, France.
| | - Véronique Regnier
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institut, Inserm, CIC1408, 108 bis avenue A. Raimond, 42 270, Saint Priest en Jarez, France.
| | - Chloé Hamant
- Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institut, Inserm, CIC1408, 108 bis avenue A. Raimond, 42 270, Saint Priest en Jarez, France.
| | - Olivier Colomban
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France.
| | - Benoit You
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Medical Oncology Department, Teaching Hospital, Lyon-Sud University, Lyon, France.
| | - Florence Ranchon
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Oncologic Pharmaceutical Department, Lyon-Sud University Teaching Hospital, Lyon, France.
| | - Jérôme Guitton
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Pharmacology-Toxicology Laboratory, Hospices Civils de Lyon, South Biology Center, Lyon, France.
| | - Pascal Girard
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France.
| | - Gilles Freyer
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Medical Oncology Department, Teaching Hospital, Lyon-Sud University, Lyon, France.
| | - Michel Tod
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France.
| | - Catherine Rioufol
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Oncologic Pharmaceutical Department, Lyon-Sud University Teaching Hospital, Lyon, France.
| | - Véronique Trillet-Lenoir
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Medical Oncology Department, Teaching Hospital, Lyon-Sud University, Lyon, France.
| | - Franck Chauvin
- EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. .,Public Health Department, Hygée Centre, Lucien Neuwirth Cancer Institut, Inserm, CIC1408, 108 bis avenue A. Raimond, 42 270, Saint Priest en Jarez, France. .,Jean Monnet University, Saint-Etienne, France.
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Zhang LY, Lu YH, Guo RX. Adherence to oral chemotherapy and related factors in patients with gastrointestinal cancer. Shijie Huaren Xiaohua Zazhi 2015; 23:2660-2664. [DOI: 10.11569/wcjd.v23.i16.2660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the adherence to oral chemotherapy and explore related factors in patients with gastrointestinal cancer, in order to provide a basis for nursing intervention and improve patient adherence.
METHODS: This study investigated 207 patients with gastrointestinal cancer who received oral chemotherapy by pill counting and questionnaire survey.
RESULTS: The rate of adherence to oral chemotherapy in patients with gastrointestinal cancer was 68.6%. The reasons for low adherence included forgetting to take, adjusting the dose for side effects, not taking drugs when out, and stopping medication as symptoms relieved. Factors related to adherence included gender, age, education level and whether there was a remainder (P < 0.05), however, diagnosis and hospitalized frequency had no significant impact on adherence (P > 0.05).
CONCLUSION: The adherence of gastrointestinal cancer patients to chemotherapy should be strengthened, especially in high-risk patients, like elderly patients, male patients, those with a low education level and those with no remainder.
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20
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Thummuri D, Kumar S, Surapaneni SK, Tikoo K. Epigenetic regulation of protein tyrosine phosphatase PTPN12 in triple-negative breast cancer. Life Sci 2015; 130:73-80. [DOI: 10.1016/j.lfs.2015.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/09/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
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21
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Spoelstra SL, Given BA, Given CW, Grant M, Sikorskii A, You M, Decker V. Issues related to overadherence to oral chemotherapy or targeted agents. Clin J Oncol Nurs 2015; 17:604-9. [PMID: 24113679 DOI: 10.1188/13.cjon.17-06ap] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Use of oral chemotherapy or targeted agents is shifting how cancer treatment is administered, moving it from supervised office visits to self-administration at home. This study examines issues related to overadherence to oral agents that were noted during a trial conducted by the authors comparing an automated voice system to strategies to reduce symptom severity and improve adherence. Overadherence to oral agents may be a significant clinical problem, occurring more often in patients with complex dosing regimens, and may lead to increased symptom severity from side effects of treatment. Avoiding overadherence may be important for the reduction or prevention of symptoms and potentially life-threatening toxicity. Nurses need to discuss with their patients the importance of the timing of the administration of their oral oncolytic regimen, as well as to provide prompts to assist in self-administration as prescribed so that overadherence can be avoided.
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22
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Zhang F, Zhang J, Liu M, Zhao L, LingHu R, Feng F, Gao X, Jiao S, Zhao L, Hu Y, Yang J. Combating HER2-overexpressing breast cancer through induction of calreticulin exposure by Tras-Permut CrossMab. Oncoimmunology 2015; 4:e994391. [PMID: 25949918 DOI: 10.4161/2162402x.2014.994391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/27/2014] [Indexed: 01/06/2023] Open
Abstract
Although trastuzumab has succeeded in breast cancer treatment, acquired resistance is one of the prime obstacles for breast cancer therapies. There is an urgent need to develop novel HER2 antibodies against trastuzumab resistance. Here, we first rational designed avidity-imporved trastuzumab and pertuzumab variants, and explored the correlation between the binding avidity improvement and their antitumor activities. After characterization of a pertuzumab variant L56TY with potent antitumor activities, a bispecific immunoglobulin G-like CrossMab (Tras-Permut CrossMab) was generated from trastuzumab and binding avidity-improved pertuzumab variant L56TY. Although, the antitumor efficacy of trastuzumab was not enhanced by improving its binding avidity, binding avidity improvement could significantly increase the anti-proliferative and antibody-dependent cellular cytotoxicity (ADCC) activities of pertuzumab. Further studies showed that Tras-Permut CrossMab exhibited exceptional high efficiency to inhibit the progression of trastuzumab-resistant breast cancer. Notably, we found that calreticulin (CRT) exposure induced by Tras-Permut CrossMab was essential for induction of tumor-specific T cell immunity against tumor recurrence. These data indicated that simultaneous blockade of HER2 protein by Tras-Permut CrossMab could trigger CRT exposure and subsequently induce potent tumor-specific T cell immunity, suggesting it could be a promising therapeutic strategy against trastuzumab resistance.
