Journal articles on the topic 'Research adherence'
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Ruppar, Todd M. "Medication Adherence Research." Western Journal of Nursing Research 34, no. 5 (June 25, 2012): 575–77. http://dx.doi.org/10.1177/0193945912442478.
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Zyryanov, Sergey K., Sergey B. Fitilev, Alexander V. Vozzhaev, Irina I. Shkrebniova, Natalya N. Shindryaeva, Dmitry A. Klyuev, Liusine N. Stepanyan, Nikolay N. Landyshev, and Yana G. Voronko. "Medication adherence in patients with stable coronary artery disease in primary care." Research Results in Pharmacology 6, no. 2 (June 30, 2020): 97–103. http://dx.doi.org/10.3897/rrpharmacology.6.54130.
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Introduction: Lack of research targeting non-adherence to cardiovascular medications in Russia prevents from developing effective interventions to improve adherence. The aim was to study medication adherence in patients with stable coronary artery disease in primary care. Material and methods: The study was conducted in a primary care setting of Moscow. Demography, medical history, pharmacotherapy data were obtained retrospectively from 386 coronary patients’ medical records. Medication adherence was measured by 8-item Morisky Medication Adherence Scale (MMAS-8). A statistical analysis was performed using SPSS Statistics V16.0. Results and discussion: According to the results from MMAS-8, 188 (48.7%) coronary patients had high medication adherence, 135 (35.0%) – moderate, and 63 (16.3%) – low. By the dichotomous interpretation: 48.7% (n = 188) – were adherent, 51.3% (n = 198) – were non-adherent. These groups were similar in gender distribution, age, and medical history profile (p > 0.1 for all variables). Smokers prevailed in the non-adherent group (13.6 vs. 5.3%; p = 0.009). Both groups were equally prescribed beta-blockers, antiplatelets, and statins (p > 0.1 for all). Use of fixed dose combinations (11.7 vs. 5.6%; p = 0.048) and the number of pills taken (mean 5.64 ± 1.52 vs. 5.99 ± 1.62; p = 0.029) were associated with better adherence. Higher values of total cholesterol (mean 5.2 ± 1.4 vs. 4.7 ± 1.2 mmol/L; p < 0.001) and low-density lipoprotein cholesterol (mean 2.9 ± 1.2 vs. 2.4 ± 0.9 mmol/L; p < 0.001) were revealed in non-adherents. Subjects with suboptimal adherence visited general practitioners more frequently (median 5 vs. 3 visits; p = 0,003). Conclusion: Medication non-adherence in coronary outpatients exceeded 50%. High adherence was associated with more frequent use of fixed dose combinations and fewer pills taken by patient. Smoking and poorer control of blood lipids prevailed in non-adherents, who also caused higher load on general practitioners.
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Zukin, Mauro, Marcos Coelho Simões Travassos Soares, Nathalia Fonseca Gamboa, Fabiano Hosken Pombo, and Lucyana Carvalho. "Oral chemotherapy follow up on a Brazilian private health care unit." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18311-e18311. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18311.
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e18311 Background: Oral antineoplastic therapy is a growing reality, and ensures greater comfort and better quality of life for patients. However, this modality of treatment requires greater attention of the professionals to avoid dispensing errors and to guarantee adherence to the treatment. The goal of this study is to present a method to follow up cancer patients to reduce percentage of problems related to medication and improve oral antineoplastic adherence. Methods: The study was conducted at a private oncology clinic in Rio de Janeiro during the year 2018. In the first dispensation, patients received verbal and written pharmaceutical advice on posology, proper storage, safe handling requirements and strategies to avoid adverse side effects and food and drugs interactions. There were also given nutrition, sexuality, rights and duties guidelines. To improve adherence and to avoid forgetfulness or duplicity of dosing, patients received a medication calendar. Pharmacist made dispensing, managed adverse side effects and assessed adherence of patient using a model based on Morisky Medication Adherence Scale. Patients that answered "yes" to any questions were considered non-adherents. All information was registered in medical record. Non-compliances were considered: wrong medicine, incorrect dose and delays of any administrative reason. Results: In 2018, on average 1487 dispensings were made and 1053 patients’ adherence behavior were measured. 94.37% were considered adherent. Monthly percentage of non-compliance was 1.5% of dispensings. Conclusions: The present study demonstrates that with education and pharmaceutical follow-up since the first dispensation, it is possible to guarantee a safer and more effective treatment for patients using oral cancer medication. It is imperative to maintain the objective of developing better techniques for dispensing, guiding and guaranteeing high adherence.
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Camejo, Natalia, Cecilia Castillo, Clara Tambasco, Noelia Strazzarino, Nicolás Requena, Silvina Peraza, Anna Boronat, et al. "Assessing adherence to adjuvant hormone therapy in breast cancer patients in routine clinical practice." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e12532-e12532. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e12532.
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e12532 Background: Adjuvant hormone therapy (HT) in patients with hormone receptor-positive breast cancer (BC) increases overall survival (OS). Adherence to HT in routine clinical practice is still poorly reported. Many BC patients are treated for other diseases and experience polypharmacy. Methods: Objective To assess adherence to HT in routine clinical practice.Materials and Methods: Adjuvant hormone therapy (HT) in patients with hormone receptor-positive breast cancer (BC) increases overall survival (OS). Adherence to HT in routine clinical practice is still poorly reported. Many BC patients are treated for other diseases and experience polypharmacy. Results: A total of 118 patients were included; 65.2% were treated with aromatase inhibitors (AI) and the rest with tamoxifen, with 36% presenting polypharmacy. Treatment adherence was observed in 81% of the patients, and it was associated with age (p=0.03, OR=0.96 for non-adherence), with adherent and non-adherent patients having a median age of 66 and 61.5 years, respectively; however, adherence was not associated with polypharmacy, territory of origin, marital status, living alone, level of education, occupation, or stage. The adherence profile was similar for both drugs, but homemakers and retired women showed greater adherence to AI. Conclusions: Adherence to HT was assessed in real life, with 19% of the patients not adhering to the treatment, despite the known benefit for OS, being a well-tolerated treatment, and being provided free of charge. The most adherent patients were the oldest. The results show the need to investigate the reasons for discontinuing HT, with Pharmacy and Medical Oncology fields combining efforts to develop coordinated strategies and interventions to increase adherence, given the impact that this may have on patients' OS.
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Camejo, Natalia, Cecilia Castillo, Clara Tambasco, Noelia Strazzarino, Nicolás Requena, Silvina Peraza, Anna Boronat, et al. "Assessing adherence to adjuvant hormone therapy in breast cancer patients in routine clinical practice." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e12532-e12532. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e12532.
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e12532 Background: Adjuvant hormone therapy (HT) in patients with hormone receptor-positive breast cancer (BC) increases overall survival (OS). Adherence to HT in routine clinical practice is still poorly reported. Many BC patients are treated for other diseases and experience polypharmacy. Methods: Objective To assess adherence to HT in routine clinical practice.Materials and Methods: Adjuvant hormone therapy (HT) in patients with hormone receptor-positive breast cancer (BC) increases overall survival (OS). Adherence to HT in routine clinical practice is still poorly reported. Many BC patients are treated for other diseases and experience polypharmacy. Results: A total of 118 patients were included; 65.2% were treated with aromatase inhibitors (AI) and the rest with tamoxifen, with 36% presenting polypharmacy. Treatment adherence was observed in 81% of the patients, and it was associated with age (p=0.03, OR=0.96 for non-adherence), with adherent and non-adherent patients having a median age of 66 and 61.5 years, respectively; however, adherence was not associated with polypharmacy, territory of origin, marital status, living alone, level of education, occupation, or stage. The adherence profile was similar for both drugs, but homemakers and retired women showed greater adherence to AI. Conclusions: Adherence to HT was assessed in real life, with 19% of the patients not adhering to the treatment, despite the known benefit for OS, being a well-tolerated treatment, and being provided free of charge. The most adherent patients were the oldest. The results show the need to investigate the reasons for discontinuing HT, with Pharmacy and Medical Oncology fields combining efforts to develop coordinated strategies and interventions to increase adherence, given the impact that this may have on patients' OS.
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Pilon, Dominic, Joyce Lamori, Carmine Rossi, Isabelle Ghelerter, Xuehua Ke, Marie-Hélène Lafeuille, Lorie Ellis, and Patrick Lefebvre. "Medication adherence among prostate cancer patients using advanced oral therapies." Journal of Clinical Oncology 39, no. 6_suppl (February 20, 2021): 44. http://dx.doi.org/10.1200/jco.2021.39.6_suppl.44.
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44 Background: Prostate cancer (PC) is associated with a high clinical and economic burden. Advanced oral (AO) therapies have become the standard of care for patients with advanced PC, but real-world data on treatment patterns and their impact on healthcare resource utilization (HRU) are lacking. This study aims to describe treatment adherence, factors associated with adherence, and its impact on HRU in patients with PC initiated on AOs. Methods: Adults with a PC diagnosis initiated on apalutamide, enzalutamide, or abiraterone acetate were identified using Symphony Health Solutions Patient Transactional Databases (10/01/2014-09/30/2019). Patients were included if they had ≥6 months of continuous clinical activity before and after AO initiation (index date) and no other cancer diagnoses. Adherence was defined using the proportion of days covered (PDC) by AOs during the 6-month period following the index date. Patients with a PDC≥80% were considered adherent. Multivariable logistic regression was used to evaluate baseline characteristics associated with AO adherence. All-cause and PC-related HRU was assessed from 6 to 18 months post-index and compared between adherent and non-adherent patients using multivariable Poisson regression. Results: A total of 27,322 patients initiated on an AO were identified. Most patients were aged ≥65 years (81%), were white (60%), had Medicare coverage (48%), and had metastatic PC (56%). At 6 months, 57% of patients were adherent to AOs. Patients aged 55-64 and 65-74 years had greater odds of being adherent versus those aged ≥75 years (24% and 22%, respectively), while Black patients had 17% lower odds of being adherent relative to white patients (all p<0.01). Medicare coverage was associated with 23% greater odds of being adherent relative to commercial insurance (p<0.01). Patients with a below median primary insurer paid amount for their first AO claim had 13% greater odds of being adherent relative to the above median amount (p<0.05). Adherent patients generally had fewer HRU compared to non-adherent patients. More specifically, adherent patients had 25% fewer all-cause inpatient days, 16% fewer all-cause emergency room (ER) visits, 18% fewer all-cause other non-outpatient services use, as well as 30% fewer PC-related inpatient days and 24% fewer PC-related ER visits (all p<0.01) relative to non-adherent patients. Conclusions: In this study, non-adherence over a 6-month period following AO initiation was associated with substantially higher HRU, including inpatient and ER visits. Moreover, non-adherence was widely observed, impacting over 40% of advanced PC patients in the first 6 months after AO initiation. Identifying factors linked to lower adherence and defining strategies to improve adherence may improve patient outcomes and associated medical resource utilization. (1)Abiraterone acetate plus prednisone is the approved therapy although the combination was not imposed.
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Sánchez Peña, Sara, María del Mar Pastor Bravo, Miguel Ángel Cánovas Tomás, Pilar Almansa-Martínez, Caridad Peñalver Guillen, and Ismael Jiménez-Ruiz. "Factores relacionados con la adherencia al tratamiento antirretroviral en mujeres con VIH: Un estudio mixto con diseño secuencial." Enfermería Global 20, no. 2 (April 1, 2021): 1–34. http://dx.doi.org/10.6018/eglobal.437711.
