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Reminders can help patients stay on oral chemo regimen

Sunday January 13, 2013
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In a study, more than 40% of patients on oral chemotherapy initially were taking too many pills or were missing doses, with poor adherence more likely among those with complex treatment regimens.

Researchers with Michigan State University randomly assigned patients to one of three groups. Members of the first group received help from an automated calling system, developed at MSU, to determine whether they were following their prescriptions and help them monitor and manage symptoms. The second group received the automated calls and follow-up calls from nurses with strategies for sticking to their pill regimen. The rest received automated calls and nurse advice on both adhering to their regimen and managing symptoms.

Patients in all three groups reported less severe symptoms at the end of the study. The automated calls were as effective alone as they were when coupled with nurse guidance. That finding suggests the automated system could be a simple and inexpensive way to help some patients take their drugs properly, said Sandra Spoelstra, RN, PhD, the MSU assistant professor of nursing who led the study.

Chemotherapy pills can target specific cancers better than some traditional intravenous drugs, Spoelstra said. But adherence can be difficult.

"Prescriptions for some oral pills have complex instructions," Spoelstra said in a news release. "Some of them require patients to take pills several times a day or cycle their doses, taking one pill a day for three weeks, then stopping for a week before starting again. And some patients take two types of pills to treat their cancer or have multiple medications for other chronic conditions. It can be very complicated."

In addition, side effects such as severe nausea, vomiting, diarrhea, fatigue, skin reactions and pain are common. Those symptoms can lead some patients to skip doses, which may render their cancer treatment ineffective.

The small study will be the springboard for more comprehensive research that may yield clearer lessons for healthcare professionals, said Barbara Given, RN, PhD, FAAN, University Distinguished Professor at MSU, who coauthored the study and leads the College of Nursingís efforts to improve oral chemotherapy.

In the meantime, she said nurses should be attentive when explaining oral chemo regimens to ensure patients and their families understand how to take the drugs as prescribed.

"Itís cutting-edge treatment, but we donít know enough about it yet," Given said. "People think if they had a life-threatening disease and their doctor recommended treatment, theyíd follow the recommendations. But itís really not that simple."

The study appears in the January/February issue of the journal Cancer Nursing. The study abstract is available at http://journals.lww.com/cancernursingonline/Abstract/2013/01000/An_Intervention_to_Improve_Adherence_and.5.aspx.

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