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Apr 2018 - Sep 2021

Oral chemotherapy management in the home: an exploratory case study of treatment adherence in people with cancer living in the Valleys of South East Wales

Student

Abdi Ali

Location

Cardiff

Funding Amount

£13,500

Supervisor

Professor Jane Hopkinson

Cancer Type

All

Funding Type

PhD

Status

Complete

Research Type

Cancer Control, survivorship and outcomes research

Colorectal cancer is the second most prevalent cancer in men and the third most prevalent in women in Wales. The increased use of oral chemotherapy agents and convenience it brings to a patient’s routine has shifted treatment management closer to home, providing greater patient autonomy. Poor adherence remains a key barrier to achieving optimal treatment outcomes.

Aim

To assess medication adherence to oral chemotherapy medicines among colorectal cancer patients in different sociodemographic groups across South Wales. To examine patient beliefs about medicines, explore the challenges with adherence and to identify influences on medication use.

Method

Patients diagnosed with colorectal cancer and prescribed oral chemotherapy medication were recruited from an outpatient clinic. Questionnaire data including sociodemographic characteristics, self-reported adherence, and beliefs about medicines were collected. A purposive sample of participants were followed up for semi-structured interviews to explore their experiences and challenges with medication adherence. The questionnaire data was analysed using descriptive statistics, and thematic analysis was used for the interviews using the framework method of analysis.

Results

Patients living in the most deprived areas had the lowest adherence rates compared to the least deprived. Non-adherent behaviours measured using the Medication Adherence Report Scale (MARS) was reported by 35.6% of the 59 patients. The Beliefs about Medicine Questionnaire (BMQ) indicated that oral chemotherapy medication was perceived necessary by 93.2% of participants, however, 44.1% had strong concerns. The interview findings (n=16) revealed that patients were concerned about their medication’s long-term effects and likelihood of permanent harm. The oral chemotherapy treatment was found to have presence of over- and under-adherence. Forgetfulness and side effects were the leading causes of non-adherence in keeping with previous literature, with hand-foot syndrome (HFS) and constant tiredness/fatigue the most common adverse effects.

Impact

This study has shown for the first time the disparity in adherence rates across the different sociodemographic groups. Patients from lower socioeconomic areas require additional support, and a range of training and information sources are needed to help patients recognise when their symptoms are subsiding within recovery time frames. A lack of an adequate support system, understanding, and disengagement from clinicians when making decisions were all factors that influenced patient’s adherence decisions.

Next Steps

The plans are to publish the main findings of the study in line with the study aims titled “Adherence to oral chemotherapy medicines: Exploring patient beliefs and influences with medication use for colorectal cancer across different sociodemographic areas in South Wales”. 

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