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      Adherencia a tratamientos antineoplásicos orales Translated title: Adherence to oral antineoplastic therapy

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          Abstract

          Introducción: Los tratamientos antineoplásicos orales presentan ventajas en cuanto a coste, comodidad y mejora potencial en la calidad de vida respecto al tratamiento endovenoso, pero es más difícil controlar la adherencia y monitorizar los efectos adversos. El objetivo de este estudio fue conocer la adherencia real en pacientes con antineoplásicos orales en nuestro centro, analizar la influencia de las características del paciente y del tratamiento, identificar motivos de no adherencia, oportunidades de mejora en la atención farmacéutica y evaluar la posible relación adherencia y respuesta al tratamiento. Método: estudio prospectivo observacional de cuatro meses de duración, en los pacientes con tratamiento antineoplásico oral dispensado desde la consulta de farmacia oncológica. Para la recogida de datos se utilizaron: orden médica, historia clínica y visita con entrevistas al paciente. Resultados: Se evaluaron un total de 141 pacientes. Un 72% se consideró totalmente adherente, mientras que en un 28% se detectó algún tipo de no adherencia. El tiempo desde el diagnóstico y la presencia de efectos adversos fueron las variables que afectaron a la adherencia. No se pudo demostrar relación entre adherencia y respuesta al tratamiento. Conclusiones: La adherencia al tratamiento antineoplásico oral en nuestro centro fue del 72%, identificando oportunidades de mejora en la atención farmacéutica dirigidas a prevenir los efectos adversos y a potenciar la adherencia de nuestros pacientes.

          Translated abstract

          Background: Oral chemotherapy agents offer advantages including cost, patient comfort and potential improvement in quality of life versus intravenous drugs. However ensuring adherence and monitoring adverse effects is more difficult. The aim of this study was to examine the real adherence in patients with oral chemotherapy agents in our hospital, to assess the influence of patient and treatment characteristics, to identify reasons for non adherence, to identify opportunities for improvement pharmaceutical care and to assess the potential relation between adherence and treatment outcomes. Method: observational, prospective study for a period of four month, in the patients who were dispensing oral chemotherapy agents in outpatient setting. The medical prescriptions, medical history and patient interviews were used to collect data. Results: 141 patients were assessing. 72% were considered as fully adherent, while 28% reported some kind of non adherence. Adherence was influenced by time from diagnosis and adverse effects. No relationship between adherence and treatment outcomes was found. Conclusions: Adherence to oral chemotherapy was 72%, identifing opportunities for improvement pharmaceutical care to prevent adverse effects and to improve our patient adherence.

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          Most cited references38

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          Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study.

          Imatinib mesylate (imatinib) has been shown to be highly efficacious in the treatment of chronic myeloid leukemia (CML). Continuous and adequate dosing is essential for optimal outcomes and with imatinib treatment possibly being lifelong, patient adherence is critical. The ADAGIO (Adherence Assessment with Glivec: Indicators and Outcomes) study aimed to assess prospectively over a 90-day period the prevalence of imatinib nonadherence in patients with CML; to develop a multivariate canonical correlation model of how various determinants may be associated with various measures of nonadherence; and to examine whether treatment response is associated with adherence levels. A total of 202 patients were recruited from 34 centers in Belgium, of whom 169 were evaluable. One-third of patients were considered to be nonadherent. Only 14.2% of patients were perfectly adherent with 100% of prescribed imatinib taken. On average, patients with suboptimal response had significantly higher mean percentages of imatinib not taken (23.2%, standard deviation [SD] = 23.8) than did those with optimal response (7.3%, SD = 19.3, P = .005; percentages calculated as proportions x 100). Nonadherence is more prevalent than patients, physicians, and family members believe it is, and therefore should be assessed routinely. It is associated with poorer response to imatinib. Several determinants may serve as alert signals, many of which are clinically modifiable.
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            Concurrent and predictive validity of a self-reported measure of medication adherence

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              Enhancing adherence to capecitabine chemotherapy by means of multidisciplinary pharmaceutical care

              Purpose In this prospective multi-centre observational cohort study, we investigated the effect of an intensified multidisciplinary pharmaceutical care programme on the adherence of cancer patients treated with capecitabine, a prodrug of fluorouracil. Patients and methods Twenty-four colorectal and 24 breast cancer patients participated in this study. Patients of the control group (n = 24) received standard care, patients of the intervention group (n = 24) received intensified pharmaceutical care consisting of written and spoken information. Adherence to capecitabine chemotherapy was measured using an electronic medication event monitoring system (MEMS™). Results Patients in the intervention group exhibited an enhanced but not significantly different mean overall adherence compared to the control group (97.9% vs 90.5%, p = 0.069). Mean daily adherence was significantly higher in the intervention group (96.8% vs 87.2%, p = 0.029). Variability of both adherence parameters was considerably reduced when pharmaceutical care was provided. At the end of the observation period of 126 days, the probability of still being treated with capecitabine was found to be 48% in the control group and 83% in the intervention group (p = 0.019, log-rank test). The relative risk for a deviating drug intake interval, i.e. 14 instead of 12 h, in the intervention group was found to be 0.51 (95% CI, 0.46–0.56) compared with the control group (p < 0.05, Chi-square test). Conclusions The provision of intensified pharmaceutical care can enhance adherence to and prolong treatment with capecitabine. The results underline the importance of multidisciplinary care to assure the effectiveness of oral chemotherapy.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                fh
                Farmacia Hospitalaria
                Farm Hosp.
                Aula Médica Ediciones (Grupo Aula Médica S.L.) (Madrid )
                1130-6343
                December 2014
                : 38
                : 6
                : 475-481
                Affiliations
                [1 ] Complejo Hospitalario Universitario de Pontevedra
                [2 ] Complejo Hospitalario Universitario de Vigo España
                Article
                S1130-63432014000600005
                10.7399/FH.2014.38.6.8061
                25542658
                2ec5646e-e388-490b-875f-11ff54d8660a

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                PHARMACOLOGY & PHARMACY

                Pharmacology & Pharmaceutical medicine
                Adherence,Oral chemotherapy,Capecitabine,Tyrosin kinase inhibitor,Pharmaceutical care,Adherencia,Antineoplásicos orales,Capecitabina,Inhibidores tirosin kinasa,Atención farmacéutica

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