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Introducción: El VIH/Sida afecta cada vez a más mujeres. La adherencia al tratamiento antirretroviral es decisiva en la calidad de vida de las personas infectadas. Objetivos: El objetivo del estudio es determinar el grado de adherencia manifestada en un grupo de mujeres con VIH/Sida, con TAR e identificar los factores y circunstancias que influyen en su adherencia.Metodología: Se ha realizado un estudio con diseño mixto secuencial explicativo. Los sujetos de estudio son 86 mujeres diagnosticadas con VIH/Sida en tratamiento con TARGA. Resultados: Se recogieron datos cualitativos de 18 de ellas. El 59,3% de las participantes son no adherentes. Los factores determinantes de la no adherencia son el grado académico, edad, ingresos, así como factores personales, interpersonales como el apoyo sociofamiliar, estigma percibido y autoestigma y factores relativos a la enfermedad y tratamiento. Conclusión: Los cuidados de enfermería deben abordar con enfoque de género aquellos factores psicosociales e individuales del proceso de adherencia. Background: HIV/AIDS is affecting more and more women. Adherence to antiretroviral treatment (ART) is decisive for those infected to achieve quality of life. Purpose: The aim of the present study is to determine the degree of adherence displayed by a group of women with HIV/AIDS and to identify those factors and circumstances which might influence their adherence to ART. Method: A sequential mixed model research design was applied. The subjects studied consisted of 86 women diagnosed with HIV/AIDS and treated with ART. Findings and discussion: Qualitative data were collected from 18 of these women. 59.3% of participants were non-adherents. The determining factors for non-adherence were level of education, age, income, as well as personal and/or interpersonal factors such as socio-familial support, perceived stigma, self-stigma and factors related to disease and treatment. Nursing care should take a gender-focused approach towards those psychological and personal factors inherent in the adherence process.
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Mooney, Ruth A., Molly C. Dougherty, Marion Anderson, and Carolyn Murdaugh. "Adherence in Clinical Nursing Research." Western Journal of Nursing Research 11, no. 5 (October 1989): 533–47. http://dx.doi.org/10.1177/019394598901100503.
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De Geest, Sabina, Leah L. Zullig, Jacqueline Dunbar-Jacob, Dyfrig Hughes, Ira B. Wilson, and Bernard Vrijens. "Improving Medication Adherence Research Reporting." Journal of Cardiovascular Nursing 34, no. 3 (2019): 199–200. http://dx.doi.org/10.1097/jcn.0000000000000572.
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Robiner, William N. "Enhancing adherence in clinical research." Contemporary Clinical Trials 26, no. 1 (February 2005): 59–77. http://dx.doi.org/10.1016/j.cct.2004.11.015.
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Patel U, Nupur, Blake A. Moore, Rebekah F. Craver, and Steven R. Feldman. "Ethical considerations in adherence research." Patient Preference and Adherence Volume 10 (December 2016): 2429–35. http://dx.doi.org/10.2147/ppa.s117802.
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DiMatteo, M. Robin, and Kelly B. Haskard. "Further Challenges in Adherence Research." Medical Care 44, no. 4 (April 2006): 297–99. http://dx.doi.org/10.1097/01.mlr.0000214527.98190.2a.
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Karmakar, Monita, Sharrel L. Pinto, Timothy R. Jordan, Iman Mohamed, and Monica Holiday-Goodman. "Predicting Adherence to Aromatase Inhibitor Therapy among Breast Cancer Survivors: An Application of the Protection Motivation Theory." Breast Cancer: Basic and Clinical Research 11 (January 1, 2017): 117822341769452. http://dx.doi.org/10.1177/1178223417694520.
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The purpose of this observational study was to determine if the Protection Motivation Theory could predict and explain adherence to aromatase inhibitor (AI) therapy among breast cancer survivors. Purposive sampling was used to identify 288 survivors who had been prescribed AI therapy. A valid and reliable survey was mailed to survivors. A total of 145 survivors completed the survey. The Morisky scale was used to measure adherence to AI. The survivors reported a mean score of 6.84 (±0.66) on the scale. Nearly 4 in 10 survivors (38%) were non-adherent. Adherence differed by age, marital status, insurance status, income, and presence of co-morbid conditions. Self-efficacy (r=0.485), protection motivation (r=0.310), and Response Efficacy (r=0.206) were positively and significantly correlated with adherence. Response Cost (r=-0.235) was negatively correlated with adherence. The coping appraisal constructs were statistically significant predictors medication adherence (β=0.437) with self-efficacy being the strongest significant predictor of adherence (β = 0.429).
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Hershman, Dawn L., Anna Moseley, Kathryn B. Arnold, Grace Hillyer, Julie Gralow, N. Lynn Henry, Alfred I. Neugut, Scott David Ramsey, and Joseph M. Unger. "Predictive model of aromatase inhibitor non-adherence using patient-reported outcomes in women with breast cancer (SWOG S1105)." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 12019. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.12019.
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12019 Background: Non-adherence to aromatase inhibitors (AIs) for breast cancer is common and increases risk of recurrence. Few prospective studies have systematically evaluated factors associated with non-adherence. We analyzed baseline sociodemographic, prescription, and patient reported outcome (PRO) symptoms and quality-of-life to identify factors associated with non-adherence prospectively over 3-years. Methods: Patients enrolled in SWOG S1105 were required to have been on an AI for ≥30 days. Patients were assessed for non-adherence to AIs every 3 months for 36 months, with non-adherence defined as urine AI metabolite assay results satisfying any of the following: < 10 ng/mL, undetectable, specimen submitted outside of the ± 21 day follow-up appointment window, or no submitted specimen. At baseline patients were asked about insurance, pill number dispensed and medication cost, and they completed PROs focused on pain and endocrine symptoms (BPI (Brief Pain Inventory), FACT-ES (Endocrine Symptoms)), as well as their beliefs about medications (TSQM (Treatment Satisfaction Questionnaire for Medicine) and BMQ (Brief Medication Questionnaire)). PRO scales were split at the median creating high vs low binary predictors. We determined the association of baseline factors and non-adherence at 36 months. We also evaluated an adverse risk model for AI non-adherence by summing the number of statistically significant adverse factors associated with non-adherence. Logistic regression was used. Results: In total, 724 patients were registered from 40 institutions between May, 2012 and September, 2013. The median age was 60.9 years, and 64.5% were on AI < 12 months prior to registration. Overall, 35.9% were non-adherent at 36 months. Younger patients ( < 65 years) were less adherent (39% vs. 29% non-adherence, OR = 1.51, p = 0.02). Baseline scores on the BPI, FACT-ES, BMQ and TSQM were each statistically significantly associated with AI adherence. Non-adherence was significantly higher among patients scoring poorly on all 4 PRO instruments (65%) compared to those scoring poorly 0 or 1 PRO instruments (27%; OR, 4.68 [2.84-7.73], p < .0001). For each increase in the number of adverse risk PRO scores, the risk of non-adherence increased by 45% (OR = 1.45, p < .0001). Similar results were found when age was included in the score. Conclusions: Presence of multiple baseline risk factors identified through PRO instruments increases non-adherence to AI’s 4-fold. Use of PROs can identify patients for targeted interventions to improve adherence.
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Partridge, Ann H., Laura Archer, Alice B. Kornblith, Julie Gralow, Debjani Grenier, Edith Perez, Antonio C. Wolff, et al. "Adherence and Persistence With Oral Adjuvant Chemotherapy in Older Women With Early-Stage Breast Cancer in CALGB 49907: Adherence Companion Study 60104." Journal of Clinical Oncology 28, no. 14 (May 10, 2010): 2418–22. http://dx.doi.org/10.1200/jco.2009.26.4671.
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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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McLarty, Sarah, Kayla E. Friend, Neha Chadha, Santosh K. Verma, Christine Sawicki, and Kjel Andrew Johnson. "Effect of secure clinical messaging on chemotherapy adherence." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18542-e18542. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18542.
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e18542 Background: Oncologists offer essential clinical information to patients face-to-face or by phone. Today, patients commonly prefer digital communication. To test the effectiveness of this in patients, we deployed proprietary secure messaging (SM) to communicate clinical messages to patients regarding prescribed oral chemotherapy in an effort to improve adherence. Methods: Chronic myelogenous leukemia (CML) patients receiving a tyrosine kinase inhibitor (TKI) were evaluated as two groups: a test group of patients starting therapy between Jan - Jun 2018 who received SM within 45 days therapy start who received SM refill reminders, adherence, condition management, laboratory testing reminders every 30 days, and information regarding side effects, versus a control group that included propensity matched patients initiating therapy between Jan - June 2017 and who received only non-clinical text message refill reminders within 45 days of therapy start. Adherence was compared 6 months after the initial prescription. Primary outcomes were medication possession ratio (MPR) (total day supply/ [(last fill date+last fill day supply)-first fill date]), number of prescriptions filled, % of patients optimally adherent (MPR ≥ 85%), and rate of discontinuation after first fill. The secondary outcome was days of therapy. A t-test evaluated MPR and length of therapy; logistic regression compared discontinuation after first fill and % optimally adherent. Results: 478 CML patients opted into SM and 478 where in the control group. MPR improved 1.6% absolute points (93.20 control v 94.80 test, p = 0.04); no change was seen in number of prescriptions filled (5.04 control v 5.17 test, p = 0.19). More patients receiving SM were optimally adherent (83.05 control v 88.31 test, p = 0.03); discontinuation after first fill was unchanged (6.90 control v 6.49 test, p = 0.79), as were days of therapy (156.51 control v 159.22 test), p = 0.35). Conclusions: Patients initiated on TKI therapy with receiving clinical SM had significantly higher adherence than the control group and were more likely to be optimally adherent, despite the high adherence rates of CML patients at baseline. Further analysis is needed to understand the durability of this adherence improvement.
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Monestime, Shanada, Ray D. Page, William M. Jordan, Subhash Aryal, and Rafia Rasu. "Factors associated with oral chemotherapy adherence in specialty pharmacies." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19137-e19137. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19137.
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e19137 Background: Specialty pharmacies are expanding in the oncology setting and often favored by payors because of economic and operational benefits. However, challenges exist in coordination of care, patient safety, cost/reimbursement, and operational efficiency. While in-house specialty pharmacies mitigate these challenges due to close proximity of health care providers, these challenges can impact medication adherence. To date, limited data are available on adherence rates and factors associated with oral chemotherapy (OC) adherence in specialty pharmacy settings. Methods: Adult cancer patients who received their first OC between Aug.-Oct. 2018 were analyzed. Pharmacies were contacted to obtain OC pick-up dates over 6 months or until treatment completion. Patients were adherent if the proportion of days covered (PDC) was ≥90%. Descriptive and bivariate logistic regression models were performed to examine demographics, specialty pharmacy type (external vs. internal), distance from pharmacy to home, and chronic comorbidities. Results: Of the 80 patients analyzed, the mean age was 63.59 (SD ±11.8), 51.21% were female, 68.75% were white, 61.25% were married, 82.50% were smokers, 53.75% were on government insurance, 73.75% were using an internal pharmacy, and the mean distance traveled to pharmacy was 17.06 miles (SD±22.66). Thirty-five patients (43.75%) were adherent (mean PDC = 78%, range, 17-100%). Patients who went to an internal pharmacy were 1.81 times likely to be adherent than those who went to an external pharmacy [OR: 1.81, 95% CI (0.64- 5.11)]. We found that males were 1.21 times more likely to be adherent than females [OR: 1.21, 95% CI (0.50- 2.93)] and smokers were 2.21 times more likely to be adherent than non-smokers [OR: 2.21, 95% CI (0.63-7.78)]. Multiple chronic conditions were significantly associated with a decrease in OC adherence, even after controlling for covariates [OR: 0.66, 95% CI (0.66- 0.95); p = 0.02]. Conclusions: Patients with fewer comorbidities receiving OC from specialty pharmacies were significantly more adherent than those with multiple comorbidities. Further studies examining the impact financial toxicity has on adherence for patients with chronic conditions are warranted.