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Key Words
- ADCC
- CDR, complementarity determining region
- CH1, constant heavy chain 1
- CL, constant light chain
- CRT, calreticulin
- CrossMab
- FCM, flow cytometry
- HER, human epidermal growth factor receptor
- HER2-ECD, extracellular domain of HER2
- HER2-overexpressing breast cancer
- LDH, lactate dehydrogenase
- PBMCs, peripheral blood mononuclear cells
- PI3K, phosphatidylinositol 3-kinase
- SEC, size-exclusion chromatography
- T cell immunity
- antibody-dependent cellular cytotoxicity
- calreticulin exposure
- mAb, monoclonal antibody
- pertuzumab
- trastuzumab
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Affiliation(s)
- Fan Zhang
- Department of Oncology; PLA General Hospital; PLA School of Medicine ; Beijing, People's Republic of China
| | - Jie Zhang
- Nursing Department; PLA General Hospital; PLA School of Medicine ; Beijing, People's Republic of China
| | - Moyan Liu
- Department of Nephrology; General Hospital of Jinan Military Command ; Jinan, People's Republic of China
| | - Lichao Zhao
- Medical Department; General Hospital of Jinan Military Command ; Jinan, People's Republic of China
| | - RuiXia LingHu
- Department of Oncology; PLA General Hospital; PLA School of Medicine ; Beijing, People's Republic of China
| | - Fan Feng
- Department of Pharmacy; General Hospital of Shenyang Military Command ; Shenyang, People's Republic of China
| | - Xudong Gao
- Department of Gastroenterology ; PLA 302 Hospital ; Beijing, People's Republic of China
| | - Shunchang Jiao
- Department of Oncology; PLA General Hospital; PLA School of Medicine ; Beijing, People's Republic of China
| | - Lei Zhao
- PLA General Hospital; PLA School of Medicine ; Beijing, People's Republic of China ; Institute for Translational Medicine; Second Military Medical University ; Shanghai, People's Republic of China
| | - Yi Hu
- Department of Oncology; PLA General Hospital; PLA School of Medicine ; Beijing, People's Republic of China
| | - Junlan Yang
- Department of Oncology; PLA General Hospital; PLA School of Medicine ; Beijing, People's Republic of China
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McCue DA, Lohr LK, Pick AM. Improving adherence to oral cancer therapy in clinical practice. Pharmacotherapy 2014; 34:481-94. [PMID: 24877187 DOI: 10.1002/phar.1399] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adherence to oral chemotherapy regimens maximizes their effectiveness and minimizes any potential toxicities. Factors specifically related to the treatment, patient, and health care provider may influence medication adherence. Treatment-related factors include the complexity of the regimen, the cost of therapy, the possibility of side effects, and the delay in treatment benefits. Meanwhile, patients may not have an adequate support system or an understanding of the need for the medication, and providers may not fully succeed in communicating the importance of adherence and the types of side effects that may occur. Nonadherence may lead to an increased risk of toxicity, decreased effectiveness, and increased utilization of health care resources. Although various methods for measuring adherence are available, self-reporting is the most widely used. Studies describing adherence in a broad range of cancers are reviewed. Treatment of chronic myeloid leukemia has been revolutionized by the development of oral tyrosine kinase inhibitors that are highly effective in managing the disease when taken consistently. However, nonadherence is relatively common and can lead to reduced rates of response and increased medical costs. Similar effects of nonadherence on outcome and cost have also been observed in patients with various other hematologic malignancies and solid tumors. Interventions to improve adherence to oral chemotherapy regimens include communication about the importance of adherence and the potential consequences of nonadherence, simplification of the patient's medication schedule (if possible), and inclusion of a caregiver or family member in the conversation. Written materials should always be provided to accompany verbal instructions. This review summarizes factors influencing medication adherence, impact of nonadherence on patient outcomes, methods for measuring adherence, previous studies of nonadherence in patients with cancer, common barriers to access, and interventions to improve adherence in the community setting.
