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Side Effects, Self-Management Activities, and Adherence to Oral Anticancer Agents

Authors Jiang Y, Wickersham KE, Zhang X, Barton DL, Farris KB, Krauss JC, Harris MR

Received 25 July 2019

Accepted for publication 27 November 2019

Published 3 January 2020 Volume 2019:13 Pages 2243—2252


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Yun Jiang,1 Karen E Wickersham,2 Xingyu Zhang,1 Debra L Barton,1 Karen B Farris,3 John C Krauss,4 Marcelline R Harris1

1University of Michigan School of Nursing, Ann Arbor, MI, USA; 2University of South Carolina College of Nursing, Columbia, SC, USA; 3University of Michigan College of Pharmacy, Ann Arbor, MI, USA; 4University of Michigan Medical School, Michigan Medicine, Ann Arbor, MI, USA

Correspondence: Yun Jiang
University of Michigan School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109, USA

Purpose: There are growing concerns about patients’ adherence to oral anticancer agents (OAAs), and the need for patients to engage in self-management of OAA-related side effects. We assessed associations among adherence, severity of side effects, and effectiveness of self-management of side effects in patients taking capecitabine.
Methods: Adherence to capecitabine at 6 weeks was measured by the Medication Event Monitoring System among 50 patients with gastrointestinal cancers. Severity of side effects related to capecitabine and effectiveness of self-management of side effects were captured using the Modified Self-Care Diary at the time of enrollment and weekly for 6 weeks. Spearman’s correlation, Mann–Whitney U-tests, and multiple linear regression were conducted, p<0.05.
Results: Overall mean adherence rate was 85.4±14.1%. Adherence rate was not significantly correlated to the mean severity of total side effects at any time point and was correlated with the mean effectiveness of self-management of total side effects only at week 2 (rho=0.29, p=0.04). However, adherence rate was associated with the mean severity of one specific side effect, diarrhea, at 6 weeks (rho=0.36, p=0.01) and marginally correlated to the mean effectiveness of self-management of diarrhea at 6 weeks (rho=0.28, p=0.05). Mean severity of diarrhea at 6 weeks was an independent predictor of adherence rate (b=4.97, p=0.01), with the control of age (b=0.52, p=0.002), number of outpatient medications (b=1.12, p=0.007), health literacy (b=2.53, p=0.04), diagnosis of colorectal cancer (b=11.6, p=0.03), and capecitabine in combination with other chemotherapies (b=16.8, p=0.001) in the model.
Conclusion: This pilot study suggests ongoing examination of both severity and effectiveness of self-management of side effects in future studies of adherence to OAAs is merited. There is a need for future studies with larger sample sizes that explore the complex relationships among adherence, severity of side effects, and effectiveness of self-management of side effects in OAA therapy.

Keywords: oral anticancer agents, adherence, side effects, self-management

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