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Wolter, Pascal, Tine Hendrickx, Vincent Renard, Jeroen Mebis, Philip R. Debruyne, Wim Wynendaele, Denis C. C. Schallier, et al. "Adherence to oral anticancer drugs (OAD) in patients (pts) with metastatic renal cancer (mRCC): First results of the prospective observational multicenter IPSOC study (Investigating Patient Satisfaction with Oral Anti-cancer Treatment)." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 4622. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.4622.
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4622 Background: Patient adherence to oral therapy is a critical issue in cancer treatment. The aim of this study is to investigate the prevalence and severity of non-adherence to OAD in mRCC and to identify factors predictive of non-adherence. Methods: Prospective observational multicenter trial performed at 11 Belgian academic and non-academic centers. All pts with mRCC starting OADs (sunitinib, pazopanib, everolimus or sorafenib) are eligible for the study. Pts are contacted by phone at baseline and at 1, 3, 6 and 12 months. At each contact, pts are asked to complete questionnaires investigating 1) medication adherence (MMAS), 2) patient satisfaction with treatment (CTSQ) and with treatment education (PS-CaTE), 3) the extent of information desire (EID), 4) quality of life (FACT-G and FKSI) and 5) the role of the pharmacist (SWiP). Adherence is measured using an electronic medication event monitoring system (MEMS, Aardex). Results: Between 02/2011 and 11/2011, 49 pts (m: 33, f: 16) with a median age of 63 years (range 25 - 87) have participated in the IPSOC study. Twenty-nine pts (64%) were treated with an OAD in first-line, 15 pts (33%) in second-line. With a median follow-up of 131 days (range 2 - 313) 45 pts (92%) claimed to be fully adherent to their treatment (based on MMAS and CTSQ data). Four patients indicated to have missed at least one dose, of whom two indicated they occasionally forgot their medication and two others interrupted treatment because of side effects. Based on MEMS data, mean adherence, defined as the percentage of days with at least the prescribed number of dosage taken, was 98.91%. Conclusions: The IPSOC study, the first to examine adherence to OAD among mRCC pts, shows that mRCC pts are almost fully adherent to treatment recommendations. This seems to be in contrast to adherence data for other, long-lasting, anti-cancer treatments. Further investigations will focus on the question whether extensive counseling and participation in side-effect programs contribute to the high percentage of adherence in this study.
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Hoppmann, Anna Lynn, Torrey Hill, Yanjun Chen, Wendy Landier, Lindsey Hageman, William E. Evans, Anne L. Angiolillo, et al. "Measuring mercaptopurine (6MP) adherence using red cell 6MP metabolite levels in children with acute lymphoblastic leukemia (ALL): A COG AALL03N1 study." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 10514. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.10514.
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10514 Background: Non-adherence to 6MP (monitored with medication event monitoring system [MEMs]) is associated with an increased risk of relapse in children with ALL.(JAMA Oncol, 2015) Self-report over-estimates true medication intake, particularly in non-adherent patients.(Blood, 2017) However, monitoring adherence using MEMs is logistically difficult. We investigated whether red cell 6MP metabolite levels (thioguanine nucleotide [TGN] and methylated mercaptopurine [MMP]) taken together, could identify non-adherent patients. Methods: The analysis included children with ALL in maintenance. To minimize variability in TGN and MMP levels due to pharmacogenetics, we excluded TPMT heterozygotes and homozygote mutants. We also excluded Asians to remove variability due to NUDT15. TGN and MMP levels were drawn at 6 consecutive monthly time points for each patient and averaged. TGN and MMP levels (pmol/8 x 108red cells) were standardized, adjusted for 6MP dose intensity, and then analyzed using cluster analysis (Spath, H. [1980]). Results: The 373 patients eligible for analysis yielded 5 clusters. Cluster #1 (n = 119; mean MMP: 15,656; mean TGN: 158); Cluster #2 (n = 211; MMP: 6,042; TGN: 135); and 3 very small outlying clusters (total N = 43). Adjusting for age, sex, race/ethnicity, cytogenetics and NCI risk, we found that patients in Cluster #2 were 2.6 times as likely to be non-adherent (MEMs-based adherence < 95%) compared to Cluster #1 (95% CI 1.5-4.4; P= 0.0007). Mean MEMs-based adherence was significantly higher for patients in Cluster #1 (94.3%) when compared to those in Cluster #2 (87.8%, p = 0.0002). Using Fine-Gray proportional subdistribution hazards models for competing risks and adjusting for clinical and sociodemographic factors, we found that patients in Cluster #2 were at a 2.3-fold higher risk of relapse compared with those in Cluster #1 (95%CI, 1.0-6.4, p = 0.058). Conclusions: These findings illustrate the potential for using a combination of red cell TGN and MMP levels in identifying non-adherent patients. We propose to use these and clinical and demographic factors associated with non-adherence in creating an adherence calculator.
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Ginex, Pamela, Haya Waseem, Kapeena Sivakumaran, Sarah Lagler-Clark, Nicole Palmer, Tejanth Pasumarthi, Kristine B. LeFebvre, Gina Degennaro, Paula T. Rieger, and Rebecca L. Morgan. "Technology interventions to support adherence to oral oncolytic agents: A systematic review and meta-analysis." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 320. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.320.
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320 Background: The increase in patients receiving oral oncolytics requires oncology health care professionals to have processes and interventions that support patient adherence. Because adherence to oral oncolytics is a priority for achieving optimal outcomes, the ASCO QOPI Standards emphasize the need to assess for adherence at meaningful intervals as well as implement interventions to promote adherence. Technology-based interventions have the potential to assess and support adherence. The objective of this review is to evaluate the overall effect of any technology-based intervention, as well as compare the use of interactive technology rather than non-interactive technology to improve oral oncolytic adherence. This review will serve as the evidence base for a clinical practice guideline on oral oncolytic adherence. Methods: A medical librarian searched EMBASE, PubMed, and CINAHL for comparative studies published in English from January 2000 to May 2021. Two reviewers screened titles and abstracts, and eligible full text articles independently and in duplicate using Covidence. When possible, quantitative findings were pooled in a meta-analysis. Risk of bias assessment for randomized controlled trials was done using the Cochrane Collaboration risk-of-bias 2.0 tool and for observational studies, the ROBINS-I instrument was used. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Results: Out of 663 studies, we identified 14 as eligible for analysis. Of the six RCTs (n = 737) that compared any technological intervention to no intervention, there was some heterogeneity across interventions (e.g., text messaging, mobile app, computer program) and reported outcome measures for adherence, including adherence rates, relative dose intensity (RDI), and number of weeks adherent. Patients using any technology rather than no technology may have higher adherence rates (MD: 8.81; 95% CI: 3.82, 13.81); however, there may be little effect on RDI (MD: -0.01; 95% CI: -0.04, 0.02) and number of weeks adherent (MD: -0.70; 95% CI: -1.96, 0.56), respectively. One RCT (n = 444) reported on adolescents receiving interactive and non-interactive interventions. There may be little effect on adherence rates among patients receiving interactive technology interventions rather than non-interactive education intervention (MD: 1.5; 95% CI, −0.2, 3.2). Conclusions: Better systems of oral oncolytic care are needed to support patients and their caregivers. Technology-based interventions may improve medication adherence in cancer patients on oral oncolytics; however, we are uncertain about the impact on other measure of adherence or the superiority of interactive rather than non-interactive technology interventions. Due to inconsistency in the evidence, additional research in this area is recommended.
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Childs, Daniel, and Aminah Jatoi. "Adherence to anti-emetic guidelines with a newly approved chemotherapy agent, trifluridine/tipiracil (TAS-102): A single-institution study." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 221. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.221.
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221 Background: To our knowledge, no study has examined adherence to antiemetic guidelines with soon-to-be-approved or newly approved chemotherapy agents. In 2015, the Food and Drug Administration approved 18 cancer drugs, underscoring the timeliness of this topic. Here, we hypothesize that patients prescribed new drugs are at risk for poor guideline adherence, and we report on antiemetic prescribing practices and outcomes with TAS-102, a recently approved drug for metastatic colorectal cancer. Methods: This study focused on all patients prescribed TAS-102 in 2015 at the Mayo Clinic in Rochester, MN for compassionate use or routine care within 3 months of FDA approval. First-cycle antiemetic prophylaxis was examined for adherence to National Comprehensive Cancer Network Guidelines, version 1.2015, for chemotherapy of low emetogenic potential based on TAS-102 phase 3 data. Results: Among 44 patients, 28 (64%) had nausea and vomiting with prior chemotherapy. With the first cycle of TAS-102, 25 (57%) were prescribed antiemetics in a guideline-adherent manner; 15 (34%) in a non-guideline-adherent/more aggressive manner; and 4 (9%) in a non-guideline-adherent/less aggressive manner. In guideline-adherent patients, rates of nausea and vomiting were 52% and 24%, respectively, with one patient requiring an unscheduled clinic visit and another an emergency department visit and hospital admission - all for nausea and vomiting. In non-guideline-adherent/more aggressive patients (who received more prophylaxis than called for), these rates were 33% and 27%, respectively, with one patient requiring a clinic visit and emergency department visit and another an emergency department visit. In non-guideline-adherent/less aggressive patients, no nausea or vomiting was reported. Conclusions: Poor adherence to antiemetic guidelines occurred often. However, because adherence was not associated with better control of nausea and vomiting, clinical judgment should complement guidelines in patients about to receive new cancer drugs, particularly with drugs of low emetogenic potential and also in patients with a history of chemotherapy-induced nausea and vomiting.
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John, Ani K., Baiyu Yang, and Roma Shah. "Impact of adherence to National Comprehensive Cancer Network (NCCN)-recommended first-line therapy on treatment duration for patients with advanced non-squamous non-small cell lung cancer (NSCLC)." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e21727-e21727. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e21727.
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e21727 Background: Identification of molecular alterations can provide essential information to guide personalized treatment selection for advanced non-small cell lung cancer (aNSCLC) patients. However, in routine oncology practice, not all eligible patients receive biomarker testing and receive treatment according to the testing results following the National Comprehensive Cancer Network (NCCN) guideline. We aim to examine the impact of adherence to guideline-recommended therapy on the duration of treatment in a real-world setting. Methods: Patients diagnosed with non-squamous aNSCLC (stage IIIB and above) and received the first-line of therapy (FLOT) between 2011 and 2019 from the nationwide Flatiron Health electronic health record-derived de-identified database were included in this analysis. Adherence was defined as using any NCCN guideline-recommended FLOT consistent with a patient’s biomarker testing results (EGFR, ALK, ROS1, BRAF and PD-L1) assessed up to 90 days before and/or 14 days after the FLOT start date. Non-adherence was defined as not receiving guideline-recommended FLOT based on the above-mentioned biomarker results, or patients treated without evidence of biomarker testing. Median time to treatment discontinuation (TTD) of FLOT was calculated using Kaplan-Meier analysis. Unadjusted and adjusted Cox proportional hazards regression models were used to evaluate the association between guideline adherence and TTD. Results: A total of 17,137 eligible patients were included (67.5% adherent, 32.5% non-adherent). Mean age at diagnosis was 67 years (SD: 10 years). The majority of patients (92%) received care at a community clinic, and 73% reported having insurance plans. Overall, 87.2% had discontinuation of FLOT, including 84.9% in the adherent group and 92.0% in the non-adherent group. The median TTD was 155 days (95% CI 153-159) in the adherent group and 128 days (95% CI 125-132) in the non-adherent group. Adherent patients had a lower risk of FLOT discontinuation in the unadjusted analysis (hazard ratio [HR] 0.78, 95% CI 0.76-0.81), which remained significant after adjusting for potential confounders including age at FLOT start, sex, history of smoking, and stage at initial diagnosis (HR 0.76, 95% CI 0.74-0.79). Conclusions: Among non-squamous aNSCLC patients, the majority of patients were adherent to NCCN guidelines. Adherence was associated with lower risk of discontinuation and longer duration of FLOT.