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24
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daCosta DiBonaventura M, Copher R, Basurto E, Faria C, Lorenzo R. Patient preferences and treatment adherence among women diagnosed with metastatic breast cancer. AMERICAN HEALTH & DRUG BENEFITS 2014; 7:386-96. [PMID: 25525495 PMCID: PMC4268769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/16/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Given the various profiles (eg, oral vs intravenous administration, risk of hot flashes vs fatigue) of treatment options (eg, endocrine therapy, chemotherapy) for metastatic breast cancer (mBC), how patients value these attributes of their medications has implications on making treatment decisions and on adherence. OBJECTIVES To understand how patients trade off medication side effects with improved effectiveness and/or quality of life, to provide estimates of nonadherence among women with mBC, and to quantify the association of medication nonadherence with health outcomes. METHODS The study was a cross-sectional, Internet-based survey of 181 women diagnosed with mBC who were recruited from cancer-specific online panels (response rate, 7%). Treatment information, demographics, nonadherent behaviors, and quality of life assessed by the Functional Assessment of Cancer Therapy-Breast (FACT-B) were collected in the survey, and each respondent completed a choice-based conjoint exercise to assess patient preferences. The patients' preferences were analyzed using hierarchical Bayesian logistic regression models, and the association between the number of nonadherent behaviors and the health outcomes was analyzed using general linear models. RESULTS The mean age of the patient sample was 52.2 years (standard deviation, ±9.1), with 93.9% of participants being non-Hispanic white. Results from the conjoint model indicated that effectiveness (overall survival) was of primary importance to patients, followed by side effects-notably alopecia, fatigue, neutropenia, motor neuropathy, and nausea/vomiting-and finally, dosing regimen. In all, 34.8% of survey respondents either discontinued their treatment or were nonadherent to their treatment regimen. Among those who have ever used oral chemotherapy (N = 95; 52.5%) and those currently using oral chemotherapy (N = 44; 24.3%), the number of nonadherent behaviors was significantly associated with a decrease in functional well-being (b [unstandardized regression coefficient] = -2.01 for patients who had ever used a targeted therapy and b = -3.14 for current users of a targeted therapy), FACT-General total score (b = -4.30 and b = -7.37, respectively), FACT-B total score (b = -3.93 and b = -6.11, respectively), and FACT trial outcome index (b = -5.22 and b = -8.63, respectively; all P <.05). CONCLUSIONS Patients were willing to accept substantial additional risks from side effects for gains in overall survival. Approximately 33% of women with mBC reported engaging in nonadherent behaviors. Because forgetfulness and adverse events were among the most frequent reasons for nonadherence, these results suggest that less complex treatment regimens, as well as regimens with less toxic profiles, may be associated with improvements in adherence and, subsequently, could correspond to perceptible patient benefits.
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Affiliation(s)
| | - Ronda Copher
- Associate Director, Health Economics and Outcomes Research, Eisai Inc, Woodcliff Lake, NJ
| | | | - Claudio Faria
- Director, Health Economics and Outcomes Research, Eisai Inc, Woodcliff Lake, NJ
| | - Rose Lorenzo
- Senior Director of Research, Kantar Health, New York, NY
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25
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Kimura M, Usami E, Iwai M, Nakao T, Yoshimura T, Mori H, Sugiyama T, Teramachi H. Oral anticancer agent medication adherence by outpatients. Oncol Lett 2014; 8:2318-2324. [PMID: 25295117 PMCID: PMC4186627 DOI: 10.3892/ol.2014.2480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 08/01/2014] [Indexed: 01/28/2023] Open
Abstract
In the present study, medication adherence and factors affecting adherence were examined in patients taking oral anticancer agents. In June 2013, 172 outpatients who had been prescribed oral anticancer agents by Ogaki Municipal Hospital (Ogaki, Gifu, Japan) completed a questionnaire survey, with answers rated on a five-point Likert scale. The factors that affect medication adherence were evaluated using a customer satisfaction (CS) analysis. For patients with good and insufficient adherence to medication, the median ages were 66 years (range, 21–85 years) and 73 years (range, 30–90 years), respectively (P=0.0004), while the median dosing time was 131 days (range, 3–3,585 days) and 219 days (24–3,465 days), respectively (P=0.0447). In 36.0% (62 out of 172) of the cases, there was insufficient medication adherence; 64.5% of those cases (40 out of 62) showed good medication compliance (4–5 point rating score). However, these patients did not fully understand the effects or side-effects of the drugs, giving a score of three points or less. The percentage of patients with good medication compliance was 87.2% (150 out of 172). Through the CS analysis, three items, the interest in the drug, the desire to consult about the drug and the condition of the patient, were extracted as items for improvement. Overall, the medication compliance of the patients taking the oral anticancer agents was good, but the medication adherence was insufficient. To improve medication adherence, a better understanding of the effectiveness and necessity of drugs and their side-effects is required. In addition, the interest of patients in their medication should be encouraged and intervention should be tailored to the condition of the patient. These steps should lead to improved medication adherence.
