Background:
Oral anti-cancer therapies are now commonplace in cancer treatment. Variable adherence is concerning, particularly for treatments with curative intent. This study reviews literature on patient preferences considering: 1) factors contributing to patient adherence; 2) benefits and limitations; 3) concordance between patient and clinician perspectives.
Methods:
This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An a priori protocol was established with systematic searches of major databases (Pubmed, Ovid Emcare, CINAHL and Scopus) from 2000 - 2020. Quantitative and qualitative studies of adult populations were included. Methodological quality was assessed using the Johanna Briggs Institute Critical Appraisal Tools. A narrative synthesis of findings was conducted.
Results:
1095 articles were screened. Following full-text review of 246 articles, 41 studies were included in the systematic review. Most studies (38/41, 93%) involved patients from USA and Europe; there were no Australian-based studies. The methodological quality of most studies (37/41, 90%) was ‘moderate’ to ‘high’. Most high quality studies (15/19, 80%) were reported in the past ten years. Factors contributing to lower adherence were: less patient education, lack of habitual administration, avoidance of side effects and reduced understanding of oral regimens. Benefits were: convenience of home administration, patient empowerment, better psychological wellbeing, and less social and productivity interruption when compared with intravenous administration. Limitations included reactive management of side-effect due to reduced contact with clinicians, as well as difficulty obtaining oral chemotherapy at community-based pharmacies. Pharmaceutical interventions were shown to improve adherence. Studies comparing patient and clinician perspectives (n= 4) identified a lack of relevant toxicity education.
Conclusions:
Barriers and enablers of oral anticancer treatment have been identified. This information should be used by clinicians to optimise this mode of cancer treatment.