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De Geest, Sabina, Leah L. Zullig, Jacqueline Dunbar-Jacob, Dyfrig Hughes, Ira B. Wilson, and Bernard Vrijens. "Improving medication adherence research reporting: ESPACOMP Medication Adherence Reporting Guideline (EMERGE)." European Journal of Cardiovascular Nursing 18, no. 4 (February 10, 2019): 258–59. http://dx.doi.org/10.1177/1474515119830298.
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Permatananda, Pande Ayu Naya, Putu Indah Budi Apsari, and Saktivi Harkitasari. "MEDICATION ADHERENCE AND QUALITY OF LIFE AMONG EPILEPSY PATIENTS: A CROSS SECTIONAL STUDY." International Journal of Research -GRANTHAALAYAH 7, no. 3 (March 31, 2019): 1–10. http://dx.doi.org/10.29121/granthaalayah.v7.i3.2019.937.
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Background: Among the cause of the treatment failure in epilepsy, low adherence to prescribed medication is the principal cause of unsuccessful drug treatment. The aim of this study was to assess the level of adherence and the relations with quality of life among epilepsy patients in Denpasar.
Method: Our research based on cross sectional design and conducted in neurology department of tertiary referral hospital in Denpasar. We used Morisky Medication Adherence Scale (MMAS) to measure level of adherence and World Health Organization (WHOQOL-BREF) questionnaire to assess quality of life (QOL) score.
Results: On this research, we found 83 epilepsy patients who fulfilled eligibility criteria, there are 43 patients categorized as non-adherent and 39 patients belong to adherent. Based on the cross tabulation between characteristic of participants and adherence, we found that age and duration of therapy influence the adherence level of epilepsy patient (p value < 0.05). Epilepsy patients who adherent to the treatment have higher score of QOL than epilepsy patients who not adherent, especially on physical domain of QOL, the difference was statistically significant (p value < 0.05).
Conclusion: Improving adherence is so important to improve the quality of life of epilepsy patients.
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Permatananda, PandeAyuNaya, Putu Indah Budi Apsari, and SaktiviHarkitasari. "MEDICATION ADHERENCE AND QUALITY OF LIFE AMONG EPILEPSY PATIENTS: A CROSS SECTIONAL STUDY." International Journal of Research -GRANTHAALAYAH 7, no. 4 (April 30, 2019): 1–10. http://dx.doi.org/10.29121/granthaalayah.v7.i5.2019.865.
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Background: Among the cause of the treatment failure in epilepsy, low adherence to prescribed medication is the principal cause of unsuccessful drug treatment. The aim of this study was to assess the level of adherence and the relations with quality of life among epilepsy patients in Denpasar.
Method: Our research based on cross sectional design and conducted in neurology department of tertiary referral hospital in Denpasar. We used Morisky Medication Adherence Scale (MMAS) to measure level of adherence and World Health Organization (WHOQOL-BREF) questionnaire to assess quality of life (QOL) score.
Results: On this research, we found 83 epilepsy patients who fulfilled eligibility criteria, there are 43 patients categorized as non-adherent and 39 patients belong to adherent. Based on the cross tabulation between characteristic of participants and adherence, we found that age and duration of therapy influence the adherence level of epilepsy patient (p value < 0.05). Epilepsy patients who adherent to the treatment have higher score of QOL than epilepsy patients who not adherent, especially on physical domain of QOL, the difference was statistically significant (p value < 0.05).
Conclusion: Improving adherence is so important to improve the quality of life of epilepsy patients.
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O'Neill, Tyler J., Vishakha Sharma, Athanasios Siadimas, Amir Babaeian, and Gayathri Yerrapragada. "Machine learning to predict tamoxifen adherence among U.S. commercially insured breast cancer patients." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 276. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.276.
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276 Background: Adherence to tamoxifen among women diagnosed with hormone receptor positive metastatic breast cancer (mBC) can improve survival and minimize recurrence. Screening for non-adherence at treatment initiation may support personalized care, improve health outcomes, and minimize cost of care. This study aimed to use real world data (RWD) and machine learning (ML) methods to classify tamoxifen non-adherence. Methods: A cohort of women diagnosed with incident mBC from 2012 to 2018 were identified from Truven MarketScan Commercial Claims and Encounters and Medicare supplemental administrative claims databases. Patients with < 80% proportion of days coverage (PDC) in the year following treatment initiation were classified non-adherent. Training and internal validation cohorts were randomly generated (4:1 ratio). Clinical procedures, comorbidity, treatment and healthcare encounter features in the year prior to treatment initiation were used to train logistic regression, boosted logistic regression, random forest, and feed forward neural network models and internally validated based on area under receiver operating characteristic (AUROC) curve. The most predictive ML approach was evaluated to assess feature importance. Results: A total of 3,022 patients were included with 39.9% classified as non-adherent. All ML models had moderate predictive accuracy. Logistic regression (AUROC 0.64) was easily interpreted with sensitivity 94% (95% confidence interval [CI]: 0.89, 0.92) and specificity 0.31 (95% CI: 0.29, 0.33). The model accurately classified adherence (negative predictive value 88.7%) but was non-discriminate for non-adherence (positive predictive value 47.7%). Variable importance identified top predictive factors, including patient features (≥55 years old) and pre-treatment procedures (lymphatic nuclear medicine, radiation oncology, arterial surgery). Conclusions: ML using baseline administrative data predicts tamoxifen adherence. Baseline claims may not be sufficient to predict treatment non-adherence. Further validation with enriched longitudinal data may improve model performance for incorporation of predictions into clinical decision support.
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Lama, Angshu, and Arunjyoti Barauah. "Medication Adherence and its Association with Subjective Well Being among Persons with Schizophrenia: A Descriptive Trial from Assam." Nursing Journal of India CVIII, no. 03 (2022): 99–102. http://dx.doi.org/10.48029/nji.2017.cviii301.
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Medicationnon-adherence has been associated with persistence of psychotic symptoms, relapse, and hospitalisation inpatientswithschizophrenia. Adherenceto antipsychotic drug treatment is a key issue for nurses and treatment team members caring forpatientswho typically are on chronic, progressive disease course. The study was conducted at LGB Regional Institute of Mental Health, Tezpur, Assam to assess the medication adherence and its association with subjective well-being. Descriptive research design was opted for the present study with 85 samples selected by using convenience sampling technique. Semi-structured interview technique was used to collect the data. Descriptive and inferential statistics were used to analyse the obtained data. Results showed that 34.1 percent patients were not adherent to medication. Significant association was found between the Subjective well-being and Medication Adherence at 0.05 level of significance. Significant association was also found between the medication adherence and Inadequate Mental Mastery Factor (Factor 8) of Subjective well-being at 0.02 level of significance.
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Salmasi, S., A. Kelly, S. J. Bartlett, M. De Wit, L. March, A. Tong, P. Tugwell, K. Tymms, S. Verstappen, and M. De Vera. "THU0565 RESEARCHERS’ PERSPECTIVES ON ADHERENCE INTERVENTION RESEARCH AND OUTCOMES IN RHEUMATOLOGY: AN INTERNATIONAL QUALITATIVE STUDY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 524.2–524. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4787.
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Background:Medication non-adherence is a significant problem among patients with rheumatic diseases. Research on adherence interventions in rheumatology is limited and disappointing, with studies using heterogeneous outcomes. Understanding these limitations is needed to inform the design of better interventions and research studies.Objectives:To describe researchers’ perspectives and experiences on adherence intervention research and outcomes in rheumatology.Methods:Semi-structured interviews using video conference were conducted with researchers who had been an investigator on an adherence study of any design in the past 10 years. Interviews were recorded and transcribed verbatim. Participants were asked about their experiences with conducting adherence research and perspectives on introduction of a core domain set of outcomes for adherence intervention trials in rheumatology. Data collection and thematic analysis were conducted iteratively, until saturation.Results:We interviewed 13 researchers from seven countries (Australia, Belgium, Canada, Netherland, Thailand, UK, and USA). A majority worked in academia (75%), specialized in epidemiology and/or health services research (62%) and had led between 2-5 adherence studies in the past five years (62%).Three themes were identified:1) challenges in designing, conducting and evaluating adherence studies;2) current outcomes in adherence intervention studies and their relevance; and3) implementing a core domain set of outcomes for adherence intervention studies.Major challenges in conducting adherence research included inconsistent adherence terminology and measurement. Participants noted a lack of guidance on outcome selection and measurement when evaluating the effectiveness of an adherence intervention and indicated their preference for research to report adherence, intervention-specific, and health-related outcomes. Finally, implementing a core domain set of outcomes was thought to be challenging but valuable in strengthening the evidence (by facilitating meta-analysis), and improving clinical outcomes (by informing clinicians about the effectiveness of interventions).Conclusion:Adherence research in rheumatology has been hindered by lack of standardization and guidance on terminology, measurement and outcome selection. Our findings form the basis for recommendations for improving the design, conduct and evaluation of adherence intervention studies in rheumatology, particularly for developing a core domain set of outcomes to improve consistency and facilitate comparisons.Table 1.Themes and representative quotations.Theme 1: Challenges in designing, conducting and evaluating studies of adherence interventions“…the people you often most want in your sample are the people who are non-adherent and often the people who are non-adherent are the people who are hardest to recruit.”“Long term the issue has been about measurements because people confuse and conflate various aspects of medication adherence.Theme 2: Current outcomes in adherence intervention studies and their relevance“you have a whole range of outcomes…psychological outcomes…there’s measures of health care utilization and things like attendance at hospital, nurse appointments and duration, things like times off work,, and also all the relevant clinical outcomes.”Theme 3: Implementing a core domain set of outcomes for adherence intervention studies“…will make trials more comparable and increase the likelihood that you’d be able to combine efforts internationally”Disclosure of Interests:Shahrzad Salmasi: None declared, Ayano Kelly: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Maarten de Wit Grant/research support from: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Consultant of: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Speakers bureau: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Lyn March: None declared, Allison Tong: None declared, Peter Tugwell: None declared, Kathleen Tymms: None declared, Suzanne Verstappen Grant/research support from: BMS, Consultant of: Celltrion, Speakers bureau: Pfizer, Mary De Vera: None declared
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Stokes, Michael Edward, Hans-Peter Goertz, Veronica Alas, Carolina Reyes, Elyse Gatt, and Luke Boulanger. "Impact of pharmacy channel on prescription abandonment and adherence to oral oncolytics." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6546. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6546.
