Oncology Nurses Must Stress Importance of Medication Adherence

Oral cancer therapies can be appealing to patients, particularly during the COVID-19 era, because they can be taken at home. However, at-home medication can also pose a threat to adherence. Oncology nurses therefore need to remain diligent in educating their patients and monitoring their adherence.

“You avoid intravenous infusions; I’m all about that. And patients feel empowered [taking their medication at home], but we have to give them the tools to succeed,” said Patricia Jakel, MN, RN, AOCN, a clinical nurse specialist in the Solid Tumor Program at UCLA Medical Center, at the 5th Annual School of Oncology Nursing Annual Meeting.

Patients may be burdened with complicated medication schedules, that could include taking 1 drug to ensure that another works properly, as well as adverse event management. Add chemotherapy-related cognitive impairments – commonly referred to as “chemo brain” – and clinicians may be surprised to see how many patients are struggling with their medications. Jakel admitted she has struggled with chemo brain.

“I’m a breast cancer patient [who was] on treatment for the last 4 years. Oral adherence was not the best for me, so I have personal experience with it,” Jakel said. She joked, “I used to be smart. I used to be really smart, and chemo brain has really affected me. It doesn’t matter if you’re taking oral agents, IV agents, or anti-estrogen agents. [Chemo brain] is really real to patients.”

Cancer treatments can affect memory, executive functioning, and a patient’s ability to organize their thoughts. Their ability to pay attention or processing speed may be affected, too. Jakel said that cognitive training, which could be as simple as doing puzzles or keeping up to date on the latest news in an area of interest, can help curb the effects of chemo brain, as can complementary treatment methods such as acupuncture.

“Poor adherence decreases clinical benefits and overall effectiveness of the healthcare system,” she said. “It not only affects the patient, but these patients who are non-adherence actually end up back in the hospital and end up with other complications.”

Strikingly, 20%-30% of medication prescriptions are never filled. And according to Jakel, there are factors besides chemo brain that contribute to non-adherence.

In her experience, Jakel has seen patients stop taking their medications once they start to feel better or that the drug is working. Others may be experiencing cost barriers or psychosocial issues that prevent them from taking their medication as prescribed. “Make sure you talk to your patients about … the reasons why they’re not taking [their medication.]”

There are steps that clinicians can take to help their patients improve medication adherence. Some are simple, like calling and checking in on them, asking them to keep a drug diary, or conducting pill counts. Doctors can also encourage patients to use apps or alarms on their phone that reminds them to take their drugs.

When discussing medication adherence, clinicians should be careful of their word choice, Jakel said.

“What I say [to patients] is ‘Tell me how you’re taking your medication.’ I don’t say ‘Are you taking it?’” Jakel said. “I think that’s very important to have them talk to you.”

Additionally, caregivers should be educated on proper drug handling, scheduling, and potential drug-drug interactions.

“Make sure that education is done for the family and the caregiver,” Jakel said. “Hopefully the patient has a caregiver or a friend or family member helping them, because that’s critical for adherence.”

Ultimately, when patients do not take their cancer drugs properly, it can lead to a barrage of other complications that will have negative consequences both for the individual with cancer and the healthcare system.

Reference

Jakel P. Breast Cancer Supportive Care in 2021. Presented at: 5th Annual School of Nursing Oncology. August 6-7, 2021. Virtual.