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Adherence to oral therapy in oncology – improving the quality of patient care. From La Spezia, Italy
  1. F. Vaira,
  2. A. Iaquinta,
  3. A. Sarteschi,
  4. S. Sannazzaro,
  5. G. Monsello
  1. 1Local Health Board ‘ASL 5’, Oncology Department, La Spezia, Italy
  2. 2Local Health Board ‘ASL 5’, Hospital Pharmacy, La Spezia, Italy
  3. 3Local Health Board ‘ASL 5’, Department of Nursing Studies, La Spezia, Italy

Abstract

Background In oncology, oral treatment and the revised use of traditional drugs have brought major changes in treatment management. Non-adherence to treatment can reduce the effects, constitute a potential risk of toxicity and a waste of resources. Our expenses for oral treatment now constitute over 30% of the overall cost of cancer treatment.

Purpose Our Oncology Department and Hospital Pharmacy have devised a programme for cancer patients undergoing oral treatment that includes visits by a specialist before each treatment cycle, provided directly by the hospital pharmacists, and ongoing toxicity monitoring. The aim of this report was to evaluate patient adherence to treatment.

Materials and methods Data regarding all the breast cancer patients treated orally (capecitabine and/or vinorelbine) by ASL5 between 2009-2010, taken from patient records and prescriptions analysed retrospectively.

Results There were 61 patients with an average of six cycles each and an average duration per cycle of 21.6 days. Three patients (5%) dropped out for unknown reasons. The others suspended treatment because of disease progression (40%), causes related to the treatment (38%) and disease stability (17%). The patients were divided into three groups based on the number of cycles undergone (<=3, 4-6, >6). The average cycle lasted 21, 22 and 23 days respectively. The first group included the three lost patients. In the first and last group 58% and 6%, respectively suspended due to toxicity, while 8% and 65% of drop-outs respectively were due to disease progression.

Conclusions The patients attended regularly, adherence and persistence were good. The programme improved the quality of care and reduced costs. Adherence to oral treatment in oncology could be improved by better selection of the patients. Predictive factors regarding compliance could be identified and organisational aspects optimised to encourage regular attendance; patient education and monitoring by the whole team could be improved.

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