Does Gender Influence Adherence?

Deborah A. Boyle, MSN, RN, AOCNS, FAAN

Editor in ChiefOncology Nursing News

Numerous risk factors and etiologies for patients’ non-adherence to medication regimens have been identified in general populations and those with cancer.^1-4 They include poor memory, misperceptions, cost concerns, polypharmacy, advanced age, family influence, and toxicity avoidance. Rarely, however, has gender been cited as a risk factor for non-adherence to medication regimens among patients with cancer.

A recent study from Taiwan focused on the relationship between sex and analgesic adherence in nearly 400 patients in an oncology out-patient department, and showed some surprising results.⁵ In the Taiwanese study, 3 domains were addressed:

• hesitancy to use analgesics
• overall regimen adherence, and
• pain management effectiveness

Overall, women reported more hesitancy to use analgesics, lower adherence to the recommended plan of care, inadequate pain control, and ultimately experiencing more pain. The researchers concluded that women with cancer should be considered a high-risk group for achieving optimum pain control; however, reasons for this finding were not proposed.

Results of this research prompt the need for further exploration of the relationship between gender and adherence within cancer care. Only 5 studies have previously addressed this phenomenon.^6-10 A multifactorial approach is required as this entity is complex and influenced by personal, social, financial, psychological, and cultural variables.

Oncology nurses at the bedside are key to the exploration of this phenomenon due to their central and ongoing relationships with patients. In the meantime, nurses can undertake their own field studies. Do you observe this phenomenon in your own practice?

References

• Kini V, Ho PM. Interventions to improve medication adherence: A review. JAMA. 2018;320(232):2461-2473.
• Yilmaz F, Colak MY. Evaluation of inappropriate medication use and compliance in elderly people. Curr Drug Safety. 2018;13(2):122-127.
• Finitsis DJ, Vose BA, Mahalak JG, Salner AL. Interventions to promote adherence to endocrine therapy amongst breast cancer survivors: A meta- analysis. Psycho-Oncol. 2018;4. doi: 10.1002/pon.4959.
• Krikorian S, Pories S, Tataronis G, et al. Adherence to oral chemotherapy: Challenges and opportunities. J Oncol Pharm Pract. 2018; doi: 10.1177/1078155218800384.
• Chou PL, Fang SY, Sun JL, Rau KM, Lee BO. Gender differences in cancer patients’ adherence to analgesics and related outcomes of pain management. Cancer Nurs. 2018;41(6): E11-E18.
• Turk DC, Okifuji A. Does sex make a difference in the prescription of treatments and the adaptation to chronic pain by cancer and non-cancer patients? Pain. 1999;82(2):139-148.
• Miaskowski C. Gender differences in pain, fatigue, and depression in patients with cancer. J Natl Cancer Inst Monographs. 2004;32, 139-143.
• Edrington JM, Paul S, Dodd M, et al. No evidence of sex differences in the severity and treatment of cancer pain. J Pain Symptom Manage. 2004;28(3):225-232.
• Donovan KA, Taliaferro LA, Brock CW, Bazargan S. Sex differences in the adequacy of pain management of patients referred to a multidisciplinary pain clinic. J Pain Symptom Manage. 2008;36(2):167-172.
• Liang SY, Wang TJ, Wu SF, et al. Gender differences associated with pain characteristics and treatment in Taiwanese oncology outpatients. Asian Pacific J Cancer Prev. 2013;14(7):4077-4082.