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Affiliation(s)
- Michio Kimura
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Eiseki Usami
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Mina Iwai
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Toshiya Nakao
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Tomoaki Yoshimura
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Hiromi Mori
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Tadashi Sugiyama
- Laboratory of Clinical Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Hitomi Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
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Abstract
OBJECTIVES The use of oral chemotherapy has increased substantially. This adds a level of complexity beyond that of traditional intravenous chemotherapy. This article discusses challenges and strategies to meet patient needs. DATA SOURCES Research and peer-reviewed journal articles. CONCLUSION Adherence is a challenge for oral chemotherapy. A systematic approach serves as the best way to facilitate a comprehensive oral chemotherapy plan. IMPLICATIONS FOR NURSING PRACTICE Nurses' knowledge is required to support and monitor patient adherence. Nurses must master effective utilization of resources to monitor and positively impact successful patient outcomes.
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Timmers L, Boons CCLM, Kropff F, van de Ven PM, Swart EL, Smit EF, Zweegman S, Kroep JR, Timmer-Bonte JNH, Boven E, Hugtenburg JG. Adherence and patients' experiences with the use of oral anticancer agents. Acta Oncol 2014; 53:259-67. [PMID: 24266637 DOI: 10.3109/0284186x.2013.844353] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A rapidly growing number of oral anticancer agents has become available in oncology and hematology. Though these introductions have several benefits, medication adherence is an issue of concern. Little is known about the factors influencing adherence to treatment with oral anticancer agents in daily practice. Material and methods. In this observational, multicenter study including 216 patients, carried out between October 2010 and March 2012, the use of oral anticancer drugs was assessed by means of a telephonic pill count, a questionnaire and a review of the patient's medical file and pharmacy medication records. Parameters collected were patients' demographics, treatment characteristics, beliefs and attitude towards disease and medicines, self-reported adherence, side effects, quality of life and satisfaction about information. Patients off treatment filled out a questionnaire about the reasons for discontinuation. Optimal adherence was defined as ≥ 95%-≤ 105%. Results. The mean adherence rate (AR) (n = 177) was 99.1% with 20.3% of patients having a sub-optimal AR (< 95%, > 105%) consisting both of under- and over-adherence. Multivariate analyses showed that being on a cyclic dosing regimen (rather than a continuous regimen), not living alone and being highly educated increased the chances of optimal adherence (ORs = 4.88, 4.59 and 2.53, respectively). In addition, optimal adherence was found to be less common in patients reporting treatment control (OR = 0.77). One third of 79 patients off treatment reported their experienced side effects as one of the reasons for discontinuation. Discussion. Although most patients are fully adherent to oral anticancer agents, there is a substantial number tending to non-adherence. Patients living alone and those on a continuous dosing regimen are most likely to adhere sub-optimally. Interventions to improve adherence should specifically address these patients and be tailored to the needs of the individual patient.
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Affiliation(s)
- Lonneke Timmers
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center , Amsterdam , The Netherlands
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Mallick R, Cai J, Wogen J. Predictors of non-adherence to systemic oral therapy for advanced hepatocellular carcinoma. Curr Med Res Opin 2013; 29:1701-8. [PMID: 24010684 DOI: 10.1185/03007995.2013.842161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES With increasing use and cost of oral oncology medications, patient non-adherence with oral therapy is of concern. This study evaluated non-adherence among patients receiving first-line oral therapy for hepatocellular carcinoma (HCC). METHODS This retrospective study used the employer-based MarketScan medical and pharmacy claims database (2005-2011) to identify adult patients with two or more diagnoses of HCC (ICD-9 155), and two or more filled prescriptions for sorafenib. Additional eligibility requirements were not having other previous cancers and a 4 month wash-out period prior to the index sorafenib date. Adherence was assessed using a modified proportion of days covered (PDC) measure with patient-specific sorafenib exposure from index date to treatment discontinuation. Non-adherence was categorized as PDC <85% (base case), with sensitivity analyses using an 80% cut-off and allowance for physician-directed therapy gaps. Logistic regression models were estimated to identify predictors of non-adherence. RESULTS A total of 1127 patients (median age = 61.0 years; 78.4% male) met eligibility criteria. Median duration of enrollment was 223 days and median sorafenib exposure was 121 days. Between 21.1% (PDC < 0.80) and 28.0% (PDC < 0.85) of patients were non-adherent. Higher age (p = 0.022), number of baseline medications (p = 0.003) and number of baseline comorbidities (p = 0.002) were associated with lower non-adherence, while prior procedures were associated with greater non-adherence (p = 0.002). LIMITATIONS In this study using billing claims data, we were unable to evaluate patient severity in terms of clinical characteristics such as the Child-Pugh score. Similarly, we could not assess clinical outcomes such as tumor response, radiological progression or overall survival, although median duration of sorafenib exposure and duration of health plan enrollment respectively were found to be good proxies. CONCLUSIONS Using a modified PDC approach, 22-29% of patients were non-adherent. Identified predictors of non-adherence in HCC should be assessed for newly emerging oral therapies, and may be used to guide patient education and other adherence-enhancing initiatives.
