For this study 30 patients with colorectal and breast cancer who are using capecitabine were included. The patients were asked to bring any medication left at the time of scheduled visits. Questionnaire was given at the first visit and 8-12 weeks after the treatment. It was found that no absolute adherence to oral capecitabine treatment, but the level of adherence was somewhat good. They had concluded that the need of a greater focus in the monitoring the involvement of patient with oral treatment (Figueiredo et al, 2014).
An observational multicenter study was carried out including 216 patients. Anti-cancer drug usage and adherence was assessed by means of a telephonic pill count, a questionnaire, a review of the patient’s medical file and pharmacy medication records. While majority of the population showed good adherence, other patients showed both under and over adherence. It was found that majority of non-adherent patients appear due to experienced side effects. Optimal adherence was shown by patients who are not living alone and being highly educated. Interventions should be taken to improve the adherence of non-adherent patients (Timmers et al, 2014).
Patients who are suffering from breast or colorectal cancer and taking capecitabine were recruited from UK teaching hospital. Non adherence was reported by 23.3% of the 43 participants. Capecitabine adherence was high with a strong conviction that the therapy is needed. It was found that further interventions should be taken to improve the adherence of the patients (Bhattacharya et al, 2012).
Qualitative study was carried out to explore processes and factors influencing non adherence and their relatedness in patients taking oral tyrosine kinase. 30 patients of different ages and with different types of cancers were interviewed. Treatment related side effects, hopes, anxiety, trust, and feedback mechanisms were used to determine the adherence. It was observed that certain processes and factors influenced non adherence. It was concluded that open climate and a trust-based relationship should be established in patients which feel comfortable to openly discuss the therapy related difficulties (Verbrugghe et al, 2016).
Another study had done with 21 chronic myeloid leukemia patients who were prescribed with Imitanib. In depth interviews were carried out and their adherence had been previously measured using a medication events monitoring device. It was found that both intentional and unintentional reasons affect for non-adherence. Finding ways to deal with side effects and using prompts as reminders to take medications were observed as favorable factors that improves adherence. It was suggested that interventions should be designed to ensure that patients with chronic myeloid leukemia adhere well to their oral drug regimens (Eliasson et al, 2011).
It was observed that the necessity of health care providers to adapt with practice changes aimed at supporting patients and optimizing adherence. To minimize barriers and enhance facilitators to oral treatment adherence, making model or personal systems were used as potential mechanisms. It was suggested that additional research is needed to understand what works for patients and how health care providers can change systems and strategies to support patients to achieve optimal adherence (Fennimore LA et al, 2017).
According to the current screened literature numerous types of interventions were investigated to evaluate the factors that affect medication in out-patients as well as steps that can be applied to overcome barriers to the adherence to oral medications. Lack of patient education, belief of the patient regarding the cure, serious nature of the side effects, cost of the medication had become major factors that affect adherence. Therefore barriers that affect adherence had to be identified first and necessary solutions must be implemented.