Accordino Melissa K, Hershman Dawn L
From the Department of Medicine and Epidemiology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.
Am Soc Clin Oncol Educ Book. 2013:271-6. doi: 10.14694/EdBook_AM.2013.33.271.
The issue of medication noncompliance is becoming increasingly important in oncology as more cancer therapies are delivered orally. Medication adherence is difficult to assess and there is no gold standard of measurement. The act of measuring adherence can affect outcomes. Medication noncompliance is common, and is estimated to be 50% in treatment of chronic diseases. Studies have shown that women initiate adjuvant hormonal therapy for breast cancer 64% to 88% of the time when prescribed. Of those who initiate therapy, 50% to 80% are adherent for the prescribed duration, depending on the study. Patients noncompliant with adjuvant hormonal therapy for breast cancer have worse overall survival than their counterparts. Suboptimal treatment responses in chronic myeloid leukemia (CML) are also associated with medication noncompliance. Poor adherence can also affect clinical trial results, leading to inaccuracies of treatment efficacy. Barriers to compliance can occur on the individual, cultural, or system level. Examples of specific barriers are side effects, cost and access to medication, and individual health beliefs. Specific populations, including racial minorities, elderly patients, and very young patients, may be at higher risk for medication noncompliance. Strategies to improve compliance are multifactorial and include improvement of patient education, reduction of treatment side effects, interventions to alter behavior, and changes in public policy to improve financial barriers to treatment. Technology has been an effective tool in improving compliance in noncancer-related illness, and ongoing studies are evaluating its role in the oncology population.
随着越来越多的癌症治疗药物采用口服给药方式，用药依从性问题在肿瘤学领域变得愈发重要。药物依从性难以评估，且不存在衡量的金标准。测量依从性的行为会影响结果。用药不依从情况很常见，据估计在慢性病治疗中达到50%。研究表明，女性在开具处方时，64%至88%的时间会开始乳腺癌辅助激素治疗。在开始治疗的患者中，50%至80%会在规定疗程内坚持用药，具体比例取决于研究。乳腺癌辅助激素治疗不依从的患者总体生存率低于依从的患者。慢性髓性白血病（CML）治疗反应欠佳也与用药不依从有关。依从性差还会影响临床试验结果，导致治疗效果不准确。依从性障碍可能出现在个人、文化或系统层面。具体障碍包括副作用、药物成本和可及性以及个人健康观念。特定人群，包括少数族裔、老年患者和非常年轻的患者，用药不依从的风险可能更高。提高依从性的策略是多方面的，包括改善患者教育、减少治疗副作用、改变行为的干预措施以及改变公共政策以改善治疗的经济障碍。技术在改善非癌症相关疾病的依从性方面是一种有效工具，正在进行的研究正在评估其在肿瘤患者中的作用。