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Affiliation(s)
- Rajiv Mallick
- Health Economics and Outcomes Research, Daiichi Sankyo Inc. , Parsippany, NJ , USA
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Bassan F, Peter F, Houbre B, Brennstuhl M, Costantini M, Speyer E, Tarquinio C. Adherence to oral antineoplastic agents by cancer patients: definition and literature review. Eur J Cancer Care (Engl) 2013; 23:22-35. [DOI: 10.1111/ecc.12124] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- F. Bassan
- Université de Lorraine; Research Section APEMAC UE 4360; Psychological and Epidemiological Approaches to Chronic Diseases, Psychology of Health Team; Metz France
| | - F. Peter
- Université de Lorraine; Research Section APEMAC UE 4360; Psychological and Epidemiological Approaches to Chronic Diseases, Psychology of Health Team; Metz France
| | - B. Houbre
- Université de Lorraine; Research Section APEMAC UE 4360; Psychological and Epidemiological Approaches to Chronic Diseases, Psychology of Health Team; Metz France
| | - M.J. Brennstuhl
- Université de Lorraine; Research Section APEMAC UE 4360; Psychological and Epidemiological Approaches to Chronic Diseases, Psychology of Health Team; Metz France
| | - M. Costantini
- Université de Lorraine; Research Section APEMAC UE 4360; Psychological and Epidemiological Approaches to Chronic Diseases, Psychology of Health Team; Metz France
| | - E. Speyer
- Université de Lorraine, Université Paris Descartes; APEMAC EA 4360; Nancy F-54000 France
| | - C. Tarquinio
- Université de Lorraine; Research Section APEMAC UE 4360; Psychological and Epidemiological Approaches to Chronic Diseases, Psychology of Health Team; Metz France
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Krolop L, Ko YD, Schwindt PF, Schumacher C, Fimmers R, Jaehde U. Adherence management for patients with cancer taking capecitabine: a prospective two-arm cohort study. BMJ Open 2013; 3:e003139. [PMID: 23872296 PMCID: PMC3717446 DOI: 10.1136/bmjopen-2013-003139] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 05/28/2013] [Accepted: 06/17/2013] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To develop and evaluate a multiprofessional modular medication management to assure adherence to capecitabine. METHODS The study was conducted as a prospective, multicentred observational cohort study. All participants received pharmaceutical care consisting of oral and written information. Daily adherence was defined as percentage of days with correctly administered capecitabine doses and assessed using medication event monitoring. According to their daily adherence during the first cycle, patients were identified as initially non-adherent (<90% adherence) or adherent (≥90% adherence). Initially non-adherent patients received additional adherence support. RESULTS Seventy-three patients with various tumour entities were enrolled, 58 were initially adherent and 15 non-adherent. Median daily adherence of initially non-adherent patients increased from 85.7% to 97.6% during the observation period of six cycles. Throughout all cycles, median daily adherence of initially adherent patients was 100.0%. Daily adherence was not associated with sociodemographic and disease-related factors. No patient was non-persistent. CONCLUSIONS An early adherence screening effectively distinguishes between patients adhering and non-adhering to capecitabine. The provision of specific adherence support is associated with enhanced adherence of initially non-adherent patients, whereas initially adherent patients remain adherent for at least six cycles without specific support. Our needs-based approach helps to use available resources for adherence management efficiently.
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Affiliation(s)
- Linda Krolop
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn, Germany
| | - Yon-Dschun Ko
- Department of Internal Medicine, Johanniter Hospital, Bonn, Germany
| | | | - Claudia Schumacher
- Specialist Breast Unit/Senology, St Elisabeth Hospital Cologne-Hohenlind, Cologne, Germany
| | - Rolf Fimmers
- Department of Informatics and Epidemiology, Institute for Medical Biometry, University of Bonn, Bonn, Germany
| | - Ulrich Jaehde
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn, Germany
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Hohneker J, Shah-Mehta S, Brandt PS. Perspectives on adherence and persistence with oral medications for cancer treatment. J Oncol Pract 2013; 7:65-7. [PMID: 21532814 DOI: 10.1200/jop.2010.000076] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2010] [Indexed: 11/20/2022] Open
Abstract
Ensuring persistence, continuing treatment for the prescribed duration, and adherence-taking medication as prescribed-have been challenges for management of patients with oral cancer and for health care cost containment in real-world settings.
