Oral anti-cancer (OAC) therapies are now commonplace in cancer treatment. Variable adherence and irregular toxicity monitoring remain 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.
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 January 2000 – March 2022. 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.
1438 articles were screened, 272 completed full-text review with 58 included studies. One-third (17/58) were published in the past 2 years. Most studies (53/58, 91%) involved patients from USA and Europe; there were 5 studies from Asia (Japan 3, China 2). Factors contributing to lower adherence were less patient education, lack of habitual administration, avoidance of side effects and reduced understanding of oral regimens. More recent trials of patient-prompting interventions such as apps and reminders had mixed efficacy. Patient-reported benefits of OAC included convenience of home administration, patient empowerment, better psychological wellbeing, and less social and productivity interruption when compared with intravenous administration. Limitations included poorer understanding of safe-handling and reactive management of side-effect due to reduced contact with clinicians. Pharmaceutical interventions were shown to improve adherence in some studies. Studies comparing patient and clinician perspectives (n=5) identified a lack of relevant toxicity education.
Barriers and enablers of oral anticancer treatment have been identified. This information should be used by clinicians to optimise this mode of cancer treatment.
The authors.
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All authors have declared no conflicts of interest.