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6546 Background: Oral chemotherapy is increasingly prescribed to treat cancer. Despite benefits such as convenience of use, concerns have been raised regarding adherence to therapy. The objective was to compare and measure rates of adherence and abandonment in patients filling prescriptions in traditional retail versus specialty pharmacy channels. Methods: Using a retrospective cohort design, we selected patients aged ≥18 years with a prescription for erlotinib, capecitabine, or imatinib during 2007-2011 from a Medco population of both U.S. commercial and Medicare health plans. Patients were classified according to the initial oral oncolytic received and the pharmacy channel providing the medication. Abandonment was defined as a reversal following the initial approval of the prescription claim with no additional paid claims for the agent within 90 days of reversal. Adherence was defined as the proportion of days covered between the date of the first and last oral prescription. Patients were classified as adherent if the proportion of days covered was ≥80%. Unadjusted comparisons of adherence and abandonment measures were assessed using chi-square tests. Logistic regression models adjusted for baseline characteristics were used to examine the impact of pharmacy channel on abandonment and adherence. Results: Among patients treated with an oral oncolytic, 15,071 were prescribed erlotinib, 20,062 were prescribed capecitabine and 7,233 were prescribed imatinib. For all study cohorts, Medco specialty channel had the highest proportion of adherent patients compared with traditional retail (erlotinib 84% vs. 80%, capecitabine 63% vs. 35%, and imatinib 72% vs. 67%, P<.001 all comparisons). Abandonment of the initial prescription was low with overall rates of 1.9%, 1.6%, and 1.2% for erlotinib, capecitabine, and imatinib, respectively. In multivariate models, specialty channel was significantly associated with lower abandonment and increased adherence for each cohort. Conclusions: Pharmacy channel appears to be influential on abandonment and adherence. Lower rates of abandonment and higher rates of adherence were observed among specialty pharmacy patients compared with traditional retail.
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Dinan, Michaela Ann, Lauren E. Wilson, Melissa A. Greiner, Lisa Spees, Jessica Pritchard, Tian Zhang, Deborah Kaye, Daniel J. George, Charles D. Scales, and Stephanie B. Wheeler. "Oral anticancer agent (OAA) adherence and survival in elderly patients with metastatic renal cell carcinoma (mRCC)." Journal of Clinical Oncology 39, no. 6_suppl (February 20, 2021): 280. http://dx.doi.org/10.1200/jco.2021.39.6_suppl.280.
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280 Background: Multiple effective oral anticancer agents (OAAs) are now approved for the treatment of patients with advanced or metastatic renal cell carcinoma (mRCC) based on improvement in overall and progression-free survival in randomized clinical trials. However, real-world adherence and outcomes associated with OAA use in the general mRCC patient population have not been previously investigated. Methods: Retrospective analysis of SEER-Medicare patients with mRCC who received treatment with an OAA between 2007 and 2015. Adherence was assessed as proportion of days covered (PDC) within 3 months of OAA initiation with PDC > 50% categorized as adherent. The impact of initial OAA adherence on overall and disease-specific survival was analyzed landmarked at 3 months after OAA initiation. Results: A total of 905 patients met study criteria, of which 577 (63.8%) were categorized as adherent to initial OAA treatment. Multivariable analysis adjusting for clinical and demographic factors revealed that living within an impoverished neighborhood was associated with a 20% lower likelihood of adherence (OR 0.80, CI 0.68 – 0.93). No association was observed between adherence and race, ethnicity, marital status, or number of comorbidities. In survival analyses OAA adherence was associated with a significant reduction in both overall (HR 0.71, CI 0.58 – 0.87) and RCC-specific mortality (HR 0.68, CI 0.57 – 0.86). Receipt of sunitinib was associated with a significant reduction in overall and disease specific mortality compared with sorafenib. Post-hoc analysis of patients taking pazopanib as their initial OAA (N = 252) demonstrated reduced all-cause mortality if they received the minimum effective dose of 800 mg daily (HR 0.50, CI 0.35 – 0.72) and decreased adherence associated with initial higher out-of-pocket payments (χ2 test, p = 0.003). Conclusions: Socioeconomic factors predict poor adherence to OAA therapy in Medicare beneficiaries with metastatic RCC, which is in turn associated with poor overall and disease-specific survival. Efforts to improve outcomes and mitigate disparities in the general mRCC population should incorporate considerations of OAA adherence and economic factors. Sunitinib and pazopanib appear associated with favorable survival and remain the most commonly used OAAs in this over 65 year old patient population.
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Mathew, Jesna, Sasha Slipak, Anil Kotru, Joseph Blansfield, Nicole Woll, and Mohsen Shabahang. "Adherence to the BCLC guidelines and impact on overall survival." Journal of Clinical Oncology 32, no. 3_suppl (January 20, 2014): 345. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.345.
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345 Background: Multiple studies exist that validate the prognostic value of the Barcelona Clinic Liver Cancer (BCLC) staging. However, none have established a survival benefit to the treatment recommendations. The aim of this study was to evaluate the adherence to the BCLC guidelines at a rural tertiary care center, and to determine the effect of following the treatment recommendations on overall survival. Methods: A retrospective chart review was conducted for 97 patients newly diagnosed with hepatocellular carcinoma (HCC) from 2000 to 2012. The treatment choice was compared with the BCLC guidelines and percentage adherence calculated. Overall survival was estimated using the Kaplan-Meier method and the log rank test was used to test the difference between the two groups. Cox regression tests were used to determine independent effects of stage, treatment aggressiveness, and guideline adherence on survival. A p-value <0.05 was considered statistically significant. Results: Of 97 patients, 75% (n=73) were male. Median overall survival was 12.9 months. In 59.8% (n=58) of the patients, treatment was adherent to stage specific guidelines proposed by the BCLC classification. There was no significant difference in overall survival between the adherent and non-adherent groups (11.2 vs 14.1 months, p<0.98). However on stage specific survival analysis, we noted a significant survival benefit for adherence to the guidelines for early stage HCC (27.9 vs 14.1 months, p<0.05), but a decrease in survival for adherence in the end stage (20 days vs 9.3 months, p<0.01). On univariate analysis, more aggressive treatment was associated with increased survival (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.22 to 0.87; p = 0.018). Multivariate analysis revealed that adherence did not independently affect survival when stage and aggressiveness of treatment were included in the model (HR, 1.3; 95% CI, 0.76 to 2.2, p = 0.34). Conclusions: Although the BCLC guidelines serve as a practical guide to the management of patients with HCC, they are not universally practiced. These results indicate that survival of patients with hepatocellular cancer is determined by stage and aggressiveness of treatment, not adherence to BCLC guidelines.
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DeClercq, Josh, and Leena Choi. "Statistical considerations for medication adherence research." Current Medical Research and Opinion 36, no. 9 (July 22, 2020): 1549–57. http://dx.doi.org/10.1080/03007995.2020.1793312.
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Stirratt, Michael J., and Christopher M. Gordon. "HIV Treatment Adherence Research and Intervention." Journal of HIV/AIDS & Social Services 6, no. 1-2 (March 27, 2007): 9–22. http://dx.doi.org/10.1300/j187v06n01_02.
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Bhatia, Smita, Lindsey Hageman, Yanjun Chen, Florence Lennie Wong, Leo Mascarenhas, David Robert Freyer, Nkechi Mba, et al. "A randomized trial of a mercaptopurine (6MP) adherence-enhancing intervention in children with acute lymphoblastic leukemia (ALL): A COG ACCL1033 study." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 10007. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.10007.
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10007 Background: We previously reported that > 40% of children with ALL are non-adherent to 6MP, and > 52% of ALL relapses are attributable to 6MP non-adherence. The most common barrier is forgetting to take 6MP; the most common facilitator is parental vigilance. These observations informed a randomized trial to enhance 6MP adherence (COG-ACCL1033, #NCT01503632; 89 COG sites). Results are described here. Methods: The Intervention Package (IP) consisted of: i) Education; ii) 6MP schedules; iii) daily personalized text message reminders from physician to patient and caregiver, to prompt iv) directly supervised therapy (DST), with text back response by patient/caregiver. Baseline adherence was measured for 4 wks, followed by intervention for 16 wks to examine the impact of IP vs. Edu (education) on 6MP adherence (measured electronically by MEMs Cap) in all patients, ≥12yo, < 12yo. Longitudinal binomial logistic regression using generalized estimating equations was used. Missing data were handled by multiple imputation. Results: 444 patients were randomly assigned to IP (n = 230) or Edu (n = 214). Baseline characteristics (age at study: 8.6y vs 7.5y; males: 67% vs 69%; non-Hispanic whites: 40% vs 42%) and adherence rates (92% vs 94%) were comparable (except paternal education: 49% vs 38%, p = 0.04). No study arm*time interaction was found; thus, the 16-week overall mean fitted adherence rates were compared between IP and Edu, adjusting for baseline adherence, time on study, parental education. All patients: Adherence rates were marginally higher on IP (94% vs 92.5%, p = 0.09). On IP, for times with a record of text response, adherence rates were higher (94%) when compared with times with no response (89%), p = 0.002. < 12yo: Adherence rates were comparable (IP: 94.4% vs Edu: 93.7%, p = 0.5). ≥12yo: Adherence rates were significantly higher on IP (93.1% vs 90.0%, p = 0.037). ≥12yo with baseline adherence < 90%: IP had the highest impact for this subgroup (83.4% vs 74.6%, p = 0.008). Conclusions: A 16-week comprehensive intervention resulted in higher 6MP adherence rates in children with ALL who were 12y or older at study. IP was most impactful in adolescents with baseline non-adherence. Clinical trial information: #NCT01503632.
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Kartashov, Alex, Thomas E. Delea, and Puza P. Sharma. "Retrospective study of predictors and consequences of nonadherence with lapatinib (LAP) in women with metastatic breast cancer (MBC) who were previously treated with trastuzumab." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e11067-e11067. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e11067.
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e11067 Background: LAP, an oral small molecule dual tyrosine kinase inhibitor has been shown to improve time to progression in combination with capecitabine vs. capecitabine alone in women with HER2+ MBC previously treated with trastuzumab, an anthracycline, and taxanes. Data on adherence, persistence, predictors and consequences of non-adherence with LAP in typical clinical practice are scarce. Methods: This was retrospective observational study of predictors and consequences of non-adherence with LAP in women with MBC who were previously treated with trastuzumab using Thomson MedStat MarketScan® Commercial and Medicare claims databases covering 80 million lives. Measures of LAP adherence were calculated from information on pharmacy claims and included medication possession ratio (MPR) and time to first treatment interruption (gap during treatment of 30 days without supply). Predictors of non-adherence to LAP and the association between non-adherence and healthcare utilization and costs were examined using multiple regression analyses. Results: A total of 666 patients met all inclusion criteria. Median follow-up was 12 mos. Mean(SD) MPR was 87% (19%); 22% of patients had MPR<80%. Twenty seven percent of patients had >=1 treatment interruptions during follow-up. Concomitant therapy with a taxane was a predictor of non-adherence (Odds ratio MPR<80%=10.3, 95%CI 3.3 to 31.9, p<0.001). In generalized linear regression models, non-adherence with LAP (1-MPR[range: 0 to 1]) was associated with more physicians' office / hospital outpatient visits (Rate ratio = 1.26, 95%CI: 1.03-1.54, p=0.028). There was a statistically non-significant trend towards an association between adherence and total costs excluding the costs of LAP (Cost ratio = 1.23, 95%CI: 0.93-1.63, p=0.146). Conclusions: Most patients receiving LAP are adherent to therapy, although there is a small group with high non-adherence that may negatively impact healthcare resource utilization. Further research is needed to identify additional predictors of LAP non-adherence so that clinicians may develop strategies to enhance adherence and improve patient outcomes.