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Ruddy KJ, Pitcher BN, Archer LE, Cohen HJ, Winer EP, Hudis CA, Muss HB, Partridge AH. Persistence, adherence, and toxicity with oral CMF in older women with early-stage breast cancer (Adherence Companion Study 60104 for CALGB 49907). Ann Oncol 2012; 23:3075-3081. [PMID: 22767584 PMCID: PMC3501229 DOI: 10.1093/annonc/mds133] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/19/2012] [Accepted: 04/02/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cyclophosphamide-methotrexate-5-fluorouracil (CMF) is often selected as adjuvant chemotherapy for older patients with early-stage breast cancer due to perceived superior tolerability. We sought to measure persistence with CMF, adherence to oral cyclophosphamide, and the association of these with toxic effects. PATIENTS AND METHODS CALGB 49907 was a randomized trial comparing standard chemotherapy (CMF or AC, provider/patient choice) with capecitabine in patients aged ≥65 with stage I-IIIB breast cancer. Those randomized to standard therapy and choosing CMF were prescribed oral cyclophosphamide 100 mg/m(2) for 14 consecutive days in six 28-day cycles. Persistence was defined as being prescribed six cycles of at least one of the three CMF drugs. Adherence was the number of cyclophosphamide doses that women reported they had taken divided by the number prescribed. Persistence and adherence were based on case report forms and medication calendars. RESULTS Of 317 randomized to standard chemotherapy, 133 received CMF. Median age was 73 (range 65-88). Seventy-one percent submitted at least one medication calendar; 65% persisted with CMF. Non-persistence was associated with node negativity (P = 0.019), febrile neutropenia (P = 0.002), and fatigue (P = 0.044). Average adherence was 97% during prescribed cycles. CONCLUSIONS Self-reported adherence to cyclophosphamide was high, but persistence was lower, which may be attributable to toxic effects.
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Affiliation(s)
- K J Ruddy
- Medical Oncology, Dana-Farber Cancer Institute, Boston.
| | - B N Pitcher
- CALGB Statistical Center, Duke University Medical Center, Durham
| | - L E Archer
- CALGB Statistical Center, Duke University Medical Center, Durham
| | - H J Cohen
- CALGB Statistical Center, Duke University Medical Center, Durham
| | - E P Winer
- Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - C A Hudis
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York
| | - H B Muss
- Medical Oncology, University of North Carolina, Chapel Hill, USA
| | - A H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston
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Thivat E, Van Praagh I, Belliere A, Mouret-Reynier MA, Kwiatkowski F, Durando X, Mahammedi H, Dillies AF, Chollet P, Chevrier R. Adherence with oral oncologic treatment in cancer patients: interest of an adherence score of all dosing errors. Oncology 2012; 84:67-74. [PMID: 23128040 DOI: 10.1159/000342087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/13/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE Patient nonadherence to oral antineoplastic therapy is a well-recognized barrier to effective treatment. In order to identify patients who may need additional support to become adherent, it is important to have a useful tool that takes into account all the parameters of adherence to prescription. The aim of this prospective study was to evaluate adherence of oral antineoplastic agents and to investigate two calculation methods of adherence score. PATIENTS AND METHODS Twenty-nine cancer patients were enrolled in this study. Fourteen were treated by capecitabine and 15 patients by aromatase inhibitors. Adherence was measured using a medication event monitoring system and adherence score was calculated by a usual method and a composite adherence score that takes into account missed doses and also intake interval errors (between 2 doses and between meals). RESULTS Across the 6-month evaluation period, average adherence was 95% with the standard calculation (capecitabine group: 89%; aromatase inhibitor group: 99%) versus 83% with the composite index (capecitabine group: 62%; aromatase inhibitor group: 99%) (p = 0.030). The composite calculation permits to highlight more nonadherent patients (29.6 vs. 7.4%), particularly in the capecitabine group (73 vs. 18%, p = 0.001). We report 2 cases identified as nonadherent with composite adherence rate. CONCLUSION The composite adherence score permits to better evaluate adherence to prescription and to identify barriers to adherence and persistence.
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Affiliation(s)
- E Thivat
- Division of Clinical Research, Centre Jean Perrin, Clermont-Ferrand, France
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Goucha S, Khaled A, Bennani Z, Rammeh S, Zéglaoui F, Zermani R, Fazaa B. Erosive lichen planus of the soles: Effective response to prednisone. Dermatol Ther (Heidelb) 2012; 1:20-4. [PMID: 22984660 PMCID: PMC3437639 DOI: 10.1007/s13555-011-0005-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Indexed: 12/02/2022] Open
Abstract
Background Erosive lichen planus (LP) of the soles is a rare variant of LP, characterized by chronic, painful, and disabling plantar ulcerations. Herein, we report a case with complete healing following treatment with systemic steroids. Case report A 38-year-old woman was referred with painful and disabling erosive bilateral plantar LP, which she had experienced for 6 weeks. A 1 mg/kg/day, oral prednisone therapy led to rapid improvement and complete healing within 3 weeks, with a sustained result under a low dose maintenance therapy. Discussion Ulcerative plantar LP is significantly known to be unresponsive to several topical and systemic therapies. Surgical excision and grafting is the treatment of choice. Systemic steroids are reported to have inefficient or partial results; both on cutaneous healing and on maintenance of the result. Our patient achieved complete cicatrisation with a sustained result of 3 months under a low dose of prednisone (5 mg/day).
