The incidence and correlates of non-adherence in adolescents receiving chemotherapy

Abstract

A retrospective chart review was conducted to investigate the prevalence of non-adherence to chemotherapy among adolescents with cancer. Chemotherapy treatment protocols were identified as Treatment I or Treatment II depending on treatment phase and disease progression. Treatment I was defined as the series of drugs given during the induction and maintenance phases of treatment. Treatment II was a different series of drugs, offered if the patient failed to achieve remission after the induction phase or experienced relapse at any time during treatment. Each treatment was analysed separately and independently. Data were extracted from a total of 49 charts. Forty-eight charts had information available from the time of diagnosis and one chart had information only from the time of relapse because the patient received initial treatment at another centre. Of the 48 patients who entered Treatment I, one patient refused chemotherapy and 47 accepted. The one patient who refused an initial offer of chemotherapy accepted an equivalent treatment of total nodal radiation. He was not considered non-adherent; however, factors that led to his decision to refuse chemotherapy will be examined. Of the 47 patients who received chemotherapy in Treatment I, one patient dropped out, four patients modified their treatment and five delayed treatment, for a total non-adherence rate of 21% (n=10). There were a total of 16 patients in Treatment II which was composed of 15 of the initial 47 patients in Treatment I and one patient transferred from another hospital. Of the 16 patients in Treatment II, two patients dropped out and three patients modified treatment for a non-adherence rate of 31% (n=5). The major reason for modification or delay of treatment was the inability to tolerate nausea and vomiting. Antiemetics were refused by 13 patients (27%) due to the unpleasant side effects of these drugs. Other factors contributing to non-adherence and implications of this study for future research are discussed.