Compliance - finding the forest amid the trees
Ive always thought that problems with patient compliance were directly correlated with the severity of illness facing a patient. OK in spite of how dizzy and nauseous my recent inner ear infection made me, I knew it wasnt life-threatening and remembering to take three antibiotic pills each day isnt the easiest thing to achieve amidst my hectic lifestyle.
Let me be the first to say, that remembering to taking one pill per day would be a distinct possibility in my more-than-full time job, one husband, two kid, two ill in-law, five pet, seemingly weekly PTA and band booster meeting-ridden life. But thinking that I will manage to take three pills daily borders on pure lunacy.
Note to pharma: find a way to limit the number of doses if adherence is the goal.
For the first few days, I did pretty well and then despite my best intentions, missing pills became easier and easier. Somewhere around day #14 of what was supposed to have been a 10-day regimen, I gave up entirely, leaving five or six pills in the bottom of the bottle.
But Ive always assumed that if I was really sick say afflicted with cancer sick Id take my medications exactly as prescribed come hell or high water.
Apparently, however, I wouldnt be any more successful at taking a truly life-saving medication than I have been with my antibiotics. The inner ear infection, by the way, is down to a tolerable roar, but Im not convinced it is gone (no surprise I would imagine, with five or six pills still in the bottle and what I did take spread out over 14 days).
But it seems even cancer patients on oral chemotherapy dont stick to their meds as they should.
People assume that if you have cancer, youre going to take your medication, but for a whole host of reasons, that may not happen, Angela DeMichele, MD, an associate professor of medicine and epidemiology at the University of Pennsylvannias Abramson Cancer Center said at the recent American Society of Clinical Oncology annual meeting. We need to recognize the reality of non-adherence and better understand how to help our patients take their medications in the most effective way.
DeMichele says when it comes to cancer medications the chief reason for poor adherence is money. Many of the medications are extremely expensive and not fully reimbursed by insurance or medicare. Side effects also are a significant problem, DeMichele reports. And education and cultural issues can be a hurdle.
Cancer survivors taking adjuvant drugs to prevent a recurrence like tamoxifen for breast cancer often tire of taking the medication, she says. Just 60-70% of patients stick with the drug regimen beyond the first two years. And adherence to drugs to prevent breast cancer is even worse around 40%.
With more and more cancers being treated with oral chemotherapy regimens, doctors must find new ways to improve adherence, DeMichele says. Behavioral interventions, such as written materials, education sessions or simplified dosing regimens show only small to modest impacts and are even less effective in the long-term, she says. But DeMichele and her colleagues believe technological interventions like cell phone programs and computerized pill boxes remain a largely untapped resource.
She points to a 2008 study in which adolescents who played a video game called Re-Mission were more adherent to their oral chemotherapy and antibiotic regimens and showed an increase in cancer-related knowledge compared to patients that did not play the game.
While text message reminders, like those used with the liver transplant patients described in todays Quick Take report (https://www.reutersevents.com/pharma/uncategorised/quick-take-text-messa...), may seem too simple to be truly effective that may be exactly their beauty. When it comes to patient compliance and adherence, it seems the simpler the better.
And take it from this parent, the beauty of text messaging is its simplicity. Im finding that my teenage daughter and I often communicate more and listen better to one another in those simple, short text message snatches than we do in face to face conversation. Minus the heavy tone or eye rolls or sighs or toe tapping that so often accompany our realtime conversations these days, the message just seems to come through clearer. Note to self: if its important and needs to be heard text first, talk later.
The same seems to be true with patients struggling to achieve adherence to their medication regimens. Keep it simple.