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Affiliation(s)
- Samia Goucha
- Dermatology Unit, Mongi Slim Hospital, Sidi Daoud, Tunis, 2046 Tunisia
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Gebbia V, Bellavia G, Ferraù F, Valerio MR. Adherence, compliance and persistence to oral antineoplastic therapy: a review focused on chemotherapeutic and biologic agents. Expert Opin Drug Saf 2011; 11 Suppl 1:S49-59. [PMID: 22149481 DOI: 10.1517/14740338.2011.645803] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION To date, orally administered chemotherapy and biologic agents represent a significant percentage of all antineoplastic treatments in several types of cancer, which are most likely to increase in the near future. In this scenario, the issue of adherence and persistence to oral therapy is a key issue since poor compliance to oral antineoplastic treatments may negatively influence patients' clinical outcomes and, in turn, cause an increase in costs, number of hospitalizations and time spent in the hospital. AREAS COVERED The issue of adherence to new oral chemotherapeutic and/or biologic agents has not been deeply evaluated and data published in medical literature are quite scarce. Adherence is a multidimensional phenomenon, which may be influenced by patient- and health-care provider-related factors, anticancer therapy itself, education and socioeconomic aspects. Patients' selection plays, therefore, a key role in maximizing adherence and persistence to oral therapies. Treating health-care practitioners should first evaluate patient reliability to avoid prescribing oral treatments to patients with socioeconomic and medical conditions, which may predict poor adherence. EXPERT OPINION Adherence and persistence to new oral biologic agents, which are linked to several side effects and whose use is constantly widening, should represent a main endpoint of clinical research in the nearest future.
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Affiliation(s)
- Vittorio Gebbia
- UO Oncologia Medica, La Maddalena, Università di Palermo, Palermo, Italy.
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Abstract
The advent of HER2-directed therapies has significantly improved the outlook for patients with HER2-positive early stage breast cancer. However, a significant proportion of these patients still relapse and die of breast cancer. Trials to define, refine and optimize the use of the two approved HER2-targeted agents (trastuzumab and lapatinib) in patients with HER2-positive early stage breast cancer are ongoing. In addition, promising new approaches are being developed including monoclonal antibodies and small-molecule tyrosine kinase inhibitors targeting HER2 or other HER family members, antibodies linked to cytotoxic moieties or modified to improve their immunological function, immunostimulatory peptides, and targeting the PI3K and IGF-1R pathways. Improved understanding of the HER2 signaling pathway, its relationship with other signaling pathways and mechanisms of resistance has also led to the development of rational combination therapies and to a greater insight into treatment response in patients with HER2-positive breast cancer. Based on promising results with new agents in HER2-positive advanced-stage disease, a series of large trials in the adjuvant and neoadjuvant settings are planned or ongoing. This Review focuses on current treatment for patients with HER2-positive breast cancer and aims to update practicing clinicians on likely future developments in the treatment for this disease according to ongoing clinical trials and translational research.
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Given BA, Spoelstra SL, Grant M. The challenges of oral agents as antineoplastic treatments. Semin Oncol Nurs 2011; 27:93-103. [PMID: 21514479 DOI: 10.1016/j.soncn.2011.02.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Given the increasing use of oral antineoplastic agents in cancer management, patient adherence is critical to successful treatment outcomes. This article reviews the scope of the problem and issues of adherence to oral antineoplastic agents. DATA SOURCES Research-based and other articles, newsletters, and conference presentations. CONCLUSION Suboptimal adherence to oral antineoplastic agents is a significant clinical problem that may result in disease or treatment complications, adjustment in treatment regimen, disease progression, and premature death. IMPLICATIONS FOR NURSING PRACTICE Healthcare providers need to monitor and facilitate adherence by identifying barriers and implementing strategies to assure adherence, and therefore, improve clinical outcomes.
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Affiliation(s)
- Barbara A Given
- Michigan State University, College of Nursing, East Lansing, MI 48824, USA.
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Schneider SM, Hess K, Gosselin T. Interventions to promote adherence with oral agents. Semin Oncol Nurs 2011; 27:133-41. [PMID: 21514482 DOI: 10.1016/j.soncn.2011.02.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The advent of oral therapies has dramatically changed the landscape of cancer therapy. Yet the degree to which patients actually take the prescribed agents as ordered remains unknown. This article outlines the challenges that oral chemotherapy agents present to both patients and providers and suggests interventions for promoting adherence. DATA SOURCES Published articles and web resources. CONCLUSION Barriers and facilitators to medication adherence are reviewed and interventions to promote medication adherence are presented. Strategies that include patient education and symptom management can promote adherence. IMPLICATIONS FOR NURSING PRACTICE Maximizing adherence to oral chemotherapy agents can have many positive outcomes, but most important is improvement in overall survival and life expectancy. Other outcomes include improved safety and quality of life. Patients risk improper dosing and an increase in disease recurrence when there is nonadherence with medications. Correct dosing, education, and symptom management are all critical to ensuring adherence. Nursing interventions that incorporate education, early symptom identification, and reminder prompts can improve outcomes.
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Affiliation(s)
- Susan M Schneider
- Duke University School of Nursing, DUMC 3322, Durham, NC 27710, USA.
