Copenhagen, Denmark—Adherence to infusional or injectable anticancer drugs is not problematic—as long as the patient gets the infusion or injection, adherence is assured—but adherence is an emergent problem with newer oral anticancer drugs.
According to a study presented at the European Society for Medical Oncology Congress, nonadherence may not be willful but may in fact be related to the presence of cognitive disturbances and depression, especially in aging patients.
“With more oral therapies being used to treat cancer, how these therapies are actually being used has become an important topic. We wanted to pay specific attention to factors that may impact adherence in elderly patients,” explained a co-investigator of the study, Bénédicte Clarisse-Lecorbeiller, PharmD, PhD, Centre François Baclesse, Caen, France.
“We wanted to assess the relationship between cognitive functions and oral medication adherence to identify patient profiles who are more likely to be nonadherent,” stated lead investigator Melanie Dos Santos, MD, of the same institution.
The prospective, single-center study enrolled 126 adult patients with cancer who were about to initiate their first oral therapy. Median age at baseline was 70 years, with >50% of patients older than 70 years of age. Before the initiation of treatment, patients took a battery of neuropsychologic tests to assess cognition, anxiety, depression, and autonomy (the ability to perform daily activities).
Adherence to oral therapy was evaluated using 2 self-assessment questionnaires and an observance sheet at 1 and 3 months after initiation of therapy.
Among the 111 patients who completed the adherence questionnaires, the rate of adherence at 1 month was 90%. In the 10% of patients who were nonadherent, both short-term memory and working memory performance (P = .03) and depression (P = .04) were significantly associated with nonadherence.
Global cognitive impairment was observed in 50% of patients evaluated with the Montreal Cognitive Assessment screening tool. Depression was observed in 18% of patients.
The investigators found a significant association between age >70 years and Montreal Cognitive Assessment scores and age >70 years and working memory impairment (P <.005).
“Both working memory disorders and depression are frequently observed among the elderly,” noted Dr Clarisse-Lecorbeiller in a separate interview.
These findings suggest that older patients who are prescribed oral anticancer therapy should be evaluated for cognitive changes and depression before starting therapy, with the awareness that these factors may have a negative influence on the ability to take oral cancer agents as prescribed.