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Villarreal-Garza, Cynthia Mayte, Bertha Alejandra Martinez-Cannon, Andrea Castro-Sanchez, Alejandra Platas, Alan Fonseca, Yoatzin Vega, Regina Barragan-Carrillo, Alejandro Mohar, Enrique Bargallo-Rocha, and Karen Bojoquez-Velazquez. "Adherence to tamoxifen in Mexican young women with breast cancer." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e12003-e12003. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e12003.
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e12003 Background: Young age has been associated with significantly increased risk of breast cancer (BC) death among women with luminal BC. One contributing factor might be the low rate of tamoxifen (TMX) adherence previously reported in this young group. Given that in Mexico a disproportionate rate of BC is diagnosed among YW, information regarding TMX adherence is particularly relevant. Our study's aim was to report TMX adherence in Mexican YW and its associated determinants. Methods: Consecutive patients ≤40y at diagnosis at the National Cancer Institute in Mexico City, under TMX treatment, completed a multiple-choice survey regarding the use and attitudes about hormonal therapy and adherence. Data of TMX disposal was collected from the pharmacy’s records, and the medication possession ratio (MPR) was calculated; an MPR ≥80% was considered adherent. Results: 135 YW with a median age at diagnosis of 35.7y (24-40) were included. 77% were undergraduate, 28% unpaired and 33% childless. Median follow-up was 26 months. 95% of patients reported a regular TMX intake: 70% did not miss any doses, while 25% missed 1-6 doses a month. Only 45% considered that the information received regarding TMX therapy was sufficient and for 37% was incomprehensive. 43% thought TMX significantly reduced their recurrence-risk and 60% strongly believed that they needed to be on TMX treatment. 73% of women reported adverse effects, being menopausal symptoms the most frequent, but only 27% were worried about the treatment long-term effects. From the 99 patients with a pharmacy record, 73% had an MPR > 80%. No significant factor was statistically associated with TMX adherence. Conclusions: Although Mexican YW and pharmacy data surprisingly sustained higher rates of TMX adherence compared to previous data, still a significant proportion of patients were non-adherent. Two-thirds of our patients reported having adverse effects, which might contribute to late TMX discontinuation. Since the newer recommendations of double hormonal blockade could lead to higher withdrawal rates of endocrine therapy in YW, adherence should be emphasized and closely monitored. Accordingly, hormonal treatment adherence should be a key component in the medical assessment of young luminal BC patients.
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Rahimi, Sama, Onyebuchi Ononogbu, Anjana Mohan, Daniel Moussa, Susan Abughosh, and Meghana V. Trivedi. "Abstract P5-14-06: Predictors of adherence to oral endocrine therapy in racial and ethnic minority patients with low socioeconomic status before and during the COVID-19 pandemic." Cancer Research 82, no. 4_Supplement (February 15, 2022): P5–14–06—P5–14–06. http://dx.doi.org/10.1158/1538-7445.sabcs21-p5-14-06.
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Abstract Introduction: Medication adherence is important in ensuring the maximum effect of oral endocrine therapy (OET) in hormone receptor-positive breast cancer (HR+ BC) patients. Low medication adherence is more seen in racial and ethnic minority patients of lower socioeconomic status. COVID-19 pandemic has further introduced complexities that have impacted patients’ medication-use behaviors. Our goal was to (1) assess the medication adherence to OET in racial and ethnic minority patients of lower socioeconomic status with HR+ BC and (2) assess the impact of the COVID-19 pandemic on their OET adherence. Patients and Methods: A retrospective, single-center study from September 2019 through September 2020 was conducted. The primary endpoint was adherence rate during the 6 months prior (September 2019 - February 2020) and 6 months after (April 2020 - September 2020) the COVID-19 pandemic started in the United States. The following three racial/ethnic groups were compared: Non-Hispanic White/Caucasian, Black/African American, and Hispanic/Latino. Chi-Square and Student’s t-tests were used to compare the adherent and nonadherent groups. The secondary endpoint was to identify predictors of nonadherence to OET. Multivariable logistic regression model was used to assess predictors of nonadherence. Results: Out of 270 patients, a total of 251 patients had a refill for an OET before COVID-19 with a mean proportion of days covered (PDC) of 0.72%. Of these, 140 (55.78%) were adherent and 111 (44.22%) were nonadherent. A total of 194 patients had a refill for an OET during COVID-19 with a mean PDC of 0.67%. Of these, 83 (42.78%) were adherent and 111 (57.22%) were nonadherent. A total of 187 patients had a refill for OET before and during the COVID-19 pandemic. There was a significant difference in the adherence before and during the pandemic when PDC was used as a continuous (p <0.0001, Student’s paired t-test) or a categorical variable (p <0.0001, McNemar chi-square test). In a multivariate analysis of data before the pandemic, Black/African American and White/Caucasian were less likely to be adherent compared to Hispanic/Latino (Black/African American: odds ratio [OR], 0.36; 95% confidence interval [CI], 0.18-0.723; White/Caucasian: OR, 0.25; 95% CI, 0.074-0.853). Patients with diabetes mellitus (DM) were more likely to be adherent compared to patients without DM (OR, 2.364; 95% CI, 1.199-4.662), and patients with hypertension (HTN) were less likely to be adherent compared to patients without HTN (OR, 0.481; 95% CI, 0.236-0.981). Patients who were prescribed aromatase inhibitors were more likely to be adherent compared to patients that were prescribed tamoxifen (OR, 0.484; 95% CI, 0.235-0.998). Patients diagnosed with invasive BC (stages 1-4) were more likely to be adherent compared to those diagnosed with non-invasive (in situ) tumors or ductal/lobular hyperplasia. During the pandemic, patients who used home delivery were more likely to be adherent compared to those who did not use home delivery (OR, 11.574; 95% CI, 2.45-54.55). There was no significant difference in the proportion of patients using home delivery between different racial and ethnic groups. Conclusion: OET adherence was reduced during the COVID-19 pandemic in racial and ethnic minority patients with low socioeconomic status. Tamoxifen therapy, Black/African American, and White/Caucasian origin, not having DM, having HTN, and diagnosed with non-invasive BC were associated with OET nonadherence in patients before the COVID-19 pandemic. Whereas, not using home delivery for OET medications predicted nonadherence in patients during the COVID-19 pandemic. Citation Format: Sama Rahimi, Onyebuchi Ononogbu, Anjana Mohan, Daniel Moussa, Susan Abughosh, Meghana V Trivedi. Predictors of adherence to oral endocrine therapy in racial and ethnic minority patients with low socioeconomic status before and during the COVID-19 pandemic [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-06.
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Smith, Samuel George, Ivana Sestak, Anthony Howell, John Forbes, and Jack Cuzick. "Participant-Reported Symptoms and Their Effect on Long-Term Adherence in the International Breast Cancer Intervention Study I (IBIS I)." Journal of Clinical Oncology 35, no. 23 (August 10, 2017): 2666–73. http://dx.doi.org/10.1200/jco.2016.71.7439.
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Purpose To assess the role of participant-reported symptoms on long-term adherence to preventive therapy in the United Kingdom sample of the International Breast Cancer Intervention Study (IBIS-I). IBIS-I was a randomized controlled trial that investigated the effectiveness of tamoxifen in reducing the risk of breast cancer among women at increased risk of the disease. Participants and Methods Women were randomly assigned to tamoxifen versus placebo (20 mg/day; n = 4,279). After 456 exclusions, 3,823 women were included in this analysis. Adherence (< 4.5 years or ≥ 4.5 years) was calculated using data from six monthly clinical visits. Analyses were adjusted for age, Tyrer-Cuzick risk, smoking, use of hormone replacement therapy, menopausal status, baseline menopausal symptoms, and treatment. Results Overall, 69.7% of women were adherent for at least 4.5 years (tamoxifen: 65.2% v placebo: 74.0%; P < .001). Differences in adherence between treatment arms were observed from 12 months onward (all P < .01) and were largest at 54 months. Dropout rates were highest in the first 12 to 18 months and decreased thereafter. Women reporting nausea/vomiting were less likely to be adherent in both the tamoxifen (odds ratio [OR], 0.57; 95% CI, 0.37 to 0.86; P = .007) and placebo (OR, 0.58; 95% CI, 0.37 to 0.93; P = .023) arms. Headaches were associated with adherence only in the placebo arm (OR, 0.62; 95% CI, 0.42 to 0.91; P = .016), whereas gynecologic symptoms were significant only in the tamoxifen arm (OR, 0.77; 95% CI, 0.62 to 0.97; P = .024). Effect sizes for each symptom on adherence were not significantly different between the treatment groups ( P > .05). In both treatment arms, we observed significant trends for lower adherence with increasing severity for all symptoms ( P < .01) except headaches ( P = .054). Conclusion In the IBIS-I trial, experiencing predefined symptoms in the first 6 months reduced long-term adherence. Effects were similar between treatment arms, suggesting that women were attributing age-related symptoms to preventive therapy. Interventions were required to support symptom management.
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Schenkel, Brad, Pam Hallworth, Alex Rider, Brian Macomson, and Jacquelyn McRae. "Comparing adherence levels of CLL treatment from both the patient and physician perspective in the U.S." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e19009-e19009. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e19009.
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e19009 Background: Prior research has shown that there is a lack of congruency between physicians and patients regarding choice of therapy in CLL care. The aim of this study was to look at whether there are any similar differences in regard to perceptions of drug adherence between a group of CLL patients and their corresponding physicians. Methods: From February to May 2016, the Adelphi CLL Disease Specific Programme (DSP) recruited US physicians who are responsible for treatment decision-making in CLL. Patient Record Forms (PRF) and Patient Self-Completion questionnaires (PSC) were completed by physicians and patients, respectively. Means and standard deviations (SD) were calculated for continuous variables, and proportions were calculated for categorical variables. Results: A total of 81 physicians and 326 patients participated in the CLL DSP. The majority of physicians were heme-oncologists (68%), male (79%), and practiced in both a hospital and office-based setting (86%). Physicians reported that 87% of their CLL patients were “always” or “almost always” adherent to their CLL treatment. However, only 42% of patients reported that they were “never” or “hardly ever” non-adherent to CLL treatment. Patients reported that their physicians addressed adherence in the following methods: physicians asked patients about adherence (56%), nurses/other staff assisted patients (23%), physician did not check (15%), pill checking (3%), materials/resources were given (1%), and other (2%). Three-quarters (75%) of physicians reported that they discussed adherence with their CLL patients consistently. Conclusions: In this study, patients’ and physicians’ perceptions of adherence with regard to CLL treatment were not aligned. Although most physicians reported consistent discussions about adherence with their patients, the majority of patients reported subpar adherence to CLL treatment. As more oncology medications, including those approved in CLL, are available in a pill or capsule formulation and thus self-administered, it will be increasingly important to make patients aware of the importance of adhering to their medication and including physicians and caregivers in this dialogue.
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Kim, Roger, Katharine A. Rendle, Christine Neslund-Dudas, Robert T. Greenlee, Andrea N. Burnett-Hartman, Stacey A. Honda, Michael J. Simoff, Jennifer M. Croswell, Debra P. Ritzwoller, and Anil Vachani. "Community-based lung cancer screening adherence to Lung-RADS recommendations." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 10540. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.10540.