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Spoelstra SL, Given CW. Assessment and Measurement of Adherence to Oral Antineoplastic Agents. Semin Oncol Nurs 2011; 27:116-32. [DOI: 10.1016/j.soncn.2011.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Giovannini M, Aldrighetti D, Zucchinelli P, Belli C, Villa E. Antiangiogenic strategies in breast cancer management. Crit Rev Oncol Hematol 2010; 76:13-35. [PMID: 20702105 DOI: 10.1016/j.critrevonc.2009.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 10/28/2009] [Accepted: 12/17/2009] [Indexed: 01/13/2023] Open
Abstract
Angiogenesis is considered one of the key mechanisms of tumour growth and survival. Therefore it represents an ideal pharmaceutical target. Many antiangiogenic agents have been developed so far in several solid tumours and also in breast cancer. Vascular endothelial growth factor (VEFG) is the main target and both monoclonal antibodies and small molecules belonging to the tyrosine kinase inhibitors directed against VEGF(R) have been developed. Some other therapeutic approaches have shown to exert some antiangiogenic activity, such as hormonal agents, metronomic chemotherapy, bisphosphonates and others. In this paper we provide an introduction of the current data supporting the angiogenesis in breast cancer and a review of the most relevant antiagiogenic therapies which have been investigated so far.
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Affiliation(s)
- Monica Giovannini
- Medical Oncology Unit, Oncology Dept, San Raffaele Scientific Institute-University Hospital, Milan, Italy.
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Enhancing adherence to capecitabine chemotherapy by means of multidisciplinary pharmaceutical care. Support Care Cancer 2010; 19:1009-18. [PMID: 20552377 PMCID: PMC3109264 DOI: 10.1007/s00520-010-0927-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 05/31/2010] [Indexed: 12/21/2022]
Abstract
Purpose In this prospective multi-centre observational cohort study, we investigated the effect of an intensified multidisciplinary pharmaceutical care programme on the adherence of cancer patients treated with capecitabine, a prodrug of fluorouracil. Patients and methods Twenty-four colorectal and 24 breast cancer patients participated in this study. Patients of the control group (n = 24) received standard care, patients of the intervention group (n = 24) received intensified pharmaceutical care consisting of written and spoken information. Adherence to capecitabine chemotherapy was measured using an electronic medication event monitoring system (MEMS™). Results Patients in the intervention group exhibited an enhanced but not significantly different mean overall adherence compared to the control group (97.9% vs 90.5%, p = 0.069). Mean daily adherence was significantly higher in the intervention group (96.8% vs 87.2%, p = 0.029). Variability of both adherence parameters was considerably reduced when pharmaceutical care was provided. At the end of the observation period of 126 days, the probability of still being treated with capecitabine was found to be 48% in the control group and 83% in the intervention group (p = 0.019, log-rank test). The relative risk for a deviating drug intake interval, i.e. <10 or >14 instead of 12 h, in the intervention group was found to be 0.51 (95% CI, 0.46–0.56) compared with the control group (p < 0.05, Chi-square test). Conclusions The provision of intensified pharmaceutical care can enhance adherence to and prolong treatment with capecitabine. The results underline the importance of multidisciplinary care to assure the effectiveness of oral chemotherapy.
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Partridge AH, Archer L, Kornblith AB, Gralow J, Grenier D, Perez E, Wolff AC, Wang X, Kastrissios H, Berry D, Hudis C, Winer E, Muss H. Adherence and persistence with oral adjuvant chemotherapy in older women with early-stage breast cancer in CALGB 49907: adherence companion study 60104. J Clin Oncol 2010; 28:2418-22. [PMID: 20368559 PMCID: PMC2881723 DOI: 10.1200/jco.2009.26.4671] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 01/29/2010] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Patient adherence is critical in evaluating the effectiveness of an oral therapy. We sought to measure adherence among women randomly assigned to capecitabine in a preplanned substudy of a multicenter clinical trial. PATIENTS AND METHODS Cancer and Leukemia Group B study CALGB 49907 was a randomly assigned trial comparing standard chemotherapy versus oral chemotherapy with capecitabine in patients age 65 years or older with early-stage breast cancer. We used microelectronic monitoring system (MEMS) caps on participants' capecitabine bottles to record pill bottle openings. Capecitabine was given in two divided daily doses for 14 consecutive days of a 21-day cycle for six cycles. Adherence was calculated as the number of doses taken divided by doses expected, taking into account toxicity-related dosing changes. A participant was defined as adherent if 80% or more of expected doses were recorded by MEMS. RESULTS Overall, 161 patients were enrolled. Median age was 71 years (range, 65 to 89 years); 124 patients (83%) persisted with capecitabine to completion of planned protocol therapy. Adherence was 78% across all cycles, and adherence did not vary by cycle (P = .32). Twenty-five percent of participants took fewer than 80% of expected doses and were nonadherent. In a logistic regression model, participants with node-negative disease (P = .01) and mastectomy (P = .01) were more likely to be nonadherent. Adherence was not related to age, tumor stage, or hormone receptor status. Adherence was not significantly associated with relapse-free survival or grade 3 or 4 toxicity. CONCLUSION Most older women with early-stage breast cancer were adherent to short-term oral chemotherapy in a randomized clinical trial. Age was not associated with adherence.
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Affiliation(s)
- Ann H Partridge
- Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115, USA.
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