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ADHERENCE TO AND EXPERIENCE OF A TREATMENT WITH THE ORAL ANTICANCER DRUG SUNITINIB
IN PATIENTS WITH METASTATIC RENAL CELL CANCER (MRCC)
PRELIMINARY RESULTS OF THE ‘INVESTIGATING PATIENT SATISFACTION WITH ORAL ANTICANCER TREATMENT’ (IPSOC1) STUDY
Veerle Foulon1, Sandra De Coster1, Valérie Lacour2, Pascal Wolter3
1
Research Centre for Pharmaceutical Care and Pharmacoeconomics, K.U.Leuven, Belgium; 2Independent pharmacist, Belgium; 3Department of General Medical Oncology, University Hospitals, Leuven, Leuven Cancer Institute, Belgium
BACKGROUND
The shift to treating cancer with oral
agents
challenges
traditional
attitudes towards cancer care and
requires
new
concepts
of
organization of oncology services1.
One
of
the
most
important
challenges is the education of
patients and the question of patients’
adherence to treatment instructions.
RESEARCH QUESTIONS
How experience patients with
metastatic renal cell cancer (MRCC)
a treatment with the oral anti-cancer
drug sunitinib?
To what extent do patients with
MRCC
adhere
to
treatment
recommendations?
METHODS
Design
Prospective observational single center trial
Setting
UZLeuven, Belgium (academic tertiary center)
Patients
Patients with mRCC starting sunitinib in first line at 50 mg/d, 4
weeks on, 2 weeks off
Study procedures
Participants were contacted by phone at baseline and at 1, 3, 6 and 12 months.
At each contact moment, patients completed questionnaires on
•
the extent of information desire (EID);
•
patient satisfaction with treatment (CTSQ) and with treatment
education (PS-CaTE);
•
medication adherence (MMAS and CTSQ);
•
quality of life (FACT-G and FKSI);
•
the role of the pharmacist (SWiP).
Data analysis
was performed with SPSS
REFERENCES
Foulon V, Schöffski P, Wolter P. Patient adherence to oral anticancer drugs: an emerging issue in modern oncology. Acta Clin
Belg. 2011 Mar-Apr;66(2):85-96.
RESULTS AND DISCUSSION
Between 06/2008 and 11/2010, 22 patients (male: 12, female: 10, median age 62.2 (43-80) years) with metastatic renal cell carcinoma treated
with sunitinib in first and second line have participated in the IPSOC1 study.
The median duration of treatment was 169 days (range 6-1059). Dose reductions due to grade III-IV toxicities were necessary in 9 patients
(40%).
Adherence data
According to the MMAS, all patients
claimed to be fully adherent, independent of
the number of sunitinib cycles (score = 4 for
15/15 patients after 1 cycle, 9/9 patients
after 3 cycles, 8/8 patients after 6 cycles
and 7/7 patients after 12 cycles).
The questions in the CTSQ about
adherence yielded about the same results,
with only 1 out of 8 patients after 6 cycles
mentioning he had not taken the medication
exactly as directed by the doctor. The
reason for this was that the patient felt like
he ‘needed a break’.
Some patients, however, mentioned they
had most of the times (1/15 after 1 cycle),
some times (1/15 after 1 cycle) or rarely
(1/15 after 1 cycle, 2/9 after 3 cycles, 0/8
after 6 cycles and 1/7 after 12 cycles)
trouble remembering to take their cancer
therapy pills.
Cancer treatment satisfaction (CTSQ)
Expectations about therapy (Fig 1) and
feelings about side effects (Fig 2) varied
widely among patients.
Satisfaction
with
education (PS-CaTE)
cancer
treatment
Satisfaction with
treatment education
(Fig 5) was high in
all patients, and did
not change over
time.
Figure 5: Satisfaction with treatment education
Figure 1: Expectations about therapy
Figure 2: Feelings about side effects
Although overall satisfaction with therapy
was high in all patients (Fig 3), intersubject
variability upon different time points was
observed. (Fig 4)
Figure 3: Satisfaction with therapy
Figure 4: Satisfaction with therapy
Preferential site for medication delivery
Most patients were satisfied about their
community pharmacist, but would not prefer
to have their oral anti-cancer drugs
delivered in the community pharmacy.
Discussion
Although satisfaction with treatment,
feelings about side effects and treatment
expectations varied between patients and
changed over time, this had influence on
the self-reported adherence to anti-cancer
pills.
CONCLUSION
Patient adherence to oral therapy is an emerging issue in cancer treatment. Preliminary data from the IPSOC1 trial in an academic tertiary
center show that mRCC patients claim to be fully adherent to treatment recommendations.
In the meanwhile, the IPSOC trial has been extended to 11 Belgian hospitals (secondary and tertiary) with different patient educational
programs. In this trial, also MEMS® data will be collected which will allow more accurate investigation of the high adherence rates recorded in
the IPSOC1 study. The collected data will also allow investigation of the relationship between patient adherence and other factors measured.