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10540 Background: In the NLST and NELSON trials, most low-dose CT (LDCT) screen-detected lung cancers were not diagnosed during the first round of screening, suggesting that longitudinal adherence to lung cancer screening (LCS) recommendations is key. Adherence was as high as 95% in clinical trials, but limited data exist regarding LCS adherence in clinical practice. We aimed to determine adherence to Lung-RADS recommendations among community-based patients undergoing LCS. Methods: We performed a multicenter retrospective cohort study of patients screened for lung cancer at healthcare systems within the Lung Population-based Research to Optimize the Screening Process (PROSPR) Consortium. We included 55-80 year-old current or former smokers who received a baseline (T0) LDCT with a Lung-RADS score between January 1, 2015 and September 30, 2017 and excluded patients who were diagnosed with lung cancer prior to the T0 scan. Over a 24-month period, we calculated the proportion of patients adherent to Lung-RADS recommendations and evaluated associations with patient-level (age, sex, race, ethnicity, smoking status, body mass index, Elixhauser comorbidities, year of T0 scan, and Lung-RADS score) and census tract (median family income, level of education) data, using multivariable logistic regression with mixed effects to account for site variability. Results: Of the 6,723 patients in our cohort (median age 65 years [IQR 60-69]; 45.1% female; 73.0% white; 59.0% current smokers), 5,583 (83.0%) had Lung-RADS 1 or 2 T0 scans, 733 (10.9%) Lung-RADS 3, 274 (4.1%) Lung-RADS 4A, and 133 (2.0%) Lung-RADS 4B or 4X. Overall, 55.2% (3,709/6,723) of patients were adherent (Table). In the final multivariable model, Black patients had reduced adherence compared to white patients (adjusted odds ratio [aOR] 0.79, 95% CI 0.66-0.94), while greater adherence was observed in former smokers compared to current smokers (aOR 1.33, 95% 1.19-1.49). Compared to individuals with a negative T0 scan (Lung-RADS 1 or 2), those with Lung-RADS 3 (aOR 1.56, 95% CI 1.31-1.86), 4A (aOR 1.63, 95% CI 1.24-2.15), or 4B/4X (aOR 3.59, 95% CI 2.30-5.60) T0 scans had greater odds of adherence. Conclusions: In the largest study of real-world patients receiving LCS to date, adherence to Lung-RADS recommendations is lower than previously observed in clinical trials. Our results highlight the need for further study of system-level mechanisms to improve longitudinal LCS adherence rates.[Table: see text]
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Schaeffer, Marcy L., Betty J. May, Brenna C. Hogan, Mikiaila M. Orellana, Michelle C. McCullough, Deborah Kay Armstrong, Kelly Myers, and Kala Visvanathan. "Breast cancer screening adherence at multiple timepoints over eight years among women in a familial cohort." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 1557. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.1557.
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1557 Background: Since 2007, U.S. guidelines recommend cancer-free women with ≥20% lifetime breast cancer (BC) risk undergo BC screening with mammogram and breast MRI. There is limited long-term data on BC screening adherence among young, high-risk women. To address this knowledge gap, we examined utilization of multiple BC screening modalities over time. Methods: Eligible women were ≥ 30 years old, had no history of BC/ovarian cancer, an intact breast, are enrolled in the Breast and Ovarian Surveillance Service (BOSS) Cohort, and visited the Johns Hopkins Cancer Genetics Clinic for risk assessment within 2 months of cohort enrollment (N = 374). All screening was self-reported at baseline, 4, and 8 years. A subset has been validated. We categorized women by BC risk (Tyrer-Cuzick version) obtained at the clinic. We examined frequency of screening over follow-up, and defined adherence to annual mammography and breast MRI based on age- and risk-based guidelines. We modeled the association between BC risk and adherence at 4 and 8 years using logistic regression. Results: At baseline, the median age was 47 years, 31% had lifetime risk < 20%, and 69% had risk ≥20%. Frequency of mammography and clinical breast exam over follow-up was > 60%, while frequency of breast MRI and breast ultrasound was < 40%. Twenty-five percent of high-risk women at 4 years and 40% at 8 years did not report any mammography, breast MRI, or breast ultrasound. At 4 years, high-risk women were 85% less adherent [multivariable adjusted OR = 0.15; 95%CI = 0.07, 0.34] to BC screening guidelines compared to women with a risk of < 20% due to low uptake of breast MRI, while at 8 years, high-risk women were also less adherent to mammography [multivariable adjusted OR = 0.42; 95%CI = 0.18, 0.95]. We observed similar associations among women at high-risk at 5- and 10-years. Adherence at 4 years predicted adherence at 8 years. Interestingly, women who did not uptake MRI complied with other health screening including for colorectal cancer. Conclusions: High-risk women were not adherent to risk-appropriate BC screening, and adherence did not improve over time. Low adherence appears specific to BC screening. New approaches to BC screening are urgently needed for this high-risk group.
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BRANDT, PATRICIA. "Childhood Diabetes: Behavioral Research." Annual Review of Nursing Research 16, no. 1 (January 1998): 63–82. http://dx.doi.org/10.1891/0739-6686.16.1.63.
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The major emphasis of behavioral research related to childhood diabetes has been on the child’s physical and emotional outcomes, the family’s response, and adherence issues. This research review focuses on adherence and related youth and family functioning. Descriptive and intervention studies are critiqued. Common conceptual and methodological issues are discussed with recommendations for future research.
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Wassermann, Johanna, Shari I. Gelber, Shoshana M. Rosenberg, Kathryn Jean Ruddy, Rulla M. Tamimi, Lidia Schapira, Virginia F. Borges, Steven E. Come, and Ann H. Partridge. "Non-adherence behaviors among young women on adjuvant endocrine therapy for breast cancer." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 526. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.526.
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526 Background: Young age at diagnosis (dx) is a predictor of worse prognosis in patients (pts) with luminal breast cancer (BC). Poorer adherence to endocrine therapy (ET) among younger women may contribute to this disparity. Aim: To assess non-adherent behaviors and associated factors among young women with stage 1-3 hormone receptor (HR)+ BC taking ET. Methods: This study is a part of a multi-center, prospective cohort of pts with dx of BC at or under age 40. On a survey 30 months after dx, among pts reporting taking ET, adherence was measured using a 3-item Likert-type scale (Do you ever forget to take your ET? If you feel worse when you take your ET, do you stop taking it? Did you take your ET exactly as directed by your doctor?). Pts reporting any non-adherent behavior during the last 3 months were classified as non-adherers. Variables with a p-value <0.20 were included in a multivariate logistic model. Results: Among361 pts eligible for this analysis, 174 (48%) reported some non-adherent behaviors in the last 3 months; 56 (16%) moderate or greater non-adherent behaviors. None of the studied variables was associated with non-adherent behaviors (table). Conclusions: Non-adherent behaviors to ET are present in almost half of the young women with HR+ BC. Further analyses of explanatory factors and impact of non-adherence are required to understand and potentially improve this problem. [Table: see text]
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Desanti de Oliveira, Beatriz, David DeStephano, Melissa Parsons Beauchemin, Cynthia Law, Kristina `. Howard, Jason Dennis Wright, Ian Kronish, Dawn L. Hershman, and Melissa Kate Accordino. "Implementation of EHR medication-adherence screening tool in breast cancer clinic." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 438. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.438.
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438 Background: Nonadherence to prescribed medications occurs frequently in patient with breast cancer (BC) and can affect BC outcomes as well as outcomes for comorbid conditions. We implemented a process to screen for medication adherence in the electronic health record (EHR) in an urban outpatient BC clinic. Methods: Plan-Do-Study-Act (PDSA) methodology was used to implement a screening process for medication adherence for all patients seen in the outpatient breast oncology clinic. At check-in (via the patient portal or clinic based kiosks), patients were asked to complete an EHR adherence screener. Two PDSA cycles were completed. During cycle one (2/16/22-5/17/22), patients were asked if they received ≥1 prescribed medication; if yes they were asked to complete the questionnaire (y/n); if yes a 3-item questionnaire was used to screen for adherence to all medications over the prior 7 days. Adherence was defined as 3 of 3 responses “none of the time” to “I have missed my medicine;” “I have skipped a dose of my medicine;” and “I did not take a dose of my medicine.” During cycle two (5/17/22-6/5/22) the screener was simplified. Patients were no longer asked to complete the survey; and the survey was modified to 1-item “I did not take a dose of my medicine”, adherence was defined as response of “none of the time”. We evaluated response rate and self-reported non-adherence rate. Results: During PDSA cycle 1 (2/16/22-5/17/22), 2840 visits occurred and 722 (25%) responses were received; 80% noted prescription of ≥1 medication, 38% agreed to complete the survey; and 87% reported adherence to all prescribed medications while 13% reported non-adherence. During PDSA cycle 2 (5/17/22-6/5/22), 512 visits occurred and 172 (33%) responses were received. Of those, 73% reported prescription of ≥1 medication; of those 66%-reported adherence to all prescribed medications, 21% reported non-adherence, and 17% preferred not to answer. Conclusions: This EHR screener is a simple and scalable tool to rapidly screen for medication adherence. Up to a quarter of patients who completed screening reported non-adherence. Further tools are needed to assess adherence among patients who lack access to the patient portal or clinic kiosk, or are uncomfortable checking in with these mechanisms. Future interventions are necessary to further screen potentially non-adherent patients and for interventions to improve adherence once vulnerable patients are identified.
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Partridge, Ann H., Andrea LaFountain, Erica Mayer, Brooke S. Taylor, Eric Winer, and Aviva Asnis-Alibozek. "Adherence to Initial Adjuvant Anastrozole Therapy Among Women With Early-Stage Breast Cancer." Journal of Clinical Oncology 26, no. 4 (February 1, 2008): 556–62. http://dx.doi.org/10.1200/jco.2007.11.5451.
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Purpose Previous research evaluating adherence to tamoxifen therapy among women with early-stage breast cancer has revealed adherence estimates ranging from 25% to 96%. No previous studies have focused on adherence to adjuvant aromatase inhibitors. Methods We used longitudinal claims data from three large commercial health programs to estimate adherence with anastrozole therapy among women with early-stage breast cancer. Adherence was defined as the proportion of days that patients had medication available over the observation period (ie, days covered); women with fewer than 80% of days covered were defined as nonadherent. Results More than 12,000 women in the databases were found to have new anastrozole prescription claims during the period of study: 1,498 women were classified as having early-stage disease in one commercial health program (Plan A) data set, 1,899 women in another program (Plan B) data set, and 8,994 women in MarketScan, a commercial data set made up of several health programs. Mean adherence over the first 12 months of therapy ranged from 82% to 88% in the three data sets. Between 19% and 28% of women had fewer than 80% of days covered. For women with 36 months of continuous eligibility, the mean adherence decreased each year, ranging from 78% to 86% in year 1 to 62% to 79% in year 3 within the three data sets. Conclusion A substantial proportion of women with early-stage breast cancer may be suboptimally adherent to adjuvant anastrozole therapy. Future research should focus on the identification of patients at risk for nonadherence with oral hormonal therapy for breast cancer and the development of interventions to improve adherence.
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Smith, Forrest, Joseph Elsoueidi, Lauren Wisnieski, Sandhya Kolagatla, and Nagabhishek Moka. "Adherence with the multitarget stool DNA test for colorectal cancer screening in rural southeastern Kentucky." Journal of Clinical Oncology 40, no. 4_suppl (February 1, 2022): 64. http://dx.doi.org/10.1200/jco.2022.40.4_suppl.064.
