Pharmacist–patient relationship is key in adherence to cancer meds

Abstract

With the availability of more oral and topical drugs for the treatment of cancer, it's surprising to learn that adherence to cancer medication is a common problem among patients. "One of the thoughts that a lot of people had was that because cancer medicines are treating a life-threatening disease, patients would be much more certain to take medications as instructed," said J. Leonard Lichtenfeld, MD, MACP, Deputy Chief Medical Officer, American Cancer Society, in an interview with Pharmacy Today. But research has shown otherwise, according to Lichtenfeld. Adherence is a problem even though oral cancer drugs—such as the older and widely used tamoxifen, as well as newer oral drugs including aromatise inhibitors, imatinib mesylate, erlotinib, and capcetabine—have fewer adverse effects and are better tolerated than I.V. chemotherapy drugs. There is no "one size fits all" explanation for lack of adherence to medications that treat a life-threatening disease like cancer. Reasons cited include adverse effects that exist even with oral and topical drugs that are better tolerated, the cost of medications, a sense of fatalism about the disease, lack of support from family members and caregivers, and, especially among older adults who often take many medications, the difficulty in remembering to take their meds or in understanding how to take them correctly. At one time, only a handful of cancer medications were available for pharmacists to dispense for patients to take or use at home. With the approval of new oral and topical drugs and the changes in health care delivery, "cancer medication dispensed by pharmacists is going to become more the norm than the exception," Lichtenfeld said, adding that the key to ensuring adherence is developing a knowledgeable, caring relationship with patients. Pharmacists can help patients with cancer understand medication complexity, put systems in place to make sure patients are taking their medications, and give patients tools, such as simple checklists, to help them remember to take their medications. Pharmacists play a critical role "not just in dispensing medications but in checking the medications for errors, making sure patients understand directions, helping them understand the potential conflicts that exist with other medications or something the patient may be taking that the physician doesn't know about"—all very important parts of the larger patient care picture, Lichtenfeld said.A community pharmacist who "knows the patient, has a relationship with the patient, knows the patient's family" can reinforce the importance of taking medications correctly. These types of opportunities are more likely to exist in a well-established cancer center where, "in an ideal world," Lichtenfeld pointed out, pharmacists are part of the patient care team and make rounds with the physician. But a community pharmacist who has direct interaction with a patient—"who knows the patient, has a relationship with the patient, knows the patient's family"—can reinforce the importance of taking medications correctly and on a timely basis, he continued. "The [community] pharmacist can be part of that warning system that there may be a problem with that patient taking their medication, or there may be a problem with that patient being able to afford their medication," Lichtenfeld explained. "That becomes a situation where the pharmacist hopefully can interact with the care team that's providing the oncology treatment for that patient." Numerous resources are available to help patients adhere to their oral cancer medication regimen. For example, CancerCare offers free 1-hour podcasts, booklets, and fact sheets with information about the latest cancer treatments, managing side effects, and coping with cancer (www.cancercare.org). "The Importance of Taking Your Pills on Schedule: Understanding Adherence" and “Understanding the Important Role of Adherence in the Medical Management of Cancer" are two podcasts for patients with cancer. Booklets and fact sheets include "The Importance of Taking Your Pills Everyday on Schedule" and "The Importance of Taking Your Pills on Schedule." Patients with chronic myelogenous leukemia (CML) can turn to "Adherence and CML: Overcome the Challenges to Taking Your Pills" and "The Importance of Taking Your Prescribed Medication During Chronic Myelogenous Leukemia Treatment." The National Council on Patient Information and Education (NCPIE) offers Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda on its Be Medicine Smart website (www.bemedicinesmart.org). CDC's online medication adherence tools are also helpful (www.cdc.gov/primarycare/materials/medication/index.html).