Cognitive Impairment, Depression Affect Oral Cancer Therapy Adherence

Patients with working memory dysfunctions and depression may be more likely to be nonadherent to oral cancer therapies, according to the results of a study (abstract 1479P) presented at the European Society for Medical Oncology (ESMO) Congress, held October 7–11 in Copenhagen, Denmark.

As the number of oral anticancer therapies in the oncology therapeutic arsenal continues to increase, it is important to track factors that influence adherence to medication, according to study researchers Florence Joly, MD, and Melanie Dos Santos, MD, of the Centre Francois Baclesse in Caen, France. In this study, the researchers assessed the relationship between cognitive functions and oral medication adherence to identify patients that were more likely to be nonadherent.

“This study included patients starting a new oral therapy and half were over 70 years of age,” the researchers said in a press release. “Before starting treatment, a standardized neuropsychological test battery including an assessment of autonomy, depression, and anxiety were performed.”

Information on sociodemographic conditions was also collected. Adherence to oral therapy was evaluated by two self-assessment questionnaires and an observance sheet at 1 and 3 months after treatment initiation.

At 1 month, 126 patients were enrolled in the study and 88% had completed the adherence questionnaire. The observed adherence rate was 90%.

Using the Montreal Cognitive Assessment, researchers observed global cognitive impairment in one-half of patients. They found two factors significantly associated with oral medication nonadherence: working memory disorders (1.38; 95% CI, 1.03–1.85; P = .0326) and depression (4.67; 95% CI, 1.11–19.59; P = .0352).

According to the researchers, “focusing on cognitive functions before initiation of oral anticancer therapy is therefore relevant to identify patient profiles more likely to fail self-management of oral anticancer therapy and therefore help decision-making, particularly in the elderly.”

Commenting on the results of this study, Bettina Ryll, MD, chair of the ESMO Patient Advocacy Working Group, said: “I believe the current concept of adherence is too narrow-ie, physicians expect patients to take their medication as prescribed and nonadherence is considered a form of disobedience. Intentional nonadherence, the patient deciding not to take medication as indicated, is actually revealing patients’ true preferences and these might simply be very different from what physicians and other stakeholders consider relevant. So instead of enforcing adherence against patients’ preferences, we need to first understand and then tackle the true reasons underlying nonadherence.”