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Stakeholder’s Perspective: Physician

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An increasing number of cancers are treated with self-administered oral medications either as the sole treatment or as a component of the patient’s cancer therapy. Most supportive and palliative medications (including antiemetics, pain relievers, and antidiarrheals) are oral, and proper adherence to these agents may be important in maximizing the patient’s quality of life. As healthcare providers, we may believe that given the gravity of the disease, patients will be especially compliant with their oral anticancer medications. As was made clear in several studies cited by Dr Hansen, this is not always the case.

While the problem has been well defined, strategies to improve compliance are poorly defined. Dr Hansen provides an excellent review of the various factors that contribute to nonadherence, such as adverse effects, high costs, and longer duration of treatment. She also outlines the few studies that describe strategies to increase adherence to selfadministered medications. As Dr Hansen notes, specific strategies to combat nonadherence include novel and high-tech concepts such as videogame interventions for teenaged patients and an electronic pill-vial cap to record adherence.

However, Dr Hansen emphasizes the importance of meaningful discussions as part of the doctor-patient relationship and cites a meta-analysis that recommends continuing education for healthcare providers to build communication skills directed specifically to the needs of cancer patients. As in many aspects of the doctor-patient relationship, effective communication is critical. Clinics are busy, and it is often easy just to provide a script to a patient and move on to the next room. However, in the long run, building a therapeutic bond by discussing a patient’s understanding of the disease, the nature of the treatment prescribed, and the patient’s concerns regarding the treatment may be more efficient because adherence to the medication plan may lead to fewer acute visits, fewer phone calls for symptoms control, and hopefully better therapeutic efficacy against the patient’s cancer.

Further, in the evolving healthcare environment, in which payment will be increasingly tied to quality-ofcare measures, developing skills to improve adherence to oral medications will also be critical. As Dr Hansen concludes, however, more research is desperately needed to better understand how to optimize adherence.

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