Even in the face of a potentially life-threatening condition, adherence rates to oncology treatment vary widely and can be as low as 46% .
And it’s to no fault of the patient. Oncology treatments are known to be complex products, often accompanied by complicated regimens for administration. Add to that the potentially debilitating symptoms of disease, both physically and emotionally, and ongoing financial, quality of life and social concerns, and it’s obvious we shouldn’t underestimate the effort and patient dedication required to start and stay on therapy.
Over the past few decades, the oncology treatment landscape has shifted towards patients bearing greater and greater responsibility for managing treatment. Where the mainstay of oncology treatment used to be in surgery, radiation, chemotherapy — all performed and administered in hospitals — over the years the treatment paradigm has shifted to (oral) self-administration, combination therapy, and longer-term ongoing treatments. In many cases, cancer has become a chronic condition and along with that comes a greater responsibility on patients to learn how to manage their own treatment.
On the healthcare provider side, oncology practices will naturally focus most on safe administration and monitoring efficacy. The full spectrum of patient’s psychosocial, motivational, educational needs and barriers may stay largely unaddressed. Manufacturers of oncology medications are in a unique position to step into this void. As the ultimate experts on the medications and the experience of taking them, pharma companies are uniquely positioned to provide education and support, and set patients up for successful initiation and longer-term adherence to therapy.
Patient Barriers to Oncology Treatment Initiation and Adherence
It’s a common misconception that a serious illness like cancer will ensure patient adherence to treatment. Surely people want to conquer their disease? The reality is much more nuanced. Of course people want to beat their cancer, but patients experience challenges throughout the course of their disease and treatment, making it difficult to initiate and take their treatment as prescribed.
Human Care Systems uses a framework of 7 barrier categories to help uncover and address the challenges patients may face while on a particular treatment:
1. Disease state: The disease itself may cause symptoms that impact adherence. Living with pain, inconsistent or fluctuating symptoms, and potential cognitive impact of disease.
2. Nature of the drug or treatment: Irregular administration schedules, titration schedules, pause weeks between therapy cycles, and combination therapies create an inconsistent regimen that causes uncertainty about correct administration and difficulty for patients to get into a medication-taking routine.
3. Financial factors: Cost and logistical issues with treatment, supplies, transportation, as well as potential loss of income and inability to work may impact initiation and adherence.
4. Motivational considerations: Especially when asymptomatic, patients may not realize the necessity of taking their medication. There may also be misconceptions about treatment efficacy.
5. Psychosocial concerns: Many patients experience depression and anxiety in response to their diagnosis, which can interfere with adherence and persistence.
6. Side effects: Oncology medications are not always well tolerated and side effects such as nausea, diarrhea, and fatigue are not uncommon. The negative impact of treatment on quality of life is an obvious consideration when deciding to start or continue treatment.
7. Provider factors: Challenges in patient-HCP communication, physician lack of time.
Throughout each patient’s treatment journey, they will face a broad set of multifaceted barriers. The result is that, to be successful, patients need to:
- Become their own health managers
- Become advocates for themselves
- Learn the terminology
- Speak up and ask questions
- Chase for paperwork and decisions
- Thoroughly understand that complicated treatment cycle
- Consistently track symptoms and side effects
Most of us are not trained to rapidly become managers of our own health when confronted with a cancer diagnosis, but that is exactly what oncology patients are required to do in order to optimally manage their condition and treatment plan. It is up to the rest of us to provide patients with as much support as possible to help them throughout this process.
Improving Adherence to Cancer Treatments
Fortunately, barriers to treatment adherence are addressable. Evidence-based interventions measurably improve all barriers, including side effect management, financial, motivation, routine, expectations and knowledge-based barriers.
While there are many factors that determine whether or not a support program is successful, a few key components are essential:
- Simple and informative content
Upon diagnosis, cancer patients are often searching for answers and are inundated with a vast amount of resources, many of them confusing and complex. The aim is to help guide patients through the noise, provide guidance using simple and effective language, and point them towards other trusted resources.
- Adherence navigators trained in the latest techniques for behavioral modification
Oncology therapies are complex, and patient often struggle to understand the differences between chemotherapy and immunotherapy, how their dosing schedules work, what the potential side effects are, how to navigate their insurance claims, etc. It is crucial to have a team of adherence navigators trained in the latest techniques of cognitive behavioral techniques and motivational interviewing. The goal is to use a patient-centered, collaborative approach to elicit and strengthen patients’ proactive self-management skills and their continuous collaboration with their Health Care Professionals.
- State-of-the-art IT application for omnichannel interaction
Each cancer patient has a unique background and specific needs, so the goal is to meet provide each patient with the right message at the right time through the right channel. To do this you need an IT solution that:
- Has the ability to assess the unique combination of barriers to adherence experienced by each patient at various points in their treatment journey and directly addresses those barriers
- Contains an assessment feature that helps identify barriers and classify patients as needing a certain type of support
- Can easily integrate with other parties like hubs, copay vendors, apps, wearables, data aggregators, etc. to capture data that will augment our communications in meaningful and actionable ways
- Uses data or other triggers to automatically develop cadences with omnichannel communications to ensure a personalized stream of helpful information
- Provides real-time insights on strategic and operational KPIs and can drive predictive analytics to further improve patient support
With the right combination of content, technology and human support, pharma manufacturers can help create a patient journey that acknowledges and addresses the full complexity of diagnosis, treatment, and life with cancer and that sets patients up for long term treatment success.
Jessica Lens is the Chief Operating Officer and Head of Product at Human Care Systems. Among her numerous responsibilities, she ensures that the Resilix® Treatment Experience Platform delivers now and tomorrow for patients, HCPs, and biopharma. Her passion for product stems from a career and personal focus in human behavior, great user experiences, and applying evidence to improve health outcomes.
1. Greer, J. A., Amoyal, N., Nisotel, L., Fishbein, J. N., MacDonald, J., Stagl, J., ... & Pirl, W. F. (2016). A systematic review of adherence to oral antineoplastic therapies. The oncologist, 21(3), 354