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Patient Education: The Cornerstone
of Successful Oral Chemotherapy Treatment
Kristine Hartigan, RN, BA, OCN ®
he number of patients
sis found that actual compliance
receiving oral chemoBecause patients with cancer self-administer oral chemowas less than half that suggested
therapy agents and the
by patients’ self-reports. Howtherapy, they typically do not receive the same amount of
intensity of these agents are preever, the researchers also found
teaching and monitoring as patients receiving IV chemodicted to increase in the near futhat measures designed to intherapy. Patient education is vital to promote patient
ture. Oral chemotherapy offers
crease compliance, including
many potential advantages, such
patient education, home psychosafety, optimal dosing, and adherence to the treatment
as patient convenience, eliminalogical support, and exercises in
plan. Oncology nurses need to tailor their patient education of the need for IV access,
pill taking, were able to increase
tion efforts to the individual needs of each patient and
and the ability to achieve suscompliance nearly threefold
use resources such as medication information sheets to
tained drug levels. One draw(Levine et al.).
back, however, is the likelihood
Measuring compliance is
reinforce teaching. This article reviews the process of
that oral chemotherapy treatment
challenging
at best. Pill counts
teaching patients about oral chemotherapy and disdistances patients from their
can be unreliable because pacusses the unique patient education challenges associhealthcare providers and, theretients can manipulate them,
fore, changes the way patients
ated with orally administered chemotherapy.
especially when they know their
are monitored. Opportunities for
pills will be counted. Also, pill
Key Words: Patient education, patient compliance, self
professional assessment may be
counts do not confirm adherence
fewer and farther between than
care
to a particular dosing schedule.
assessments of patients who reThe microelectronic monitoring
been described in the literature and the in- system (MEMS) is a newer method to asceive IV chemotherapy (Birner, 2003).
Patient education, therefore, becomes the formation can be used to guide the teaching sess compliance. The system uses an
cornerstone of successful oral chemotherapy of patients receiving oral chemotherapy.
“intelligent” tablet bottle that electronically
Clinicians generally assume that patients records the date and time (to the nearest
treatment. Effective patient teaching about
oral chemotherapy promotes patient safety, are taking medications as prescribed and be- hour) when the cap is removed. Data are coloptimal dosing, adherence to the treatment lieve their patients when they say they are lected for up to several weeks, recorded, and
plan, accurate assessment of side effects and doing so (Partridge, Avorn, Wang, & Winer, processed by a computer to generate a list
toxicities, and implementation of self-care 2002). In chronic medical conditions, such of the dates and times of bottle openings and
as diabetes and hypertension, estimates of a graph of the number of doses taken daily,
measures.
medication nonadherence range from 15%– the number of missed or extra doses, and the
93% (Myers & Midence, 1998). Although dosing intervals (Partridge et al., 2002). AlMedication Adherence
patients with cancer are thought to be highly though opening a pill container does not
The issue of medication adherence is a mi- motivated by the gravity of their disease necessarily mean that the patient ingested the
nor one with regard to IV chemotherapy but (Waterhouse, Calzone, Mele, & Brenner, pill as prescribed, MEMS may help to proa potentially large one with oral chemo- 1993), a noncompliance rate of 43% was re- vide a more accurate assessment of a
therapy administration. In many cases, the ported in a study of 51 outpatients with patient’s medication compliance.
degree of patient adherence with an oral che- breast cancer who received 26 weeks of oral
Noncompliance affects all age groups,
motherapy regimen is related directly to the cyclophosphamide (Lebovits et al., 1990).
but older patients are more vulnerable to
degree of treatment success. Nonadherence
A study examining allopurinol and predto a prescribed oral chemotherapy treatment nisone compliance in a cohort of outpatients
Mention of specific products and opinions
plan generally will result in ineffective or in- who received concomitant chemotherapy
related to those products do not indicate or
adequate treatment.
for hematologic malignances found that,
imply endorsement by the Clinical Journal of
Adherence issues are not well understood, with no interventions, complete compliance
Oncology Nursing or the Oncology Nursing
and the specific process of medication ad- with the oral medication regimen occurred
Society.
herence is difficult to measure with any de- in only 17% of the patients (Levine et al.,
gree of accuracy. However, this concept has 1987). Furthermore, pharmacokinetic analy- Digital Object Identifier: 10.1188/03.CJON.S6.21-24
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CLINICAL JOURNAL OF ONCOLOGY NURSING • SUPPLEMENT TO VOLUME 7, NUMBER 6 • PATIENT EDUCATION
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