Category: Federal Forum Posters
Purpose: Compliance of oral cytostatic drugs of oncological patients at the ambulatory level is important for the success of the treatment. The continuity of the treatment contributes to achieve remission of the disease and avoid relapses. The main objective of the study was to evaluate the adherence to treatment with oral cytostatic drugs in cancer patients. The secondary objective was to analyze the variables that can influence in adherence related to the patient's characteristics, treatment and disease.
Methods: Prospective observational study. Adult patients who start treatment with oral cytostatic drugs in Pharmacy Service were included (March-May 2017). Study was approved by the ethic committee and informed consent was obtained for all subjects.
Data collected: related to patient (sex, date of birth, living alone vs not, toxic habits, profession), disease (diagnosis, stage, date of diagnosis, treatment line, Eastern Cooperative Oncology Group (ECOG), concomitant diseases, mental disease) and treatment (drugs, tablets per day, frequency, fasting or food intake, alternative therapy, adverse effects (AE), medication administers: patient, supervised administration or by caregiver).
Main variable: % compliance. Measurement of adherence methods: 1)Registration of dispensations, 2)Morisky-Green Test, 3)Self-assessment by the patient of their own adherence (visual analog scale of 1-10, from worst to best compliance). Patients were considered adherent if during the entire study period: 1)Measurement of adherence 100%, 2)Morisky-Green Test high adherence and 3)Self-assessment by the patient 10.
Statistics: Sample size determination (80% compliance similar to the published, p<0.05, accuracy +/-10%). Quantitative variables: mean +/- standard deviation. Qualitative variables: absolute value and percentage (95% confidence interval). Comparison of means: Student's T test or Mann-Whitney test (according to normal Kolgomorov-Smirnov test). Association of qualitative variables: Chi square test or Fischer exact test. To determine the association of different variables associated with lack of adherence, logistic regression models were used (p <0.05). SPSS software 19.0.
Results: 74 patients. 41/74 men. 63.2+/-11.5 years old. 14.9% lived alone. 10.8% smoking patients. 41.9% active work. Diagnostic: colon/rectal cancer n=46(62.2%), central nervous system cancers n=7(9.5%), kidney cancer n=7(9.5%), breast cancer n=4(5.4%), lung cancer n=3(4.0%) and others n=7(9.4%) (ovarian cancer, melanoma, gastrointestinal stromal tumors and thyroid carcinoma, prostate cancer, neuroendocrine tumor, soft tissue sarcoma). Stage II/III 45.9%, IV 54.1%. Treatment line: adjuvant/neoadjuvant therapy 47.3%, first-line treatment of metastatic 35.1%, others metastatic lines 17.6%. 33 patients ECOG=0, 37 patients ECOG=1, 4 patients ECOG=2-3. 41.9% without concomitant diseases, 32.4% 1-2 diseases, 25.7% 3 or more. 14/74 mental health patients. Treatment: Capecitabine n=49, temozolomide n=7, sunitinib n=6, pazopanib=2, osimertinib n=2, n=1: imatinib, enzalutamide, everolimus, olaparib, dabrafenib, afatinib, axitinib and sorafenib. 48.6% (36/74) concomitant intravenous antineoplastic. 60.9% patients: 1-6 tablets/day, 39.1% patients: 7-16 tablets/day. Frecuency of administration: 28.4% once a day, 71.6% twice daily. Food: 71.6%; fasting 14.9%; indifferent 13.5%. 5.4% alternative therapy. 37.8% no AE; 48.6%: 1-2 AE; 13.5%: >=3 AE. 9.5% medication administered by caregiver/supervised.
Adherence results: 74.3% patients (55/74) 100%adherent. Sex: 85.4% men vs 60.6% women (p=0.015). Medication administers: 77.6% patient vs 42.9% others (p=0.045). No statistical significance was found in the other variables evaluated.
Conclusion: The percentage of adherent patients was similar to that published in the bibliography. Sex and who administers the medication influence compliance with treatment. The pharmacist must be actively involved in the detection of non-adherent patients and contribute to an improvement of therapeutic compliance through education of the patient and his family.
Maria Mateos Salvador– Hospital Pharmacist, Xerencia Xestión Integrada A Coruña, A Coruña, Galicia, Spain