Department of Gastroenterology and Hepatology, 108 Military Central Hospital, Hanoi, Vietnam.
BMC Cancer. 2024 Jul 15;24(1):841. doi: 10.1186/s12885-024-12601-2.
Standard oral cancer chemotherapy (OCT) or targeted therapy (OTT) has expanded the treatment methods for hepatocellular carcinoma (HCC). However, its principal nonadherence causes a reduction in efficacy. We aimed to evaluate the status of nonadherence and influencing factors among outpatient patients with HCC.
In 2021, a prospective observational study was conducted on 384 patients with either old or newly diagnosed HCC treated with OTT. Nonadherence to OCT was determined using the eight-item Morisky Medication Adherence Scale, with a score < 6 points. The patients were finished with a six-month follow-up investigation by questionnaires.
54,8% of HCC outpatients were nonadherent to OCT, with a mean Morisky score of 5.19. They dropped out of the treatment mainly because of drug side effects, such as fatigue (72.4%), hand-foot syndrome (42.7%), diarrhea (38.3%), nausea (25%), insomnia (24.7%), abdominal pain (12%), and anxiety about these adverse events (65.9%). Additionally, financial difficulties and low relative copayments were significantly correlated with the noncompliant treatment of patients (OR = 2.29, 95% CI = 1.32-3.98, P = 0.003; OR = 4.36, 95% CI = 0.95-19.93, P = 0.039, respectively). Moreover, inadequate individual information about the clinical course, the art of treatment, and medication usage instructions were suggestive barriers to adherence to treatment (OR = 1.96, 95% CI = 1.08-3.55, P = 0.024; OR = 1.86, 95% CI = 1.1-3.14, P = 0.02; OR = 2.34, 95% CI = 1.29-4.26, P = 0.004, respectively). Finally, a low level of trust in doctors was an essential factor in nonadherence (Mean of the Anderson Trust in Physician Scale scores counted 38.12 vs. 43.97, respectively for non-adherence vs. adherence, P = 0.00001).
This study suggests a high rate of primary nonadherence to standard oral targeted therapy among HCC outpatient patients because of drug side effects, patient awareness of treatment, and lack of confidence in healthcare providers. Close supervision, proper medication instructions, appropriate dosage reductions, and comprehensive patient counseling might be necessary to control nonadherence.
标准口腔癌化疗（OCT）或靶向治疗（OTT）已扩大了肝细胞癌（HCC）的治疗方法。然而，其主要的不依从性导致疗效降低。我们旨在评估 HCC 门诊患者的不依从性现状及其影响因素。
2021 年，对接受 OTT 治疗的 384 例新旧 HCC 患者进行了前瞻性观察性研究。采用 Morisky 药物依从性量表的 8 项评估 OCT 的不依从性，得分<6 分。通过问卷对患者进行了为期 6 个月的随访调查。
54.8%的 HCC 门诊患者不依从 OCT，Morisky 评分平均为 5.19。他们主要因药物副作用（疲劳 72.4%、手足综合征 42.7%、腹泻 38.3%、恶心 25%、失眠 24.7%、腹痛 12%、对这些不良反应的焦虑 65.9%）而停止治疗。此外，经济困难和相对自付费用低与患者治疗的不依从显著相关（OR=2.29，95%CI=1.32-3.98，P=0.003；OR=4.36，95%CI=0.95-19.93，P=0.039）。此外，缺乏关于临床过程、治疗艺术和用药说明的个人信息提示了对治疗的依从性障碍（OR=1.96，95%CI=1.08-3.55，P=0.024；OR=1.86，95%CI=1.1-3.14，P=0.02；OR=2.34，95%CI=1.29-4.26，P=0.004）。最后，对医生的信任程度低是不依从的一个重要因素（安德森医生信任量表评分均值分别为不依从者 38.12 和依从者 43.97，P=0.00001）。
本研究表明，由于药物副作用、患者对治疗的认识和对医疗保健提供者的缺乏信心，HCC 门诊患者对标准口服靶向治疗的原发性不依从率较高。需要密切监督、适当的用药说明、适当的剂量减少和全面的患者咨询，以控制不依从性。
