Sampathkumar Yashasvini, Voils Corrine I, Mazza Gina L, Rogak Lauren, Ginos Brenda F, Kantor Elizabeth D, Bennett Antonia V, Los Santos Yulianny De, Suarez Jennifer, Lopez Camila, Narang Bharat, González Javier, Killoran Kathleen, Spears Patricia A, Wolf Anna P, Weiss Anna, Wheeler Stephanie B, Reeve Bryce B, Basch Ethan, Gany Francesca, Blinder Victoria
Memorial Sloan Kettering Cancer Center, New York, NY.
University of Utah School of Medicine, Salt Lake City, UT.
JCO Oncol Pract. 2025 Aug 19:OP2500477. doi: 10.1200/OP-25-00477.
Patients with cancer take different types of medications with varying schedules and settings. They are also sometimes instructed to stop medications due to toxicity. To measure self-reported nonadherence in this heterogeneous population, we modified and evaluated a measure originally developed to assess nonadherence to daily oral antihypertensives, the Domains of Subjective Extent of Nonadherence (DOSE-Nonadherence).
The measure was refined in an iterative process incorporating feedback from patient investigators and participant interviews in English and Spanish. Branching logic was added for participant selection of medication administration setting: (1) only home, (2) only clinic, or (3) partly home/partly clinic. Participants reported their adherence to medications taken over a setting-specific reference period (1 week for home, 1 month for clinic medications). Participants who missed medications then reported on reasons for nonadherence. Adherence was dichotomized for analysis (complete adherence any nonadherence). For participants who received clinic-administered medications, concordance between chart-abstracted and self-reported adherence was evaluated.
Seventy-three participants completed the measure (68% English; 32% Spanish; 86% female; 44% age ≥60 years). The majority had breast cancer; 64% had metastatic disease. Twenty-six percent (15/58) of participants who received medication in clinic and 24% (11/46) of those who took medication at home reported nonadherence. Participants felt able to respond accurately to both reference periods and perceived all reasons for nonadherence to be relevant. Among participants who completed the final version of the measure for clinic-administered medication, 96% (26/27) accurately reported their adherence compared with chart-abstracted data.
Our results support the validity of the DOSE-Nonadherence-Cancer for assessing cancer treatment nonadherence. This measure can be used to assess nonadherence in patients with cancer receiving a broad array of systemic therapies.
癌症患者服用不同类型的药物，服药时间表和服药环境各不相同。他们有时还会因毒性反应而被要求停药。为了衡量这一异质性人群中自我报告的不依从情况，我们对最初用于评估每日口服抗高血压药物不依从性的一种测量方法——不依从主观程度域（DOSE-不依从）进行了修改和评估。
该测量方法在一个迭代过程中得到完善，纳入了来自患者研究者以及用英语和西班牙语进行的参与者访谈的反馈。增加了分支逻辑，以便参与者选择药物服用环境：（1）仅在家中，（2）仅在诊所，或（3）部分在家/部分在诊所。参与者报告他们在特定环境的参考期内（在家为1周，诊所用药为1个月）对所服药物的依从情况。错过服药的参与者随后报告不依从的原因。依从性分为两类进行分析（完全依从与任何不依从）。对于接受诊所给药的参与者，评估图表摘要的依从性与自我报告的依从性之间的一致性。
73名参与者完成了该测量（68%为英语使用者；32%为西班牙语使用者；86%为女性；44%年龄≥60岁）。大多数患有乳腺癌；64%患有转移性疾病。在诊所接受药物治疗的参与者中有26%（15/58）、在家服药的参与者中有24%（11/46）报告有不依从情况。参与者认为能够准确回答两个参考期的问题，并认为所有不依从的原因都相关。在完成诊所给药最终版测量方法的参与者中，与图表摘要数据相比，96%（26/27）准确报告了他们的依从情况。
我们的结果支持DOSE-不依从-癌症在评估癌症治疗不依从性方面的有效性。该测量方法可用于评估接受多种全身治疗的癌症患者的不依从情况。
