Patient perspectives on the barriers associated with medication adherence to oral chemotherapy

Purpose Appropriate use of oral chemotherapy is a challenge for patients and clinicians. The purpose of this study was to analyze cancer patients' use of oral chemotherapies and identify opportunities to improve adherence. Methods We developed a 30-question survey to address frequency and reasons for reducing/skipping doses; sources of information for oral chemotherapy use; perceived importance of food-drug effects; and ease of understanding labeling directions. Results Ninety-three patients taking oral chemotherapies with chronic myeloid leukemia, renal cell carcinoma, breast cancer, and colorectal cancer completed the survey. This was a well-educated population with 69% (n=62) having completed some college; 51% (n=47) female and 59% (n=54) older than 50 years of age. Thirty percent of patients reported forgetting to take their oral chemotherapy at least sometimes. Younger patients (<50 vs. 50, p=0.002), shorter treatment duration (<6 vs. 6 months p=0.03), or with chronic myeloid leukemia (vs. other diagnoses, p=0.015) forget to take their oral chemotherapy at higher rates. Twenty-three percent (n=21) indicated they intentionally skipped their oral chemotherapies and 38% (n=8) of those did not inform their physicians. Forty-one percent (n=28) taking drugs with significant food-drug effects did not think about their last meal before taking their oral chemotherapy and 80% (n=55) did not understand the potential interactions. Additionally, 39% (n=36/92) never looked at labeling and 15% (n=14/91) had difficulty understanding label directions. Conclusion There are three main barriers associated with appropriate use of oral chemotherapies: misunderstanding about the timing of drug with food; stopping drug without informing physicians; and difficulty understanding labeling directions. A multipronged approach is needed to optimize communication of directions for optimal oral chemotherapy use.