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64 Background: Colorectal cancer (CRC) screening has shown to improve early detection and reduce mortality. Despite, the availability of multiple screening tests for CRC, the current screening rates remains below the national goal. The multi-target stool (MTS) DNA test (commercially known as Cologuard) has contributed to an increase in population adherence to CRC screening and is currently recommended by multiple guidelines. Southeastern Kentucky (SE KY) has a high incidence of colorectal cancer and a low rate of CRC screening. The aim of this study is to assess the adherence to the MTSDNA test in rural SE KY. Methods: A retrospective review of all patients 45 and older with a MTSDNA test ordered between August 2020 and February 2021 at a large primary care group in SE KY. All patients had Tests ordered and kits delivered. Cross-sectional adherence was defined as completion and return of the kit within 180 days from test order and was assessed as overall adherence and by patient characteristics including age, sex and healthcare coverage. Results: 450 tests were ordered. 160 (35%) were male and 290 (65%) females. Mean age was 62 with age range (46-87). 207 tests were returned with a cross-sectional adherence of 46%. Adherence was significantly lower for age 45 - 55 at 35.2% (26.2-45.2) compared to age 55 - 65 at 48.9% (40.9-56.3), 65 and older at 50.0% (42.3-57.7) (P = 0.04). Highest adherence with Medicaid coverage 65.4% [44.3-82.8] and lowest in Managed Care Organization (MCO) coverage 34.0% [4.7-44.2] (P < 0.01). Gender was not associated with adherence (P = 0.75). Conclusions: This retrospective study showed that only 46% of patients were adherent to the MTS DNA test for colorectal screening which is significantly lower than previously reported in larger studies and further studies are needed to identify the barriers to non-adherence to this test, especially in the younger population with alarming increase in incidence of CRC. There is impending need to implement different strategies to improve screening adherence.
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Hershman, Dawn L., Joseph M. Unger, Hillyer Grace, Anna Moseley, Kathryn B. Arnold, Shaker R. Dakhil, Benjamin Esparaz, et al. "Randomized trial of text messaging (TM) to reduce early discontinuation of aromatase inhibitor (AI) therapy in women with breast cancer: SWOG S1105." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 6516. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6516.
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6516 Background: Non-adherence to AI’s for breast cancer is common and increases risk of recurrence. Text messaging (TM) has been shown to increase adherence to medications for chronic conditions. We conducted a multicenter randomized trial to evaluate if TM reminders improve AI adherence. Methods: Patients taking an AI for ≥30 days and having ≥36 mos of planned therapy were eligible. Patients were randomly assigned 1:1 to receive either TM or NO-TM twice a week for 36 mos. Randomization was stratified by length of time on prior AI therapy ( < 12 (64%) vs. 12-24 mos (36%)) and AI class (anastrozole, letrozole, exemestane). Content themes of the 36 TMs focused on overcoming barriers to adherence. Patients were assessed for discontinuation of AIs every 3 mos for 36 mos. The primary outcome was time to non-adherence, where non-adherence was defined as urine AI metabolite assay results satisfying the following: < 10 [units], undetectable, or no submitted specimen. A stratified Log-rank test was conducted. Multiple sensitivity analyses were performed using Cox regression. Results: In total, 724 patients were registered between May, 2012 and September, 2013, among whom 696 (338/360 (93.9%) on TM and 338/364 (92.9%) on NO-TM) were eligible and adherent at baseline. Observed (time-independent) adherence at 36 mos was 55.4% for TM and 55.4% for NO-TM. The primary analysis showed no difference in time-to-adherence failure between patients on the TM and NO-TM arms (HR = 0.89, 95% CI:0.76,1.05 p = .18). An analysis of negative urine tests alone resulted in similar non-significant results. With missed appointments not counted as failures, time to self-reported discontinuation (89.6% vs. 89.7%; HR = 1.17, 95% CI:0.69-1.98, p = .57) and site reported discontinuation (78.1% vs. 81.1%; HR = 1.31, 95% CI:0.86-2.01, p = .21) were also similar between the 2 groups. Conclusions: As the first large long-term randomized trial of an intervention directed at improving AI adherence, we found high rates of AI discontinuation. Bi-weekly text reminders did not improve adherence to AIs compared to usual care. Improving long—term adherence will likely require sustained behavioral interventions and support. Clinical trial information: NCT01515800.
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Lin, Yannan, Tianran Zhang, William Hsu, Denise R. Aberle, and Ashley Prosper. "Patient adherence to LungRADS recommendations at an academic institution." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18592-e18592. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18592.
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e18592 Background: The National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality when screened with low dose computed tomography (LDCT) as opposed to chest radiography. Notably, participants’ adherence to the screening protocol was 90%. To date, published evidence on the adherence of patients enrolled in clinical lung cancer screening (LCS) programs to LungRADS recommendations is limited. We investigate the adherence rate at our institution and determine the predictors of non-adherence to LungRADS recommendations. Methods: We performed a retrospective analysis on patients aged 50-80 years at time of baseline screen with initial screening exam at our institution between Jan 1, 2015 and Jan 12, 2021. Patients were excluded if 1) their follow-up period was insufficient to determine adherence as of Jan 28, 2021, 2) the follow-up recommendation was inconsistent with LungRADS guidelines, or 3) they died before the expected follow-up date. Adherence was defined as completion of recommended or more invasive follow-up at our institution within 12 months for LungRADS 0, 15 months for LungRADS 1/2, 9 months for LungRADS 3, 5 months for LungRADS 4A, and 3 months for LungRADS 4B/4X. A univariate logistic regression was used to determine predictors of non-adherence. Results: Among the 2120 eligible patients, 1266 (60%) were male and 854 (40%) were female with a median age of 65 at the baseline screen. One thousand four hundred and seventy-seven (70%) patients identified as White, 286 (13%) declared another racial group, and 357 (17%) did not disclose their race. One hundred and nine (5%) patients identified as Hispanic and 165 (8%) patients did not state their ethnicity. There were 1113 (53%) former smokers, 748 (35%) current smokers, and 259 (12%) patients of unspecified smoking status. Median tobacco exposure was 30 pack years (range 0.15 to 240). Fifty-seven percent of patients had private or commercial insurance while 39% had Medicare as primary insurance (3 patients were unspecified). The distribution of baseline LungRADS scores was 0: < 1%, 1: 14%, 2: 71%, 3: 7%, 4A: 4%, 4B: 2%, and 4X: < 1%. Overall adherence was 31% with 0: 38%, 1: 21%, 2: 27%, 3: 46%, 4A: 68%, 4B: 80%, and 4X: 100%. Of the 1463 non-adherent patients, 528 completed a follow-up exam beyond the expected date while 935 did not have any follow-up before the end of the study. Patients who were over 65 at baseline screen (OR = 1.34, 95% CI: 1.11, 1.61), former smokers (OR = 1.24, 95% CI: 1.02, 1.52), had Medicare insurance (OR = 1.35 95% CI: 1.12, 1.63), or had LungRADS 3/4 (referent: LR 1/2, OR = 4.29, 95% CI: 3.32, 5.55) were more likely to be adherent. Conclusions: Patient adherence to LungRADS recommendations at time of baseline screen in clinical practice is suboptimal, particularly among those with negative screens (LungRADS 1/2), with a non-adherence rate of > 70%. Baseline LungRADS scores, age, smoking status, and insurance are predictive of LCS non-adherence.
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Ramachandiran, Balaji, Biswajit Dubashi, Smita Kayal, Vikas Menon, K. Yuvaraj, C. Deepika, Deepa Francis, Deeksha Debbarma, and Devika S. Nair. "Assessment of Oral Anticancer Medication Adherence: A Survey from a Tertiary Cancer Center." South Asian Journal of Cancer 10, no. 02 (April 2021): 127–30. http://dx.doi.org/10.1055/s-0041-1723120.
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Abstract Background Adherence to oral anticancer medication is important in cancer chemotherapy, with the advent of many oral anticancer regimens to ensure adequate cytologic response. Literature on adherence to oral anticancer therapy in India is very less. Materials and Methods This is a cross sectional analytical study consisting of all fit patients > 18 years of age taking oral anticancer therapy, with or without intravenous (IV) chemotherapy. Adherence was determined using Morisky–Green–Levine (MGL) scale, and factors affecting adherence details about cancer and treatment were obtained. All fit patients were recruited. Information was obtained using Tamil questionnaire and pro forma. Observation Of 152 patients, only 111 patients were found to be adherent to treatment. The mean age of the study population was 49.03 ± 13.48 years. Only 12.5% of patients were aware of the diagnosis, treatment, and outcome. The study population consisted mainly of patients with chronic myeloid leukemia, colorectal carcinoma, breast carcinoma, and stomach carcinoma, which amounted for 78.3% of the study population. Bivariate analysis concluded that duration of treatment, adverse drug reaction (ADR), duration of oral anticancer drug intake in a month, coadministration with IV anticancer drugs, and frequency of drug intake (anticancer drug) were significant factors affecting drug adherence. Multivariate analysis of the above variables was insignificant, but ADR tended toward significance. Conclusion Drug adherence plays a major role in treatment outcome in cancer patients. ADR was independently associated with decreased drug adherence. Key interventions which should include counseling and behavioral modifications will reduce nonadherence.
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Guseinova, E. T., Yu V. Lukina, N. P. Kutishenko, S. N. Tolpygina, V. P. Voronina, O. M. Drapkina, and S. Yu Martsevich. "Adherence to therapy and the risk of cardiovascular events in patients with heart failure: data from the outpatient registry." Cardiovascular Therapy and Prevention 21, no. 10 (November 3, 2022): 3389. http://dx.doi.org/10.15829/1728-8800-2022-3389.
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Aim. To determine the adherence to drug therapy and the prevalence of cardiovascular events (CVEs) in patients with heart failure (HF) after a 1-year follow-up in a specialized cardiology unit of a research center.Material and methods. CVEs were analyzed within the prospective observational study COMPLIANCE (Assessment of adherenСe tO Medical theraРy and its infLuence on long-term outcomes In pAtieNts with Chronic hEart failure in the outpatient registry). The study included 72 patients with HF, verified according to clinical guidelines. Patients were divided into 2 groups: adherent and non-adherent to treatment. Overall adherence to therapy and adherence to specific drugs were assessed using the original National Society for Evidence-Based PharmacotherapyAdherence Scale. The study included 2 visits: inclusion in the study and a visit after 1-year follow-up. After a 1-year follow-up, a comparative analysis of the two groups was performed to achieve the primary composite endpoint: death, acute cerebrovascular accident, myocardial infarction, decompensated HF with and without hospitalization.Results. A Kaplan-Meier analysis of 1-year survival showed that the mean time to onset of primary composite endpoint was 10,2 (95% confidence interval: 9,5-10,8) months. A significant relationship was found between the occurrence of composite endpoint and adherence to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (p=0,001), which was not confirmed for beta-blockers and mineralocorticoid receptor antagonists (p=0,338 and p=0,335, respectively). The risk of composite endpoint was 3,6 times higher in non-adherent patients than in adherent patients (hazard ratio, 3,6; 95% confidence interval, 1,5-8,5 (p=0,003)).Conclusion. A significant relationship was found between nonadherence to treatment and the incidence of CVEs, the risk of which increases by 3,6 times in non-adherent patients compared with adherent patients with HF.