Hirao Chieko, Mikoshiba Naoko, Shibuta Tomomi, Yamahana Reiko, Kawakami Aki, Tateishi Ryosuke, Yamaguchi Hironori, Koike Kazuhiko, Yamamoto-Mitani Noriko
Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo.
Jpn J Clin Oncol. 2017 Sep 1;47(9):786-794. doi: 10.1093/jjco/hyx087.
The purpose of this study was to investigate medication adherence to oral chemotherapy medications and determinants of medication non-adherence to them among gastroenterological cancer patients.
A cross-sectional study was conducted on 117 consecutive, consenting, eligible patients visiting an outpatient clinic of university hospital in Japan. Good medication adherence was defined as taking 100% of the prescribed dose. Medication adherence was measured via self-report. We hypothesized that there was a significant relationship between medication non-adherence and the five factors defined by the World Health Organization: patient-related, socioeconomic-related, condition-related, treatment-related, and healthcare-system/provider-related factors. Multiple logistic regression models were used to identify factors associated with oral chemotherapy medication non-adherence.
The proportion of patients showing good medication adherence was 56.4%. The multiple logistic regression analysis revealed that the determinants of medication non-adherence to oral chemotherapy medications included having a history of patient-caused treatment interruptions due to worsening of symptoms (adjusted odds ratio [AOR] = 9.59, 95% confidence interval [CI] = 1.38-66.47), having diarrhea (AOR = 3.25, 95% CI = 1.13-9.34), experiencing pain (AOR = 0.17, 95% CI = 0.05-0.55), taking oral chemotherapy medication every 8 h (AOR = 5.52, 95% CI = 1.71-17.81), and diminished sense of priority for medication (AOR = 1.40, 95% CI = 1.21-1.63).
This study suggests that many patients with gastroenterological cancer were non-adherent to oral chemotherapy medications. It might be necessary to conduct periodic screening and connect patients at a high risk of medication non-adherence to appropriate support.
本研究旨在调查胃肠道癌症患者口服化疗药物的用药依从性以及用药不依从的决定因素。
对连续就诊于日本某大学医院门诊的117名自愿参与且符合条件的患者进行了横断面研究。良好的用药依从性定义为服用规定剂量的100%。用药依从性通过自我报告进行测量。我们假设用药不依从与世界卫生组织定义的五个因素之间存在显著关系:患者相关因素、社会经济相关因素、病情相关因素、治疗相关因素以及医疗系统/提供者相关因素。采用多元逻辑回归模型来确定与口服化疗药物用药不依从相关的因素。
表现出良好用药依从性的患者比例为56.4%。多元逻辑回归分析显示,口服化疗药物用药不依从的决定因素包括因症状加重导致患者自行中断治疗的病史(调整后的优势比[AOR]=9.59,95%置信区间[CI]=1.38 - 66.47)、腹泻(AOR = 3.25,95% CI = 1.13 - 9.34)、疼痛(AOR = 0.17,95% CI = 0.05 - 0.55)、每8小时服用一次口服化疗药物(AOR = 5.52,95% CI = 1.71 - 17.81)以及用药优先级意识降低(AOR = 1.40,95% CI = 1.21 - 1.63)。
本研究表明,许多胃肠道癌症患者未坚持口服化疗药物治疗。可能有必要进行定期筛查,并将用药不依从风险高的患者与适当的支持措施联系起来。