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Compliance and cost: Bitter pills to swallow in the age of oral chemotherapy
Date:5/28/2009

esponsible for drug costs when they reach the "donut hole," where coverage ends but their need for cancer therapy continues. Side effects, from joint pain to hot flashes to nausea, may also make the drugs unpalatable. And education and cultural issues may pose barriers, if a patient can't read their medication instructions or holds religious beliefs that conflict with prescribed treatment. The change in drug schedule that oncology patients sometimes experience when, for instance, their number of infection-fighting white blood cells falls too low to continue therapy for a time may also lead to confusion about the importance of remaining on target with dosing instructions.

Patients who are considered cancer "survivors" are taking adjuvant drugs to prevent a recurrence like tamoxifen for breast cancer may simply tire of taking the drugs over the long term even when they feel well. In trials studying drugs like these, just 60 to 70 percent of patients stick with their regimen beyond two years, even though the trials are often designed to stretch out to five years for maximum benefit. Adherence to drugs given to prevent cancer is even worse, with studies showing that as many as 40 percent of women prescribed drugs for breast cancer prevention failed to take the drugs or took them only intermittently. Research shows the poor compliance takes a toll in one study, women who filled fewer than 70 percent of their tamoxifen prescriptions had an increased risk of death.

With more oral agents coming to market each year they are now available to treat cancers that attack the breast, blood, colon and lungs, among others DeMichele and her colleagues are calling upon oncologists to find new ways to improve adherence. While patients with other chronic conditions like hypertension or high cholesterol may be able to duck in and out of drug treatment without urgent threat to their health, poor compliance with cancer drugs often poses an immediate danger: Some
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Contact: Holly Auer
holly.auer@uphs.upenn.edu
215-200-2313
University of Pennsylvania School of Medicine
Source:Eurekalert

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