7 Oral Adherence Tips from Nurses and Pharmacists

Sandra Spoelstra, PhD, RN

Sandra Spoelstra, PhD, RN

As the number of approved oral anticancer agents grows, so too does the need for oncology nursing professionals to help patients adhere to these drug regimens when they are at home to ensure patients get the most benefit from their treatment. In a recent feature article for our sister publication, CURE magazine, several nurses and pharmacists shared their perspectives on this important topic, and the consensus is clear: communication is essential.

1. Take a personalized approach. Intense side effects from oral agents can make it difficult for patients to take their medication, and individuals respond differently to the medications.

“The side effects vary from drug to drug, and the more intense they are, the less likely patients are to take their medication. … Each patient’s response is subjective and unique.”

—Susan Schneider, PhD, RN, associate professor in the Duke University School of Nursing

2. Monitor for drug interactions. A patient’s tolerance of oral anticancer agents can be affected by interactions between the drug and other medications for high blood pressure, diabetes, or other problems.

“Ideally, drug profiles should be run on each patient to uncover issues with drug interactions, but this is easier said than done.”

—Sandra Spoelstra, PhD, RN, associate dean of research at the Medical School of Nursing at Grand Valley State University

3. Be on the lookout for prescription stretching. Because of the cost of oral medications, patients may take half a pill, or take a pill every other day, to make the prescription stretch, or just hold off on refilling the prescription.

“When the medication is $2000 a month or more, patients (sometimes) take them creatively.” (Schneider)

“All of these forms of nonadherence [such as not taking pills properly] can have an impact on a patient’s health.”

—Ann O’Mara, PhD, RN, MPH, head of palliative care in the Division of Cancer Prevention at the National Cancer Institute.

4. Check in early and often—don’t wait for the patient to call you. Checking on a patient’s management and tolerance of treatment as well as offering tips to handle side effects can help. And, many patients may fear calling their nurse or pharmacist, especially to discuss side effects, for fear their dosage may be reduced.

“Back in the day, when patients were in the clinic receiving their infusions, the nurses would come around and talk to them, asking how they were managing and tolerating their treatment. They would offer tips on how to handle side effects. That support made a tremendous difference.” (Schneider)

“We initiate calls ourselves. Usually, we can come up with strategies to address their problems. For example, we found that freezing a marshmallow and cutting off small pieces to wrap around pills really helps with mouth sores.”

—Iris Zhao, PharmD, BCPS, lead pharmacist of Oncology Specialty Pharmacy Program, University of California Davis Comprehensive Cancer Center

5. Alerts, alarms, or text messages, can help, along with aligning medication times with the patient’s daily routine, for example, if the patient always watches the 6 o’clock news that can be a reminder. In addition to reminders, a weekly message can be used to ask about symptoms.

6. Cost matters. Drug costs can distress patients. Work with the healthcare team to identify grant support or contact the manufacturer for assistance.

“We don’t want patients stressing about money, so we find grants or go directly to the manufacturer for assistance. Organizations like the Patient Access Network Foundation can offer between $4000 and $15,000 a year. There is a need for support that the nursing staff doesn’t always have the time to provide. This is fast becoming a huge area for pharmacists.” (Zhao)

7. Provide patient education upfront and reinforce the message. Patients must have a full understanding of what they need to do and why. Follow-up phone calls help.

“People have to truly understand what they need to do and why they need to do it. Follow-up phone calls are really helpful, as patients strive to change their behavior and make a routine out of taking their medications.” (Spoelstra)

To read the full article, “Making a Connection: Staying in Touch for Better Anticancer Drug Adherence,” click here.