Treating cancer is not always about a cure, sometimes it is more realistic to aim for controlling it long term as a chronic condition, which is a topic I explored earlier this year in Cancer Cure Vs. Control. It can be appropriate in some cases to control cancer with the goal of keeping it from spreading. The development of oral oncology agents supports the control of cancer in this way.
At this year’s American Society of Clinical Oncology annual meeting in Chicago, IL, oral medications for treating cancers such as chronic lymphocytic leukemia (CLL) garnered attention. These new oral options are a welcome advancement in treatment choices, but they do require new adherence behaviors in patients who require the medications long term. Obviously, patients who are more compliant with cancer treatment stand to benefit from better outcomes.
One of the studies at the American Society of Clinical Oncology meeting shared patient compliance data in treating CLL. Progression-free survival – which is another way to describe cancer as a chronic condition – improved in patients who did not miss doses of their medication. In this study, nearly one-third of patients skipped eight or more days of treatment; these patients, not surprisingly, were in the group with worse progression-free survival rates.
There is no doubt that as cancer becomes a chronic condition for some patients, medication adherence emerges as a major factor in treatment outcome. When medication use transitions from a short-term or acute setting (often clinic- or hospital-based) to that of a chronic, home-based treatment, keeping compliance levels high face new challenges.
Consider the three components of compliance:
- Initiating a prescription request
- Taking the medication for the prescribed duration
- Taking the medication in the correct dosage
Each of these compliance components has its own challenges that can interfere with overall adherence for a patient. These challenges come in predictable categories, including:
- Patient factors: age, ethnicity, social and family support, attitudes toward treatment, beliefs, and socioeconomic factors
- Medication factors: cost, route of administration, side effect profile, dose requirements, length of treatment
- Systemic factors: insurance, ease of accessing physician, appointment scheduling
Recognizing barriers to adherence for individual patients and then actively addressing each of the barriers is a main focus of our specialty pharmacy. It’s how we improve adherence rates, which in turn works toward our goal of successful patient outcomes.
Barr PM, Brown JR, Hillmen P, et al. Dose adherence and baseline exposure analysis of the ibrutinib 420 mg dose administered to patients with previously treated chronic lymphocytic leukemia (CLL). J Clin Oncol 2015;33:(suppl; abstr 7012)
Hughes D. Novel oral TKI in chronic leukemia requires genetic testing, adherence to therapy. American Society of Clinical Oncology May 31, 2015.